The COVID-19 and Healthcare Workers: An Active Intervention
Condition: Brief Video-based Intervention; Non Intervention Control
Study type: Interventional

Summary: 
      The overarching goal of this study is to examine the efficacy of a brief video intervention
      in reducing stigma and fear, and improving help-seeking behavior, among health care providers
      (N=1,200), with pre- post- and follow-up assessments (at day 14 and day 30). Participants
      will be recruited via Amazon Turk and randomly assigned to either a) a video-based
      intervention (day 1 and a "booster intervention" of the same content on day 14 of the study)
      featuring the personal story of a health care provider during COVID-19 pandemic, his/her
      struggles and barriers to care, (b) video-based intervention (day 1 only), and a written
      description of the same story on day 14 (c) no-intervention control arm (questionnaires
      only).

      The invetsigators aim to (1) determine whether video-based intervention reduce stigma and
      fear, and increase help-seeking behavior in relation to COVID-19 among health care providers,
      and (2) compare high-risk areas (e.g., NY) to low-risk areas (e.g., Montana) on intervention
      outcomes, and (3) test whether symptoms of depression, anxiety, PTSD and Moral Injury
      (measured by the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7),
      the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) and the Moral Injury Events Scale (MIES))
      would change over time.
    

Detailed description: 
      Coronavirus disease 2019 (COVID-19) has widely and rapidly spread around the world. To
      effectively respond to the COVID-19 outbreak, various governments have implemented rapid and
      comprehensive public health emergency interventions that include social restrictions and
      quarantines, which is the separation and restriction of movement of people who might have
      been exposed to the virus. While the physical risk (e.g. pneumonia, respiratory breakdown) is
      getting the most scientific and clinical attention, this outbreak also has significant mental
      health risks and extreme psychological fear-related responses. Psychological responses to
      previous large-scale outbreaks, particularly to the Ebola Virus Disease (EVD) epidemic during
      2014-2016, provide insight into the potential impact of rapidly spreading diseases on mental
      health problems. During the Ebola outbreak, fear-related behaviors such as stigmatizing
      infected survivors and ignoring medical procedures impeded public health efforts and
      negatively affected the recovery of survivors. Anxiety, posttraumatic stress disorder (PTSD),
      and depression were found in nearly half of the EVD survivors and their contacts.

      The COVID-19 outbreak exceeds the scope and magnitude of most previous disasters over the
      last 100 years. It entails a blend of risk factors for both acute and long-term mental health
      problems. Data that is started to emerge from the COVID-19 outbreak, suggest that front lines
      health workers (doctors; nurses) are particularly at risk. A recent study in 1257 health care
      workers from 34 hospitals, conducted between January 29 to February 3, 2020, revealed that
      more than half (50.4%) of the health workers were screened positive for depression, 44.6% for
      anxiety, and 34.0% for insomnia. Consistent with previous disaster studies a dose-response
      relationship was found between the level of exposure and outcomes. Others may develop a moral
      injury, profound psychological distress which results in actions, or the lack of them, which
      violet one's moral or ethical code. Given the magnitude of the COVID-19 outbreak, its risk to
      physical and mental health, an effective and timely response is essential to address the
      psychosocial needs associated with the ongoing exposure to disease, death, and distress among
      health care providers, across low and high risks areas.

      Many health care providers reluctant to seek support from friends and family, as well as
      mental health care due to stigma and fear (e.g., "it would be too embarrassing", "I would be
      seen as week"). Despite enduring symptoms, they may wait months to years before they seek
      help. Among reasons to avoid seeking mental health care, individuals report mistrust in
      mental health providers, being seen as weak or stereotyped as "crazy", and a belief that they
      may be responsible for having mental health problems. Applying strategies to reduce stigma
      and fear towards mental health care and improve help-seeking behavior may ameliorate impaired
      functioning and reduce risks for long-term psychiatric illness.

      Previous studies have shown that social contact is the most effective type of intervention to
      reduce stigma- related attitudes and to improve help-seeking behavior. Social contact
      involves interpersonal contact with members of the stigmatized group: members of the general
      public who meet and interact with individuals who suffer from stress, fear, depression, or
      anxiety and seek mental health care, are likely to lessen their stigma. Corrigan has
      identified the most important ingredients of contact-based programs: an empowered presenter
      with lived experience who attains his/her goals (e.g., "I was able to fight the
      depression/distress that I had following the COVID-19"). While both direct, in-person social
      contact and indirect, video-based social contact have effectively improved attitudes toward
      mental issues and care, the latter can be implemented on a larger scale, use a minimal
      resource and easily disseminated.
    

Intervention name(s): Video-Based intervention
Intervention type(s): Other
Intervention description(s): Three minutes video of a nurse that shares her personal story
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Health Services Research