# title
Mental Health Outcomes of a Mobile App-Based Positive Psychology Intervention for Healthcare Workers During the COVID-19 Pandemic: A Single-Arm PrePost Pilot Study (Preprint)

# abstract
BACKGROUND
Healthcare workers are exposed to high levels of occupational stressors that threaten their mental well-being and healthcare system performance. This has important implications for both patient care and workforce sustainability. To build staff resilience and support their mental health, various approaches have been investigated, including positive psychological interventions (PPIs). However, evidence from real-world healthcare settings, particularly for PPIs delivered through a mobile mental health app, remains limited.
OBJECTIVE
This study aimed to evaluate a self-guided PPI delivered through a mobile mental health app for healthcare workers in a large healthcare system during the COVID-19 pandemic. We evaluated changes in positive and negative emotion, emodiversity (the diversity of emotional experiences), anxiety, depression, and burnout.
METHODS
Healthcare workers voluntarily enrolled in an 8-week, brief, daily self-guided PPI. Participants completed questionnaires at pre-, mid-, and post-intervention. Positive and negative emotions and emodiversity were assessed using the mDES, while anxiety, depression, and mindfulness were assessed using the GAD-7, PHQ-8, and FMI, respectively. Burnout was assessed among healthcare providers only using the MBI-HSS (MP). Longitudinal changes were analyzed using mixed-effects regression. Differences between participants who continued and those who dropped out were examined using two-sample t tests or permutation tests, as appropriate. Emodiversity outcomes were evaluated using group-level comparisons.
RESULTS
: Positive emotion and mindfulness significantly increased over time (P = .001 and P = .004, respectively), while negative emotion significantly decreased (P = .006). Positive emodiversity remained stable across assessments, whereas negative emodiversity significantly decreased (P = .035). Anxiety (GAD-7) and depression (PHQ-8) significantly decreased from pre- to post-intervention (both P < .001). Burnout subscales (emotional exhaustion, depersonalization, and personal accomplishment) did not show significant change over time.
CONCLUSIONS
The outcomes suggest that a brief mobile appbased PPI was associated with improvements in emotional outcomes and reductions in anxiety and depressive symptoms among healthcare workers. Reductions in negative emodiversity may further indicate favorable changes in emotional experience; however, burnout did not change, suggesting that individual-level interventions may be less effective than organizational-level interventions for constructs such as burnout. High attrition underscores the need for improved retention strategies in mobile mental health programs.

# authors[].organizations[].label
Center for Health Organization Transformation

# authors[].organizations[].label
Institute for Engineering Education and Innovation

# authors[].organizations[].label
Institute for Science, Technology, and Public Policy

# authors[].organizations[].label
Center for Remote Health Technologies and Systems

# authors[].organizations[].label
Texas A&M Engineering Experiment Station (TEES)

# authors[].organizations[].label
Bush School of Government and Public Service

# authorList[]
Ahmadi, N., Sasangohar, F., Jones-wood, S., Moskowitz, J., & Phillips, R.