A Virtual Community promoting mental Health, psychosocial Adjustment, and peer supporT (vCHAT) for patients living with increased risk for COVID-19

Mental health needs are pronounced for individuals with chronic heart failure (CHF) or advanced chronic kidney disease (CKD). Clinically significant symptoms of depression and anxiety are prevalent in 22% (11% to 35%)1 and 33% (30 to 40%)2 3 of outpatients with CHF, respectively; and in 26%4, 5 and 12 to 52%6 of outpatients with advanced CKD, respectively. In addition, two psychosocial factors are well-known to compound the disease burden experienced by persons with these chronic progressive conditions. Diminished social support or social isolation is reported by both CHF and CKD patients7, and this is well-known to compromise the psychological well-being and quality of life, while contributing to caregiver burden/stress.8, 9 Presently, persons with CHF or advanced CKD live with increased risk of exposure to Severe Acute Respiratory Syndrome-Related Coronavirus 2 (SARS-CoV-2) and associated mortality.10, 11 The impact on mental health includes acute anxiety and mood disturbance due to health concerns for self and significant others, added social isolation due to social distancing, disruption to sleep or eating patterns, impaired concentration due to stress,12-14 and increased use of drugs or alcohol.15

It is a priority to optimize the therapeutic potential of an innovative program of social network support and automated digital counseling that promotes mental health and quality of life among patients with chronic medical conditions who are living with increased risk for SARS-CoV-2. A program of social network support and automated digital counseling is central to this proposed study due to its demonstrated potential to (i) improve psychological well-being and quality of life while reducing social isolation16-18, (ii) increase patient engagement with digital counseling resources19, 20, and (iii) reinforce preventive self-care for mental health with positive role modeling, information sharing and structured presentations.21 Moreover, this digital initiative complements home-based telemonitoring programs (e.g. Medly22) that are changing the practice of outpatient medical care. It was recently reported that patients are declining to attend essential outpatient appointments due to fear of SARS-CoV-2 exposure.23 This highlights the critical need to conduct a study that will provide novel insights on how to optimize the therapeutic impact (efficacy potential and usability) of a social network-digital counseling program for mental health that is scalable and evidence-based.