Correlates of symptoms of anxiety and depression and mental wellbeing associated with COVID-19: a cross-sectional study of UK-based respondents

A qualitative study of patients’ experiences and acceptance of computerised cognitive behavioural therapy in primary care, Scotland

Computerised cognitive behavioural therapy (CCBT) has been made available within the National Health Service (NHS) across Scotland as an alternative treatment for mild to moderate anxiety and depression. However, the provision of CCBT services is still limited in the NHS, possibly affecting delivery of this computer-aided therapy to patients and inhibiting acceptance and uptake of this intervention. This paper reports on the qualitative exploration of patients’ experiences and acceptance of one CCBT programme delivering computer-assisted therapy (Beating the Blues: BTB), examining particularly the point of referral, access to treatment, and support. Thematic analysis was conducted on semi-structured face-to-face and email interviews with 33 patients at different NHS organisations across Scotland. Data analysis generated six key themes which illustrated patients’ experiences relating to referral and access to the treatment, and the challenges they faced: (1) information dissemination; (2) expectations and the impact of waiting for BTB; (3) impact of locations on experience of BTB; (4) preference for home access; (5) desire for better human support; and (6) desire for additional application support features. The findings highlighted that better methods of implementing and delivering such CCBT services together with the design of the technological interventions are vital to the success of these services.

Key learning aims

(1)

Impact of COVID-19 induced lockdown on physical activity and sedentary behavior among university students: A systematic review

Background

The COVID-19 pandemic has entailed a significant socio-economic impact on various layers of the population. In many countries, attempts to control viral dissemination involved lockdown measures that limited citizens' overall mobility and professional and leisure activities.

Objective

This systematic review investigates the impact of COVID-19-induced lockdowns on university student physical activity and sedentary behav-ior, as these relate to physical and mental well-being.

Methods

Data was collected through PubMed/MEDLINE, Embase, SCOPUS, and APA PsycInfo databases until January 2021.

Results

Seven studies conducted in five different countries (United States, Spain, Italy, China, and United Kingdom) were included in the final review. Overall, most studies reported a significant decrease in mild physical activity (i.e., walking) among undergraduate students but not among graduate students. Consistently, most studies reported a significant increase in sedentary time (i.e., sitting time on weekdays) in undergraduate students but not in graduate students. We observed that students who were more sedentary previous to lockdown, increased or did not change their moderate and/or vigorous physical activity. In contrast, those who were less sedentary previous to lockdown decreased their moderate and/or vigorous physical activity.

Conclusions

COVID 19 induced lockdowns appear to have negatively affected walking and sedentary behavior among undergraduate students but not among graduate students. Our results highlight the importance of promoting the World Health Organization recommendations for physical activity and sedentary behavior among university students to improve health outcomes.

The uptake and effectiveness of online cognitive behaviour therapy for symptoms of anxiety and depression during COVID-19

BACKGROUND

The mental health impacts of COVID-19 have been considerable with many individuals experiencing significant anxiety and depression. Online cognitive behavioural therapy (iCBT) programs provide scalable access to psychological interventions, however the effectiveness of these programs during the pandemic has not been investigated. This study examined the uptake and effectiveness of iCBT for symptoms of anxiety and depression during the first eight months of the pandemic in Australia (March- October 2020) and compared outcomes to the 12 months prior to COVID-19.

METHODS

6,132 adults commenced iCBT (5,074 during the pandemic and 1,058 in the year before) and completed measures of anxiety and depression symptom severity, and psychological distress pre- and post-treatment.

RESULTS

In the COVID-19 period, we observed a 504% increase in the number of monthly course registrations compared to the year prior (with a peak increase of 1,138% between April and June 2020). Baseline anxiety and depression symptom severity were similar for the COVID and pre-COVID groups. Prior to and during the pandemic, the iCBT course was associated with large effect size reductions in anxiety (g = 0.94-1.18) and depression (g = 0.92-1.12) symptom severity, as well as psychological distress (g = 1.08-1.35).

LIMITATIONS

lack of control group and long-term follow-up, as well as lack of detailed information about course users (e.g., health status and life context).

CONCLUSION

Results indicate the considerable increase in demand for psychological support during the COVID-19 pandemic in Australia and demonstrate the effectiveness and scalability of iCBT for symptoms of anxiety and depression.

Longitudinal changes in the mental health of UK young male and female adults during the COVID-19 pandemic

An increasing body of research indicates that, whilst young adults are at the lowest risk of becoming severely physically ill as a result of COVID-19, they are at the greatest risk of adverse mental health outcomes. Using data from the Understanding Society COVID-19 survey, the current study examined the mental health of 18-25-year-olds during the pandemic. Current mental health was measured at six time points using the 12-item General Health Questionnaire (GHQ-12), a validated measure for mental distress. The analytic sample included 880 young adults (292 = males; 588 = females). The trajectory of mental health was modeled from April to November 2020, using demographic information and health behaviors (physical activity, alcohol consumption, and smoking cigarettes) as covariates. Growth curve modeling indicated that alcohol consumption, smoking, being female, having a lower income, and having a pre-existing mental health condition were risk factors for worse mental health during the pandemic. For females, their mental health was lowest in April but gradually improved until September, when it began to decline again. Males, in contrast, had a relatively stable trajectory of mental health across the pandemic. These findings can help inform targeted interventions for at risk groups to minimize the adverse impact of the pandemic on young adults' mental health.

The impact of COVID-19 on the physical activity and sedentary behaviour levels of pregnant women with gestational diabetes

Background

The aim of this study was to understand how physical activity and sedentary behaviour levels of pregnant women with gestational diabetes in the UK have been affected by COVID-19.

Methods

An online survey exploring physical activity and sedentary behaviour levels of pregnant women with gestational diabetes during COVID-19 was distributed through social media platforms. Women who had been pregnant during the COVID-19 outbreak and had gestational diabetes, were resident in the UK, were 18 years old or over and could understand written English were invited to take part.

Results

A total of 724 women accessed the survey, 553 of these met the eligibility criteria and took part in the survey. Sedentary time increased for 79% of the women during the pandemic. Almost half of the women (47%) were meeting the physical activity guidelines pre COVID-19 during their pregnancy, this dropped to 23% during the COVID-19 pandemic. Fear of leaving the house due to COVID-19 was the most commonly reported reason for the decline. Significant associations were found between meeting the physical activity guidelines during COVID-19 and educational attainment, fitness equipment ownership and knowledge of how to exercise safely in pregnancy.

Conclusions and implications

These results show the impact of COVID-19 on physical activity and sedentary behaviour levels and highlight the need for targeted public health initiatives as the pandemic continues and for future lockdowns. Women with gestational diabetes need to know how it is safe and beneficial to them to engage in physical activity and ways to do this from their homes if fear of leaving the house due to COVID-19 is a barrier for them. Online physical activity classes provided by certified trainers in physical activity for pregnant women may help them remain active when face-to-face appointments are reduced and limited additional resources are available.

Perceived Decrease in Workplace Security Since the Beginning of the COVID-19 Pandemic: The Importance of Management Styles and Work-Related Attitudes

The coronavirus disease 2019 (COVID-19) pandemic has reduced the sense of security of people in everyday life. The efforts of managers in the workplace to minimize the health risks and economic damage, however, can provide the employees with a greater sense of security. The aim of this study was to identify the types of workplace responses to the pandemic outbreak with respect to the characteristics of employees and their employers accomplishing the differences in subjective sense of workplace security before the pandemic and during the outbreak. Three hundred and thirty-seven Polish employees completed an online survey during the first 2 weeks of the COVID-19 pandemic in March 2020. Using the cluster analysis, we identified four subgroups of employees differing in their sense of workplace security, work-related psychological factors, and perceived management styles of their supervisors. Employees led by developers and executive managers sustained a high sense of work security and positive attitude to work, while those led by compromisers and deserter managers suffered from the highest drop of subjective security. In this study, we proposed how employees can be protected from overreactions and unnecessary panic in a time of global crisis by virtue of the psychological competences of their supervisors and employers.

Perceived neighborhood cohesion buffers COVID-19 impacts on mental health in a United States sample

Objective

This study examined whether perceived neighborhood cohesion (the extent to which neighbors trust and count on one another) buffers against the mental health effects of the 2020 COVID-19 pandemic.

Methods

The XXX University National COVID-19 and Mental Health Study surveyed US adults (N = 3965; M age = 39 years), measuring depressive symptoms, staying home more during than before the 2020 pandemic, and perceived neighborhood cohesion.

Results

A series of linear regressions indicated that perceiving one's neighborhood as more cohesive was not only associated with fewer depressive symptoms, but also attenuated the relationship between spending more time at home during the pandemic and depressive symptoms. These relationships persisted even after taking into account several individual-level sociodemographic characteristics as well as multiple contextual features, i.e., median household income, population density, and racial/ethnic diversity of the zip codes in which participants resided.

Conclusions

Neighborhood cohesion may be leveraged to mitigate pandemic impacts on depressive symptoms.

Determining the effect of sertraline on nitrogen transformation through the microbial food web in sediments based on 15N-DNA-stable isotope probing

Antidepressants may influence the food web and alter the nitrogen cycle through top-down forces. However, the effect of antidepressants on the key nitrogen-using species in the benthic microbial food web remains unclear, particularly the resulting changes in the nitrogen transformation process within the microecosystems. Therefore, in this study, we employed DNA stable-isotope probing to detect nitrogen-converting organisms at various trophic levels and quantify the nitrogen transformation process for the first time. The input of sertraline greatly increased nitrogen-transforming microorganisms and promoted more species to participate in the nitrogen transformation process. 100 μg/L sertraline was observed to stimulate the predation of bacteria via protozoa and metazoan, increasing the total nitrogen flow flux through the microbial food web to 31.50%, 1.32 times that of the natural condition. The results confirm that at sertraline concentrations close to the lowest observable effect concentration in the meiobenthos (100 μg/L), key components in the microbial food web were largely interfered and exerted a long-term interference on the nutrient cycle in the river sediment ecosystem. These findings confirm that sertraline has negative effects on river ecosystems from the perspective of microbial food webs and open a new line of inquiry into assessing ecological risks of antidepressants.

Putting the social back into physical distancing: The role of digital connections in a pandemic crisis

During the COVID-19 pandemic, physical distancing is necessary to reduce the spread of the coronavirus. To compensate for the lack of social encounters, people have been advised to connect with others via digital communication channels. Drawing on a psychological framework combined with assumptions from communication science, we therefore investigated whether technology-mediated communication can actually meet individuals' social needs to foster compliance with distancing measures and whether there are differences between distinct communication channels. Based on an online survey (N = 301) during the first national lockdown in Germany, we found that the impact of audio-visual communication is limited. Instead, the data showed that text-based communication indirectly fostered willingness to adhere to physical distancing through the pathway of increased feelings of social support and life satisfaction. Three follow-up surveys (N = 180) revealed that while feelings of social support increased, people's technology-based communication and willingness to adhere to distancing measures decreased. Our results challenge the assumption that audio-visual communication compensates for lack of physical contact more effectively than text-based communication. This study highlights the potential of text-based communication to increase feelings of social support, which may be particularly important during a pandemic.

Direct and indirect effects of SARS-CoV-2 on wastewater treatment

The novel SARS-CoV-2 is expanding internationally. While the current focus is on limiting its transmission from direct contact with infected patients and surfaces during the pandemic, the secondary transmission potential via sewage should not be underestimated, especially in low-income and developing countries with weak wastewater treatment technologies. Recent studies have indicated SARS-CoV-2 positivity also be detected in the feces of patients. Therefore, the risk of transmission and infection can be increased into sewage by the fecal-oral way, mainly in some parts of the globe with a high amount of open defecation. This review collected scattered data and recent studies about the direct and indirect effects of coronavirus in the water cycle. The direct impacts of COVID-19 on wastewater are related to the presence of the coronavirus and suitable viral removal methods in different phases of treatment in wastewater treatment plants. The indirect effects of COVID-19 on wastewater are related to the overuse of cleaning and disinfecting products to protect against viral infection and the overuse of certain drugs to protect against virus or novel mental problems and panic to COVID-19 and consequently their presence in wastewater. This unexpected situation leads to changes in the quality of wastewater and brings adverse and harmful effects for the human, aquatic organisms, and the environment. Therefore, applying effective wastewater treatment technologies with low toxic by-products in wastewater treatment plants will be helpful to prevent the increasing occurrence of these extra contaminants in the environment.

Taylor L, Shevlin M, McHugh L, Carr A, Burke T. A remote self-directed psychological intervention for the public: The PAUSE programme protocol

Background: This protocol outlines procedures for the development and evaluation of a remotely accessible intervention tool known as the ‘Psychology And yoU: Self-Enhancement programme’ (i.e., PAUSE programme). The PAUSE programme aims to support and promote psychological well-being using positive psychological concepts and principles. The programme has been developed in the context of the coronavirus disease 2019 pandemic, where effective and evidence-based remote interventions are needed. The PAUSE programme will provide users with valuable tools and skills that they may choose to implement in their daily lives, in order to foster and support positive mental well-being. The programme includes six modules: Well-being and Happiness; Healthy Body and Mind; Being Grateful and Savouring Life; Thought and Action; Strengthening Relationships; and Overcoming Challenges. Methods: Participants will be recruited using media outlets, social media, and professional networking websites in Ireland. Those who choose to participate in this study will be asked to complete a set of measures at baseline, immediate follow-up, and six weeks post-intervention. This will allow for changes in subjective well-being scores to be analysed and interpreted over time. This study adopts a Groups x Time design, with participants being randomly assigned to either an intervention or wait-list control group. Ethical approval is currently under review at the host institution. Dissemination: The dissemination strategy will follow the Evidence-based model for the Transfer and Exchange of Research Knowledge (EMTReK) and study findings will be prepared in line with various formats (e.g. study newsletters, conferences/meetings) in order to meet the needs of different audiences. Targeted and timely dissemination activities are anticipated, and the team intends to disseminate research in an ongoing manner, throughout the lifetime of the project. Registration: This RCT protocol is pre-results and has been registered with an international database resulting in an International Standard Randomised Controlled Trials Number (ISRCTN14772616)

Subjective Impact of the COVID-19 Pandemic on Schizotypy and General Mental Health in Germany and the United Kingdom, for Independent Samples in May and in October 2020

Studies reported a strong impact on mental health during the first wave of the COVID-19 pandemic in March-June, 2020. In this study, we assessed the impact of the pandemic on mental health in general and on schizotypal traits in two independent general population samples of the United Kingdom (May sample N: 239, October sample N: 126; participation at both timepoints: 21) and in two independent general population samples of Germany (May sample N: 543, October sample N: 401; participation at both timepoints: 100) using online surveys. Whereas general psychological symptoms (global symptom index, GSI) and percentage of responders above clinical cut-off for further psychological investigation were higher in the May sample compared to the October sample, schizotypy scores (Schizotypal Personality Questionnaire) were higher in the October sample. We investigated potential associations, using general linear regression models (GLM). For schizotypy scores, we found that loneliness, use of drugs, and financial burden were more strongly corrected with schizotypy in the October compared to the May sample. We identified similar associations for GSI, as for schizotypy scores, in the May and October samples. We furthermore found that living in the United Kingdom was related to higher schizotypal scores or GSI. However, individual estimates of the GLM are highly comparable between the two countries. In conclusion, this study shows that while the general psychological impact is lower in the October than the May sample, potentially showing a normative response to an exceptional situation; schizotypy scores are higher at the second timepoint, which may be due to a stronger impact of estimates of loneliness, drug use, and financial burden. The ongoing, exceptional circumstances within this pandemic might increase the risk for developing psychosis in some individuals. The development of general psychological symptoms and schizotypy scores over time requires further attention and investigation.

Impact of COVID-19-like symptoms on occurrence of anxiety/depression during lockdown among the French general population

BACKGROUND

The outbreak of the COVID-19 epidemic lead to high levels of morbidity and mortality around the globe. Consequences of this outbreak and possible associated infection are an increase in mental health disorders and an increased likelihood of internalizing problems, particularly depression. However, to date few studies have tested this hypothesis while taking into account individuals' preexisting mental health difficulties.

METHODS

We used longitudinal data collected among 729 persons in the context of the French TEMPO cohort between March and June 2020 (7 waves of data collection). COVID-19-like symptoms as well as anxiety/depression (assessed by the Adult Self Report), were reported at each wave of data collection. To study the relationship between COVID-19-like symptoms and anxiety/depression, we used generalized estimation equation (GEE) models controlled for socio-demographic and health-related characteristics, including anxiety/depression prior to 2020.

RESULTS

Overall, 27.2% of study participants reported anxiety/depression during lockdown. 17.1% of participants reported COVID-19-like symptoms during the course of follow-up, 7.3% after the beginning of lockdown, with an average number of 2.7 symptoms, and 3.6% reported respiratory distress. In multivariate analyses, nearly all the considered indicators of COVID-19-like symptoms were associated with higher odds of symptoms of anxiety/depression (symptoms Yes/No: OR = 1.66, 95% CI = 1.08-2.55; symptoms after the beginning of lockdown: OR = 1.91, 95% CI = 1.03-3.52; number of symptoms: OR for each additional symptom = 1.19, 95% CI = 1.02-1.39. This relationship exists after taking into account prior symptoms of anxiety/depression, which are associated with a 5-fold increased likelihood of psychological distress. And this impact is stronger among men than women.

CONCLUSIONS

Our study shows higher risk of anxiety/depression among persons who experienced COVID-19-like symptoms, even after accounting for prior mental health difficulties. COVID-19 infection could have both a direct and indirect impact on the occurrence of psychological difficulties, and this association should be studied in greater detail.

Levels of physical activity in four domains and affective wellbeing before and during the Covid-19 pandemic

BACKGROUND

Latest studies indicated that the general mental health level is low during the pandemic. Probably, this deterioration of the mental health situation is partly due to declines in physical activity. The aim of this study was to investigate differences in and the association between affective wellbeing and levels of different domains of physical activity at three time points before and during the pandemic.

METHOD

We used a nationwide online panel with a trend data design encompassing a total sample of N = 3517, representing the German population (> 14 years). Four different activity domains (sport and exercise, light outdoor activity, housework/gardening, active travel) and affective wellbeing (positive and negative affect) were assessed at three time points before and during the Covid-19 pandemic (October 2019, March 2020, October 2020).

RESULTS

Multivariate analyses of variance (MANOVA) indicate differences regarding affective wellbeing over the three time points with the lowest values at the second time point. Levels of activity in the four domains differed significantly over time with the strongest decrease for sport and exercise from the first to the second time point. Partial correlations indicated that the relationships between sport and exercise and positive affect were most consistent over time.

CONCLUSIONS

Overall, our findings suggest that physical activity plays a particularly important role in the pandemic period as a protective factor against poor mental health. Especially sports and exercise seem to be supportive and should be encouraged, e.g. by providing additional support in finding adequate outdoor, home-based or digital substitutes.

The psychological impact of the COVID-19 pandemic on pregnant women

The aim was to examine the psychological effects caused by the COVID-19 pandemic on pregnant women, as well as the factors influencing these effects. The study design was cross-sectional and the participants were 200 pregnant women. The first group called the Pandemic Group (PG) included 100 women who were evaluated with psychological assessment instruments during the COVID-19 pandemic. The second group titled Pre-Pandemic Group (PPG) consisted of 100 women who were evaluated prior to the pandemic. Perceived stress, prenatal concerns and psychopathological symptoms were evaluated and compared. Pandemic Group scored significantly higher than Pre-Pandemic Group in the depression dimension of the SCL-90, in the phobic anxiety dimension, and in the Perceived Stress Scale. In addition, insomnia, along with having recently suffered the loss of a loved one explained 25% of the score variance in the depression dimension of the SCL-90. Insomnia also explained 13% of the variance of the results found in the Perceived Stress Scale. The fear of contagion by COVID-19 increased the scores obtained in the phobic anxiety dimension, explaining 11% of the variance. Thus, the COVID-19 pandemic could produce an increase in psychopathological symptomatology and stress, which can lead to negatively affecting pregnant women's mental health.

Effects of the COVID-19 pandemic and lockdown on alcohol use disorders and complications

PURPOSE OF REVIEW

To understand the effect of COVID-19 pandemic and lockdown on persons with alcohol use disorders.

RECENT FINDINGS

From a total of 455 titles on COVID-19 and alcohol, 227 abstracts were screened, and 95 articles were reviewed (on November 25th, 2020). The immediate effect was an increase in alcohol related emergencies including alcohol withdrawal, related suicides, and methanol toxicity. Although there are mixed findings with respect to changes in the quantity of drinking, there are reports of binge/heavy drinking during the lockdown as well as relapse postlockdown. Psychological, social, biological, economic and policy-related factors appear to influence the changes in drinking. Although preliminary data suggest no change in alcohol use among persons with comorbid mental illness, findings in this population are presently limited. Among patients with alcohol related liver disease, outcomes appear worse and caution is warranted with the use of medications. Alcohol also appears to increases the risk of COVID-19 infection and complicates its course.Although some nations banned alcohol sales completely during lockdown, others declared it as an essential commodity, resulting in different problems across countries. Alcohol use has added to the burden of the problem particularly among vulnerable groups like the adolescents, elderly, patients with cancer, as well as health professionals. Services for patients with alcohol use disorders have been affected.

SUMMARY

The COVID-19 pandemic has had considerable impact on alcohol use, with an increase in alcohol related emergencies, changes in alcohol use patterns, increased risk of contracting COVID-19, effect on alcohol policies and sales, and an effect on vulnerable groups. It is essential to understand and respond to the current situation, intervene early, and prevent further repercussions of the pandemic.Video abstract link: https://drive.google.com/file/d/1IJWtIs6e554PryKWhdma4VB--mjSZq1C/view?usp=sharing.

Dealing With the Pandemic of COVID-19 in Portugal: On the Important Role of Positivity, Experiential Avoidance, and Coping Strategies

The global COVID-19 pandemic crisis has caused an unprecedented impact on most areas of people's lives. Thus, framed within the scope of Existential Positive Psychology (PP2.0), this study aimed at assessing the psychological distress of adults living in Portugal during the first national lockdown, how they are coping with stress, as well to contribute to a deeper understanding about the role that positivity, experiential avoidance, and coping strategies have in psychological distress and well-being. For this purpose, 586 Portuguese adults (73% females) ranging between 18 and 78 years old (M = 38.96, SD = 12.20) completed an online survey during the initial phase of the pandemic crisis in Portugal. Findings suggest that experiential avoidance was the strongest predictor of a negative response (depression, anxiety, stress, loneliness, and negative emotions), whereas positivity was a better predictor of psychological well-being and lower levels of depression. Additionally, self-blame, behavioral disengagement, and emotional venting were strong risk factors for psychological distress, whereas positive reframing, planning, and acceptance were associated with more positive outcomes. These findings highlight the critical role of experiential avoidance on individuals' psychological distress and the essential contribution of positive life orientation in promoting flourishing. By offering a better understanding of the complex navigation through the dialectics between positive and negative life features, this study provides important and useful cues for psychological interventions directed at promoting a more positive and adaptive human functioning even through such potential adverse and painful life events.

Influence of Social and Cultural Factors on the Decision to Consent for Monoclonal Antibody Treatment among High-Risk Patients with Mild-Moderate COVID-19

BACKGROUND

The clinical outcomes of patients who decline anti-spike monoclonal antibody therapies for coronavirus disease-2019 (COVID-19) is not known. Factors associated with the decision to accept or decline the offer for anti-spike monoclonal antibody therapies are not established. This study aimed to identify factors impacting the decision to consent for monoclonal antibody therapies and assess the differences in clinical outcomes of patients who accepted compared to those who declined these therapies.

METHODS

This retrospective cohort study enrolled 2820 adult patients who were offered monoclonal antibody therapies, bamlanivimab and casirivimab-imdevimab, for COVID-19 at Mayo Clinic in the Midwest between 11/19/2020 and 12/31/2020. The primary endpoint is the decision to accept or decline monoclonal antibody treatment. Secondary endpoints were patient-level factors that could have impacted the decision to accept treatment (age, gender, race, ethnicity, primary language spoken, and medical comorbidities). The main clinical endpoint was hospitalization within 28 days of COVID-19 diagnosis.

RESULTS

59.1% (n = 1669) chose to accept monoclonal antibody therapy, and 40.9% (n = 1151) chose to decline the offer for treatment. Patients were more likely to accept treatment if they were non-Hispanic White, English speaking, identified a spouse or life partner, had a religious affiliation, and possessed more medical comorbidities. Overall, 28-day hospitalization rate was 2.6% (n = 72/2820) and was higher among those who declined (3.3%) than those who accepted monoclonal antibody therapy (2.0%; Rate Ratio = 0.62, 95% Confidence Interval, 0.39-0.98).

CONCLUSIONS

Despite having more comorbidities, patients who accepted monoclonal antibody treatments had a lower rate of hospitalization compared to patients who declined treatment. Several social and cultural factors were associated with the decision to decline therapy, including race, language, ethnicity, and lack of social support. These findings can inform public health efforts to reduce social disparities in the treatment of COVID-19 and increase utilization of monoclonal antibody therapies in high risk populations.

Impact of COVID-19 lockdown on psychosocial factors, health, and lifestyle in Scottish octogenarians: The Lothian Birth Cohort 1936 study

BACKGROUND

Little is known about effects of COVID-19 lockdown on psychosocial factors, health and lifestyle in older adults, particularly those aged over 80 years, despite the risks posed by COVID-19 to this age group.

METHODS

Lothian Birth Cohort 1936 members, residing mostly in Edinburgh and the surrounding Lothians regions in Scotland, mean age 84 years (SD = 0.3), responded to an online questionnaire in May 2020 (n = 190). We examined responses (experience and knowledge of COVID-19; adherence to guidance; impact on day-to-day living; social contact; self-reported physical and mental health; loneliness; and lifestyle) and relationships between previously-measured characteristics and questionnaire outcomes.

RESULTS

Four respondents experienced COVID-19; most had good COVID-19 knowledge (94.7%) and found guidance easy to understand (86.3%). There were modest declines in self-reported physical and mental health, and 48.2% did less physical activity. In multivariable regression models, adherence to guidance by leaving the house less often associated with less professional occupational class (OR = 0.71, 95%CI 0.51-0.98) and poorer self-rated general health (OR = 0.62, 95%CI 0.42-0.92). Increased internet use associated with female sex (OR = 2.32, 95%CI 1.12-4.86) and higher general cognitive ability (OR = 1.53, 95%CI 1.03-2.33). Loneliness associated with living alone (OR = 0.15, 95%CI 0.07-0.31) and greater anxiety symptoms (OR = 1.76, 95%CI 0.45-1.24). COVID-19 related stress associated with lower emotional stability scores (OR = 0.40, 95%CI 0.24-0.62). Decreased physical activity associated with less professional occupational class (OR = 1.43, 95%CI 1.04-1.96), and lower general cognitive ability (OR = 0.679, 95%CI 0.491-0.931).

CONCLUSIONS

Characteristics including cognitive function, occupational class, self-rated health, anxiety, and emotional stability, may be related to risk of poorer lockdown-related psychosocial and physical outcomes.

Psychological Effects of Home Confinement and Social Distancing Derived from COVID-19 in the General Population-A Systematic Review

(1) Background: Home confinement and social distancing are two of the main public health measures to curb the spread of SARS-Cov-2, which can have harmful consequences on people’s mental health. This systematic review aims to identify the best available scientific evidence on the impact that home confinement and social distancing, derived from the SARS-CoV-2 pandemic, have had on the mental health of the general population in terms of depression, stress and anxiety. (2) Methods: A systematic search was conducted on PubMed, Scopus, Web of Science and ScienceDirect between 2 January 2021 and 7 January 2021, in accordance with the recommendations of the PRISMA Declaration. The selection of studies and the evaluation of their methodological quality were performed in pairs, independently and blindly, based on predetermined eligibility criteria. (3) Results: The 26 investigations reviewed were developed in different regions and countries. Factors that are associated with poor mental health were female gender, young ages, having no income and suffering from a previous psychiatric illness. Inadequate management of the pandemic by authorities and a lack or excess of information also contributed to worse mental health. (4) Conclusions: There are groups of people more likely to suffer higher levels of anxiety, depression and stress during the restrictive measures derived from COVID-19.

Importance of connectedness for the management of embitterment and loneliness in the era of COVID-19

Background: Coronavirus disease 2019 (COVID-19) has made ‘untact’ life a new standard (next normal) way of life, minimizing physical contacts among people. Emotional exchanges between people are rapidly being replaced by contact through the Internet, social networks, and over-the-top services.Current Concepts: People are expressing more stress and anxiety that are caused by fear of infection, and also embitterment due to perceived distrust and injustice is increasing. In the era of COVID-19, it is necessary and important to manage burnout, depression, and anxiety symptoms of medical staff and quarantine personnel. The pandemic and the resulting social changes intensifies loneliness, leading to deterioration in mental and physical health. The World Health Organization has warned that loneliness and social isolation are leading to the exacerbation of physical illness and increased mortality due to suicide and other mental health problems.Discussion and Conclusion: It is needed to establish a next standard of mental health service such as untact diagnosis and follow-up support system. Government and society should establish a sustainable system even after the COVID-19 crisis, rather than stopgap measures made with people’s sacrifice as collateral.

Impacto del Covid-19 en la salud mental: revisión de la literatura

Introducción: el 12 de diciembre de 2019 en Wuhan, China, se reportó el primer caso de COVID-19, que después se extendió y alcanzó la categoría de pandemia mundial, obligando a los gobiernos a tomar medidas de salud pública urgentes; lo que ha implicado la aparición o complicación de los problemas de salud mental en la población. Objetivo: describir el impacto del COVID-19 en la salud mental a partir de la revisión de la literatura científica. Materiales y métodos: se revisó la literatura consultando 9 bases de datos con los términos de búsqueda “COVID-19” y “mental” y el operador booleano “AND”. Los artículos fueron revisados y sintetizados con la ayuda de una matriz de 5 pasos y evaluados con las pruebas STROBE y CASPe. Un total de 43 artículos fueron seleccionados. Resultados: se encontró que China con 21 estudios (46,7%) presentó la mayor producción, utilizando diversos tipos de instrumentos aplicados de modo remoto. Las muestras fueron tomadas en momentos diferentes del brote (fase inicial, pico de brote y después del pico), desde diciembre 2019 hasta abril de 2020, en especial con diseños transversales (90.7%). El impacto psicológico se agrupó en las categorías de afectos negativos, afectos positivos, pensamientos negativos, ansiedad, depresión, estrés, alteraciones del comportamiento, consumo de sustancias psicoactivas, síntomas fisiológicos, alteraciones del sueño, impacto psicológico y cambios positivos en el bienestar. Conclusiones: se evidenciaron impactos del brote del COVID-19 en la salud mental. No se hallaron estudios colombianos.

Psychological Impact of COVID-19 on People with Pre-Existing Chronic Disease

The COVID-19 pandemic has caused an increase in anxiety and depression levels across broad populations. While anyone can be infected by the virus, the presence of certain chronic diseases has been shown to exacerbate the severity of the infection. There is a likelihood that knowledge of this information may lead to negative psychological impacts among people with chronic illness. We hypothesized that the pandemic has resulted in increased levels of anxiety and depression symptoms among people with chronic illness. We recruited 540 participants from the ongoing Prospective Urban and Rural Epidemiology (PURE) study in British Columbia, Canada. Participants were asked to fill out an online survey that included the Hospital Anxiety Depression Scale (HADS) to assess anxiety and depression symptoms. We tested our hypothesis using bivariate and multivariable linear regression models. Out of 540 participants, 15% showed symptoms of anxiety and 17% reported symptoms of depression. We found no significant associations between having a pre-existing chronic illness and reporting higher levels of anxiety or depression symptoms during COVID-19. Our results do not support the hypothesis that having a chronic illness is associated with greater anxiety or depression symptoms during the COVID-19 pandemic. Our results were similar to one study but in contrast with other studies that found a positive association between the presence of chronic illness and developing anxiety or depression during this pandemic.

The effect of COVID-19 on medical students' education and wellbeing: a cross-sectional survey

BACKGROUND

Canadian medical school curriculums have undergone major restructuring during the COVID-19 pandemic. This study's goal was to assess the perceived impact of COVID-19 on medical students' education and wellbeing.

METHODS

An online survey was distributed to Canadian medical students. Descriptive analyses and ANOVAs were used to assess changes in mental health, health habits and quality of education during the pandemic.

RESULTS

248 medical students from 13 schools across Canada participated in this study. 74% reported a reduction in the quality of their education since COVID-19. 58% of students found online to be inferior to in-person teaching. 65% of students had more time for wellness and leisure activities, about half of the cohort felt more depressed (48%) and lonelier (52%). Student's overall health habits worsened after the start of the pandemic (F=37.4, p < 0.001). Alcohol drinking, time spent seated, and screen time also increased since the pandemic (p < 0.001). During the pandemic, students with a prior history of depression or anxiety expressed increased depressive symptoms (66% vs. 42%, p =0.003), increased anxiety (69% vs. 41%, p < 0001), worse sleep quality (34% vs. 18%, p = 0.031), and poorer quality of life (55% vs. 65%, p = 0.024) versus those with no prior history.

CONCLUSION

Canadian medical student's education and wellbeing has been negatively impacted during the pandemic.

The association between COVID-19 diagnosis or having symptoms and anxiety among Canadians: A repeated cross-sectional study

BACKGROUND

The mental health effects of being diagnosed with COVID-19 are unknown. The present study examined whether individuals or those with someone close to them with a COVID-19 diagnosis differentially experienced anxiety during the pandemic.

METHODS

Four web-based repeated cross-sectional surveys were conducted among Canadians aged 18 and older (n = 4015) regarding the impact of COVID-19 on mental health between May 8th and July 14th, 2020. Data on sociodemographic, COVID-19 symptoms/diagnoses for self or someone close, and anxiety were collected. Multiple logistic regression analyses were performed controlling for potential confounders.

RESULTS

Anxiety among individuals affected by the pandemic remained stable over time. Individuals or those with someone close diagnosed with COVID-19 had greater odds of having anxiety (OR = 1.55; 95%CI 1.12, 2.14) compared to those who had not been diagnosed (self or close other) with COVID-19. Individuals or those with someone close to them who had symptoms of COVID-19 had greater odds of having anxiety (OR = 2.08; 95%CI 1.51, 2.87) compared to those who did not report symptoms (self or close other).

CONCLUSIONS

This evidence highlights the importance of targeted psychosocial interventions for those directly impacted by the COVID-19 virus.

Positive Organisational Arts-Based Youth Scholarship: Redressing Discourse on Danger, Disquiet, and Distress during COVID-19

This methodological article argues for the potential of positive organisational arts-based youth scholarship as a methodology to understand and promote positive experiences among young people. With reference to COVID-19, exemplars sourced from social media platforms and relevant organisations demonstrate the remarkable creative brilliance of young people. During these difficult times, young people used song, dance, storytelling, and art to express themselves, (re)connect with others, champion social change, and promote health and wellbeing. This article demonstrates the power of positive organisational arts-based youth scholarship to understand how young people use art to redress negativity via a positive lens of agency, peace, collectedness, and calm.

Change in modifiable dementia risk factors during COVID-19 lockdown: The experience of over 50s in Tasmania, Australia

INTRODUCTION

Containment measures implemented to minimize the spread of coronavirus disease 2019 (COVID-19) are reported to be negatively affecting mental health, diet, and alcohol consumption. These factors, as well as poor cardiometabolic health and insufficient physical and cognitive activity, are known to increase the risk of developing dementia. COVID-19 "lockdown" measures may have exacerbated these dementia risk factors among people in mid-to-later life.

METHODS

We compared longitudinal data from before (October 2019) and during (April-June 2020) the first COVID-19 lockdown period in Tasmania, Australia. Participants (n = 1671) were 50+ years of age and engaged in a public health program targeting dementia risk reduction, with one-third participating in the Preventing Dementia Massive Open Online Course (PD-MOOC). Regression models were used to assess changes in smoking, alcohol use, body mass index (BMI), diet, physical exercise, cognitive and social activity, anxiety and depression, and management of cholesterol, diabetes, and blood pressure. Where significant changes were noted, the moderating influence of being in current employment, living with others, and completing the PD-MOOC was tested.

RESULTS

Although friend networks contracted marginally during lockdown, no detrimental effects on modifiable dementia risk factors were noted. Anxiety levels and alcohol consumption decreased, there was no change in depression scores, and small but significant improvements were observed in cognitive and physical activity, smoking, diet, and BMI. Stronger improvements in cognitive activity were observed among people who were cohabiting (not living alone) and both cognitive activity and adherence to the MIND diet (Mediterranean-DASH diet Intervention for Neurological Delay) improved more for people who participated in the PD-MOOC.

DISCUSSION

Longitudinal data did not show widespread negative effects of COVID-19 lockdown on modifiable dementia risk factors in this sample. The results counter the dominant narratives of universal pandemic-related distress and suggest that engaging at-risk populations in proactive health promotion and education campaigns during lockdown events could be a protective public health strategy.

Loneliness, Wellbeing, and Social Activity in Scottish Older Adults Resulting from Social Distancing during the COVID-19 Pandemic

This study examined the impact of social distancing during the COVID-19 pandemic on loneliness, wellbeing, and social activity, including social support, in Scottish older adults. A mixed methods online survey was used to examine these factors during social distancing mid-lockdown, July 2020. Participants were asked to state whether loneliness, wellbeing, social activity, and social support had changed since pre-social distancing, and to provide details of strategies used to keep socially active. A total of 1429 adults (84% aged 60+ years) living in Scotland took part. The majority reported that social distancing regulations made them experience more loneliness and less social contact and support. Loneliness during lockdown was higher than reported norms for this age group before the pandemic. A larger social network, more social contact, and better perceived social support seemed to be protective against loneliness and poor wellbeing. Positive coping strategies reported included increasing online social contact with both existing social networks and reconnecting with previous networks, as well as increasing contact with neighbours and people in the community. This underlines the importance of addressing loneliness and social support in older adults but particularly during situations where risk of isolation is high.

Response of UK Horse, Pony and Donkey Owners to the Early Stages of the COVID-19 Pandemic

In the UK, March 2020 was a time of great uncertainty as COVID-19 became increasingly widespread. The government responded by making suggestions about how people could reduce the risk of spread on 16 March, moved swiftly into closing schools on the 18 March before announcing a mandatory lockdown on the 23rd March. This was a challenging time for UK equestrians who had to balance maintaining their equine's routine and daily care alongside the increasing biosecurity measures. A cross-sectional survey was distributed to UK equestrians via social media over two days (28 and 29 March 2020) to better understand the decisions made by UK horse, pony and donkey owners during this time. Data from 452 respondents were generated across all four countries comprising the UK, although there were no significant differences in owner response to the pandemic between locations. The changes respondents made differed between the 16th and the 18th of March 2020, with an early emphasis on improving yard biosecurity and opting to stop riding, as well as reducing the time spent at the yard. After the 18 March, respondents placed more emphasis on risk reduction by changing the activities they did with their horse, including riding, with common examples including avoiding "high risk" activities such as riding on busy roads, jumping, riding young or nervous horses. Few respondents reported having an emergency plan in place should they become ill or otherwise unable to care for their equine. The findings highlight areas that would significantly benefit from in-depth investigation in future research. Equestrian behaviour and mindset around risk-taking and risk perception have already been researched in relation to equestrian activities and sport but have received little attention in the context of wider health challenges. Understanding the uptake of emergency planning and preparation in the UK equestrian community also warrants consideration. Using this information effectively to promote forward planning is likely to be of great benefit in equestrian responses to future health or climate-related crises.

Comorbidity and COVID-19: investigating the relationship between medical and psychological well-being

OBJECTIVE

The unprecedented occurrence of a global pandemic is accompanied by both physical and psychological burdens that may impair quality of life. Research relating to COVID-19 aims to determine the effects of the pandemic on vulnerable populations who are at high risk of developing negative health or psychosocial outcomes. Having an ongoing medical condition during a pandemic may lead to greater psychological distress. Increased psychological distress may be due to preventative public health measures (e.g. lockdown), having an ongoing medical condition, or a combination of these factors.

METHODS

This study analyses data from an online cross-sectional national survey of adults in Ireland and investigates the relationship between comorbidity and psychological distress. Those with a medical condition (n = 128) were compared to a control group without a medical condition (n = 128) and matched according to age, gender, annual income, education, and work status during COVID-19. Participants and data were obtained during the first public lockdown in Ireland (27 March 2020-8 June 2020).

RESULTS

Individuals with existing medical conditions reported significantly higher levels of anxiety (p < .01) and felt less gratitude (p ≤ .001). Exploratory analysis indicated that anxiety levels were significantly associated with illness perceptions specific to COVID-19. Post hoc analysis revealed that psychological well-being was not significantly related to condition type (e.g. respiratory disorders).

CONCLUSION

This research supports individualised supports for people with ongoing medical conditions during the COVID-19 pandemic, and has implications for the consideration of follow-up care specifically for mental health. Findings may also inform future public health policies and post-vaccine support strategies for vulnerable populations.

Impact of the COVID-19 Pandemic on Older Adults: Rapid Review

BACKGROUND

The COVID-19 pandemic has drastically changed the lives of countless members of the general population. Older adults are known to experience loneliness, age discrimination, and excessive worry. It is therefore reasonable to anticipate that they would experience greater negative outcomes related to the COVID-19 pandemic given their increased isolation and risk for complications than younger adults.

OBJECTIVE

This study aims to synthesize the existing research on the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults. The secondary objective is to investigate the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults with Alzheimer disease and related dementias.

METHODS

A rapid review of the published literature was conducted on October 6, 2020, through a search of 6 online databases to synthesize results from published original studies regarding the impact of the COVID-19 pandemic on older adults. The Human Development Model conceptual framework-Disability Creation Process was used to describe and understand interactions between personal factors, environmental factors, and life habits. Methods and results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement.

RESULTS

A total of 135 records were included from the initial search strategy of 13,452 individual studies. Of these, 113 (83.7%) studies were determined to be of level 4 according to the levels of evidence classification by the Centre for Evidence-Based Medicine. The presence of psychological symptoms, exacerbation of ageism, and physical deterioration of aged populations were reported in the included studies. Decreased social life and fewer in-person social interactions reported during the COVID-19 pandemic were occasionally associated with reduced quality of life and increased depression. Difficulties accessing services, sleep disturbances, and a reduction of physical activity were also noted.

CONCLUSIONS

Our results highlight the need for adequate isolation and protective measures. Older adults represent a heterogeneous group, which could explain the contradictory results found in the literature. Individual, organizational, and institutional strategies should be established to ensure that older adults are able to maintain social contacts, preserve family ties, and maintain the ability to give or receive help during the current pandemic. Future studies should focus on specific consequences and needs of more at-risk older adults to ensure their inclusion, both in public health recommendations and considerations made by policy makers.

Assessing Knowledge, Preventive Practices, and Depression among Chinese University Students in Korea and China during the COVID-19 Pandemic: An Online Cross-Sectional Study

To investigate the knowledge, preventive practices, and depression of Chinese university students living in South Korea and Mainland China during the COVID-19 outbreak and explore the determinants of depression among these students, an online cross-sectional questionnaire survey was conducted from 23 March to 12 April 2020. The online questionnaire included questions on knowledge and preventive practices related to COVID-19, and the Patient Health Questionnaire-9 was used to diagnose depressive symptoms. A total of 420 Chinese university students were finally included in the study (171 students from South Korea and 249 students from Mainland China). The majority of these students had a good level of knowledge of COVID-19. Students living in South Korea displayed better preventive practices than those living in Mainland China; however, the proportion of students (28.7%) with moderate-to-severe depression in this group was relatively higher than that (18.9%) of the Mainland Group (χ² = 5.50, p < 0.05). More severe depression was related to high levels of concern about family members and contracting COVID-19 as well as suspecting themselves of having come into contact with patients. Displaying more preventive behaviors decreased the depressive symptoms in both groups. These data could be used as a reference for further studies in different regions to take measures (e.g., psychological counseling and encouragement for physical activities) to reduce depressive symptoms in university students.

The Impact of the COVID-19 Pandemic on Mental Health: Evidence from Cyprus

The aim of the current study was to examine mental health effects of the first wave of COVID-19 (Corona Virus Disease-19) in Cyprus. Accordingly, 388 individuals aged 18–65+ responded to the Components of Mental Health Questionnaire that was distributed via social media for two weeks assessing how emotional distress, support and interest in self and others, lifestyle changes, engagement in protective measures, and avoidant behaviors were related to participants’ gender, age, and place of residency. Additionally, we measured the level of concern of individuals during and after the first wave outbreak of the pandemic. The results suggest that (a) females experience higher levels of anxiety, stress, fear, worry, and despair than males and are more likely to undertake protective measures, (b) older individuals and those who live in urban areas perceive greater social support and interest in the emotional experience of significant others, (c) emotional distress and support and interest in self and others are associated with all other variables, indicating the importance of these constructs to the experience of a pandemic, and (d) there was a decrease in participants’ concern after the end of the first wave of the pandemic. Mental health professionals could find this information useful when developing and implementing prevention programs that aim to offer psychological support during this stressful period.

CCopeY: A Mixed-Methods Coproduced Study on the Mental Health Status and Coping Strategies of Young People During COVID-19 UK Lockdown

PURPOSE

Exploring the impact of the COVID-19 pandemic on young people's mental health is an increasing priority. Studies to date are largely surveys and lack meaningful involvement from service users in their design, planning, and delivery. The study aimed to examine the mental health status and coping strategies of young people during the first UK COVID-19 lockdown using coproduction methodology.

METHODS

The mental health status of young people (aged 16-24) in April 2020 was established utilizing a sequential explanatory coproduced mixed methods design. Factors associated with poor mental health status, including coping strategies, were also examined using an online survey and semi-structured interviews.

RESULTS

Since the lockdown, 30.3% had poor mental health, and 10.8% had self-harmed. Young people identifying as Black/Black-British ethnicity had the highest increased odds of experiencing poor mental health (odds ratio [OR] 3.688, 95% CI .54-25.40). Behavioral disengagement (OR 1.462, 95% CI 1.22-1.76), self-blame (OR 1.307 95% CI 1.10-1.55), and substance use (OR 1.211 95% CI 1.02-1.44) coping strategies, negative affect (OR 1.109, 95% CI 1.07-1.15), sleep problems (OR .915 95% CI .88-.95) and conscientiousness personality trait (OR .819 95% CI .69-.98) were significantly associated with poor mental health. Three qualitative themes were identified: (1) pre-existing/developed helpful coping strategies employed, (2) mental health difficulties worsened, and (3) mental health and nonmental health support needed during and after lockdown.

CONCLUSION

Poor mental health is associated with dysfunctional coping strategies. Innovative coping strategies can help other young people cope during and after lockdowns, with digital and school promotion and application.

Psychological distress associated with the COVID-19 lockdown: A two-wave network analysis

BACKGROUND

Although preliminary research has evidenced negative psychological consequences of the COVID-19 pandemic among the general population, little research has been carried out examining the interplay among the broader dimensions and correlates of individual distress. Via network analysis, the current study investigated the pathways that underlie some components of psychological distress and their changes over time (during and post COVID-19-related lockdown).

METHODS

1,129 adult participants (79.1% women) completed a two-wave online survey during and after the lockdown, and reported on variables such as depression, anxiety, stress, fear of COVID, intolerance of uncertainty, emotion regulation and social support. The networks were estimated via Gaussian Graphical Models and their temporal changes were compared through the centrality measures.

RESULTS

Depression, stress, anxiety and fear of COVID formed a spatially contiguous pattern, which remained unchanged in both the two waves. After the lockdown, the fear of COVID node reduced its strength in the network, whereas inhibitory intolerance of uncertainty and emotion suppression were associated with depression. Emotion regulation was connected to depression, but not to stress and anxiety during both waves. Perceived emotional support had few connections to the other nodes.

LIMITATIONS

Only 32.7% of participants provided complete responses for both waves.

CONCLUSION

The COVID-19 outbreak has had a significant psychosocial impact on adults. In the context of the network approach, depressive symptoms had the highest strength and their associations to other dimensions of individual distress may be key factors in understanding the influence of exposure to the COVID-19 outbreak on mental health.

Association between sexual orientation and subjective cognitive complaints in the general population in England

There is a scarcity of literature investigating the association between minority sexual orientations and subjective cognitive complaints (SCC). Therefore, the aim of this study was to investigate the association between identifying as a sexual minority and SCC in a large sample of adults from England. The study further aimed to identify the extent to which the association could be explained by several behavioral, psychological and clinical factors. Cross-sectional data from the 2007 Adult Psychiatric Morbidity Survey (APMS) were analyzed. Sexual orientation was dichotomized into heterosexual and sexual minority orientation. SCC referred to subjective concentration and memory complaints. Control variables included sex, age, ethnicity, marital status, education, employment, and income. Influential factors included smoking status, alcohol dependence, perceived stress, the number of stressful life events, depression, any anxiety disorder, sleep problems, and obesity. This study included 7,400 participants (51.4% women; mean [standard deviation] age 46.3 [18.6] years). After adjusting for control variables, sexual minority orientation was positively and significantly associated with subjective concentration (OR = 1.40, 95% CI = 1.12-1.76) but not memory complaints (OR = 1.19, 95% CI = 0.96-1.47). The number of stressful life events, sleep problems and any anxiety disorder explained 13.4%, 11.0% and 10.9% of the association between sexual orientation and subjective concentration complaints, respectively. In this large sample of English adults, identifying as a sexual minority was significantly associated with subjective concentration complaints, while stressful life events, sleep problems, and anxiety explained a large proportion of the association. Targeted interventions towards sexual minority groups to reduce SCC may be warranted.

Understanding the heart-brain axis response in COVID-19 patients: A suggestive perspective for therapeutic development

In-depth characterization of heart-brain communication in critically ill patients with severe acute respiratory failure is attracting significant interest in the COronaVIrus Disease 19 (COVID-19) pandemic era during intensive care unit (ICU) stay and after ICU or hospital discharge. Emerging research has provided new insights into pathogenic role of the deregulation of the heart-brain axis (HBA), a bidirectional flow of information, in leading to severe multiorgan disease syndrome (MODS) in patients with confirmed infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Noteworthy, HBA dysfunction may worsen the outcome of the COVID-19 patients. In this review, we discuss the critical role HBA plays in both promoting and limiting MODS in COVID-19. We also highlight the role of HBA as new target for novel therapeutic strategies in COVID-19 in order to open new translational frontiers of care. This is a translational perspective from the Italian Society of Cardiovascular Researches.

Lifestyle Habits and Mental Health in Light of the Two COVID-19 Pandemic Waves in Sweden, 2020

The COVID-19 pandemic has become a public health emergency of international concern, which may have affected lifestyle habits and mental health. Based on national health profile assessments, this study investigated perceived changes of lifestyle habits in response to the COVID-19 pandemic and associations between perceived lifestyle changes and mental health in Swedish working adults. Among 5599 individuals (50% women, 46.3 years), the majority reported no change (sitting 77%, daily physical activity 71%, exercise 69%, diet 87%, alcohol 90%, and smoking 97%) due to the pandemic. Changes were more pronounced during the first wave (April–June) compared to the second (October–December). Women, individuals <60 years, those with a university degree, white-collar workers, and those with unhealthy lifestyle habits at baseline had higher odds of changing lifestyle habits compared to their counterparts. Negative changes in lifestyle habits and more time in a mentally passive state sitting at home were associated with higher odds of mental ill-health (including health anxiety regarding one’s own and relatives’ health, generalized anxiety and depression symptoms, and concerns regarding employment and economy). The results emphasize the need to support healthy lifestyle habits to strengthen the resilience in vulnerable groups of individuals to future viral pandemics and prevent health inequalities in society.

Impact of COVID-19 on the Anxiety Perceived by Healthcare Professionals: Differences between Primary Care and Hospital Care

The COVID-19 pandemic has had an emotional impact on healthcare professionals at different levels of care, and it is important to understand the levels of anxiety of hospital personnel (HP) compared to those of primary care personnel (PCP). The objectives herein were to assess the differences in anxiety levels between these populations and to detect factors that may influence them. The anxiety levels (measured using the Hospital Anxiety and Depression (HAD) scale) of the HP and PCP groups were compared using data collected from a cross-sectional study. The secondary variables included demographic and health data, confinement factors, contact with COVID-19 patients, having suffered from COVID-19, perceptions of protection, caregiver overload, threat, and satisfaction with management. We found anxiety "case" (35.6%) and "at-risk" (21%), with statistically significant differences in the group "at risk", and higher scores in the PCP group. The factors associated with the perception of threat and protection were significant determinants of an increase in anxiety, with all of them showing statistically significant differences. There were greater symptoms of anxiety in the PCP group than the HP group (32% vs. 18%). The factors associated with the prevalence of anxiety symptoms were the perceptions of threat, protection, management, caregiver overload, and perceived degree of threat associated with COVID-19.

Social isolation, mental health, and use of digital interventions in youth during the COVID-19 pandemic: A nationally representative survey

Background

Public health measures to curb SARS-CoV-2 transmission rates may have negative psychosocial consequences in youth. Digital interventions may help to mitigate these effects. We investigated the associations between social isolation, COVID-19-related cognitive preoccupation, worries, and anxiety, objective social risk indicators, and psychological distress, as well as use of, and attitude toward, mobile health (mHealth) interventions in youth.

Methods

Data were collected as part of the “Mental Health And Innovation During COVID-19 Survey”—a cross-sectional panel study including a representative sample of individuals aged 16–25 years (N = 666; M_age = 21.3; assessment period: May 5, 2020 to May 16, 2020).

Results

Overall, 38% of youth met criteria for moderate or severe psychological distress. Social isolation worries and anxiety, and objective risk indicators were associated with psychological distress, with evidence of dose–response relationships for some of these associations. For instance, psychological distress was progressively more likely to occur as levels of social isolation increased (reporting “never” as reference group: “occasionally”: adjusted odds ratio [aOR] 9.1, 95% confidence interval [CI] 4.3–19.1, p < 0.001; “often”: aOR 22.2, CI 9.8–50.2, p < 0.001; “very often”: aOR 42.3, CI 14.1–126.8, p < 0.001). There was evidence that psychological distress, worries, and anxiety were associated with a positive attitude toward using mHealth interventions, whereas psychological distress, worries, and anxiety were associated with actual use.

Conclusions

Public health measures during pandemics may be associated with poor mental health outcomes in youth. Evidence-based digital interventions may help mitigate the negative psychosocial impact without risk of viral infection given there is an objective need and subjective demand.

Smokers Are More Likely to Smoke More after the COVID-19 California Lockdown Order

To determine if cigarette smoking, electronic cigarette use, and rate of consumption of these products differed before and after a pandemic lockdown order, two convenience samples of adults in Central California were recruited and surveyed before (March 2020) and after (May 2020) COVID-19 lockdown orders were implemented in California (n = 2571). Multivariable logistic and negative binomial regression models tested the association between adults recruited pre- or post-California lockdown and past month cigarette use, past month electronic cigarette use, past month cigarette consumption, and past month e-cigarette consumption among current users, controlling for demographic differences. Adults pre- and post-lockdown had equal odds of using cigarettes during the past month. Cigarette users who responded post-lockdown had higher cigarette consumption rates compared to cigarette users who responded pre-lockdown (IRR = 1.13, 95% CI = 1.15, 1.23). Adults who responded post-lockdown had lower odds of using electronic cigarettes during the past month compared to participants surveyed before the order (OR = 0.66, 95% CI: 0.55, 0.78). Cigarette users may be using more cigarettes during the state mandated lockdown. Possible causes for this increase in cigarette use may include increased stress, the change in workplace smokefree protections coverage, and increased opportunities for smoking or vaping.

The psychological impact of the COVID-19 pandemic on adults with autism: a survey study across three countries

Background

Previous studies have reported a negative psychological and mental health impact of the COVID-19 pandemic. This impact is likely to be stronger for people with autism as they are at heightened risk of mental health problems and because the pandemic directly affects social functioning and everyday routines. We therefore examined COVID-19 pandemic-related changes in mental health, the impact of the pandemic on their social life and routines, satisfaction with pandemic-related information and tips, and participants’ wishes for guidance.

Methods

We used a mixed-method approach, collecting quantitative and qualitative survey data from adults with and without autism across three European countries: Belgium, the Netherlands, and the UK (N = 1044).

Results

We found an increase in depression and anxiety symptoms in response to the pandemic for both the non-autism and the autism group, which was greater for adults with autism. Furthermore, adults with autism showed a greater increase in worries about their pets, work, getting medication and food, and their own safety/security. They felt more relieved from social stress, yet experienced the loss of social contact as difficult. Adults with autism also felt more stressed about the loss of routines. Pleasant changes noted by adults with autism were the increase in solidarity and reduced sensory and social overload. Adults with autism frequently reported problems with cancellation of guidance due to the pandemic and expressed their wish for (more) autism-specific information and advice.

Limitations

Our sample is likely to reflect some degree of selection bias, and longitudinal studies are needed to determine long-term effects.

Conclusions

Results highlight the psychological burden of the pandemic on adults with autism and shed light on how to support them during this COVID-19 pandemic, which is especially important now that the pandemic is likely to have a prolonged course. There is a need for accessible, affordable (continued) support from health services. Guidance may focus on the maintenance of a social network, and adjusting routines to the rapid ongoing changes. Finally, we may learn from the COVID-19 pandemic-related changes experienced as pleasant by adults with autism to build a more autism-friendly society post-pandemic.

Sociodemographic and Psychological Risk Factors for Anxiety and Depression: Findings from the Covid-19 Health and Adherence Research in Scotland on Mental Health (CHARIS-MH) Cross-sectional Survey

Background

Investigations about mental health report prevalence rates with fewer studies investigating psychological and social factors influencing mental health during the Covid-19 pandemic. Study aims: (1) identify sociodemographic groups of the adult population at risk of anxiety and depression and (2) determine if the following social and psychological risk factors for poor mental health moderated these direct sociodemographic effects: loneliness, social support, threat perception, illness representations.

Methods

Cross-sectional nationally representative telephone survey in Scotland in June 2020. If available, validated instruments were used, for example, Patient Health Questionnaire (PHQ-4) to measure anxiety and depression. Simple linear regressions followed by examination of moderation effect.

Results

A total of 1006 participants; median age 53 years, 61.4% female, from all levels of area deprivation (i.e., 3.8% in the most deprived decile and 15.6% in the most affluent decile). Analyses show associations of anxiety and depression with sociodemographic (age, gender, deprivation), social (social support, loneliness) and psychological factors (perceived threat and illness representations). Mental health was poorer in younger adults, women and people living in the most deprived areas. Age effects were exacerbated by loneliness and illness representations, gender effects by loneliness and illness representations and deprivation effects by loneliness, social support, illness representations and perceived threat. In each case, the moderating variables amplified the detrimental effects of the sociodemographic factors.

Conclusions

These findings confirm the results of pre-Covid-19 pandemic studies about associations between sociodemographics and mental health. Loneliness, lack of social support and thoughts about Covid-19 exacerbated these effects and offer pointers for pre-emptive action.

Factor structure and psychometric properties of a Polish adaptation of the Warwick-Edinburgh Mental Wellbeing Scale

Background

The study of mental wellbeing requires reliable, valid, and practical measurement tools. One of the most widely used measures of mental wellbeing is the Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS). We conducted four studies to validate the Polish version of the WEMWBS. Their objectives are the following: (1) to present the psychometric properties of the Polish version of the WEMWBS (study 1: n = 1197); (2) to evaluate the test–retest reliability of the Polish version of the WEMWBS (study 2: n = 24); (3) to determine the validity of the WEMWBS (study 3: n = 610); (4) to examine sensitivity of the WEMWBS scale to detect population with different levels of pro-health behaviours (study 4: n = 430).

Methods

To explore the dimensional structure of the scale we tested a one-factor model. The evaluation employed explanatory and confirmatory factor analyses and tested reliability and stability. To determine the convergent validity of the WEMWBS we analysed correlations among wellbeing and life satisfaction and risk depression. To examine sensitivity of the WEMWBS scale to detect a population with different levels of health-related behaviours we used Student’s t test.

Results

The results presented confirm that the psychometric properties of the Polish adaptation of WEMWBS are very good. Using EFA and CFA it was shown that a one-factor solution is optimal. Reliability, measured using the Cronbach’s alpha coefficient and McDonald's omega proved to be very high. The estimation of the stability of the Polish version of the WEMWBS proved to be high. Our validation studies also provided data demonstrating sensitivity of the WEMWBS to detect a population with different levels of health-related behaviours, indicating that group with high level of pro-health behaviours achieved higher WEMWBS wellbeing results than group with low level of pro-health behaviours.

Conclusions

WEMWBS was confirmed as a short, reliable and valid measure with good psychometric properties. Due to the high indicators for its psychometric properties, the scale may therefore prove to be a particularly useful tool not only in empirical research, but also in mental wellbeing monitoring, and could serve as support in educational and preventive.

Changes in dietary fat intake and associations with mental health in a UK public sample during the COVID-19 pandemic

Background

Consumption of unhealthy foods may have changed during the COVID-19 pandemic. This study explored how dietary fat intake was impacted in a sample of the UK public who were social distancing during the COVID-19 pandemic.

Methods

Data were collected from a UK COVID-19 online survey. Fat intake was measured using the Dietary Instrument for Nutrition Education questionnaire. Anxiety and depressive symptoms were assessed using Becks’ Anxiety and Depression Inventories, while the short-form Warwick-Edinburgh Mental Well-being Scale assessed mental well-being. Differences between individuals who increased versus decreased fat intake were explored using chi-square or independent sample t-tests. Association between fat intake and mental health was explored using adjusted linear regression models.

Results

Eight hundred and eighty-seven adults were included. Approximately, 34% recorded medium-to-high levels of fat consumption during social distancing. Around 48% reported decreased fat intake during social distancing compared to usual levels, while 41.3% documented increased fat intake. Fat intake was not significantly associated (P > 0.05) with any measures of mental health.

Conclusions

A higher proportion of a sample of UK adults social distancing during the COVID-19 pandemic recorded decreased fat intake when compared to levels prior to social distancing. There appeared to be no associations between fat intake and mental health.

Psychological and neuropsychiatric implications of COVID-19

COVID-19 infections have spread quickly, resulting in massive healthcare burden to societies worldwide. The most urgent interventions needed in the present climate include epidemiological measures to reduce the spread of infection, efficient treatment of patients with severe illness to reduce mortality rates, as well as development of diagnostic tests. Alongside this, the acute, medium, and long-term mental-health consequences of the COVID-19 outbreak for patients, their family members, medical professionals, and the public at large should not be underestimated. Here, we draw on evidence from previous coronavirus outbreaks (i.e., SARS, MERS) and emerging evidence from China, Europe, Asia and the US to synthesize the current knowledge regarding the psychological and neuropsychiatric implications of the COVID-19 pandemic.

Exploring the mental health experiences of young trans and gender diverse people during the Covid-19 pandemic

Background

Both anxiety and depression have been identified as negative health outcomes associated with the distressing nature of the Covid-19 pandemic, especially among young people. Within this age demographic, trans and gender diverse people may be particularly vulnerable to pandemic-related mental health outcomes, such as anxiety and depression, due to the social challenges, gender dissonance, and poor mental health they experience. Furthermore, the social distancing measures impose several unique social and help-seeking challenges which may further contribute to the worsening of mental health. While there has been acknowledgment that vulnerable populations may be disproportionally affected by the pandemic, the experiences of trans and gender diverse youth have received very little empirical attention.

Aims

To explore the mental health impact of Covid-19 on the lives of young trans and gender diverse people in the UK.

Method

In total, 243 people took part in an online survey between May and July in 2020. Eighty-two people were removed due to providing insufficient data. The analyzed dataset therefore comprised of 161 respondents ranging from 16 to 25 years (M = 20; SD = 2.68). Participants were asked how social distancing measures had impact on their social lives, mental health and access to health services. They were also asked to complete validated measures of anxiety and depression.

Results

This study found that those who experienced a greater impact of the Covid-19 outbreak and its associated social distancing measures, reported poorer mental health. Lack of social support, negative interpersonal interactions, unsupportive and non-affirming living environments and the inability to access mental health support and gender-affirming interventions were all factors that were associated with poor mental health.

Conclusion

The findings provide specific direction for the tailoring of mental health service delivery to this population, noting the need for private, safe spaces in which young people can feel supported and have their gender identity affirmed.

Perceived vulnerability to disease, knowledge about COVID-19, and changes in preventive behavior during lockdown in a German convenience sample

The COVID-19 pandemic has called worldwide for strong governmental measures to contain its spread, associated with considerable psychological distress. This study aimed at screening a convenience sample in Germany during lockdown for perceived vulnerability to disease, knowledge about COVID-19, symptoms of depression and anxiety, and behavioral responses. In an online survey, 1358 participants completed the perceived vulnerability to disease scale (PVD), the Patient Health Questionnaire (PHQ-4), and questionnaires on knowledge about COVID-19 and self-perceived change in behaviors in response to COVID-19. Lower and upper quartiles of the PVD were used to classify individuals into low and high PVD. A confirmatory factor analysis supported three factors representing risk, preventive and adaptive behavior as behavioral responses to COVID-19 lockdown. A structural equation model showed that the score of the knowledge scale significantly predicted the self-reported increase in adaptive and preventive behavior. The score in the PVD-subscale Perceived Infectability predicted a self-reported increase in preventive behavior, whereas the Germ Aversion score predicted a self-reported increase in preventive and a decrease in risk behavior. The score in PHQ-4 predicted a higher score in the perceived infectability and germ aversion subscales, and a self-reported decrease in adaptive behavior. Low-, medium- and high-PVD groups reported distinct patterns of behavior, knowledge, and mental health symptoms. This study shows that perceived vulnerability to disease is closely linked to preventive behaviors and may enhance adaptation to COVID-19 pandemic.

Antidepressant drugs as emerging contaminants: Occurrence in urban and non-urban waters and analytical methods for their detection

Antidepressants are drugs with a direct action on the brain's biochemistry through their interaction with the neurotransmitters, such as dopamine, norepinephrine, and serotonin. The increasing worldwide contamination from these drugs may be witnessed through their increasing presence in the urban water cycle. Furthermore, their occurrence has been detected in non-urban water, such as rivers and oceans. Some endemic aquatic animals, such as certain fish and mollusks, have bioaccumulated different antidepressant drugs in their tissues. This problem will increase in the years to come because the present COVID-19 pandemic has increased the general worldwide occurrence of depression and anxiety, triggering the consumption of antidepressants and, consequently, their presence in the environment. This work provides information on the occurrence of the most administrated antidepressants in urban waters, wastewater treatment plants, rivers, and oceans. Furthermore, it provides an overview of the analytical approaches currently used to detect each antidepressant presented. Finally, the ecotoxicological effect of antidepressants on several in vivo models are listed. Considering the information provided in this review, there is an urgent need to test the presence of antidepressant members of the MAOI and TCA groups. Furthermore, incorporating new degradation/immobilization technologies in WWTPs will be useful to stop the increasing occurrence of these drugs in the environment.