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McDool E, Mukuria C, Peasgood T. Psychometric Performance of the EQ Health and Wellbeing Short in a United Kingdom Population Sample. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:1215-1224. [PMID: 38795959 DOI: 10.1016/j.jval.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 04/22/2024] [Accepted: 05/13/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES This study assessed the psychometric performance and construct validity of the EQ Health and Wellbeing Short (EQ-HWB-S), using a validated measure, the EQ-5D-5L, as a comparator. METHODS The experimental version of the EQ-HWB-S was compared with the EQ-5D-5L to assess the psychometric performance of the measures. Data were drawn from the valuation stages of the Extending the Quality-Adjusted Life-Year project (UK general population, n = 429) and the EQ-5D-5L UK valuation pilot study (UK general population, n = 248). Construct validity was assessed based on convergent validity, using Spearman correlations and Pearson correlations. Known-group validity was assessed by estimating effect sizes to assess the ability of the EQ-HWB-S and EQ-5D-5L to discriminate between known groups based on "healthy" status, presence of a long-term condition, health and life satisfaction, age, and employment status. The degree of agreement in utility values across instruments was also evaluated using Bland-Altman plots. RESULTS Strong associations (rs ≥ 0.5, P < .001) were found between conceptually overlapping dimensions and the utility scores of the EQ-HWB-S and EQ-5D-5L. The instruments performed comparably in discriminating between known groups including healthy versus unhealthy groups (based on the visual analog scale ≥ 80), long-term condition (vs no long-term condition), and above versus below average health and life satisfaction and employed (vs unemployed and long-term sick). CONCLUSIONS The EQ-HWB-S performs favorably with utility values successfully discriminating between groups in which differences are expected. Convergence between the EQ-HWB-S and EQ-5D-5L is evident, especially between conceptually overlapping dimensions.
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Affiliation(s)
- Emily McDool
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, England, UK
| | - Clara Mukuria
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, England, UK.
| | - Tessa Peasgood
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, England, UK
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Schrempft S, Pullen N, Baysson H, Zaballa ME, Lamour J, Lorthe E, Nehme M, Guessous I, Stringhini S. Mental health trajectories among the general population and higher-risk groups following the COVID-19 pandemic in Switzerland, 2021-2023. J Affect Disord 2024; 359:277-286. [PMID: 38772508 DOI: 10.1016/j.jad.2024.05.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/15/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Mental health deteriorated in the early stages of the COVID-19 pandemic, but improved relatively quickly as restrictions were eased, suggesting overall resilience. However, longer-term follow-up of mental health in the general population is scarce. METHODS We examined mental health trajectories in 5624 adults (58 % women; aged 18-97 years) from the Specchio-COVID19 cohort, using the Generalized Anxiety Disorder scale-2 and the Patient Health Questionnaire-2, administered each month from February to June 2021, and in Spring 2022 and 2023. RESULTS Depressive and anxiety symptoms declined during a pandemic wave from February to May 2021 (β = -0.06 [-0.07, -0.06]; -0.06 [-0.07, -0.05]), and remained lower at longer-term follow-up than at the start of the wave. Loneliness also declined over time, with the greatest decline during the pandemic wave (β = -0.25 [-0.26, -0.24]). Many higher-risk groups, including socioeconomically disadvantaged individuals, those with a chronic condition, and those living alone had poorer mental health levels throughout the study period. Women and younger individuals had a faster improvement in mental health during the pandemic wave. Loneliness trajectories were associated with mental health trajectories throughout the study period. LIMITATIONS We cannot definitively conclude that the observed changes in mental health were due to experiences of the pandemic. CONCLUSIONS While there was a need for additional mental health support during stricter policy responses to COVID-19, overall, mental health improved relatively soon after measures were eased. Nevertheless, the persistence of mental health disparities highlights the need for further efforts from the government and healthcare practitioners to support vulnerable groups beyond the pandemic.
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Affiliation(s)
- Stephanie Schrempft
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
| | - Nick Pullen
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Hélène Baysson
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland; Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - María-Eugenia Zaballa
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Julien Lamour
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Elsa Lorthe
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland; Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics Paris (CRESS), Paris, France
| | - Mayssam Nehme
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland; Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada; University Centre for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
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Henson GJ, van der Mei I, Taylor BV, Blacklow P, Claflin SB, Palmer AJ, Hurst C, Campbell JA. The quality of life impact of the COVID-19 pandemic and lockdowns for people living with multiple sclerosis (MS): evidence from the Australian MS Longitudinal Study. Qual Life Res 2024; 33:1675-1689. [PMID: 38578380 PMCID: PMC11116258 DOI: 10.1007/s11136-024-03620-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE People living with multiple sclerosis (PwMS) in metropolitan Victoria, Australia, experienced a 112-day, COVID-19-related lockdown in mid-2020. Contemporaneously, Australian PwMS elsewhere experienced minimal restrictions, resulting in a natural experiment. This study investigated the relationships between lockdowns, COVID-19-related adversity, and health-related quality of life (HRQoL). It also generated health state utilities (HSU) representative of changes in HRQoL. METHODS Data were extracted from Australian MS Longitudinal Study surveys, which included the Assessment of Quality of Life-Eight Dimensions (AQoL-8D) instrument and a COVID-19 questionnaire. This COVID-19 questionnaire required participants to rank their COVID-19-related adversity across seven health dimensions. Ordered probits were used to identify variables contributing to adversity. Linear and logit regressions were applied to determine the impact of adversity on HRQoL, defined using AQoL-8D HSUs. Qualitative data were examined thematically. RESULTS N = 1666 PwMS (average age 58.5; 79.8% female; consistent with the clinical presentation of MS) entered the study, with n = 367 (22.0%) exposed to the 112-day lockdown. Lockdown exposure and disability severity were strongly associated with higher adversity rankings (p < 0.01). Higher adversity rankings were associated with lower HSUs. Participants reporting major adversity, across measured health dimensions, had a mean HSU 0.161 (p < 0.01) lower than participants reporting no adversity and were more likely (OR: 2.716, p < 0.01) to report a clinically significant HSU reduction. Themes in qualitative data supported quantitative findings. CONCLUSIONS We found that COVID-19-related adversity reduced the HRQoL of PwMS. Our HSU estimates can be used in health economic models to evaluate lockdown cost-effectiveness for people with complex and chronic (mainly neurological) diseases.
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Affiliation(s)
- Glen J Henson
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, 7000, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, 7000, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, 7000, Australia
| | - Paul Blacklow
- Tasmanian School of Business and Economics, University of Tasmania, Churchill Avenue, Sandy Bay, 7005, Australia
| | - Suzi B Claflin
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, 7000, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, 7000, Australia
| | - Carol Hurst
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, 7000, Australia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, 7000, Australia.
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4
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Tsiachristas A, Holland J, Guo B, Chitsabesan P, Sayal K, Abdul Pari AA. The impact of the COVID-19 pandemic on children and adolescent mental health in-patient service use in England: interrupted time-series analysis of national patient records. BJPsych Open 2024; 10:e69. [PMID: 38511352 PMCID: PMC10988600 DOI: 10.1192/bjo.2024.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 10/31/2023] [Accepted: 01/10/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND During the initial phases of the COVID-19 pandemic, children and young people (CYP) faced significant restrictions. The virus and mitigation approaches significantly impacted how health services could function and be safely delivered. AIMS To investigate the impact of COVID-19 lockdowns on CYP psychiatric admission trends during lockdown 1 (started 23 Mar 2020) and lockdown 2 (started 5 Nov 2020) of the COVID-19 pandemic in England. METHOD Routinely collected, retrospective English administrative data regarding psychiatric hospital admissions, length of stay and patient demographic factors were analysed using an interrupted time series analysis (ITSA) to estimate the impact of COVID-19 lockdowns 1 and 2 on service use trends. We analysed data of 6250 CYP (up to 18 years of age) using ordinary least squares (OLS) regression analysis with Newey-West standard errors to handle autocorrelation and heteroscedasticity. RESULTS Psychiatric hospital admissions for CYP significantly fell during lockdown 1, and then fell even further during lockdown 2. A greater proportion of admissions during lockdown were out of area or to independent sector units. During lockdown, the average age of CYP admitted was higher, and a greater proportion were female. There was also a significant increase in the proportion of looked-after children and CYP from the most socioeconomically deprived areas admitted during lockdown 2. CONCLUSIONS During both lockdowns, fewer CYP had psychiatric admissions. The subsequent rise in admissions for more socioeconomically deprived CYP and looked-after children suggests that these CYP may have been disproportionately affected by the pandemic, or overlooked during earlier phases.
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Affiliation(s)
- Apostolos Tsiachristas
- Nuffield Department of Primary Care Health Sciences & Department of Psychiatry, University of Oxford, UK
| | - Josephine Holland
- Mental Health and Clinical Neurosciences, Institute of Mental Health, University of Nottingham, UK
| | - Boliang Guo
- Mental Health and Clinical Neurosciences, Institute of Mental Health, University of Nottingham, UK
| | | | - Kapil Sayal
- Mental Health and Clinical Neurosciences, Institute of Mental Health, University of Nottingham, UK
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Ferwana I, Varshney LR. The impact of COVID-19 lockdowns on mental health patient populations in the United States. Sci Rep 2024; 14:5689. [PMID: 38454064 PMCID: PMC10920688 DOI: 10.1038/s41598-024-55879-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 02/27/2024] [Indexed: 03/09/2024] Open
Abstract
During the start of the COVID-19 pandemic in 2020, lockdowns and movement restrictions were thought to negatively impact population mental health, since depression and anxiety symptoms were frequently reported. This study investigates the effect of COVID-19 mitigation measures on mental health across the United States, at county and state levels using difference-in-differences analysis. It examines the effect on mental health facility usage and the prevalence of mental illnesses, drawing on large-scale medical claims data for mental health patients joined with publicly available state- and county-specific COVID-19 cases and lockdown information. For consistency, the main focus is on two types of social distancing policies, stay-at-home and school closure orders. Results show that lockdown has significantly and causally increased the usage of mental health facilities in regions with lockdowns in comparison to regions without such lockdowns. Particularly, resource usage increased by 18% in regions with a lockdown compared to 1% decline in regions without a lockdown. Also, female populations have been exposed to a larger lockdown effect on their mental health. Diagnosis of panic disorders and reaction to severe stress significantly increased by the lockdown. Mental health was more sensitive to lockdowns than to the presence of the pandemic itself. The effects of the lockdown increased over an extended time to the end of December 2020.
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Affiliation(s)
- Ibtihal Ferwana
- Coordinated Science Laboratory, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA.
| | - Lav R Varshney
- Coordinated Science Laboratory, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
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6
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Segovia MS, Huseynov S, Palma MA, Nayga RM. The mental burden of stay-at-home order extensions during COVID-19. Sci Rep 2024; 14:4293. [PMID: 38383527 PMCID: PMC10881574 DOI: 10.1038/s41598-024-54059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024] Open
Abstract
This study evaluates the psychological impact of stay-at-home extension orders during COVID-19 and its relationship with individuals' expectations on the duration of the extensions. An online survey was administered to 1259 US adult residents to measure symptoms of post-traumatic stress disorder (PTSD), anxiety and stress induced by different stay-at-home order extensions using hypothetical length scenarios. We find that individuals exposed to two 2-week order extensions exhibit higher levels of stress and anxiety compared to those exposed to a single 4-week extension. We also find that subjects with longer expected extensions exhibit more signs of psychological damage than those with shorter expected extensions. Furthermore, we find that the negative psychological consequences of providing two shorter extensions is observed only among subjects with extension expectations of four weeks or less. Our results demonstrate that people's expectations affect the level of psychological damage caused by lockdown mandates. Our findings suggest that whenever lockdown extensions are necessary, reduced psychological distress may be possible by implementing a one-time restriction, rather than extending multiple smaller extensions perhaps due to manipulation of personal expectations.
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Affiliation(s)
- Michelle S Segovia
- Department of Applied Economics and Statistics, University of Delaware, 204 Townsend Hall, Newark, DE, 19716, USA.
| | - Samir Huseynov
- Department of Agricultural Economics and Rural Sociology, Auburn University, 202 Comer Hall, Auburn, AL, 36849, USA
| | - Marco A Palma
- Department of Agricultural Economics, Texas A&M University, 2124 TAMU, College Station, TX, 77843, USA
| | - Rodolfo M Nayga
- Department of Agricultural Economics, Texas A&M University, 2124 TAMU, College Station, TX, 77843, USA
- Korea University, Seoul, South Korea
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7
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Chan HF, Cheng Z, Mendolia S, Paloyo AR, Tani M, Proulx D, Savage DA, Torgler B. Residential mobility restrictions and adverse mental health outcomes during the COVID-19 pandemic in the UK. Sci Rep 2024; 14:1790. [PMID: 38245576 PMCID: PMC10799952 DOI: 10.1038/s41598-024-51854-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
During the COVID-19 pandemic, several governments tried to contain the spread of SARS-CoV-2, the virus that causes COVID-19, with lockdowns that prohibited leaving one's residence unless carrying out a few essential services. We investigate the relationship between limitations to mobility and mental health in the UK during the first year and a half of the pandemic using a unique combination of high-frequency mobility data from Google and monthly longitudinal data collected through the Understanding Society survey. We find a strong and statistically robust correlation between mobility data and mental health survey data and show that increased residential stationarity is associated with the deterioration of mental wellbeing even when regional COVID-19 prevalence and lockdown stringency are controlled for. The relationship is heterogeneous, as higher levels of distress are seen in young, healthy people living alone; and in women, especially if they have young children.
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Affiliation(s)
- Ho Fai Chan
- School of Economics and Finance, Queensland University of Technology, Brisbane, QLD, 4000, Australia.
- Centre for Behavioural Economics, Society and Technology (BEST), Brisbane, QLD, 4000, Australia.
- Centre for Behavioural Insights for Technology Adoption (BITA), Brisbane, QLD, 4000, Australia.
| | - Zhiming Cheng
- Social Policy Research Centre, University of New South Wales, Kensington, NSW, 2052, Australia
- Department of Management, Macquarie Business School, Macquarie University, Sydney, NSW, 2109, Australia
| | - Silvia Mendolia
- Department of Economics, Social Studies and Applied Mathematics and Statistics, University of Turin, Turin, Italy
| | | | | | - Damon Proulx
- Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
| | - David A Savage
- Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
| | - Benno Torgler
- School of Economics and Finance, Queensland University of Technology, Brisbane, QLD, 4000, Australia
- Centre for Behavioural Economics, Society and Technology (BEST), Brisbane, QLD, 4000, Australia
- Centre for Behavioural Insights for Technology Adoption (BITA), Brisbane, QLD, 4000, Australia
- Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
- CREMA - Center for Research in Economics, Management and the Arts, Basel, Switzerland
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Anderes M, Pichler S. Mental health effects of social distancing in Switzerland. ECONOMICS AND HUMAN BIOLOGY 2023; 51:101302. [PMID: 37659211 DOI: 10.1016/j.ehb.2023.101302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/04/2023]
Abstract
This analysis examines the effect of COVID-19 on public mental health in Switzerland. Following an event-study framework, we compare helpline call volume and duration before and after the outbreak of the first and second wave. The use of administrative phone-level data allows us to i) decompose the total effects into an intensive and extensive margin and ii) calculate a measure of unmet need. For the first wave, our results show that callers with a history of helpline contacts increase calls substantially. We also identify capacity constraints leading to unmet need for psychological counseling. Finally, we find no effects in the second wave, which might be explained by a number of factors including the absence of a lockdown and less restrictive social distancing measures.
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Affiliation(s)
- Marc Anderes
- ETH Zurich, KOF Swiss Economic Institute, Zurich, 8092, Switzerland
| | - Stefan Pichler
- University of Groningen, Department of Economics, Econometrics and Finance, Nettelbosje 2, 9747AE, Groningen, Netherlands.
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Colella S, Dufourt F, Hildebrand VA, Vivès R. Mental health effects of COVID-19 lockdowns: A Twitter-based analysis. ECONOMICS AND HUMAN BIOLOGY 2023; 51:101307. [PMID: 37918062 DOI: 10.1016/j.ehb.2023.101307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 11/04/2023]
Abstract
We use a distinctive methodology that leverages a fixed population of Twitter users located in France to gauge the mental health effects of repeated lockdown orders. To do so, we derive from our population a mental health indicator that measures the frequency of words expressing anger, anxiety and sadness. Our indicator did not reveal a statistically significant mental health response during the first lockdown, while the second lockdown triggered a sharp and persistent deterioration in all three emotions. Our estimates also show a more severe deterioration in mental health among women and younger users during the second lockdown. These results suggest that successive stay-at-home orders significantly worsen mental health across a large segment of the population. We also show that individuals who are closer to their social network were partially protected by this network during the first lockdown, but were no longer protected during the second, demonstrating the gravity of successive lockdowns for mental health.
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Affiliation(s)
- Sara Colella
- Aix-Marseille Univ, CNRS, AMSE, Marseille, France.
| | | | - Vincent A Hildebrand
- Glendon College, York University, Canada; Dalla Lana School of Public Health, University of Toronto, Canada.
| | - Rémi Vivès
- Glendon College, York University, Canada.
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Schurer S, Atalay K, Glozier N, Vera-Toscano E, Wooden M. Quantifying the human impact of Melbourne's 111-day hard lockdown experiment on the adult population. Nat Hum Behav 2023; 7:1652-1666. [PMID: 37653145 PMCID: PMC10846680 DOI: 10.1038/s41562-023-01638-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/22/2023] [Indexed: 09/02/2023]
Abstract
Lockdown was used worldwide to mitigate the spread of severe acute respiratory syndrome coronavirus 2 and was the cornerstone non-pharmaceutical intervention of zero-COVID strategies. Many previous impact evaluations of lockdowns are unreliable because lockdowns co-occurred with severe coronavirus disease related health and financial insecurities. This was not the case in Melbourne's 111-day lockdown, which left other Australian jurisdictions unaffected. Interrogating nationally representative longitudinal survey data and quasi-experimental variation, and controlling for multiple hypothesis testing, we found that lockdown had some statistically significant, albeit small, impacts on several domains of human life. Women had lower mental health (-0.10 s.d., P = 0.043, 95% confidence interval (CI) = -0.21 to -0) and working hours (-0.13 s.d., P = 0.006, 95% CI = -0.22 to -0.04) but exercised more often (0.28 s.d., P < 0.001, 95% CI = 0.18 to 0.39) and received more government transfers (0.12 s.d., P = 0.048, 95% CI = 0.001 to 0.24). Men felt less part of their community (-0.20 s.d., P < 0.001, 95% CI = -0.30 to -0.10) and reduced working hours (-0.12 s.d., P = 0.004, 95% CI = -0.20 to -0.04). Heterogeneity analyses demonstrated that families with children were driving the negative results. Mothers had lower mental health (-0.27 s.d., P = 0.014, 95% CI = -0.48 to -0.06), despite feeling safer (0.26 s.d., P = 0.008, 95% CI = 0.07 to 0.46). Fathers increased their alcohol consumption (0.35 s.d., P = 0.002, 95% CI = 0.13 to 0.57). Some outcomes worsened with lockdown length for mothers. We discuss potential explanations for why parents were adversely affected by lockdown.
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Affiliation(s)
- Stefanie Schurer
- School of Economics, University of Sydney, Sydney, New South Wales, Australia.
- IZA Institute of Labor Economics, Bonn, Germany.
- Australian Research Council Centre of Excellence, Families and Children over the Lifecourse, Sydney, New South Wales, Australia.
| | - Kadir Atalay
- School of Economics, University of Sydney, Sydney, New South Wales, Australia
- Australian Research Council Centre of Excellence, Families and Children over the Lifecourse, Sydney, New South Wales, Australia
| | - Nick Glozier
- Australian Research Council Centre of Excellence, Families and Children over the Lifecourse, Sydney, New South Wales, Australia
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Esperanza Vera-Toscano
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Parkville, Victoria, Australia
| | - Mark Wooden
- IZA Institute of Labor Economics, Bonn, Germany
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Parkville, Victoria, Australia
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11
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Zeilinger EL, Knefel M, Schneckenreiter C, Pietschnig J, Lubowitzki S, Unseld M, Füreder T, Bartsch R, Masel EK, Adamidis F, Kum L, Kiesewetter B, Zöchbauer-Müller S, Raderer M, Krauth MT, Staber PB, Valent P, Gaiger A. The impact of COVID-19 and socioeconomic status on psychological distress in cancer patients. Int J Clin Health Psychol 2023; 23:100404. [PMID: 37663044 PMCID: PMC10469068 DOI: 10.1016/j.ijchp.2023.100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Objective We aimed to investigate the impact of the COVID-19 pandemic on psychological symptom burden against the socioeconomic background of cancer patients using data from routine assessments before and during the pandemic. Method In this cross-sectional study, standardised assessment instruments were applied in N = 1,329 patients to screen for symptoms of anxiety, depression, post-traumatic stress, and fatigue from 2018 to 2022. Two MANOVAs with post-hoc tests were computed. First, only time was included as predictor to examine the isolated impact of the pandemic. Second, income level and education level were included as further predictors to additionally test the predictive power of socioeconomic factors. Results In the final model, only income had a significant impact on all aspects of psychological symptom burden, with patients with low income being highly burdened (partial η² = .01, p = .023). The highest mean difference was found for depressive symptoms (MD = 0.13, CI = [0.07; 0.19], p < .001). The pandemic had no further influence on psychological distress. Conclusions Although the pandemic is a major stressor in many respects, poverty may be the more important risk factor for psychological symptom burden in cancer outpatients, outweighing the impact of the pandemic.
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Affiliation(s)
- Elisabeth Lucia Zeilinger
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Academy for Ageing Research, Haus der Barmherzigkeit, Vienna, Austria
| | - Matthias Knefel
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine, Landesklinikum Baden-Mödling, Baden, Austria
| | - Carmen Schneckenreiter
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Jakob Pietschnig
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Simone Lubowitzki
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Matthias Unseld
- Academy for Ageing Research, Haus der Barmherzigkeit, Vienna, Austria
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Thorsten Füreder
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Rupert Bartsch
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Eva Katharina Masel
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Feroniki Adamidis
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Lea Kum
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesewetter
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Sabine Zöchbauer-Müller
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Markus Raderer
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Maria Theresa Krauth
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Philipp B Staber
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Alexander Gaiger
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
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12
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Perlis RH, Lunz Trujillo K, Safarpour A, Quintana A, Simonson MD, Perlis J, Santillana M, Ognyanova K, Baum MA, Druckman JN, Lazer D. Community Mobility and Depressive Symptoms During the COVID-19 Pandemic in the United States. JAMA Netw Open 2023; 6:e2334945. [PMID: 37755830 PMCID: PMC10534266 DOI: 10.1001/jamanetworkopen.2023.34945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/09/2023] [Indexed: 09/28/2023] Open
Abstract
Importance Marked elevation in levels of depressive symptoms compared with historical norms have been described during the COVID-19 pandemic, and understanding the extent to which these are associated with diminished in-person social interaction could inform public health planning for future pandemics or other disasters. Objective To describe the association between living in a US county with diminished mobility during the COVID-19 pandemic and self-reported depressive symptoms, while accounting for potential local and state-level confounding factors. Design, Setting, and Participants This survey study used 18 waves of a nonprobability internet survey conducted in the United States between May 2020 and April 2022. Participants included respondents who were 18 years and older and lived in 1 of the 50 US states or Washington DC. Main Outcome and Measure Depressive symptoms measured by the Patient Health Questionnaire-9 (PHQ-9); county-level community mobility estimates from mobile apps; COVID-19 policies at the US state level from the Oxford stringency index. Results The 192 271 survey respondents had a mean (SD) of age 43.1 (16.5) years, and 768 (0.4%) were American Indian or Alaska Native individuals, 11 448 (6.0%) were Asian individuals, 20 277 (10.5%) were Black individuals, 15 036 (7.8%) were Hispanic individuals, 1975 (1.0%) were Pacific Islander individuals, 138 702 (72.1%) were White individuals, and 4065 (2.1%) were individuals of another race. Additionally, 126 381 respondents (65.7%) identified as female and 65 890 (34.3%) as male. Mean (SD) depression severity by PHQ-9 was 7.2 (6.8). In a mixed-effects linear regression model, the mean county-level proportion of individuals not leaving home was associated with a greater level of depression symptoms (β, 2.58; 95% CI, 1.57-3.58) after adjustment for individual sociodemographic features. Results were similar after the inclusion in regression models of local COVID-19 activity, weather, and county-level economic features, and persisted after widespread availability of COVID-19 vaccination. They were attenuated by the inclusion of state-level pandemic restrictions. Two restrictions, mandatory mask-wearing in public (β, 0.23; 95% CI, 0.15-0.30) and policies cancelling public events (β, 0.37; 95% CI, 0.22-0.51), demonstrated modest independent associations with depressive symptom severity. Conclusions and Relevance In this study, depressive symptoms were greater in locales and times with diminished community mobility. Strategies to understand the potential public health consequences of pandemic responses are needed.
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Affiliation(s)
- Roy H. Perlis
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Kristin Lunz Trujillo
- Northeastern University, Boston, Massachusetts
- Harvard University, Cambridge, Massachusetts
| | - Alauna Safarpour
- Northeastern University, Boston, Massachusetts
- Harvard University, Cambridge, Massachusetts
| | - Alexi Quintana
- Northeastern University, Boston, Massachusetts
- Harvard University, Cambridge, Massachusetts
| | | | | | | | | | | | | | - David Lazer
- Northeastern University, Boston, Massachusetts
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13
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van den Boom W, Marra E, van der Vliet N, Elberse J, van Dijken S, van Dijk M, Euser S, Derks M, Leurs M, Albers C, Sanderman R, de Bruin M. General Mental Health, Loneliness, and Life Satisfaction in the Context of COVID-19 Policies: A 2-Year Cohort Study in the Netherlands, April 2020-January 2022. Public Health Rep 2023; 138:812-821. [PMID: 37408335 PMCID: PMC10323514 DOI: 10.1177/00333549231176000] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE Although the COVID-19 pandemic has affected mental health, understanding who has been affected most and why is incomplete. We sought to understand changes in mental health in the context of transmission numbers and pandemic (social) restrictions and whether changes in mental health varied among population groups. METHODS We analyzed data from 92 062 people (aged ≥16 years and able to read Dutch) who participated in the Corona Behavioral Unit cohort study at the National Institute for Public Health and the Environment, the Netherlands, from April 17, 2020, through January 25, 2022. Participants self-reported mental well-being through multiple rounds of surveys. We used a multivariable linear mixed-effects model to analyze loneliness, general mental health, and life satisfaction. RESULTS As strictness of pandemic prevention measures and social restrictions increased, people's feelings of loneliness increased and mental health and life satisfaction decreased. As restrictions were relaxed, loneliness decreased and general mental health improved. Younger people (aged 16-24 y) versus older people (aged ≥40 y), people with low (vs high) education levels, and people living alone (vs living together) were more likely to have negative well-being outcomes. We observed that trajectories over time differed considerably only by age, with participants aged 16-24 years affected substantially more than participants aged ≥40 years by pandemic social restrictions. These patterns were consistent across multiple waves of SARS-CoV-2 infection. CONCLUSIONS Our findings suggest that the social restrictions imposed by the Dutch government during the study period were associated with reduced mental well-being, especially among younger people. However, people appeared resilient as they recovered during periods when restrictions were relaxed. Monitoring and supporting well-being, in particular to reduce loneliness, may help younger people during periods of intense social restrictions.
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Affiliation(s)
- Wijnand van den Boom
- Corona Behavioral Unit, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Elske Marra
- Corona Behavioral Unit, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Centre for Environmental Safety and Security, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Nina van der Vliet
- Corona Behavioral Unit, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Janneke Elberse
- Corona Behavioral Unit, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Centre for Environmental Safety and Security, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | - Mart van Dijk
- Corona Behavioral Unit, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Saskia Euser
- Corona Behavioral Unit, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Mare Derks
- Corona Behavioral Unit, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Mariken Leurs
- Corona Behavioral Unit, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Casper Albers
- Heymans Institute for Psychological Research, University of Groningen, Groningen, the Netherlands
| | - Robbert Sanderman
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands
| | - Marijn de Bruin
- Corona Behavioral Unit, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Institute of Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
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14
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Chiu C, Wong A, Melvin O, Vernon J, Liu JX, McCoy SI, Packel LJ. Effects of the COVID-19 pandemic on sales of sexual and reproductive health products: an ecological study of pharmacies in Kenya. BMJ Open 2023; 13:e068222. [PMID: 37385741 PMCID: PMC10314534 DOI: 10.1136/bmjopen-2022-068222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 06/14/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVES To examine how sales of sexual and reproductive health (SRH) products varied among pharmacies in Kenya using administrative data, leveraging natural variation in the COVID-19 pandemic and accompanying policy restrictions between 2019 and 2021. DESIGN AND SETTING Ecological study of pharmacies in Kenya. PARTICIPANTS 761 pharmacies using the Maisha Meds product inventory management system (capturing 572 916 products sold). OUTCOMES Sales quantity, price and revenue of SRH products sold per pharmacy per week. RESULTS COVID-19 deaths were associated with a -2.97% (95% CI -3.82%, -2.11%) decrease in sales quantity, a 1.09% (95% CI 0.44%, 1.72%) increase in sales price and a -1.89% (-1.00%, -2.79%) decrease in revenues per pharmacy per week. Results were similar when considering new COVID-19 cases (per 1000) and the Average Policy Stringency Index. Results differed substantially between individual SRH products-a large decrease in sales quantity in pregnancy tests, injectables and emergency contraception, a modest decrease in condoms and no change in oral contraception. Sales price increases were similarly varied; four of the five most sold products were revenue neutral. CONCLUSIONS We found a robust negative association between SRH sales at pharmacies in Kenya and COVID-19 reported cases, deaths and policy restriction. Although our data cannot definitively point to reduced access, existing evidence from Kenya regarding unchanged fertility intentions, increases in unintended pregnancies and reported reasons for non-use of contraceptives during COVID-19 suggests a prominent role of reduced access. While policymakers may have a role in sustaining access, their role may be limited by broader macroeconomic problems, such as global supply chain disruptions and inflation, during supply shocks.
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Affiliation(s)
- Calvin Chiu
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Anne Wong
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | | | | | - Jenny X Liu
- School of Nursing, University of California San Francisco, San Francisco, California, USA
- Institute for Health and Aging, Bixby Center for Global Reproductive Health, University of California San Francisco, San Francisco, California, USA
| | - Sandra I McCoy
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Laura J Packel
- School of Public Health, University of California Berkeley, Berkeley, California, USA
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15
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Rouxel P, Chandola T. No Substitute for In-Person Interaction: Changing Modes of Social
Contact during the Coronavirus Pandemic and Effects on the Mental Health of
Adults in the UK. SOCIOLOGY 2023:00380385231172123. [PMCID: PMC10189533 DOI: 10.1177/00380385231172123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Life-course theories on how social relationships affect mental health are limited in causal claims. The restrictions in social contact during the coronavirus pandemic provided a natural experiment that modified the frequency of in-person contact and allowed us to estimate the effect of changes in in-person social contact frequency on mental health in four large nationally representative age-cohorts of adults living in the UK. There was consistent evidence of a small but statistically significant effect of less frequent social contact on anxiety-depression. Online modes of social contact did not compensate for the restrictions in in-person social contact during the pandemic. Young adults who increased their online social media frequency during the pandemic experienced a deterioration in mental health. Life-course theories cannot ignore the importance of the mode of social contact for social relationships, especially during young adulthood.
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Affiliation(s)
| | - Tarani Chandola
- University of Hong Kong, Hong Kong &
University of Manchester, UK
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16
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Ludwig-Dehm SM, Dones I, Ciobanu RO. Between here and there: comparing the worry about the pandemic between older Italian international migrants and natives in Switzerland. COMPARATIVE MIGRATION STUDIES 2023; 11:8. [PMID: 37033418 PMCID: PMC10072918 DOI: 10.1186/s40878-023-00331-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
Since the beginning of the pandemic in 2020, people have been worried about COVID-19. As one of the risk groups, persons aged 65 and older are especially vulnerable. Additionally, minorities and migrants are hit harder by the pandemic than natives. Using data from the TransAge survey, a study including over 3000 older persons (65+) living in Switzerland and Italy, we show that the levels of worry about the pandemic are significantly higher among Italian international migrants living in Switzerland than among Swiss natives. We are not able to fully explain the difference using sociodemographic variables, the COVID-19 situation at the time of the interview, and international migrants' transnationalism behavior. Nevertheless, transnationalism explains a large part of the difference in worry between the two groups and our study sheds light on the importance of two specific transnational aspects, having Swiss nationality and voting behavior, for the prevention of elevated levels of worry of international migrants.
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Affiliation(s)
- Sarah M. Ludwig-Dehm
- Faculty of Social Work (HETS/HES-SO), University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Iuna Dones
- Faculty of Social Work (HETSL/HES-SO), University of Applied Sciences and Arts Western Switzerland, Ch. des Abeilles 14, 1010 Lausanne, Switzerland
- Swiss Centre of Expertise in Life Course Research, University of Geneva, Geneva, Switzerland
| | - Ruxandra Oana Ciobanu
- Faculty of Social Work (HETSL/HES-SO), University of Applied Sciences and Arts Western Switzerland, Ch. des Abeilles 14, 1010 Lausanne, Switzerland
- Swiss Centre of Expertise in Life Course Research, University of Geneva, Geneva, Switzerland
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17
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Botha F, Morris RW, Butterworth P, Glozier N. Trajectories of psychological distress over multiple COVID-19 lockdowns in Australia. SSM Popul Health 2023; 21:101315. [PMCID: PMC9742066 DOI: 10.1016/j.ssmph.2022.101315] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
The impact of the global COVID-19 pandemic, including the indirect effect of policy responses, on psychological distress has been the subject of much research. However, there has been little consideration of how the prevalence of psychological distress changed with the duration and repetition of lockdowns, or the rate of resolution of psychological distress once lockdowns ended. This study describes the trajectories of psychological distress over multiple lockdowns during the first two years of the pandemic across five Australian states for the period May 2020 to December 2021 and examines whether psychological distress trajectories varied as a function of time spent in lockdown, or time since lockdown ended. A total of N = 574,306 Australian adults completed Facebook surveys over 611 days (on average 940 participants per day). Trajectories of psychological distress (depression and anxiety) were regressed on lockdown duration and time since lockdown ended. Random effects reflecting the duration of each lockdown were included to account for varying effects on psychological distress associated with lockdown length. The prevalence of psychological distress was higher during periods of lockdown, more so for longer lockdowns relative to shorter lockdowns. Psychological distress increased rapidly over the first ten weeks of lockdowns spanning at least twelve weeks, though less rapidly for short lockdowns of three weeks or less. Psychological distress levels tended to stabilise, or even decrease, after ten consecutive weeks of lockdown. After lockdown restrictions were lifted, psychological distress rapidly subsided but did not return to pre-lockdown levels within four weeks, although continued to decline afterwards. In Australia short lockdowns of pre-announced durations were associated with slower rises in psychological distress. Lockdowns may have left some temporary residual population effect, but we cannot discern whether this reflects longer term trends in increasing psychological distress. However, the findings do re-emphasise the resilience of individuals to major life stressors.
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Affiliation(s)
- Ferdi Botha
- Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, & ARC Centre of Excellence for Children and Families Over the Life Course, Australia
| | - Richard W. Morris
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, & School of Psychology, Faculty of Science, University of Sydney, & ARC Centre of Excellence for Children and Families Over the Life Course, Australia
| | - Peter Butterworth
- Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, & National Centre for Epidemiology and Population Health, The Australian National University, Australia
| | - Nick Glozier
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, & ARC Centre of Excellence for Children and Families Over the Life Course, Australia,Corresponding author
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18
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Huang F, Liu H. The impact of the COVID-19 pandemic and related policy responses on non-COVID-19 healthcare utilization in China. HEALTH ECONOMICS 2023; 32:620-638. [PMID: 36397307 DOI: 10.1002/hec.4636] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/20/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
We investigate the impact of the COVID-19 pandemic and related policy responses on non-COVID-19 healthcare utilization (i.e., different types of outpatient care) up to October 2020 in China. Using an administrative database from a large prefecture-level city, we find that both direct exposure to the COVID-19 pandemic and the strict containment policy responses led to reductions in outpatient care utilization. The largest decline during the lockdown was observed in preventive care visits, which nevertheless recovered to pre-pandemic levels 2 months after the lockdown. The disruptions in prenatal care visits could not be offset by the recovery later on. Chronic care and emergency department visits had not returned to pre-pandemic levels as of October 2020, which may be driven by extended days' supply of prescription medication, increased use of telemedicine, and improved health-protective behaviors. In the reopening period, there were increases in visits for mental and sleep disorders, especially among children, and for medical abortion. Among health facilities at all levels, primary care facilities saw the least reductions in total outpatient visits. Our results emphasize the need for strategies to ensure access to urgent or essential care services when managing the current epidemiologic transition and future crises.
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Affiliation(s)
- Feng Huang
- School of Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Hong Liu
- School of Labor and Human Resources, Renmin University of China, Beijing, China
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19
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Costi C, Hollingsworth B, O'Sullivan V, Zucchelli E. Does caring for others affect our mental health? Evidence from the COVID-19 pandemic. Soc Sci Med 2023; 321:115721. [PMID: 36827903 PMCID: PMC9872568 DOI: 10.1016/j.socscimed.2023.115721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/14/2022] [Accepted: 01/23/2023] [Indexed: 01/26/2023]
Abstract
Despite a growing literature about the mental health effects of COVID-19, less is known about the psychological costs of providing informal care during the pandemic. We examined longitudinal data from the UK's Understanding Society Survey, including eight COVID surveys, to estimate fixed effects difference-in-differences models combined with matching, to explore the causal effects of COVID-19 among informal carers. While matching accounts for selection on observables into caregiving, multiple period difference-in-differences specifications allow investigation of heterogeneous mental health effects of COVID-19 by timing and duration of informal care. The estimates suggest that while mental health fluctuated following the imposition of social restrictions, informal carers who started caregiving during the pandemic show the largest mental health deterioration, especially during lockdowns. Policies to mitigate the psychological burden of caregiving might be more effective if targeted at those starting to provide care for the first time.
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Affiliation(s)
- Chiara Costi
- Department of Economics, Lancaster University Management School (LUMS), Lancaster University, UK.
| | | | | | - Eugenio Zucchelli
- Madrid Institute for Advanced Study (MIAS) and Department of Economic Analysis, Universidad Autónoma de Madrid (UAM), Spain; IZA, Germany; Lancaster University, UK
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20
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Oberndorfer M, Henery PM, Dundas R, Leyland AH, Paranjothy S, Stock SJ, Wood R, Nelson SM, Kearns R, Pearce A. Study protocol: examining the impacts of COVID-19 mitigation measures on pregnancy and birth outcomes in Scotland-a linked administrative data study. BMJ Open 2023; 13:e066293. [PMID: 36792327 PMCID: PMC9933130 DOI: 10.1136/bmjopen-2022-066293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION This protocol outlines aims to test the wider impacts of the COVID-19 pandemic on pregnancy and birth outcomes and inequalities in Scotland. METHOD AND ANALYSIS We will analyse Scottish linked administrative data for pregnancies and births before (March 2010 to March 2020) and during (April 2020 to October 2020) the pandemic. The Community Health Index database will be used to link the National Records of Scotland Births and the Scottish Morbidity Record 02. The data will include about 500 000 mother-child pairs. We will investigate population-level changes in maternal behaviour (smoking at antenatal care booking, infant feeding on discharge), pregnancy and birth outcomes (birth weight, preterm birth, Apgar score, stillbirth, neonatal death, pre-eclampsia) and service use (mode of delivery, mode of anaesthesia, neonatal unit admission) during the COVID-19 pandemic using two analytical approaches. First, we will estimate interrupted times series regression models to describe changes in outcomes comparing prepandemic with pandemic periods. Second, we will analyse the effect of COVID-19 mitigation measures on our outcomes in more detail by creating cumulative exposure variables for each mother-child pair using the Oxford COVID-19 Government Response Tracker. Thus, estimating a potential dose-response relationship between exposure to mitigation measures and our outcomes of interest as well as assessing if timing of exposure during pregnancy matters. Finally, we will assess inequalities in the effect of cumulative exposure to lockdown measures on outcomes using several axes of inequality: ethnicity/mother's country of birth, area deprivation (Scottish Index of Multiple Deprivation), urban-rural classification of residence, number of previous children, maternal social position (National Statistics Socioeconomic Classification) and parental relationship status. ETHICS AND DISSEMINATION NHS Scotland Public Benefit and Privacy Panel for Health and Social Care scrutinised and approved the use of these data (1920-0097). Results of this study will be disseminated to the research community, practitioners, policy makers and the wider public.
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Affiliation(s)
- Moritz Oberndorfer
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Wien, Austria
| | | | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Sarah Jane Stock
- Public Health Scotland, Glasgow, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Rachael Wood
- Public Health Scotland, Glasgow, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Scott M Nelson
- Dentristy and Nursing, School of Medicine, University of Glasgow, Glasgow, UK
| | - Rachel Kearns
- Dentristy and Nursing, School of Medicine, University of Glasgow, Glasgow, UK
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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21
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Cui Y, Han Y. The Impact of the COVID-19 Pandemic on the Mental Health of Urban Residents-Evidence from China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16190. [PMID: 36498263 PMCID: PMC9741404 DOI: 10.3390/ijerph192316190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/13/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Based on a nationwide micro-survey in China from 2018 to 2021, this paper empirically estimates the causal impact of the COVID-19 pandemic on the mental health of Chinese residents, by exploiting the distribution of the outflow population from Wuhan as an instrumental variable (IV). Our findings suggest that for every 10% increase in the cumulative confirmed cases, the number of mentally unhealthy days reported by urban residents in the past 30 days will increase by 2.19, an increase of 46.90% compared with the mean value. The impact is more significant among females, people aged 30 or above, and private-sector employees. Further evidence highlights the negative impact of the COVID-19 pandemic on residents' expectations of future income and confidence in macroeconomic development, both of which we interpret as mechanisms related to economic concerns. In addition, application of the multi-period difference-in-differences (DID) strategy revealed that the negative impact still exists two years post-pandemic, but it has been dramatically alleviated since the initial stage.
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22
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Wang J, Spencer A, Hulme C, Corbett A, Khan Z, Da Silva MV, O’Dwyer S, Wright N, Testad I, Ballard C, Creese B, Smith R. Healthcare utilisation, physical activity and mental health during COVID-19 lockdown: an interrupted time-series analysis of older adults in England. Eur J Ageing 2022; 19:1617-1630. [PMID: 36692792 PMCID: PMC9702630 DOI: 10.1007/s10433-022-00741-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/29/2022] Open
Abstract
COVID-19 measures which reduce interpersonal contact may be effective in containing the transmission, but their impacts on peoples' well-being and daily lives overtime remain unclear. Older adults are more vulnerable to both the virus and social isolation. It is therefore imperative to understand how they were affected during this period. Major concerns arising from the pandemic cover the aspects of mental health, healthcare utilisation and individual behavioural changes. Complementing the existing before-and-after analyses, we explore the impacts of easing and re-introducing COVID-19 measures by using a time-series data in England. The data was collected between May and November 2020 from the monthly surveys of the Platform for Research Online to Investigate Genetics and Cognition in Aging (PROTECT). Chi-squared analysis and interrupted time-series analysis were conducted to examine impacts of easing and re-introducing COVID-19 measures. Overall, mental health improves overtime but at a decreasing rate. The use of telephone/video consultations with a doctor or health professional presented a decreasing trend during the pandemic, whilst that of in-person consultation was increasing overtime. We observed significant variations in the time trends of mental health measures, healthcare utilisation and physical activity following the ease but not the re-introduction of COVID-19 measures. Future research is required to understand if these asymmetric impacts were driven by adaption of the people or stringency of the measures. Supplementary Information The online version contains supplementary material available at 10.1007/s10433-022-00741-y.
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Affiliation(s)
- Jiunn Wang
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Department of Applied Health Research, University College London, London, UK
| | - Anne Spencer
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Claire Hulme
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Anne Corbett
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Zunera Khan
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Miguel Vasconcelos Da Silva
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Siobhan O’Dwyer
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Natalie Wright
- Global Operations, UK Health Security Agency (UKHSA), London, UK
| | - Ingelin Testad
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Centre for Age-Related Medicine - SESAM, Stavanger University Hospital, Stavanger, Norway
| | - Clive Ballard
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Byron Creese
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Richard Smith
- Department of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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Rippon D, Hand A, Dismore L, Caiazza R. The Impact of the COVID-19 Pandemic on Informal Caregivers of People With Parkinson's Disease Residing in the UK: A Qualitative Study. J Geriatr Psychiatry Neurol 2022; 36:233-245. [PMID: 36268777 PMCID: PMC9596687 DOI: 10.1177/08919887221135555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Informal caregivers can experience various demands when providing care and support for People with Parkinson's disease (PwP) in their own homes. The outbreak of SARS-CoV-2 and public health strategies employed to mitigate the spread of COVID-19 have presented challenges to the general populace on a global basis. The present study used a qualitative research design to explore how the COVID-19 pandemic has impacted informal caregivers in their role of providing care for PwP in their own homes. A series of 1:1 semi-structured interviews were conducted with 11 informal caregivers of PwP (M age = 72.64 years, SD = 8.94 years). A thematic analysis indicated that 1) vulnerabilities to COVID-19, 2) home maintenance & activities of daily living and 3) engagement with healthcare services were 3 themes that provided indications on how the COVID-19 pandemic impacted informal caregivers of PwP. The present study provides illustrations of how being an informal caregiver of PwP and being identified as high risk to COVID-19 can present challenges to the process of caring for loved ones who are also vulnerable to SARS-CoV-2. The results of the present study highlights the necessity to develop strategies to ensure that informal caregivers have the necessary resources to provide care for PwP in their homes and also maintain their own well-being in the post COVID-19 era.
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Affiliation(s)
- Daniel Rippon
- Northumbria University, Newcastle Upon Tyne, UK,Daniel Rippon, Northumbria University,
Northumberland Building, Newcastle Upon Tyne NE1 8ST, UK.
| | - Annette Hand
- Northumbria University, Newcastle Upon Tyne, UK,Northumbria Healthcare, NHS Foundation Trust, North Shields, UK
| | - Lorelle Dismore
- Northumbria Healthcare, NHS Foundation Trust, North Shields, UK
| | - Roberta Caiazza
- Northumbria Healthcare, NHS Foundation Trust, North Shields, UK
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24
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Grygarová D, Adámek P, Juríčková V, Horáček J, Bakštein E, Fajnerová I, Kesner L. Impact of a Long Lockdown on Mental Health and the Role of Media Use: Web-Based Survey Study. JMIR Ment Health 2022; 9:e36050. [PMID: 35605112 PMCID: PMC9277533 DOI: 10.2196/36050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Due to the COVID-19 pandemic, the Czech population experienced a second lockdown lasting for about half a year, restricting free movement and imposing social isolation. However, it is not known whether the impact of this long lockdown resulted in habituation to the adverse situation or in the traumatization of the Czech population, and whether the media and specific media use contributed to these effects. OBJECTIVE The aim of this study was to elucidate the effect of the long lockdown on the mental health of the Czech population, and the role of exposure to COVID-19 news reports and specific forms of media news use in mental health. METHODS We conducted two consecutive surveys in the early (November 2020) and late (March/April 2021) phases of the nationwide lockdown on the same nationally representative group of Czech adults (N=1777) participating in a longitudinal panel study. RESULTS Our findings showed that the self-reported symptoms of anxiety and depression increased in the second observation period, confirming the negative effect of the pandemic lockdown as it unfolded, suggesting that restrictive measures and continuous exposure to a collective stressor did not result in the strengthening of resilience but rather in ongoing traumatization. The results also suggest a negative role of the media's coverage of the COVID-19 pandemic in mental health during the early, and particularly late, phases of the lockdown. Furthermore, we found several risk and protective factors of specific media news use. The media practice in news consumption connected to social media use was the strongest predictor of exacerbated mental health symptoms, particularly in the late phase of the lockdown. Moreover, news media use characterized by internalization of information learned from the news, as well as negative attitudes toward media news, were associated with higher levels of anxiety and depression. Conversely, the use of infotainment, together with an in-depth and contextual style of reading news articles, were related to improvement of mental health. CONCLUSIONS Our study showed that the long lockdown resulted in traumatization rather than habituation, and in more pronounced effects (both negative and positive) of media use in mental health.
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Affiliation(s)
- Dominika Grygarová
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Klecany, Czech Republic
| | - Petr Adámek
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Veronika Juríčková
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Klecany, Czech Republic.,First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Horáček
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Eduard Bakštein
- Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic.,Early Stages of Severe Mental Illness Research Center, National Institute of Mental Health, Klecany, Czech Republic
| | - Iveta Fajnerová
- Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Virtual Reality in Mental Health and Neuroscience Research Center, National Institute of Mental Health, Klecany, Czech Republic
| | - Ladislav Kesner
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Klecany, Czech Republic.,Faculty of Arts, Masaryk University, Brno, Czech Republic
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25
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Yao H, Wang J, Liu W. Lockdown Policies, Economic Support, and Mental Health: Evidence From the COVID-19 Pandemic in United States. Front Public Health 2022; 10:857444. [PMID: 35719685 PMCID: PMC9201054 DOI: 10.3389/fpubh.2022.857444] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022] Open
Abstract
During the COVID-19 pandemic, various lockdown policies were put in place by the governments in different countries and different levels, which effectively curbed the spread of the virus, but also cause substantial damage to the mental health of local residents. We use statistics provided by the Household Pulse Survey and OxCGRT between 23 April 2020 and 30 August 2021 to analyze the impact of lockdown on overall mental health levels in US states during the COVID-19 pandemic at the macro level. The results show that the lockdown policies implemented by the state governments lead to a deterioration in psychological conditions, and this relationship varies to some extent depending on the level of high-quality economic support, that the state governments implement to alleviate the symptoms of depression and anxiety associated with the lockdown. Therefore, we argue that although lockdown policies are necessary during the COVID-19 pandemic, further government efforts are needed to give high-quality economic and mental health support to mitigate the negative effects of lockdown on mental health.
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Affiliation(s)
- Haitang Yao
- Business School, Qingdao University, Qingdao, China
| | - Jiayang Wang
- Business School, Qingdao University, Qingdao, China
| | - Wei Liu
- Business School, Qingdao University, Qingdao, China
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26
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Demkowicz O, Ashworth E, O’Neill A, Hanley T, Pert K. “Will My Young Adult Years be Spent Socially Distancing?”: A Qualitative Exploration of Adolescents’ Experiences During the COVID-19 UK Lockdown. JOURNAL OF ADOLESCENT RESEARCH 2022. [DOI: 10.1177/07435584221097132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
For older adolescents, the COVID-19 pandemic and UK restrictions arrived during a critical period in the transition to adulthood. Early research exploring impact of the pandemic paints a picture of worsened adolescent wellbeing and mental health. We explore the subjective experiences of 16- to 19-year-olds during the first UK lockdown, with an emphasis on wellbeing and coping, to complement quantitative evidence and inform strategies and provision for support. In May 2020, we invited UK-based 16- to 19-year-olds to share written accounts of their experiences of the initial UK lockdown for The TELL Study. A total of 109 participants engaged, submitting anonymous written accounts via an online survey portal. We used inductive reflexive thematic analysis to develop rich experiential themes. We constructed seven main themes: heightened emotionality; feelings of loss, change, and uncertainty; recognizing the value of self-care; efforts to think positively; opportunities for relief, growth, and development; the importance of togetherness; and frustration with government and media. Findings highlight the multifaceted nature of adolescents’ lockdown experiences, and offer insight into emotional impact and new concerns alongside the value placed on self-care and staying connected. We offer directions for supporting adolescents as pandemic consequences continue.
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27
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Butterworth P, Schurer S, Trinh TA, Vera-Toscano E, Wooden M. Effect of lockdown on mental health in Australia: evidence from a natural experiment analysing a longitudinal probability sample survey. Lancet Public Health 2022; 7:e427-e436. [PMID: 35461593 PMCID: PMC9023006 DOI: 10.1016/s2468-2667(22)00082-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Many studies have examined population mental health during the COVID-19 pandemic but have been unable to isolate the direct effect of lockdowns. The aim of this study was to examine changes in the mental health of Australians aged 15 years and older during the COVID-19 pandemic using a quasi-experimental design to disentangle the lockdown effect. METHODS We analysed data from ten annual waves (2011-20) of the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) Survey to identify changes in the mental health of respondents from the pre-COVID-19 period (2011-19) to the COVID-19 period (2020). Difference-in-differences models were used to compare these changes between respondents in the state of Victoria who were exposed to lockdown at the time of the 2020 interviews (treatment group) and respondents living elsewhere in Australia (who were living relatively free of restrictions; control group). The models included state, year (survey wave), and person-specific fixed effects. Mental health was assessed using the five-item Mental Health Inventory (MHI-5), which was included in the self-complete questionnaire administered during the survey. FINDINGS The analysis sample comprised 151 583 observations obtained from 20 839 individuals from 2011 to 2020. The treatment group included 3568 individuals with a total of 37 578 observations (34 010 in the pre-COVID-19 and 3568 in the COVID-19 period), and the control group included 17 271 individuals with 114 005 observations (102 867 in the pre-COVID-19 and 11 138 in the COVID-19 period). Mean MHI-5 scores did not differ between the treatment group (72·9 points [95% CI 72·8-73·2]) and control group (73·2 points [73·1-73·3]) in the pre-COVID-19 period. In the COVID-19 period, decreased mean scores were seen in both the treatment group (69·6 points [69·0-70·2]) and control group (70·8 points [70·5-71·2]). Difference-in-differences estimation showed a small but statistically significant effect of lockdown on MHI-5 scores, with greater decline for residents of Victoria in 2020 than for those in the rest of Australia (difference -1·4 points [95% CI -1·7 to -1·2]). Stratified analyses showed that this lockdown effect was larger for females (-2·2 points [-2·6 to -1·7]) than for males (-0·6 [-0·8 to -0·5]), and even larger for women in couples with children younger than 15 years (-4·4 points [-5·0 to -3·8]), and for females who lived in flats or apartments (-4·1 points [-5·4 to -2·8]) or semi-detached houses, terraced houses, or townhouses (-4·8 points [-6·4 to -3·2]). INTERPRETATION The imposition of lockdowns was associated with a modest negative change in overall population mental health. The results suggest that the mental health effects of lockdowns differ by population subgroups and for some might have exaggerated existing inequalities in mental health. Although lockdowns have been an important public health tool in suppressing community transmission of COVID-19, more research is needed into the potential psychosocial impacts of such interventions to inform their future use. FUNDING US National Institutes of Health.
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Affiliation(s)
- Peter Butterworth
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Stefanie Schurer
- School of Economics, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Trong-Anh Trinh
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, VIC, Australia
| | - Esperanza Vera-Toscano
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, VIC, Australia
| | - Mark Wooden
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, VIC, Australia.
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28
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Koltai J, Raifman J, Bor J, McKee M, Stuckler D. COVID-19 Vaccination and Mental Health: A Difference-In-Difference Analysis of the Understanding America Study. Am J Prev Med 2022; 62:679-687. [PMID: 35012830 PMCID: PMC8674498 DOI: 10.1016/j.amepre.2021.11.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/17/2021] [Accepted: 11/12/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Mental health problems increased during the COVID-19 pandemic. The knowledge that one is less at risk after being vaccinated may alleviate distress, but this hypothesis remains unexplored. This study tests whether psychological distress declined in those vaccinated against COVID-19 in the U.S. and whether changes in anticipatory fears mediated any association. METHODS A nationally representative cohort of U.S. adults (N=8,090) in the Understanding America Study were interviewed regularly from March 2020 to June 2021 (28 waves). Difference-in-differences regression tested whether vaccination reduced distress (Patient Health Questionnaire 4 scores), with mediation analysis used to identify potential mechanisms, including perceived risks of infection, hospitalization, and death. RESULTS Vaccination was associated with a 0.04-SD decline in distress (95% CI= -0.07, -0.02). Vaccination was associated with a 7.77-percentage point reduction in perceived risk of infection (95% CI= -8.62, -6.92), a 6.91-point reduction in perceived risk of hospitalization (95% CI= -7.72, -6.10), and a 4.68-point reduction in perceived risk of death (95% CI= -5.32, -4.04). Including risk perceptions decreased the vaccination-distress association by 25%. Event study models suggest that vaccinated and never vaccinated respondents followed similar Patient Health Questionnaire 4 trends before vaccination, diverging significantly after vaccination. Analyses were robust to individual and wave fixed effects and time-varying controls. The effect of vaccination on distress varied by race/ethnicity, with the largest declines observed among American Indian and Alaska Native individuals (β= -0.20, p<0.05, 95% CI= -0.36, -0.03). CONCLUSIONS COVID-19 vaccination was associated with declines in distress and perceived risks of infection, hospitalization, and death. Vaccination campaigns could promote these additional benefits of receiving the COVID-19 vaccine.
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Affiliation(s)
- Jonathan Koltai
- Department of Sociology, University of New Hampshire, Durham, New Hampshire.
| | - Julia Raifman
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
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29
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Restricting the spread of SARS-CoV-2 or safeguarding mental health: a false dichotomy? Lancet Public Health 2022; 7:e392-e393. [PMID: 35461591 PMCID: PMC9023009 DOI: 10.1016/s2468-2667(22)00091-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/04/2022] [Indexed: 11/24/2022]
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30
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Aknin LB, Andretti B, Goldszmidt R, Helliwell JF, Petherick A, De Neve JE, Dunn EW, Fancourt D, Goldberg E, Jones SP, Karadag O, Karam E, Layard R, Saxena S, Thornton E, Whillans A, Zaki J. Policy stringency and mental health during the COVID-19 pandemic: a longitudinal analysis of data from 15 countries. THE LANCET PUBLIC HEALTH 2022; 7:e417-e426. [PMID: 35461592 PMCID: PMC9023007 DOI: 10.1016/s2468-2667(22)00060-3] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 12/15/2022] Open
Abstract
Background To date, public health policies implemented during the COVID-19 pandemic have been evaluated on the basis of their ability to reduce transmission and minimise economic harm. We aimed to assess the association between COVID-19 policy restrictions and mental health during the COVID-19 pandemic. Methods In this longitudinal analysis, we combined daily policy stringency data from the Oxford COVID-19 Government Response Tracker with psychological distress scores and life evaluations captured in the Imperial College London-YouGov COVID-19 Behaviour Tracker Global Survey in fortnightly cross-sections from samples of 15 countries between April 27, 2020, and June 28, 2021. The mental health questions provided a sample size of 432 642 valid responses, with an average of 14 918 responses every 2 weeks. To investigate how policy stringency was associated with mental health, we considered two potential mediators: observed physical distancing and perceptions of the government's handling of the pandemic. Countries were grouped on the basis of their response to the COVID-19 pandemic as those pursuing an elimination strategy (countries that aimed to eliminate community transmission of SARS-CoV-2 within their borders) or those pursuing a mitigation strategy (countries that aimed to control SARS-CoV-2 transmission). Using a combined dataset of country-level and individual-level data, we estimated linear regression models with country-fixed effects (ie, dummy variables representing the countries in our sample) and with individual and contextual covariates. Additionally, we analysed data from a sample of Nordic countries, to compare Sweden (that pursued a mitigation strategy) to other Nordic countries (that adopted a near-elimination strategy). Findings Controlling for individual and contextual variables, higher policy stringency was associated with higher mean psychological distress scores and lower life evaluations (standardised coefficients β=0·014 [95% CI 0·005 to 0·023] for psychological distress; β=–0·010 [–0·015 to –0·004] for life evaluation). Pandemic intensity (number of deaths per 100 000 inhabitants) was also associated with higher mean psychological distress scores and lower life evaluations (standardised coefficients β=0·016 [0·008 to 0·025] for psychological distress; β=–0·010 [–0·017 to –0·004] for life evaluation). The negative association between policy stringency and mental health was mediated by observed physical distancing and perceptions of the government's handling of the pandemic. We observed that countries pursuing an elimination strategy used different policy timings and intensities compared with countries pursuing a mitigation strategy. The containment policies of countries pursuing elimination strategies were on average less stringent, and fewer deaths were observed. Interpretation Changes in mental health measures during the first 15 months of the COVID-19 pandemic were small. More stringent COVID-19 policies were associated with poorer mental health. Elimination strategies minimised transmission and deaths, while restricting mental health effects. Funding None.
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