{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T19:35:53Z","timestamp":1791920153504,"version":"4.3.4"},"reference-count":70,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,8,24]],"date-time":"2021-08-24T00:00:00Z","timestamp":1629763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>This study explores differences in stress, anxiety, and depression experienced by different ethnic groups during the COVID-19 pandemic. This was a cross-sectional online survey of subscribers of the COVID-19 Text4Hope text messaging program in Alberta. Stress, anxiety, and depression were measured among Caucasian, Indigenous, Asian, and other ethnic groups using the Perceived Stress Scale (PSS)-10, Generalized Anxiety Disorder (GAD)-7, and Patient Health Questionnaire (PHQ)-9 scales, respectively. The burden of depression and stress were significantly higher in Indigenous populations than in both Caucasian and Asian ethnic groups. The mean difference between Indigenous and Caucasian for PHQ-9 scores was 1.79, 95% CI of 0.74 to 2.84, p &lt; 0.01 and for PSS-10 it was 1.92, 95% CI of 0.86 to 2.98, p &lt; 0.01). The mean difference between Indigenous and Asian for PHQ-9 scores was 1.76, 95% CI of 0.34 to 3.19, p = 0.01 and for PSS-10 it was 2.02, 95% CI of 0.63 to 3.41, p &lt; 0.01. However, Indigenous participant burden of anxiety was only significantly higher than Asian participants\u2019 (mean difference for GAD-7 was 1.91, 95% CI of 0.65 to 3.18, p &lt; 0.01). Indigenous people in Alberta have higher burden of mental illnesses during the COVID-19 pandemic. These findings are helpful for service planning and delivery.<\/jats:p>","DOI":"10.3390\/bs11090115","type":"journal-article","created":{"date-parts":[[2021,8,24]],"date-time":"2021-08-24T22:12:22Z","timestamp":1629843142000},"page":"115","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["COVID-19 Pandemic: Stress, Anxiety, and Depression Levels Highest amongst Indigenous Peoples in Alberta"],"prefix":"10.3390","volume":"11","author":[{"given":"Mobolaji A.","family":"Lawal","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B, Canada"},{"name":"Addiction and Mental Health, Alberta Health Services, Edmonton, AB T5K 2J5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3717-6398","authenticated-orcid":false,"given":"Reham","family":"Shalaby","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chidi","family":"Chima","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B, Canada"},{"name":"Addiction and Mental Health, Alberta Health Services, Edmonton, AB T5K 2J5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8990-4804","authenticated-orcid":false,"given":"Wesley","family":"Vuong","sequence":"additional","affiliation":[{"name":"Addiction and Mental Health, Alberta Health Services, Edmonton, AB T5K 2J5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Hrabok","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B, Canada"},{"name":"Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"April","family":"Gusnowski","sequence":"additional","affiliation":[{"name":"Addiction and Mental Health, Alberta Health Services, Edmonton, AB T5K 2J5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shireen","family":"Surood","sequence":"additional","affiliation":[{"name":"Addiction and Mental Health, Alberta Health Services, Edmonton, AB T5K 2J5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Greenshaw","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2743-0372","authenticated-orcid":false,"given":"Vincent I. O.","family":"Agyapong","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B, Canada"},{"name":"Addiction and Mental Health, Alberta Health Services, Edmonton, AB T5K 2J5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"102092","DOI":"10.1016\/j.ajp.2020.102092","article-title":"Epidemic of COVID-19 in China and associated Psychological Problems","volume":"51","author":"Ahmed","year":"2020","journal-title":"Asian J. Psychiatry"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Mazza, C., Ricci, E., Biondi, S., Colasanti, M., Ferracuti, S., Napoli, C., and Roma, P. (2020). A Nationwide Survey of Psychological Distress among Italian People during the COVID-19 Pandemic: Immediate Psychological Responses and Associated Factors. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17093165"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.bbi.2020.04.031","article-title":"The differential psychological distress of populations affected by the COVID-19 pandemic","volume":"87","author":"Zhang","year":"2020","journal-title":"Brain Behav. Immun."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"102052","DOI":"10.1016\/j.ajp.2020.102052","article-title":"Chinese mental health burden during the COVID-19 pandemic","volume":"51","author":"Huang","year":"2020","journal-title":"Asian J. Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e100213","DOI":"10.1136\/gpsych-2020-100213","article-title":"A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations","volume":"33","author":"Qiu","year":"2020","journal-title":"Gen. Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1002\/wps.20758","article-title":"Anxiety and depression among general population in China at the peak of the COVID-19 epidemic","volume":"19","author":"Li","year":"2020","journal-title":"World Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"113098","DOI":"10.1016\/j.psychres.2020.113098","article-title":"Psychological Outcomes Associated with Stay-at-Home Orders and the Perceived Impact of COVID-19 on Daily Life","volume":"289","author":"Tull","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Madani, A., Boutebal, S.E., and Bryant, C.R. (2020). The Psychological Impact of Confinement Linked to the Coronavirus Epidemic COVID-19 in Algeria. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17103604"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C.S., and Ho, R.C. (2020). Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17051729"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"102076","DOI":"10.1016\/j.ajp.2020.102076","article-title":"Assessing the anxiety level of Iranian general population during COVID-19 outbreak","volume":"51","year":"2020","journal-title":"Asian J. Psychiatry"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"683","DOI":"10.3389\/fpsyt.2019.00683","article-title":"Mental Health Effects in Primary Care Patients 18 Months After a Major Wildfire in Fort McMurray: Risk Increased by Social Demographic Issues, Clinical Antecedents, and Degree of Fire Exposure","volume":"10","author":"Moosavi","year":"2019","journal-title":"Front. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s40696-015-0008-x","article-title":"Mental health and psychological impacts from the 2011 Great East Japan Earthquake Disaster: A systematic literature review","volume":"1","author":"Harada","year":"2015","journal-title":"Disaster Mil. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1440108","DOI":"10.1080\/17482631.2018.1440108","article-title":"In their own words: Disaster and emotion, suffering, and mental health","volume":"13","author":"McKinzie","year":"2018","journal-title":"Int. J. Qual. Stud. Health Well-Being"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1056\/NEJMoa2001017","article-title":"A Novel Coronavirus from Patients with Pneumonia in China, 2019","volume":"382","author":"Zhu","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_15","unstructured":"(2020, July 02). World Health Organization Timeline of WHO\u2019s Response to COVID-19. Available online: https:\/\/www.who.int\/news-room\/detail\/29-06-2020-covidtimeline."},{"key":"ref_16","unstructured":"(2020, July 01). World Health Organization Coronavirus Disease (COVID-19) Situation Report\u2014163. Available online: https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/situation-reports\/20200701-covid-19-sitrep-163.pdf?sfvrsn=c202f05b_2."},{"key":"ref_17","unstructured":"(2020, July 01). World Health Organization Mental Disorders Affect One in Four People. Available online: https:\/\/www.who.int\/whr\/2001\/media_centre\/press_release\/en\/#:~:text=Geneva%2C%204%20October%E2%80%94%20One%20in,ill%2Dhealth%20and%20disability%20worldwide."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(18)32279-7","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"392","author":"Disease","year":"2018","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"E1296","DOI":"10.1503\/cmaj.180698","article-title":"Global Burden of Disease Study trends for Canada from 1990 to 2016","volume":"190","author":"Lang","year":"2018","journal-title":"CMAJ"},{"key":"ref_20","unstructured":"Mental Health Commission of Canada (2011). The Life and Economic Impact of Major Mental Illnesses in Canada: 2011 to 2041. Risk Analytica, on Behalf of the Mental Health Commission of Canada 2011, Risk Analytica."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Depressive Disorders. Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_22","unstructured":"(2020, July 02). Government of Canada Suicide in Canada: Key Statistics (Infographic). Available online: https:\/\/www.canada.ca\/en\/public-health\/services\/publications\/healthy-living\/suicide-canada-key-statistics-infographic.html."},{"key":"ref_23","unstructured":"(2020, July 01). Statistics Canada Indigenous Peoples in Canada: First Nations People, M\u00e9tis and Inuit. Available online: https:\/\/www12.statcan.gc.ca\/nhs-enm\/2011\/as-sa\/99-011-x\/99-011-x2011001-eng.pdf."},{"key":"ref_24","unstructured":"(2020, July 05). Statistics Canada First Nations People, Metis and Inuit in Canada: Diverse and Growing Populations. Available online: https:\/\/www150.statcan.gc.ca\/n1\/en\/pub\/89-659-x\/89-659-x2018001-eng.pdf?st=W7cSG4EI."},{"key":"ref_25","first-page":"1569","article-title":"Indigenous health","volume":"155","author":"MacMillan","year":"1996","journal-title":"CMAJ"},{"key":"ref_26","first-page":"3","article-title":"Acute care hospitalization by Indigenous identity, Canada, 2006 through 2008","volume":"27","author":"Carriere","year":"2016","journal-title":"Health Rep."},{"key":"ref_27","first-page":"10","article-title":"Avoidable mortality among First Nations adults in Canada: A cohort analysis","volume":"26","author":"Park","year":"2015","journal-title":"Health Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1155\/2012\/825107","article-title":"Prevalence of asthma and chronic obstructive pulmonary disease in Indigenous and non-Indigenous populations: A systematic review and meta-analysis of epidemiological studies","volume":"19","author":"Ospina","year":"2012","journal-title":"Can. Respir. J."},{"key":"ref_29","unstructured":"Kielland, N., and Simeone, T. (2020, July 05). Current Issues in Mental Health in Canada: The Mental Health of First Nations and Inuit Communities. Available online: https:\/\/lop.parl.ca\/staticfiles\/PublicWebsite\/Home\/ResearchPublications\/InBriefs\/PDF\/2014-02-e.pdf."},{"key":"ref_30","unstructured":"Canada, G.O. (2006). The Mental Health and Well-Being of Indigenous Peoples in Canada, The Human Face of Mental Health and Mental Illness in Canada 2006."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1186\/s12939-018-0860-7","article-title":"Hospitalization for mental health related ambulatory care sensitive conditions: What are the trends for First Nations in British Columbia?","volume":"17","author":"Lavoie","year":"2018","journal-title":"Int. J. Equity Health"},{"key":"ref_32","unstructured":"Pulver, L.J., Haswell, M.R., Ring, I., Waldon, J., Clark, W., Whetung, V., Kinnon, D., Graham, C., Chino, M., and LaValley, J. (2010). Indigenous Health\u2014Australia, Canada, Aotearoa, New Zealand and the United States\u2014Laying Claim to a Future that Embraces Health for Us All, World Health Organisation. Background Paper, 33."},{"key":"ref_33","unstructured":"(2000, December 20). IHS Special Diabetes Program for Indians | 2014 Report to Congress Changing the Course of Diabetes: Turning Hope into Reality. Available online: https:\/\/www.nihb.org\/sdpi\/docs\/05022016\/SDPI_2014_Report_to_Congress.pdf."},{"key":"ref_34","unstructured":"(2020, July 01). National Center for Chronic Disease Prevention and Health Promotion in Centers for Disease Control and Prevention Native Americans with Diabetes, Available online: https:\/\/www.cdc.gov\/vitalsigns\/aian-diabetes\/index.html."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e020196","DOI":"10.1136\/bmjopen-2017-020196","article-title":"Common mental disorders among Indigenous people living in regional, remote and metropolitan Australia: A cross-sectional study","volume":"8","author":"Nasir","year":"2018","journal-title":"BMJ Open"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1111\/1753-6405.12766","article-title":"Factors relating to high psychological distress in Indigenous Australians and their contribution to Indigenous-non-Indigenous disparities","volume":"42","author":"McNamara","year":"2018","journal-title":"Aust. N. Z. J. Public Health"},{"key":"ref_37","unstructured":"(2020, July 05). United Nations Department of Economic and Social Affairs State of the World\u2019s Indigenous Peoples. Available online: https:\/\/www.un.org\/development\/desa\/indigenouspeoples\/wp-content\/uploads\/sites\/19\/2018\/03\/The-State-of-The-Worlds-Indigenous-Peoples-WEB.pdf."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1177\/070674370505000610","article-title":"Prevalence of depression and prescriptions for antidepressants, Bella Coola Valley, 2001","volume":"50","author":"Thommasen","year":"2005","journal-title":"Can. J. Psychiatry"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.jpsychires.2016.09.032","article-title":"The prevalence of depression and anxiety disorders in indigenous people of the Americas: A systematic review and meta-analysis","volume":"84","author":"Kisely","year":"2017","journal-title":"J. Psychiatr. Res."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Pollock, N.J., Naicker, K., Loro, A., Mulay, S., and Colman, I. (2018). Global incidence of suicide among Indigenous peoples: A systematic review. BMC Med., 16.","DOI":"10.1186\/s12916-018-1115-6"},{"key":"ref_41","unstructured":"Kumar, M.B., and Tjepkema, M. (2020, July 05). Suicide among First Nations people, M\u00e9tis and Inuit (2011\u20132016): Findings from the 2011 Canadian Census Health and Environment Cohort (CanCHEC). Available online: https:\/\/www150.statcan.gc.ca\/n1\/en\/pub\/99-011-x\/99-011-x2019001-eng.pdf?st=8IX6ph_l."},{"key":"ref_42","first-page":"15","article-title":"Associations between household food insecurity and health outcomes in the Indigenous population (excluding reserves)","volume":"22","author":"Willows","year":"2011","journal-title":"Health Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1089\/heq.2019.0041","article-title":"Social Determinants of Health Inequities in Indigenous Canadians Through a Life Course Approach to Colonialism and the Residential School System","volume":"3","author":"Kim","year":"2019","journal-title":"Health Equity"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2184","DOI":"10.2105\/AJPH.2013.301479","article-title":"The lifetime effect of residential school attendance on indigenous health status","volume":"104","author":"Kaspar","year":"2014","journal-title":"Am. J. Public Health"},{"key":"ref_45","unstructured":"(2020, July 02). Truth and Reconciliation Commission of Canada Honouring the Truth, Reconciling for the Future Summary of the Final Report of the Truth and Reconciliation Commission of Canada. Available online: http:\/\/nctr.ca\/assets\/reports\/Final%20Reports\/Executive_Summary_English_Web.pdf."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e924609","DOI":"10.12659\/MSM.924609","article-title":"Comparison of Prevalence and Associated Factors of Anxiety and Depression Among People Affected by versus People Unaffected by Quarantine during the COVID-19 Epidemic in Southwestern China","volume":"26","author":"Lei","year":"2020","journal-title":"Med. Sci. Monit."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Zhang, Y., and Ma, Z.F. (2020). Impact of the COVID-19 Pandemic on Mental Health and Quality of Life among Local Residents in Liaoning Province, China: A Cross-Sectional Study. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17072381"},{"key":"ref_48","unstructured":"Ritchie, H., Roser, M., and Mental Health Published online at OurworldInData.org (2000, December 20). Our World in Data 2018. Available online: https:\/ourworldindata.org\/mental-health."},{"key":"ref_49","first-page":"1","article-title":"Coronavirus Disease 2019 Pandemic: Health System and Community Response to a Text Message (Text4Hope) Program Supporting Mental Health in Alberta","volume":"22","author":"Agyapong","year":"2020","journal-title":"Disaster Med. Public Health Prep."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Agyapong, V.I., Mrklas, K., Juhas, M., Omeje, J., Ohinmaa, A., Dursun, S.M., and Greenshaw, A.J. (2016). Cross-sectional survey evaluating Text4Mood: Mobile health program to reduce psychological treatment gap in mental healthcare in Alberta through daily supportive text messages. BMC Psychiatry, 16.","DOI":"10.1186\/s12888-016-1104-2"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e022433","DOI":"10.1136\/bmjopen-2018-022433","article-title":"Enhancing peer support experience for patients discharged from acute psychiatric care: Protocol for a randomised controlled pilot trial","volume":"8","author":"Urichuk","year":"2018","journal-title":"BMJ Open"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Agyapong, V.I.O., Juh\u00e1s, M., Ohinmaa, A., Omeje, J., Mrklas, K., Suen, V.Y.M., Dursun, S.M., and Greenshaw, A.J. (2017). Randomized controlled pilot trial of supportive text messages for patients with depression. BMC Psychiatry, 17.","DOI":"10.1186\/s12888-017-1448-2"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.jad.2012.02.040","article-title":"Supportive text messaging for depression and comorbid alcohol use disorder: Single-blind randomised trial","volume":"141","author":"Agyapong","year":"2012","journal-title":"J. Affect Disord."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jsat.2018.08.014","article-title":"Randomized controlled pilot trial of supportive text messaging for alcohol use disorder patients","volume":"94","author":"Agyapong","year":"2018","journal-title":"J. Subst. Abus. Treat."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e013587","DOI":"10.1136\/bmjopen-2016-013587","article-title":"Supportive text messages for patients with alcohol use disorder and a comorbid depression: A protocol for a single-blind randomised controlled aftercare trial","volume":"7","author":"Hartnett","year":"2017","journal-title":"BMJ Open"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"385","DOI":"10.2307\/2136404","article-title":"A Global Measure of Perceived Stress","volume":"24","author":"Cohen","year":"1983","journal-title":"J. Health Soc. Behav."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: The GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e19292","DOI":"10.2196\/19292","article-title":"Closing the Psychological Treatment Gap During the COVID-19 Pandemic With a Supportive Text Messaging Program: Protocol for Implementation and Evaluation","volume":"9","author":"Agyapong","year":"2020","journal-title":"JMIR Res. Protoc."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Mrklas, K., Shalaby, R., Hrabok, M., Gusnowski, A., Vuong, W., Surood, S., Urichuk, L., Li, D., Li, X.-M., and Greenshaw, A.J. (2020). COVID-19 pandemic: Prevalence of Perceived Stress, Anxiety, Depression, and Obsessive-Compulsive Symptoms vary among Healthcare and non-Healthcare Workers in Alberta. JMIR Ment. Health.","DOI":"10.2196\/preprints.20041"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Abba-Aji, A., Li, D., Hrabok, M., Shalaby, R., Gusnowski, A., Vuong, W., Surood, S., Nkire, N., Li, X.M., and Greenshaw, A.J. (2020). COVID-19 Pandemic and Mental Health: Prevalence and Correlates of New-Onset Obsessive-Compulsive Symptoms in a Canadian Province. Int. J. Environ. Res. Public Health, 17.","DOI":"10.2196\/preprints.19648"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Nwachukwu, I., Nkire, N., Shalaby, R., Hrabok, M., Vuong, W., Gusnowski, A., Surood, S., Urichuk, L., Greenshaw, A.J., and Agyapong, V.I.O. (2020). COVID-19 Pandemic: Age-Related Differences in Measures of Stress, Anxiety and Depression in Canada. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17176366"},{"key":"ref_63","unstructured":"(2020, July 01). Statista Canadian Aboriginal\u2019s Life Stress Perception 2007\u20132014, by Indigenous Identity. Available online: https:\/\/www.statista.com\/statistics\/817337\/perceived-life-stress-among-aboriginals-canada-by-aboriginal-identity\/."},{"key":"ref_64","unstructured":"(2020, July 04). Statista Share of Canadian Aboriginals with a Mood Disorder 2007\u20132014, by Indigenous Identity. Available online: https:\/\/www.statista.com\/statistics\/817334\/mood-disorders-among-aboriginals-canada-by-aboriginal-identity\/."},{"key":"ref_65","unstructured":"Cardinal, J., Schopflocher, D., Svenson, L., Morrison, K., and Laing, L. (2020, July 01). First Nations in Alberta: A Focus on Health Service Use. Edmonton: Alberta Health and Wellness. Available online: https:\/\/open.alberta.ca\/dataset\/212381eb-ba02-49c8-82d0-27950a9a16df\/resource\/43a8b731-3937-41f1-b52e-06bba2e0b613\/download\/First-Nation-Service-Use-2004.pdf."},{"key":"ref_66","unstructured":"(2020, July 02). Statistics Canada Table 17-10-0005-01 Population Estimates on 1 July by Age and Sex. Available online: https:\/\/www150.statcan.gc.ca\/t1\/tbl1\/en\/tv.action?pid=1710000501."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3233\/THC-120707","article-title":"Perception of patients with alcohol use disorder and comorbid depression about the usefulness of supportive text messages","volume":"21","author":"Agyapong","year":"2013","journal-title":"Technol. Health Care"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"50","DOI":"10.2174\/157340011795945847","article-title":"Mobile Phone Text Message Interventions in Psychiatry\u2014What are the Possibilities?","volume":"7","author":"Agyapong","year":"2011","journal-title":"Curr. Psychiatry Rev."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.jad.2013.05.058","article-title":"Six-months outcomes of a randomised trial of supportive text messaging for depression and comorbid alcohol use disorder","volume":"151","author":"Agyapong","year":"2013","journal-title":"J. Affect. Disord."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"e55","DOI":"10.2196\/resprot.4371","article-title":"Supportive Text Messages to Reduce Mood Symptoms and Problem Drinking in Patients With Primary Depression or Alcohol Use Disorder: Protocol for an Implementation Research Study","volume":"4","author":"Agyapong","year":"2015","journal-title":"JMIR Res. 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