3  Results

3.1  Website and call volumes
Visits to the MindSpot Clinic website increased by 89% between the two time periods. Call volumes to MindSpot increased by at least 90% in the same period, although the exact figure is not available due to difficulty tracking the higher volume at the time when MindSpot staff were transitioning to fully working from home, in response to government directives. Phone records also show that average duration of calls increased by 100%, reflecting the level of distress of callers and the complexity of reported needs.

3.2  Symptom and demographic characteristics
Table 1 compares the demographic and symptom characteristics of the two samples. Patients in the COVID-19 sample were more likely to be female and were less likely to be employed. Despite the lower proportion in employment, there was no difference in reported psychosocial stressors, including financial stress or concerns about physical health. The COVID-19 sample had higher anxiety symptoms, and more people who self-reported being anxious than the comparison sample. A greater proportion of the COVID-19 sample reported that symptoms of anxiety and depression had emerged within the previous two weeks, although the proportions were still small. However, no differences were found in the level of symptoms of psychological distress, depression, or suicidal thoughts or plans.
Table 1 Comparison of demographic and symptom characteristics.
Comparison sample1–28 September 2019 COVID-19 sample19 March–15 April 2020 Significance
Demographics
Mean age (SD), range 35.0 (13.5), 18–86 34.9 (13.6), 18–92 F = 0.04, p = .84
18–29 years 43.6% (720/1650) 44.6% (744/1668) ꭙ2 = 0.32, p = .57
35–54 years 45.6% (752/1650) 43.9% (732/1668) ꭙ2 = 0.96, p = .33
55 years and over 10.8% (178/1650) 11.5% (192/1668) ꭙ2 = 0.44, p = .51
Proportion female 72.9% (1203/1650) 76.9% (1282/1668) ꭙ2 = 6.67, p = .01⁎⁎
Capital city or surrounding suburbs 60.4% (932/1544) 58.7% (904/1541) ꭙ2 = 0.92, p = .34
Aboriginal or Torres Strait Islander 4.7% (55/1163) 3.3% (39/1188) ꭙ2 = 3.20, p = .07
University education 42.4% (654/1543) 41.2% (633/1535) ꭙ2 = 0.42, p = .52
Employed full or part time 60.8% (939/1544) 52.8% (811/1536) ꭙ2 = 20.17, p < .001⁎⁎⁎
Marital status 36.9% (568/1541) 34.7% (534/1539) ꭙ2 = 1.39, p = .24



Psychosocial stressors% (number) of patients who indicated the following stressors were a current concern
Relationships with friends or family 53.4% (881/1650) 52.7% (879/1668) ꭙ2 = 0.16, p = .69
Work, study, or vocational activities 47.9% (791/1650) 44.8% (748/1668) ꭙ2 = 3.20, p = .07
Physical health 37.6% (621/1650) 35.2% (587/1668) ꭙ2 = 2.14, p = .14
Finances 26.2% (432/1650) 24.6% (410/1668) ꭙ2 = 1.12, p = .29



Psychological symptoms
K-10 (mean and SD) 31.2 (7.6) 31.4 (7.8) F = 0.52, p = .47
PHQ-9 (mean and SD) 14.3 (6.2) 14.4 (6.2) F = 0.24, p = .63
GAD-7 (mean and SD) 12.1 (5.1) 12.5 (5.3) F = 4.13, p < .05⁎
Self-reported anxiety 86.2% (1317/1528) 89.3% (1341/1502) ꭙ2 = 6.74, p < .01⁎⁎
Anxiety < two weeks 3.0% (39/1317) 5.4% (73/1341) ꭙ2 = 9.97, p < .01⁎⁎
Self-reported depression 69.5% (1062/1528) 69.0% (1037/1502) ꭙ2 = 0.08, p = .78
Depression < two weeks 4.0% (43/1062) 6.8% (71/1037) ꭙ2 = 7.90, p < .01⁎⁎
Suicidal thoughts 30.6% (423/1383) 27.5% (367/1334) ꭙ2 = 3.11, p = .08
Suicidal intentions or plans 3.7% (51/1383) 2.9% (39/1334) ꭙ2 = 1.24, p = .27
⁎ p < .05.
⁎⁎ p < .01.
⁎⁎⁎ p < .001.

3.3  Concern about and impact of COVID-19
Table 2 shows responses to the COVID-19 questions added to the MindSpot online assessment in March 2020. Although only a small number of users personally knew someone who had been infected by the virus, the majority (93.8%) in the COVID-19 sample were concerned about getting COVID-19, and 87.1% reported they had made changes in lifestyle or routines to avoid infection. In response to a question about changes they had made, as shown in Table 2, around half (47.9%) reported they were following recommended strategies including social distancing, self-isolation, and increased hygiene, and 18.5% reported changes associated with efforts to maintain resilience.
Table 2 Response to COVID-19 specific questions.
% (n)
Have you or has anyone you know been diagnosed with COVID-19?
No 97.1% (1030/1054)
Yes, someone I know 2.8% (23/1054)
Yes, myself 0.1% (1/1054)



Overall, how concerned are you about COVID-19?
Extremely concerned 21.1% (310/1471)
Moderately concerned 42.8% (630/1471)
Slightly concerned 29.9% (440/1471)
Not at all concerned 6.2% (91/1471)



Have you had to make any changes to help you to manage the impact of COVID-19?
Significant changes 29.0% (425/1463)
Moderate changes 34.2% (500/1463)
Slight changes 23.9% (349/1463)
No changes 12.9% (189/1463)



If you have made changes, what has been most helpful?
Following practical and recommended measures (e.g., social distancing, increased hygiene) 47.9% (346/723)
Practicing resilience (e.g., establishing new routines, goals and plans, self-care, decreasing use of social media and news sites) 18.5% (134/723)



What has been challenging?
Financial insecurity, including difficulties accessing groceries and essentials 12.4% (90/723)
Compounding of pre-existing symptoms or Increased feelings of anxiety, stress or worry 11.5% (83/723)
Managing relationships within the home 4.6% (33/723)

3.4  Analysis by age group
Table 3 shows symptom scores on the K-10, PHQ-9, and GAD-7 by age group for both the comparison sample and the COVID-19 sample, and the level of concern and changes to routine by age group for the COVID-19 sample. Baseline symptom scores on the K-10, PHQ-9, and GAD-7 decreased with age for both samples, however the degree of concern about COVID-19 increased with age, from 15.0% in the 18–29 years age group to 35.5% in the over 55 years age group. Similarly, changes to routine increased with age, with 24.8% of 18–29-year olds reporting significant changes compared to 37.8% of the over 55 years age group.
Table 3 Analyses of symptom scores and COVID-19 responses by sample and age group.
18–29 years 30–54 years 55 years and over Significance
Comparison sample
 K-10 32.6 (7.3) 30.3 (7.6) 29.1 (8.1) F = 22⁎⁎⁎
 PHQ-9 15.2 (6.1) 13.6 (6.3) 13.2 (6.0) F = 14.13, p < .001⁎⁎⁎
 GAD-7 12.8 (5.0) 12.0 (5.2) 10.3 (5.5) F = 14.67, p < .001⁎⁎⁎
COVID-19 sample
 K-10 33.2 (7.1) 30.4 (8.0) 28.1 (8.1) F = 39.12, p < .001⁎⁎⁎
 PHQ-9 15.6 (5.8) 13.6 (6.3) 12.3 (6.5) F = 27.30, p < .001⁎⁎⁎
 GAD-7 13.2 (5.0) 12.4 (5.4) 10.5 (5.8) F = 16.77, p < .001⁎⁎⁎
Knows someone diagnosed with COVID-19 2.6% (17/666) 3.3% (21/632) 2.3% (4/171) ꭙ2 = 0.88, p = .64
Extremely concerned about COVID-19 15.0% (100/665) 23.5% (149/634) 35.5% (61/172) ꭙ2 = 37.31, p < .001⁎⁎⁎
Made significant changes to routine 24.8% (165/663) 30.8% (195/629) 37.8% (65/171) ꭙ2 = 13.40, p < .01⁎⁎
⁎ p < .05.
⁎⁎ p < .01.
⁎⁎⁎ p < .001.

3.5  Patient concerns reported by therapists
Therapists reported that patients presented with a range of concerns, including anxiety about either themselves or an elderly relative contracting COVID-19, job loss, financial insecurity and concern about obtaining essential items (12.4%), compounding pre-existing anxiety or stress (11.5%), and managing relationships within the home (4.6%). Health professionals and front-line staff contacting MindSpot reported concerns for their own safety and concerns that they may inadvertently infect family members.