Impact of the COVID-19 pandemic on substance use among adults without children, parents, and adolescents

Investigating Substance Use as a Coping Strategy Among Adolescent Psychiatric Inpatients: A Comparative Analysis Before and During the COVID-19 Pandemic

The COVID-19 pandemic resulted in significant changes in daily life, potentially impacting mental health and substance use behavior. Research on COVID-related changes in adolescent substance use have yielded mixed findings. The current cross-sectional chart review study compared rates of past-year substance use before and during COVID-19 among adolescent psychiatric inpatients, and investigated how motives for coping with COVID-19 changes were related to psychiatric acuity, and past-year substance use. Count models assessed if the number of past-year days of alcohol and cannabis use was higher among adolescents (n = 491, 11-18 years, 61% female) hospitalized during COVID-19 (3/14/20 to 4/5/21) versus adolescents hospitalized before COVID-19 (8/30/2019 to 3/13/20). For a subsample of COVID-19 inpatients (n = 124; 75% female), we evaluated psychiatric correlates of endorsing substances to cope with COVID-19 changes/rules. Results indicated adolescents admitted during COVID-19 reported significantly more past-year alcohol and cannabis use days than adolescents admitted before COVID-19. Adolescents endorsed using alcohol (19%), cannabis (33%), and e-cigarettes/vaping (25%) to cope with COVID-19. E-cigarette/vaping to cope with COVID-19 was significantly related to lifetime suicide attempt. Endorsing alcohol or cannabis to cope with COVID-19 was associated with a significantly greater number of past-year use days for each respective substance. Adolescent psychiatric inpatients admitted during COVID-19 reported more substance use days than adolescents admitted before COVID-19. Using substances to cope was linked to psychiatric correlates (e.g., suicidality). Assessing the presence and function of substance use in this population may be important to identify, treat, and prevent compounding negative outcomes during times of community stress.

Childhood Maltreatment and Toxic Stress: What We Have Learned From the COVID-19 Pandemic Era

Stress is a natural state that emerges due to the dynamics of an individual's life. Children must learn how to effectively manage stress as part of their growth and development. Resolution is possible when children are exposed to stress and receive adequate support from their families. However, when stress is intense, frequent, protracted, or traumatic, as in cases of childhood abuse, it can become toxic and interfere with the development of the child's brain and body. This results in vulnerability, which can have detrimental effects on the child's overall physical, mental, and emotional health. This perspective discusses the impact of childhood maltreatment and toxic stress, drawing on insights gained during the COVID-19 pandemic. We aimed to shed light on the lessons learned from this unique and challenging period and how they inform our understanding of the effects of stress on children's well-being.

"An escape from the isolation": Youth thoughts about the impact of COVID-19 on adolescent sexual behavior and alcohol use

INTRODUCTION

The COVID-19 pandemic likely affected adolescent sexual behaviors and alcohol use, although how is not well understood.

METHOD

Youth were sampled from the national, online longitudinal Growing up with Media study. They responded via text messaging to open-ended questions about how the COVID-19 pandemic may have impacted the sexual behavior and alcohol use of adolescents. Conventional content analysis summarized open-ended responses.

RESULTS

416 responses were analyzed from 335 participants (aged 15-30, US residents), 81 of whom provided data for both topics. Participants suggested that the pandemic affected some youths' sexual health precautions (increased and varying) and attitudes about sex (positive and negative). They discussed how adolescents met partners during the pandemic, including increased use of online platforms. Participants also suggested researchers investigate sexual risk in the realm of COVID-19 transmission and the practice of "safe sex." Many participants believed adolescents were drinking alcohol more as a result of the pandemic, both alone and with friends; however, others perceived adolescents were drinking less. Participants proposed researchers investigate adolescent drinking habits during the pandemic, as well as how this compares to before the pandemic and the type and quantity of alcohol consumed.

CONCLUSIONS

Young people believe adolescent sexual relationships and drinking behaviors changed due to the pandemic, though how varied. Future research could examine the contexts and individual differences that shape these varying behaviors. Overall, this study highlights the importance of directly asking youth about their pandemic experiences and the diversity of views on how the pandemic has influenced adolescent behavior.

Changes in substance use among adolescents before and during the COVID-19 pandemic in Guatemala

Objectives

Due to the COVID-19 pandemic, on March 16th, schools had to be closed in Guatemala and went to online teaching. We sought to analyze the change in substance use among high school students in Guatemala associated with the lockdown.

Methods

Data from two surveys (2019, n=2096, and 2020, n=1606) of a student cohort in private high schools in Guatemala City was used. Logistic models for past 30-day cigarette, e-cigarette, marijuana, and alcohol (including binge drinking) were used, regressing these on survey wave, while adjusting for sex, scholastic performance, high school year of student, parental education, substance use, and household member tobacco use.

Results

Prevalence declined for smoking (10% to 3%, p<0.001), e-cigarette (31% to 14%, p<0.001), marijuana (4.3% to 1.9%, p<0.001), and alcohol use (47% to 38.5%, p<0.001), and binge drinking (24% to 13%, p<0.001). Adjusted models showed wave 2 associated with lower odds of using cigarettes (AOR=0.44, 95%CI=0.32-0.62), e-cigarettes (AOR=0.41, 95% CI=0.35-0.49, p<0.001), and binge drinking (AOR=0.73, 95%CI=0.59-0.89; p=0.002).

Conclusion

Among Guatemalan adolescents, COVID-19 restrictions were associated with a significant decrease in smoking, e-cigarette use, and binge drinking.

Counts and child protection reports of diagnosed child maltreatment before and after the COVID-19 pandemic onset

BACKGROUND

Mechanisms for reporting child maltreatment (CM) were affected by changes in service provision immediately following the onset of the COVID-19 pandemic.

OBJECTIVE

To examine changes in counts and CPS reporting of CM medical encounters before and after the onset of COVID-19.

PARTICIPANTS AND SETTING

All emergency department and inpatient medical encounters with at least one CM diagnosis during the study period at Rady Children's Hospital San Diego, the largest pediatric hospital in California between 2016 and November 2021.

METHODS

Using linked medical record and CPS administrative data, interrupted time series models tested for changes in monthly counts and percentages of CM medical encounters reported to CPS with the onset of COVID-19. Logistic regression tested for the likelihood of a CPS report being associated with a CM encounter.

RESULTS

CM medical encounters totaled 2528, including 793 after the onset of COVID-19. Interrupted time series models indicated with the onset of the pandemic, the counts of CM encounters increased 18 % (RR: 1.18, 95 % CI 1.03-1.34) and the percentages reported to CPS increased 10 % (RR: 1.10, 95 % CI: 1.05-1.17). CM encounters that occurred after the onset of the COVID-19 pandemic had increased odds of a CPS report (fully adjusted model: OR: 1.08; 95 % CI: 1.05-1.12).

CONCLUSIONS

This study found increases in monthly counts and a higher percentage of CM medical encounters with CPS reports after the pandemic onset.

Substance use, psychiatric symptoms, personal mastery, and social support among COVID-19 long haulers: A compensatory model

BACKGROUND

Substance use has become a critical health concern during the COVID-19 pandemic, and emerging attention has been paid to people with the persistent symptoms of COVID-19 (COVID-19 long haulers) due to their high vulnerability. However, scant research has investigated their substance use and relevant psychosocial factors. The current study was to (1) examine substance use behaviors (i.e., legal drug use, illicit drug use, and non-medical use of prescription drugs); and (2) assessed their associations with psychiatric symptoms (i.e., depression, anxiety, and post-traumatic stress disorder) and psychosocial factors (i.e., personal mastery and social support) among COVID-19 long haulers.

METHODS

In January-March 2022, 460 COVID-19 long haulers (50% female), with an average age of 32, completed online surveys regarding their demographics, substance use, psychiatric symptoms, and psychosocial factors.

RESULTS

In the past three months, the most commonly used or non-medically used substances were tobacco (82%) for legal drugs, cocaine (53%) for illicit drugs, and prescription opioids (67%) for prescription drugs. Structural equation modeling suggested that psychiatric symptoms were positively associated with substance use behaviors (βs = 0.38 to .68, ps < 0.001), while psychosocial factors were negatively associated with substance use behaviors (βs = -0.61 to -0.43, ps < 0.001).

CONCLUSION

Substance use is common in COVID-19 long haulers and psychiatric symptoms are the risk factors. Personal mastery and social support appear to offer protection offsetting the psychiatric influences. Substance use prevention and mental health services for COVID-19 long haulers should attend to personal mastery and social support.

The relationship between salivary Fibroblast Growth Factor-2 and cortisol reactivity and psychological outcomes prior to and during the COVID-19 pandemic

Background

Fibroblast growth factor-2 (FGF2) is a biomarker that is associated with depression, anxiety and stress in rodents. In humans, we have previously demonstrated that salivary FGF2 increased following stress in a similar pattern to cortisol, and FGF2 (but not cortisol) reactivity predicted repetitive negative thinking, a transdiagnostic risk factor for mental illness. The current study assessed the relationship between FGF2, cortisol, and mental health before and during the COVID-19 pandemic.

Methods

We employed a longitudinal correlational design using a convenience sample. We assessed whether FGF2 and cortisol reactivity following the Trier Social Stress Task (TSST) were associated with DASS-21 depression, anxiety and stress, measured at the time of the TSST in 2019-20 (n = 87; time 1), and then again in May 2020 during the first wave of COVID-19 in Sydney (n = 34 of the original sample; time 2).

Results

FGF2 reactivity (but not absolute FGF2 levels) at time 1 predicted depression, anxiety, and stress across timepoints. Cortisol reactivity at time 1 was associated with stress over timepoints, and absolute cortisol levels were associated with depression across timepoints.

Limitations

The sample was comprised of mostly healthy participants from a student population, and there was high attrition between timepoints. The outcomes need to be replicated in larger, more diverse, samples.

Conclusions

FGF2 and cortisol may be uniquely predictive of mental health outcomes in healthy samples, potentially allowing for early identification of at-risk individuals.

Overall and Telehealth Addiction Treatment Utilization by Age, Race, Ethnicity, and Socioeconomic Status in California After COVID-19 Policy Changes

Importance

Addiction treatment rapidly transitioned to a primarily telehealth modality (telephone and video) during the COVID-19 pandemic, raising concerns about disparities in utilization.

Objective

To examine whether there were differences in overall and telehealth addiction treatment utilization after telehealth policy changes during the COVID-19 pandemic by age, race, ethnicity, and socioeconomic status.

Design, Setting, and Participants

This cohort study examined electronic health record and claims data from Kaiser Permanente Northern California for adults (age ≥18 years) with drug use problems before the COVID-19 pandemic (from March 1, 2019, to December 31, 2019) and during the early phase of the COVID-19 pandemic (March 1, 2020, to December 31, 2020; hereafter referred to as COVID-19 onset). Analyses were conducted between March 2021 and March 2023.

Exposure

The expansion of telehealth services during COVID-19 onset.

Main Outcomes and Measures

Generalized estimating equation models were fit to compare addiction treatment utilization during COVID-19 onset with that before the COVID-19 pandemic. Utilization measures included the Healthcare Effectiveness Data and Information Set of treatment initiation and engagement (including inpatient, outpatient, and telehealth encounters or receipt of medication for opioid use disorder [OUD]), 12-week retention (days in treatment), and OUD pharmacotherapy retention. Telehealth treatment initiation and engagement were also examined. Differences in changes in utilization by age group, race, ethnicity, and socioeconomic status (SES) were examined.

Results

Among the 19 648 participants in the pre-COVID-19 cohort (58.5% male; mean [SD] age, 41.0 [17.5] years), 1.6% were American Indian or Alaska Native; 7.5%, Asian or Pacific Islander; 14.3%, Black; 20.8%, Latino or Hispanic; 53.4%, White; and 2.5%, unknown race. Among the 16 959 participants in the COVID-19 onset cohort (56.5% male; mean [SD] age, 38.9 [16.3] years), 1.6% were American Indian or Alaska Native; 7.4%, Asian or Pacific Islander; 14.6%, Black; 22.2%, Latino or Hispanic; 51.0%, White; and 3.2%, unknown race. Odds of overall treatment initiation increased from before the COVID-19 pandemic to COVID-19 onset for all age, race, ethnicity, and SES subgroups except for patients aged 50 years or older; patients aged 18 to 34 years had the greatest increases (adjusted odds ratio [aOR], 1.31; 95% CI, 1.22-1.40). Odds of telehealth treatment initiation increased for all patient subgroups without variation by race, ethnicity, or SES, although increases were greater for patients aged 18 to 34 years (aOR, 7.17; 95% CI, 6.24-8.24). Odds of overall treatment engagement increased (aOR, 1.13; 95% CI, 1.03-1.24) without variation by patient subgroups. Retention increased by 1.4 days (95% CI, 0.6-2.2 days), and OUD pharmacotherapy retention did not change (adjusted mean difference, -5.2 days; 95% CI, -12.7 to 2.4 days).

Conclusions

In this cohort study of insured adults with drug use problems, there were increases in overall and telehealth addiction treatment utilization after telehealth policies changed during the COVID-19 pandemic. There was no evidence that disparities were exacerbated, and younger adults may have particularly benefited from the transition to telehealth.

Ingestion of Illicit Substances by Young Children Before and During the COVID-19 Pandemic

Importance

Information about the trend in illicit substance ingestions among young children during the pandemic is limited.

Objectives

To assess immediate and sustained changes in overall illicit substance ingestion rates among children younger than 6 years before and during the COVID-19 pandemic and to examine changes by substance type (amphetamines, benzodiazepines, cannabis, cocaine, ethanol, and opioids) while controlling for differing statewide medicinal and recreational cannabis legalization policies.

Design, Setting, and Participants

Retrospective cross-sectional study using an interrupted time series at 46 tertiary care children's hospitals within the Pediatric Health Information System (PHIS). Participants were children younger than 6 years who presented to a PHIS hospital for an illicit substance(s) ingestion between January 1, 2017, and December 31, 2021. Data were analyzed in February 2023.

Exposure

Absence or presence of the COVID-19 pandemic.

Main Outcome(s) and Measure(s)

The primary outcome was the monthly rate of encounters for illicit substance ingestions among children younger than 6 years defined by International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code(s) for poisoning by amphetamines, benzodiazepines, cannabis, cocaine, ethanol, and opioids. The secondary outcomes were the monthly rate of encounters for individual substances.

Results

Among 7659 children presenting with ingestions, the mean (SD) age was 2.2 (1.3) years and 5825 (76.0%) were Medicaid insured/self-pay. There was a 25.6% (95% CI, 13.2%-39.4%) immediate increase in overall ingestions at the onset of the pandemic compared with the prepandemic period, which was attributed to cannabis, opioid, and ethanol ingestions. There was a 1.8% (95% CI, 1.1%-2.4%) sustained monthly relative increase compared with prepandemic trends in overall ingestions which was due to opioids. There was no association between medicinal or recreational cannabis legalization and the rate of cannabis ingestion encounters.

Conclusions and Relevance

In this study of illicit substance ingestions in young children before and during the COVID-19 pandemic, there was an immediate and sustained increase in illicit substance ingestions during the pandemic. Additional studies are needed to contextualize these findings in the setting of pandemic-related stress and to identify interventions to prevent ingestions in face of such stress, such as improved parental mental health and substance treatment services, accessible childcare, and increased substance storage education.

The Impact of Helping Children with Distance Learning During COVID-19 on U.S. Parents' Alcohol Consumption

We examined the impact of distance learning-related parental stress due to COVID-19 on parental alcohol consumption using an online survey in May 2020 with a convenience sample of U.S. adults. This article focuses on the 361 parents who had children under the age of 18 living with them. Seventy-eight percent had children who were engaged in distance learning; 59% reported being stressed because they were not sure how to help their children with distance learning. Stressed parents reported consuming significantly more alcohol and binge drinking more often than parents who were not stressed by distance learning. We hope that public health professionals can use our findings to better target alcohol prevention programs aimed at parents to reduce parental stress, and hopefully, parental alcohol consumption.

Effects of prenatal opioid exposure on synaptic adaptations and behaviors across development

In this review, we focus on prenatal opioid exposure (POE) given the significant concern for the mental health outcomes of children with parents affected by opioid use disorder (OUD) in the view of the current opioid crisis. We highlight some of the less explored interactions between developmental age and sex on synaptic plasticity and associated behavioral outcomes in preclinical POE research. We begin with an overview of the rich literature on hippocampal related behaviors and plasticity across POE exposure paradigms. We then discuss recent work on reward circuit dysregulation following POE. Additional risk factors such as early life stress (ELS) could further influence synaptic and behavioral outcomes of POE. Therefore, we include an overview on the use of preclinical ELS models where ELS exposure during key critical developmental periods confers considerable vulnerability to addiction and stress psychopathology. Here, we hope to highlight the similarity between POE and ELS on development and maintenance of opioid-induced plasticity and altered opioid-related behaviors where similar enduring plasticity in reward circuits may occur. We conclude the review with some of the limitations that should be considered in future investigations. This article is part of the Special Issue on 'Opioid-induced addiction'.

Suicidal ideation among people with disabilities during the COVID-19 pandemic in Bangladesh: prevalence and associated factors

BACKGROUND

Evidence from pandemic and pre-pandemic studies conducted globally indicates that people with disabilities (PWDs) have a higher risk for suicidality. However, none of these studies has assessed suicidality among PWDs in Bangladesh.

AIMS

The purpose of this study was to determine the prevalence of and factors associated with suicidal ideation among PWDs during the COVID-19 pandemic in Bangladesh.

METHOD

Using a snowball sampling technique, a cross-sectional survey was conducted from February to April 2021 among PWDs from six districts in the northern region of Bangladesh. Information related to sociodemographic factors, clinical characteristics, behavioural factors and suicidal ideation was collected. Chi-squared test and logistic regression were used to describe the data and explain the relationship of factors associated with suicidal ideation.

RESULTS

The prevalence of COVID-19-related past-year suicidal ideation was 23.9%. The factors associated with suicidal ideation included: age above 35 years, being female, acquiring a disability later in life, lack of sleep and current substance use. In addition, higher education appeared to be a protective factor against suicidal ideation.

CONCLUSIONS

This study highlighted that PWDs had an increased risk of suicide; that is, one-fourth of them had past-year suicidal ideation. This may have been because of COVID-19-related restrictions and stressors. Thus, the government and policy makers need to pay more attention to developing effective suicide assessment, treatment and management strategies, especially for at-risk groups, to minimise the impact of the COVID-19 outbreak.

Substance use, psychiatric symptoms, personal mastery, and social support among COVID-19 long haulers: A compensatory model

BACKGROUND

Substance use has become a critical health concern during the COVID-19 pandemic, and emerging attention has been paid to people with the persistent symptoms of COVID-19 (COVID-19 long haulers) due to their high vulnerability. However, scant research has investigated their substance use and relevant psychosocial factors. The current study was to (1) examine substance use behaviors (i.e., legal drug use, illicit drug use, and non-medical use of prescription drugs); and (2) assessed their associations with psychiatric symptoms (i.e., depression, anxiety, and post-traumatic stress disorder) and psychosocial factors (i.e., personal mastery and social support) among COVID-19 long haulers.

METHODS

In January - March 2022, 460 COVID-19 long haulers (50% female), with an average age of 32, completed online surveys regarding their demographics, substance use, psychiatric symptoms, and psychosocial factors.

RESULTS

In the past three months, the most commonly used or non-medically used substances were tobacco (82%) for legal drugs, cocaine (53%) for illicit drugs, and prescription opioids (67%) for prescription drugs. Structural equation modeling suggested that psychiatric symptoms were positively associated with substance use behaviors ( β s = .38 to .68, p s < .001), while psychosocial factors were negatively associated with substance use behaviors ( β s = -.61 to -.43, p s < .001).

CONCLUSION

Substance use is common in COVID-19 long haulers and psychiatric symptoms are the risk factors. Personal mastery and social support appear to offer protection offsetting the psychiatric influences. Substance use prevention and mental health services for COVID-19 long haulers should attend to personal mastery and social support.

Exploring the unseen effect of COVID 19 pandemic on blood transfusion services in a tertiary care centre

Background

The coronavirus pandemic confronted blood transfusion services with major challenges. The present study was conducted to explore the effect of the COVID-19 pandemic on blood transfusion services including seroprevalence of transfusion-transmitted infections.

Material and Methods

A retrospective cross-sectional study was conducted and data on blood donation, utilization, camps, plateletpheresis and seroprevalence of transfusion-transmitted infections (TTI) was retrieved from software from March to September 2020 and 2021 and compared with corresponding time periods of three preceding non-pandemic years.

Results

There was a decline of 53.79% and 34.4% in blood donations in 2020 and 2021 respectively with a significant reduction in voluntary donations from 91.8% in the pre-pandemic period to 72.2% in 2020 and 77.7% in 2021. Replacement donors increased by 60.81% and 72.89% in 2020 and 2021 respectively. There was a decline of 48.4% in the number of plateletpheresis procedures in 2020 which increased in 2021 during the dengue outbreak. The decline in total blood donations and issue of packed red blood cells was statistically significant but supply and demand were balanced with no deficit. TTI seroprevalence increased from 1.01% to 1.49%(p<0.001) and 1.51%(p<0.001) in 2020 and 2021 respectively. Replacement donors showed a significantly higher TTI prevalence as compared to voluntary donors(p<0.001). A significant increase in prevalence was observed for Syphilis (0.4%) in 2020 and HBsAg (0.54%), HCV(0.63%) and syphilis (0.25%) in 2021.

Conclusion

The potential consequences of the COVID-19 pandemic on blood safety cannot be undermined. Developing a strong database of regular voluntary donors can be instrumental in dealing with future waves and surges in infections.

The impact of psychological hardiness on intolerance of uncertainty in university students during the COVID-19 pandemic

The purpose of the study was to measure the impact of psychological hardiness on the intolerance of uncertainty (IOU) among university students during the coronavirus disease 2019 (COVID-19) pandemic. A cross-sectional correlational research design was used in the study, where participants were selected by convenience sampling. The data was collected from 1217 undergraduate students from a university in Turkey through web-based questionnaires. The Intolerance of Uncertainty Scale assessed data, including intolerance of uncertainty. In addition, the Personal Views Survey III-R was used to measure students' psychological hardiness. The results indicated that Turkish undergraduate students overall had high IOU and above-average psychological hardiness. Psychological hardiness was negatively correlated with IOU. Students losing a loved one because of COVID-19 had increased intolerance to uncertainty and lower psychological hardiness. Psychological hardiness was a powerful predictor of IOU. These findings show the need to implement hardiness-training programs for undergraduate students to increase their tolerance to uncertainty and reduce the effect of grief.

Substance use disorder among adolescents before and during the COVID-19 pandemic in Uganda: Retrospective findings from a psychiatric ward registry

It has been reported that the COVID-19 pandemic has predisposed adolescents to risky behaviors such as substance use and subsequent substance use disorder (SUD). However, it is unknown how the pandemic has changed the prevalence of SUD among adolescents in Uganda. We aimed to determine the prevalence of SUD and associated factors among adolescents in southwestern Uganda. Retrospectively, psychiatry ward records from November 2018 to July 2021 were collected from the largest tertiary hospital in southwestern Uganda. A total of 441 adolescent records were included in the analysis, with a mean age was 17±1.88 years, and the majority were males (50.34%). The overall prevalence of SUD was 7.26% (5.90% and 9.80% before and during the pandemic). Despite a little rise in SUD (3.9% increment) during the COVID-19 pandemic, there was no statistical difference compared to before the pandemic. The likelihood of being diagnosed with SUD was more among older adolescents at any period. In addition, having a diagnosis of bipolar mood disorder reduced the likelihood of SUD during the pandemic. This study indicated no statistical change in the diagnosis of SUD among adolescents before and during the COVID-19 pandemic. As older-male adolescents (17 to 19 years) were at higher risk of SUD, there is a need for early intervention for this group.