{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:01:16Z","timestamp":1787317276868,"version":"build-2736575974"},"reference-count":82,"publisher":"JMIR Publications Inc.","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Ment Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>During pandemics, effective containment and mitigation measures may also negatively influence psychological stability. As knowledge about COVID-19 rapidly evolves, global implementation of containment and mitigation measures has varied greatly, with impacts to mental wellness. Assessing the impact of COVID-19 on the mental health needs of health care workers and other workers may help mitigate mental health impacts and secure sustained delivery of health care and other essential goods and services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study assessed the self-reported prevalence of stress, anxiety, depression, and obsessive-compulsive symptoms in health care workers and other workers seeking support through Text4Hope, an evidence-based SMS text messaging service supporting the mental health of residents of Alberta, Canada, during the COVID-19 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An online cross-sectional survey gathered demographic (age, gender, ethnicity, education, relationship, housing and employment status, employment type, and isolation status) and clinical characteristics using validated tools (self-reported stress, anxiety, depression, and contamination\/hand hygiene obsessive-compulsive symptoms). Descriptive statistics and chi-square analysis were used to compare the clinical characteristics of health care workers and other workers. Post hoc analysis was conducted on variables with &gt;3 response categories using adjusted residuals. Logistic regression determined associations between worker type and likelihood of self-reported symptoms of moderate or high stress, generalized anxiety disorder, and major depressive disorder, while controlling for other variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 8267 surveys were submitted by 44,992 Text4Hope subscribers (19.39%). Of these, 5990 respondents were employed (72.5%), 958 (11.6%) were unemployed, 454 (5.5%) were students, 559 (6.8%) were retired, 234 (2.8%) selected \u201cother,\u201d and 72 (0.9%) did not indicate their employment status. Most employed survey respondents were female (n=4621, 86.2%). In the general sample, the 6-week prevalence rates for moderate or high stress, anxiety, and depression symptoms were 85.6%, 47.0%, and 44.0%, respectively. Self-reported symptoms of moderate or high stress, anxiety, and depression were all statistically significantly higher in other workers than in health care workers (P&lt;.001). Other workers reported higher obsessive-compulsive symptoms (worry about contamination and compulsive handwashing behavior) after the onset of the pandemic (P&lt;.001), while health care worker symptoms were statistically significantly higher before and during the COVID-19 pandemic (P&lt;.001). This finding should be interpreted with caution, as it is unclear the extent to which the adaptive behavior of health care workers or the other workers might be misclassified by validated tools during a pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Assessing symptoms of prevalent stress, anxiety, depression, and obsessive-compulsive behavior in health care workers and other workers may enhance our understanding of COVID-19 mental health needs. Research is needed to understand more fully the relationship between worker type, outbreak phase, and mental health changes over time, as well as the utility of validated tools in health care workers and other workers during pandemics. Our findings underscore the importance of anticipating and mitigating the mental health effects of pandemics using integrated implementation strategies. Finally, we demonstrate the ease of safely and rapidly assessing mental health needs using an SMS text messaging platform during a pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>International Registered Report Identifier (IRRID)<\/jats:title>\n                    <jats:p>RR2-10.2196\/19292<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/22408","type":"journal-article","created":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T18:37:01Z","timestamp":1599763021000},"page":"e22408","source":"Crossref","is-referenced-by-count":83,"title":["Prevalence of Perceived Stress, Anxiety, Depression, and Obsessive-Compulsive Symptoms in Health Care Workers and Other Workers in Alberta During the COVID-19 Pandemic: Cross-Sectional Survey"],"prefix":"10.2196","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3887-1843","authenticated-orcid":false,"given":"Kelly","family":"Mrklas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3717-6398","authenticated-orcid":false,"given":"Reham","family":"Shalaby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1663-9285","authenticated-orcid":false,"given":"Marianne","family":"Hrabok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4665-0490","authenticated-orcid":false,"given":"April","family":"Gusnowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8990-4804","authenticated-orcid":false,"given":"Wesley","family":"Vuong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9776-2348","authenticated-orcid":false,"given":"Shireen","family":"Surood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1013-5921","authenticated-orcid":false,"given":"Liana","family":"Urichuk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2644-5342","authenticated-orcid":false,"given":"Daniel","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8546-8590","authenticated-orcid":false,"given":"Xin-Min","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9097-900X","authenticated-orcid":false,"given":"Andrew James","family":"Greenshaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2743-0372","authenticated-orcid":false,"given":"Vincent Israel Opoku","family":"Agyapong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2020,9,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2020200490"},{"key":"ref2","unstructured":"World Health OrganizationPublic statement on collaboration on COVID-19 vaccine development20202020-04-13https:\/\/www.who.int\/news-room\/detail\/13-04-2020-public-statement-for-collaboration-on-covid-19-vaccine-development"},{"key":"ref3","unstructured":"World Health OrganizationWHO Timeline - COVID-192020-04-13https:\/\/www.who.int\/news-room\/detail\/08-04-2020-who-timeline---covid-19"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/s1473-3099(20)30120-1"},{"key":"ref5","unstructured":"PetherickAHPhillipsTWebsterSVariation in Government Responses to COVID-19Blavatnik School Working Paper2020-04-13https:\/\/www.bsg.ox.ac.uk\/research\/publications\/variation-government-responses-covid-19"},{"key":"ref6","unstructured":"LoayzaNSmart containment and mitigation measures to confront the COVID-19 pandemic: Tailoring the pandemic response to the realities of developing countriesWorld Bank Group Blogs202004072020-04-13https:\/\/blogs.worldbank.org\/developmenttalk\/smart-containment-and-mitigation-measures-confront-covid-19-pandemic-tailoring"},{"key":"ref7","unstructured":"Public Health Agency of CanadaCommunity-based measures to mitigate the spread of coronavirus disease (COVID-19) in Canada - Provincial and territorial resources for COVID-19Government of Canada20202020-04-13https:\/\/www.canada.ca\/en\/public-health\/services\/diseases\/2019-novel-coronavirus-infection\/symptoms\/provincial-territorial-resources-covid-19.html"},{"key":"ref8","unstructured":"World BankWorld Development Report 201420132020-04-13https:\/\/openknowledge.worldbank.org\/handle\/10986\/16092"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)30460-8"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2018.210"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1159\/000507639"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.924171"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.923767"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2020.112958"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2020.04.028"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1177\/0020764020915212"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.5812\/archcid.102779"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.3976"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1016\/s2215-0366(20)30073-0"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2020.03.007"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/gbaa048"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1080\/07481187.2020.1748481"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17093165"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajp.2020.102052"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2020.04.024"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1016\/j.purol.2020.04.015"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2020.03.028"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2020.112936"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn121094-20200219-00063"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.4006"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcaa110"},{"issue":"6","key":"ref32","doi-asserted-by":"crossref","first-page":"743","DOI":"10.47102\/annals-acadmedsg.verma","volume":"33","author":"Verma, S","year":"2004","journal-title":"Ann Acad Med Singap"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2018.10.003"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2011.02.003"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-015-0450-0"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1136\/jech.57.11.857"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.3201\/eid1007.030703"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajp.2020.102066"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.7405"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1055\/a-1159-5562"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1642"},{"key":"ref42","unstructured":"HonermannBAn epidemic within an outbreak: the mental health consequences of infectious disease epidemics2020-04-10https:\/\/oneill.law.georgetown.edu\/epidemic-within-outbreak-mental-health-consequences-infectious-disease-epidemics\/"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1590\/0102-311X00054020"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2020.112934"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.7150\/ijbs.45120"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2009.06.008"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2020.03.025"},{"issue":"1","key":"ref48","first-page":"71","volume":"83","author":"van Ommeren, M","year":"2005","journal-title":"Bull World Health Organ"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.1017\/s0033291715000884"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2020.25"},{"key":"ref51","doi-asserted-by":"crossref","unstructured":"Public Health Agency of CanadaReport from the Canadian Chronic Disease Surveillance System: Mood and anxiety disorders in Canada20162020-04-13https:\/\/www.canada.ca\/en\/public-health\/services\/reports-publications\/health-promotion-chronic-disease-prevention-canada-research-policy-practice\/vol-36-no-12-2016\/report-summary-mood-anxiety-disorders-canada-2016.html","DOI":"10.24095\/hpcdp.36.12.05"},{"key":"ref52","author":"Taylor, S","year":"2019","journal-title":"The psychology of pandemics: preparing for the next global outbreak of infectious disease"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(20)30168-1"},{"key":"ref54","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2020.100317"},{"key":"ref55","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000003414"},{"key":"ref56","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-020-01591-x"},{"key":"ref57","unstructured":"Alberta Health ServicesText4Hope Advertisement: Text4Hope - Supporting Mental Health and Wellness in a Time of Stress and Isolation2020-04-11https:\/\/www.albertahealthservices.ca\/topics\/Page17019.aspx"},{"key":"ref58","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2012.02.040"},{"key":"ref59","doi-asserted-by":"publisher","DOI":"10.3233\/thc-120707"},{"key":"ref60","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2013.05.058"},{"key":"ref61","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-016-1104-2"},{"key":"ref62","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2018.00345"},{"issue":"4","key":"ref63","doi-asserted-by":"crossref","first-page":"385","DOI":"10.2307\/2136404","volume":"24","author":"Cohen, S","year":"1983","journal-title":"J Health Soc Behav"},{"key":"ref64","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"ref65","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"ref66","doi-asserted-by":"publisher","DOI":"10.3109\/08039488.2014.884631"},{"key":"ref67","unstructured":"IBM CorpSPSS Statistics2020-09-22https:\/\/www.ibm.com\/ca-en\/products\/spss-statistics"},{"key":"ref68","unstructured":"Government of AlbertaAlberta Labour Force Profiles Aged 45 and older20172020-04-10https:\/\/open.alberta.ca\/publications\/2292-6682"},{"key":"ref69","unstructured":"Statistics CanadaCensus Profile 2016: Province of Alberta201908092020-04-13https:\/\/www12.statcan.gc.ca\/census-recensement\/2016\/dp-pd\/prof\/details\/page.cfm?Lang=E&Geo1=PR&Code1=48&Geo2=PR&Code2=01&SearchText=Canada&SearchType=Begins&SearchPR=01&B1=Housing&TABID=1&type=1"},{"key":"ref70","unstructured":"Government of AlbertaIndustry profiles: health care and social assistance industry20182020-09-22https:\/\/open.alberta.ca\/dataset\/2292-8936\/resource\/d2e6f99a-7d83-4bed-8c12-d250d38c8f54"},{"key":"ref71","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD013574"},{"key":"ref72","unstructured":"Government of AlbertaIncreasing mental health supports in response to COVID-1920202020-09-22https:\/\/www.alberta.ca\/release.cfm?xID=70099FD5A018B-07BD-2B06-3BD3E6BD3108AF41"},{"key":"ref73","unstructured":"Morneau ShepellThe Mental Health Index Report Canada - April 2020 Spotlight on the mental health impact of the COVID-19 pandemic20202020-05-09https:\/\/www.morneaushepell.com\/ca-en\/insights\/mental-health-index-report"},{"key":"ref74","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(20)30142-5"},{"key":"ref75","doi-asserted-by":"publisher","DOI":"10.1016\/s2215-0366(20)30171-1"},{"key":"ref76","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0231924"},{"key":"ref77","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2020.112966"},{"issue":"10","key":"ref78","first-page":"1245","volume":"168","author":"Maunder, R","year":"2003","journal-title":"CMAJ"},{"key":"ref79","unstructured":"Pan American Health OrganizationProtecting Mental Health During Epidemics200905042020-04-13https:\/\/www.paho.org\/en\/documents\/protecting-mental-health-during-epidemics"},{"key":"ref80","doi-asserted-by":"publisher","DOI":"10.30773\/pi.2020.0058"},{"key":"ref81","doi-asserted-by":"publisher","DOI":"10.7326\/M20-1236"},{"key":"ref82","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(20)30046-8"}],"container-title":["JMIR Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/mental.jmir.org\/2020\/9\/e22408","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:30:58Z","timestamp":1782840658000},"score":1,"resource":{"primary":{"URL":"http:\/\/mental.jmir.org\/2020\/9\/e22408\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,25]]},"references-count":82,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2196\/22408","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.22408","asserted-by":"object"}]},"ISSN":["2368-7959"],"issn-type":[{"value":"2368-7959","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,25]]}}}