Efficacy of online psychoeducation and relaxation training program (OnPR) on mental health problems in COVID-19 patients: A randomized controlled trial

Purpose: Prior studies found that the prevalence of anxiety, depression, stress and insomnia were relatively high in COVID-19 patients. This study aimed to explore the efficacy of OnPR on mental health outcomes in patients with asymptomatic or mildly symptomatic COVID-19. Patients and methods: We employed a randomized controlled trial following the CONSORT guidelines. The Thai Clinical Trials Registry identification number of this study is TCTR20220729003. We used a block of 4 randomizations generated by a computer program. The intervention group (n = 38) received the OnPR program, and the control group (n = 36) received care as usual. OnPR was an online psychological intervention comprising psychoeducation, sleep hygiene education and relaxation techniques. OnPR was provided by qualified therapists trained with a standard protocol. The primary outcomes were depression, anxiety, and stress, which were determined by the Depression Anxiety and Stress Scale-21 (DASS-21). Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Outcomes were compared between groups at pre-intervention and postintervention at 1, 4, and 12 weeks using paired t -test or Wilcoxon signed-rank test. In addition, a linear mixed model was employed to demonstrate the effect changes of OnPR over time. All analyses were two-tailed, with a significance level of 0.05. Results: Of 74 Thai participants, 89.2 % were female, and 11.8 % were male. The average age was 31 years. Participants' baseline characteristics were not statistically significant between the intervention and control groups except for depression and stress scores from DASS-21. OnPR resulted in significantly better improvement in depression, anxiety, stress, and sleep quality. The mean differences between groups of DASS-21 scores in depression, anxiety and stress at 7-day follow-up were -4.69, -3.29, and -5.50 respectively. The differences continue to be significant at 4-week and 12-week follow-ups. The mean difference between groups of PSQI at 7day follow-up is -0.91. Conclusion: OnPR improved mental health outcomes, and the effect on depression, anxiety and stress lasted for at least a 12-week follow-up period. In addition, it could enhance sleep quality after the intervention.