Intended for healthcare professionals

Letters Covid-19: psychological effects on healthcare workers

Digital approaches for mental health in the age of covid-19

BMJ 2020; 369 doi: (Published 29 June 2020) Cite this as: BMJ 2020;369:m2541
  1. Bernard P Chang, associate professor of emergency medicine1,
  2. Ronald C Kessler, McNeil family professor of health care policy2,
  3. Harold A Pincus, professor3,
  4. Matthew K Nock, Edgar Pierce professor of psychology4
  1. 1Department of Emergency Medicine, Columbia University Irving Medical Center, 622 West 168th Street, VC2—Suite #260, New York, NY 10032, USA
  2. 2Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
  3. 3Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
  4. 4Department of Psychology, Harvard University, Boston, MA, USA
  1. bpc2103{at}

Gold’s editorial on psychological first aid interventions recognises the major psychological consequences arising in the covid-19 pandemic.1 In this current climate, mounting effective mental health responses faces challenges, including the widespread reduction of available in-person mental health services and broad limitations in mobility as a result of the public health measures enacted.

Covid-19 is occurring in an age of unprecedented adoption of digital technology, creating opportunities for data driven testing and dissemination of effective solutions to assess and treat mental health problems in the wake of the pandemic. Digital mental health programmes offer the ability to respond quickly and efficiently and to reach people over great distances with minimal mobility requirements.

There are currently over 10 000 smartphone apps related to mental health, each with diverse approaches ranging from remote cognitive behavioural therapy to the use of automated “chat bots.”2 Despite the large number of available digital treatment options, little evidence based guidance exists. It is vital to deploy digital mental health services that are evidence based and efficacious.

Pragmatic clinical trials could allow us to rapidly assess the association between digital interventions and outcomes in a real world context.3 Whereas randomised trials of traditional mental health interventions typically take years, recent studies using digital interventions have shown that they can be carried out among more than 1000 participants in a matter of weeks.4 Pragmatic trials could lead to dramatic enhancements in our abilities to monitor, assess, and treat mental health, not just during covid-19 but potentially for populations in historically underserved areas such as rural populations or low income regions, faced with limited availability of local mental health resources.

Guided by a rigorous evidence based approach, digital health solutions might be the “killer app” to help combat the behavioural and psychosocial fallout from this global pandemic.


This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.


View Abstract