Primary Outcomes

Description: Outcome measure of depression will be assessed as the change in depression between baseline (pre-treatment) and post treatment (up to 12 weeks).

Measure: Level of depression as measured by the Hamilton Depression Rating Scale

Time: Up to 12 weeks.

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Primary Outcomes

Description: change in magnitude of BOLD signal with fMRI bold signal from DLPFC

Measure: Change in magnitude of Bold signal

Time: 6 weeks after initiating intervention

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Secondary Outcomes

Description: Recordings of brain activity

Measure: Electrophysiological changes using MEG and EEG measures

Time: 6 weeks after initiating intervention

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Description: Clinical symptom scales from which we derive scores

Measure: Clinical Rating Scales: BSL, C-SSRS, CTQ, HAM-A, NIH-BFI, PANAS, RBANS, RRS, SHAPS, and TLEQ

Time: Variable: some 6 weeks after initiating intervention; others weekly

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Primary Outcomes

Description: changes in MFQ scores over time

Measure: Mood and Feelings Questionnaire

Time: Ongoing

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Primary Outcomes

Description: Change in taste threshold measures (sweet, salt, bitter, sour) between baseline and post-probe(s) at day 1 and 28 days after antidepressant treatment is initiated is assessed with the assistance of a taste test device.

Measure: Change in taste threshold with antidepressant treatment

Time: 4-6 weeks (per patient)

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Description: Change in mood (assessed by score on the Beck Depression Inventory (BDI)) with antidepressant treatment is assessed. BDI scores may range from 0-63, where 0 demonstrates the lowest depression score and 63 the most severe depression.

Measure: Change in mood (assessed by score on the Beck Depression Inventory) with antidepressant treatment

Time: 4-6 weeks (per patient)

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Secondary Outcomes

Description: Changes in scores on the Clinical Global Impression scale, as assessed by the participant's general medical practitioner is recorded. This scale ranges from 0-7, where 0 is the least severely ill and 7 the most severely ill.

Measure: Change in mood with antidepressant treatment, measured by the Clinical Global Impression Scale (CGI scale)

Time: 4-6 weeks (per patient)

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Description: Change in mood with antidepressant treatment, measured by the Patient Health Questionnaire 9 (PHQ9). PHQ9 scores range from 0-27, where 0 is the score for the least depressed patients and 27 the most severely depressed patients.

Measure: Change in mood with antidepressant treatment, measured by the Patient Health Questionnaire 9 (PHQ9)

Time: 4-6 weeks (per patient)

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Description: Change in mood with antidepressant treatment, measured by the Hospital Anxiety and Depression scale (HADS). HADS scores for depression range from 0-21, where 0-7 is normal, 8-10 borderline and 11+ indicates clinical depression

Measure: Change in mood with antidepressant treatment, measured by the Hospital Anxiety and Depression scale (HADS)

Time: 4-6 weeks (per patient)

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Description: Change in mood with antidepressant treatment, measured by the Quick Inventory of Depressive symptomatology (QIDS). Scores for QIDS range from 0-27, where 0 indicates no symptoms of depression and 27 indicates the most severe depression.

Measure: Change in mood with antidepressant treatment, measured by the Quick Inventory of Depressive symptomatology (QIDS)

Time: 4-6 weeks (per patient)

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Description: A computerised algorithm will be used to direct the taste test to assess taste sensitivity. The algorithm has been developed to direct the taste test, indicating which taste solutions should be presented to the participant in which order. Every solution presented is recorded, along with answers given. These will be examined after testing to validate the code's ability to follow the algorithm created and properly determine taste thresholds.

Measure: Validation of diagnostic algorithm, comparing the sequence of taste testing determined by software with the algorithm described in the software specification.

Time: 12 months (duration of trial)

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Description: User views on ease of use of the device and testing process will be collected. Users will be asked to give ease of use a score from 1-5, where 1 is very easy and 5 is very difficult. Participants will also be asked whether they would use the taste test again.

Measure: User assessment of ease of use of the device and testing process.

Time: 4-6 weeks (per patient)

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Primary Outcomes

Description: Universal 1) Adolescents with PHQ-9 score >10 (screen Sept-Mar of the school year) or who at any point in the year exhibit behavior concerning for MDD prompting a SAP triage request, 2) Adolescents identified with MDD by SAP triage, and 3) Adolescents who successfully engage with at least one SAP recommendation. Prior Sept-Nov screening adjusted per school preference. Targeted 1) Adolescents with behavior concerning for MDD prompting a SAP triage request, 2) Adolescents identified with MDD by SAP triage, and 3) Adolescents who successfully engage with at least one SAP recommendation Concern for MDD based on a primary or secondary potentially MDD related SAP "incoming referral reason" SAP triage is not diagnostic, so MDD identified based on recommendations for MDD related school or community services (e.g. mental health treatment services) HRSA funds mostly rural schools (anticipated N=4738; all rural but one school) and PCORI funds urban schools (anticipated N=7768)

Measure: MDD composite: Adolescents MDD screen positive by PHQ-9 (universal arm) or with concern for MDD prompting Student Assistance Program (SAP) triage request, identified with MDD by SAP, and who engage with at least one SAP recommended service or treatment

Time: up to 9 months

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Secondary Outcomes

Description: Universal screening arm: Adolescents who have a PHQ-9 score >10 (screening with the PHQ-9 is planned during the academic year, e.g. September to March) or who at any point in the school year exhibit behavior concerning for MDD which prompts self or collateral request for SAP triage. Targeted screening arm: Adolescents with behavior concerning for MDD which prompts self or collateral request for SAP triage at any point during the school year. Concern for MDD is based on a primary or secondary potentially MDD related SAP "incoming referral reason".

Measure: MDD screen positive/concern: Adolescents who screen positive for MDD either by PHQ-9 (universal screening arm only) or by concern for MDD prompting a request for SAP triage

Time: up to 9 months

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Description: Universal screening arm: Patient health questionnaire positive response to question #9 re: suicidal thoughts, which requires management by the state-mandated school crisis plan or student self or collateral report of suicidal thoughts, which requires management by the state-mandated school crisis plan (source school district). Targeted screening arm: Student self or collateral report of suicidal thoughts, which requires management by the state-mandated school crisis plan (source school district). Any student suicide attempts or completed suicides shared with the school district will also be included.

Measure: Suicidal Adolescent

Time: up to 9 months

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Description: Universal and targeted screening arms: Adolescents who are identified as having MDD based on triage by the school SAP team. As SAP triage is not diagnostic, MDD identified will be based on SAP recommendations for school or community services which are MDD related (e.g. mental health treatment services).

Measure: MDD identification: Adolescents who are identified as having MDD based on triage by the school SAP team

Time: up to 9 months

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Description: Universal and targeted screening arms: Adolescents who successfully engage with at least one SAP recommendation. This may be fulfilled by parental report that an appointment was successfully scheduled.

Measure: MDD treatment engagement: Successful engagement with at least one SAP recommendation

Time: up to 9 months

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Description: This performance measure represents the percentage of all students scoring Proficient or Advanced on the Mathematics Algebra I Keystone Exam. Algebra I Keystone scores reflect students' best score to date for all 11th grade students enrolled in the school for the full academic year.

Measure: Standardized test scores: Keystone exams mathematics (school district). This information may no longer be available due to COVID-19 school closures and cancellation of state standardized testing.

Time: up to 9 months

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Description: This performance measure represents the percentage of all students scoring Proficient or Advanced on the ELA/Literature Keystone Exam. Literature Keystone scores reflect students' best score to date for all 11th grade students enrolled in the school for the full academic year.

Measure: Standardized test scores: Keystone exams English language arts (ELA; school district) This information may no longer be available due to COVID-19 school closures and cancellation of state standardized testing.

Time: up to 9 months

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Description: This performance measure represents the percentage of all students scoring Proficient or Advanced on the Science/Biology Keystone Exam. Biology Keystone scores reflect students' best score to date for all 11th grade students enrolled in the school for the full academic year.

Measure: Standardized test scores: Keystone exams science (school district) This information may no longer be available due to COVID-19 school closures and cancellation of state standardized testing.

Time: up to 9 months

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Description: This performance measure represents the percent of 12th grade students who have taken the PSAT or Plan at any time over the course of their educational experience.

Measure: Preliminary Scholastic Aptitude Test (PSAT)/Plan (school district) This information may no longer be available due to COVID-19 school closures and cancellation of state standardized testing.

Time: up to 9 months

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Description: This performance measure represents the percent of 12th grade students meeting both SAT College and Career Readiness benchmarks and/or scoring 22 or higher on the ACT taken at any time over the course of their educational experience.

Measure: Scholastic Aptitude Test (SAT)/ American College Testing (ACT) performance (school district) This information may no longer be available due to COVID-19 school closures and cancellation of state standardized testing.

Time: up to 9 months

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Description: data aggregate by grade level only schools currently track the number of student policy violations (e.g. for drug and alcohol, violence) and student suspensions

Measure: Student school policy violations and suspensions based on school district data

Time: up to 9 months

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Description: data aggregate by grade level only

Measure: Missed school days

Time: up to 9 months

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Description: data aggregate by grade level only

Measure: Grade point average

Time: up to 9 months

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Description: data aggregate by grade level only

Measure: Grade advancement: This measure represents the percent of students promoted in each grade for the school (grades 9-11, school district data)

Time: up to 9 months

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Description: data aggregate by grade level only

Measure: Graduation: This measure represents the percent of students who graduate 12th grade with a high school diploma (school district data)

Time: up to 9 months

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Other Outcomes

Description: Sex (Male, Female), Ethnicity, Race, Rural/Urban

Measure: Subgroup analyses based on school district demographic data

Time: up to 9 months

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Primary Outcomes

Description: Acceptability assessed with Qualitative interview

Measure: Qualitative interview

Time: post intervention (month 3)

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Description: Credibility assessed with Credibility Expectancy Questionnaire (CEQ), credibility subscale. The credibility subscale of the CEQ, is a 3 item subscale of the 6 item CEQ. The 3 items are measured on a 1-9 scale (not at all - very), Higher scores indicate greater credibility.

Measure: Credibility Expectancy Questionnaire (CEQ) - Credibility Subscale

Time: Week 1

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Description: Patient expectations assessed with the Credibility Expectancy Questionnaire (CEQ), expectancy subscale. The expectancy subscale is a 3 item subscale of the 6 item CEQ. One of the 3 items are measured on a 1-9 scale (not at all - very), 2 are on a 0-10 scale (0-100%). Higher scores indicate greater expectations.

Measure: Credibility Expectancy Questionnaire (CEQ) - Expectancy Subscale

Time: Week 1

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Description: Satisfaction with treatment assessed with The Client Satisfaction Questionnaire (CSQ-8). The CSQ-8 is an 8-item measure with each item measured on a 1-4 scale. Higher scores indicate greater client satisfaction.

Measure: The Client Satisfaction Questionnaire (CSQ-8)

Time: Post intervention (month 3)

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Description: Yoga home practice assessed with a Home practice questionnaire. Duration, frequency, and type of formal and informal home yoga practice between class sessions.

Measure: Home practice questionnaire

Time: Post intervention (month 3)

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Description: Participant safety/adverse events will be measured using the SAFTEE. Participants will also be asked weekly if they experienced any injuries as a result of yoga.

Measure: Systematic assessment of treatment-emergent events-general inquiry (SAFTEE)

Time: Post intervention (month 3)

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Secondary Outcomes

Description: Change in depression symptom severity will be assessed via blind evaluator using the the QIDS. The QIDS is a 17 item measure with scores ranging from 0-30. Higher scores indicate greater depressive symptoms.

Measure: Quick Inventory of Depression - Adolescent Version - Clinician Rating (QIDS-A-CR)

Time: Baseline to post intervention (month 3); Baseline to 6 months; Baseline to 9 months

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Primary Outcomes

Description: Self-report measure of severity of depressive symptoms to be completed prior to each intervention class. Each of the 9 items is scored 0-3 (0 = not at all; 3 = nearly every day), yielding a total between 0 and 27, with higher scores representing increased severity of depression symptoms.

Measure: Patient Health Questionnaire-9 (PHQ-9)

Time: Change measure (baseline, week 2, week 3, and week 4)

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Description: Self-report measure of severity of generalized anxiety symptoms to be completed prior to each intervention class. Each of the 7 items is scored 0-3 (0 = not at all; 3 = nearly every day), yielding a total between 0 and 21, with higher scores representing increased severity of generalized anxiety symptoms.

Measure: Generalized Anxiety Disorder-7 (GAD-7)

Time: Change measure (baseline, week 2, week 3, and week 4)

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Description: Self-report measure of the acceptability of different elements of the intervention to be completed prior to the first and fourth classes.

Measure: Acceptability Survey

Time: Change measure (baseline and week 4)

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Description: Self-report measure of the acceptability of different elements of the intervention to be completed prior to the first and fourth intervention classes.

Measure: Class Evaluation Form

Time: Data collected weekly throughout the four weeks of study enrolment

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Secondary Outcomes

Description: Self-report measure of improvement in symptoms to be completed prior to intervention classes 2, 3 and 4. The single item is scored 1-7 (1 = very much improved; 7 = very much worse), yielding a total between 1 and 7, with higher scores representing a worsening of symptoms.

Measure: Clinical Global Impression scale (CGI)

Time: Change measure (baseline at week 2, week 3, and week 4)

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Description: Self-report measure of the extent of participants' learning and implementation of cognitive and behavioural coping skills to be completed prior to each intervention class. Each of the 16 items is scored 1-5 (1 = I don't do this; 5 = I always do this). The measure is comprised of two subscales, (1) Behavioural Activation (7 questions) and (2) Cognitive Restructuring (9 questions); item scores are summed to yield subscale scores, with higher scores indicating increased implementation of the respective subscale skills. The two subscales can be summed to create a total score, yielding a total between 16 and 80, with higher scores representing increased implementation of both sets of skills.

Measure: Cognitive Behaviour Therapy Skills Questionnaire (CBTSQ)

Time: Change measure (baseline, week 2, week 3, and week 4)

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Description: Self-report measure related to perceptions of the therapy and participants' ability to engage in the skills taught during the class to be completed prior to intervention classes 2, 3, and 4. Each of the 10 items is scored from 1-7 (1 = disagree strongly; 7 = agree strongly), yielding a total between 10 and 70, with higher scores representing positive perceptions of treatment acceptability and adherence.

Measure: Treatment Acceptability/Adherence Scale (TAAS)

Time: Change measure (baseline, week 2, week 3, and week 4)

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Description: Self-report measure of homework completion and skills practice to be completed prior to intervention classes 2, 3 and 4.

Measure: Homework Record

Time: Data collected weekly throughout the four weeks of study enrolment

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Primary Outcomes

Description: Waking EEG Theta power - Brain rhythm assessed during waking used to measure net synaptic strength

Measure: Compare indices of net synaptic strength (theta power, transcranial magnetic stimulation evoked potentials) and markers associated with plasticity (BDNF, behavioral measures of learning/memory) in individuals with MDD to healthy controls

Time: up to a month

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Secondary Outcomes

Description: Hamilton rating scale for depression - Clinician-administered measure of depression severity

Measure: Determine if slow-wave disruption alters mood in individuals with MDD

Time: up to a month

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Primary Outcomes

Description: Brief BA psychological treatment is delivered by non-specialist providers. The perinatal depressive symptoms are measured by the Edinburgh Postnatal Depression Scale. The minimum and maximum values for the Edinburgh Postnatal Depression Scale are 0 and 30 respectively. Higher scale scores are associated with higher perinatal depressive symptoms. The assessment period is extended to account for post-treatment outcomes when there are interruptions to treatment (e.g., giving birth, obstetrical complications and COVID-19 related events).

Measure: Treatment of perinatal depressive symptoms by non-specialist providers

Time: 3-months post-randomization

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Description: Brief BA psychological treatment is delivered through telemedicine. The perinatal depressive symptoms are measured by the Edinburgh Postnatal Depression Scale. The minimum and maximum values for the Edinburgh Postnatal Depression Scale are 0 and 30 respectively. Higher scale scores are associated with higher perinatal depressive symptoms. The assessment period is extended to account for post-treatment outcomes when there are interruptions to treatment (e.g., giving birth, obstetrical complications and COVID-19 related events).

Measure: Treatment of perinatal depressive symptoms through telemedicine

Time: 3-months post-randomization

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Secondary Outcomes

Description: Brief BA psychological treatment is delivered by non-specialist providers. The anxiety symptoms are measured by the Generalized Anxiety 7 Item Questionnaire. The minimum and maximum values for the Generalized Anxiety 7 Item Questionnaire are 0 and 21 respectively. Higher scale scores are associated with higher perinatal anxiety symptoms. The assessment period is extended to account for post-treatment outcomes when there are interruptions to treatment (e.g., giving birth, obstetrical complications and COVID-19 related events).

Measure: Treatment of perinatal anxiety symptoms by non-specialist providers

Time: 3-months post-randomization

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Description: Brief BA psychological treatment is delivered through telemedicine. The anxiety symptoms are measured by the Generalized Anxiety 7 Item Questionnaire. The minimum and maximum values for the Generalized Anxiety 7 Item Questionnaire are 0 and 21 respectively. Higher scale scores are associated with higher perinatal anxiety symptoms. The assessment period is extended to account for post-treatment outcomes when there are interruptions to treatment (e.g., giving birth, obstetrical complications and COVID-19 related events).

Measure: Treatment of perinatal anxiety symptoms through telemedicine

Time: 3-months post-randomization

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Description: Child mental development is measured by Bayley Mental Developmental Scale III and the provision of psychosocial stimulation by the mother measured by Home Observation Measurement Evaluation. Cognitive development, expressive and receptive language, and fine and gross motor development composite scores are measured by Bayley Mental Developmental Scale III. The composite scores are scaled to a metric, with a mean of 100, standard deviation of 15, and range of 40 to 160. Higher scaled scores are associated with higher mental health development in child. The minimum and maximum values for the Home Observation Measurement Evaluation scale scores are 0 and 45 respectively. Higher scores are associated with more enriched environment.

Measure: Child Mental Health Development

Time: 9 to 15 months post child birth

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Description: Response and Remission is measured by Patient Health Questionnaire 9. The minimum and maximum values for Patient Health Questionnaire 9 are 0 and 27 respectively. Response and Remission is defined as PHQ-9 of less than 10 and 5 respectively. The assessment period is extended to account for post-treatment outcomes when there are interruptions to treatment (e.g., giving birth, obstetrical complications and COVID-19 related events).

Measure: Response and Remission

Time: 3-months post-randomization

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Primary Outcomes

Description: The scale contains 17 variables. Some are defined in terms of a series of categories of increasing intensity, while others are defined by a number of equal-valued terms. The form on which ratings are recorded also includes: four :Diurnal variation, de- realization, paranoid symptoms, obsessional symptoms.score Range of its score is from 0-54. from 0-6 means no depression. 7-17: mild depression 18-24:moderate depression 24 and more: Severe depression

Measure: The Hamilton Depression Rating Scale.

Time: 6 months

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Secondary Outcomes

Description: To assess depression as a symptom variable. Total scores range from 0 to 27 and high score means the worse outcome .The total score is obtained by adding the scores for each of the nine symptom domains of the DSM-IV MDD criteria: depressed mood, loss of interest or pleasure, concentration/decision making, self-outlook, suicidal ideation, energy/fatiguability, sleep, weight/appetite change, and psychomotor changes.

Measure: Quick Inventory of Depressive Symptomatology Self Report-16.

Time: 6 months

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Description: To assess suicidal ideation as symptom variable. Suicidal Ideation Score: The maximum suicidal ideation category (1-5 on the C- SSRS) present at the assessment. Assign a score of 0 if no ideation is present.

Measure: Columbia Suicide Severity Rating Scale.

Time: 6 months

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Description: To assess mania as a symptom variable.There are four items that are graded on a 0 to 8 scale (irritability, speech, thought content, and disruptive/aggressive behavior), while the remaining seven items are graded on a 0 to 4 scale. These four items are given twice the weight of the others to compensate for poor cooperation from severely ill patients. There are well described anchor points for each grade of severity. The authors encourage the use of whole or half point ratings once experience with the scale is acquired. Typical YMRS baseline scores can vary a lot. They depend on the patients' clinical features such as mania (YMRS = 12), depression (YMRS = 3), or euthymia (YMRS = 2). Sometimes a clinical study entry requirement of YMRS > 20 generates a mean YMRS baseline of about 30. Strengths of the YMRS include its brevity, widely accepted use, and ease of administration. The usefulness of the scale is limited in populations with diagnoses other than mania.

Measure: Young Mania Rating Scale.

Time: 6 months

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Description: To assess side effects as a functional variable. A patient self-report used to quantify the overall side effect burden. Used in combination with the PRISE. Rated for the last 7 days. Each item uses a 7-point Likert-type scale rated from 0 (i.e. no side effects) to 6 (i.e. intolerable). 3 global ratings encompass all side effects to study treatment experienced over the past week. One item rates frequency, another rating the intensity of side effects encountered in the prior week that the participant believes were due to the antidepressant treatment, and the third asks participants to estimate the overall burden or degree of interference in day-to-day activities and functioning due to the side effects.

Measure: Frequency, Intensity, and Burden of Side Effects Ratings *Edited for rTMS

Time: 6 months

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Description: To assess side effects as a functional variable. A patient self-report used to qualify side effects by identifying and evaluating the tolerability of each symptoms. Used in combination with the FIBSER. Rated for the last 7 days. 7 item assessment of the side effects in the following symptom domains; Gastrointestinal, Heart, Skin, Nervous System, Eyes/Ears, Genital/Urinary, Sleep, Sexual Functioning, and Other. Each domain has multiple symptoms which can be endorsed. For each domain the patient rates whether or not the symptoms are tolerable or distressing.

Measure: Patient Rated Inventory of Side Effects.

Time: 6 months

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Description: To assess disability as a functional variable.The scoring has three steps: Step 1 - Summing of recoded item scores within each domain. Step 2 - Summing of all six domain scores. Step 3 - Converting the summary score into a metric ranging from 0 to 100 (where 0 = no disability; 100 = full disability).

Measure: World Health Organization Disability Assessment 2.0

Time: 6 months

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Description: To assess the quality of life as a functional variable. Each of the five dimensions comprising the EQ-5D descriptive system is divided into five levels of perceived problems: LEVEL 1: indicating no problem LEVEL 2: indicating slight problems LEVEL 3: indicating moderate problems LEVEL 4: indicating severe problems LEVEL 5: indicating unable to/extreme problems A unique health state is defined by combining one level from each of the five dimensions.

Measure: (The EuroQol-5 Dimension Assessment).

Time: 6 months

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Description: To assess patient satisfaction with service as a service variable.Identify survey questions that receive low scores and prioritize improving those areas (i.e., connect them to investigators strategic goals or propose them as an area of focus for the Board). Benchmark results against: The previous survey results Investigators peers Industry standard Best practices "Bright spots" in primary care

Measure: Patient Satisfaction/ Community Service Experience Survey

Time: 3 months

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Primary Outcomes

Description: This outcome will be measured using the "Intention to use Technology " questions of the Technology Acceptance Model questionnaire. These are questions 11, 12, and 13 and allow participants the option of circling Strongly Disagree, Disagree, Neutral, Agree, or Strongly Agree.

Measure: Participant's desire to continue using VR after the study ends

Time: 4-weeks

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Description: Participant treatment dropout will be compared across each study arm.

Measure: Rates of dropout of VR-BA

Time: 4-weeks

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Description: This outcome will be measured using the "Attitudes Toward Use " questions of the Technology Acceptance Model questionnaire. These are questions 7, 8, 9, and 10 and allow participants the option of circling Strongly Disagree, Disagree, Neutral, Agree, or Strongly Agree.

Measure: Participant's satisfaction with the VR-BA treatment

Time: 4-weeks

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Description: This will be measured by noting the amount of times the VR headset is used.

Measure: Participant's use of the VR headset

Time: 4-weeks

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Description: This will be measured using the overall Technology Acceptance Model questionnaire, which encompasses 13 questions and allows participants the option of circling Strongly Disagree, Disagree, Neutral, Agree, or Strongly Agree.

Measure: Participant's acceptance of VR-BA treatment

Time: 4-weeks

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Description: This will be determined by the Simulator Sickness Questionnaire, which names 16 adverse symptoms and asks participants to circle as compared to baseline: No more than usual, Slightly more than usual, Moderately more than usual, or Severely more than usual.

Measure: How well can participants tolerate the VR-BA treatment?

Time: 4-weeks

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Description: This will be measured using the Presence Questionnaire, which asks three questions and asks the participants to circle either Not at all, Slightly, Moderately, Strongly, or Very Strongly.

Measure: How present did individuals in the VR-BA treatment feel?

Time: 4-weeks.

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Secondary Outcomes

Description: How participants' depression scores PHQ-9 change over time using VR-BA compared to BA in real life and a waitlist control. The PHQ-9 is a 9-question screener with a score range of 0-29, with 29 indicating the most severe depression and 0 indicating a lack of depression symptoms.

Measure: Clinical efficacy of using VR as a tool to deliver BA

Time: 4-weeks

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Primary Outcomes

Description: 21-item validated scale assessing symptoms of depression, anxiety, and stress (DASS-21): Min score = 0, Max score = 21; higher score indicates a worse outcome

Measure: Depression, Anxiety and Stress Scale

Time: Single measurement (upon study enrolment)

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Other Outcomes

Description: 3 items on fear of the situation, confidence the government can manage the situation, and assessed chance of being infected (each rated using 4-point scales: min = 1, max = 4; higher scores indicate increased confidence / likelihood / fear)

Measure: Assessment of COVID-19 situation

Time: Single measurement (upon study enrolment)

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Description: Participants' self-report of their familiarity (yes/no) and belief of specific (yes/no), and whether they shared these on social media (yes/no)

Measure: Familiarity and trust in COVID-related rumours

Time: Single measurement (upon study enrolment)

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Primary Outcomes

Description: The Patient Health Questionnaire 9 (PHQ-9; Kroenke, Spitzer & Williams, 2001) is used to measure symptoms of depression in accordance with the diagnostic criteria for major depressive disorder. The questionnaire consists of nine items where each is scored on a four-point Likert scale (0-3), with the range of scores from 0 to 27. Higher scores indicate greater depression severity, and scores above 10 are considered as the cut-off that indicating that the patient is within the depressive area.

Measure: Patient Health Questionnaire 9

Time: All data was collected between March 31st 2020 and April 7th 2020, a period where the NPIs (non-pharmacological interventions) against the COVID-19 pandemic were identical and constant in Norway

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Description: The Generalized Anxiety Disorder 7 (GAD-7; Spitzer, Kroenke, Williams & Löwe, 2006) is a questionnaire consisting of seven items measuring symptoms of anxiety and worry. The items are scored on a four-point Likert scale (0-3), with the scores ranging from 0 to 21. Higher scores indicate greater anxiety severity, and scores that are above the cut-off of 10 are considered to be in the clinical range (Spitzer et al., 2006). Specific cut-off for Norwegian samples have been found yielding a cut-off of 8 and above for high sensitivity and specificity (Johnson, Ulvenes, Øktedalen & Hoffart, 2019).

Measure: Generalized Anxiety Disorder 7

Time: All data was collected between March 31st 2020 and April 7th 2020, a period where the NPIs (non-pharmacological interventions) against the COVID-19 pandemic were identical and constant in Norway

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Description: Measures of adherence to all eight non-pharmacological interventions (NPIs) employed against COVID-19 is measured, with each item being on a five-point Likert scale (0-4).

Measure: Measures of adherence

Time: All data was collected between March 31st 2020 and April 7th 2020, a period where the NPIs (non-pharmacological interventions) against the COVID-19 pandemic were identical and constant in Norway

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Primary Outcomes

Description: To investigate the impact of a web-based psychosocial intervention on Edinburgh Postnatal Depression Scale (EPDS) in urban women living in Hong Kong and Shanghainese women. Scores of EPDS range from min = 0 to max=30. The higher the score, the more depressed a woman is.

Measure: Edinburgh Postnatal Depression Scale (EPDS)

Time: 4-6 weeks postpartum

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Secondary Outcomes

Description: Correlation between mental health status (EPDS, GAD7, IES-R) and COVID-19 pandemic among pregnant women. GAD 7 Generalized anxiety questionnaire IES-R Impact Event Scale to assess Post traumatic stress Disorder (PTSD) COVID-19 questionnaire

Measure: Mental health status and COVID-19

Time: 4-6 weeks postpartum

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Description: Impact of web-based psychosocial intervention on mental health and pregnancy outcomes among women from different socio-economic and cultural environments. Socio-economic information gained by sociodemographic questions.

Measure: Socio-economic status (education level, income, marital status, profession, nationality)

Time: 4-6 weeks postpartum

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Description: Relationship between mental health status of pregnant women and rates of elective cesarean section (CS) on maternal request.

Measure: Elective CS

Time: 4-6 weeks postpartum

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Primary Outcomes

Description: The UCLA Loneliness Scale-8 (ULS-8) measures the frequency and intensity of aspects of the lonely experience, using a 1 (never) to 4 (always) Likert-type scale. A composite score was computed by summing the items after reverse coding when appropriate, such that higher scores indicate greater loneliness. In terms of symptoms, validated measures routinely used in clinical practice to screen symptom-levels suggestive of psychiatric diagnosis were utilized.

Measure: UCLA Loneliness Scale-8 (ULS-8)

Time: From March31st 2020 to April 7th 2020

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Description: The Patient Health Questionnaire-9 (PHQ-9)16 consists of nine items covering the DSM-IV criteria for major depression scored on a four-point Likert-scale (0-3), with scores ranging from 0 to 27. High scores on the PHQ-9 reveal greater depression severity and scores above 10 are considered as the cut-off indicative of a depressive diagnosis with a sensitivity and specificity of 88%.16 The PHQ-9 has revealed good psychometric properties, as demonstrated by Kroenke et al. (2001).

Measure: Patient Health Questionnaire-9 (PHQ-9)

Time: From March31st 2020 to April 7th 2020

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Description: The Generalized Anxiety Disorder-7 (GAD-7)17 consists of seven items covering the DSM-IV criteria for GAD on a four-point Likert scale (0-3) with scores ranging from 0 to 21. Higher scores reveal greater GAD symptoms, and scores above 10 are considered as the cut-off indicative of a GAD-diagnosis with a specificity of 82% and sensitivity of 89%.17 The GAD-7 has revealed construct validity and reliability (Kroenke, Spitzer, Williams, Monahan & Löwe, 2007; Löwe et al., 2008).

Measure: Generalized Anxiety Disorder-7 (GAD-7)

Time: From March31st 2020 to April 7th 2020

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Primary Outcomes

Description: assess the emotional impact of women's separation from their partners following childbirth and then their family isolation when they return home in the context of the health crisis linked to the COVID-19 epidemic

Measure: Proportion of patients with postpartum depression defined by an EPDS score >12

Time: Between week 6 and week 8

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Description: assess the emotional impact of women's separation from their partners following childbirth and then their family isolation when they return home in the context of the health crisis linked to the COVID-19 epidemic

Measure: Proportion of patients with postpartum depression defined by an EPDS score >12

Time: Between day 10 and day 12

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Secondary Outcomes

Measure: Socio-demographic data

Time: Between day 1 and day 5

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Measure: Occurrence of a maternal or fetal pathology in a previous pregnancy

Time: Between day 1 and day 5

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Measure: Pregnant maternal pathology (hypertension, diabetes, threat of premature delivery)

Time: Between day 1 and day 5

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Description: as above, maternal psychological history as vulnerability factor included : history of perinatal loss, IMG, history of post partum depression.

Measure: Presence of psycological maternal risk factor

Time: Between day 1 and day 5

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Measure: Dyadic adjustment scale 16 (DAS-16)

Time: Between day 10 and day 12 and at between week 6 and week 8

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Measure: Perinatal post traumatic stress disorder questionnaire (PPQ scale)

Time: Between day 10 and day 12

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Measure: Mother to infant bonding scale (MIBS) autoquestionnaire

Time: Between day 10 and day 12 and at between week 6 and week 8

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Description: Participants will be asked open-ended questions about their post-partum experience in the context of COVID-19 epidemic lockdown. The interviews will be transcribed and tagged with codes which have been extracted from the data. As more data is collected codes can be regrouped into concepts and then categories. These categories are the basis of the "theory model" that emerge from the narrative of the patients. The verbatim of the interview will be analyzed using NVIVO software which allows a grounded theory approach. Using software package as Nvivo (Hutchison, 2010) with automatic analysis of the verbatim to extract codes and concepts provides a transparent account of the data and enhance study validity. Verbatim are download in the software, that extract repeated lexical fields the categories from the mother's narrative. As this is a qualitative study, there are no expected outcomes. Outcomes will be determined by the themes that arise from the post-partum interview process.

Measure: Measure Qualitative Interviews by Grounded theory

Time: Week 14

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Primary Outcomes

Description: 21-item validated scale assessing symptoms of depression, anxiety and stress (DASS-21): Min score = 0, Max score = 21; higher score indicates a worse outcome.

Measure: Change in DASS scores across 7 days

Time: Twice: once during initial enrollment, and then 8 days after

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Description: 1 item each day on fear specifically of the COVID-19 situation (measured on a 4 point scale: min = 1, max = 4; higher scores indicating greater fear about the outbreak).

Measure: Changes in fear with regards the COVID-19 situation across 1 week

Time: 1 week, starting from date after initial DASS survey completion

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Description: 1 item each day on how much they thought about the outbreak that day (measured on a 5 point scale: min = 1, max = 5; higher scores indicating more thinking about the outbreak).

Measure: Changes in amount of thinking about the COVID-19 situation across 1 week

Time: 1 week, starting from date after initial DASS survey completion

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Primary Outcomes

Description: Measured by Mood and Anxiety Symptom Questionnaire (MASQ-30). It measures the dimensions of Clark and Watson's tripartite model, covering both shared and distinct symptoms of depression and anxiety. It has three sub-scales: Negative Affect (NA), associated with both depression and anxiety; lack of Positive Affect (PA), associated with depressive moods; and Somatic Arousal (SA), associated with anxiety. Scores are ranging from 10 to 50, with higher scores indicating more severe psychopathology.

Measure: Changes in depression-, anxiety- and psychosomatic stress symptoms

Time: pre-test (before starting the training), post-test (immediately after the training), follow-up (two months after the training)

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Secondary Outcomes

Description: Measured by Rumination Response Scale (RRS). This 22-item questionnaire provides a total rumination score (range: 22 - 88), as well as Brooding and Reflection sub-scale scores (range: 5 - 20). Brooding is characterized by a passive style of moody pondering. Higher scores indicate a worse outcome.

Measure: Changes in rumination.

Time: pre-test (before starting the training), post-test (immediately after the training), follow-up (two months after the training)

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Description: Measured by the Cognitive Emotion Regulation Questionnaire (CERQ). Which measures different emotion regulation strategies. This questionnaire has 9 sub-scales: self-blame, other-blame, rumination, catastrophizing, putting into perspective, positive refocusing, positive reappraisal, acceptance and planning. Each sub-scale has a scoring range between 4 and 20. A higher score represents a greater frequency of engaging in that emotion regulation strategy.

Measure: Changes in cognitive emotion regulation strategies.

Time: pre-test (before starting the training), post-test (immediately after the training), follow-up (two months after the training)

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Description: Measured by a baseline measure in our OCAT app and measure of the end of the training period.

Measure: Changes in emotional attention

Time: pre-test (before starting the training), post-test (immediately after the training)

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Other Outcomes

Description: Measured by the COVID questionnaire (designed by the researchers).

Measure: How variables related to COVID-19 and the quarantine affect the life of participants

Time: pre-test (before starting the training)

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Description: Measured by Center for Epidemiological Studies - Depression (CES-D), which has 20 items. A higher score represents more depressive feelings (range: 0 - 60).

Measure: Changes in depressive complaints

Time: pre-test (before starting the training), post-test (immediately after the training), follow-up (two months after the training)

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Description: Measured by the Generalized Anxiety Disorder 7 item scale (GAD-7). Scores may vary from 0 to >15. A higher score represents more symptoms of anxiety.

Measure: Changes in symptoms of anxiety

Time: pre-test (before starting the training), post-test (immediately after the training), follow-up (two months after the training)

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Description: Measured by the Warwick-Edinburgh Mental Well-being Scales (WE-MWB). This 14-item scale indexes positive aspects of mental health. Scores may vary between 14 and 70. A higher score represents a more positive mental health.

Measure: Changes in well-being

Time: pre-test (before starting the training), post-test (immediately after the training), follow-up (two months after the training)

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Description: Measured by a Visual Analogue Stress Scale, is scored from 1 (not at all) - 10 (a lot).

Measure: Changes in perceived stress

Time: pre-test (before starting the training), post-test (immediately after the training), follow-up (two months after the training)

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Description: Measured by the Credibility/Expectancy Questionnaire (CEQ). It measures participants' credibility and expectancy of the training. In the credibility scale the items are rated on 9- point scales ranging from 1 (Not at all logical/useful/confident) to 9 (Very logical/effective/confident). This leads to a total score on this scale between 3 and 27. In the expectancy scale the same 9-point scale is used and an 11-point scale (from 0% to 100%). Responses are standardized to get the total expectancy score. Higher scores represent higher credibility and expectancy.

Measure: Treatment Credibility and Expectancy

Time: post-test (immediately after the training)

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Description: A question was added to determine how pleasant the training is perceived by the participants. It is scored on a scale from 0 to 10 where 0 stands for "very unpleasant" and 10 stands for "very pleasant".

Measure: Perceived pleasantness of the training

Time: post-test (immediately after the training)

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Primary Outcomes

Description: Assessed using PROMIS Anxiety (CAT)

Measure: Change in anxiety

Time: Baseline, 6 weeks, 6 months

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Description: Assessed using PROMIS Depression (CAT)

Measure: Change in depression

Time: Baseline, 6 weeks, 6 months

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Description: Assessed using PROMIS Social Isolation (CAT)

Measure: Change in feelings of social isolation

Time: Baseline, 6 weeks, 6 months

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Description: Assessed using PROMIS Positive Affect (CAT)

Measure: Change in positive affect

Time: Baseline, 6 weeks, 6 months

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Description: Assessed using PROMIS Meaning and Purpose (CAT)

Measure: Change in sense of meaning and purpose

Time: Baseline, 6 weeks, 6 months

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Primary Outcomes

Description: proportion of women with an Edinburgh score higher than 12 between 4 and 6 weeks postpartum

Measure: Report postnatal depression between 4 of 6 weeks during the covid 19 pandemia

Time: 4-6 weeks postpartum

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Secondary Outcomes

Description: Existence of an association with postnatal depression and these factors: socio demographic women's characteristics, modalities of pregnancy management, satisfaction and experience about delivery, postnatal pelvic floor disorders, self rated health for the woman and the child, modalities of delivery, prenatal anxiety

Measure: Report factors associated with postnatal depression between 4 of 6 weeks during the covid 19 pandemia

Time: 4-6 weeks postpartum

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Description: Scale from 0 to 10 of satisfaction ; answers to the WOMBLSQ4 questionnaire about childbirth experience and satisfaction

Measure: Describe the experience and the satisfaction about delivery during the covid 19 pandemia

Time: within the week after delivery

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Primary Outcomes

Description: To understand the prevalence (magnitude) of depression and anxiety of general adult population during COVID-19 using Generalized Anxiety Disorder Scale (GAD-7)

Measure: Prevalence (magnitude) of anxiety of general adult population during COVID-19

Time: 1 YEAR

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Description: To understand the prevalence (magnitude) of depression and anxiety of general adult population during COVID-19 using Patient Health Questionnaire (PHQ-9).

Measure: prevalence (magnitude) of depression and anxiety of general adult population during COVID 19

Time: 1 Year

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Primary Outcomes

Description: Prevalence of burnout risk

Measure: Prevalence of burnout among ICU nurses during Covid-19

Time: 2 months

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Description: Prevalence of depression risk

Measure: Prevalence of depression among ICU nurses during Covid-19

Time: 2 months

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Description: Prevalence of self perceived medical errors

Measure: Prevalence of self-perceived medical errors among ICU nurses during Covid-19

Time: 2 months

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Description: To find out if there exists a relationship between burnout, depression and medical errors

Measure: Association of burnout, depression and medical errors among anaesthesiology clinicians during Covid-19

Time: 2 months

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Primary Outcomes

Description: PCL-5 is 20-item self-administered questionnaire which assesses the full domain of the DSM-5 PTSD diagnosis. The self-report rating scale is 0-4 for each symptom. Rating scale descriptors are: "Not at all," "A little bit," Moderately," "Quite a bit," and "Extremely."The PCL-5 has four subscales, corresponding to each of the symptom clusters in the DSM-5.

Measure: PTSD Checklist for DSM-5 (PCL-5)

Time: All data was collected between March 31st 2020 and April 7th 2020, a period where the NPIs (nonpharmacological interventions) against the COVID-19 pandemic were identical and constant in Norway

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Secondary Outcomes

Description: The Patient Health Questionnaire 9 (PHQ-9; Kroenke, Spitzer & Williams, 2001) is used to measure symptoms of depression in accordance with the diagnostic criteria for major depressive disorder. The questionnaire consists of nine items where each is scored on a four-point Likert scale (0-3), with the range of scores from 0 to 27.

Measure: Patient Health Questionnaire 9 (PHQ-9)

Time: All data was collected between March 31st 2020 and April 7th 2020, a period where the NPIs (nonpharmacological interventions) against the COVID-19 pandemic were identical and constant in Norway

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Description: The Generalized Anxiety Disorder 7 (GAD-7; Spitzer, Kroenke, Williams & Löwe, 2006) is a questionnaire consisting of seven items measuring symptoms of anxiety and worry. The items are scored on a four-point Likert scale (0-3), with the scores ranging from 0 to 21.

Measure: The Generalized Anxiety Disorder 7 (GAD-7)

Time: All data was collected between March 31st 2020 and April 7th 2020, a period where the NPIs (nonpharmacological interventions) against the COVID-19 pandemic were identical and constant in Norway]

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Description: Symptoms of health anxiety was measured with two items from the validated Health Anxiety Inventory (HAI), one item measuring specific fear of being infected by coronavirus, and an item measuring fear of dying by the coronavirus. All items used a Likert scale from 0-3, and the new total score of health anxiety had a range from 0-12.

Measure: Health anxiety

Time: All data was collected between March 31st 2020 and April 7th 2020, a period where the NPIs (nonpharmacological interventions) against the COVID-19 pandemic were identical and constant in Norway

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Primary Outcomes

Description: depressive symptomatology with Patient Health Questionnaire : PHQ-9 scale (PHQ 9 higher score, more depressive -> min : 0 max : 27)

Measure: Depressive Symptomatology

Time: during confinement

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Secondary Outcomes

Description: depressive symptomatology with Patient Health Questionnaire : PHQ-9 scale (PHQ 9 higher score, more depressive -> min : 0 max : 27)

Measure: Depressive Symptomatology

Time: post-confinement : 15 days, 3 months, 6 months

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Other Outcomes

Description: Psychological pain : likert scale (higher score, more psychological pain-> min : 0 max : 10)

Measure: Psychological pain

Time: during confinement

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Description: quality of sleep assessed with Insomnia Seveity Index (ISI Insomnia Severity Scale ; higher score, more insomnia -> min : 0 max : 28)

Measure: sleep

Time: during confinement

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Description: quality of sleep assessed with Insomnia Seveity Index (ISI Insomnia Severity Scale ; higher score, more insomnia -> min : 0 max : 28)

Measure: sleep

Time: post-confinement (15 days, 3 months, 6 months)

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Description: anxiety intensity assessed by Generalized Anxieety Disorder (GAD 7 Generalized Anxiety Disorder higher score, more anxious -> min : 0 max : 21)

Measure: anxiety

Time: during confinement

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Description: anxiety intensity assessed by Generalized Anxieety Disorder (GAD 7 Generalized Anxiety Disorder higher score, more anxious -> min : 0 max : 21)

Measure: anxiety

Time: post-confinement (15 days, 3 months, 6 months)

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Description: psychological pain : likert scale (higher score, more psychological pain-> min : 0 max : 10)

Measure: psychological pain

Time: post-confinement (15 days, 3 months, 6 months)

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Description: psychological pain : likert scale (higher score, more psychological pain-> min : 0 max : 10)

Measure: physical pain

Time: during confinement

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Description: psychological pain : likert scale higher score, more psychological pain-> min : 0 max : 10)

Measure: physical pain

Time: post-confinement (15 days, 3 months, 6 months)

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Description: staxi state scale (STAXI ; State and Trait Anger Expression Inventory : higher score, more anger -> min : 0 max : 50)

Measure: anger

Time: during confinement

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Description: staxi state scale (STAXI ; State and Trait Anger Expression Inventory : higher score, more anger -> min : 0 max : 50)

Measure: anger

Time: post-confinement (15 days, 3 months, 6 months)

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Description: Assessed by the Stressful Event Impact Scale - Horowitz (HOROWITZ higher score, more traumatizes -> min : 0 max : 45) )

Measure: Stressful Event Impact

Time: during confinement

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Description: Assessed by the Stressful Event Impact Scale - Horowitz (HOROWITZ higher score, more traumatizes -> min : 0 max : 45)

Measure: Stressful Event Impact

Time: post-confinement (15 days, 3 months, 6 months)

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Description: Number of patients declaring an increase of psychotropic drug use

Measure: Use of psychotropic drugs

Time: during confinement

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Description: Number of patients declaring an increase of psychotropic drug use

Measure: Use of psychotropic drugs

Time: post-confinement (15 days, 3 months, 6 months)

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Description: Number of patients declaring an increase of tobacco consumption

Measure: Tobacco consumption

Time: during confinement

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Description: Number of patients declaring an increase of tobacco consumption

Measure: Tobacco consumption

Time: post-confinement (15 days, 3 months, 6 months)

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Description: Number of patients declaring an increase of alcohol consumption

Measure: alcohol consumption

Time: post-confinement (15 days, 3 months, 6 months)

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Description: Number of patients declaring an increase of alcohol consumption

Measure: alcohol consumption

Time: confinement

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Description: Number of patients declaring an increase of illicit substances consumption

Measure: Illicit substances consumption

Time: confinement

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Description: Number of patients declaring an increase of illicit substances consumption

Measure: Illicit substances consumption

Time: post-confinement (15 days, 3 months, 6 months)

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Description: Life Orinetation Test Revised (LOT-R questionnaire): higher score, more optimistic --> min : 0 max : 24

Measure: orientation of life

Time: confinement

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Description: Life Orinetation Test Revised (LOT-R questionnaire): higher score, more optimistic --> min : 0 max : 24

Measure: orientation of life

Time: post-confinement (15 days, 3 months, 6 months)

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Primary Outcomes

Description: Three items from the Danish Parental Stress Scale (PSS) was selected, which intends to be a short measure of perceived stress resulting from being a parent (Pontoppidan et al., 2018). The scale consists of nine items measuring parental stress where each is measured on a five-point Likert scale (1-5), with the scores ranging from 3 to 15. Higher scores indicate higher parental stress. The following three were chosen in this large-scale investigation: 1) I feel overwhelmed by the responsibility of being a parent. 2) The major source of stress in my life is my child(ren), and 3) It is difficult to balance different responsibilities because of my child(ren) (Pontoppidan et al., 2018).

Measure: Measure of parental stress

Time: All data was collected between March 31st 2020 and April 7th 2020, a period where the NPIs (nonpharmacological interventions) against the COVID-19 pandemic were identical and constant in Norway

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Description: The Patient Health Questionnaire 9 (PHQ-9; Kroenke, Spitzer & Williams, 2001) is used to measure symptoms of depression in accordance with the diagnostic criteria for major depressive disorder. The questionnaire consists of nine items where each is scored on a four-point Likert scale (0-3), with the range of scores from 0 to 27. Higher scores indicate greater depression severity, and scores above 10 are considered as the cut-off that indicating that the patient is within the depressive area.

Measure: Patient Health Questionnaire 9

Time: All data was collected between March 31st 2020 and April 7th 2020, a period where the NPIs (nonpharmacological interventions) against the COVID-19 pandemic were identical and constant in Norway

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Description: The Generalized Anxiety Disorder 7 (GAD-7; Spitzer, Kroenke, Williams & Löwe, 2006) is a questionnaire consisting of seven items measuring symptoms of anxiety and worry. The items are scored on a four-point Likert scale (0-3), with the scores ranging from 0 to 21. Higher scores indicate greater anxiety severity, and scores that are above the cutoff of 10 are considered to be in the clinical range (Spitzer et al., 2006). Specific cut-off for Norwegian samples have been found yielding a cut-off of 8 and above for high sensitivity and specificity (Johnson, Ulvenes, Øktedalen & Hoffart, 2019).

Measure: Generalized Anxiety Disorder 7

Time: All data was collected between March 31st 2020 and April 7th 2020, a period where the NPIs (nonpharmacological interventions) against the COVID-19 pandemic were identical and constant in Norway

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Primary Outcomes

Description: Anxiety measured by General Anxiety Disorder-7 (GAD-7) scale. Scoring:5-9 mild; 10-14 moderate; >15 severe. Minimum 0, maximum 21 points

Measure: Anxiety

Time: 4 months

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Description: Depression measured by Patient Health Questionnaire-9 (PHQ-9) scale. Scoring: 5-9 mild;10-14 moderate; 15-19 moderately severe; >20 severe. Minimum 0 maximum 27 points

Measure: Depression

Time: 4 months

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Primary Outcomes

Description: Depressive symptoms will be measured with the Patient Health Questionnaire-9 (PHQ-9) instrument. The PHQ-9 is a nine item survey to assess depressive symptoms over the previous 2 weeks. The patient may answer "not at all" (scored as a 0) , "several days" (scored as a 1), "more than half the days" (scored as a 2), or "nearly every day" (scored as a 3) for each item. The range in total scores is from 0 (no depressive symptoms or best outcome) to 27 (severe depressive symptoms or worst outcome). The primary out come measure is to calculate the change in the mean scores of PHQ-9 from baseline to the end of the study between the intervention and the control.

Measure: Change in Depressive symptoms measured by Patient Health Questionnaire-9

Time: 6-12 weeks

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Description: The Generalized Anxiety Disorder 7-item scale is a 7- item self-report measure of generalized anxiety. Participants rate the frequency with which they experience anxiety-related symptoms on a scale of 0 (Not at all) to 3 (Nearly every day). Total scores range from 0-21 with higher scores indicating greater anxiety symptoms. The second primary out come measure is to calculate the change in the mean scores of GAD-7 from baseline to the end of the study between the intervention and the control.

Measure: Change in Anxiety symptoms measured by Generalized Anxiety Disorder-7

Time: 6-12 WEEKS

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Secondary Outcomes

Description: Proportion of subjects with Significant Depression (Defined as PHQ-9 total score ≥ 10 ) in each arm

Measure: Proportion of subjects with Significant Depression

Time: 6-12 weeks

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Description: Proportion of subjects with Significant Anxiety (Defined as GAD-7 total score ≥ 10 ) in each arm

Measure: Proportion of subjects with Significant Anxiety

Time: 6-12 weeks

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Primary Outcomes

Description: Evaluation of depression and anxiety score changes of covid-19 positive pregnants Pregnant women are questioned how this period was affected, as the pandemic period loaded with extra stress and caused depression and anxiety.

Measure: Evaluation of depression and anxiety score changes of covid-19 positive pregnants

Time: 4 months

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Primary Outcomes

Description: Participants are asked to give information about: age, gender, educational status, height, weight, occupation, working status, city inhabited, whether they live alone or with someone, whether they have a chronic disease, have a pet, do physical activity, eat healthy and sufficient, have qualified sleep, whether they are supported economically.

Measure: Sociodemographic information form

Time: two months after Covid 19 recognised as pandemic

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Description: Zung depression scale, developed by Zung (Zung, 1965), is patient rating depression scale, was used to asses four domains related to depression; somatic, mood disorders, psychomotor and psychological disorders. Each question is rated on a 4-point Likert scale (0- never, 1- sometimes, 2- frequently, 3- always). Scale contains 10 straight 10 reverse questions. The total score is calculated from the raw score obtained (total score = (raw score / 80) * 100). Accordingly, scores less than 50 are normal or no psychopathology; between 50 and 59 points indicates mild level, between 60 and 69 points indicate moderate level and 70 and above points indicate severe level depression (Thurber et al., 2002). The validity reliability of the scale was studied on Turkish society (Gencdogan & Nihal, 2011)

Measure: Zung Depression Scale

Time: two months after Covid 19 recognised as pandemic

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Description: World Health Organization Quality of Life Bref is the short version of the WHOQOL-100 to assess the health-related quality of life (Harper et al., 1998), which has efficient psychometric properties, valid and reliable for Turkish society (Eser et al., 1999). It is essential for epidemiological survey and international report has built for psychometric properties for 26 country where Turkey within (Skevington et al., 2004). It has 4 domains; physical health, psychology, social relations and environment. Each question is answered on a 5-point Likert scale. The raw score is converted into a percentage system. The quality of life is interpreted as good as it gets closer to 100% (Akvardar et al., 2006).

Measure: World Health Organization Quality of Life - Bref

Time: two months after Covid 19 recognised as pandemic

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Primary Outcomes

Description: Patient Health Questionnaire 9 scale (PHQ-9), a 9 item scale with a score range from 0 to 27. A higher score means a worse outcome.

Measure: Rate reduction in Depressive symptoms

Time: 6 months after psychotherapeutic intervention has started

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Description: General Anxiety Disorder 7 Scale (GAD-7), a 7 item scale with a score range from 0 to 21. A higher score means a worse outcome.

Measure: Rate reduction in Anxiety symptoms

Time: 6 months after psychotherapeutic intervention has started

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Description: Post-traumatic Stress Scale for DSM-5 (PCL-5), a 20 item scale with a score range from 0 to 80. A higher score means a worse outcome.

Measure: Rate reduction in Post traumatic Stress symptoms

Time: 6 months after psychotherapeutic intervention has started

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Description: Perceived stress scale (PSS), a 10 item scale with a score range from 0 to 40. A higher score means a worse outcome.

Measure: Rate reduction in Perceived stress level

Time: 6 months after psychotherapeutic intervention has started

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Primary Outcomes

Description: The worsening of the cardiovascular risk factors during or after quarantine (versus before quarantine) will be considered in case of: - introduction or increase of antihypertensive, lipid-lowering or hypoglycaemic drug treatment on the prescription

Measure: worsening of cardiovascular risk (treatments)

Time: at 1, 6 and 12 month

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Description: The worsening of the cardiovascular risk factors during or after quarantine (versus before quarantine) will be considered in case of increased smoking consumption

Measure: worsening of cardiovascular risk (smoking consumption)

Time: at 1, 6 and 12 month

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Description: The worsening of the cardiovascular risk factors during or after quarantine (versus before quarantine) will be considered in case of alteration of the food balance

Measure: worsening of cardiovascular risk (food balance)

Time: at 1, 6 and 12 month

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Description: The worsening of the cardiovascular risk factors during or after quarantine (versus before quarantine) will be considered in case of weight gain

Measure: worsening of cardiovascular risk (weight gain)

Time: at 1, 6 and 12 month

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Description: The worsening of the cardiovascular risk factors during or after quarantine (versus before quarantine) will be considered in case of: - reduction in the level of physical activity

Measure: worsening of cardiovascular risk (physical activity)

Time: at 1, 6 and 12 month

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Secondary Outcomes

Description: " Generalized Anxiety Disorder " (GAD-7) : Spitzer, R. L., Kroenke, K., Williams, J. B. W. et Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092-1097.

Measure: psychological impact of the quarantine on anxiety

Time: at 1, 6 and 12 month

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Description: "Patient Health Questionnaire " (PHQ-9) : Kroenke, K., Spitzer, R. L. et Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med, 16(9), 606-613.

Measure: psychological impact of the quarantine on health

Time: at 1, 6 and 12 month

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Description: " Impact of Event Scale - Revised " (IES-R) : Weiss, D. S. et Marmar, C. R. (1996). The Impact of Event Scale-Revised. Dans J. P. Wilson et T. M. Keane (dir.). Assessing psychological trauma and PTSD. New York : Guildford Press. Brunet, A., St-Hilaire, A., Jehel, L. et King, S. (2003). Validation of a French Version of the Impact of Event Scale-Revised.

Measure: psychological impact of the quarantine on stress

Time: at 1, 6 and 12 month

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Primary Outcomes

Description: Scale to evaluate Post-traumatic Stress Disorder symptoms

Measure: Impact of Event Scale - Revised (IES-R)

Time: Two weeks

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Description: Scale to evaluate anxiety symptoms

Measure: General Anxiety Disorder (GAD-7)

Time: Two weeks

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Description: Scale to evaluate depressive symptoms

Measure: Patient Health Questionnaire (PHQ-9)

Time: Two weeks

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Secondary Outcomes

Description: Qualitative data will be coded and analyzed to show emerging themes.

Measure: Qualitative Data

Time: Two weeks

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Primary Outcomes

Description: 10-item Perceived Stress Scale (PSS), score 0-40, higher the score, higher stress

Measure: Stress

Time: Change from baseline stress at 1-Month

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Description: 10-item Perceived Stress Scale (PSS), score 0-40, higher the score, higher stress

Measure: Stress

Time: Change from baseline stress at 2-Month

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Description: 10-item Perceived Stress Scale (PSS), score 0-40, higher the score, higher stress

Measure: Stress

Time: Change from baseline stress in 3-Month

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Description: 14-item Warwick-Edinburgh Wellbeing Scale (WEMWBS), score14-70, higher score higher wellbeing

Measure: Wellbeing

Time: Change from baseline wellbeing in 2-week

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Description: 14-item Warwick-Edinburgh Wellbeing Scale (WEMWBS), score14-70, higher score higher wellbeing

Measure: Wellbeing

Time: Change from baseline wellbeing in 4-week

---

Description: 14-item Warwick-Edinburgh Wellbeing Scale (WEMWBS), score14-70, higher score higher wellbeing

Measure: Wellbeing

Time: Change from baseline wellbeing in 6-week

---

Description: 14-item Warwick-Edinburgh Wellbeing Scale (WEMWBS), score14-70, higher score higher wellbeing

Measure: Wellbeing

Time: Change from baseline wellbeing in 8-week

---

Description: 14-item Warwick-Edinburgh Wellbeing Scale (WEMWBS), score14-70, higher score higher wellbeing

Measure: Wellbeing

Time: Change from baseline wellbeing in 10-week

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Description: 14-item Warwick-Edinburgh Wellbeing Scale (WEMWBS), score14-70, higher score higher wellbeing

Measure: Wellbeing

Time: Change from baseline wellbeing in 12-week

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Secondary Outcomes

Description: 2-item PHQ-4, score 2-8, higher score higher anxiety

Measure: Anxiety

Time: Change from baseline anxiety in 2-week

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Description: 2-item PHQ-4, score 2-8, higher score higher anxiety

Measure: Anxiety

Time: Change from baseline anxiety in 4-week

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Description: 2-item PHQ-4, score 2-8, higher score higher anxiety

Measure: Anxiety

Time: Change from baseline anxiety in 6-week

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Description: 2-item PHQ-4, score 2-8, higher score higher anxiety

Measure: Anxiety

Time: Change from baseline anxiety in 8-week

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Description: 2-item PHQ-4, score 2-8, higher score higher anxiety

Measure: Anxiety

Time: Change from baseline anxiety in 10-week

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Description: 2-item PHQ-4, score 2-8, higher score higher anxiety

Measure: Anxiety

Time: Change from baseline anxiety in 12-week

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Description: 2-item PHQ-4, score 2-8, higher score higher depression

Measure: Depression

Time: Change from baseline depression in 2-week

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Description: 2-item PHQ-4, score 2-8, higher score higher depression

Measure: Depression

Time: Change from baseline depression in 4-week

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Description: 2-item PHQ-4, score 2-8, higher score higher depression

Measure: Depression

Time: Change from baseline depression in 6-week

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Description: 2-item PHQ-4, score 2-8, higher score higher depression

Measure: Depression

Time: Change from baseline depression in 8-week

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Description: 2-item PHQ-4, score 2-8, higher score higher depression

Measure: Depression

Time: Change from baseline depression in 10-week

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Description: 2-item PHQ-4, score 2-8, higher score higher depression

Measure: Depression

Time: Change from baseline depression in 12-week

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Description: 6-item Brief Resilience Scale (BRS), score 6-30, higher score higher resilience

Measure: Resilience

Time: Change from baseline resilience in 1-month

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Description: 6-item Brief Resilience Scale (BRS), score 6-30, higher score higher resilience

Measure: Resilience

Time: Change from baseline resilience in 2-month

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Description: 6-item Brief Resilience Scale (BRS), score 6-30, higher score higher resilience

Measure: Resilience

Time: Change from baseline resilience in 3-month

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Description: 10-item Positive Affect Scale, score - 10 to 50, higher score more positive affect

Measure: Positive Affect

Time: Change from baseline positive affect in 2-week

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Description: 10-item Positive Affect Scale, score - 10 to 50, higher score more positive affect

Measure: Positive Affect

Time: Change from baseline positive affect in 4-week

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Description: 10-item Positive Affect Scale, score - 10 to 50, higher score more positive affect

Measure: Positive Affect

Time: Change from baseline positive affect in 6-week

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Description: 10-item Positive Affect Scale, score - 10 to 50, higher score more positive affect

Measure: Positive Affect

Time: Change from baseline positive affect in 8-week

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Description: 10-item Positive Affect Scale, score - 10 to 50, higher score more positive affect

Measure: Positive Affect

Time: Change from baseline positive affect in 10-week

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Description: 10-item Positive Affect Scale, score - 10 to 50, higher score higher positive affect

Measure: Positive Affect

Time: Change from baseline positive affect in 12-week

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Description: 10-item Negative Affect Scale, score - 10 to 50, higher score higher negative affect

Measure: Negative Affect

Time: Change from baseline negative affect in 2-week

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Description: 10-item Negative Affect Scale, score - 10 to 50, higher score higher negative affect

Measure: Negative Affect

Time: Change from baseline negative affect in 4-week

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Description: 10-item Negative Affect Scale, score - 10 to 50, higher score higher negative affect

Measure: Negative Affect

Time: Change from baseline negative affect in 6-week

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Description: 10-item Negative Affect Scale, score - 10 to 50, higher score higher negative affect

Measure: Negative Affect

Time: Change from baseline negative affect in 8-week

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Description: 10-item Negative Affect Scale, score - 10 to 50, higher score higher negative affect

Measure: Negative Affect

Time: Change from baseline negative affect in 10-week

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Description: 10-item Negative Affect Scale, score - 10 to 50, higher score higher negative affect

Measure: Negative Affect

Time: Change from baseline negative affect in 12-week

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Primary Outcomes

Description: This scale will explore the effort and confidence of the participants. The minimum score for each facet is 10, and the maximum score is 70.

Measure: Academic Self-Concept Scale Score

Time: up to 3 months

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Description: This inventory will be used to identify the presence and intensity of depressive disorders. The minimum score is 0, and the maximum score is 27.

Measure: PHQ-9 Score

Time: up to 3 months

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Description: This questionnaire will be used to evaluate the presence and intensity of anxiety disorders. The minimum score is 0, and the maximum score is 21.

Measure: GAD-7 Score

Time: up to 3 months

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Description: Students' preference of classroom or online classes.

Measure: Preference of teaching method

Time: up to 3 months

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Description: Students' perception of changes in their academic performance: got better, worse, or stayed the same.

Measure: Self perceived academic performance

Time: up to 3 months

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Description: Students' perception of changes in their grades: got better, worse, or stayed the same.

Measure: Academic grades changes

Time: up to 3 months

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Primary Outcomes

Description: Measure of depressive symptoms. Possible range for the total sum: 0 to 63 (created by summing up the score from each item). Clinical ranges for minimal, mild, moderate and severe major depressive disorder are considered to be 0-13, 13-19, 20-28, and 29-63 points.

Measure: Becks Depression Inventory-II

Time: Change between baseline and end of treatment after seven weeks.

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Description: Measure of quality of life, total score ranging from 0 to 96 with a higher score indicating a higher quality of life. The scores of each of the six primary questions regarding perceived quality of life within an area of life are multiplied with the score of an item measuring the perceived importance of the area in question.

Measure: Brunnsviken Brief Quality of Life Scale

Time: Change between baseline and end of treatment after seven weeks.

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Secondary Outcomes

Description: Measure of depressive symptoms. Possible range for the total sum: 0 to 27 (created by summing up the score from each item). Clinical cut-offs for mild, moderate, moderately severe and severe major depressive disorder are considered to be 5, 10, 15, and 20 points.

Measure: Patient Health Questionnaire

Time: Change between baseline and end of treatment after seven weeks.

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Description: The Alcohol Use Disorders Identification Test is a 10-item screening tool to assess alcohol consumption, drinking behaviors, and alcohol-related problems. 10 items and scores ranging from 0-40.

Measure: Alcohol Use Disorder Identification Test

Time: Change between baseline and end of treatment after seven weeks.

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Description: Measure of insomnia severity and symptoms of disordered sleep. The total score can range between 0 (no sleep problems) to 28 (severe sleep problems and insomnia). Norm score ranges include low likelihood of sleep problems (0 to 7 points), some sleep problems (8 to 14 points), moderate sleep problems (15 to 21 points), severe sleep problems (22 to 28 points).

Measure: Insomnia Severity Index

Time: Change between baseline and end of treatment after seven weeks.

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Description: Screening for health impact and exposure of the coronavirus pandemic.

Measure: The CoRonavIruS Health Impact Survey

Time: At baseline

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Description: Assesses subjective distress caused by traumatic events. Items are rated on a 5-point scale ranging from 0 ("not at all") to 4 ("extremely"). The Impact of Event Scale-Revised yields a total score (ranging from 0 to 88).

Measure: Impact of Event Scale-Revised

Time: Change between baseline and end of treatment after seven weeks.

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Description: It is a measure of the degree to which situations in one's life are appraised as stressful. It contains 10 items that are scored on a range between 0 (never) to 4 (very often).

Measure: Perceived Stress Scale

Time: Change between baseline and end of treatment after seven weeks.

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Description: Same as during the treatment phase.

Measure: Becks Depression Inventory-II

Time: Change between posttreatment and 12-month follow-up.

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Description: Same as during the treatment phase.

Measure: Brunnsviken Brief Quality of Life Scale

Time: Change between posttreatment and 12-month follow-up.

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Primary Outcomes

Description: Less than or equal to 10 This scale is used to quantify the severity of symptoms of depression Scale range: 0-76 (total score) Lower scores indicate lower severity of depressive symptoms (i.e., better outcome) Higher scores indicate higher severity of depressive symptoms (i.e., worse outcome)

Measure: Proportion achieving remission on Hamilton Rating Scale for Depresion 24-it (HRSD-24)

Time: Up to 10 days (From screening/baseline to end of the acute treatment)

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Secondary Outcomes

Description: changes in scores This scale is used to quantify the severity of symptoms of depression Scale range: 0-76 (total score) Lower scores indicate lower severity of depressive symptoms (i.e., better outcome) Higher scores indicate higher severity of depressive symptoms (i.e., worse outcome)

Measure: Change in Hamilton Rating Scale for Depresion 24-it (HRSD-24)

Time: Up to 10 days (From screening/baseline to end of the acute treatment)

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Description: 50% Reduction in score This scale is used to quantify the severity of symptoms of depression Scale range: 0-76 (total score) Lower scores indicate lower severity of depressive symptoms (i.e., better outcome) Higher scores indicate higher severity of depressive symptoms (i.e., worse outcome)

Measure: Response on Hamilton Rating Scale for Depresion 24-it (HRSD-24)

Time: Up to 10 days (From screening/baseline to end of the acute treatment)

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Description: changes in scores This scale is used to quantify the severity of symptoms of mania Scale range: 0-60 (total score) Lower scores indicate lower severity of manic symptoms (i.e., better outcome) Higher scores indicate higher severity of manic symptoms (i.e., worse outcome)

Measure: Change in Young Mania Rating Scale (YMRS)

Time: Up to 10 days (From screening/baseline to end of the acute treatment)

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Description: Less than or equal to 4 This scale is used to quantify the severity of symptoms of depression Scale range: 0-27 (total score) Lower scores indicate lower severity of depressive symptoms (i.e., better outcome) Higher scores indicate higher severity of depressive symptoms (i.e., worse outcome)

Measure: Remission on Patient Health Questionnaire (PHQ-9)

Time: Up to 10 days (From screening/baseline to end of the acute treatment)

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Description: 50% Reduction in score This scale is used to quantify the severity of symptoms of depression Scale range: 0-27 (total score) Lower scores indicate lower severity of depressive symptoms (i.e., better outcome) Higher scores indicate higher severity of depressive symptoms (i.e., worse outcome)

Measure: Response on Patient Health Questionnaire (PHQ-9)

Time: Up to 10 days (From screening/baseline to end of the acute treatment)

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Description: changes in scores This scale is used to quantify the severity of symptoms of depression Scale range: 0-27 (total score) Lower scores indicate lower severity of depressive symptoms (i.e., better outcome) Higher scores indicate higher severity of depressive symptoms (i.e., worse outcome)

Measure: Change in Patient Health Questionnaire (PHQ-9)

Time: Up to 10 days (From screening/baseline to end of the acute treatment)

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Description: Less than or equal to 4 This scale is used to quantify the severity of symptoms of anxiety Scale range: 0-21 (total score) Lower scores indicate lower severity of anxiety symptoms (i.e., better outcome) Higher scores indicate higher severity of anxiety symptoms (i.e., worse outcome)

Measure: Remission on General Anxiety Disorder 7 item (GAD-7)

Time: Up to 10 days (From screening/baseline to end of the acute treatment)

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Description: 50% Reduction in score This scale is used to quantify the severity of symptoms of anxiety Scale range: 0-21 (total score) Lower scores indicate lower severity of anxiety symptoms (i.e., better outcome) Higher scores indicate higher severity of anxiety symptoms (i.e., worse outcome)

Measure: Response on General Anxiety Disorder 7 item (GAD-7)

Time: Up to 10 days (From screening/baseline to end of the acute treatment)

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Description: changes in scores This scale is used to quantify the severity of symptoms of anxiety Scale range: 0-21 (total score) Lower scores indicate lower severity of anxiety symptoms (i.e., better outcome) Higher scores indicate higher severity of anxiety symptoms (i.e., worse outcome)

Measure: Change in General Anxiety Disorder 7 item (GAD-7)

Time: Up to 10 days (From screening/baseline to end of the acute treatment)

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Description: Less than or equal to 12 This scale is used to quantify the severity of symptoms of depression Scale range: 0-63 (total score) Lower scores indicate lower severity of depressive symptoms (i.e., better outcome) Higher scores indicate higher severity of depressive symptoms (i.e., worse outcome)

Measure: Remission on Beck Depression Inventory (BDI-II)

Time: Up to 10 days (From screening/baseline to end of the acute treatment)

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Description: 50% Reduction in Score This scale is used to quantify the severity of symptoms of depression Scale range: 0-63 (total score) Lower scores indicate lower severity of depressive symptoms (i.e., better outcome) Higher scores indicate higher severity of depressive symptoms (i.e., worse outcome)

Measure: Response on Beck Depression Inventory (BDI-II)

Time: Up to 10 days (From screening/baseline to end of the acute treatment)

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Description: changes in scores This scale is used to quantify the severity of symptoms of depression Scale range: 0-63 (total score) Lower scores indicate lower severity of depressive symptoms (i.e., better outcome) Higher scores indicate higher severity of depressive symptoms (i.e., worse outcome)

Measure: Change on Beck Depression Inventory (BDI-II)

Time: Up to 10 days (From screening/baseline to end of the acute treatment)

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Description: Score of 0 This scale is used to assess the presence or absence of suicidal ideation and the degree of severity of suicidal ideas Scale range: 0 - 38 (total score) Lower scores indicate lower severity of suicidal ideation (i.e., better outcome) Higher scores indicate higher severity of suicidal ideation (i.e., worse outcome)

Measure: Remission on Beck Scale for Suicidal Ideation (SSI)

Time: Up to 10 days (From screening/baseline to end of the acute treatment)

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Description: changes in scores This scale is used to assess the presence or absence of suicidal ideation and the degree of severity of suicidal ideas Scale range: 0 - 38 (total score) Lower scores indicate lower severity of suicidal ideation (i.e., better outcome) Higher scores indicate higher severity of suicidal ideation (i.e., worse outcome)

Measure: Change on Beck Scale for Suicidal Ideation (SSI)

Time: Up to 10 days (From screening/baseline to end of the acute treatment)

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Description: changes in scores

Measure: Change in WHO Disability Assessment Schedule (WHODAS) Range 0-38

Time: Up to 10 days (From screening/baseline to end of the acute treatment)

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Description: Includes number of treatment days needed and number going on to receive ECT

Measure: Proportion of Patients Maintaining Response During Relapse Prevention

Time: 24 weeks (Tapering and Relapse prevention phase)

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Primary Outcomes

Description: Anxiety for relative of ICU patient will be measured by the Hospital Anxiety and depression scale (HADS) assessed 3 months after the ICU discharge of patient. HADS ranges from 0 to 42; higher scores indicate worse symptoms.

Measure: Anxiety

Time: at 3 months

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Description: Anxiety for relative of ICU patient will be measured by the Hospital Anxiety and depression scale (HADS) assessed 3 months after the ICU discharge of patient. HADS ranges from 0 to 42; higher scores indicate worse symptoms.

Measure: Depression

Time: at 3 months

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Secondary Outcomes

Description: Impact of post traumatic stress disorder for relative of ICU patient will be measured with the Event scale revised (IES-R) assessed 3 months after the ICU discharge of patient. IES-R ranges from 0 to 88; higher scores indicate worse symptoms

Measure: post-traumatic stress disorder

Time: at 3 months

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Primary Outcomes

Description: Prevalence of postpartum depression during the Covid-19 pandemic with EPDS scale (Edinburgh postnatal depression scale)

Measure: Correlation between the Covid-19 pandemic and postpartum depression with EPDS scale (Edinburgh postnatal depression scale)

Time: 40 days postpartum

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Secondary Outcomes

Description: Association between the Covid-19 pandemic, postpartum depression and type of anaesthesia (general, epidural, spinal, combined, epidural analgesia for vaginal delivery)

Measure: Correlation between the Covid-19 pandemic, postpartum depression and type of anaesthesia (general, epidural, spinal, combined, epidural analgesia for vaginal delivery)

Time: 10 minutes postpartum

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Description: Association between the Covid-19 pandemic, postpartum depression and postpartum pain assessed during postanesthesia care unit stay assessed by Numeric Pain Rating Scale (Scale 0-10 where 0 equals no pain and 10 maximum possible pain)

Measure: Correlation between the Covid-19 pandemic, postpartum depression and postpartum pain

Time: 2 minutes prior to discharge from the Postanaesthesia care unit

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Description: Association between the Covid-19 pandemic, postpartum depression and postpartum pain assessed during postanesthesia care unit stay assessed by Numeric Pain Rating Scale (Scale 0-10 where 0 equals no pain and 10 maximum possible pain)

Measure: Correlation between the Covid-19 pandemic, postpartum depression and postpartum pain

Time: 2 minutes after admission to the Postanaesthesia care unit

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Primary Outcomes

Description: • The Patient Health Questionnaire 9 (PHQ-9; Kroenke, Spitzer & Williams, 2001) is used to measure symptoms of depression in accordance with the diagnostic criteria for major depressive disorder. The questionnaire consists of nine items where each is scored on a four-point Likert scale (0-3), with the range of scores from 0 to 27. Higher scores indicate greater depression severity, and scores above 10 are considered as the cut-off that indicating that the patient is within the depressive area.

Measure: Patient Health Questionnaire 9

Time: Data is set to be collected starting from 22nd of June until enough data has been collected.The data collection period will last no longer than three weeks.

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Description: • The Generalized Anxiety Disorder 7 (GAD-7; Spitzer, Kroenke, Williams & Löwe, 2006) is a questionnaire consisting of seven items measuring symptoms of anxiety and worry. The items are scored on a four-point Likert scale (0-3), with the scores ranging from 0 to 21. Specific cut-off for Norwegian samples have been found yielding a cut-off of 8 and above for high sensitivity and specificity (Johnson, Ulvenes, Øktedalen & Hoffart, 2019).

Measure: Generalized Anxiety Disorder 7

Time: Data is set to be collected starting from 22nd of June until enough data has been collected.The data collection period will last no longer than three weeks.

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Primary Outcomes

Description: The Patient Health Questionnaire 9 (PHQ-9; Kroenke, Spitzer & Williams, 2001) is used to measure symptoms of depression in accordance with the diagnostic criteria for major depressive disorder. The questionnaire consists of nine items where each is scored on a four-point Likert scale (0-3), with the range of scores from 0 to 27. Higher scores indicate greater depression severity, and scores above 10 are considered as the cut-off that indicating that the patient is within the depressive area.

Measure: Patient Health Questionnaire 9 (PHQ-9)

Time: Data is set to be collected starting from 22th of June. The data collection period will last no longer than three weeks depending on the response to the questionnaire

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Description: The Generalized Anxiety Disorder 7 (GAD-7; Spitzer, Kroenke, Williams & Löwe, 2006) is a questionnaire consisting of seven items measuring symptoms of anxiety and worry. The items are scored on a four-point Likert scale (0-3), with the scores ranging from 0 to 21. Specific cut-off for Norwegian samples have been found yielding a cut-off of 8 and above for high sensitivity and specificity (Johnson, Ulvenes, Øktedalen & Hoffart, 2019). The Generalized Anxiety Disorder 7 (GAD-7; Spitzer, Kroenke, Williams & Löwe, 2006) is a questionnaire consisting of seven items measuring symptoms of anxiety and worry. The items are scored on a four-point Likert scale (0-3), with the scores ranging from 0 to 21. Specific cut-off for Norwegian samples have been found yielding a cut-off of 8 and above for high sensitivity and specificity (Johnson, Ulvenes, Øktedalen & Hoffart, 2019).

Measure: The Generalized Anxiety Disorder - 7

Time: Data is set to be collected starting from 22th of June. The data collection period will last no longer than three weeks depending on the response to the questionnaire

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Description: 6 items from DERS (Gratz & Roemer, 2004)

Measure: Difficulties in Emotion Regulation Scale

Time: Data is set to be collected starting from 22th of June. The data collection period will last no longer than three weeks depending on the response to the questionnaire

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Description: 17 Items from IIP-64 (Horowitz et al. 2000)

Measure: Interpersonal problems

Time: Data is set to be collected starting from 22th of June. The data collection period will last no longer than three weeks depending on the response to the questionnaire

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Primary Outcomes

Description: The Danish Parental Stress Scale is developed as a short measure of parental stress consisting of nine items. Three items from this scale were chosen by a panel of clinical experts, with the aim of avoiding topological overlap: 1) I feel overwhelmed by the responsibility of being a parent, 2) The major source of stress in my life is my child(ren), and 3) It is difficult to balance different responsibilities because of my child(ren).

Measure: Parental stress

Time: Data is set to be collected starting from 22th of June. The data collection period will last no longer than three weeks depending on the response to the questionnaire

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Primary Outcomes

Description: • The Patient Health Questionnaire 9 (PHQ-9; Kroenke, Spitzer & Williams, 2001) is used to measure symptoms of depression in accordance with the diagnostic criteria for major depressive disorder. The questionnaire consists of nine items where each is scored on a four-point Likert scale (0-3), with the range of scores from 0 to 27. Higher scores indicate greater depression severity, and scores above 10 are considered as the cut-off that indicating that the patient is within the depressive area.

Measure: Patient Health Questionnaire 9

Time: Data is set to be collected starting from 22th of June. The data collection period will last no longer than three weeks depending on the response to the questionnaire

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Description: The Generalized Anxiety Disorder 7 (GAD-7; Spitzer, Kroenke, Williams & Löwe, 2006) is a questionnaire consisting of seven items measuring symptoms of anxiety and worry. The items are scored on a four-point Likert scale (0-3), with the scores ranging from 0 to 21. Specific cut-off for Norwegian samples have been found yielding a cut-off of 8 and above for high sensitivity and specificity (Johnson, Ulvenes, Øktedalen & Hoffart, 2019).

Measure: Generalized Anxiety Disorder 7

Time: Data is set to be collected starting from 22th of June. The data collection period will last no longer than three weeks depending on the response to the questionnaire

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Description: • Symptoms of health anxiety will be measured measured with two items from the validated Health Anxiety Inventory (HAI; Salkovskis et al., 2002), one item measuring specific fear of being infected by coronavirus, and an item measuring fear of dying by the coronavirus on a four-point Likert scale (0-3).

Measure: Health Anxiety Symptoms

Time: Data is set to be collected starting from 22th of June. The data collection period will last no longer than three weeks depending on the response to the questionnaire

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Primary Outcomes

Description: Total score of Beck Depression Inventory (Minimin score: 0, Maximum score: 63; higher scores mean worse outcome)

Measure: Score of Beck Depression Inventory

Time: through study completion, an average of 6 months

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Primary Outcomes

Description: The Patient Health Questionnaire-9 (PHQ-9; Kroenke, Spitzer, & Williams, 2001) consists of nine items covering the DSM-IV criteria for major depression scored on a four-point 0 (not at all) to 3 (almost every day) scale, with total scores ranging from 0 to 27. The PHQ-9 has revealed good psychometric properties, as demonstrated by Kroenke, Spitzer, and Williams (2001).

Measure: Patient Health Questionnaire-9 (PHQ-9)

Time: From 22nd of June to 13th of July

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Description: The Cognitive Attentional Syndrome-1 (CAS-1; Wells, 2009) measures maladaptive mental and behavioral coping with thoughts and feelings (8 items, 0-8 scales) and negative and positive metacognitions (8 items, 0-100 scales). The CAS-1 has proved to have satisfactory psychometric properties (Nordahl & Wells, 2019).

Measure: Cognitive-Attentional Syndrome-1 (CAS-1)

Time: From 22nd of June to 13th of July

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Primary Outcomes

Description: Self-reported symptoms with the Depression, Anxiety and Stress Scale (DASS-21), which have 21 items, each scoring between 0 and 3, the minimum score is 0 and the maximum score of 63. The cut-off score for the depression subscale is 6, Anxiety is 5, Stress is 6.

Measure: Depression, Anxiety and Stress Scale (DASS-21)

Time: Up to 4 weeks

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Description: The Columbia-Suicide Severity Rating Scale (C-SSRS) is a questionnaire used for suicide assessment. This scale has 6 items and each item has to be answered Yes or No. The total score is 6. A score of 0 is no ideation is present.

Measure: Columbia-Suicide Severity Rating Scale (C-SSRS)

Time: Up to 4 weeks

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Description: Self-report of harmful alcohol drinking. 4 items. CAGE stands for: C: Have you felt the need to Cut down drinking? A: Have you ever felt Annoyed by criticism of drinking? G: Have you had Guilty feelings about drinking? E: Do you ever take a morning Eye opener (a drink first thing in the morning to steady your nerves or get rid of a hangover)? The range score goes from 0 to 4. The point cut off is >= 2.

Measure: CAGE

Time: Up to 4 weeks

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Description: Adaptation of The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) interview model, including prescription and nonprescription drugs and vaping. It has 8 items exploring the frequency of substance use in the last 3 months (daily, weekly, yearly) and the problems associated with the use. It explores the use of 10 kinds of drugs.

Measure: Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)

Time: Up to 4 weeks

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Secondary Outcomes

Description: Ad hoc self-report survey: Current age University enrollment year Current years of study Sex Gender Civil status Parenting and number of child(s) Nationality Etnicity Ocupational situation: only study, part-time worker, fulltime worker and study Carrer Maximum parents studies degree: analphabet, school, undergraduate, postgraduate; complete or incomplete studies. Payment of studies: credit, schollarship, self-pay Travel time from home to campus: minutes, hours.

Measure: Sociodemographic characteristics

Time: Up to 4 weeks

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Description: Self-perception on a subjective analogous scale of physical health

Measure: General Health perception

Time: Up to 4 weeks

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Description: Self-perception on a subjective analogous scale of mental health

Measure: General Menta Health perception

Time: Up to 4 weeks

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Description: Ad hoc self-report survey of any previous chronic physical disease

Measure: History of chronic diseases

Time: Up to 4 weeks

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Description: Ad hoc self-report survey of minutes of physical activity during the past week

Measure: Physical activity

Time: Up to 4 weeks

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Description: Ad hoc self-report survey of time spent with friends or social gatherings

Measure: Social activities

Time: Up to 4 weeks

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Description: Family functionality APGAR score: a 5-item measure of perceived family support in the domains of adaptation, partnership, growth, affection, and resolve. E.g. "I find that my family accepts my wishes to take on new activities or make changes in my lifestyle". Scores range from 0 to 10, being 10 a total satisfaction with family functionality.

Measure: Family functionality (APGAR)

Time: Up to 4 weeks

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Description: Ad hoc self-report questionnaire of personal and family mental health history: Previous diagnosis of depression, bipolar disorder, panic attacks, anxiety disorders, eating disorders, ADHD. Current psychotherapy of psychiatric medication Family history of psychiatric disorders

Measure: History of personal and family mental health problems

Time: Up to 4 weeks

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Description: Self-report of insomnia perception. it has 7 items, and responses can range from 0 to 4, where higher scores indicate more acute symptoms of insomnia. Scores ranges from 0 to 28. A clinical Insomnia threshold score of 15.

Measure: Insomnia Severity Index (ISI)

Time: Up to 4 weeks

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Description: Ad hoc self-report survey of violence suffered from teachers, administrative, auxiliaries, and other students; discrimination and bullying.

Measure: University violence and bullying

Time: Up to 4 weeks

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Description: Ad hoc self-report survey of sexual health, including sexual orientation, the current status of an emotional relationship, number of sex partners in the last year, history of Sexually Transmitted Disease (STD).

Measure: Sexuality and sexual health

Time: Up to 4 weeks

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Description: Sense of Social and Academic Fit (SSAF) is a self-report questionnaire of 17 items, with responses on a Likert format from 1-7. It measures academic and social sense of belonging. The score is produced as the average of the scores reported in each item. The minimum score is 1 and the maximum score is 17. A higher score means higher sense of belonging.

Measure: Sense of Social and Academic Fit (SSAF)

Time: Up to 4 weeks

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Description: Ad-hoc self-report survey of current perception and possible diagnosis of COVID-19: Fear or preoccupation about getting COVID-19 Sense of severity if diagnosed with COVID-19 Fear or preoccupation about a family member or friend to get COVID-19 Current diagnosis of COVID-19 A family member diagnosed with COVID19 Sense of compliance with social isolation and quarantine Persons living with (family, friends, alone) Frequency of: going out of home, gather with others, virtual socialization, keeping a routine, exercise realized, recreative activities, meditation or prayer, seek information about the situation of COVID19 Frequency of the following symptoms: nervousness, hopelessness, depression, amount of effort required to realize activities, self-value, anhedonia.

Measure: COVID-19 questions

Time: Up to 4 weeks

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Primary Outcomes

Description: The State/Trait Anxiety Inventory consists of two subscales of 20 items each that measure anxiety as a transient state of tension (Scale A-State), and as a characteristic of the personality relatively stable over time (Scale B -trait). The items are composed by an assertion to which the subject responds indicating their degree of identification. In the case of state anxiety, the scale goes from 1 (not at all), 2 (somewhat), 3 (moderately), 4 (very much), while in the trait anxiety it ranges from 1 (almost never), 2 (sometimes), 3 (often), 4 (almost always). In both, a percentage of the items evaluate well-being or absence of anxiety, while the rest of the items to the presence of anxiety. Scores range from 20 to 80, in each subscale, with higher scores correlating with greater anxiety. It is expected a statistically significant decrease (P < 0.05) in the anxiety symptoms.

Measure: Decrease in the score of Anxiety symptoms

Time: [Time Frame: 2 weeks to one month, depending on the development of the patient and the completion of the 15 modules.]

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Description: The Beck Depression Inventory is a self-report that provides a measure of the presence and severity of depression. Contains 21 items indicative of symptoms such as sadness, crying, loss of pleasure, feelings of failure and guilt, suicidal thoughts or desires, pessimism, etc. Each item is answered on a 4-point scale, from 0 to 3, where each number is identified differently for each item, in all of them 0 means absence and 3 full presence (e.g. sadness), except for items 16 (changes in the sleep pattern) and 18 (changes in appetite) that contain 7 categories. The minimum and maximum scores in the test are 0 and 63. Cut-off points ha that allow classifying those evaluated in one of the following four groups: 0-13, minimum depression; 14-19, mild depression; 20-28, moderate depression; and 29-63, severe depression. It is expected a statistically significant decrease (P < 0.05) in the depression symptoms.

Measure: Change in the symptoms of depression

Time: [Time Frame: 2 weeks to one month, depending on the development of the patient and the completion of the 15 modules.]

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Description: On the Generalized Anxiety Disorder 7-item (GAD-7) scale subjects are asked how often, during the last 2 weeks, they have been bothered by each of the 7 core symptoms of generalized anxiety disorder. Response options are "not at all," "several days," "more than half the days," and "nearly every day," scored as 0, 1, 2, and 3, respectively. Therefore, GAD-7 scores range from 0 to 21, with scores of ≥5, ≥10, and ≥15 represent mild, moderate, and severe anxiety symptom levels, respectively. It is expected a statistically significant decrease (P < 0.05) in the General Anxiety symptoms.

Measure: Change in the symptoms of General Anxiety Disorder

Time: [Time Frame: 2 weeks to one month, depending on the development of the patient and the completion of the 15 modules.]

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Description: The Scale of Post-traumatic Stress Traits in the Mexican Youth Exposed to Social Violence It is a brief scale with 24 symptoms corresponding to the diagnosis of PTSD, to respond by self-report, and a scale was used discretely from 1 (strongly disagree) to 4 (strongly agree). The total score was obtained by arithmetic sum. The minimum possible is 24 and the maximum 96. It is expected a statistically significant decrease (P < 0.05) in the posttraumatic stress symptoms.

Measure: Change in the score of Posttraumatic stress symptoms

Time: [Time Frame: 2 weeks to one month, depending on the development of the patient and the completion of the 15 modules.]

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Description: It is composed of seven items with options of 0 = nothing, 3 = a lot, and measures the fear in its emotional component, that is, the fear to adversities in the context and the feelings it disseminates, as well as others economic and social fears, in this case, adapted for the Sars-Cov2 pandemic. In previous studies, an acceptable internal consistency of .95 was reached. It consists of several items about the fear of being a SARS Cov2 victim in diverse contexts. In the present study, a Cronbach alpha coefficient of 0.96 was obtained. It is expected a statistically significant decrease (P < 0.05) in the widespread fear symptoms.

Measure: Changes in the Widespread fear Scale

Time: [Time Frame: 2 weeks to one month, depending on the development of the patient and the completion of the 15 modules.]

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Description: This instrument assesses the quality patterns of sleep. It differentiates the "poor" and "good" sleep by measuring seven areas, where the range score of answers are from 0 to 3, the global sum of this scale can be a value between 0 to 60, and the cutoff point is "5" that indicates a "poor" sleep quality. It is expected a statistically significant increase (P < 0.05) in the Sleep Quality Index.

Measure: Change in the score of The Pittsburgh Sleep Quality Index.

Time: [Time Frame: 2 weeks to one month, depending on the development of the patient and the completion of the 15 modules.]

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Secondary Outcomes

Description: This scale aims to assess the frequency of attitudes, behaviors and plans to commit suicide. It is divided into 19 items with a response option of 0 to 2, giving a total of 0 to 38 where a score equal to or greater than 10 indicates an existing risk of suicide. This scale has been validated in the Mexican population (González-Macip & Díaz-Martínez, 2000).

Measure: Change on the Suicidal Thoughts Scale

Time: [Time Frame: 2 weeks to one month, depending on the development of the patient and the completion of the 15 modules.]

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Primary Outcomes

Description: Patient Health Questionnaire 9 item (PHQ-9). The PHQ-9 has scores from 0 to 27. Higher scores mean a worse outcome.

Measure: Depression scores

Time: Change from baseline to 8 week follow-up

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Description: General Anxiety Disorder 7 item (GAD-7). The GAD-7 has scores from 0 to 21. Higher scores mean a worse outcome.

Measure: Anxiety scores

Time: Change from baseline to 8 week follow-up

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Secondary Outcomes

Description: The self-reported mood rating 3 hours after receiving a message. The score is from 0-9. A higher mood rating indicates a better outcome.

Measure: Self reported mood ratings

Time: 8 weeks

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Primary Outcomes

Description: The Depression, Anxiety and Stress Scale - 21 Items (DASS-21) - Scale: 0-3 (0 = never, 3 = frequently)

Measure: Change in Stress

Time: Baseline, week 6, week 12

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Description: 14 Item Resilience Scale (RS-14) - Scale: 1-7 (1 = strongly disagree, 7 = strongly agree)

Measure: Change in Resilience

Time: Baseline, week 6, week 12

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Description: The Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) - Scale: 1-5 (1 = very poor, 5 = very good)

Measure: Change in Quality of Life Assessment

Time: Baseline, week 6, week 12

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Description: Generalized Anxiety Disorder 7 (GAD-7) - Scale: 0-3 (0 = not at all, 3 = nearly every day)

Measure: Change in Symptom Severity - 1

Time: Baseline, week 6, week 12

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Description: Montgomery-Asberg Depression Rating Scale (MADRS) - Scale: 0-6 (0 = not at all, 6 = frequent/very much)

Measure: Change in Symptom Severity - 2

Time: Baseline, week 6, week 12

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Description: Patient Health Questionnaire 9 (PHQ-9) - Scale: 0-3 (0 = not at all, 3 = nearly every day)

Measure: Change in Symptom Severity - 3

Time: Baseline, week 6, week 12

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Secondary Outcomes

Description: Healthcare providers who administered the e-psychotherapy for duration of project will be asked through focus groups questions surrounding the feasibility of providing the e-psychotherapy, how it compared to in-person psychotherapy with respect to time commitment, feelings of 'connectedness' to participant, and any perceived benefits/drawbacks to e-psychotherapy.

Measure: Qualitative Information: Healthcare Providers

Time: Week 12

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Description: In focus groups, participants will be asked questions regarding personal, social, and cultural factors (gender, sexuality, background, supportive resources, structural/social barriers, etc.) that could impact participant experience with e-psychotherapy. This will be extracted using an Interpretive Phenomenological Analysis (IPA) approach.

Measure: Qualitative Information: Personal, social, and cultural factors

Time: Week 12

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Primary Outcomes

Description: The gold standard measure of PPD in clinical practice/research. A change of 4 points is recognized as a clinically meaningful/significant improvement.

Measure: Edinburgh Postnatal Depression Scale (EPDS)

Time: Differences between experimental and control groups from T1 (baseline) to T2 (12 weeks) will be compared.

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Secondary Outcomes

Description: Healthcare resource utilization data will be collected using a questionnaire based on the Canadian Community Health Survey and the Service Use and Resources Form adapted for the postpartum period and used in previous PPD research. Costs will be calculated using provincial or other standard billing rates.

Measure: Cost-effectiveness: Costs of service

Time: Resources consumed over the 12-week trial period from the perspective of public healthcare payer will be measured.

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Description: The EQ-5D-5L, a utility-based health-related quality of life instrument will be used. Its validity in measuring the impact of depression is established. Its Canadian scoring algorithm will be used. For each participant, a QALY will be calculated by multiplying the health utility for the matching time period (i.e., the area under the curve approach).

Measure: Cost-effectiveness: Quality-Adjusted Life Year (QALY)

Time: QALYs will be measured over the 12-week trial period.

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Other Outcomes

Description: A 7-item self-report scale of symptoms of generalized anxiety disorder, the most common PPD comorbidity.

Measure: Generalized Anxiety Disorder-7 (GAD-7)

Time: 12 weeks

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Description: 25-item maternal-report scale of mother-infant attachment.

Measure: Postpartum Bonding Questionnaire

Time: 12 weeks

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Description: The SPS is a 24-item self-report measures of the degree to which an individual's social relationships provide support.

Measure: Social Provisions Scale

Time: 12 weeks

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Description: A 37-item meausure of infant behavior and temperament.

Measure: Infant Behavior Questionnaire - Revised (Very Short Form)

Time: 12 weeks

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Description: Differences between experimental and control groups from T1 (baseline) to T2 (12 weeks) will be compared.

Measure: Beck Depression Inventory-II (BDI-II)

Time: 12 weeks

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Primary Outcomes

Description: Variation of prevalence of clinically-significant post-partum depressive symptoms

Measure: Variation of prevalence of clinically-significant post-partum depressive symptoms

Time: up to 35 days after delivery

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Primary Outcomes

Description: Beck Scale for Suicide Ideation is a 21-item self-report scale that quantifies suicidal ideation. Items are scored 0 to 2 and yield a total score ranging from 0 to 38. Higher scores reflect greater severity of suicidal ideation.

Measure: Change in suicidal ideation using Beck Scale for Suicide Ideation

Time: From baseline to 3 months; also administered at screening, 1 week and 1 month

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Secondary Outcomes

Description: The QIDS-SR is a 16-item validated self-report depression scale. Total scores range from 0 (none) to 27 (very severe).

Measure: Change in depression symptoms using the Quick Inventory of Depressive Symptoms self-report scale (QIDS-SR)

Time: From baseline to 3 months; also administered at 1 week and 1 month

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Description: The GAD-7 is a brief 7-item self-report scale measuring anxiety symptoms. Total scores range from 0 to 21, with higher scores reflecting more severe anxiety.

Measure: Change in anxiety symptoms using the Generalized Anxiety Disorder 7-item scale (GAD-7)

Time: From baseline to 3 months; also administered at 1 week and 1 month

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Description: The ACSS is a 20-item self-report instrument to assess the construct of acquired capability. Total scores range from 0 to 80, with higher scores reflecting greater acquired capability.

Measure: Change in Acquired Capability of Suicide Scale (ACSS)

Time: From baseline to 3 months; also administered at 1 week and 1 month

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Description: The Interpersonal Needs Questionnaire is a 15-item self-report scale assessing connectedness to others and burdensomeness. Items are rated 1 to 7, with total scores ranging from 15 to 105. Higher scores reflect worse outcomes.

Measure: Change in Interpersonal Needs Questionnaire score

Time: From baseline to 3 months; also administered at 1 week and 1 month

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Description: The DARS is a 26-item self-report scale measuring anhedonia across four domains. Items are scored on a 5-point Likert scale with lower total scores reflecting more severe anhedonia.

Measure: Change in Dimensional Anhedonia Rating Scale (DARS) score

Time: From baseline to 3 months; also administered at 1 week and 1 month

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Description: The SDS is a brief 3-item self-report scale that probes work/school, social, and family/home functioning. Each item is scored from 0 to 10. Total scores range from 0 (unimpaired) to 30 (highly impaired).

Measure: Change in Sheehan Disability Scale (SDS) score

Time: From baseline to 3 months; also administered at 1 month

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Description: Use of healthcare services will be assessed through four questions enquiring about the frequency and description of health care professional visits, use of mental health services, hospital admissions, and emergency room visits in the preceding specified time frame (1-3 months).

Measure: Change in Treatment Utilization

Time: From screening to 3 months; also administered at 1 month

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Other Outcomes

Description: Feasibility and Acceptability survey and interview created in-house with questions designed to collect quantitative and qualitative feedback from participants with respect to the feasibility and acceptability of the Brief-SfSL intervention.

Measure: Participant feedback on their experiences with specific aspects of the Brief-SfSL intervention

Time: 3 months

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Primary Outcomes

Description: using the Depression Anxiety Stress Scale -21. Scores for individual question range from 0 (Did not apply to me at all) to 3 (Applied to me very much or most of the time). A high score means a higher level of stress symptoms. Minimum score is 0. Maximum score is 21.

Measure: Change in stress symptoms

Time: Change from recruitment to 4 weeks after

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Description: using the Depression Anxiety Stress Scale -21. Scores for individual question range from 0 (Did not apply to me at all) to 3 (Applied to me very much or most of the time). Minimum score is 0. Maximum score is 21. And using the Pregnancy Related Anxiety Scale. Scores for individual question range from 1 (Not at all) to 5 (Very much). Minimum score is 10. Maximum score is 50. A high score in both scales means a high level of anxiety symptoms.

Measure: Change in anxiety symptoms

Time: Change from recruitment to 4 weeks after

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Description: using the Depression Anxiety Stress Scale -21. Scores for individual question range from 0 (Did not apply to me at all) to 3 (Applied to me very much or most of the time). A high score means a higher level of depression symptoms. Minimum score is 0. Maximum score is 21.

Measure: Change in depression symptoms

Time: Change from recruitment to 4 weeks after

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Description: using the Mindfulness Attention Awareness Scale. Scores for individual question range from 1 (Almost Never) to 6 (Almost Always). Minimum score is 15. Maximum score is 90. And using Toronto Mindfulness Scale. Scores for individual question range from 0 (Not at all) to 4 (Very much). This scale has 2 subscales. Minimum score is 0. Maximum score is 24 for the first subscale and 28 for the second subscale. A high score in both scales (and subscales)means a high mindful awareness level.

Measure: Change in mindful awareness

Time: Change from recruitment to 4 weeks after

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Secondary Outcomes

Description: Duration of mindfulness practice

Measure: Mindfulness practice

Time: 4 weeks

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Description: Gestational age of the newborn (in weeks and days) at the time of delivery

Measure: Gestational age

Time: variable (less than 20 weeks from recruitment)

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Primary Outcomes

Description: The Patient Health Questionnaire 9 (PHQ-9; Kroenke, Spitzer & Williams, 2001) is used to measure symptoms of depression in accordance with the diagnostic criteria for major depressive disorder. The questionnaire consists of nine items scored on a four-point Likert scale (0-3), with the range of scores from 0 to 27. Higher scores indicate greater depression severity, and scores above 10 are considered as the cut-off that indicating that the patient is within the depressive area. Specific cut-off for primary care samples in Chile have been found yielding a cut-off of 7 and above for high sensitivity and specificity (Saldivia, Aslan, Cova, Vicente, Inostroza & Rincón, 2019)

Measure: Depressive symptoms

Time: Month 1 (first follow-up) and month 6 (second follow-up)

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Description: The Generalized Anxiety Disorder 7 (GAD-7; Spitzer, Kroenke, Williams & Löwe, 2006) is used to measure symptoms of anxiety and worry. The questionnaire consists of seven items scored on a four-point Likert scale (0-3), with the scores ranging from 0 to 21. Specific cut-off for primary care samples in Spain have been found yielding a cut-off of 10 and above for high sensitivity and specificity (García-Campayo et al, 2010).

Measure: Symptoms of anxiety

Time: Month 1 (first follow-up) and month 6 (second follow-up)

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Description: The Impact of Events Scale (IES-R; Weiss & Marmar, 1997) is used to measure symptoms of post-traumatic stress disorder (PTSD). There scale consists of 22 questions which are scored on a five-point Likert scale (0=not at all, 1=a little bit, 2=moderately, 3=quite a bit, 4=extremely). There are three subscales (i.e., avoidance, intrusion, hyperarousal) and the sum of the three subscales scores comprise the total score. A total score ≥33 indicates the likely presence of PTSD using criteria from the Diagnostic Symptom Manual (DSM-IV).

Measure: Symptoms of post-traumatic stress disorder

Time: Month 1 (first follow-up) and month 6 (second follow-up)

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Description: Change in visual analogue scale-assessed transdiagnostic measures across all psychiatric symptoms, and World Health Organization (WHO)-5 well-being in the last 2 weeks compared to the last 2 weeks of "regular life" before the COVID-19 outbreak.

Measure: Change in mental health symptoms, well-being from last 2 weeks before the pandemic to last 2 weeks during COVID-19 pandemic

Time: Change from last 2 weeks before pandemic to month 1 (first follow-up)

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Secondary Outcomes

Description: Three-Item Revised UCLA Loneliness Scale

Measure: Loneliness

Time: Month 1 (first follow-up) and month 6 (second follow-up)

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Description: Change in general physical health, self-rated, on a VAS scale from 0 to 100

Measure: Change in general physical health

Time: Change from last 2 weeks before pandemic to month 1 (first follow-up)

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Description: Change in general mental, self-rated, on a VAS scale from 0 to 100

Measure: Change in general mental health

Time: Change from last 2 weeks before pandemic to month 1 (first follow-up)

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Primary Outcomes

Description: The study aims to evaluate changes in perceived levels of stress in survey participants and the effect yoga or reading a book has over them. We use a validated scale for this purpose named, Perceived Stress Scale. The scale measures the degree to which situations in participant's life are appraised as stressful. This is the primary outcome for our study. We assess for change in perceived stress levels by analyzing the PSS score for each participant and comparing it to pre & post intervention results.

Measure: Change in Perceived Stress Levels

Time: Baseline, 6 weeks and 12 weeks.

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Secondary Outcomes

Description: The study aims to evaluate changes in resilience levels in survey participants and the effect yoga or reading a book has over them. We use a validated scale for this purpose named, Brief Resilience Scale. The scale identifies the individual's ability to bounce back or recover from a stress. This is the key secondary outcome for our study. We assess for change in resilience levels by analyzing the 6-item BRS, which computes a score for each participant by dividing total score obtained/number of questions responded; (range 6-30) and comparing it to pre & post intervention results.

Measure: Changes in Resilience Levels

Time: Baseline, 6 weeks and 12 weeks

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Description: The study aims to evaluate changes in Covid-19 prevalence in survey participants and the effect yoga or reading a book has over them. Based on the reported number of cases in the participant cohort we compute Period Prevalence for 3 specified time points. We assess for change in reported prevalence and stratify the results to match with region-wise prevalence.

Measure: Changes in Covid-19 Prevalence

Time: Baseline, 6 weeks and 12 weeks

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Description: The study aims to evaluate changes in self-reported duration of fever and respiratory symptoms in Covid-19 positive survey participants and the effect yoga or reading a book has over them. Based on the reported number of positive cases in the participant cohort we compare the frequency of duration between the two cohorts i.e. yoga practitioners and control; followed by a comparison between the two control groups viz: yoga group vs idle group.

Measure: Changes in self-reported duration of fever and respiratory symptoms in COVID-19 positive participants

Time: Baseline, 6 weeks and 12 weeks

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Description: The study aims to evaluate changes in self-reported readiness to return to work in Covid-19 positive survey participants and the effect yoga or reading a book has over them. Based on the reported number of positive cases in the participant cohort we compare the frequency of readiness between the two cohorts i.e. yoga practitioners and control; followed by a comparison between the two control groups viz: yoga group vs idle group.

Measure: Changes in self-reported readiness to return to work in COVID-19 positive participants

Time: Baseline, 6 weeks and 12 weeks

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Other Outcomes

Description: We assessed for change in Mindfulness levels in all participants by using a short form of the validated scale for this purpose namely, Mindfulness Attention Awareness Scale (MAAS). The scale measures the individuals' ability for receptive awareness and attention to present. We compute the MAAS scores for each participant which is a mean score for 5 item questionnaires and compare the pre & post intervention results to look for change.

Measure: Changes in Mindfulness

Time: Baseline, 6 weeks and 12 weeks

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Description: We assess for change in the individuals' ability to feel joy and look for it in the mundane by using a validated scale for this purpose namely, Dispositional Positive Emotions Scale (DPES) particularly the Joy subscale. The Sub-scale measures the individuals' dispositional ability to feel joy in life. We compute the DPES-JOY subscale scores for each participant which is a mean score for 6 item questionnaires and compare the pre & post intervention results to look for change.

Measure: Changes in Dispositional Positive Emotions Scale (DPES- Joy subscale)

Time: Baseline, 6 weeks and 12 weeks

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Description: The study aims to evaluate changes in anxiety and depression levels in survey participants and the effect yoga or reading a book has over them. We use a validated scale for this purpose named, 4 Item-Patient Health Questionnaire measuring Anxiety and Depression (PHQ-4) Scale. The 4 question scale screens for anxiety and depression in participants by computing sum for the responses (scores range: 0-12) and comparing it to pre & post intervention results.

Measure: Changes in 4 Item-Patient Health Questionnaire measuring Anxiety and Depression (PHQ-4) levels

Time: Baseline, 6 weeks and 12 weeks

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Description: The study aims to evaluate changes in wellbeing levels in survey participants and the effect yoga or reading a book has over them. We use a validated scale for this purpose named, Warwick- Edinburgh Wellbeing Scale (WEMWBS). The scale identifies the individual's aspects of mental health such as: positive affect, satisfying interpersonal relationship and positive functioning. We assess for change in 14 item well-being levels by analyzing the total WEMWBS score for each participant and comparing it to pre & post intervention results.

Measure: Changes in well being levels

Time: Baseline, 6 weeks and 12 weeks

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Description: The purpose of the growth inventory is to capture the positive outcomes reported by a person who have experienced a traumatic event. This scale collects information from only those participants who identify as being hospitalized during the COVID-19 pandemic and look for their coping ability to the aftermath of the trauma. This 21 item scale is rated on a 6-point Likert response scale. Response from each of the 6 question is then summed to create a total PTGI score.

Measure: Changes in Post Traumatic Growth Inventory (PTGI) scores

Time: Baseline, 6 weeks and 12 weeks

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Primary Outcomes

Description: The Depression, Anxiety and Stress Scale - 21 Items (DASS-21) is a set of three self-report scales designed to measure the emotional states of depression, anxiety and stress.

Measure: Depression, Anxiety and Stress Scales 21 Score

Time: 5 months

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Description: The Insomnia Severity Index (ISI) is a brief instrument that was designed to assess the severity of both nighttime and daytime components of insomnia.

Measure: Insomnia severity index score

Time: 5 months

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Primary Outcomes

Description: MADRS-S is a nine-item questionnaire used to measure severity of depression. The score ranges from 0-54.

Measure: Change from baseline in depressive symptoms using the Montgomery-Asberg Depression Rating Scale, MADRS-S

Time: Baseline; Intervention Week 1; Intervention Week 2; Intervention Week 3; Intervention Week 4; 1 month post-intervention; 3 months post-intervention; 6 months post-intervention.

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Secondary Outcomes

Description: GDS-15 is a 15-item questionnaire used to identify depression in the elderly. The score ranges from 0-15.

Measure: Change from baseline in depressive symptoms using the Geriatric Depression Rating Scale 15, GDS-15

Time: Baseline; Intervention Week 4; 1 month post-intervention; 3 months post-intervention; 6 months post-intervention.

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Description: PHQ-9 is a nine-item questionnaire used to identify depression as well as measuring severity of depression. The score ranges from 0-27.

Measure: Change from baseline in depressive symptoms using the Patient Health Questionnaire 9, PHQ-9

Time: Baseline; Intervention Week 4; 1 month post-intervention; 3 months post-intervention; 6 months post-intervention.

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Description: MINI is a structured clinical interview used to assess the presence/absence of common psychiatric disorders.

Measure: Change in depression diagnosis assessed using the Mini International Neuropsychiatric Interview, MINI

Time: Baseline; Intervention Week 4.

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Description: GAD-7 is a seven-item questionnaire used to identify generalized anxiety disorder as well as measuring severity of anxiety symptoms. The score ranges from 0-21.

Measure: Change from baseline in anxiety symptoms using the Generalized Anxiety Disorder 7-item, GAD-7

Time: Baseline; Intervention Week 4; 1 month post-intervention; 3 months post-intervention; 6 months post-intervention.

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Description: BADS-SF is a nine-item questionnaire used to measure changes in avoidance and activation. The score ranges from 0-54.

Measure: Change from baseline in behavioral activation using The Behavioral Activation for Depression Scale - Short Form, BADS-SF

Time: Baseline; Intervention Week 4; 1 month post-intervention; 3 months post-intervention; 6 months post-intervention.

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Description: WHODAS-12 is a 12-item questionnaire used to assess disability due to health conditions. The total score ranges from 0-48.

Measure: Change from baseline in health and disability using The WHO Disability Assessment Schedule 12-item, WHODAS

Time: Baseline; Intervention Week 4; 1 month post-intervention; 3 months post-intervention; 6 months post-intervention.

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Description: NEQ is a 20-item questionnaire used to assess adverse and unwanted effects of psychological treatments.

Measure: Adverse and unwanted effects of the experimental intervention using the Negative Effects Questionnaire, NEQ

Time: Experimental Intervention Week 4.

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Description: Psi-Q is a 35-item questionnaire assessing the vividness of mental imagery. In this study we plan to use the visual subscale with five items, with a total score ranging from 0-50.

Measure: Mental imagery is assessed at baseline using the Plymouth Sensory Imagery Questionnaire, Psi-Q

Time: Baseline; Intervention Week 4.

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Primary Outcomes

Description: To compare depression and anxiety HAD score of women who have a medical history ofpost-partum depression according to a follow-up or not during the quarantine by tele-consultation Score less than or egal to 7 = no case Score between 8 and 10 = uncertain case Score higher than or equal to 11 = confirmed case

Measure: Evaluation of Hospital anxiety and depression scale (HAD)

Time: 15 minutes

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Secondary Outcomes

Description: To compare the result of EPDS in women who have a child of less 2 years old according to a follow-up or not by tele-consultation during the quarantine

Measure: Evaluation of Edinburgh Postpartum Depression Scale (EPDS)

Time: 15 minutes

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Description: Anxiety and depression of fathers will be assessed with HAD scale

Measure: Evaluation of HAD score in fathers

Time: 15 minutes

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Description: EPDS will be assessed in fathers who have a child of less than 2 years old

Measure: Evaluation of EPDS in fathers

Time: 15 minutes

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Description: The aim is to show that maternals anxious and depressive symptoms would be correlated to paternals positively symptoms

Measure: Study of the relationship between maternals and paternals symptoms

Time: 15 minutes

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Description: Look for a correlation between the difficulties in child during the quarantine describe by parents and anxiety and depression symptoms in parents The difficulties in child will be illustrated with the rate of children with difficulties describe by the parents

Measure: Study of difficuties in child during the quarantine

Time: 15 minutes

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Description: Description of risk factors and protection factors setting up by the family during this quarantine period

Measure: Risk and protection factors

Time: 15 minutes

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Primary Outcomes

Description: The Subjective Happiness Scale consists of four items: (1) "In general, I consider myself _______." Responses options run from 1 = "not a very happy person" to 7= "a very happy person." (2) "Compared to most of my peers, I consider myself ________" with response options from 1 = "less happy" to 7 = "more happy." (3) "Some people are generally very happy. They enjoy life regardless of what is going on, getting the most out of everything. To what extent does this characterization describe you?" (1 = "not at all" to 7 = "a great deal"). (4) "Some people are generally not very happy. Although they are not depressed, they never seem as happy as they might be. To what extent does this characterization describe you?" (1= "not at all" to 7= "a great deal"; reverse coded) These four items will be averaged into a scale ranging from 1-7, where higher scores indicate greater subjective happiness.

Measure: Change in happiness from baseline using the subjective happiness scale

Time: baseline, end of weeks 1, 2, 3, and 5

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Description: Respondents' individual perceptions of whether their life has value will be measured using the valued life subscale developed by Morgan and Farsides. This measure will consist of the average of the following four items: (1) "My life is worthwhile," (2) "My life is significant," (3) I really value my life," and (4) I hold my own life in high regard." In each instance, response options will run from -3 = "strongly disagree" to 3 = "strongly agree".

Measure: Change in valued life assessment from baseline using 4-item scale

Time: baseline, end of weeks 1, 2, 3, and 5

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Description: Depression will be measured using the well-established 8-item short-form of the Centre for Epidemiological Studies-Depression Scale (CES-D). Respondents will report how often in the past week they (1) felt depressed, (2) felt that everything was an effort, (3) felt that sleep was restless, (4) felt happy (reverse coded), (5) enjoyed life (reverse coded), (6) felt lonely, (7) felt sad, and (8) could not get going. Responses will be scored where 0 = "rarely or none of the time," 1 = "some of the time," 2 = "a moderate amount of time," and 3 = "most or all of the time."

Measure: Change in depression from baseline using the CESD (8-item)

Time: baseline, end of weeks 1, 2, 3, and 5

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Description: Anxiety will be measured with the Hospital Anxiety and Depression Scale-Anxiety (HADS-A), which is both commonly used and well-validated. This is a 7-item scales that asks respondents how often in the past week they: (1) felt tense or wound up, (2) got a frightened feeling as if something awful was about to happen, (3) had worrying thoughts go through their mind, (4) got a frightened feeling like butterflies in the stomach, (5) felt restless as if they had to be on the move, (6) had a sudden feeling of panic, and (7) could sit at ease and feel relaxed. To ensure consistency with our measure of depression, responses will be coded where 0 = "rarely or none of the time," 1 = "some of the time," 2 = "a moderate amount of time," and 3 = "most or all of the time."

Measure: Change in anxiety from baseline using the HADS-A

Time: baseline, end of weeks 1, 2, 3, and 5

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Primary Outcomes

Description: Theoretical range: 8-32, higher score indicates higher satisfaction. This sum score is based on 8 items, each scored 1-4. The original preregistered range of 7-28 was an erratum.

Measure: Satisfaction with treatment as indicated by a mean Client Satisfaction Questionnaire (CSQ-8) score of at least 22

Time: Post-treatment assessment (immediately after treatment, completed within 45 days)

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Secondary Outcomes

Description: Session attendance registered once each week by a clinician during the treatment period

Measure: Adherence operationalized as the average number of completed sessions

Time: From week 1 to week 6

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Description: Dichotomous outcome (Jacobson & Truax, 1991) based on the Patient Health Questionnaire 9 (PHQ-9, theoretical range: 0-27, higher score indicates more symptoms of depression)

Measure: At least 1/3 patients reporting a clinically significant improvement in symptoms of depression

Time: Pre-treatment assessment (within 2 weeks before treatment) to post-treatment assessment (immediately after treatment, completed within 45 days)

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Description: Dichotomous outcome (Jacobson & Truax, 1991) based on the GAD-7 (theoretical range: 0-21, higher score indicates more general anxiety)

Measure: At least 1/3 patients reporting a clinically significant improvement in symptoms of general anxiety

Time: Pre-treatment assessment (within 2 weeks before treatment) to post-treatment assessment (immediately after treatment, completed within 45 days)

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Measure: Change in lifestyle behaviors

Time: Pre-treatment assessment (within 2 weeks before treatment) to post-treatment assessment (immediately after treatment, completed within 45 days)

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Description: Weekly question: "Since the last assessment, have you experienced any adverse event, side effect, or unwanted effect of your participation in this study?"

Measure: Number of adverse events

Time: From week 1 to week 6

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Description: Clinical interview

Measure: Proportion of patients in need of additional treatment

Time: Post-treatment assessment (within 45 days after treatment)

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Description: Patient Health Questionnaire 9 (PHQ-9, theoretical range: 0-27, higher score indicates more symptoms of depression)

Measure: Average change in symptoms of depression

Time: Pre-treatment assessment (within 2 weeks before treatment) to post-treatment assessment (immediately after treatment, completed within 45 days)

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Description: GAD-7 (theoretical range: 0-21, higher score indicates more general anxiety)

Measure: Average change in general anxiety

Time: Pre-treatment assessment (within 2 weeks before treatment) to post-treatment assessment (immediately after treatment, completed within 45 days)

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Description: Perceived Stress Scale, 10-item version (PSS-10, theoretical range: 0-40, higher score indicates more perceived stress)

Measure: Average change in perceived stress

Time: Pre-treatment assessment (within 2 weeks before treatment) to post-treatment assessment (immediately after treatment, completed within 45 days)

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Description: World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2, theoretical range: 0-100, higher score indicates more disability)

Measure: Average change in disability

Time: Pre-treatment assessment (within 2 weeks before treatment) to post-treatment assessment (immediately after treatment, completed within 45 days)

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Primary Outcomes

Description: Change in depressive symptoms measured by Personal Health Questionnaire (PHQ-8) (min: 0; max: 24, with higher score indicating more severe depression).

Measure: Change in depressive symptoms

Time: Change from Baseline to Post treatment (5 weeks)

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Secondary Outcomes

Description: Change in anxiety symptoms measured by the Generalized Anxiety Disorder (GAD-7) scale (min: 0; max: 21, with higher score indicating more severe anxiety).

Measure: Change in anxiety symptoms

Time: Change from Baseline to Post treatment (5 weeks)

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Description: Change in parent report of child depressive symptoms measured by the Mood and Feelings Questionnaire (MFQ) (min: 0; max: 26, with higher score indicating more severe depression)

Measure: Change in parent report of child depressive symptoms

Time: Change from Baseline to Post treatment (5 weeks)

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Primary Outcomes

Description: HCWs in the intervention condition (RECHARGE) demonstrate a lower level of distress after the intervention and at 2-month follow-up than HCWs in the active control condition.

Measure: Change from Baseline in psychological distress Kessler Psychological Distress Scale (K10) at Week 5 and Week 13

Time: Baseline (Week 1), post-intervention (Week 5) and 2 month follow-up (Week 13)

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Secondary Outcomes

Description: HCWs in the intervention condition demonstrate fewer worries after the intervention and at 2-month follow-up than HCWs in the active control condition. Worries are measured using the Generalized Anxiety Disorder Assessment (GAD-7)

Measure: Fewer worries in intervention group than in active control group

Time: post-intervention (Week 5) and 2 month follow-up (Week 13)

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Description: HCWs in the intervention condition demonstrate less anxiety after the intervention and at 2-month follow-up than HCWs in the active control condition. Anxiety is measured using the Hospital Anxiety and Depression Scale (HADS).

Measure: Less anxiety symptoms in intervention group than in active control group

Time: post-intervention (Week 5) and 2 month follow-up (Week 13)

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Description: HCWs in the intervention condition demonstrate fewer symptoms of depression after the intervention and at 2-month follow-up than HCWs in the active control condition. Depression is measured using the Hospital Anxiety and Depression Scale (HADS).

Measure: Fewer depression symptoms in intervention group than in active control group

Time: post-intervention (Week 5) and 2 month follow-up (Week 13)

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Description: HCWs in the intervention condition demonstrate a lower level of burnout after the intervention and at 2-month follow-up than HCWs in the active control condition. Burnout is measured using the Maslach Burnout Inventory (MBI).

Measure: Lower level of burnout in intervention group than in active control group

Time: post-intervention (Week 5) and 2 month follow-up (Week 13)

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Description: HCWs in the intervention condition demonstrate less traumatic stress after the intervention and at 2-month follow-up than HCWs in the active control condition. Traumatic stress is measured using the PTSD Checklist (PCL-5).

Measure: Less traumatic stress in intervention group than in active control group

Time: post-intervention (Week 5) and 2 month follow-up (Week 13)

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Description: HCWs in the intervention condition demonstrate a lower level of distress due to perceived moral injury after the intervention and at 2-month follow-up than HCWs in the active control condition. Distress due to perceived moral injury is measured using Moral Injury Appraisals (MI).

Measure: Lower level of distress due to perceived moral injury in intervention group than in active control group

Time: post-intervention (Week 5) and 2 month follow-up (Week 13)

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Description: HCWs in the intervention condition demonstrate a higher work performance after the intervention and at 2-month follow-up than HCWs in the active control condition. Work performance is measured using the Work Ability Index (WAI).

Measure: Higher work performance in intervention group than in active control group

Time: post-intervention (Week 5) and 2 month follow-up (Week 13)

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Primary Outcomes

Description: A composite measure of Generalised Anxiety Disorder questionnaire (GAD-7) and Patient Health Questionnaire (PHQ-9). Min score = 0, Max score = 48, with higher scores indicating higher levels of distress.

Measure: Change in Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS)

Time: At baseline, 6 weeks (mid-therapy) and 12 weeks (end of therapy)

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Secondary Outcomes

Description: Social functioning. Min score = 0, Max score = 40 , with higher scores indicating greater functional impairment.

Measure: Change in Work and social adjustment scale (WSAS)

Time: At baseline, 6 weeks (mid-therapy) and 12 weeks (end of therapy)

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Description: Quality of life. Min score = 5, Max score = 15 , with higher scores more problems in the scale dimensions.

Measure: Change in EQ-5D-3L

Time: At baseline, 6 weeks (mid-therapy) and 12 weeks (end of therapy)

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Description: IPQ-R tailored to COVID-19 to establish emotional responses regarding the COVID-19 pandemic. Min score = 0, Max score = 24 , with higher scores indicating higher emotional responses.

Measure: Change in Illness perception questionnaire - revised (IPQ-R), emotional subscale

Time: At baseline, 6 weeks (mid-therapy) and 12 weeks (end of therapy)

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Primary Outcomes

Description: >/= 70% of participants attending >/= 50% of their intervention sessions, reporting satisfaction with treatment.

Measure: Acceptability

Time: 6 months at end of treatment

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Description: Widely used measure of depression and anxiety in clinical monitoring and outcome assessment.

Measure: Hopkins Symptom Checklist-25 (change)

Time: Baseline and 3, 6, and 12 months after baseline

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Description: Assessment of standing balance, timed 4-m walk, and timed test of five chair-rise repetitions, to assess functional limitations. A virtual option will be used while in person assessment is not possible due to COVID-19.

Measure: Short Physical Performance Battery (change)

Time: Baseline and 3, 6, and 12 months after baseline

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Description: Self-report instrument designed to measure both functional capacity and components of disability.

Measure: Late-Life Function and Disability Instrument (LLFDI) - functional component (change)

Time: Baseline and 3, 6, and 12 months after baseline

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Primary Outcomes

Description: The frequencies of diagnosed surgical indication before pandemic but surgeries deferred until re-opening of full elective lists will be documented.

Measure: Incidence of elective surgeries has postponed during COVID-19 pandemic in geriatric population

Time: June 2020 - October 2020

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Secondary Outcomes

Description: The frequencies of diagnosed malignant cases with surgical indication before pandemic but surgeries deferred until re-opening of full elective lists will be documented.

Measure: Incidence of cancer surgeries postponed during COVID-19 pandemic in geriatric population

Time: June 2020 - December 2020

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Description: Assessment using specific scores for depression and frailty prior to surgery

Measure: Physical and psychological impact of postponed elective surgery in geriatric population during COVID-19 pandemic

Time: June 2020 - December 2020

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Primary Outcomes

Description: This scale is composed of two parts, part one measures anxiety traits and part two measures anxiety state. Each part comprises 20 statements. This scale is a (4) point scale, with a score ranging a minimum of 20 grades to a maximum of 80 grades.

Measure: The mean scores anxiety and depression among pregnant women during COVID-19 pandemic

Time: one hour

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Primary Outcomes

Description: The Hospital Anxiety and Depression Scale evaluation includes a total of 14 questions (score range 0-3), which are scored to separately estimate anxiety and depressive status (7 questions each). The individual score for the anxiety and depression subscales may vary from 0 to 21. The aim of this scoring system is not to make an objective diagnosis, but to determine the current presence and tendency to anxiety or depression at the time of diagnosis. A HADS score of 8 to 10 is broadly accepted as indicating mild symptoms, a score between 11-16 suggests moderate anxiety or depression, and a score of 16 or more indicates severe anxiety or depressive symptoms

Measure: Hospital Anxiety and Depression Scale

Time: 3 months

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Description: The Covid 19 Phobia Scale is a self-report instrument with a five-point Likert-type scale to assess the levels of SARS-CoV-2 phobia. All items are rated on a 5-point scale from "strongly disagree (1)" to "strongly agree (5)." The scores on the scale can range between 20 and 100 and a higher score indicates a greater phobia in the respected subscales and total scale. In the present study total scale scores ranged from 20 to 100. The scale examines four main factors: psychological, psycho-somatic, economic and social

Measure: Covid 19 Phobia Scale

Time: 3 months

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Primary Outcomes

Description: This study is investigating three different conditions (PTSD, Depression and Burnout) each assessed with its own primary endpoint. Thus, the trial will have three primary endpoints. Change over a 6 months period in symptoms of PTSD measured by the Post-Traumatic Stress Disorder Checklist Scale for Diagnostic and Statistical Manual of mental disorders fifth edition ((DSM-5), PCL-5). The PCL-5 score is on a scale from 0 to 80. The higher the score, the higher the level of PTSD symptoms are.

Measure: Efficacy on symptoms of Post-Traumatic Stress Disorder

Time: From inclusion to 6 months after inclusion

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Description: Change over a 6 months period in symptoms of Burnout measured by the Professional Quality Of Life questionnaire (ProQOL). The ProQOL score is on a scale from 30 to 150. The higher the score, the higher the level of Burnout symptoms are.

Measure: Efficacy on symptoms of Burnout

Time: From inclusion to 6 months after inclusion

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Description: Change over a 6 months period in symptoms of depression measured by the Patient Health Questionnaire (PHQ-9). The PHQ-9 score is on a scale from 0 to 27. The higher the score, the higher the level of depression symptoms are.

Measure: Efficacy on symptoms of Depression

Time: From inclusion to 6 months after inclusion

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Secondary Outcomes

Description: Change over a 3 months period in symptoms of PTSD measured by the Post-Traumatic Stress Disorder Checklist Scale for Diagnostic and Statistical Manual of mental disorders fifth edition ((DSM-5), PCL-5). The PCL-5 score is on a scale from 0 to 80. The higher the score, the higher the level of PTSD symptoms are.

Measure: Short-term efficacy on symptoms of PTSD

Time: From inclusion to 3 months after inclusion

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Description: Change over a 3 months period in symptoms of Burnout measured by the Professional Quality Of Life questionnaire (ProQOL). The ProQOL score is on a scale from 30 to 150. The higher the score, the higher the level of Burnout symptoms are.

Measure: Short-term efficacy on symptoms of Burnout

Time: From inclusion to 3 months after inclusion

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Description: Change over a 3 months period in symptoms of depression measured by the Patient Health Questionnaire (PHQ-9). The PHQ-9 score is on a scale from 0 to 27. The higher the score, the higher the level of depression symptoms are.

Measure: Short-term efficacy on symptoms of Depression

Time: From inclusion to 3 months after inclusion

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Description: Change over a 12 months period in symptoms of PTSD measured by the Post-Traumatic Stress Disorder Checklist Scale for Diagnostic and Statistical Manual of mental disorders fifth edition ((DSM-5), PCL-5) for the participants who will be enrolled in the trial at M0 of the cohort. The PCL-5 score is on a scale from 0 to 80. The higher the score, the higher the level of PTSD symptoms are.

Measure: Long-term efficacy on symptoms of PTSD

Time: From inclusion to 12 months after inclusion

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Description: Change over a 12 months period in symptoms of Burnout measured by the Professional Quality Of Life questionnaire (ProQOL) for the participants who will be enrolled in the trial at M0 of the cohort. The ProQOL score is on a scale from 30 to 150. The higher the score, the higher the level of Burnout symptoms are.

Measure: Long-term efficacy on symptoms of Burnout

Time: From inclusion to 12 months after inclusion

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Description: Change over a 12 months period in symptoms of depression measured by the Patient Health Questionnaire (PHQ-9) for the participants who will be enrolled in the trial at M0 of the cohort. The PHQ-9 score is on a scale from 0 to 27. The higher the score, the higher the level of depression symptoms are.

Measure: Long-term efficacy on symptoms of Depression

Time: From inclusion to 12 months after inclusion

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Description: Change over a 6 months period in anxiety measured by the Generalized Anxiety Disorder-7 questionnaire (GAD-7). The GAD-7 score is on a scale from 0 to 21. The higher the score, the higher the level of anxiety symptoms are.

Measure: Efficacy on symptoms of Anxiety

Time: From inclusion to 6 months after inclusion

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Description: Change over a 12 months period in anxiety measured by the Generalized Anxiety Disorder-7 questionnaire (GAD-7) for the participants who will be enrolled in the trial at M0 of the cohort. The GAD-7 score is on a scale from 0 to 21. The higher the score, the higher the level of anxiety symptoms are.

Measure: Long-term efficacy on symptoms of Anxiety

Time: From inclusion to 12 months after inclusion

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Description: Number of suicide attempts over a 6-month period from baseline

Measure: Efficacy on suicide attempts

Time: From inclusion to 6 months after inclusion

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Other Outcomes

Description: Changes in the level of suicidal ideation over a 6 months period from baseline measured by Visual Analog Scale (VAS). The VAS is on a scale from 0 to 10. The higher the VAS score, the higher suicidal ideation level is.

Measure: Efficacy on suicidal ideation

Time: From inclusion to 6 months after inclusion

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Description: Changes in the level of suicidal ideation over a 12 months period from baseline measured by Visual Analog Scale (VAS) for the participants who are enrolled in the trial at M0 of the cohort. The VAS is on a scale from 0 to 10. The higher the VAS score, the higher suicidal ideation level is.

Measure: Long-term efficacy on suicidal ideation

Time: From inclusion to 12 months after inclusion

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Description: Change in the impact of health on functioning (Role Emotional (RE) subdomain of the MOS Short Form-36 health survey v1.3 (SF-36)) over a 6 months period from baseline. The RE score is on a scale from 0 to 100. The higher the score, the better Role Emotional is.

Measure: Efficacy on the impact of health on functioning: Role Emotional

Time: From inclusion to 6 months after inclusion

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Description: Change in the impact of health on functioning (Role Emotional (RE) subdomain of the MOS Short Form-36 health survey v1.3 (SF-36)) over a 12 months period from baseline for the participants who are enrolled in the trial at M0 of the cohort. The RE score is on a scale from 0 to 100. The higher the score, the better Role Emotional is.

Measure: Long-term efficacy on the impact of health on functioning: Role Emotional

Time: From inclusion to 12 months after inclusion

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Description: Change in the impact of health on functioning (Role Physical (RP) subdomain of the MOS Short Form-36 health survey v1.3 (SF-36)) over a 6 months period from baseline. The RP score is on a scale from 0 to 100. The higher the score, the better Role Physical is.

Measure: Efficacy on the impact of health on functioning: Role Physical

Time: From inclusion to 6 months after inclusion

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Description: Change in the impact of health on functioning (Role Physical (RP) subdomain of the MOS Short Form-36 health survey v1.3 (SF-36)) over a 12 months period from baseline for the participants who are enrolled in the trial at M0 of the cohort. The RP score is on a scale from 0 to 100. The higher the score, the better Role Physical is.

Measure: Long-term efficacy on the impact of health on functioning: Role Physical

Time: From inclusion to 12 months after inclusion

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Description: Evolution of substance use over 6 months

Measure: Substance use

Time: From inclusion to 6 months after inclusion

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Description: Evolution of substance use over 12 months for the participants who are enrolled in the trial at M0 of the cohort

Measure: Long-term substance use

Time: From inclusion to 12 months after inclusion

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Description: Evolution of medication use over 6 months

Measure: Medication use

Time: From inclusion to 6 months after inclusion

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Description: Evolution of medication use over 12 months for the participants who are enrolled in the trial at M0 of the cohort

Measure: Long-term medication use

Time: From inclusion to 12 months after inclusion

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Description: Number of consultations of health professionals within the period of follow-up (general practitioner, psychiatrist, psychotherapist, psychologist, professionals who are practicing alternative medicines); Occurrence of EMDR therapy within the control group; Number of visits at the emergency unit of a hospital; Number of nights spent in hospital as a patient (short-term); Number of nights spent in rehabilitation facilities as a patient.

Measure: Health care utilization

Time: From inclusion to 6 months after inclusion

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Description: Number of consultations of health professionals within the period of follow-up (general practitioner, psychiatrist, psychotherapist, psychologist, professionals who are practicing alternative medicines); Occurrence of EMDR therapy within the control group; Number of visits at the emergency unit of a hospital; Number of nights spent in hospital as a patient (short-term); Number of nights spent in rehabilitation facilities as a patient. For the participants who are enrolled in the trial at M0 of the cohort

Measure: Long-term health care utilization

Time: From inclusion to 12 months after inclusion

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Description: Proportion of those who will be offered EMDR and will actually receive EMDR

Measure: Acceptability of EMDR in the EMDR group

Time: From inclusion to 12 months after inclusion

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Description: Number of sessions attended over the total planned number

Measure: Compliance in the EMDR group

Time: From inclusion to 12 months after inclusion

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Primary Outcomes

Description: Change of psychological distress measured with the Hopkins Symptom Checklist (HSCL-25) serves as primary beneficiary-related health outcome. The 25 items are rated on a scale from 1 to 4. Higher scores indicate more pronounced symptom severity.

Measure: Change in psychological distress

Time: Baseline assessment, 1 week post-intervention assessment (6 weeks after baseline), 3 month post-intervention assessment (4-4.5 months after baseline), 12 month post intervention assessment

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Secondary Outcomes

Description: Change in posttraumatic stress disorder symptoms measured with the PTSD Checklist for DSM-5 (PCL-5). Responses are scored on a scale from 0 to 4 with higher scores indicating more pronounced symptom severity.

Measure: Change in posttraumatic stress disorder symptoms

Time: Baseline assessment, 1 week post-intervention assessment (6 weeks after baseline), 3 month post-intervention assessment (4-4.5 months after baseline), 12 month post intervention assessment

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Description: Change in functional disability measured with the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). The items are rated on a scale from 1 to 5. Higher scores indicate more pronounced functional disability.

Measure: Change in functional disability

Time: Screening, 1 week post-intervention assessment (6 weeks after baseline), 3 month post-intervention assessment (4-4.5 months after baseline), 12 month post intervention assessment

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Other Outcomes

Description: Assessment of change in self-reported problems measured with the PSYCHLOPS. The Psychological Outcomes Profiles (PSYCHLOPS) scale is a patient-generated outcome measure, serving as an indicator of change in response to therapy. Items are rated on a scale from 1 to 5 (respectively 1 - 7) with lower scores indicating greater improvement in self reported problems.

Measure: Assessment of change in self-reported problems

Time: Baseline assessment, 1 week post-intervention assessment (6 weeks after baseline), 3 month post-intervention assessment (4-4.5 months after baseline), 12 month post intervention assessment

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Description: Exposure to traumatic events will be assessed using the Traumatic Events (TE) - a combination of two standardized questionnaires, namely the Life Events Checklist and the Harvard Trauma Questionnaire.

Measure: Exposure to traumatic events

Time: Measured at baseline assessment and 12-months follow up only

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Description: Changes in post-migration stressors will be assessed using a version of the Post-Migration Living Difficulties Checklist (PMLDC). Items are rated on a scale from 0 to 4 with lower scores representing fewer post-migration stressors.

Measure: Reduction of post-migration stressors

Time: Baseline assessment, 1 week post-intervention assessment (6 weeks after baseline), 3 month post-intervention assessment (4-4.5 months after baseline), 12 month post intervention assessment

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Description: Somatization and somatic symptoms will be assessed using the Patient Health Questionnaire-15 (PHQ-15). Items are rated on a scale from 1 to 3. Higher scores indicate higher symptom severity.

Measure: Somatization and somatic symptoms

Time: Baseline assessment, 1 week post-intervention assessment (6 weeks after baseline), 3 month post-intervention assessment (4-4.5 months after baseline), 12 month post intervention assessment

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Description: Level of integration will be measured using the Immigration Policy Lab Integration Index (IPL-12).

Measure: Level of integration

Time: Screening, 1 week post-intervention assessment (6 weeks after baseline), 3 month post-intervention assessment (4-4.5 months after baseline), 12 month post intervention assessment

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Description: General Self-Efficacy will be assessed using a short form of the General Self-Efficacy Scale (GSE-6). Reponses are given on a scale from 1 to 4 with higher scores representing higher general self-efficacy.

Measure: General Self-Efficacy

Time: Baseline assessment, 1 week post-intervention assessment (6 weeks after baseline), 3 month post-intervention assessment (4-4.5 months after baseline), 12 month post intervention assessment

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Description: Attitudes towards mental health will be measured with with a set of selected questions (e.g. "Mentally ill people tend to be violent").This questionnaire has been used with Syrian refugees in previous research.

Measure: Attitudes towards mental health

Time: Baseline assessment, 1 week post-intervention assessment (6 weeks after baseline), 3 month post-intervention assessment (4-4.5 months after baseline), 12 month post intervention assessment

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Description: The impact of the COVID-19 pandemic will be assessed with a set of selected questions regarding medical state, psychological state, financial situation and resources (own questionnaire).

Measure: Impact of COVID-19 pandemic

Time: Baseline assessment, 1 week post-intervention assessment (6 weeks after baseline), 3 month post-intervention assessment (4-4.5 months after baseline), 12 month post intervention assessment

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Description: The Client Service Receipt Inventory (CSRI) was developed for the collection of data on service utilization and related characteristics of people with mental disorders, as the basis for calculating the costs of care for mental health cost-effectiveness research.

Measure: Cost of Care

Time: Baseline assessment, 1 week post-intervention assessment (6 weeks after baseline), 3 month post-intervention assessment (4-4.5 months after baseline), 12 month post intervention assessment

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Description: A set of question regarding previous contact with the mental health care services and the previous experiences regarding the utilization of any forms of mental support (own questionnaire).

Measure: Access to health care services

Time: Baseline assessment

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Description: The outcome is measured with a nine-item scale that was developed to assess the extent to which the participants perceives that they use the specific strategies, which are trained during the study intervention. The items are rated on a scale from 0 to 4. Higher scores represent greater usage of the strategies.

Measure: Assessing the extent to which the strategies taught in PM+ are used before and after the study participation with the Reducing Tension Checklist

Time: Baseline assessment, 1 week post-intervention assessment (6 weeks after baseline), 3 month post-intervention assessment (4-4.5 months after baseline), 12 month post intervention assessment.

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Primary Outcomes

Description: Depression questionnaire. Scores range from 0 to 27. Lower scores indicate less depression.

Measure: Change in Patient Health Questionnaire-9 (PHQ-9)

Time: Up to 12 weeks post-intervention

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Description: Anxiety questionnaire. Total scores range from 0-21. Lower scores indicate less anxiety.

Measure: Change in Generalized Anxiety Disorder Screener-7 (GAD-7)

Time: Up to 12 weeks post-intervention

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Description: Subjective Well-being questionnaire. Total scores range from 7 to 35. Higher values indicate higher well-being scores.

Measure: Change in Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS)

Time: Up to 12 weeks post-intervention

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Description: Questionnaire measuring the acceptability of an intervention. Acceptability refers to the perception that a given treatment is agreeable or satisfactory. The total score ranges from 4 to 20. Higher scores indicate higher acceptability ratings.

Measure: Ratings of Acceptability of Intervention Measure (AIM)

Time: Immediately after the intervention

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Description: Participants answered questions relating to each module's mechanism of change on a 7-point Likert Scale, from "strongly disagree" to "strongly agree". Specifically, we asked participants: How capable they feel about managing negative thoughts If they will intentionally spend time doing activities they enjoy If they will notice and appreciate good things If they will be able to treat themselves with empathy and compassion

Measure: Mechanism Questions

Time: Up to 12 weeks post-intervention

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Description: 2 questions related to their ability to cope with stressors over the upcoming weeks (including challenges relating to COVID-19). Participants answered these questions on a 7-point Likert Scale, from "strongly disagree" to "strongly agree". Specifically, we asked participants: if they will be able to handle lifestyle changes due to the coronavirus, if the pandemic will have an extremely negative impact on their life.

Measure: Ability to Cope with COVID-19

Time: Up to 12 weeks post-intervention

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Description: We asked participants three items to assess secondary control (Weisz et al., 2010). The items are scored on a 4-point Likert scale, ranging from 0 ("Very false") to 3 ("Very true"). The three items are: When something bad happens, I can find a way to think about it that makes me feel better. After a really hard day, I can make myself feel better by remembering some good things that happened. When bad things happen to me that I can't control, there are lots of things I can do to feel better. Higher scores will indicate greater secondary control.

Measure: Secondary Control

Time: Up to 12 weeks post-intervention

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Description: Participants were asked to rate three items relating to the perceived utility of each module. Specifically, we asked participants: How helpful the module was How engaging the module was How much they will continue applying content from the module Higher scores will indicate greater perceived utility.

Measure: Perceived Utility

Time: Immediately after the intervention

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Primary Outcomes

Description: Depression questionnaire. Scores range from 0 to 27. Lower scores indicate less depression.

Measure: Change in Patient Health Questionnaire-9 (PHQ-9)

Time: Up to 12 weeks post-intervention

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Description: Anxiety questionnaire. Total scores range from 0-21. Lower scores indicate less anxiety.

Measure: Change in Generalized Anxiety Disorder Screener-7 (GAD-7)

Time: Up to 12 weeks post-intervention

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Description: Subjective Well-being questionnaire. Total scores range from 7 to 35. Higher values indicate higher well-being scores.

Measure: Change in the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS)

Time: Up to 12 weeks post-intervention

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Secondary Outcomes

Description: Questionnaire measuring the acceptability of an intervention. Acceptability refers to the perception that a given treatment is agreeable or satisfactory. The total score ranges from 4 to 20. Higher scores indicate higher acceptability ratings.

Measure: Ratings on the Acceptability of Intervention Measure (AIM)

Time: Immediately after the intervention

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Description: Questionnaire measuring the appropriateness of an intervention. Appropriateness refers to the perceived fit or relevance of an intervention. The total score ranges from 4 to 20. Higher scores indicate higher appropriateness.

Measure: Ratings on the Intervention Appropriateness Measure (IAM)

Time: Immediately after the intervention

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Description: Participants answered questions relating to each module's mechanism of change on a 7-point Likert Scale, from "strongly disagree" to "strongly agree". Specifically, we asked participants: How capable they feel about managing negative thoughts If they will intentionally spend time doing activities they enjoy If they will notice and appreciate good things

Measure: Mechanisms of Change

Time: Up to 12 weeks post-intervention

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Description: 2 questions related to their ability to cope with stressors over the upcoming weeks (including challenges relating to COVID-19). Participants answered these questions on a 7-point Likert Scale, from "strongly disagree" to "strongly agree". Specifically, we asked participants: if they will be able to handle lifestyle changes due to the coronavirus, if the pandemic will have an extremely negative impact on their life.

Measure: Ability to Cope with COVID-19

Time: Up to 12 weeks post-intervention

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Description: We asked participants three items to assess secondary control (Weisz et al., 2010). The items are scored on a 4-point Likert scale, ranging from 0 ("Very false") to 3 ("Very true"). The three items are: When something bad happens, I can find a way to think about it that makes me feel better. After a really hard day, I can make myself feel better by remembering some good things that happened. When bad things happen to me that I can't control, there are lots of things I can do to feel better. Higher scores indicate greater secondary control.

Measure: Secondary Control

Time: Up to 12 weeks post-intervention

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Description: Participants were asked to rate three items relating to the perceived utility of each module. Specifically, we asked participants: How helpful the module was How engaging the module was How much they will continue applying content from the module Higher scores indicate greater perceived utility.

Measure: Perceived Utility

Time: Immediately after the intervention

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Description: Questionnaire measuring positive affect and negative affect. Scores on the positive affect subscale range from 10-50, with higher scores representing higher levels of positive affect. Scores on the negative affect subscale range from 10-50, with lower scores representing lower levels of negative affect

Measure: Positive and Negative Affect Schedule

Time: Up to 12 weeks post-intervention

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Description: Questionnaire measuring perceived stress. Scores range from 0-16, with higher scores indicating greater stress.

Measure: Perceived Stress Scale-4

Time: Up to 12 weeks post-intervention

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Description: Questionnaire measuring social connectedness. Scores range from 8 to 48, with higher scores indicating greater social connectedness.

Measure: The Social Connectedness Scale

Time: Up to 12 weeks post-intervention

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Primary Outcomes

Description: The EPDS-10 is a validated (English and Arabic versions) instrument that assesses perinatal depression. It consists of ten questions. The total score will range from zero (no depression) to 30 (severe depression).

Measure: Baseline (T0) perinatal depression through the 10-points Edinburgh Postnatal Depression (Scale (EPDS-10)

Time: Baseline in their second trimester (Beginning of 14th week till end of 27th week of gestation)

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Description: The EPDS-10 is a validated (English and Arabic versions) instrument that assesses perinatal depression. It consists of ten questions. The total score will range from zero (no depression) to 30 (severe depression).

Measure: Change (T1-T0) from baseline perinatal depression on the 10-points Edinburgh Postnatal Depression Scale (EPDS-10) at third trimester (T1)

Time: During the third trimester (Beginning of the 28th week till end of 42nd week of gestation)

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Description: The EPDS-10 is a validated (English and Arabic versions) instrument that assesses perinatal depression. It consists of ten questions. The total score will range from zero (no depression) to 30 (severe depression).

Measure: Change (T2-T1) from third trimester perinatal depression on the 10-points Edinburgh Postnatal Depression Scale (EPDS-10) at 3-5 weeks postnatal (T2)

Time: During the postnatal phase (3-5 weeks after birth)

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Description: The EPDS-10 is a validated (English and Arabic versions) instrument that assesses perinatal depression. It consists of ten questions. The total score will range from zero (no depression) to 30 (severe depression).

Measure: Change (T3-T2) in perinatal depression on the 10-points Edinburgh Postnatal Depression Scale (EPDS-10) at 2-4 months postnatal (T3)

Time: During the postnatal phase (2-4 months after birth)

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Description: The EPDS-10 is a validated (English and Arabic versions) instrument that assesses perinatal depression. It consists of ten questions. The total score will range from zero (no depression) to 30 (severe depression).

Measure: Change (T4-T3) in perinatal depression on the 10-points Edinburgh Postnatal Depression Scale (EPDS-10) at 5-7 months postnatal (T4)

Time: During the postnatal phase (5-7 months after birth)

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Description: The EPDS-10 is a validated (English and Arabic versions) instrument that assesses perinatal depression. It consists of ten questions. The total score will range from zero (no depression) to 30 (severe depression).

Measure: Change (T5-T4) in perinatal depression on the 10-points Edinburgh Postnatal Depression Scale (EPDS-10) at 8-10 months postnatal (T5)

Time: During the postnatal phase (8-10 months after birth)

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Description: The Covid-9 Specific phobia questionnaire consists of seven items (five-item Likert-type scale). The answers include "strongly disagree," "disagree," "neither agree nor disagree," "agree," and "strongly agree". A total score is calculated ranging from 7 to 35. The higher the score, the greater the fear of cororonavirus-19.

Measure: Baseline (T0) Covid-19 Specific phobia through the Covid-19 Specific phobia questionnaire

Time: Baseline in their second trimester (Beginning of 14th week till end of 27th week of gestation)

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Description: The Covid-9 Specific phobia questionnaire consists of seven items (five-item Likert-type scale). The answers include "strongly disagree," "disagree," "neither agree nor disagree," "agree," and "strongly agree". A total score is calculated ranging from 7 to 35. The higher the score, the greater the fear of cororonavirus-19.

Measure: Change (T1-T0) in Covid-19 Specific phobia through the Covid-19 Specific phobia questionnaire at third trimester (T1)

Time: During the third trimester (Beginning of the 28th week till end of 42nd week of gestation)

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Description: The Covid-9 Specific phobia questionnaire consists of seven items (five-item Likert-type scale). The answers include "strongly disagree," "disagree," "neither agree nor disagree," "agree," and "strongly agree". A total score is calculated ranging from 7 to 35. The higher the score, the greater the fear of cororonavirus-19.

Measure: Change (T2-T1) in Covid-19 Specific phobia through the Covid-19 Specific phobia questionnaire at 3-5 weeks after birth (T2)

Time: During the postnatal phase (3-5 weeks after birth)

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Description: The Covid-9 Specific phobia questionnaire consists of seven items (five-item Likert-type scale). The answers include "strongly disagree," "disagree," "neither agree nor disagree," "agree," and "strongly agree". A total score is calculated ranging from 7 to 35. The higher the score, the greater the fear of cororonavirus-19.

Measure: Change (T3-T2) in Covid-19 Specific phobia through the Covid-19 Specific phobia questionnaire at 2-4 months after birth (T3)

Time: During the postnatal phase (2-4 months after birth)

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Description: The Covid-9 Specific phobia questionnaire consists of seven items (five-item Likert-type scale). The answers include "strongly disagree," "disagree," "neither agree nor disagree," "agree," and "strongly agree". A total score is calculated ranging from 7 to 35. The higher the score, the greater the fear of cororonavirus-19.

Measure: Change (T4-T3) in Covid-19 Specific phobia through the Covid-19 Specific phobia questionnaire at 5-7 months after birth (T4)

Time: During the postnatal phase (5-7 months after birth)

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Description: The Covid-9 Specific phobia questionnaire consists of seven items (five-item Likert-type scale). The answers include "strongly disagree," "disagree," "neither agree nor disagree," "agree," and "strongly agree". A total score is calculated ranging from 7 to 35. The higher the score, the greater the fear of cororonavirus-19.

Measure: Change (T5-T4) in Covid-19 Specific phobia through the Covid-19 Specific phobia questionnaire at 8-10 months after birth (T5)

Time: During the postnatal phase (8-10 months after birth)

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Description: A subscale of Edinburgh Postnatal Depression Scale (EPDS-3) will be used and includes three items of EPDS-10. The total score will range from zero (no anxiety) till nine (severe anxiety).

Measure: Baseline (T0) perinatal anxiety through a subscale of Edinburgh Postnatal Depression Scale (EPDS-3)

Time: Baseline in their second trimester (Beginning of 14th week till end of 27th week of gestation)

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Description: A subscale of Edinburgh Postnatal Depression Scale (EPDS-3) will be used and includes three items of EPDS-10. The total score will range from zero (no anxiety) till nine (severe anxiety).

Measure: Change (T1-T0) in perinatal anxiety through a subscale of Edinburgh Postnatal Depression Scale (EPDS-3) at third trimester (T1)

Time: During the third trimester (Beginning of the 28th week till end of 42nd week of gestation)

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Description: A subscale of Edinburgh Postnatal Depression Scale (EPDS-3) will be used and includes three items of EPDS-10. The total score will range from zero (no anxiety) till nine (severe anxiety).

Measure: Change (T2-T1) in perinatal anxiety through a subscale of Edinburgh Postnatal Depression Scale (EPDS-3) at 3-5 weeks after birth (T2)

Time: During the postnatal phase (3-5 weeks after birth)

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Description: A subscale of Edinburgh Postnatal Depression Scale (EPDS-3) will be used and includes three items of EPDS-10. The total score will range from zero (no anxiety) till nine (severe anxiety).

Measure: Change (T3-T2) in perinatal anxiety through a subscale of Edinburgh Postnatal Depression Scale (EPDS-3) at 2-4 months after birth (T3)

Time: During the postnatal phase (2-4 months after birth)

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Description: A subscale of Edinburgh Postnatal Depression Scale (EPDS-3) will be used and includes three items of EPDS-10. The total score will range from zero (no anxiety) till nine (severe anxiety).

Measure: Change (T4-T3) in perinatal anxiety through a subscale of Edinburgh Postnatal Depression Scale (EPDS-3) at 5-7 months after birth (T4)

Time: During the postnatal phase (5-7 months after birth)

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Description: A subscale of Edinburgh Postnatal Depression Scale (EPDS-3) will be used and includes three items of EPDS-10. The total score will range from zero (no anxiety) till nine (severe anxiety).

Measure: Change (T5-T4) in perinatal anxiety through a subscale of Edinburgh Postnatal Depression Scale (EPDS-3) at 8-10 months after birth (T5)

Time: During the postnatal phase (8-10 months after birth)

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Primary Outcomes

Description: Change in depression symptom severity as measured by CAT-MH Depression Inventory (DI) scores completed at baseline and every 4 weeks during the 24 weeks after randomization. Difference between MBCT-R arm and CHA-MW monitoring alone arm is primary outcome. Difference between iCBT arm and CHA-MW monitoring alone arm is secondary outcome. Difference between iCBT arm and MBCT-R is an exploratory outcome.

Measure: Depression Severity (CAT-DI)

Time: Baseline, Weeks 4, 8, 12, 16, 20, 24

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Secondary Outcomes

Description: Rates of positive toxicology screens for illicit drugs or unprescribed controlled substances at 24 weeks. Rates of positive toxicology for illicit drug use or controlled substances (non prescribed) at week 24 is the secondary outcome.

Measure: Drug Use Rates

Time: Week 24

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Description: We will conduct an Alcohol Use History at Week 24. We will conduct 30-day alcohol and substance use history using the TimeLine Follow Back (TLFB) Method at Week 24 visit by telephone or video conference. Heavy Drinking Days in past 30 days is the secondary outcome.

Measure: Heavy Drinking Days

Time: Week 24

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Description: Number of mental health clinician televisits during 24 weeks

Measure: Televisits

Time: Randomization through Week 24

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Other Outcomes

Description: Participants report the frequency of emotions using a 5-point scale: 0 = none of the time, 1 = a little of the time, 2 = some of the time, 3 = most of the time, 4 = all of the time. The NA scale consists of 14 items: restless or fidgety, nervous, worthless, so sad nothing could cheer you up, everything is an effort, hopeless, lonely, afraid, jittery, irritable, ashamed, upset, angry, and frustrated. The PA scale consists of 13 items: in good spirits, cheerful, extremely happy, calm and peaceful, satisfied, full of life, close to others, like you belong, enthusiastic, attentive, proud, active, and confident. Daily NA and PA are calculated by averaging the items within each subscale, and then aggregating scores across interview days.

Measure: Positive and Negative Affect Reactivity Scales

Time: Weeks -4, -3, -2, -1, 0, 9, 10, 11

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Description: The Daily Inventory of Stressful Events is used to assess whether each of 7 types of stressors occurred in the past 24 hours: argument, avoided an argument, stressor at work or school, stressor at home, discrimination, network stressor (i.e., stressful event that happened to a close friend or family member), and any other stressor. A day is categorized as a "stressor day" if the participant endorsed at least one stressor, or a "nonstressor day" if the participant indicated that no stressors occurred. Stressor frequency is defined as the percentage of interview days during which at least one stressor occurred. Salivary Cytokine Panels will be collected on two of these stressor and non stressor days respectively.

Measure: Daily Inventory of Stressful Events

Time: Weeks -4, -3, -2, -1, 9, 10, 11, 12

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Description: Difference between mean level of salivary Interleukin-6 during 2 low stressor and 2 high stressor days is exploratory outcome. Evening salivary passive drool samples (which assess TNF-a, IL-1b and IL-8 in addition to IL-6) will be collected 4 times during weeks -4-0 and 4 times during weeks 9-12 during diary collection. They will be primed with REDCAP branching logic activated by 2 multi-stressor (high) stressor days and 2 no stressor days. REDCAP will specifically tell them to select a color/letter coded sampling contained and they will collect that sample that evening. They will place samples immediately in the freezer.

Measure: Inflammatory Cytokines (IL-6, IL-1b, IL-8, TNF-a)

Time: Weeks -4, -3, -2, -1, 9, 10, 11, 12

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Description: A 15-item scale with content from six dimensions of experiential avoidance.

Measure: Brief Experiential Avoidance Questionnaire (BEAQ)

Time: Baseline, Weeks 4, 8, 12

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Description: The Difficulties in Emotion Regulation (DERS) Scale is a 36-item self-report scale designed to assess emotional dysregulation using a 5 point Likert scale. The scale assesses 6 aspects of emotional dysregulation: non-acceptance of emotional responses, difficulties engaging in goal directed behavior, impulse control difficulties, lack of emotional awareness, limited access to emotion regulation strategies, and lack of emotional clarity. Subscales are summed and a lower total score represents a better outcome. Individual subscales will also be assessed.

Measure: Difficulties in Emotion Regulation Scale (DERS)

Time: Baseline, Weeks 4, 8, 12

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Description: The Perceived Stress Scale (PSS-14) (14 items) measures the degree to which situations in life are stressful. Items are designed to evaluate how overloaded, unpredictable, and uncontrollable one finds one's life. Each item is scored on a 5 point Likert scale from 0 (Never) to 4 (Very often).

Measure: Perceived Stress Scale (PSS-14)

Time: Baseline, Weeks 4, 8, 12, 24

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Description: The short-form Self-Compassion Scale (SCS-SF) is an abbreviated 12-item form of the original 26-item Self-Compassion Scale. The scale is scored on a 5 point Likert scale (1 = Almost never; 5 = Almost always), and negative subscale items are reverse scored.

Measure: Self-Compassion Scale Short Form (SCS-SF)

Time: Baseline, Weeks 4, 8, 12

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Description: The Multidimensional Assessment of Interoceptive Awareness (MAIA-2) is a 37 item self-report scale designed to assess multiple aspects of interoception and interoceptive awareness. The scale assesses 8 aspects of interoceptive awareness: noticing, not-distracting, not-worrying, attention regulation, emotional awareness, self-regulation, body listening, and trusting. Subscales are summed and a higher total score represents a better outcome. Individual subscales will also be assessed, especially Body Listen, Body Trust, and Self-Regulation.

Measure: Multidimensional Assessment of Interoceptive Awareness (MAIA-2)

Time: Baseline, Weeks 4, 8, 12

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Description: The adult self-report COVID-19 Responses to Stress Questionnaire is a 72-item survey. Responses are recorded on a 4-point Likert scale (1 = Not at All, 4 = Very/A lot). Items in the RSQ cover 5 factors of coping and stress responses: primary control engagement coping (i.e., problem solving, emotional expression, emotional modulation), secondary control engagement coping (i.e., positive thinking, cognitive restructuring, acceptance, distraction), disengagement coping (i.e., avoidance, denial, wishful thinking); involuntary engagement (e.g., physiological arousal, rumination), and involuntary disengagement (e.g., emotional numbing).

Measure: Responses to Stress Questionnaire - COVID -19 (RSQ-COVID-19) Stress coping style (disengagement, involuntary engagement)

Time: Baseline, Weeks 12, 24

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Description: This is a 20-item self-report measure of decentering and is conceptualized as a protective factor and capable of measuring resilience to depressive relapse. The EQ uses a 5-point Likert scale with responses from "never" to "all the time". A sample item from the decentering subscale is "I can observe unpleasant feelings without being drawn into them."

Measure: Experiences Questionnaire (EQ) (Rumination and Decentering)

Time: Baseline, Weeks 4, 8, 12

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Description: Computer Adaptive Testing for Mental Health (CAT-MH) interviews are diagnostic interviews designed to be completed online using a computer, tablet or phone. Items from each of the modules for depression (CAT-DI), anxiety (ANX-CAT), mania and hypomania (M/HM-CAT), PTSD (PTSD-CAT), psychosis (PSY-S-CAT), suicidality (SS-CAT), and substance abuse (SUD-CAT) are chosen from large item banks based on multidimensional item response theory, adapting each item presented to the individual's severity so that different individuals are tested with different items depending on their severity level.

Measure: Computerized Adaptive Testing for Mental Health (CAT-MH) Interviews

Time: Screening, Baseline, Weeks 1, 2, 3, 4, 5, 6, 7, 8, 12, 16, 20, 24

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Description: The Beck Depression Inventory (BDI-II) is a 21-item self-report scale designed to assess depression severity over the past 2 weeks with well-established internal consistency, reliability and validity.

Measure: Beck Depression Inventory (BDI-II)

Time: Baseline

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Description: Rank Desire for each intervention option will be assessed at baseline.

Measure: Rank Desire

Time: Baseline

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Description: Credibility/Expectancy for the assigned option will be assessed at Week 2. Treatment expectancy and credibility for each arm will be assessed with the 4-item Credibility/ Expectancy Questionnaire (CEQ)

Measure: Credibility and Expectancy

Time: Week 2

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Description: The COVID-19 Fear scale is a 7-item questionnaire recorded on a 5-point Likert scale (1 = Strongly Disagree to 5 = Strongly Agree). Responses to scale items were found to positively correlate with perceived vulnerability, hospital anxiety, and depression. Sample questions include "I am most afraid of coronavirus-19," and "It makes me uncomfortable to think about coronavirus-19."

Measure: COVID-19 Fear

Time: Baseline, Week 12

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Description: Participants will be asked to self-report on REDCap.

Measure: COVID-19 status (self-report)

Time: Week 0, 4, 8, 12, 16, 20, 24

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Description: Participants will be asked to complete a salivary sample to assess COVID-19 status. COVID-19 IgG samples: Antibodies for COVID-19 will be sampled at week 12 among all participants to establish whether they were exposed to COVID-19 during the study. They will place samples immediately in the freezer.

Measure: COVID-19 status (salivary IgG)

Time: Week 12

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Description: The UCI Oral Health Questionnaire is an 12-item survey that asks sociodemographic questions, questions about oral and physical health, as well as additional oral health questions drawn from the WHO Oral Health Survey. The questionnaire includes basic questions about dental health characteristics of participants to be used as an exclusion criteria for the salivary collection portion of the study and to track changes in oral health that might impact salivary data collection.

Measure: UCI Oral Health Questionnaire

Time: Screening and at Week 12

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Description: The Home Skills Use Diary will be completed for the 8 weeks during the intervention period and will come in two types (1: weekly mindfulness practice and resource use diary for the MBCT-R group and 2: General CBT coping skills use diary card for both the iCBT and CHA MindWell arms).

Measure: Home Skills Use Diary

Time: Weeks 1, 2, 3, 4, 5, 6, 7, 8

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Description: The Adverse Event Patient Participant Self-Report Form will be systematically assessed at assessment timepoints (baseline, 4-weeks, 8-weeks, 12-weeks, 16-weeks, 20-weeks and 24-weeks). In addition, group leaders and research coordinators will be trained to identify and report any adverse events that occur or are reported during weekly group visits.

Measure: Adverse Event Patient Participant Self-Report Form

Time: Baseline, Weeks 4, 8, 12, 16, 20, 24

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Primary Outcomes

Description: Number of depressive symptoms evaluated by Edinburgh Postnatal Depression Scale (EPDS). Scores range from 0 to 30. Higher scores mean worse outcome

Measure: Depressive symptoms

Time: June 2020- June 2021

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Description: Number of Post-Traumatic Stress Disorders (PTSD) symptoms evaluated by check list of DSM-5. HIgher number of symptoms mean worse outcomes

Measure: Posttraumatic Stress Disorder

Time: June 2020- June 2021

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Description: Number of anxiety symptoms evaluated by General Anxiety Disorder questionnaire (GAD 7). Scores range from 0 to 21. Higher scores mean worse outcomes.

Measure: Anxiety symptoms

Time: June 2020- June 2021

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Primary Outcomes

Description: % prevalence of depression in adult population of south punjab will be assessed

Measure: Prevalence estimation of depression in adults

Time: study will be completed in 15 days maximum

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Primary Outcomes

Description: The Children's Depression Inventory (CDI) 2 - short form (CDI-SF) is a reliable, valid measure of youth-reported depression severity, normed for youth age and sex and yielding raw and T scores.

Measure: Change in adolescent depressive symptom severity

Time: Pre-intervention to 3-month follow-up; Pre-intervention to 6-month follow-up; Pre-intervention to 12-month follow-up; Pre-intervention to 18-month follow-up; Pre-intervention to 24-month follow-up

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Secondary Outcomes

Description: The Children's Depression Inventory (CDI) 2 - parent form will be used to note differences in youth depression severity.

Measure: Changes in parent-reported adolescent symptom severity

Time: Pre-intervention to 3-month follow-up; Pre-intervention to 6-month follow-up; Pre-intervention to 12-month follow-up; Pre-intervention to 18-month follow-up; Pre-intervention to 24-month follow-up

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Other Outcomes

Description: Parents will report demographic, family, and other background information (e.g. age, sex, gender identity, race, mental health treatment history).

Measure: Demographics

Time: Pre-intervention only (sex, race); Pre-intervention, 3-month follow-up, 6-month follow-up, 12-month follow-up, 18-month follow-up, 24-month follow-up (age, gender identity, mental health treatment history)

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Description: Youth will complete the Pubertal Development Scale, given effects of puberty on depression onset.

Measure: Pubertal development

Time: Pre-intervention only

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Description: The ACEs questionnaire will ask parents about their child's and their own exposure to violence, childhood emotional, physical, or sexual abuse, and household dysfunction during childhood.

Measure: Adverse Childhood Experiences (ACEs) for parent and child

Time: Pre-intervention only

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Description: Adolescents' self-hate will be assessed using the 7-item Self-Hate Scale (SHS). Adolescents will indicate the extent to which each statement is true for them (e.g. "I hate myself") on a 7-point Likert scale. The SHS is a valid measure of self-hate, with excellent internal consistency.

Measure: Self-Hate and related constructs

Time: Pre-intervention to 3-month follow-up; Pre-intervention to 6-month follow-up; Pre-intervention to 12-month follow-up; Pre-intervention to 18-month follow-up; Pre-intervention to 24-month follow-up

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Description: Adolescents will complete the 99-item version of the IDAS-II. Respondents indicate the extent to which they had experienced each symptom "during the past two weeks, including today" on a 5-point scale ranging from not at all to extremely. The IDAS contains scales evaluating levels of Dysphoria; Well-Being; Panic; Suicidality, Lassitude, and Insomnia; Social Anxiety and Ill Temper; Traumatic Intrusions scale; and Appetite Loss and Appetite Gain; and Depression and Dysphoria. The IDAS-II is well-validated and nationally-normed for use with adolescents.

Measure: Inventory of Depression and Anxiety Symptoms (IDAS-II)

Time: Pre-intervention to 3-month follow-up; Pre-intervention to 6-month follow-up; Pre-intervention to 12-month follow-up; Pre-intervention to 18-month follow-up; Pre-intervention to 24-month follow-up

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Description: Given high comorbidity between depression and anxiety, adolescent anxiety symptom severity will be assessed via adolescent and parent reports using the SCARED: a reliable, valid, widely used youth anxiety assessment with analog parent and youth-report forms.

Measure: Screen for Child Anxiety and Related Disorders (SCARED)

Time: Pre-intervention to 3-month follow-up; Pre-intervention to 6-month follow-up; Pre-intervention to 12-month follow-up; Pre-intervention to 18-month follow-up; Pre-intervention to 24-month follow-up

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Description: Youths' approach versus disengagement from rewarding activities will be assessed via the BADS, a 9-item youth-report questionnaire with strong reliability, predictive validity, and sensitivity to change following BA for adolescent MD.

Measure: Behavioral Activation for Depression Scale (BADS)-Short Form

Time: Pre-intervention to 3-month follow-up; Pre-intervention to 6-month follow-up; Pre-intervention to 12-month follow-up; Pre-intervention to 18-month follow-up; Pre-intervention to 24-month follow-up

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Description: The SRET is a web-based behavioral measure of self-referent information processing biases that assesses judgements of self-descriptiveness, response latencies and free recall of emotionally valanced stimuli. Adolescents will make decisions about whether positive and negative adjectives are self-descriptive. Participants view various adjectives (26 positive adjectives, 26 negative adjectives) one at a time and make rapid judgments about whether or not each word presented described themselves following word offset. Participants will be told to use the Q or P keys on their keyboard to answer whether the word described them or not. Each trial will be followed by a 1,500 ms intertrial interval.

Measure: Self-Referential Encoding Task (SRET)

Time: Pre-intervention

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Description: The DRS-2 is a 9-item measure evaluating restrictive eating, bingeing, and purging behaviors in participants. 6 items ask adolescents whether or not they have engaged in restrictive eating, bingeing, or purging behaviors in the past year or in the past 3 months (0 = no; 1 = yes). The other 3 items assess the frequency of these behaviors over the past 28 days.

Measure: The Dietary Restriction Screener (DRS)

Time: Pre-intervention to 3-month follow-up; Pre-intervention to 6-month follow-up; Pre-intervention to 12-month follow-up; Pre-intervention to 18-month follow-up; Pre-intervention to 24-month follow-up

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Description: Four items from a self-report version of the SITBI-SF will be used to assess each adolescent's lifetime history of suicide ideation, suicide attempts, and deliberate self-harm. The SITBI-SF is a widely used measure of the continuum of suicidality and self-harm and has demonstrated high test-retest reliability, high internal consistency, and moderate-to-high concurrent validity. Score range for this measure can range widely (per wide variation in instances of self-harming behaviors across one's lifetime); thus, we anticipate a minimum score of 0 and are unable to predict the top (maximum) score.

Measure: Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF)

Time: Pre-intervention to 3-month follow-up; Pre-intervention to 6-month follow-up; Pre-intervention to 12-month follow-up; Pre-intervention to 18-month follow-up; Pre-intervention to 24-month follow-up

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Description: The SCSC is a 20-item scale measuring youths' perceived ability to shape the personal impact of objective conditions on oneself, by adjusting oneself to fit those conditions. Youth rate agreement with items reflecting various kinds of secondary control, such as adjusting cognition ("When something bad happens, I can find a way to think about it that makes me feel better"). The SCSC has shown acceptable reliability and validity in a large youth sample.

Measure: Secondary Control Scale for Children (SCSC)

Time: Pre-intervention to 3-month follow-up; Pre-intervention to 6-month follow-up; Pre-intervention to 12-month follow-up; Pre-intervention to 18-month follow-up; Pre-intervention to 24-month follow-up

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Description: The Becks Hopelessness Scale (BHS) asks both parents and youth to rate 4 statements based on their sense of hopelessness. Participants rate the 4 statements on a 4 point scale ranging from 0 (Absolutely Disagree) to 3 (Absolutely Agree). Total score ranges from 0 to 12, with higher scores indicating greater levels of hopelessness.

Measure: Hopelessness

Time: Immediately Pre- to Immediately Post-intervention; Pre-intervention to 3-month follow-up; Pre-intervention to 6-month follow-up; Pre-intervention to 12-month follow-up; Pre-intervention to 18-month follow-up; Pre-intervention to 24-month follow-up

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Description: The Primary Control Scale for Children (PCSC) is a 24-item scale measuring youths' perceived ability to influence or alter objective events or conditions through personal effort. Youth rate agreement with statements about their ability to exert primary control (e.g., "I can do well on tests if I study hard"; "I can get other kids to like me if I try"). This PCSC has shown acceptable internal consistency, 6-month test-retest reliability, and strong inverse relations to adolescent depressive symptoms.

Measure: Perceived agency

Time: Pre-intervention to 3-month follow-up; Pre-intervention to 6-month follow-up; Pre-intervention to 12-month follow-up; Pre-intervention to 18-month follow-up; Pre-intervention to 24-month follow-up

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Description: The IPTQ asks youth to rate the extent of their agreement with three statements linked to the malleability of personality, using a 1-to-7 Likert scale (e.g. "Your personality is something about you that you can't change very much." Higher summed scores on these three items indicate a stronger fixed personality mindset, a lower scores, a stronger growth personality mindset.

Measure: Implicit Personality Theory Questionnaire (IPTQ)

Time: Immediately Pre- to Immediately Post-intervention; Pre-intervention to 3-month follow-up; Pre-intervention to 6-month follow-up; Pre-intervention to 12-month follow-up; Pre-intervention to 18-month follow-up; Pre-intervention to 24-month follow-up

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Description: The BFAMG provides an overview of family functioning. Adolescents and parents rate 14 statements describing the family (e.g. "We feel loved in our family.") using a 0-3 Likert scale.

Measure: Brief Family Assessment Measure (General Scale)

Time: Pre-intervention to 3-month follow-up; Pre-intervention to 6-month follow-up; Pre-intervention to 12-month follow-up; Pre-intervention to 18-month follow-up; Pre-intervention to 24-month follow-up

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Description: The MVPS is a self-report scale assessing adolescents' experiences of peer victimization. This study will include the social manipulation, verbal victimization, and physical victimization scales, totaling 12 items. Adolescents rate how often peers have victimized them in various ways in the past year (e.g. "called me names"; "tried to turn my friends against me").

Measure: Multidimensional Peer Victimization Scale

Time: Pre-intervention to 3-month follow-up; Pre-intervention to 6-month follow-up; Pre-intervention to 12-month follow-up; Pre-intervention to 18-month follow-up; Pre-intervention to 24-month follow-up

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Description: The ULS is a widely used self-report scale of loneliness in adolescents. The brief 8-item version will be used here. Adolescents rate agreement with 8 items reflecting loneliness (e.g. "I feel left out"; "I feel isolated from others"). The ULS has shown adequate reliability and validity in adolescent samples.

Measure: UCLA Loneliness Scale

Time: Pre-intervention to 3-month follow-up; Pre-intervention to 6-month follow-up; Pre-intervention to 12-month follow-up; Pre-intervention to 18-month follow-up; Pre-intervention to 24-month follow-up

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Description: The BSI-18 is a valid, reliable screening tool for adult (here, parental) psychological distress. Adult respondents rate endorsement of 18 physical and emotional complaints on a 0-4 Likert scale. The BSI-18 includes 3 subscales for somatic, anxiety, and depressive symptoms, respectively. The total sum score yields an additional total distress score.

Measure: Brief Symptom Inventory-18

Time: Pre-intervention to 3-month follow-up; Pre-intervention to 6-month follow-up; Pre-intervention to 12-month follow-up; Pre-intervention to 18-month follow-up; Pre-intervention to 24-month follow-up

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Description: Parents will complete the Barriers to Accessing Care Evaluation at baseline, modified for use by parents. Parents rate the degree to which various beliefs, concerns, circumstances, and logistical difficulties have stopped, delayed or discouraged them from getting professional care for their child's mental health problem. Higher total scores indicate greater perceived barriers to care.

Measure: Perceived barriers to treatment

Time: Pre-SSI only

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Description: Prognostic Pessimism for Depression (PPD) consists of five short questions, adapted from previous research, that aim to quantify a participants' perception of depression as a fixed or malleable condition. Both parents and adolescents will complete the PPD. Questions ask how permanent participants expect depression to be, why, and what might make it less so. An analogous set of questions are posed to parents, who are asked to respond about their children.

Measure: Prognostic Pessimism For Depression

Time: Pre-intervention to 3-month follow-up; Pre-intervention to 6-month follow-up; Pre-intervention to 12-month follow-up; Pre-intervention to 18-month follow-up; Pre-intervention to 24-month follow-up

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Description: Adapted from CDC Item Bank questions, these questions ask parents about the effects of COVID-19 on their families. Questions ask about stress caused by the pandemic, coping, illness, and effects on other items such as finances, mental health treatment, and employment.

Measure: COVID-19 Items

Time: Pre-intervention only

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Description: The ESM surveys will include selected items from the Patient Health Questionnaire-9, a widely-used measure of adolescent and adult depressive symptoms. Items will assess symptoms that could plausibly shift in any 2-3 hour period. At the end of the final survey on each day, adolescents will be asked two additional free response questions: "What was the most pleasant event today?" and "What was the most unpleasant event today?".

Measure: Ecological Sampling Method Surveys (ESM)

Time: Pre-intervention only

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Primary Outcomes

Description: Number of consenting participants out of total number contacted over the recruitment period

Measure: Consent rate

Time: At recruitment

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Description: Investigators will report on rates of missing data from baseline and follow-up questionnaires

Measure: Data completion rate

Time: From recruitment launch to completion of follow-up (4 months)

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Description: Logs and checklists will be used to evaluate completion of intervention, as per protocol

Measure: Fidelity of intervention completion

Time: A 8 week follow-up

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Description: Using the validated 9 item Patient Health Questionnaire (PHQ-9). Scores range from 0 to 27 - higher score indicates more severe depression

Measure: Severity of depression symptoms

Time: At baseline

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Description: Using the validated 9 item Patient Health Questionnaire (PHQ-9). Scores range from 0 to 27 - higher score indicates more severe depression

Measure: Severity of depression symptoms

Time: At 8 week follow-up

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Description: Using the validated 7 item General Anxiety Disorder (GAD-7) instrument. Scores range from 0 to 21 - higher score indicates more severe anxiety

Measure: Severity of anxiety symptoms

Time: At baseline

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Description: Using the validated 7 item General Anxiety Disorder (GAD-7) instrument. Scores range from 0 to 21 - higher score indicates more severe anxiety

Measure: Severity of anxiety symptoms

Time: At 8 week follow-up

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Description: Using questions developed by the team and administrative databases to assess use of hospital and mental health care services

Measure: Use of health care services

Time: At baseline

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Description: Using questions developed by the team and administrative databases to assess use of hospital and mental health care services

Measure: Use of health care services

Time: At 8 week follow-up

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Description: Using adherence questions developed by the team, not scored

Measure: Use of the self-care materials

Time: At 8 week follow-up

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Primary Outcomes

Description: Mood and Anxiety Symptoms Questionnaire (MASQ)

Measure: Changes in Anxiety, Depression, and Distress

Time: Pre-Treatment, Post-Treatment (4-5 weeks after starting treatment), 3-Month Follow-Up, 9-Month Follow-Up, 2-Year Follow-Up

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Description: Depression Anxiety Stress Scale (DASS)

Measure: Changes in Anxiety, Depression, and Distress

Time: Pre-Treatment, Post-Treatment (4-5 weeks after starting treatment), 3-Month Follow-Up, 9-Month Follow-Up, 2-Year Follow-Up

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Description: Penn State Worry Questionnaire (PSWQ)

Measure: Changes in Worry

Time: Pre-Treatment, Post-Treatment (4-5 weeks after starting treatment), 3-Month Follow-Up, 9-Month Follow-Up, 2-Year Follow-Up

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Description: Rumination-Reflection Questionnaire (RRQ)

Measure: Changes in Rumination

Time: Pre-Treatment, Post-Treatment (4-5 weeks after starting treatment), 3-Month Follow-Up, 9-Month Follow-Up, 2-Year Follow-Up

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Description: Sheehan Disability Scale (SDS)

Measure: Changes in Functional Impairment

Time: Pre-Treatment, Post-Treatment (4-5 weeks after starting treatment), 3-Month Follow-Up, 9-Month Follow-Up, 2-Year Follow-Up

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Description: Brief Multidimensional Students' Life Satisfaction Scale (BMSLSS)

Measure: Changes in Life Satisfaction

Time: Pre-Treatment, Post-Treatment (4-5 weeks after starting treatment), 3-Month Follow-Up, 9-Month Follow-Up, 2-Year Follow-Up

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Description: Patient-Reported Outcomes Measurement Information System (PROMIS): Meaning and Purpose

Measure: Changes in Life Satisfaction

Time: Pre-Treatment, Post-Treatment (4-5 weeks after starting treatment), 3-Month Follow-Up, 9-Month Follow-Up, 2-Year Follow-Up

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