An App-Based Ecological Momentary Assessment of Undergraduate Mental Health During the COVID-19 pandemic in Canada (Smart Healthy Campus Version 2.0): Longitudinal Study

medRxiv (Cold Spring Harbor Laboratory)(2023)

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Abstract
This paper presents results from the Smart Healthy Campus 2.0 study/smartphone app, developed and used to collect mental health-related lifestyle data from 86 Canadian undergraduates January – August 2021. This was a longitudinal repeat measures study conducted over 40 weeks. A 9-item mental health questionnaire was accessible once daily in the app. Two variants of this mental health questionnaire existed; the first was a weekly variant, available each Monday or until a participant responded during the week. The second was a daily variant available after the weekly variant. Mixed models were fit for responses to the two variants and 12 phone digital measures (e.g. GPS, step counts). A second round of models was fit based on backward elimination to determine associations between the 12 digital measures and the variants. 6518 digital measure samples and 1722 questionnaire responses were collected. The daily questionnaire had positive associations with floors walked, installed apps, and campus proximity, while having negative associations with uptime, and daily calendar events. Daily depression had a positive association with uptime. Daily resilience appeared to have a slight positive association with campus proximity. The weekly questionnaire variant had positive associations with device idling and installed apps, and negative associations with floors walked, calendar events, and campus proximity. Physical activity, weekly, had a negative association with uptime, and a positive association with calendar events and device idling. SHC 2.0, via phone digital measures, identified indicators of lifestyle that appeared to be associated with measures of mental health in undergraduates during COVID-19. Author Summary This paper analyzes the associations between digital measures from smartphones (such as GPS and step counts) and a broad mental health questionnaire (covering items like depression and anxiety). This data was collected from students at a relatively large, urban university in Canada during the COVID-19 pandemic. We conducted this study because smartphone-based studies observing aspects of mental health in students as they go about their daily lives are uncommon in Canada. Additionally, mental health concerns, such as depression and anxiety, can be common on university campuses, although it isn’t always clear what is associated with those concerns, especially when only looking at them with smartphone data. We were also interested in how an overview of student mental health would relate to digital measures coming from smartphones during the pandemic, as this information would be relevant to inform future pandemics. In general, these relationships might potentially inform ways to improve student mental health, or potentially predict aspects of it, based on data coming in from smartphones. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Study incentives were funded by FIMS, Western University, Canada. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics approval was provided by Western University Health Sciences Research Ethics Board (HSREB) in October 2020 (Project ID 116670). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data for this project is not publicly available as it was an EMA-type study that repeatedly sampled the same participants for potentially sensitive data, such as location. * CPU : Central Processing Unit EMA : Ecological Momentary Assessment EMAX1 : Ecological Momentary Assessment eXtensions 1st edition software EMAX2 : Ecological Momentary Assessment eXtensions 2nd edition software SHC : Smart Healthy Campus SHCv2 : Smart Healthy Campus Version 2 study SPE : Student Pandemic Experience
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Key words
undergraduate mental health,mental health,smart healthy campus version,longitudinal study,app-based
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