Background: The COVID-19 pandemic has largely affected people’s mental health and psychological well-being. Specifically, individuals with a pre-existing mental health disorder seem more impaired by lockdown measures posing as major stress factors. Medical rehabilitation treatment can help people cope with these stressors. The internet and digital apps provide a platform to contribute to regular treatment and to conduct research on this topic. Objective: Making use of internet-based assessments, this study investigated individuals from the general population and patients from medical, psychosomatic rehabilitation clinics. Levels of depression, anxiety, loneliness, and perceived stress during the COVID-19 pandemic, common COVID-19–related worries, and the intention to use digital apps were compared. Furthermore, we investigated whether participating in internet-delivered digital trainings prior to and during patients’ rehabilitation stay, as well as the perceived usefulness of digital trainings, were associated with improved mental health after rehabilitation. Methods: A large-scale, online, cross-sectional study was conducted among a study sample taken from the general population (N=1812) in Germany from May 2020 to April 2021. Further, a longitudinal study was conducted making use of the internet among a second study sample of psychosomatic rehabilitation patients at two measurement time points—before (N=1719) and after (n=738) rehabilitation—between July 2020 and April 2021. Validated questionnaires and adapted items were used to assess mental health and COVID-19–related worries. Digital trainings were evaluated. Propensity score matching, multivariate analyses of covariance, an exploratory factor analysis, and hierarchical regression analyses were performed. Results: Patients from the psychosomatic rehabilitation clinics reported increased symptoms with regard to depression, anxiety, loneliness, and stress (F_4,2028=183.74, P<.001, η²_p=0.27) compared to the general population. Patients perceived greater satisfaction in communication with health care professionals (F_1,837=31.67, P<.001, η²_p=0.04), had lower financial worries (F_1,837=38.96, P<.001, η²_p=0.04), but had higher household-related worries (F_1,837=5.34, P=.02, η²_p=0.01) compared to the general population. Symptoms of depression, anxiety, loneliness, and perceived stress were lower postrehabilitation (F_1,712=23.21, P<.001, η²_p=0.04) than prior to rehabilitation. Psychosomatic patients reported a higher intention to use common apps and digital trainings (F_3,2021=51.41, P<.001, η²_p=0.07) than the general population. With regard to digital trainings offered prior to and during the rehabilitation stay, the perceived usefulness of digital trainings on rehabilitation goals was associated with decreased symptoms of depression (β=–.14, P<.001), anxiety (β=–.12, P<.001), loneliness (β=–.18, P<.001), and stress postrehabilitation (β=–.19, P<.001). Participation in digital group therapy for depression was associated with an overall change in depression (F_1,725=4.82, P=.03, η²_p=0.01) and anxiety (F_1,725=6.22, P=.01, η²_p=0.01) from pre- to postrehabilitation. Conclusions: This study validated the increased mental health constraints of psychosomatic rehabilitation patients in comparison to the general population and the effects of rehabilitation treatment. Digital rehabilitation components are promising tools that could prepare patients for their rehabilitation stay, could integrate well with face-to-face therapy during rehabilitation treatment, and could support aftercare. Trial Registration: ClinicalTrials.gov NCT04453475; https://clinicaltrials.gov/ct2/show/NCT04453475 and ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735

中文翻译：

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COVID-19 期间的心身康复患者和一般人群：数字培训和康复效果的在线横断面和纵向研究

背景： COVID-19 大流行在很大程度上影响了人们的心理健康和心理健康。具体而言，作为主要压力因素的封锁措施似乎对先前存在精神健康障碍的人造成了更大的损害。医疗康复治疗可以帮助人们应对这些压力。互联网和数字应用程序提供了一个平台，有助于定期治疗和开展有关该主题的研究。客观的：本研究利用基于互联网的评估，调查了来自普通人群的个人和来自医疗、心身康复诊所的患者。比较了 COVID-19 大流行期间抑郁、焦虑、孤独和感知压力的程度、常见的 COVID-19 相关担忧以及使用数字应用程序的意图。此外，我们调查了在患者康复之前和期间参加互联网提供的数字培训，以及数字培训的有用性是否与康复后的心理健康改善有关。方法：对 2020 年 5 月至 2021 年 4 月德国一般人群（N=1812）的研究样本进行了大规模、在线、横断面研究。此外，还利用互联网在2020 年 7 月至 2021 年 4 月期间，在两个测量时间点——康复前 (N=1719) 和康复后 (n=738) 的心身康复患者的第二个研究样本。经过验证的问卷和改编项目用于评估心理健康和 COVID-19 ——相关的担忧。对数字培训进行了评估。进行了倾向评分匹配、协方差的多变量分析、探索性因素分析和层次回归分析。结果：与一般人群相比，来自心身康复诊所的患者报告的抑郁、焦虑、孤独和压力症状增加 ( F _4,2028 =183.74, P <.001, η ² _p =0.27)。患者在与医疗保健专业人员的交流中感到更高的满意度 ( F _1,837 =31.67, P <.001, η ² _p =0.04)，财务担忧较低 ( F _1,837 =38.96, P <.001, η ² _p =0.04)，但有较高的家庭相关担忧（F _1,837 =5.34，P =.02, η ² _p =0.01) 与一般人群相比。与康复前相比，康复后抑郁、焦虑、孤独和感知压力的症状较低 ( F _1,712 =23.21, P <.001, η ² _p =0.04)。心身患者报告了更高的使用常用应用程序和数字培训的意愿 ( F _3,2021 =51.41, P <.001, η ² _p=0.07) 比一般人群。对于康复住院前和康复期间提供的数字培训，数字培训对康复目标的感知有用性与抑郁症状的减少有关（β =–.14，P <.001）、焦虑（β =–.12 , P <.001)、孤独感 ( β =–.18, P <.001) 和康复后的压力 ( β =–.19, P <.001)。参与抑郁症数字团体治疗与抑郁症（F _1,725 =4.82, P =.03, η ² _p =0.01）和焦虑的整体变化有关（F _1,725 =6.22, P =.01, η ² _p =0.01) 从康复前到康复后。结论：本研究证实，与一般人群相比，心身康复患者的心理健康限制有所增加，以及康复治疗的效果。数字康复组件是很有前景的工具，可以让患者为康复住院做好准备，可以在康复治疗期间与面对面的治疗很好地结合，并可以支持善后。试验注册： ClinicalTrials.gov NCT04453475；https://clinicaltrials.gov/ct2/show/NCT04453475 和 ClinicalTrials.gov NCT03855735；https://clinicaltrials.gov/ct2/show/NCT03855735