Trajectories of Mental Distress Among U.S. Adults During the COVID-19 Pandemic

Social alignment matters: Following pandemic guidelines is associated with better wellbeing

Background

In response to the Covid-19 pandemic, most countries implemented physical distancing measures. Many mental health experts warned that through increasing social isolation and anxiety, these measures could negatively affect psychosocial wellbeing. However, socially aligning with others by adhering to these measures may also be beneficial for wellbeing.

Methods

We examined these two contrasting hypotheses using cross-national survey data (N = 6675) collected fortnightly from participants in 115 countries over 3 months at the beginning of the pandemic. Participants reported their wellbeing, perceptions of how vulnerable they were to Covid-19 (i.e., high risk of infection) and how much they, and others in their social circle and country, were adhering to the distancing measures.

Results

Linear mixed-effects models showed that being a woman, having lower educational attainment, living alone and perceived high vulnerability to Covid-19 were risk factors for poorer wellbeing. Being young (18–25) was associated with lower wellbeing, but longitudinal analyses showed that young people’s wellbeing improved over 3 months. In contrast to widespread views that physical distancing measures negatively affect wellbeing, results showed that following the guidelines was positively associated with wellbeing even for people in high-risk groups.

Conclusions

These findings provide an important counterpart to the idea that pandemic containment measures such as physical distancing negatively impacted wellbeing unequivocally. Despite the overall burden of the pandemic on psychosocial wellbeing, social alignment with others can still contribute to positive wellbeing. The pandemic has manifested our propensity to adapt to challenges, particularly highlighting how social alignment can forge resilience.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13130-y.

Mental health and drinking to cope in the early COVID period: Data from the 2019-2020 US National Alcohol Survey

BACKGROUND

Studies show drinking to cope and mental health problems have increased during the COVID-19 pandemic, however, their samples have been limited by convenience sampling or lack of a pre-pandemic measure. We examined the early impact of the COVID-19 pandemic on mental health, drinking to cope and their association using a probability-based sample of the US adult population.

METHODS

Data was drawn from the probability samples of the 2019-2020 National Alcohol Survey (N = 7,233) to examine differences in drinking to cope and symptoms of depression and anxiety. Analyses compared participants who responded to the survey just prior to the widespread onset of the pandemic to those who responded after March 2020, in the total sample and by sex.

RESULTS

Respondents in the early- vs. pre-COVID-19 period had a 1.48 higher odds (p = 0.03) of higher agreement with drinking to forget one's worries and problems, with a significant association observed among women only. Respondents with symptoms of depression and anxiety had a 2.94 and 1.56 higher odds, respectively, of higher agreement with drinking to forget one's worries. We observed significant associations between early- vs. pre-COVID-19 period, depression and anxiety symptoms, and drinking to forget one's worries among women only; however, moderation by sex in the total sample was not statistically significant.

CONCLUSIONS

We observed higher prevalence of depression and anxiety symptoms and greater drinking to forget worries in the early months of COVID restrictions relative to the period just prior, with some effects more prominent among women. These observations call for sustained monitoring of and support for the mental health of the general population, and of women in particular during the course of the pandemic.

Trajectories of depression and anxiety during the COVID-19 pandemic in a population-based sample of middle-aged and older adults

The COVID-19 pandemic and the related governmental restrictions have greatly impacted the lives of people worldwide and have been suggested to negatively impact mental health. We describe the trajectories of depressive and anxiety symptoms during the pandemic and their determinants in a large population-based sample of middle-aged and older adults. From April to June 2020, participants of the Rotterdam Study were asked to complete questionnaires including questions on depressive symptoms (Center of Epidemiological Studies Depression Scale, 10 item version) and anxiety symptoms (Hospital Anxiety and Depression Scale, anxiety subscale). We compared depressive and anxiety symptom scores to those before the pandemic and described its trajectories during the pandemic by demographic variables, chronic disease status and pre-pandemic clinically relevant depressive or anxiety symptoms. In total, 6241 participants responded to the questionnaires (mean age [standard deviation] 70.1 years [11.6]; 58% women). Participants more often reported clinically relevant depressive symptoms during than before the pandemic (19% vs. 12%, P < .001), which was similar for clinically relevant anxiety symptoms (17% vs. 12%, P < .001). During the pandemic, depressive symptoms persisted over time while anxiety symptoms improved. Depressive and anxiety symptoms were more common among women, persons living alone, with chronic diseases and with pre-pandemic clinically relevant symptoms, although the trajectories of these symptoms over time were broadly similar for the subgroups. Together, these results suggest that it is important to be aware of long-term depressive symptoms following the COVID-19 pandemic in the general population.

A Qualitative Study of the Impact of the COVID-19 Pandemic on a Sample of Patients With Chronic Pain

This qualitative phenomenological study examined the impact of the COVID-19 pandemic on the lives of patients living with chronic pain. Patients referred to an intensive interdisciplinary pain management program between June 2020 to June 2021 were asked, “How did the COVID-19 pandemic affect your life?” as part of their interdisciplinary assessment. Ninety patients (50 Veterans, 40 civilians) provided comments to this question, which were independently organized into themes using an inductive approach by 4 researchers. Nine main themes emerged: (1) changed psychological state, (2) minimal to no effect, (3) affected personal life activities, (4) changes in accessing care, (5) changes in work/education situation, (6) changes in family dynamics, (7) experiencing more annoyances, (8) COVID-19 pandemic is a barrier to making positive changes, and (9) got COVID-19. Themes are consistent with topics of interest in light of this ongoing, global stressor. Most commonly reported themes reflected changes in psychological well-being and changes in access to care, highlighting similarities between life with chronic pain and life under the pandemic for this group.

Psychological distress and mental health trajectories during the COVID-19 pandemic in Argentina: a longitudinal study

Psychological-distress increased at the onset of the COVID-19 pandemic in Argentina. Longitudinal studies in developing countries are scarce. Particularly, Argentina had one of the longest lockdowns. Differences in preventive measures against the virus spread between countries may differentially affect the mental health of the populations. Here we aimed to characterize distinct psychological-distress and related-symptoms trajectories associated with the pandemic and explore risk/protective factors. In this longitudinal study, data from 832 Argentineans were collected every 3–5 months, between April 2020–August 2021. Mean psychological-distress levels and related-symptoms tended to increase over time. However, latent-class analysis identified four distinct psychological-distress trajectories. Most individuals had consistently good mental health (Resilient). Two classes showed psychological-distress worsening during the initial phase of the pandemic and recovered at different time points (Fast Recovery; Slow Recovery). The remaining class maintained a mild -level of psychological-distress and began to deteriorate in March 2021 (Deteriorating) continuously. Individuals who are younger, female, have pre-existing psychiatric diagnoses, or have high neuroticism or lower resilience were more likely to experiencing fluctuations in psychological-distress. The mental health trajectory during the pandemic had a complex dynamic. Although most participants remained resilient, a vulnerable group was detected, which deteriorated over time and should be considered by health-services.

Association of Non-Pharmaceutical Interventions to Reduce the Spread of SARS-CoV-2 With Anxiety and Depressive Symptoms: A Multi-National Study of 43 Countries

Objectives: To examine the association of non-pharmaceutical interventions (NPIs) with anxiety and depressive symptoms among adults and determine if these associations varied by gender and age. Methods: We combined survey data from 16,177,184 adults from 43 countries who participated in the daily COVID-19 Trends and Impact Survey via Facebook with time-varying NPI data from the Oxford COVID-19 Government Response Tracker between 24 April 2020 and 20 December 2020. Using logistic regression models, we examined the association of [1] overall NPI stringency and [2] seven individual NPIs (school closures, workplace closures, cancellation of public events, restrictions on the size of gatherings, stay-at-home requirements, restrictions on internal movement, and international travel controls) with anxiety and depressive symptoms. Results: More stringent implementation of NPIs was associated with a higher odds of anxiety and depressive symptoms, albeit with very small effect sizes. Individual NPIs had heterogeneous associations with anxiety and depressive symptoms by gender and age. Conclusion: Governments worldwide should be prepared to address the possible mental health consequences of stringent NPI implementation with both universal and targeted interventions for vulnerable groups.

Mechanisms associated with the trajectory of depressive and anxiety symptoms: A linear mixed-effects model during the COVID-19 Pandemic

With the fluctuations in anxious and depressive symptomatology accompanied by the pandemic crises, studies on the trajectories of these symptom domains are warranted to monitor the development of mental health problems in the population. This pre-registered longitudinal study examines stable factors and mechanistic processes covarying with the trajectory of anxiety and depressive symptoms using linear-mixed effects models in 4936 adults from the pandemic's onset to four months into the COVID-19 pandemic in Norway. Prevalence estimates of moderate to severe levels of clinically impairing symptoms of anxiety and depression revealed high but reduced occurrence four months into the pandemic where social distancing protocols were substantially lightened in severity, revealing associations between symptoms and viral mitigation protocols after stringent control of plausible confounders. Subgroups at risk at the onset of the pandemic sustained their relative position compared to their counterparts four months into the pandemic, indicating prolonged suffering of these subgroups. Among mechanistic processes, key differences were identified regarding the trajectory of anxiety and depressive symptoms. Physical exercise was associated with long-term but not momentaneous alleviations in anxiety. In contrast, reductions in depressive symptoms were associated with both the simultaneous exertion as well as dose-increases in exercise over time. Increased knowledge about how to best cope with pandemic challenges was associated with greater improvement in depressive but not anxiety symptoms. Reductions in maladaptive coping strategies and negative metacognitive beliefs was substantially associated with greater improvement of both anxious and depressive symptomatology. Mechanistic processes divergently relate to the trajectory of depressive and anxious symptomatology, yielding domain-specific information of utility for preventive and interventive efforts aimed at impeding deleterious symptom levels.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-022-02732-9.

Changes in drinking days among United States adults during the COVID-19 pandemic

AIMS

To examine changes in drinking behavior among United States (US) adults between March 10 and July 21, 2020, a critical period during the COVID-19 pandemic.

DESIGN

Longitudinal, internet-based panel survey.

SETTING

The Understanding America Study (UAS), a nationally representative panel of US adults age 18 or older.

PARTICIPANTS

A total of 4298 US adults who reported alcohol use.

MEASUREMENTS

Changes in number of reported drinking days from March 11, 2020 through July 21, 2020 in the overall sample and stratified by sex, age, race/ethnicity, household structure, poverty status, and census region.

FINDINGS

Compared with March 11, the number of drinking days per week was significantly higher on April 1 by an average of 0.36 days (95% CI = 0.30, 0.43), on May 1 by an average of 0.55 days (95% CI = 0.47, 0.63), on June 1 by an average of 0.41 days (95% CI = 0.33, 0.49), and on July 1 by an average of 0.39 days (95% CI = 0.31, 0.48). Males, White participants, and older adults reported sustained increases in drinking days, whereas female participants and individuals living under the federal poverty line had attenuated drinking days in the latter part of the study period.

CONCLUSIONS

Between March and mid-July 2020, adults in the United States reported increases in the number of drinking days, with sustained increases observed among males, White participants, and older adults.

Economic and Social Consequences of COVID-19 and Mental Health Burden Among Latinx Young Adults During the 2020 Pandemic

Latinx young adults 18-25 years old face unique challenges that disproportionately put them at high risk of experiencing health as well as economic and social burden due to the Coronavirus disease (COVID-19) pandemic. The present study examined how economic and psychosocial consequences as a result of the pandemic were associated with mental health issues among a community sample of Latinx young adults (N = 83) from Central Texas. Participants completed an online survey of COVID-related experiences and mental health needs. The survey asked about personal and family experiences of COVID-19 in two significant areas: (a) economic strain (e.g., economic hardship, food insecurity) and (b) psychosocial burden (e.g., losing relationships, substance use). Regression analyses examined the association of COVID-19 consequences on level of mental health symptoms and clinically significant outcomes. Relative to economic consequences, psychosocial consequences due to the COVID-19 pandemic were associated with higher levels of mental health symptoms. In contrast, in few cases, economic strain resultant from the pandemic was correlated with clinically significant outcomes among this sample. Collectively, findings suggest that the costs of the pandemic do not only pertain to mortality from illness but also to morbidity as it relates to deteriorating social circumstances and mental health. Findings from this study call for immediate attention to implement policies and programs to help mitigate the economic and social-emotional consequences of COVID-19 such as easy access to low-cost virtual mental health resources to Latinx young adults.

Physical isolation and mental health among older US adults during the COVID-19 pandemic: longitudinal findings from the COVID-19 Coping Study

PURPOSE

We investigated the relationships between physical isolation at home during the period when many US states had shelter-in-place orders and subsequent longitudinal trajectories of depression, anxiety, and loneliness in older adults over a 6 month follow-up.

METHODS

Data were from monthly online questionnaires with US adults aged ≥ 55 in the nation-wide COVID-19 Coping Study (April through October 2020, N = 3978). Physical isolation was defined as not leaving home except for essential purposes (0, 1-3, 4-6, and 7 days in the past week), measured at baseline (April-May). Outcomes were depressive symptoms (8-item Center for Epidemiological Studies Depression Scale), anxiety symptoms (5-item Beck Anxiety Inventory), and loneliness (3-item UCLA loneliness scale), measured monthly (April-October). Multivariable, population- and attrition-weighted linear mixed-effects models assessed the relationships between baseline physical isolation with mental health symptoms at baseline and over time.

RESULTS

Physical isolation (7 days versus 0 days in the past week) was associated with elevated depressive symptoms (adjusted β = 0.85; 95% CI 0.10-1.60), anxiety symptoms (adjusted β = 1.22; 95% CI 0.45-1.98), and loneliness (adjusted β = 1.06; 95% CI 0.51-1.61) at baseline, but not with meaningful rate of change in these mental health outcomes over time. The symptom burden of each mental health outcome increased with increasing past-week frequency of physical isolation.

CONCLUSION

During the early COVID-19 pandemic, physical isolation was associated with elevated depressive symptoms, anxiety symptoms, and loneliness, which persisted over time. These findings highlight the unique and persistent mental health risks of physical isolation at home under pandemic control measures.

The association of COVID-19 vaccine availability with mental health among adults in the United States

OBJECTIVE

To assess whether COVID-19 vaccine approval and availability was associated with reduction in the prevalence of depression and anxiety among adults in the United States.

METHODS

We adopted cross sectional and quasi-experimental design with mental health measurements before vaccine availability (June 2020, N = 68,009) and after vaccine availability (March 2021, N = 63,932) using data from Census Pulse Survey. Depression and anxiety were derived from PHQ-2 and GAD-2 questionnaires. We compared rates of depression and anxiety between June 2020 and March 2021. Unadjusted and adjusted analysis with replicate weights were conducted.

RESULTS

Depression prevalence was 25.0% in June 2020 and 24.6% in March 2021; anxiety prevalence was 31.7% in June 2020 and 30.0% in March 2021 in the sample. In adjusted analysis, there were no significant differences in likelihood of depression and anxiety between June 2020 and March 2021.

CONCLUSION

Depression and anxiety were not significantly different between June 2020 and March 2021, which suggests that the pandemic effect continues to persist even with widespread availability of vaccines.

Addiction in the time of COVID-19: Longitudinal course of substance use, psychological distress, and loneliness among a transnational Tyrolean sample with substance use disorders

INTRODUCTION

Next to an increased use of alcohol, the current pandemic has been associated with increased psychological distress among the general population. Research on its effects on individuals suffering from substance use disorders (SUD) is scarce. This study aimed at expanding the existing literature on this topic with a focus on the impact of loneliness and perceived social support.

METHODS

Sixty-eight people diagnosed with SUD according to ICD-10 from the Austrian state of Tyrol and from the Italian Province of South Tyrol who had been treated in a psychiatric hospital in 2019 and one hundred and thirty-six matched reference subjects of the same regional background participated in an online survey. Sociodemographic variables and scores on the Brief Symptom Checklist, the Three-Item Loneliness Scale, and the Multidimensional Scale of Perceived Social Support were collected at baseline and 5 months thereafter. Baseline took place after the first wave, while follow-up largely coincided with the second wave of the pandemic.

RESULTS

Among both patients and the matched reference group, substance use as a means to feel better facing the pandemic rose and predicted higher levels of psychological distress. Patients were less likely to receive specific care at follow-up than at baseline and presented with a significantly higher prevalence of clinically relevant psychological distress and loneliness than the matched reference group at both assessment times. Among both groups, psychological burden remained unchanged over time. Perceived social support was generally significantly higher in the matched reference group than in patients. Loneliness and, to a lesser degree, low perceived social support predicted psychological distress.

CONCLUSION

These findings emphasize the need of preventive and educational measures regarding substance use behavior for both individuals suffering from SUD and those without mental health disorders.

Associations between COVID-19 mobility restrictions and economic, mental health, and suicide-related concerns in the US using cellular phone GPS and Google search volume data

During the COVID-19 pandemic, US populations have experienced elevated rates of financial and psychological distress that could lead to increases in suicide rates. Rapid ongoing mental health monitoring is critical for early intervention, especially in regions most affected by the pandemic, yet traditional surveillance data are available only after long lags. Novel information on real-time population isolation and concerns stemming from the pandemic's social and economic impacts, via cellular mobility tracking and online search data, are potentially important interim surveillance resources. Using these measures, we employed transfer function model time-series analyses to estimate associations between daily mobility indicators (proportion of cellular devices completely at home and time spent at home) and Google Health Trends search volumes for terms pertaining to economic stress, mental health, and suicide during 2020 and 2021 both nationally and in New York City. During the first pandemic wave in early-spring 2020, over 50% of devices remained completely at home and searches for economic stressors exceeded 60,000 per 10 million. We found large concurrent associations across analyses between declining mobility and increasing searches for economic stressor terms (national proportion of devices at home: cross-correlation coefficient (CC) = 0.6 (p-value <0.001)). Nationally, we also found strong associations between declining mobility and increasing mental health and suicide-related searches (time at home: mood/anxiety CC = 0.53 (<0.001), social stressor CC = 0.51 (<0.001), suicide seeking CC = 0.37 (0.006)). Our findings suggest that pandemic-related isolation coincided with acute economic distress and may be a risk factor for poor mental health and suicidal behavior. These emergent relationships warrant ongoing attention and causal assessment given the potential for long-term psychological impact and suicide death. As US populations continue to face stress, Google search data can be used to identify possible warning signs from real-time changes in distributions of population thought patterns.

An examination of racial and ethnic disparities in mental health during the Covid-19 pandemic in the U.S. South

BACKGROUND

The mental health of racial/ethnic minority groups in the United States may be disproportionately impacted by the COVID-19 pandemic due to greater experience of peri-pandemic stressors. Yet, few studies have systematically examined racial/ethnic differences in mental health outcomes in this context.

METHODS

Data came from the COVID-19 Southern Cities Study, a probability-based, cross-sectional study conducted in May/June 2020 among adults living in the metropolitan statistical areas of Atlanta, Austin, Dallas, Houston, and New Orleans. Unadjusted and adjusted associations between racial/ethnic identity and past-week depression and/or anxiety symptoms (Patient Health Questionnaire-2 score ≥ 3 or Generalized Anxiety Disorder-2 score ≥ 3), trouble sleeping, physical reactions when thinking about COVID-19, and self-rated worsened mental health due to the pandemic were estimated in separate logistic regression models.

RESULTS

Over 30% of respondents reported depression and/or anxiety symptoms, 21% reported physical reactions, 25% had trouble sleeping, and 33% worsened mental health since the pandemic began. Adjusting for sociodemographic and health-related characteristics and pandemic-related stressors, odds of anxiety symptoms (odds ratio (OR) 0.53, 95% confidence interval (CI) 0.30-0.95) and worsened mental health (OR 0.58, 95% CI 0.36-0.94) were lower among non-Hispanic Black vs. non-Hispanic white respondents.

LIMITATIONS

No diagnostic assessments were used, and results may not be generalizable to later phases of the pandemic and the entire U.S. South.

CONCLUSIONS

Despite greater pandemic-related stressor experience, poor mental health outcomes were not more common among racial/ethnic minority individuals. However, interventions to reduce disparities in stressor experience and promote mental health are needed.

Gun purchasing behaviours during the initial phase of the COVID-19 pandemic, March to mid-July 2020

We sought to characterize gun and ammunition purchasing during the initial phase of the COVID-19 pandemic using a nationally representative sample of U.S. adults. We fielded a survey using NORC's Amerispeak Panel between 7 and 22 July 2020 (survey completion rate = 91.1%, N = 1337). We used survey-weighted data to calculate the proportion of adults who purchased a gun during this time period and types of guns and amount of ammunition purchased. Between March and mid-July 2020, 6% of adults purchased a gun and 9% bought ammunition. Of those purchasing a gun, 34% were first-time purchasers. Among those purchasing ammunition, 19% reported purchasing more than usual in response to the COVID-19 pandemic while 27% purchased less than usual. An estimated 6,451,163 adults bought guns for the first time between March and mid-July 2020. Increases in gun purchasing, particularly among first-time gun owners, could pose significant short- and long-term implications for public health.

A longitudinal study of predictors of serious psychological distress during COVID-19 pandemic

BACKGROUND

The prevalence of serious psychological distress (SPD) was elevated during the COVID-19 pandemic in the USA, but the relationships of SPD during the pandemic with pre-pandemic SPD, pre-pandemic socioeconomic status, and pandemic-related social stressors remain unexamined.

METHODS

A probability-based sample (N = 1751) of the US population age 20 and over was followed prospectively from February 2019 (T1), with subsequent interviews in May 2020 (T2) and August 2020 (T3). Multinomial logistic regression was used to assess prospective relationships between T1 SPD with experiences of disruption of employment, health care, and childcare at T2. Binary logistic regression was then used to assess relationships of T1 SPD, and socioeconomic status and T2 pandemic-related stressors with T3 SPD.

RESULTS

At T1, SPD was associated with age, race/ethnicity, and household income. SPD at T1 predicted disruption of employment (OR 4.5, 95% CI 1.4-3.8) and health care (OR 3.2, 95% CI 1.4-7.1) at T2. SPD at T1 (OR 10.2, 95% CI 4.5-23.3), low household income at T1 (OR 2.6, 95% CI 1.1-6.4), disruption of employment at T2 (OR 3.2, 95% CI 1.4-7.6), and disruption of healthcare at T2 (OR 3.3, 95% CI 1.5-7.2) were all significantly associated with elevated risk for SPD at T3.

CONCLUSIONS

Elevated risk for SPD during the COVID-19 pandemic is related to multiple psychological and social pathways that are likely to interact over the life course. Policies and interventions that target individuals with pre-existing mental health conditions as well as those experiencing persistent unemployment should be high priorities in the mental health response to the pandemic.

Longitudinal analysis of the UK COVID-19 Psychological Wellbeing Study: Trajectories of anxiety, depression and COVID-19-related stress symptomology

COVID-19 has had a negative impact on the mental health of individuals. The aim of the COVID-19 Psychological Wellbeing Study was to identify trajectories of anxiety, depression and COVID-19-related traumatic stress (CV19TS) symptomology during the first UK national lockdown. We also sought to explore risk and protective factors. The study was a longitudinal, three-wave survey of UK adults conducted online. Analysis used growth mixture modelling and logistic regressions. Data was collected from 1958 adults. A robust 4-class model for anxiety, depression, and CV19TS symptomology distinguished participants in relation to the severity and stability of symptomology. Classes described low and stable and high and stable symptomology, and symptomology that improved or declined across the study period. Several risk and protection factors were identified as predicting membership of classes (e.g., mental health factors, sociodemographic factors and COVID-19 worries). This study reports trajectories describing a differential impact of COVID-19 on the mental health of UK adults. Some adults experienced psychological distress throughout, some were more vulnerable in the early weeks, and for others vulnerability was delayed. These findings emphasise the need for appropriate mental health support interventions to promote improved outcomes in the COVID-19 recovery phase and future pandemics.

Food insecurity is adversely associated with psychological distress, anxiety and depression during the COVID-19 pandemic

Early COVID-19 pandemic data showed a spike in both food insecurity and poor mental health. The purpose of this study was to examine the relationship between food insecurity and mental health outcomes nine months after the start of the COVID-19 pandemic. A national survey of adults 18 years and older was administered in December 2020 (N = 8,355). Multivariable logistic models and post-estimation margins commands were used to show the predicted probability of mental health outcomes (psychological distress, anxiety, and depression) by food security status. The majority of participants (68.5%) reported high/marginal food security, 15.5% had low food security, and 16.0% had very low food security. There was a strong dose response relationship between food insecurity and higher psychological distress, anxiety and depression. Fewer than one in five adults with high/marginal food security screened positive for all three mental health outcomes, while more than two in five adults with low food security screened positive for psychological distress (39.9%), depression (41.7%) and anxiety (41.3%). Among adults with very low food security, nearly half screened positive for psychological distress (47.7%), depression (48.1%) and anxiety (49.4%). Younger adults had higher prevalence of psychological distress compared to older adults regardless of food security status. Food insecure adults, particularly young adults, have higher rates of psychological distress, anxiety, and depression than their food secure counterparts. Facilitating opportunities to connect at risk populations with food assistance and affordable mental healthcare should be prioritized as the pandemic continues and beyond.

COVID-19 vaccines and mental distress

BACKGROUND

The COVID-19 pandemic brought about large increases in mental distress. The uptake of COVID-19 vaccines is expected to significantly reduce health risks, improve economic and social outcomes, with potential benefits to mental health.

PURPOSE

To examine short-term changes in mental distress following the receipt of the first dose of the COVID-19 vaccine.

METHODS

Participants included 8,003 adults from the address-based sampled, nationally representative Understanding America Study (UAS), surveyed at regular intervals between March 10, 2020, and March 31, 2021 who completed at least two waves of the survey. Respondents answered questions about COVID-19 vaccine status and self-reported mental distress as measured with the four-item Patient Health Questionnaire (PHQ-4). Fixed-effects regression models were used to identify the change in PHQ-4 scores and categorical indicators of mental distress resulting from the application of the first dose of the COVID-19 vaccine.

RESULTS

People who were vaccinated between December 2020 and March 2021 reported decreased mental distress levels in the surveys conducted after receiving the first dose. The fixed-effects estimates show an average effect of receiving the vaccine equivalent to 4% of the standard deviation of PHQ-4 scores (p-value<0.01), a reduction in 1 percentage point (4% reduction from the baseline level) in the probability of being at least mildly depressed, and of 0.7 percentage points (15% reduction from the baseline level) in the probability of being severely depressed (p-value = 0.06).

CONCLUSIONS

Getting the first dose of COVID-19 resulted in significant improvements in mental health, beyond improvements already achieved since mental distress peaked in the spring of 2020.

The challenge of COVID-19 for adult men and women in the United States: disparities of psychological distress by gender and age

Objectives

During the COVID-19 pandemic, the prevalence of psychological distress rose from 11% in 2019 to more than 40% in 2020. This study aims to examine the disparities among US adult men and women.

Study design

We used 21 waves of cross-sectional data from the Household Pulse Survey that were collected between April and December 2020 for the study. The Household Pulse Survey was developed by the U.S. Census Bureau to document the social and economic impact of COVID-19.

Methods

The study population included four groups of adults: emerging adults (18–24 years); young adults (25–44 years); middle-aged adults (45–64 years); and older adults (65–88 years). Psychological distress was measured by their Generalized Anxiety Disorder score and the Patient Health Questionnaire. The prevalence of psychological stress was calculated using logistic models adjusted for socio-demographic variables including race/ethnicity, education, household income, and household structure. All descriptive and regression analysis considered survey weights.

Results

Younger age groups experienced higher prevalence of psychological distress than older age groups. Among emerging adults, the prevalence of anxiety (42.6%) and depression (39.5%) was more than twice as high as older adults who experienced prevalence of anxiety at 20% and depression at 16.6%. Gender differences were also more apparent in emerging adults. Women between 18 and 24 years reported higher differential rates of anxiety and depression than those with men (anxiety: 43.9% vs. 28.3%; depression: 33.3% vs. 24.9%).

Conclusion

Understanding the complex dynamics between COVID-19 and psychological distress has emerged as a public health priority. Mitigating the negative mental health consequences associated with the COVID-19 pandemic, for younger generations and females in particular, will require local efforts to rebuild capacity for social integration and social connection.

Experiences of cancer care during COVID-19: Phase 1 results of a longitudinal qualitative study

Background

Healthcare services have responded to the challenges of service delivery during COVID-19 with telehealth and hybrid models of care. However, there is limited understanding of the experiences of care amongst people affected by cancer and how their experiences may change and evolve against the shifting landscape of COVID-19 incidence, mortality, vaccination and refinements in service delivery.

Objectives

This study explores the experiences of cancer care amongst people affected by cancer in Ireland during the COVID-19 pandemic. This paper presents the results of the initial cross-sectional semi-structured interviews and the longitudinal qualitative research design which will be employed in this study.

Design

A longitudinal descriptive qualitative study.

Setting

Ireland

Participants

People living with and after cancer or caring for someone with cancer during the COVID-19 pandemic.

Methods

Participants were recruited to the study via social media advertisements and consented to participate in up to three semi-structured interviews between January and July 2021. Initial semi-structured interviews were conducted with 16 participants in January 2021. Participants completed measures of resilience (2-item Connor‐Davidson Resilience Scale) and distress (The National Comprehensive Cancer Network Distress Thermometer). Interviews were recorded, transcribed and analysed thematically.

Results

Participants reported low levels of distress and moderate to high levels of resilience on average. Three themes were generated from analysis of the first phase of cross-sectional interviews. Participants described a counterbalance of being cautious of infection and keeping safe through prevention and shielding strategies. Although hospitals felt safe and were working efficiently, some participants felt COVID-19 had compromised person-centredness and empathy in care. While participants valued the measures taken to minimize infection risk, substitution of face-to-face appointments with telehealth services and attending essential face-to-face appointments alone restricted participants' access to professional and social support. Despite this, many participants felt public health measures to reduce transmission of COVID-19 had created a sense of not missing out, feeling safe and reduced difficult social interactions requiring explanation of their diagnosis.

Conclusions

There is an opportunity to learn from the experiences of healthcare delivery from the perspectives of people affected by cancer during the COVID-19 pandemic. The results highlight the complexities and dualities of living with, after or caring for someone with cancer during the COVID-19 pandemic. Opportunities for longitudinal qualitative research to explore the evolving experiences, concerns and persistent and emerging unmet information and clinical needs within the rapidly changing socio-political, socio-cultural and healthcare contexts of the COVID-19 pandemic are highlighted.

Uncovering survivorship bias in longitudinal mental health surveys during the COVID-19 pandemic

AIMS

Markedly elevated adverse mental health symptoms were widely observed early in the coronavirus disease-2019 (COVID-19) pandemic. Unlike the U.S., where cross-sectional data indicate anxiety and depression symptoms have remained elevated, such symptoms reportedly declined in the U.K., according to analysis of repeated measures from a large-scale longitudinal study. However, nearly 40% of U.K. respondents (those who did not complete multiple follow-up surveys) were excluded from analysis, suggesting that survivorship bias might partially explain this discrepancy. We therefore sought to assess survivorship bias among participants in our longitudinal survey study as part of The COVID-19 Outbreak Public Evaluation (COPE) Initiative.

METHODS

Survivorship bias was assessed in 4039 U.S. respondents who completed surveys including the assessment of mental health as part of The COPE Initiative in April 2020 and were invited to complete follow-up surveys. Participants completed validated screening instruments for symptoms of anxiety, depression and insomnia. Survivorship bias was assessed for (1) demographic differences in follow-up survey participation, (2) differences in initial adverse mental health symptom prevalence adjusted for demographic factors and (3) differences in follow-up survey participation based on mental health experiences adjusted for demographic factors.

RESULTS

Adjusting for demographics, individuals who completed only one or two out of four surveys had significantly higher prevalence of anxiety and depression symptoms in April 2020 (e.g. one-survey v. four-survey, anxiety symptoms, adjusted prevalence ratio [aPR]: 1.30, 95% confidence interval [CI]: 1.08-1.55, p = 0.0045; depression symptoms, aPR: 1.43, 95% CI: 1.17-1.75, p = 0.00052). Moreover, individuals who experienced incident anxiety or depression symptoms had significantly higher adjusted odds of not completing follow-up surveys (adjusted odds ratio [aOR]: 1.68, 95% CI: 1.22-2.31, p = 0.0015, aOR: 1.56, 95% CI: 1.15-2.12, p = 0.0046, respectively).

CONCLUSIONS

Our findings reveal significant survivorship bias among longitudinal survey respondents, indicating that restricting analytic samples to only respondents who provide repeated assessments in longitudinal survey studies could lead to overly optimistic interpretations of mental health trends over time. Cross-sectional or planned missing data designs may provide more accurate estimates of population-level adverse mental health symptom prevalence than longitudinal surveys.

Addressing the critical need for long-term mental health data during the COVID-19 pandemic: Changes in mental health from April to September 2020

Despite the large amounts of research currently being conducted and the high number of editorials warning about the potential mental health impacts, there is a stunning lack of longitudinal mental health data on the effects of the pandemic. Yet, the pandemic may have sizable long-term impacts on psychological distress and health behaviors-these effects may be long-lasting and may disproportionately affect some demographic groups more than others. Data came from a longitudinal international study of the impacts of the COVID-19 pandemic on adults' psychological distress and wellbeing (N = 1567). We found high rates of depression (55% were diagnosable with probable depression at baseline), anxiety (65%), and risk for PTSD (51%). More than one-third of participants who reported that they drank alcohol indicated that their drinking had increased since the start of the pandemic. Over time, depressive symptoms and suicidal thoughts and behaviors increased significantly, but acute stress symptoms decreased. Specific demographic groups (people of color and sexual and gender minorities) appeared to be at high risk of distress across analyses. Our findings suggest high rates of depression, anxiety, acute stress, and other signs of distress like isolation, hopelessness, and use of substances to cope-even at five-month follow-up. Our findings suggest a need to prioritize availability of, and access to, mental health care during both the pandemic and the recovery.