1
|
Hao S, McLuhan A, Moloney G, Kaur N, Moineddin R, Turner NE, Matheson FI. Operational status of mental health, substance use, and problem gambling services: A system-level snapshot two years into the COVID-19 pandemic. Int J Health Plann Manage 2024; 39:980-992. [PMID: 38192113 DOI: 10.1002/hpm.3763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND The aim of this paper is to provide a system-level snapshot of the operational status of mental health, substance use, and problem gambling services 2 years into the pandemic in Ontario, Canada, with a specific focus on services that target individuals experiencing vulnerable circumstances (e.g., homelessness and legal issues). METHODS We examined data from 6038 publicly funded community services that provide mental health, substance use, and problem gambling services in Ontario. We used descriptive statistics to describe counts and percentages by service type and specialisation of service delivery. We generated cross-tabulations to analyse the relationship between the service status and service type for each target population group. RESULTS As of March 2022, 38.4% (n = 2321) of services were fully operational, including 36.0% (n = 1492) of mental health, 44.1% (n = 1037) of substance use, and 23.4% (n = 78) of problem gambling services. These service disruptions were also apparent among services tailored to sexual/gender identity (women/girls, men/boys, 2SLGBTQQIA + individuals), individuals with legal issues, with acquired brain injury, and those experiencing homelessness. CONCLUSION Accessible community-based mental health, substance use and problem gambling services are critical supports, particularly for communities that have historically contended with higher needs and greater barriers to care relative to the general population. We discuss the public health implications of the findings for the ongoing pandemic response and future emergency preparedness planning for community-based mental health, substance use and problem gambling services.
Collapse
Affiliation(s)
- Sherry Hao
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Arthur McLuhan
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Gary Moloney
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Nigel E Turner
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Flora I Matheson
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Abramoff BA, Hentschel C, Dillingham IA, Dillingham T, Baraniecki-Zwil G, Williams A, Pezzin LE. The association of multiple sclerosis, traumatic brain injury, and spinal cord injury to acute and long COVID-19 outcomes. PM R 2024; 16:553-562. [PMID: 38145343 PMCID: PMC11189756 DOI: 10.1002/pmrj.13121] [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: 01/18/2023] [Revised: 09/06/2023] [Accepted: 12/10/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Although persons with disabilities are a high-risk group, little is known about the association between specific disabling conditions and acute or long COVID outcomes. OBJECTIVE To examine the severity of acute SARS-CoV-2 infection and post-COVID outcomes among people with a preexisting diagnosis of multiple sclerosis (MS), spinal cord injury (SCI), or traumatic brain injury (TBI). METHODS This was a retrospective cohort study using the TrinetX Research Database, a large representative database of medical records. COVID-19-positive persons with MS, SCI, or TBI (cases) were matched 1:1 on age, gender, race, ethnicity, and comorbidities to COVID-19-positive persons without these diagnoses (controls). The main outcomes assessed were hospitalization for acute COVID-19, length of stay (LOS), the total number of hospitalizations, mortality, and incidence of six prevalent post-COVID sequelae within 6 months following a COVID-19 diagnosis. RESULTS There were 388,297 laboratory-confirmed COVID-19 cases identified. Of these cases, 2204 individuals had one of the following preexisting diagnoses: 51.3% TBI, 31.4% MS, and 17.3% SCI. People with TBI, MS, and SCI were significantly more likely to be hospitalized for COVID-19 (odds ratio [OR] = 1.22, 95% confidence interval [CI] = 1.03-1.46) than matched controls. There was no difference in LOS, total hospitalizations, or mortality during the 6 months following the initial COVID diagnosis. Multivariable analyses reveal that persons with TBI, MS, and SCI were more likely to experience new weakness (OR = 1.54, 95% CI = 1.19-2.00), mobility difficulties (OR = 1.66, 95% CI = 1.17-2.35), and cognitive dysfunction (OR = 1.79, 95% CI = 1.38-2.33) than controls, even after controlling for the presence of these symptoms prior to their COVID infection and other risk factors. There were no differences in fatigue, pain, or dyspnea. CONCLUSIONS Having a history of MS, SCI or TBI was not associated with higher mortality risk from COVID-19. However, associations between these diagnoses and postacute COVID-19 symptoms raise concern about widening health outcome disparities for individuals with such potentially disabling conditions following COVID-19 infection.
Collapse
Affiliation(s)
- Benjamin A. Abramoff
- Department of Physical Medicine and Rehabilitation, The University of Pennsylvania- Perelman School of Medicine 1800 Lombard Street, Philadelphia, PA 19146
| | - Claudia Hentschel
- Department of Physical Medicine and Rehabilitation, Harvard University School of Medicine, 25 Shattuck Street Boston, MA 02115
| | | | - Timothy Dillingham
- Department of Physical Medicine and Rehabilitation, The University of Pennsylvania- Perelman School of Medicine 1800 Lombard Street, Philadelphia, PA 19146
| | - Gwen Baraniecki-Zwil
- Department of Physical Medicine and Rehabilitation, The University of Pennsylvania- Perelman School of Medicine 1800 Lombard Street, Philadelphia, PA 19146
| | - Asha Williams
- Lincoln University, 1570 Baltimore Pike, Lincoln University, PA, 19352
| | - Liliana E. Pezzin
- Institute of Health and Equity, Collaborative for Healthcare and Delivery Science, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226
| |
Collapse
|
3
|
Genova HM, Chen MH, Botticello A, Voelbel G, Kim G, Elsayed HE, Myszko Z, DeLuca J, McGrath RE, Arnett P, Goverover Y. An Examination of Positive and Negative Outcomes During the COVID-19 Pandemic Among Persons With Multiple Sclerosis. Am J Occup Ther 2023; 77:7706205090. [PMID: 38015490 DOI: 10.5014/ajot.2023.050287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
IMPORTANCE This study provides information to clinicians about how persons with MS coped in both positive and negative ways during a potentially traumatic experience (the coronavirus disease 2019 [COVID-19] pandemic), which will help clinicians to provide better services to this population in the face of stressful events. OBJECTIVE To describe both positive and negative outcomes among persons with multiple sclerosis (MS) and to examine whether resilience and social support were related to positive and negative outcomes during the peak of the pandemic. DESIGN An online survey administered during the COVID-19 pandemic. PARTICIPANTS Participants were 74 individuals with MS and 104 healthy controls (HCs) recruited through social media and community support groups. OUTCOMES AND MEASURES The survey included questionnaires that assessed both positive and negative responses to the pandemic, including benefit finding, loneliness, and distress. Resilience and social support were also assessed. RESULTS Differences were noted between persons with MS and HCs on negative but not positive outcomes. Better social support and resilience were related to positive outcomes. CONCLUSIONS AND RELEVANCE Both persons with MS and HCs were similar in benefit finding and stress management. However, negative outcomes were worse in the MS group. Our findings shed light on the importance of individuals with MS adopting a positive outlook to help during times of adversity. What This Article Adds: Among persons with disabilities such as multiple sclerosis, finding benefits during stressful times can be a potential coping mechanism. Furthermore, resilience and social support should be taken into account to moderate the effects of adverse events.
Collapse
Affiliation(s)
- Helen M Genova
- Helen M. Genova, PhD, is Associate Director, Center for Autism Research, and Director, Social Cognition and Neuroscience Laboratory, Kessler Foundation, East Hanover, NJ, and Associate Professor, Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, the State University of New Jersey, Newark
| | - Michelle H Chen
- Michelle H. Chen, PhD, is Assistant Professor, Department of Neurology, Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, New Brunswick
| | - Amanda Botticello
- Amanda Botticello, PhD, MPH, is Associate Director, Centers for Outcomes & Assessment Research, Kessler Foundation, East Hanover, NJ, and Vice Chair of Research Education, Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, the State University of New Jersey, Newark
| | - Gerald Voelbel
- Gerald Voelbel, PhD, is Associate Professor, Department of Occupational Therapy, New York University, New York
| | - Grace Kim
- Grace Kim, PhD, is Associate Professor, Department of Occupational Therapy, New York University, New York
| | - Heba E Elsayed
- Heba E. Elsayed, MD, is Associate Research Scientist, Kessler Foundation, East Hanover, NJ
| | - Zuzanna Myszko
- Zuzanna Myszko, BA, is Doctoral Student, Montclair State University, Montclair, NJ
| | - John DeLuca
- John DeLuca, PhD, is Senior Vice President for Research and Training, Kessler Foundation, East Hanover, NJ, and Professor, Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, the State University of New Jersey, Newark
| | - Robert E McGrath
- Robert E. McGrath, PhD, is Professor, Psychology Department, School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, NJ
| | - Peter Arnett
- Peter Arnett, PhD, is Professor, Psychology Department, Pennsylvania State University, University Park
| | - Yael Goverover
- Yael Goverover, PhD, is Visiting Professor, Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, the State University of New Jersey, Newark, and Professor, Department of Occupational Therapy, New York University, New York;
| |
Collapse
|
4
|
Kero K, Podlesek A, Kavcic V. Meaning in challenging times: Sense of meaning supports wellbeing despite pandemic stresses. SSM - MENTAL HEALTH 2023:100226. [PMID: 37359070 PMCID: PMC10199818 DOI: 10.1016/j.ssmmh.2023.100226] [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] [Received: 09/20/2022] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 06/28/2023] Open
Abstract
The COVID-19 pandemic created stress and trauma for many individuals. Traumatic experiences often trigger reflection on meaning in life, with subsequent growth or despair. This study evaluates the role of meaning in life in buffering stressors in the early stages of the COVID-19 pandemic. The purpose of this study was to determine the extent to which the negative effects of COVID-19 stressors (self-perceived stress, emotional state, and cognitive adaptation to stress in the pandemic) are influenced by meaning in life in the context of the early stages of the pandemic. Further, this study described differences in meaning in life observed across demographic groups. Web-based surveys were completed by 831 Slovenian participants in April of 2020. Demographic data; perceptions of stressors related to lacking necessities, movement restrictions, and concerns at home; meaning in life; perceived overall health status; anxiety; emotional state; and perceived stress were measured. A moderately strong sense of meaning in life (M = 5.0, SD = 0.74, range 1-7) was reported by participants, and meaning in life was associated with enhanced wellbeing (B = 0.06-.28, p < .01). Both direct and indirect relationships were observed between stressors and wellbeing outcomes. The indirect effects of meaning in life were especially prominent in the relationship between stressors related to lacking necessities and concerns at home and outcomes of anxiety, perceived stress, and negative emotions, contributing 13-27% of the total observed effects. Increased meaning in life was observed across older age groups (F(5, 825) = 4.8, p < .001) and for those in partnered relationships (t(829) = -3.397, p <.001). A strong sense of meaning in life was associated with improved well-being, even for individuals who experienced pandemic-related stressors. Public health initiatives and media may help improve resilience to pandemic trauma by emphasizing the collective meaning in challenging situations.
Collapse
Affiliation(s)
- Katherine Kero
- Institute of Gerontology, Wayne State University, Detroit, MI, United States
| | - Anja Podlesek
- Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
| | - Voyko Kavcic
- Institute of Gerontology, Wayne State University, Detroit, MI, United States
- International Institute of Applied Gerontology, Ljubljana, Slovenia
| |
Collapse
|
5
|
Salazar AP, Lecours S, Engel L, Gignac MAM, Rotenberg S, Zarshenas S, McDonald M, Bottari C. Understanding the Early Impacts of the COVID-19 Pandemic on Brain Injury Associations Across Canada: A Qualitative Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231209161. [PMID: 37970821 PMCID: PMC10655638 DOI: 10.1177/00469580231209161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/02/2023] [Accepted: 09/01/2023] [Indexed: 11/19/2023]
Abstract
The COVID-19 pandemic has increased challenges for people living with brain injury and community associations to support this vulnerable population. This study aimed to gain an in-depth understanding of the challenges faced by brain injury survivors during the first year of the pandemic and how community brain injury associations adapted their services to respond to these needs. Findings from seven focus-group with 31 representatives of Canadian brain injury associations revealed 4 main themes: (1) Addressing evolving client needs; (2) Keeping clients safe; (3) Challenges and opportunities navigating the digital world; and (4) Sustaining brain injury associations in the face of uncertainties and disruptions. To comply with public health measures, associations reported pivoting their service delivery online, despite recognizing the difficulties this could create for many brain injury survivors in accessing and using technology. Our findings also highlight concrete directions for not-profit organizations providing instrumental help with activities, acting as a liaison and interpreter of public health guidelines, and in connecting with clients using technology while handling potential cognitive and technological challenges. Addressing these issues has the potential to protect people living with brain injury and community associations from external threats, like pandemics, in the future.
Collapse
Affiliation(s)
- Ana Paula Salazar
- School of Rehabilitation, Université de Montréal, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal du CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC, Canada
| | - Sophie Lecours
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal du CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC, Canada
| | - Lisa Engel
- Department of Occupational Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
- Institute for Work & Health, Toronto, ON, Canada
| | - Monique A. M. Gignac
- Institute for Work & Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shlomit Rotenberg
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sareh Zarshenas
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Carolina Bottari
- School of Rehabilitation, Université de Montréal, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal du CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC, Canada
| |
Collapse
|