Cited by 173Digital Mental Health InterventionsCOVID-19 and Mental HealthAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Efficacy of internet-based integrated intervention on depression and anxiety symptoms in patients with COVID-19

Open access
Wei, Ning, Huang, Bo-chao, Lu, Shao-jia, Hu, Jian-bo, Zhou, Xiao-yi, Hu, Chan-chan, Chen, Jing-kai, Huang, Jin-wen +5 more·2020·Journal of Zhejiang University-SCIENCE B

Abstract

Public health crises, such as the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since Dec. 2019, are widely acknowledged as severe traumatic events that impose threats not only because of physical concerns but also because of the psychological distress of infected patients. We designed an internet-based integrated intervention and evaluated its efficacy on depression and anxiety symptoms in patients infected by SARS-CoV-2.

Integrity signals

Registry

Crossref · 10.1631/jzus.b2010013

Cites

15 of 15 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 11 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    17-HAMD scores were significantly lower in the intervention group than in the control group at the end of week one.

    “Post hoc analyses of the individual time points showed that scores of 17-HAMD and HAMA were significantly decreased in patients of the intervention group at the end of the first (17-HAMD, t=−2.381, P=0.026; HAMA, t=−2.263, P=0.033) and second (17-HAMD, t=−3.089, P=0.005; HAMA, t=−3.746, P=0.001) weeks, when compared with the patients of the control group (Fig. 1).”
    Quote in the paperSubstantial claim
  • Findingown data

    There was a group-by-time interaction for 17-HAMD scores.

    “and a group-by-time interaction (17-HAMD: F=5.268, P=0.009; HAMA: F=3.743, P=0.031)”
    Quote in the paperSubstantial claim
  • Findingown data

    Mean 17-HAMD scores decreased significantly over time.

    “Overall, there was a significant time effect indicating reduction in mean scores of 17-HAMD (F=37.35, P<0.001) and HAMA (F=26.58, P<0.001)”
    Quote in the paperSubstantial claim
  • Findingown data

    There was a main effect of group on HAMA scores.

    “as well as a main effect of group (17-HAMD: F=4.384, P=0.047; HAMA: F=5.634, P=0.026)”
    Quote in the paperSubstantial claim
  • Findingown data

    Age, gender, and illness severity had no main or interactive effects on 17-HAMD or HAMA scores when included as covariates.

    “There were no main or interactive effects of age, gender, or severity of illness on scores of 17-HAMD and HAMA when introduced as covariates in the analyses.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 6
  • May combine two claims. 9
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The types of internet-based interventions that predominated as efficacious included information and education with or without professional psychological support, and to a lesser extent combined with peer and psychological support.

    “The types of interventions that predominated as efficacious included information and education with or without professional psychological support, and, to a lesser extent, combined with peer and psychological support (Sherifali et al., 2018).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Sherifali et al., 2018 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    At the end of week two, three intervention-group patients and one control-group patient missed assessments because they had been discharged.

    “Three patients in the intervention group and one patient in the control group failed to complete the assessments at the end of the second week because of discharge from hospital.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    After recruitment, the 26 participants were allocated with equal probability to the internet-based integrated intervention or to supportive care alone, with 13 in each arm.

    “After recruitment, 26 participants were randomly assigned to groups sequentially, with an equal probability of receiving an internet-based integrated intervention (intervention group) or just supportive care (control group), with 13 participants in each group.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Symptoms of SARS-CoV-2 infection and side effects of treatments could worsen mental distress.

    “Moreover, symptoms of the infection, such as fever, fatigue, and dyspnea, as well as the side effects of treatments, could result in worsening mental distress (Xiang et al., 2020).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Xiang et al., 2020 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The trial was prospective, randomized, controlled, and lasted two weeks at a Hangzhou hospital between early and late February 2020.

    “This is a prospective, randomized, controlled, 2-week study conducted in the First Affiliated Hospital, School of Medicine, Zhejiang University (Hangzhou, China) from Feb. 2 to Feb. 28, 2020.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    In an internet-based intervention with five structured confrontational writing assignments for bereaved and significantly distressed individuals, writing decreased emotional loneliness and increased positive mood but did not affect grief or depressive symptoms.

    “Nevertheless, in an internet-based intervention comprising five structured confrontational writing assignments, for individuals who experienced the death of a first-degree relative and who were significantly distressed, although writing decreased feelings of emotional loneliness and increased positive mood, writing did not affect grief or depressive symptoms.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites van der Houwen et al., 2010 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Internet-based intervention could also diminish the risk of infection in mental healthcare providers.

    “Internet-based intervention could also diminish the risk of infection in mental healthcare providers.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisecitation

    Internet-based interventions have advantages over face-to-face therapy, including low threshold accessibility, flexible use, independence of time and place, self-determined pace, autonomy and privacy, and lower costs.

    “Furthermore, internet-based interventions also showed advantages over face-to-face therapy, and the benefits mainly included low threshold accessibility, flexible use, independence of time and place, use at a self-determined pace, a high level of autonomy and privacy, and lower costs (Schröder et al., 2016).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Schröder et al., 2016 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    A computer generated the random sequence assignments at the start of the trial.

    “A list of random sequence assignments for each group was drawn up by computer at the beginning of the study.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisecitation

    COVID-19 patients experience mental health problems such as stress, anxiety, depressive symptoms, insomnia, and fear.

    “These situations are giving rise to mental health problems, such as stress, anxiety, depressive symptoms, insomnia, and fear in patients with confirmed SARS-CoV-2.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Xiang et al., 2020 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The two groups did not differ significantly at baseline in age, gender, illness severity, or scores on PHQ-9, GAD-7, 17-HAMD, or HAMA.

    “No significant difference between the two groups was observed for age, gender, severity of illness, baseline scores of PHQ-9, GAD-7, 17-HAMD, or HAMA.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Study design and conductreasoning

    The two-week study period was short for assessing efficacy, and no follow-up measures were included to confirm stability of effects.

    “Thirdly, the study period of two weeks was relatively short for efficacy assessment, and follow-up measures that might confirm the stability of the current effects were not included in this study.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Interpretationreasoning

    The advantages of internet-based interventions might be especially relevant for COVID-19 patients because human-to-human transmission was confirmed and infected patients were in quarantine.

    “These factors might be especially relevant for COVID-19 patients since the human-to-human transmission of SARS-CoV-2 was confirmed and the infected patients were in quarantine.”
    Quote in the paperSubstantial claim
13 of 13
  • The paper relies on this without support.

    This is the first evaluation of the efficacy of this internet-based self-help intervention in COVID-19 patients with psychological distress.

    “To the best of our knowledge, it is the first time that the efficacy of this internet-based self-help intervention has been evaluated for COVID-19 patients with psychological distress.”
  • The paper relies on this without support.

    Evidence-based interventions targeted at COVID-19 patients are scarce.

    “However, evidence-based interventions targeted at COVID-19 patients are scarce.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Mindfulness-based intervention has been shown helpful in the treatment of mental health.

    “Mindfulness-based intervention (MBI) is an approach that focuses on the cultivation of conscious awareness, and orientation towards the present moment with curiosity and openness, which has been shown helpful in the treatment of mental health [17–20].”

    From Mindfulness-based online intervention on mental health and quality of life among COVID-19 patients in China: an intervention design (2021) · cites this paper as [18]

    The paper’s intervention description (section labeled Abstract; page not provided) identifies mindfulness body scan as one of four components. Its results report reduced depression and anxiety symptoms in COVID-19 patients receiving the combined intervention. Because mindfulness was not evaluated separately, the paper does not establish that mindfulness-based intervention itself produced the benefit. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • The results could suggest modest results of the intervention with a small sample size, compared to other studies involving web-based interventions implemented during the pandemic with larger sample sizes and reduction in symptoms of anxiety and depression.

    “Thus, the results of this study could suggest modest results of the intervention with a small sample size, compared to other studies involving web-based interventions implemented during the pandemic with larger sample sizes and reduction in symptoms of anxiety [81-84] and depression [81,82,84].”

    From Evaluation and Future Challenges in a Self-Guided Web-Based Intervention With and Without Chat Support for Depression and Anxiety Symptoms During the COVID-19 Pandemic: Randomized Controlled Trial (2024) · cites this paper as [84]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured
  • Online mindfulness training reduced anxiety and depression in Covid-19 patients during isolation.

    “Furthermore, online mindfulness training proved a reduction of anxiety and depression in Covid-19 patients themselves during isolation41, an increase of resilience in adolescents42, as well as employees’ sleep duration and work engagement43.”

    From Mindfulness-based online intervention increases well-being and decreases stress after Covid-19 lockdown (2022) · cites this paper as [41]

    The study reports significantly lower depression and anxiety scores after an online intervention among COVID-19 patients in an isolation ward (results reported in our copy under Abstract; no page given). However, the intervention combined mindfulness body scanning with breath relaxation, “refuge” skills, and the butterfly hug method. It does not establish that mindfulness training alone produced the reductions. (LLM, conf=0.90)

    Experimental — accuracy not yet measured
  • Online mindfulness exercises work effectively and can help in the treatment of psychological suffering during the COVID-19 period of uncertainty.

    “Thus, it was noticed that online exercises work effectively, and these interventions can help in the treatment of psychological suffering in this period of uncertainty experienced with COVID-19 4 .”

    From The effects of mindfulness-based interventions in COVID-19 times: a systematic review (2022) · cites this paper as [4]

    The Results (page not available in our copy) report significantly lower depression and anxiety scores after an online intervention for patients with COVID-19. However, the intervention combined mindfulness with three other exercises, so the study does not establish that online mindfulness exercises alone were effective. The authors also describe the findings as preliminary and limited to patients with mild to moderate symptoms. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • The integrated internet intervention is effective in improving mood disorders and should be used to treat psychological symptoms in patients with COVID-19.

    “This indicates that this intervention is effective in improving mood disorders and should be used to treat psychological symptoms in patients with COVID-19 4 .”

    From The effects of mindfulness-based interventions in COVID-19 times: a systematic review (2022) · cites this paper as [4]

    The conclusion (page unavailable) reports a preliminary improvement in mild-to-moderate depression and anxiety symptoms among patients with COVID-19. The claim broadens that finding to mood disorders and recommends using the intervention to treat psychological symptoms generally, whereas the paper says its findings need confirmation in further studies. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Xinhua Net, 2020. Xinhua Headlines: a race against time! Wuhan battles coronavirus. http://www.xinhuanet.com/english/2020-01/30/c_138743900.htm [Accessed on Mar. 12, 2020].

Cited by

Sorted by citations

Authors
Wei, N., Huang, B.-C., Lu, S.-J., Hu, J.-B., Zhou, X.-Y., Hu, C.-C., Chen, J.-K., Huang, J.-W., Li, S.-G., Wang, Z., Wang, D.-D., Xu, Y., & Hu, S.-H.
Affiliations
First Affiliated Hospital Zhejiang University (CN)
Corresponding author
Xu, Yi
Venue
Journal of Zhejiang University-SCIENCE B
Published
2020-04-01
Volume
21
Issue
5
Pages
400-404
ISSN
  • 1673-1581 (ISSN-L)
  • 1862-1783
OpenAlex
W3021716926
Cited by
173
References
15
Citations by year
2025: 4 · 2024: 31 · 2023: 29 · 2022: 50 · 2021: 48 · 2020: 11
FWCI
31.20
Type
journal article
Language
en
Open access
Locations
  • Journal of Zhejiang University SCIENCE B (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • the Science and Technology Department of Zhejiang Province (2017C37037)
  • the National Key Research and Development Program of China (2016YFC1307100, 2018YFC1314200)
  • the Zhejiang Provincial Natural Science Foundation of China (LQ20H090012, LQ20H090010)
  • the Zhejiang University Special Scientific Research Fund for COVID-19 Prevention and Control , China (2020XGZX046)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
COVID-19 pandemic, depression, anxiety, online intervention, psychological distress, integrated intervention
MeSH terms
Betacoronavirus, Psychological Distress, COVID-19, SARS-CoV-2, Adult, Anxiety, China, Depression, Female, Humans, Male, Middle Aged, Pneumonia, Viral, Prospective Studies, Relaxation Therapy, Self Care, Coronavirus Infections, Internet, Cell Phone, Pandemics, Mindfulness

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