Rise in Use of Digital Mental Health Tools and Technologies in the U.S. During the COVID-19 Pandemic.

BACKGROUND: Accompanying the rising rates of reported mental distress during the coronavirus disease 2019 (COVID-19) pandemic has been a reported increase by the media in use of digital technologies to manage health generally, and mental health more specifically. OBJECTIVE: The objective of the study was to systematically examine COVID-19 pandemic-related increase in self-reported use of digital mental health tools and other technologies to manage mental health. METHODS: We analyzed results from a survey of 5,907 individuals in the U.S. using Amazon Mechanical Turk (MTurk) collected across all 50 states and Washington D.C. during four week-long periods in 2020. The first set of analyses employed two different logistic regression models to estimate the likelihood of having symptoms indicative of clinical depression and anxiety, respectively, as a function of the rate of COVID-19 cases per ten people and survey time point. The second set employed seven different logistic regression models to estimate the likelihood of using seven different types of digital mental health tools and other technologies to manage one's mental health, as a function of symptoms indicative of clinical depression and anxiety, rate of COVID-19 cases per ten people, and survey time point. These models also examined potential interactions between symptoms of clinical depression and anxiety, respectively, and rate of COVID-19 cases. All models controlled for respondent sociodemographic characteristics and state fixed effects. RESULTS: Higher COVID-19 case rates were associated with a significantly greater likelihood of reporting symptoms of depression (odds ratio (OR)=2.06, 95% confidence interval (95% CI)=[1.27,3.35]), but not anxiety (OR=1.21, 95% CI=[0.77,1.88]). Survey time point, a proxy for time, was associated with a greater likelihood of reporting clinically meaningful symptoms of depression and anxiety (OR=1.19, 95% CI=[1.12,1.27] and OR=1.12, 95% CI=[1.05,1.19], respectively). Reported symptoms of depression and anxiety were associated with a greater likelihood of using each type of technology. Higher COVID-19 case rates were associated with a significantly greater likelihood of using mental health forums, websites, or apps (OR=2.70, 95% CI=[1.49,4.88]), and other health forums, websites, or apps (OR=2.60, 95% CI=[1.55,4.34]). Time was associated with increased odds of reported use of mental health forums, websites, or apps (OR=1.20, 95% CI=[1.11,1.30]), phone-based or text-based crisis lines (OR=1.20, 95% CI=[1.10,1.31]); and online, computer, or console gaming/video gaming (OR=1.12, 95% CI=[1.05,1.19]). Interactions between COVID-19 case rate and mental health symptoms were not significantly associated with any of the technology types. CONCLUSIONS: Findings suggested increased use of digital mental health tools and other technologies over time during the early stages of the COVID-19 pandemic. As such, additional effort is urgently needed to consider the quality of these products, either by ensuring users have access to evidence-based and evidence-informed technologies and/or providing them with the skills to make informed decisions around their potential efficacy.