Global mental health and COVID-19

Suicide prevention in the covid-19 era

The COVID-19 pandemic is affecting the health of people all around the world including mental health as social isolation which has been one of the best infection mitigation efforts is strongly associated with anxiety, depression, self-harm and suicide attempts. These feelings are consistent with past pandemics where there was loss of routine and sociability. Suicidality has been on the rise in the United States and it is within this context that the pandemic has struck. With the risk of suicide being increased, preventative measures need to be implemented at the universal, selective and indicated levels. Universal suicide prevention is needed for the population as a whole regardless of their risk of suicide. Selective prevention is for subgroups at an increased risk and lastly indicated prevention corresponds to people at a very high risk, for example those with recent suicide attempts. Telemedicine, informative and responsible media, as well as monetary help from governments, banks and other major institutions can all help with suicide prevention in these during the pandemic. These resources can broadly help the population at large, but more targeted approaches will be needed for high risk individuals including those with psychiatric diagnoses, COVID-19 survivors, frontline healthcare workers and the elderly. Additionally, those with recent suicide attempts should warrant even more attention.

The benefit of an ambulant psychiatric rehabilitation program in Vienna, Austria: an uncontrolled repeated measures study

We investigated the benefit of a 6-week ambulant psychiatric rehabilitation program in an ambulant psychiatric rehabilitation clinic in Vienna, Austria, from January 2014 to December 2016 by an uncontrolled repeated measures study. The potential of this intervention program was assessed by effectiveness and cost measures using suitable statistical analyses. We compared the effectiveness and cost measures of this ambulant psychiatric rehabilitation program on patients for the period of up to 12 months after discharge to the period of 12 months before admission to the intervention program based on self-reported catamnesis questionnaires. For the program's effectiveness measures, we accounted for both psychological indices for measuring depression severity, symptom burden, and functioning to document the health improvement of patients and economy-related indices such as the number of sick leave days for patients. For the program's cost measures, both direct tangible treatment and medication costs and indirect tangible costs based on the productivity loss measured in non-working days of the patients were considered. The results significantly demonstrated that all psychological effectiveness measures for the patients highly improved by the 6-weeks rehabilitation program and remained rather stable 12 months after discharge. We found that costs for the 6-week ambulant psychiatric rehabilitation program could be easily covered within 12 months after discharge once a total societal cost perspective was considered. Even additional total cost savings of up to over 5000 Euro could be achieved which were highest for employed patients, followed by unemployed patients receiving rehabilitation allowance due to both their high direct medication and treatment costs as well as high indirect costs for productivity loss. The most important finding was that this treatment program was especially beneficial for rehabilitation patients in earlier stages of psychiatric diseases who were still employed, indicating the need for early intervention in mental disorder.

Long-Term Impact of Economic Downturn and Loneliness on Psychological Distress: Triple Crises of COVID-19 Pandemic

Background: The COVID-19 crisis poses global mental health and global economy challenges. However, there is a lack of longitudinal research investigating whether financial instability and social disruption may increase the risk of developing mental health problems over time that may potentially outlast the pandemic. Methods: We conducted an online survey for members of the general population (n = 2703) in Germany during the twelve months spanning from April 2020 to March 2021. We investigated the development of COVID-19 related psychological distress, the number of unemployed people, federal government debt, income distribution, and loneliness over the time period. Results: Over a period of twelve months, 53.6% of respondents in Germany reported experiencing psychological distress, varying from mild levels, 34.2%, to severe levels, 19.4%, of distress. High federal government debt, high incident COVID-19 cases, low incomes, and the prevalence of loneliness were found to be associated with increased long-term mental health problems. Psychological distress scores were most strongly increased in female and young respondents as well as those who reported fewer years of education, low income, and higher loneliness. Conclusions: Our study highlights factors that have a long-term impact on mental health amid the COVID-19 pandemic. We suggest that specific mental-health services could be offered to support high-risk groups experiencing financial fragility and loneliness. For purposes of safeguarding their mental health there is a need to monitor and track such risk factors in real time.

Exploring the public health potential of RED January, a social media campaign supporting physical activity in the community for mental health: a qualitative study

STATEMENT OF PROBLEM

RED January is an annual social media campaign challenging individuals to be physically active every day during January, and highlighting the potential for improvements in mood and wellbeing. Our aim was to explore elements of the challenge that motivate engagement with, and sustained participation in, physical activity for mental health.

METHOD

RED January registrants (n= 55,772, female = 45,802; 82%) were invited to take part. Volunteers supplied information on sex, age band and moderate-to-vigorous physical activity in the past week. Forty registrants (24 female), recruited in December 2019 using a purposive sampling approach to identify a maximum-variation sample, participated in semi-structured interviews (31 face-to-face) after completing the challenge. The resulting transcripts were thematically analysed, using the Framework method.

RESULTS

Two main themes relating to motivation were identified. 'Pleasure' referred to how daily activity promoted physical enjoyment and positive affective states via engaging with the environment, finding mental space and peace, and enjoyable social interactions. 'Purpose' referred to the experiences of engaging with the campaign, and observed changes in health outcomes. These included setting flexible and appropriate goals, measuring and reviewing progress, noting wider biological and behavioural changes, and receiving support from the social media community. Points for consideration were feelings of failure when not achieving self-imposed targets, the unintended facilitation of obsessive exercising, and social media posts that triggered negative thoughts among a minority of participants.

CONCLUSIONS

Findings suggest RED January may have potential as a public health resource. The challenge might not suit individuals with severe disorders.

Community interventions for improving adult mental health: mapping local policy and practice in England

BACKGROUND

Public mental health (PMH) aims to improve wellbeing and prevent poor mental health at the population level. It is a global challenge and a UK priority area for action. Communities play an important role in the provision of PMH interventions. However, the evidence base concerning community-based PMH interventions is limited, meaning it is challenging to compare service provision to need. Without this, the efficient and equitable provision of services is hindered. Here, we sought to map the current range of community-based interventions for improving mental health and wellbeing currently provided in England to inform priority areas for policy and service intervention.

METHOD

We adopted an established mapping exercise methodology, comparing service provision with demographic and deprivation statistics. Five local authority areas of England were selected based on differing demographics, mental health needs and wider challenging circumstances (i.e. high deprivation). Community-based interventions were identified through: 1) desk-based research 2) established professional networks 3) chain-referral sampling of individuals involved in local mental health promotion and prevention and 4) peer researchers' insight. We included all community-based, non-clinical interventions aimed at adult residents operating between July 2019 and May 2020.

RESULTS

407 interventions were identified across the five areas addressing 16 risk/protective factors for PMH. Interventions for social isolation and loneliness were most prevalent, most commonly through social activities and/or befriending services. The most common subpopulations targeted were older adults and people from minority ethnic backgrounds. Interventions focusing on broader structural and environmental determinants were uncommon. There was some evidence of service provision being tailored to local need, though this was inconsistent, meaning some at-risk groups such as men or LGBTQ+ people from minority ethnic backgrounds were missed. Interventions were not consistently evaluated.

CONCLUSIONS

There was evidence of partial responsiveness to national and local prioritising. Provision was geared mainly towards addressing social and individual determinants of PMH, suggesting more integration is needed to engage wider service providers and policy-makers in PMH strategy and delivery at the community level. The lack of comprehensive evaluation of services to improve PMH needs to be urgently addressed to determine the extent of their effectiveness in communities they serve.

Threats to Global Mental Health From Unregulated Digital Phenotyping and Neuromarketing: Recommendations for COVID-19 Era and Beyond

The new era of digitalized knowledge and information technology (IT) has improved efficiency in all medical fields, and digital health solutions are becoming the norm. There has also been an upsurge in utilizing digital solutions during the COVID-19 pandemic to address the unmet mental healthcare needs, especially for those unable to afford in-person office-based therapy sessions or those living in remote rural areas with limited access to mental healthcare providers. Despite these benefits, there are significant concerns regarding the widespread use of such technologies in the healthcare system. A few of those concerns are a potential breach in the patients' privacy, confidentiality, and the agency of patients being at risk of getting used for marketing or data harnessing purposes. Digital phenotyping aims to detect and categorize an individual's behavior, activities, interests, and psychological features to properly customize future communications or mental care for that individual. Neuromarketing seeks to investigate an individual's neuronal response(s) (cortical and subcortical autonomic) characteristics and uses this data to direct the person into purchasing merchandise of interest, or shaping individual's opinion in consumer, social or political decision making, etc. This commentary's primary concern is the intersection of these two concepts that would be an inevitable threat, more so, in the post-COVID era when disparities would be exaggerated globally. We also addressed the potential "dark web" applications in this intersection, worsening the crisis. We intend to raise attention toward this new threat, as the impacts might be more damming in low-income settings or/with vulnerable populations. Legal, health ethics, and government regulatory processes looking at broader impacts of digital marketing need to be in place.

Psychiatry in the Digital Age: A Blessing or a Curse?

Social distancing and the shortage of healthcare professionals during the COVID-19 pandemic, the impact of population aging on the healthcare system, as well as the rapid pace of digital innovation are catalyzing the development and implementation of new technologies and digital services in psychiatry. Is this transformation a blessing or a curse for psychiatry? To answer this question, we conducted a literature review covering a broad range of new technologies and eHealth services, including telepsychiatry; computer-, internet-, and app-based cognitive behavioral therapy; virtual reality; digital applied games; a digital medicine system; omics; neuroimaging; machine learning; precision psychiatry; clinical decision support; electronic health records; physician charting; digital language translators; and online mental health resources for patients. We found that eHealth services provide effective, scalable, and cost-efficient options for the treatment of people with limited or no access to mental health care. This review highlights innovative technologies spearheading the way to more effective and safer treatments. We identified artificially intelligent tools that relieve physicians from routine tasks, allowing them to focus on collaborative doctor-patient relationships. The transformation of traditional clinics into digital ones is outlined, and the challenges associated with the successful deployment of digitalization in psychiatry are highlighted.

Policing in a Pandemic: a Commentary on Officer Well-being During COVID-19

The role of police officers during the coronavirus (COVID-19) pandemic is challenging, faced with the difficult task of keeping communities safe and preventing the spread of COVID-19 while putting their physical and mental health at risk. Emerging evidence points to the stress experiences of officers during the COVID-19 pandemic. With cases now surpassing 174 million and close to four million deaths worldwide, as well as stringent lockdown measures, police officers are faced with unprecedented challenges resulting from the pandemic. This commentary suggests police departments strengthen resources by putting in place appropriate emergency planning for future public health incidents, in addition to preparing for temporary or permanent loss of human resources. It is important to implement robust training plans post-pandemic to allow officers to offer better care for communities when faced with future public health emergencies. Finally, police officers should be provided with the resources and support to cope with the stresses associated with COVID-19.

Depression and Coping Styles of College Students in China During COVID-19 Pandemic: A Systemic Review and Meta-Analysis

Background: The rapid spread and uncertain outcome of the 2019 novel coronavirus disease (COVID-19) around the world have caused worry, fear, and stress among the general population. Nevertheless, the prevalence of depression among college students in China during lockdown, following the COVID-19 pandemic, and their coping strategies have not been quantitatively assessed. Objective: We aimed to evaluate the prevalence of depression among college students in China during the lockdown due to the COVID-19 pandemic and assess their coping strategies. Methods: Systematic review and meta-analysis were conducted to assess the prevalence of depression among college students in China and their coping strategies. Results: The results indicated that, during lockdown in the COVID-19 pandemic, the prevalence rates of college students in China suffering from mild, moderate, and severe depression were 25% (95% CI = 17-33%), 7% (95% CI = 2-14%), and 2% (95% CI = 1-5%), respectively. Besides, the proportion of college students who use WeChat and Weibo to acquire COVID-19 knowledge was 39% (95% CI = 13-68%), whereas the proportion of college students using mental health application services (APPs) to deal with depression was 59% (95% CI = 41-73%). Conclusions: The prevalence of depression among college students in China was high during the lockdown in the COVID-19 pandemic. Thus, considering the adverse outcomes of depression, it is imperative to screen college students in China for depression during the CIVID-19 pandemic and provide them with necessary psychological interventions to control and prevent depression. Social media platforms, such as WeChat and Weibo, and mental health APPs could provide an opportunity for psychological health information dissemination for college students. However, their effectiveness in reducing depression will have to be assessed.

Understanding global mental health: a conceptual review

Background

Mental health disorders are viewed as a global concern requiring globally led approaches to address them. Since the publication of the 2007 Lancet series on global mental health (GMH), the term has become widespread. Over the last two decades, GMH has become increasingly affiliated with policy reform, academic courses, funding bodies and research. However, it is not always obvious how those working in the field of GMH are using the term, resulting in a lack of clarity. Therefore, work is needed to synthesise the current understanding(s) of GMH to help characterise its meaning.

Aim

To synthesise the literature and identify the different ways GMH is understood.

Method

A conceptual review, using a systematic search and a content analysis, was conducted to develop a conceptual framework of the different conceptual understandings of GMH.

Results

We developed a conceptual framework of four understandings of GMH. These understandings of GMH are as follows: an area of research generating findings to establish a GMH evidence-base; implementation of research into practice; improving the mental health environment; learning from and supporting low-and-middle-income countries (LMICs).

Conclusion

Our review proposes a simple framework, clarifying the key characteristics of the GMH landscape. The findings highlight the diversity of usage of the term in the literature, as well as present the wide scope that comprises the field of GMH. Referring to this framework may help those engaged with GMH to be more specific with which aspect of the field they are concerned with.

Modelling the effect of the COVID-19 pandemic on violent discipline against children

BACKGROUND

The COVID-19 pandemic could increase violence against children at home. However, collecting empirical data on violence is challenging due to ethical, safety, and data quality concerns.

OBJECTIVE

This study estimated the anticipated effect of COVID-19 on violent discipline at home using multivariable predictive regression models.

PARTICIPANTS

Children aged 1-14 years and household members from the Multiple Indicator Cluster Surveys (MICS) conducted in Nigeria, Mongolia, and Suriname before the COVID-19 pandemic were included.

METHODS

A conceptual model of how the COVID-19 pandemic could affect risk factors for violent discipline was developed. Country specific multivariable linear models were used to estimate the association between selected variables from MICS and a violent discipline score which captured the average combination of violent disciplinary methods used in the home. A review of the literature informed the development of quantitative assumptions about how COVID-19 would impact the selected variables under a "high restrictions" pandemic scenario, approximating conditions expected during a period of intense response measures, and a "lower restrictions" scenario with easing of COVID-19 restrictions but with sustained economic impacts. These assumptions were used to estimate changes in violent discipline scores.

RESULTS

Under a "high restrictions" scenario there would be a 35%-46% increase in violent discipline scores in Nigeria, Mongolia and Suriname, and under a "lower restrictions" scenario there would be between a 4%-6% increase in violent discipline scores in these countries.

CONCLUSION

Policy makers need to plan for increases in violent discipline during successive waves of lockdowns.

COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health

Most of the global population live in low-income and middle-income countries (LMICs), which have historically received a small fraction of global resources for mental health. The COVID-19 pandemic has spread rapidly in many of these countries. This Review examines the mental health implications of the COVID-19 pandemic in LMICs in four parts. First, we review the emerging literature on the impact of the pandemic on mental health, which shows high rates of psychological distress and early warning signs of an increase in mental health disorders. Second, we assess the responses in different countries, noting the swift and diverse responses to address mental health in some countries, particularly through the development of national COVID-19 response plans for mental health services, implementation of WHO guidance, and deployment of digital platforms, signifying a welcome recognition of the salience of mental health. Third, we consider the opportunity that the pandemic presents to reimagine global mental health, especially through shifting the balance of power from high-income countries to LMICs and from narrow biomedical approaches to community-oriented psychosocial perspectives, in setting priorities for interventions and research. Finally, we present a vision for the concept of building back better the mental health systems in LMICs with a focus on key strategies; notably, fully integrating mental health in plans for universal health coverage, enhancing access to psychosocial interventions through task sharing, leveraging digital technologies for various mental health tasks, eliminating coercion in mental health care, and addressing the needs of neglected populations, such as children and people with substance use disorders. Our recommendations are relevant for the mental health of populations and functioning of health systems in not only LMICs but also high-income countries impacted by the COVID-19 pandemic, with wide disparities in quality of and access to mental health care.

Factors Influencing Anxiety Among WeChat Users During the Early Stages of the COVID-19 Pandemic in Mainland China: Cross-sectional Survey Study

BACKGROUND

The rapid outbreak of COVID-19 around the world has adversely affected the mental health of the public. The prevalence of anxiety among the public has increased dramatically during the COVID-19 pandemic. However, there are few studies evaluating the effects of positive psychological responses and information-seeking behaviors on anxiety experienced among social media users during the COVID-19 pandemic.

OBJECTIVE

This study evaluated the prevalence of anxiety and its associated factors among WeChat users in mainland China during the early stages of the COVID-19 pandemic.

METHODS

From February 10 to February 24, 2020, a nationwide, web-based cross-sectional survey study was carried out using convenience sampling. Participants' levels of anxiety, positive psychological responses, and information-seeking behaviors were assessed. The survey was distributed among WeChat users via the WeChat smartphone platform. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with anxiety.

RESULTS

This study found that the prevalence of anxiety (Generalized Anxiety Disorder 7-item [GAD-7] scale score ≥7) among WeChat users in China was 17.96% (446/2483) during the early stages of the COVID-19 pandemic. Results of multivariable logistic regression analysis showed that information-seeking behaviors such as cannot stop searching for information on COVID-19, being concerned about the COVID-19 pandemic, and spending more than 1 hour per day consuming information about the pandemic were found to be associated with increased levels of anxiety. Additionally, participants who chose social media and commercial media as the primary sources to obtain information about the COVID-19 pandemic were found more likely to report anxiety. Conversely, participants who were confident or rational about the COVID-19 pandemic were less likely to report anxiety.

CONCLUSIONS

This study found that positive psychological responses and information-seeking behaviors were closely associated with anxiety among WeChat users during the COVID-19 pandemic in China. It might be paramount to enhance mental well-being by helping people respond to the COVID-19 pandemic more rationally and positively in order to decrease symptoms of anxiety.

Feelings of loneliness and mental health needs and services utilization among Chinese residents during the COVID-19 epidemic

BACKGROUND

Due to the implementation of social distancing and quarantine measures, loneliness has been a major public health concern during the COVID-19 pandemic. However, few studies have examined loneliness in Chinese residents during the COVID-19 epidemic, as well as its associations with mental health needs and services utilization.

METHODS

The present study was a cross-sectional survey during the COVID-19 outbreak in China. A total of 7741 adults were invited and completed an online self-administered questionnaire. The Chinese 12-item General Health Questionnaire was used to screen for common mental health problems, loneliness was measured with a single-item self-report question ("How often do you feel lonely in recent days?"), and two standardized questions were used to assess perceived needs for and use of mental health services.

RESULTS

In total, 24.2 % of the participants felt lonely in recent days. Age of 16-29 years (OR = 1.36, P = 0.020), marital status of never-married (OR = 1.47, P < 0.001), marital status of "others" (re-married, co-habiting, separated, divorced, and widowed) (OR = 1.72, P < 0.001), having infected family members or close relatives (OR = 1.64, P = 0.026), and having infected colleagues, friends, or classmates (OR = 1.62, P < 0.001) were significant correlates of loneliness. Rates of mental health needs (17.4 % vs. 4.9 %, P < 0.001) and services utilization (2.7 % vs. 1.0 %, P < 0.001) were significantly higher in lonely than not lonely participants. After adjusting for socio-demographic and epidemic characteristics and common mental health problems, loneliness was still significantly associated with mental health needs (OR = 2.50, P < 0.001) and services utilization (OR = 1.62, P = 0.020).

CONCLUSIONS

Feelings of loneliness are prevalent among Chinese residents affected by the COVID-19 epidemic and the presence of loneliness is associated with high levels of mental health needs and greater services utilization. Effective measures aiming at preventing or reducing loneliness are potentially beneficial for the mental wellbeing of COVID-19-affected population and reducing the use of the limited mental health service resources during the COVID-19 pandemic.

Coronavirus disease 2019 (COVID-19) and global mental health

The mental health effects of the coronavirus disease 2019 (COVID-19) pandemic may shape population health for many years to come. Failure to address the mental health issues stemming from the pandemic is likely to prolong its impact. The COVID-19 pandemic has created a significant global challenge and, in lower-income countries, even a disruption of mental health services. Given our experience with previous pandemics, the present COVID-19 crisis can be expected to cause psychological trauma, and steps are needed to address this issue proactively. Policies focusing on the long-term mental health consequences of COVID-19 may equal the importance of those currently seeking to mitigate its physical effects. The implications of the COVID-19 pandemic for mental health call for a greater focus on the needs of those with mental disorders and on mental health issues affecting health care workers and the general public. Timely preventive and therapeutic mental health care is essential in addressing the psychosocial needs of populations exposed to the pandemic. In addition to specialist care, "task-shifting" and digital technologies may provide cost-effective means of providing mental health care in lower-income countries worldwide as well as in higher-income countries with mental health services overwhelmed by the effects of the COVID-19 pandemic. In view of the ever-increasing pressure on global health systems resulting from the COVID-19 pandemic, adopting and adapting "task-shifting", i.e., the delegation of psychotherapeutic interventions to trained non-specialists, as an element of the provision of mental health services, is overdue. Digital technologies can be used to enhance social support and facilitate resilience to the detrimental mental health effects of the pandemic; they may also offer an efficient and cost-effective way to provide easy access to mental health care.

Neurological Consequences of SARS-CoV-2 Infection and Concurrence of Treatment-Induced Neuropsychiatric Adverse Events in COVID-19 Patients: Navigating the Uncharted

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to the angiotensin-converting enzyme 2 (ACE2) receptor and invade the human cells to cause COVID-19-related pneumonia. Despite an emphasis on respiratory complications, the evidence of neurological manifestations of SARS-CoV-2 infection is rapidly growing, which is substantially contributing to morbidity and mortality. The neurological disorders associated with COVID-19 may have several pathophysiological underpinnings, which are yet to be explored. Hypothetically, SARS-CoV-2 may affect the central nervous system (CNS) either by direct mechanisms like neuronal retrograde dissemination and hematogenous dissemination, or via indirect pathways. CNS complications associated with COVID-19 include encephalitis, acute necrotizing encephalopathy, diffuse leukoencephalopathy, stroke (both ischemic and hemorrhagic), venous sinus thrombosis, meningitis, and neuroleptic malignant syndrome. These may result from different mechanisms, including direct virus infection of the CNS, virus-induced hyper-inflammatory states, and post-infection immune responses. On the other hand, the Guillain-Barre syndrome, hyposmia, hypogeusia, and myopathy are the outcomes of peripheral nervous system injury. Although the therapeutic potential of certain repurposed drugs has led to their off-label use against COVID-19, such as anti-retroviral drugs (remdesivir, favipiravir, and lopinavir-ritonavir combination), biologics (tocilizumab), antibiotics (azithromycin), antiparasitics (chloroquine and hydroxychloroquine), and corticosteroids (dexamethasone), unfortunately, the associated clinical neuropsychiatric adverse events remains a critical issue. Therefore, COVID-19 represents a major threat to the field of neuropsychiatry, as both the virus and the potential therapies may induce neurologic as well as psychiatric disorders. Notably, potential COVID-19 medications may also interact with the medications of pre-existing neuropsychiatric diseases, thereby further complicating the condition. From this perspective, this review will discuss the possible neurological manifestations and sequelae of SARS-CoV-2 infection with emphasis on the probable underlying neurotropic mechanisms. Additionally, we will highlight the concurrence of COVID-19 treatment-associated neuropsychiatric events and possible clinically relevant drug interactions, to provide a useful framework and help researchers, especially the neurologists in understanding the neurologic facets of the ongoing pandemic to control the morbidity and mortality.

Telepsychiatry in Low- and Middle-Income Countries During COVID-19: Pandemic, Barriers, and Road Model

ABSTRACT

To date, there is lack of specific effective treatment or vaccine for the SARS-CoV-2, and clinical and laboratory research is still ongoing to find successful drugs. Therefore, prevention to be infected through social distancing and isolation is the most effective way. However, all the other physical and mental illnesses continue to exist, if possible even more burdened by the emergency situation and social distancing. The COVID-19 pandemic, especially in many low- and middle-income countries, has caused a deeper gap in seeking psychiatric help. In this scenario, telepsychiatry could play a decisive role in implementing clinical care for frail patients and ensuring continuous mental care. Therefore, we felt the urge to write this article to express our hope that the old health care system at this time of crisis, as we know it, can offer the chance to implement pervasive care technologies that perfectly fit current psychiatric needs.

Food insecurity measurement and prevalence estimates during the COVID-19 pandemic in a repeated cross-sectional survey in Mexico

OBJECTIVE

To validate the telephone modality of the Latin American and Caribbean Food Security Scale (ELCSA) included in three waves of a phone survey to estimate the monthly household food insecurity prevalence during the COVID-19 pandemic in Mexico.

DESIGN

We examined the reliability and internal validity of the ELCSA scale in three repeated waves of cross-sectional surveys with Rasch models. We estimated the monthly prevalence of food insecurity in the general population and in households with and without children and compared them with a national 2018 survey. We tested concurrent validity by testing associations of food insecurity with socio-economic status and anxiety.

SETTING

ENCOVID-19 is a monthly telephone cross-sectional survey collecting information on the well-being of Mexican households during the pandemic lockdown. Surveys used probabilistic samples, and we used data from April (n 833), May (n 850) and June 2020 (n 1674).

PARTICIPANTS

Mexicans 18 years or older who had a mobile telephone.

RESULTS

ELCSA had an adequate model fit and food insecurity was associated, within each wave, with more poverty and anxiety. The COVID-19 lockdown was associated with an important reduction in food security, decreasing stepwise from 38·9 % in 2018 to 24·9 % in June 2020 in households with children.

CONCLUSIONS

Telephone surveys were a feasible strategy to monitor reductions in food security during the COVID-19 lockdown.

Implementation of Telehealth Services to Assess, Monitor, and Treat Neurodevelopmental Disorders: Systematic Review

BACKGROUND

In response to COVID-19, there has been increasing momentum in telehealth development and delivery. To assess the anticipated exponential growth in telehealth, it is important to accurately capture how telehealth has been used in specific mental health fields prior to the pandemic.

OBJECTIVE

This systematic review aimed to highlight how telehealth has been used with clinical samples in the neurodevelopmental field, including patients with neurodevelopmental disorders (NDDs), their families, and health care professionals. To identify which technologies show the greatest potential for implementation into health services, we evaluated technologies for effectiveness, economic impact, and readiness for clinical adoption.

METHODS

A systematic search of literature was undertaken in April 2018 and updated until December 2019, by using the Medline, Web of Science, Scopus, CINAHL Plus, EMBASE, and PsycInfo databases. Extracted data included the type of technology, how the technology was used (ie, assessment, treatment, and monitoring), participant characteristics, reported outcomes and authors' views on clinical effectiveness, user impact (ie, feasibility and acceptability), economic impact, and readiness for clinic adoption. A quality review of the research was performed in accordance with the Oxford Centre for Evidence-Based Medicine Levels of Evidence.

RESULTS

A total of 42 studies met the inclusion criteria. These studies included participants and family members with autism spectrum disorders (21/42, 50%), attention deficit hyperactivity disorders (8/42, 19%), attention deficit hyperactivity or autism spectrum disorders (3/42, 7%), communication disorders (7/42, 17%), and tic disorders (2/42, 5%). The focus of most studies (33/42, 79%) was on treatment, rather than assessment (4/42, 10%) or monitoring (5/42, 12%). Telehealth services demonstrated promise for being clinically effective, predominantly in relation to diagnosing and monitoring NDDs. In terms of NDD treatment, telehealth services were usually equivalent to control groups. There was some evidence of positive user and economic impacts, including increased service delivery efficiency (eg, increased treatment availability and decreased waiting times). However, these factors were not widely recorded across the studies. Telehealth was demonstrated to be cost-effective in the few studies that considered cost-effectiveness. Study quality varied, as many studies had small sample sizes and inadequate control groups. Of the 42 studies, only 11 (26%) were randomized controlled trials, 12 (29%) were case studies or case series, 6 (14%) were qualitative studies, and 5 (12%) were noncomparative trials.

CONCLUSIONS

Telehealth has the potential to increase treatment availability, decrease diagnosis waiting times, and aid in NDD monitoring. Further research with more robust and adequately powered study designs that consider cost-effectiveness and increased efficiency is needed. This systematic review highlights the extent of telehealth technology use prior to the COVID-19 pandemic and the movement for investing in remote access to treatments.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42018091156; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018091156.

Psychosocial impact of the COVID-19 pandemic: a cross-sectional study of online help-seeking Canadian men

Purpose: The COVID-19 pandemic has had a profound impact on the lives of men. The present study investigated psychosocial impacts of the COVID-19 pandemic on a help-seeking sample of Canadian men, focusing on diverse aspects of their psychosocial well-being.Methods: A cross-sectional, open survey study design was used. Canadian adult men who were visiting an eHealth depression resource (HeadsUpGuys.org) were recruited to complete an online survey. Descriptive statistics, including means and standard deviations for continuous variables and frequency and percentages for categorical variables, were used to summarize survey responses. Regression analysis was utilized to identify factors associated with various mental health indicators (anxiety, depression, fear of COVID-19, suicidality). The Patient Health Questionnaire-4, Fear of COVID-19 Scale, and item 9 (suicidality item) from the Patient Health Questionnaire-9 were used to assess the mental health indicators.Results: A total of 434 men completed the study. Most respondents (79.3%; N = 344) indicated that their mental health was negatively affected by COVID-19, and two-thirds (65.5%; N = 284) conveyed that government-imposed physical distancing measures had negatively affected their mental health. Half the sample (51.2%; N = 222) reported at least moderate financial stress due to COVID-19. Nearly a third of respondents (31.1%; N = 135) reported that their current living situation has had a considerable or severe negative impact on their mental health since COVID-19. About two-fifths (37.7%; N = 94) of men felt that COVID-19 has had a negative impact on their relationship with their intimate partner. Nearly a third of respondents who were in a relationship (30.9%; N = 77) reported that they engaged in some type of abuse (primarily verbal abuse, 22.9%; N = 57) toward their intimate partner during COVID-19, and more than a quarter (27.3%; N = 68) reported being abused by their intimate partner (also primarily verbal abuse, 22.5%; N = 56). Just under half (42.2%; N = 183) of the respondents indicated experiencing suicidal ideation.Conclusion: These findings can help inform providers of health services to Canadian men, as well as policies that will be implemented during subsequent waves of COVID-19 or during future infectious outbreaks.

Increased Psychological Distress, Loneliness, and Unemployment in the Spread of COVID-19 over 6 Months in Germany

Background: The COVID-19 pandemic poses a challenge to global mental health. Loneliness and isolation may put people at higher risk for increased psychological distress. However, there is a lack of research investigating the development of COVID-19-related distress over time. Materials and Methods: We undertook an online survey among general population (N = 1903) in Germany throughout 6 months from the peak transmission period in April to the off-peak period by September 2020. Results: We found that the average prevalence of psychological distress caused by the COVID-19 pandemic significantly rose from 24% to 66% between the peak and off-peak transmission period, respectively. Unemployment rate and loneliness increased negative mental health outcomes, although the number of active COVID-19 cases decreased from April to September. Psychological distress scores increased mostly in female, young, and lonely people. Conclusions: Our results underline the importance of considering innovative alternatives to facilitate employment opportunities, distant contacts, and self-help over the course of the pandemic. Our study highlights the urgent need to pay attention to mental health services specifically targeting female, young, unemployed, and lonely people.

Exploring resource scarcity and contextual influences on wellbeing among young refugees in Bidi Bidi refugee settlement, Uganda: findings from a qualitative study

BACKGROUND

Contextual factors including poverty and inequitable gender norms harm refugee adolescent and youths' wellbeing. Our study focused on Bidi Bidi refugee settlement that hosts more than 230,000 of Uganda's 1.4 million refugees. We explored contextual factors associated with wellbeing among refugee adolescents and youth aged 16-24 in Bidi Bidi refugee settlement.

METHODS

We conducted 6 focus groups (n = 3: women, n = 3: men) and 10 individual interviews with young refugees aged 16-24 living in Bidi Bidi. We used physical distancing practices in a private outdoor space. Focus groups and individual interviews explored socio-environmental factors associated with refugee youth wellbeing. Focus groups were digitally recorded, transcribed verbatim, and coded by two investigators using thematic analysis. Analysis was informed by a social contextual theoretical approach that considers the interplay between material (resource access), symbolic (cultural norms and values), and relational (social relationships) contextual factors that can enable or constrain health promotion.

RESULTS

Participants included 58 youth (29 men; 29 women), mean age was 20.9 (range 16-24). Most participants (82.8%, n = 48) were from South Sudan and the remaining from the Democratic Republic of Congo (17.2% [n = 10]). Participant narratives revealed the complex interrelationships between material, symbolic and relational contexts that shaped wellbeing. Resource constraints of poverty, food insecurity, and unemployment (material contexts) produced stress and increased sexual and gender-based violence (SGBV) targeting adolescent girls and women. These economic insecurities exacerbated inequitable gender norms (symbolic contexts) to increase early marriage and transactional sex (relational context) among adolescent girls and young women. Gendered tasks such as collecting water and firewood also increased SGBV exposure among girls and young women, and this was exacerbated by deforestation. Participants reported negative community impacts (relational context) of COVID-19 that were associated with fear and panic, alongside increased social isolation due to business, school and church closures.

CONCLUSIONS

Resource scarcity produced pervasive stressors among refugee adolescents and youth. Findings signal the importance of gender transformative approaches to SGBV prevention that integrate attention to resource scarcity. These may be particularly relevant in the COVID-19 pandemic. Findings signal the importance of developing health enabling social contexts with and for refugee adolescents and youth.

Digital Gaming Interventions in Psychiatry: Evidence, Applications and Challenges

Human evolution has regularly intersected with technology. Digitalization of various services has brought a paradigm shift in consumerism. Treading this path, mental health practice has gradually moved to Digital Mental Health Interventions (DMHI), to improve service access and delivery. Applied games are one such innovation that has gained recent popularity in psychiatry. Based on the principles of gamification, they target psychosocial and cognitive domains, according to the deficits in various psychiatric disorders. They have been used to deliver cognitive behaviour therapy, cognitive training and rehabilitation, behavioural modification, social motivation, attention enhancement, and biofeedback. Research shows their utility in ADHD, autistic spectrum disorders, eating disorders, post-traumatic stress, impulse control disorders, depression, schizophrenia, dementia, and even healthy aging. Virtual reality and artificial intelligence have been used in conjunction with gaming interventions to improvise their scope. Even though these interventions hold promise in engagement, ease of use, reduction of stigma, and bridging the mental-health gap, there are pragmatic challenges, especially in developing countries. These include network quality, infrastructure, feasibility, socio-cultural adaptability, and potential for abuse. Keeping this in the background, this review summarizes the scope, promise, and evidence of digital gaming in psychiatric practice, and highlights the potential caveats in their implementation.

Remote CBT for Psychosis During the COVID-19 Pandemic: Challenges and Opportunities

The COVID pandemic is now leading to the emergence of a secondary mental health pandemic. Clients with psychosis are at increased risk of poorer medium- and long-term psychosocial and clinical outcomes. In response to the pressing need to flexibly deliver high-quality care to individuals with psychosis, this brief report proposes high yield cognitive behavioral techniques for psychosis (HY-CBt-p) facilitated by task sharing and digital enhancements. HY-CBt-p is delivered over fewer sessions than formulation-based Cognitive Behavioral Therapy for psychosis (CBTp), can be learned by a range of providers, and includes techniques such as developing a normalizing explanation; techniques to reduce anxiety, depression, and insomnia, which perpetuate psychotic symptoms; self-monitoring; reality testing; and wellness planning. Previous research suggests that effect sizes will be lower than that of 16-session formulation-driven CBTp, but additional research is needed to test the feasibility, acceptability, efficacy, and comparative effectiveness of different forms of remote-delivered CBTp.

Risk Factors Underlying COVID-19 Lockdown-Induced Mental Distress

Recent reports suggest that the COVID-19 lockdown resulted in changes in mental health, however, potential age-related changes and risk factors remain unknown. We measured COVID-19 lockdown-induced stress levels and the severity of depressive symptoms prior to and during the COVID-19 lockdown in different age groups and then searched for potential risk factors in a well-characterized general population-based sample. A total of 715 participants were tested for mental distress and related risk factors at two time-points, baseline testing prior to COVID-19 and follow-up testing during COVID-19, using a battery of validated psychological tests including the Perceived Stress Scale and the Patient Health Questionnaire. Longitudinal measurements revealed that the prevalence of moderate to high stress and the severity of depressive symptoms increased 1.4- and 5.5-fold, respectively, during the COVID-19 lockdown. This surge in mental distress was more severe in women, but was present in all age groups with the older age group exhibiting, cross-sectionally, the lowest levels of mental distress prior to and during the lockdown. Illness perception, personality characteristics such as a feeling of loneliness, and several lifestyle components were found to be associated with a significant increase in mental distress. The observed changes in mental health and the identified potential risk factors underlying these changes provide critical data justifying timely and public emergency-tailored preventive, diagnostic, and therapeutic mental health interventions, which should be integrated into future public health policies globally.

Psychological Screening and Tracking of Athletes and Digital Mental Health Solutions in a Hybrid Model of Care: Mini Review

BACKGROUND

There is a persistent need for mental ill-health prevention and intervention among at-risk and vulnerable subpopulations. Major disruptions to life, such as the COVID-19 pandemic, present an opportunity for a better understanding of the experience of stressors and vulnerability. Faster and better ways of psychological screening and tracking are more generally required in response to the increased demand upon mental health care services. The argument that mental and physical health should be considered together as part of a biopsychosocial approach is garnering acceptance in elite athlete literature. However, the sporting population are unique in that there is an existing stigma of mental health, an underrecognition of mental ill-health, and engagement difficulties that have hindered research, prevention, and intervention efforts.

OBJECTIVE

The aims of this paper are to summarize and evaluate the literature on athletes' increased vulnerability to mental ill-health and digital mental health solutions as a complement to prevention and intervention, and to show relationships between athlete mental health problems and resilience as well as digital mental health screening and tracking, and faster and better treatment algorithms.

METHODS

This mini review shapes literature in the fields of athlete mental health and digital mental health by summarizing and evaluating journal and review articles drawn from PubMed Central and the Directory of Open Access Journals.

RESULTS

Consensus statements and systematic reviews indicated that elite athletes have comparable rates of mental ill-health prevalence to the general population. However, peculiar subgroups require disentangling. Innovative expansion of data collection and analytics is required to respond to engagement issues and advance research and treatment programs in the process. Digital platforms, machine learning, deep learning, and artificial intelligence are useful for mental health screening and tracking in various subpopulations. It is necessary to determine appropriate conditions for algorithms for use in recommendations. Partnered with real-time automation and machine learning models, valid and reliable behavior sensing, digital mental health screening, and tracking tools have the potential to drive a consolidated, measurable, and balanced risk assessment and management strategy for the prevention and intervention of the sequelae of mental ill-health.

CONCLUSIONS

Athletes are an at-risk subpopulation for mental health problems. However, a subgroup of high-level athletes displayed a resilience that helped them to positively adjust after a period of overwhelming stress. Further consideration of stress and adjustments in brief screening tools is recommended to validate this finding. There is an unrealized potential for broadening the scope of mental health, especially symptom and disorder interpretation. Digital platforms for psychological screening and tracking have been widely used among general populations, but there is yet to be an eminent athlete version. Sports in combination with mental health education should address the barriers to help-seeking by increasing awareness, from mental ill-health to positive functioning. A hybrid model of care is recommended, combining traditional face-to-face approaches along with innovative and evaluated digital technologies, that may be used in prevention and early intervention strategies.

Association between mental illness and COVID-19 susceptibility and clinical outcomes in South Korea: a nationwide cohort study

BACKGROUND

Evidence for the associations between mental illness and the likelihood of a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result and the clinical outcomes of COVID-19 is scarce. We aimed to investigate these associations with data from a national register in South Korea.

METHODS

A nationwide cohort study with propensity score matching was done in South Korea using data collected from the Health Insurance Review and Assessment Service of Korea. We defined mental illness as present if one of the relevant ICD-10 codes was recorded at least twice within 1 year for an outpatient or inpatient. Severe mental illness was considered as non-affective or affective disorders with psychotic features. We included all patients aged older than 20 years who were tested for SARS-CoV-2 through services facilitated by the Korea Centers for Disease Control and Prevention, the Health Insurance Review and Assessment Service of Korea, and the Ministry of Health and Welfare, South Korea. We investigated the primary outcome (SARS-CoV-2 test positivity) in the entire cohort and the secondary outcomes (severe clinical outcomes of COVID-19: death, admission to the intensive care unit, or invasive ventilation) among those who tested positive.

FINDINGS

Between Jan 1 and May 15, 2020, 216 418 people were tested for SARS-CoV-2, of whom 7160 (3·3%) tested positive. In the entire cohort with propensity score matching, 1391 (3·0%) of 47 058 patients without a mental illness tested positive for SARS-CoV-2, compared with 1383 (2·9%) of 48 058 with a mental illness (adjusted odds ratio [OR] 1·00, 95% CI 0·93-1·08). Among the patients who tested positive for SARS-CoV-2, after propensity score matching, 109 (8·3%) of 1320 patients without a mental illness had severe clinical outcomes of COVID-19 compared with 128 (9·7%) of 1320 with a mental illness (adjusted OR 1·27, 95% CI 1·01-1·66).

INTERPRETATION

Diagnosis of a mental illness was not associated with increased likelihood of testing positive for SARS-CoV-2. Patients with a severe mental illness had a slightly higher risk for severe clinical outcomes of COVID-19 than patients without a history of mental illness. Clinicians treating patients with COVID-19 should be aware of the risk associated with pre-existing mental illness.

FUNDING

National Research Foundation of Korea.

Mental health research in the lower-middle-income countries of Africa and Asia during the COVID-19 pandemic: A scoping review

BACKGROUND

Lower middle - income countries of Africa and Asia have accommodated a large portion of the world's population, where mental health research has been under-prioritized. This study aimed to review all published research on mental health issues related to the COVID-19 pandemic in lower middle - income countries of the Afro-Asian region.

METHODS

A search was conducted in the PubMed and PubMed Central databases using the terms "mental health," "psychiatric disorders," "COVID-19", "coronavirus," "Asia," "Africa," "Lower Middle-income countries." All articles published in the English language until 3rd July 2020 were included.

RESULT

A total of 133 papers were found in lower-middle-income countries of Africa (n = 11) and Asia (n = 122), which discussed various aspects of mental health in the context of COVID-19. Most of the studies are cross-sectional studies that addressed mental morbidities, psychological reactions, stress, coping among the general population, and focused groups (healthcare workers, students, elderly, patients). Researchers attempted to develop and validate tools that measure certain psychological constructs (fear, anxiety) concerning COVID-19. Online surveys were the primary modality of researching this COVID-19 pandemic.

CONCLUSION

COVID-19 related mental health research is scarce in lower-middle-income countries of Africa and Asia. Available researches suggest that mental health challenges during this COVID-19 pandemic are enormous and need attention. There is a need for policy and recommendations to deal with the mental health challenges in lower middle - income countries of Africa and Asia.

An Integrated Blueprint for Digital Mental Health Services Amidst COVID-19

In-person traditional approaches to mental health care services are facing difficulties amidst the coronavirus disease (COVID-19) crisis. The recent implementation of social distancing has redirected attention to nontraditional mental health care delivery to overcome hindrances to essential services. Telehealth has been established for several decades but has only been able to play a small role in health service delivery. Mobile and teledigital health solutions for mental health are well poised to respond to the upsurge in COVID-19 cases. Screening and tracking with real-time automation and machine learning are useful for both assisting psychological first-aid resources and targeting interventions. However, rigorous evaluation of these new opportunities is needed in terms of quality of interventions, effectiveness, and confidentiality. Service delivery could be broadened to include trained, unlicensed professionals, who may help health care services in delivering evidence-based strategies. Digital mental health services emerged during the pandemic as complementary ways of assisting community members with stress and transitioning to new ways of living and working. As part of a hybrid model of care, technologies (mobile and online platforms) require consolidated and consistent guidelines as well as consensus, expert, and position statements on the screening and tracking (with real-time automation and machine learning) of mental health in general populations as well as considerations and initiatives for underserved and vulnerable subpopulations.