HIV, psychological resilience, and substance misuse during the COVID-19 pandemic: A multi-cohort study

The role of resilience in the relationship between stress and alcohol

Stress plays a well-documented role in alcohol consumption and the risk for developing alcohol use disorder. The concept of resilience - coping with and successfully adapting to stressful life experiences - has received increasing attention in the field of addiction research in recent decades, and there has been an accumulation of evidence for resilience as a protective factor against problematic alcohol consumption, risk for alcohol use disorder, disorder severity, and relapse. The conceptual and methodological approaches used in the generation of this evidence vary considerably across investigations, however. In light of this, we carried out this review in order to provide a more thorough understanding of the meaning and scope of resilience, what factors contribute to resilience, how it is measured, and how it relates to alcohol-associated phenotypes. Implications for treatment through the use of resilience-building interventions are likewise discussed, as well as implications for future research on the role of resilience in the etiology and clinical outcomes of alcohol use disorder.

Maltreatment, resilience, and sexual relationship power in a sample of justice-involved women with opioid use disorder

Justice-involved women frequently report maltreatment and intimate relationships characterized by violence and abuse throughout adulthood. The present study aimed to (a) investigate the association between victimization and sexual relationship power (SRP) among justice-involved women with opioid use disorder (OUD) and (b) explore resilience as a potential moderating factor of the association between victimization and SRP. Under the ongoing Kentucky Justice Community Opioid Innovation Network (JCOIN) cooperative, justice-involved women (N = 700) were randomly selected from eight jails in Kentucky, screened for OUD, consented to participate, and interviewed by research staff. SRP was examined using the Sexual Relationship Power Scale, a validated instrument with two distinct subscales measuring decision-making dominance (DMD) and relationship control (RC); prior maltreatment was measured using the Global Appraisal of Individual Needs General Victimization Scale, and resilience was assessed using the Brief Resilience Scale. Linear regression was used to examine the association between maltreatment and SRP, with three models constructed to account for SRP, DMD, and RC, controlled for demographic characteristics. Finally, we examined whether the association between victimization and SRP varied as a function of resilience. Significant negative associations between maltreatment and the SRP were observed, ps < .001. Resilience moderated the association between maltreatment and DMD, p = .005; however, resilience did not moderate the associations between maltreatment and SRP, p = .141, or RC, p = .735. These findings highlight the importance of increasing resilience in justice-involved women with OUD to reduce the impact of maltreatment on SRP. Prioritizing resilience may offer significant benefits for preventing and addressing maltreatment.

Acceptability and Feasibility of "Latinos Unidos": A Microgame Resource Combatting Health Misinformation for Latinos Living with HIV

COVID-19 mitigation strategies, including shelter-in-place orders, masking, and social distancing combined with the widespread "infodemic" may interact synergistically to worsen already compromised mental health outcomes of people living with HIV (PLWH). We developed a three-part microgame intervention, "Latino Unidos," targeting media health literacy education that could be mobilized to protect the mental health of Latinx PLWH as well as promote HIV care during the pandemic. We utilized a community-based approach by working with two local community partners and conducted interviews and focus groups from three perspectives: Latino PLWH, ID providers, and community health workers. Participants evaluated three microgame modules for literacy objectives, acceptability, and feasibility. Feedback offered from each round of module review indicated that each of the game experiences supported the aim of addressing health mis/disinformation. Results indicated relative success demonstrated by positive responses on module literacy goals, acceptability, and feasibility. Our approach illuminates the intersection between content development around media literacy and microgame modality as a novel mHealth resource. Study outcomes offer suggestions and strategies for optimizing content effectiveness and intervention material dissemination.

The association of changes in depression severity after the onset of the COVID-19 pandemic and viral nonsuppression among people with HIV

OBJECTIVE

This study sought to characterize changes in depressive symptom severity during the COVID-19 pandemic and the association of these changes with HIV viral nonsuppression among people with HIV (PWH).

DESIGN

A clinical cohort study.

METHODS

We included PWH in the Johns Hopkins HIV Clinical Cohort who completed the Patient Health Questionnaire 8 (PHQ-8) prepandemic (1 March 2018 to 28 February 2020) and during the COVID-era (1 September 2020 to 28 February 2022). PWH were classified according to depression severity categories prepandemic and during the COVID-era as: consistently depressed (prepandemic PHQ-8 >4 and no change in severity category); consistently nondepressed (prepandemic PHQ-8 ≤4 and no change in severity category); worsened (changed to a higher severity category) and; improved (change to a lower severity category). The association between changes in depressive symptom severity and viral nonsuppression (HIV RNA >200 copies/ml on the earliest viral load measured 7 days before to 12 months after the COVID-era PHQ-8 survey) was assessed using multivariable logistic regression.

RESULTS

Of 793 PWH, mean age was 56 (SD 10) years, 60% were male individuals and 88% were Black. After the onset of the pandemic, 60% were consistently nondepressed, 9% were consistently depressed, 15% worsened and 16% improved. PWH who worsened had 2.47 times the odds of viral nonsuppression (95% CI: 1.09-5.55) compared with the nondepressed group. Associations among other groups were not statistically significant.

CONCLUSION

Worsening depression during the COVID-era was associated with HIV viral nonsuppression. Strategies to monitor and address depression among PWH may contribute to reduced risk of viral nonsuppression.

Infectious Illness Symptoms Are Associated with Elevated Anxiety in a Sample of Sexual and Gender Minority Young Adults During the COVID-19 Pandemic

BACKGROUND

To evaluate whether infectious illness symptoms (IIS) are associated with generalized anxiety symptoms during the COVID-19 pandemic in sexual/gender (SGM) minority young adults assigned male at birth (AMAB).

METHOD

Four hundred eighteen participants (median age = 25; range, 20-40) were recruited through RADAR, an ongoing Chicago-based cohort study of SGM-AMAB between September 2020 and February 2021. Participants completed online surveys. A subset (n = 145) provided dried blood spot samples to assess SARS-CoV-2 serostatus.

RESULTS

One hundred twenty participants (28.7%) had GAD-7 scores of 10 or greater, which indicates generalized anxiety symptoms that may be clinically significant. In a binomial logistic regression model adjusting age, gender identity, race/ethnicity, substance use, and HIV status, the authors found that having a higher IIS count since March 1, 2020, was associated with greater odds of having a GAD-7 score of 10 or greater (OR = 1.14; 95% CI, 1.04, 1.25; P = 0.007). This effect was more pronounced in a binomial logistic regression model adjusting for the same covariates but using current IIS count as the independent variable (OR = 1.39; 95% CI, 1.13, 1.74; P = 0.002).

CONCLUSION

Among SGM-AMAB young adults, those who experienced ISS reported higher scores on the GAD-7, a widely used and validated screening measure for generalized anxiety symptoms. These findings highlight the importance of screening for anxiety disorders when patients present with IIS in clinical settings and psychobehavioral health follow-ups when indicated.

Differences in the Evolution of Clinical, Biochemical, and Hematological Indicators in Hospitalized Patients with COVID-19 According to Their Vaccination Scheme: A Cohort Study in One of the World's Highest Hospital Mortality Populations

COVID-19 vaccines primarily prevent severe illnesses or hospitalization, but there is limited data on their impact during hospitalization for seriously ill patients. In a Mexican cohort with high COVID-19 mortality, a study assessed vaccination's effects. From 2021 to 2022, 462 patients with 4455 hospital days were analyzed. The generalized multivariate linear mixed model (GENLINMIXED) with binary logistic regression link, survival analysis and ROC curves were used to identify risk factors for death. The results showed that the vaccinated individuals were almost half as likely to die (adRR = 0.54, 95% CI = 0.30-0.97, p = 0.041). When stratifying by vaccine, the Pfizer group (BNT162b2) had a 2.4-times lower risk of death (adRR = 0.41, 95% CI = 0.2-0.8, p = 0.008), while the AstraZeneca group (ChAdOx1-S) group did not significantly differ from the non-vaccinated (adRR = 1.04, 95% CI = 0.5-2.3, p = 0.915). The Pfizer group exhibited a higher survival, the unvaccinated showed increasing mortality, and the AstraZeneca group remained intermediate (p = 0.003, multigroup log-rank test). Additionally, BNT162b2-vaccinated individuals had lower values for markers, such as ferritin and D-dimer. Biochemical and hematological indicators suggested a protective effect of both types of vaccines, possibly linked to higher lymphocyte counts and lower platelet-to-lymphocyte ratio (PLR). It is imperative to highlight that these results reinforce the efficacy of COVID-19 vaccines. However, further studies are warranted for a comprehensive understanding of these findings.

Interactions between the principal risk factors for reduction of the eGFR in unvaccinated COVID‑19 survivors: Normal pre-COVID‑19 eGFR, not having diabetes and being hospitalized

There are contradictory results regarding changes in estimated glomerular filtration rate (eGFR) in coronavirus disease 2019 (COVID-19) survivors. An analysis of eGFR changes and clinical characteristics associated with those changes was conducted among COVID-19 survivors. eGFR values were compared at different time points (before and 4-, 8- and 12-months after COVID-19 infection). A multivariate generalized linear mixed model (GENLINMIXED procedure) with a binary logistic regression link was used to determine factors associated with eGFR reduction of ≥10 ml/min/1.73 m2. Being hospitalized (RR=2.90, 95% CI=1.10-7.68, P=0.032), treated with Ivermectin (RR=14.02, 95% CI=4.11-47.80, P<0.001) or anticoagulants (RR=6.51, 95% CI=2.69-15.73, P<0.001) are risk factors for a reduced eGFR. Having a low eGFR (<90 ml/min/1.73 m2) before COVID-19 infection, having B-positive blood type, diabetes, taking vitamin C during the acute phase of COVID-19 or suffering from chronic COVID-19 symptoms, were identified as protective factors. Analysis involving a two-way interaction (A x B, where A and B are factors) demonstrated that the combination of patients with a normal eGFR value before COVID-19 infection without diabetes (RR=58.60, 95% CI=11.62-295.38, P<0.001), or a normal eGFR value with being hospitalized for COVID-19 (RR=38.07, 95% CI=8.68-167.00, P<0.001), increased the probability of a reduced eGFR. The changes in eGFR in COVID-19 survivors varied depending on patient characteristics. Furthermore, the principal risk factors for post-COVID-19 eGFR reduction were analyzed in separate models.

Changes in self-reported cannabis use during the COVID-19 pandemic: a scoping review

BACKGROUND

The COVID-19 pandemic is affecting mental health and substance use (MHSU) issues worldwide. The purpose of this study was to characterize the literature on changes in cannabis use during the pandemic and the factors associated with such changes.

METHODS

We conducted a scoping review by searching peer-reviewed databases and grey literature from January 2020 to May 2022 using the Arksey and O'Malley Framework. Two independent reviewers screened a total of 4235 documents. We extracted data from 129 documents onto a data extraction form and collated results using content analytical techniques.

RESULTS

Nearly half (48%) of the studies reported an increase/initiation of cannabis use, while 36% studies reported no change, and 16% reported a decrease/cessation of cannabis use during the pandemic. Factors associated with increased cannabis use included socio-demographic factors (e.g., younger age), health related factors (e.g., increased symptom burden), MHSU factors (e.g., anxiety, depression), pandemic-specific reactions (e.g., stress, boredom, social isolation), cannabis-related factors (e.g., dependence), and policy-related factors (e.g., legalization of medical/recreational cannabis).

CONCLUSION

Public health emergencies like the COVID-19 pandemic have the potential to significantly impact cannabis use. The pandemic has placed urgency on improving coping mechanisms and supports that help populations adapt to major and sudden life changes. To better prepare health care systems for future pandemics, wide-reaching education on how pandemic-related change impacts cannabis use is needed.

The Impact of the COVID-19 Pandemic on Mental Health and Substance Use among People with and without HIV

People with HIV (PWH) may be particularly vulnerable to the psychological impacts of COVID-19. To assess this, participants were recruited from two established cohorts of PWH and HIV- adults with the available pre-pandemic baseline data and completed the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Alcohol Use Identification Test (AUDIT), National Institute on Drug Abuse Quick Screen (NIDA-QS), and Pittsburgh Sleep Quality Index (PSQI) at two distinct intra-pandemic time periods. All outcomes were evaluated using generalized linear mixed models. In total, 87 participants completed all the questionnaires; 45 were PWH and 42 were HIV-. The pre-pandemic mean BDI-II, BAI, AUDIT and PSQI scores were higher in the PWH cohort. After the onset of the pandemic, the mean BDI-II, AUDIT and PSQI scores increased within the sample as a whole (p < 0.001, p = 0.029 and p = 0.046, respectively). The intra-pandemic mean BDI-II scores fell slightly for both groups and the AUDIT scores increased slightly for the PWH group and fell slightly for the HIV- group, but not significantly. The intra-pandemic PSQI scores increased sharply for both groups. The percentage of PWH and HIV- participants who moved into a more severe category of depression was identical (18%), but more PWH met the criteria for clinical evaluation. The BAI and NIDA-QS scores did not increase significantly. In conclusion, the measures of mental health symptoms and alcohol use increased in both groups after the onset of the pandemic. Although there were no significant differences in the changes between the groups, the PWH had higher baseline scores and the changes in this group had more clinical impacts.

Temporal association of pre-pandemic perceived social support with psychological resilience and mental well-being during the COVID-19 pandemic among people with a history of injection drug use

BACKGROUND

There are limited data on whether modifiable social factors foster psychological resilience and mental well-being among people who use drugs following Big Events. We examined the temporal association of pre-pandemic perceived social support with psychological resilience and negative mental health symptoms during the COVID-19 pandemic among people with a history of injection drug use.

METHODS

Between June and September 2020, we conducted a telephone survey among 545 participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study: a community-based cohort of adults with a history of injection drug use. Leveraging data from study visits in 2018-early 2020, associations of pre-pandemic perceived social support with psychological resilience scores (range=1-5) and the probability of negative mental health symptoms during the pandemic were assessed using multivariable linear and modified Poisson regression models, respectively.

RESULTS

Participants' median age was 58 years, 38.2% were female, 83.3% identified as Black, and 30.3% were living with HIV. During the pandemic, 14.5% had low (<3) resilience scores, 36.1% experienced anxiety, and 35.8% reported increased loneliness. Compared to participants in the lowest tertile of pre-pandemic social support, participants in the highest tertile had higher mean resilience scores (β = 0.27 [95% CI = 0.12, 0.43]), a lower probability of anxiety (prevalence ratio [PR] = 0.71 [95% CI = 0.52, 0.96]), and a lower probability of increased loneliness (PR = 0.62 [95% CI = 0.45, 0.84]).

CONCLUSIONS

Pre-pandemic perceived social support was associated with greater psychological resilience and generally better mental well-being during the pandemic. Interventions that improve social support may foster psychological resilience and protect the mental well-being of people who use drugs, especially during periods of social disruption.

Resilience and alcohol use in adulthood in the United States: A scoping review

High levels of alcohol use and the development of alcohol use disorder (AUD) are associated with various adverse consequences. Resilience has been proposed as a protective factor against increased alcohol use, though the existing research is limited by inconsistencies in the conceptualization and measurement of resilience. As such, the current scoping review examined 14 studies on individual, trait-level resilience as a protective factor against alcohol use and related consequences in adults over the age of 21 in the United States. Findings from the included studies generally suggest resilience as a protective factor against various outcomes, though methodological limitations should be considered. Although future research in this area should improve upon methodological limitations, the present review suggests clinical implications of resilience as beneficial in prevention and intervention programming for alcohol use outcomes.

The impact of the COVID-19 pandemic on mental health, associated factors and coping strategies in people living with HIV: a scoping review

INTRODUCTION

The COVID-19 pandemic and associated measures implemented by authorities have created additional stressors and increased the risk of psychological illnesses among people living with HIV (PLWH). Yet, there is no collective evidence on the mental health status of this population during the global pandemic and associated factors. This scoping review aimed to synthesize the evidence in the current literature related to the mental health outcomes and challenges faced by PLWH during the COVID-19 pandemic, identify the associated factors with psychological distress and summarize various coping strategies to ease these psychological distresses used by this population.

METHODS

We conducted a scoping review following the PRISMA-ScR guideline and a literature search in four electronic databases in August 2022. Three reviewers independently screened all the search records and extracted the data from studies that met the inclusion criteria. Factors associated with worsened mental health outcomes were synthesized according to the socio-ecological framework.

RESULTS

Among 1100 research records, 45 articles met the eligibility criteria and were included in the final review and data extraction, most of which were quantitative analyses. PLWH reported high rates of mental health problems during the pandemic. Multi-level factors were associated with increased psychological distress, including substance use, antiretroviral adherence, social support, financial hardship and economic vulnerability during the pandemic. PLWH used social media as a coping strategy to foster social support to deal with growing mental distress. Increased mental health illnesses were associated with increased substance use, it was also found associated with suboptimal medication adherence and antiretroviral therapy (ART) care engagement.

DISCUSSION

PLWH experienced high rates of mental health illnesses, such as depression during the global COVID-19 pandemic. There is an urgent need to provide comprehensive HIV treatment and mental health services as the pandemic continues to evolve.

CONCLUSIONS

The review summarized how the mental health of PLWH was affected during the COVID-19 pandemic. Future work in the implementation of effective interventions to promote mental health in this population is needed, not only to ensure their quality of life but also to help them maintain ART adherence and healthcare during more unprecedented times.

The Relationship Between Public Risk Familiarity and Mental Health During the COVID-19 Epidemic: A Moderated Mediation Model

In order to explore, from the perspective of the social ecological model, the relationship and its mechanism linking public risk familiarity and mental health during the new coronary pneumonia epidemic, the new coronary pneumonia epidemic risk perception scale, psychological resilience scale, Chinese mental health scale, and SARS familiarity scale were used 741 members of the public were surveyed as research objects. The results show that: (1) When gender, age, and educational background are controlled, risk familiarity has a significant positive predictive effect on public mental health; (2) Risk familiarity predicts mental health through the mediating effect of mental toughness; (3) The mediating effect of mental toughness is moderated by the public's familiarity with SARS. Specifically, for members of the public with low SARS familiarity, the indirect effect of risk familiarity on mental health through mental toughness is smaller than that for those with high SARS familiarity. The results of this study integrate psychological resilience into the theory of risk cognition, which has implications for the improvement of public mental health.