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Rahmani A, Najand B, Maharlouei N, Zare H, Assari S. COVID-19 Pandemic as an Equalizer of the Health Returns of Educational Attainment for Black and White Americans. J Racial Ethn Health Disparities 2024; 11:1223-1237. [PMID: 37490210 PMCID: PMC11101502 DOI: 10.1007/s40615-023-01601-w] [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: 12/09/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND COVID-19 pandemic has immensely impacted the social and personal lives of individuals around the globe. Marginalized-related diminished returns (MDRs) theory suggests that educational attainment shows a weaker protective effect for health and behavioral outcomes for Black individuals compared to White individuals. Previous studies conducted before the COVID-19 pandemic demonstrated diminished returns of educational attainment for Black individuals compared to White individuals. OBJECTIVES The study has three objectives: First, to test the association between educational attainment and cigarette smoking, e-cigarette vaping, presence of chronic medical conditions (CMC), self-rated health (SRH), depressive symptoms, and obesity; second, to explore racial differences in these associations in the USA during the COVID-19 pandemic; and third, to compare the interaction of race and return of educational attainment pre- and post-COVID-19 pandemic. METHODS This study utilized data from the Health Information National Trends Survey (HINTS) 2020. Total sample included 1313 adult American; among them, 77.4% (n = 1017) were non-Hispanic White, and 22.6% (n = 296) were non-Hispanic Black. Educational attainment was the independent variable operationalized as years of education. The main outcomes were cigarette smoking, e-cigarette vaping, CMC, SRH, depressive symptoms, and obesity. Age, gender, and baseline physical health were covariates. Race/ethnicity was an effect modifier. RESULTS Educational attainment was significantly associated with lower CMC, SRH, depressive symptoms, obesity, cigarette smoking, and e-cigarette vaping. Educational attainment did not show a significant interaction with race on any of our outcomes, suggesting that the health returns of education is similar between non-Hispanic White and non-Hispanic Black individuals. CONCLUSION COVID-19 may have operated as an equalizer of the returns of educational attainment. This observation may be because White may have more to lose; Black communities may be more resilient or have economic and social policies that buffered unemployment and poverty regardless of historical anti-Black oppression.
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Affiliation(s)
- Arash Rahmani
- Marginalized-Related Diminished Returns (MDRs) Center, Los Angeles, CA, USA
| | - Babak Najand
- Marginalized-Related Diminished Returns (MDRs) Center, Los Angeles, CA, USA
| | - Najmeh Maharlouei
- Marginalized-Related Diminished Returns (MDRs) Center, Los Angeles, CA, USA
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- School of Business, University of Maryland Global Campus (UMGC), Adelphi, 20783, USA
| | - Shervin Assari
- Marginalized-Related Diminished Returns (MDRs) Center, Los Angeles, CA, USA.
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.
- Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.
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Bogenschutz M, Johnson KR, Hall S, Lineberry S, Rand J, Rossetti Z, Shikarpurya S, Ticha R. An Equity-Based Research Agenda to Promote Social Inclusion and Belonging for People With IDD. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 62:186-199. [PMID: 38802094 DOI: 10.1352/1934-9556-62.3.186] [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: 02/01/2023] [Accepted: 07/24/2023] [Indexed: 05/29/2024]
Abstract
Having a sense of social inclusion and belonging, typically characterized by our personal relationships and community participation, is the central essence of life for most people, yet it remains elusive for many people with intellectual and developmental disabilities (IDD). This article summarizes the work of a diverse group of researchers and advocates to propose 6 big-picture, equity-based goals to drive future research in the field: (1) understanding the role of intersectionality, (2) understanding intimate relationships, (3) promoting formation of communities of care to support social inclusion, (4) understanding life course trajectories of social inclusion, (5) understanding social inclusion in virtual spaces, and (6) understanding how to promote social inclusion in the entire research process.
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Affiliation(s)
- Matthew Bogenschutz
- Matthew Bogenschutz, Virginia Commonwealth University, School of Social Work, Khalilah Robinson Johnson, University of North Carolina at Chapel Hill, Division of Occupational Science and Occupational Therapy, Sarah Hall, University of Minnesota, Institute on Community Integration, Sarah Lineberry, Virginia Commonwealth University, Partnership for People with Disabilities, Joseph Rand, University of Minnesota, Extension, Center for Youth Development, Zach Rossetti, Boston University, Wheelock College of Education & Human Development, Sehrish Shikarpurya, University of Maryland, College of Education, and Renata Ticha, University of Minnesota, Institute on Community Integration
| | - Khalilah Robinson Johnson
- Matthew Bogenschutz, Virginia Commonwealth University, School of Social Work, Khalilah Robinson Johnson, University of North Carolina at Chapel Hill, Division of Occupational Science and Occupational Therapy, Sarah Hall, University of Minnesota, Institute on Community Integration, Sarah Lineberry, Virginia Commonwealth University, Partnership for People with Disabilities, Joseph Rand, University of Minnesota, Extension, Center for Youth Development, Zach Rossetti, Boston University, Wheelock College of Education & Human Development, Sehrish Shikarpurya, University of Maryland, College of Education, and Renata Ticha, University of Minnesota, Institute on Community Integration
| | - Sarah Hall
- Matthew Bogenschutz, Virginia Commonwealth University, School of Social Work, Khalilah Robinson Johnson, University of North Carolina at Chapel Hill, Division of Occupational Science and Occupational Therapy, Sarah Hall, University of Minnesota, Institute on Community Integration, Sarah Lineberry, Virginia Commonwealth University, Partnership for People with Disabilities, Joseph Rand, University of Minnesota, Extension, Center for Youth Development, Zach Rossetti, Boston University, Wheelock College of Education & Human Development, Sehrish Shikarpurya, University of Maryland, College of Education, and Renata Ticha, University of Minnesota, Institute on Community Integration
| | - Sarah Lineberry
- Matthew Bogenschutz, Virginia Commonwealth University, School of Social Work, Khalilah Robinson Johnson, University of North Carolina at Chapel Hill, Division of Occupational Science and Occupational Therapy, Sarah Hall, University of Minnesota, Institute on Community Integration, Sarah Lineberry, Virginia Commonwealth University, Partnership for People with Disabilities, Joseph Rand, University of Minnesota, Extension, Center for Youth Development, Zach Rossetti, Boston University, Wheelock College of Education & Human Development, Sehrish Shikarpurya, University of Maryland, College of Education, and Renata Ticha, University of Minnesota, Institute on Community Integration
| | - Joseph Rand
- Matthew Bogenschutz, Virginia Commonwealth University, School of Social Work, Khalilah Robinson Johnson, University of North Carolina at Chapel Hill, Division of Occupational Science and Occupational Therapy, Sarah Hall, University of Minnesota, Institute on Community Integration, Sarah Lineberry, Virginia Commonwealth University, Partnership for People with Disabilities, Joseph Rand, University of Minnesota, Extension, Center for Youth Development, Zach Rossetti, Boston University, Wheelock College of Education & Human Development, Sehrish Shikarpurya, University of Maryland, College of Education, and Renata Ticha, University of Minnesota, Institute on Community Integration
| | - Zach Rossetti
- Matthew Bogenschutz, Virginia Commonwealth University, School of Social Work, Khalilah Robinson Johnson, University of North Carolina at Chapel Hill, Division of Occupational Science and Occupational Therapy, Sarah Hall, University of Minnesota, Institute on Community Integration, Sarah Lineberry, Virginia Commonwealth University, Partnership for People with Disabilities, Joseph Rand, University of Minnesota, Extension, Center for Youth Development, Zach Rossetti, Boston University, Wheelock College of Education & Human Development, Sehrish Shikarpurya, University of Maryland, College of Education, and Renata Ticha, University of Minnesota, Institute on Community Integration
| | - Sehrish Shikarpurya
- Matthew Bogenschutz, Virginia Commonwealth University, School of Social Work, Khalilah Robinson Johnson, University of North Carolina at Chapel Hill, Division of Occupational Science and Occupational Therapy, Sarah Hall, University of Minnesota, Institute on Community Integration, Sarah Lineberry, Virginia Commonwealth University, Partnership for People with Disabilities, Joseph Rand, University of Minnesota, Extension, Center for Youth Development, Zach Rossetti, Boston University, Wheelock College of Education & Human Development, Sehrish Shikarpurya, University of Maryland, College of Education, and Renata Ticha, University of Minnesota, Institute on Community Integration
| | - Renata Ticha
- Matthew Bogenschutz, Virginia Commonwealth University, School of Social Work, Khalilah Robinson Johnson, University of North Carolina at Chapel Hill, Division of Occupational Science and Occupational Therapy, Sarah Hall, University of Minnesota, Institute on Community Integration, Sarah Lineberry, Virginia Commonwealth University, Partnership for People with Disabilities, Joseph Rand, University of Minnesota, Extension, Center for Youth Development, Zach Rossetti, Boston University, Wheelock College of Education & Human Development, Sehrish Shikarpurya, University of Maryland, College of Education, and Renata Ticha, University of Minnesota, Institute on Community Integration
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DiRosa E, Van Deinse T, Cuddeback G, Murray-Lichtman A, Carda-Auten J, Rosen D. Mental Healthcare Practices from Entry to Release across Southeastern Jails. RESEARCH SQUARE 2024:rs.3.rs-4144413. [PMID: 38586059 PMCID: PMC10996800 DOI: 10.21203/rs.3.rs-4144413/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Background Individuals with mental illnesses are disproportionately incarcerated in jails, which have become de facto mental health institutions across the US. Yet there is limited research describing mental healthcare practices from entry to release among multiple jails and states. Methods We conducted 34 semi-structured interviews with jail healthcare personnel across five Southeastern states. Results We report results on challenges and practices related to mental health staffing, screening, additional evaluations and services, and discharge planning in jails. Initial mental health screenings were often restricted to the detection of suicidality and history of treatment and medications as opposed to current mental health symptoms. Use of validated mental health screening forms was uncommon. We found delays in care between the initial health screening and being evaluated by a mental health professional. Most jails reported primary responsibilities for mental health care as preventing suicides and managing psychiatric medications. Jails reported mental health care as challenging to manage, with high volumes of individuals with mental health needs, yet limited resources, especially regarding staffing. Discharge planning was limited despite reports of poor continuity of mental healthcare. Conclusions Jails have a constitutional duty and opportunity to provide adequate healthcare to individuals with mental illnesses, yet practices are insufficient and resources are limited across jails. Based on our findings, we recommend 1) greater adoption and revisions of jail health standards 2) system improvement that expands identification of mental illnesses and quicker, less variable follow-up mental health evaluations, 3) improved linkages and supports for community resources that prevent incarceration of this population.
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Quartana PJ, Beymer MR, Gomez SAQ, Adler AB, Santo TJ, Thomas JL, Bell AM. COVID-19 Concerns, Information Needs, and Adverse Mental Health Outcomes among U.S. Soldiers. Mil Med 2024; 189:e878-e887. [PMID: 37715687 DOI: 10.1093/milmed/usad350] [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: 04/11/2023] [Revised: 07/31/2023] [Accepted: 08/24/2023] [Indexed: 09/18/2023] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic disrupted U.S. Military operations and potentially compounded the risk for adverse mental health outcomes by layering unique occupational stress on top of general restrictions, fears, and concerns. The objective of the current study was to characterize the prevalence of COVID-19 concerns and information needs, demographic disparities in these outcomes, and the degree to which COVID-19 concerns and information needs were associated with heightened risk for adverse mental health outcomes among U.S. Army soldiers. MATERIALS AND METHODS Command-directed anonymous surveys were administered electronically to U.S. soldiers assigned to one of three regional commands in the Northwest United States, Europe, and Asia-Pacific Region. Surveys were administered in May to June 2020 to complete (time 1: n = 21,294) and again in December 2020 to January 2021 (time 2: n = 10,861). Only active duty or active reservists/national guard were eligible to participate. Members from other branches of service were also not eligible. RESULTS Highly prevalent COVID-19 concerns included the inability to spend time with friends/family, social activities, and changing rules, regulations, and guidance related to COVID-19. Some information needs were endorsed by one quarter or more soldiers at both time points, including stress management/coping, travel, how to protect oneself, and maintaining mission readiness. COVID-19 concerns and information needs were most prevalent among non-White soldiers. Concerns and information needs did not decline overall between the assessments. Finally, COVID-19 concerns were associated with greater risk of multiple adverse mental health outcomes at both time points. CONCLUSIONS COVID-19 concerns and information needs were prevalent and showed little evidence of decrement over the course of the first 6 months of the pandemic. COVID-19 concerns were consistently associated with adverse mental health outcomes. These data highlight two targets and potential demographic subgroups such that local leadership and Army medicine and public health enterprises can be better prepared to monitor and address to maintain force health and readiness in the face of possible future biomedical threats.
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Affiliation(s)
| | - Matthew R Beymer
- U.S. Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
| | | | - Amy B Adler
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | | | | | - Amy Millikan Bell
- U.S. Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
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Bhandari N, Gupta S. Trends in Mental Wellbeing of US Children, 2019-2022: Erosion of Mental Health Continued in 2022. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:132. [PMID: 38397623 PMCID: PMC10887976 DOI: 10.3390/ijerph21020132] [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: 12/25/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
We provide fresh estimates of a change in the nationwide prevalence of mental health symptoms among US children during the COVID-19 pandemic using National Health Interview Survey data (2019-22) on children aged 2-17 years (n = 27,378; age subgroups 2-5, 6-11, and 12-17) to assess overall mental distress and 19 specific outcomes related to developmental, communicative, cognitive, affective, and behavioral domains. Raw and adjusted (for socio-demographics) linear regressions estimated the change in prevalence for each outcome between 2019 (baseline year) and three succeeding years (2020-2022). Summary scores for mental distress rose between 2019 and 2020 (1.01 to 1.18 points, range of 0-15), declined slightly in 2021 (1.09), and climbed sharply again in 2022 (1.25). The declines primarily affected adolescents (1.11 at baseline, 1.24 in 2020, 1.30 in 2021, and 1.49 in 2022). Specific outcomes belonging to all domains of mental health showed similar increases in prevalence. US children suffered significant erosion of mental health during the COVID-19 pandemic that continued into 2022. Expansion of mental health programs aimed at school-going children will likely be needed to respond effectively to the ongoing crisis.
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Affiliation(s)
- Neeraj Bhandari
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA
| | - Shivani Gupta
- Department of Health Administration, College of Business, University of Houston-Clear Lake, Houston, TX 77058, USA;
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Gohari MR, Patte KA, Ferro MA, Haddad S, Wade TJ, Bélanger RE, Romano I, Leatherdale ST. Adolescents' Depression and Anxiety Symptoms During the COVID-19 Pandemic: Longitudinal Evidence From COMPASS. J Adolesc Health 2024; 74:36-43. [PMID: 37777949 DOI: 10.1016/j.jadohealth.2023.07.024] [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: 11/15/2022] [Revised: 06/15/2023] [Accepted: 07/21/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE There is concern over the potentially detrimental impact of the COVID-19 pandemic on adolescents' mental health. We examined changes in depression and anxiety symptoms from before (2018-19) to the early (2019-20) and ongoing pandemic (2020-21) responses among Canadian adolescents in the context of a natural experiment. METHODS We used linked survey data from 5,368 Canadian secondary school students who participated in three consecutive waves of the cannabis use, obesity, mental health, physical activity, alcohol use, smoking, and sedentary behaviour study during the 2018-19, 2019-20, and 2020-21 school year. Separate fixed effects models examined whether changes in depression (Center for Epidemiologic Studies Depression Scale Revised-10) and anxiety (General Anxiety Disorder-7) symptoms differed between two cohorts. The cohorts differed in the timing of their second data collection wave; one cohort participated before the pandemic and the other cohort participated in the early pandemic (spring 2020). RESULTS Depression and anxiety symptoms increased during the early and ongoing pandemic periods in the overall sample and both cohorts. The two cohorts experienced similar elevations in their symptoms. Females and younger respondents presented greater elevations over time. The proportion of adolescents with significant depressive (29.4%) and moderate-to-severe anxiety (17.6%) symptoms at baseline increased by 1.5 times, reaching 44.8% and 29.8% in the ongoing pandemic period, respectively. DISCUSSION Findings suggest that internalizing symptoms have consistently increased since before the onset of COVID-19, particularly in the ongoing pandemic period; however, we found no evidence of the increase being due to the pandemic in the early COVID-19 period when comparing the two cohorts. Ongoing evaluation of adolescents' mental health is necessary to capture potentially dynamic impacts over time.
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Affiliation(s)
- Mahmood R Gohari
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
| | - Karen A Patte
- Faculty of Applied Health Sciences, Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Slim Haddad
- Department of Social and Preventive Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Terrance J Wade
- Faculty of Applied Health Sciences, Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Richard E Bélanger
- Faculty of Medicine, Department of Pediatrics, Université Laval, Quebec City, Quebec, Canada
| | - Isabella Romano
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Scott T Leatherdale
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Bernhart JA, Fellers AW, Wilson MJ, Hutto B, Bailey S, Turner-McGrievy GM. COVID-19 Pandemic Associations on Mental and Physical Health in African Americans Participating in a Behavioral Intervention. J Racial Ethn Health Disparities 2023; 10:3070-3076. [PMID: 36469289 PMCID: PMC9734885 DOI: 10.1007/s40615-022-01481-6] [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: 07/07/2022] [Revised: 11/01/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic has had disproportionate effects on communities of color, with higher death rates among African Americans (AA). The purpose of this study was to assess associations in African Americans' mental and physical health with the COVID-19 pandemic. Data for this study came from a larger nutrition intervention of AAs in the Southeastern United States, the Nutritious Eating with Soul study. Data collected before and after March 15, 2020 (the day when local South Carolina schools and businesses closed), were analyzed to assess the association of the pandemic on participants' stress, control of healthy eating, physical activity, and body mass index. Repeated measures analysis of covariance using full maximum likelihood estimation to handle missing data was used. At the onset of the COVID-19 pandemic, 150 participants were enrolled in the study (48.2 ± 10.6 years old, 79% female, 75% with college degree or higher). Participants' reporting of stress did not show statistically significant change over time. Cognitive control increased 1.43 points (F = 20.60, p < 0.0001) and body mass index increased 0.72 kg/m2 (F = 10.68, p = 0.001). Future longitudinal studies should investigate how the COVID-19 pandemic continues to present challenges to understanding and improving health among African Americans. The study is registered at www.clinicaltrials.gov NCT03354377.
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Affiliation(s)
- J A Bernhart
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Room 536, 915 Greene Street, SC, 29208, Columbia, USA.
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, USA.
| | - A W Fellers
- University of South Carolina School of Medicine, 6439 Garners Ferry Road, Columbia, SC, 29209, USA
| | - M J Wilson
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, USA
- Department of Health Services, Policy, and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - B Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, USA
| | - S Bailey
- Department of Health Services, Policy, and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - G M Turner-McGrievy
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Room 536, 915 Greene Street, SC, 29208, Columbia, USA
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He C, Igwe N, Damian C, Feder A, Feingold J, Ripp J, Pietrzak R, Peccoralo L, Hurtado A, Chan C. Racial & ethnic differences in mental health outcomes and risk factors among frontline healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry 2023; 85:1-7. [PMID: 37716020 DOI: 10.1016/j.genhosppsych.2023.09.003] [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: 03/15/2023] [Revised: 08/06/2023] [Accepted: 09/07/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE To examine racial/ethnic differences in mental health outcomes and risk factors during the COVID-19 pandemic among frontline healthcare workers (FHCWs). METHODS A survey was conducted on FHCWs at a large metropolitan hospital during winter 2021. Depression, anxiety, and post-traumatic stress symptoms, demographic characteristics, and COVID-19-related occupational factors were assessed. Multivariable logistic regression examined factors associated with screening positive for psychiatric symptoms and their interactions with race/ethnicity. RESULTS Of 1437 FHCWs, 762 (53.0%) self-identified as white, 451 (31.4%) as Asian, 118 (8.2%) as Black, and 106 (7.4%) as Latinx. Black FHCWs had a higher prevalence of screening positive for depression (18.6%) than other groups (6.6%-11.7%, p < .05). Significant risk factors by race/ethnicity interactions indicated that having cared for patients who died from COVID-19 increased risk of psychiatric symptoms among white and Black individuals, having to make difficult decisions prioritizing patients increased risk most significantly among white and Asian individuals, and working more hours increased risk most significantly among Latinx individuals. CONCLUSION Results suggest that occupational stressors may have differential impacts on mental health among racial/ethnic groups of FHCWs. Findings provide insight on subgroups with increased vulnerability to certain risk factors and inform interventions to improve mental health in diverse FHCWs.
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Affiliation(s)
- Celestine He
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA.
| | - Nnamdi Igwe
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA
| | - Candida Damian
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, NY, NY 10029, USA
| | - Jordyn Feingold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, NY, NY 10029, USA
| | - Jonathan Ripp
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1087, NY, NY 10029, USA
| | - Robert Pietrzak
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, NY, NY 10029, USA
| | - Lauren Peccoralo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1087, NY, NY 10029, USA
| | - Alicia Hurtado
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, NY, NY 10029, USA
| | - Chi Chan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, NY, NY 10029, USA
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9
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Johnson S, Quick KN, Rieder AD, Rasmussen JD, Sanyal A, Green EP, Duerr E, Nagy GA, Puffer ES. Social Vulnerability, COVID-19, Racial Violence, and Depressive Symptoms: a Cross-sectional Study in the Southern United States. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01831-y. [PMID: 37884856 DOI: 10.1007/s40615-023-01831-y] [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: 01/31/2023] [Revised: 09/21/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND In March 2020, the novel 2019 coronavirus disease (COVID-19) was declared a pandemic. In May 2020, George Floyd was murdered, catalyzing a national racial reckoning. In the Southern United States, these events occurred in the context of a history of racism and high rates of poverty and discrimination, especially among racially and ethnically minoritized populations. OBJECTIVES In this study, we examine social vulnerabilities, the perceived impacts of COVID-19 and the national racial reckoning, and how these are associated with depression symptoms in the South. METHODS Data were collected from 961 adults between June and November 2020 as part of an online survey study on family well-being during COVID-19. The sample was majority female (87.2%) and consisted of 661 White participants, 143 Black participants, and 157 other racial and ethnic minoritized participants. Existing social vulnerability, perceived impact of COVID-19 and racial violence and protests on families, and depressive symptoms were assessed. Hierarchical regression analysis was used to predict variance in depressive symptoms. RESULTS Half of the sample (52%) reported a negative impact of COVID-19, and 66% reported a negative impact of national racial violence/protests. Depressive symptoms were common with 49.8% meeting the cutoff for significant depressive symptoms; Black participants had lower levels of depressive symptoms. Results from the hierarchical regression analysis indicate social vulnerabilities and the perceived negative impact of COVID-19 and racial violence/protests each contribute to variance in depressive symptoms. Race-specific sensitivity analysis clarified distinct patterns in predictors of depressive symptoms. CONCLUSION People in the South report being negatively impacted by the confluence of the COVID-19 pandemic and the emergence of racial violence/protests in 2020, though patterns differ by racial group. These events, on top of pre-existing social vulnerabilities, help explain depressive symptoms in the South during 2020.
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Affiliation(s)
- Savannah Johnson
- Duke University, Durham, NC, USA.
- Duke Global Health Institute, Durham, NC, USA.
| | - Kaitlin N Quick
- Duke Global Health Institute, Durham, NC, USA
- University of North Carolina at Greensboro, Greensboro, NC, USA
| | | | - Justin D Rasmussen
- Duke University, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | | | | | | | | | - Eve S Puffer
- Duke University, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
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10
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Obichi CC, Omenka O, Perkins SM, Oruche UM. Experiences of Minority Frontline Healthcare Workers During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01833-w. [PMID: 37851241 DOI: 10.1007/s40615-023-01833-w] [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: 06/07/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
Minority healthcare worker (MHW) experiences during the COVID-19 pandemic has received little attention in the published literature compared to their majority counterparts. This study describes healthcare systems, mental health, and advocacy challenges that MHWs experienced during the pandemic in the United States. A descriptive cross-sectional design was used to gather data from a convenience sample (n = 74) of MHWs who identified as registered nurses, advanced nurse practitioners, physicians, pharmacists, nursing assistants, dentists, and respiratory therapists. Data were imported into SAS Version 9.4 (Cary, NC) for analysis. Responses to each survey question were tabulated, and percentages of participants responding in the affirmative to each health system, mental health, and advocacy question were displayed. Findings indicate the pandemic both exacerbated old and imposed new challenges. Health systems should offer both tangible and intangible or emotional resources that support resilience; build an inclusive work environment that would consider the experiences and knowledge of MHWs; implement and sustain workplace changes that support and promote self-advocacy without fear of retribution; and increase research on MHWs to inform effective and culturally relevant interventions for challenges experienced by MHWs.
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Affiliation(s)
- Chidiebele Constance Obichi
- Alpha Chapter Campus Counselor, Sigma Theta Tau International, Indiana University Northwest, 3400 Broadway, Gary, IN, 46408, USA.
| | - Ogbonnaya Omenka
- Butler University College of Pharmacy and Health Sciences, 4600 Sunset Avenue, PHSB 404E, Indianapolis, IN, 46208, USA
| | - Susan M Perkins
- Indiana University School of Medicine, 410 W. 10Th Street, Suite 3000, Indianapolis, IN, 46202, USA
| | - Ukamaka M Oruche
- University of South Florida Health College of Nursing, 12901 Bruce B. Downs Blvd, MDC 22, Tampa, FL, 33612, USA
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11
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Lee J, Howard JT. Increased Self-Reported Mental Health Problems Among Asian-Americans During the COVID-19 Pandemic in the United States: Evidence from a Nationally Representative Database. J Racial Ethn Health Disparities 2023; 10:2344-2353. [PMID: 36129608 PMCID: PMC9491255 DOI: 10.1007/s40615-022-01414-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND To investigate changes in mental health outcomes among racial groups between 2019 and 2020. METHODS A retrospective cohort study was conducted using the third through fourth quarters of 2019-2020 longitudinal data from the National Health Interview Survey. Self-reports of diagnosed depression and anxiety disorder were key outcomes. We calculated the percentage of depression and anxiety disorder across baseline sample characteristics. Discrete-time hazard models stratified by race/ethnicity were conducted, with hazard ratios (HRs), 95% confidence intervals (CIs), and p-values reported. RESULTS Of a total 10,415 individuals, 16.3 and 14.1% reported that they were diagnosed with depression and anxiety disorder in 2019, respectively. In the multivariable model, only Asian-Americans experienced a significant increase in the probability of receiving a diagnosis of depression by 104% between 2019 and 2020 (HR 2.04, 95%CI 1.19-3.52; p = 0.010). Also, Asian-Americans had a 97% (HR 1.97, 95%CI 1.23-3.15; p = 0.005) greater probability of being diagnosed with anxiety disorder in 2020 than in the previous year, while Hispanics and Whites had a relatively moderate increase of 40% (HR 1.40, 95%CI 1.01-1.76; p = 0.040) and 11% (HR 1.11, 95%CI 1.03-1.20; p = 0.007), respectively. CONCLUSIONS Asian-Americans experienced a disproportionate increase in mental health conditions during the COVID-19 pandemic. Discriminatory behaviors against Asian-Americans may be important contributors. The study findings suggest the need for serious actions to address this issue.
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Affiliation(s)
- Jusung Lee
- Department of Public Health, College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, USA.
| | - Jeffrey T Howard
- Department of Public Health, College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, USA
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12
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Shi W, Donovan EE, Quaack KR, Mackert M, Shaffer AL, De Luca DM, Nolan-Cody H, Yang J. A Reasoned Action Approach to Social Connection and Mental Health: Racial Group Differences and Similarities in Attitudes, Norms, and Intentions. HEALTH COMMUNICATION 2023:1-14. [PMID: 37733424 DOI: 10.1080/10410236.2023.2259690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
This study employed a Reasoned Action Approach to investigate two communication behaviors that were being built into a statewide behavioral health campaign: initiating a conversation about one's own mental health struggles, and starting a conversation to discuss someone else's mental health difficulties. We examined whether the extent of attitudes, perceived norms, and perceived behavioral control regarding intent to perform these behaviors varied by racial identity. Using original survey data from Texans (N = 2,033), we conducted regression analyses for the two communication behaviors and found that intention to seek help was primarily explained by instrumental attitude, injunctive norm, descriptive norm, and perceived capacity; and intention to start a conversation to help someone else was primarily explained by instrumental attitude, injunctive norm, and perceived capacity. Additionally, we identified important common and distinct determinants of the two behaviors across different racial groups. Implications for health communication campaign message development and audience segmentation are discussed.
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Affiliation(s)
- Weijia Shi
- Center for Health Communication, Moody College of Communication & Dell Medical School, The University of Texas at Austin
| | - Erin E Donovan
- Center for Health Communication, Moody College of Communication & Dell Medical School, The University of Texas at Austin
- Department of Communication Studies, Moody College of Communication, The University of Texas at Austin
| | - Karly R Quaack
- Department of Communication Studies, Moody College of Communication, The University of Texas at Austin
| | - Michael Mackert
- Center for Health Communication, Moody College of Communication & Dell Medical School, The University of Texas at Austin
- Stan Richards School of Advertising and Public Relations, Moody College of Communication, The University of Texas at Austin
- Department of Population Health, Dell Medical School, The University of Texas at Austin
| | - Audrey L Shaffer
- Department of Communication Studies, Moody College of Communication, The University of Texas at Austin
| | - Daniela M De Luca
- Department of Population Health, Dell Medical School, The University of Texas at Austin
| | - Haley Nolan-Cody
- Department of Communication Studies, Moody College of Communication, The University of Texas at Austin
| | - Jiahua Yang
- Stan Richards School of Advertising and Public Relations, Moody College of Communication, The University of Texas at Austin
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13
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White LL, Goldberg SR, Spencer Feigelson H, Burnett-Hartman AN. Depression, anxiety, & loneliness among cancer survivors during the COVID-19 pandemic. J Psychosoc Oncol 2023; 42:242-255. [PMID: 37486169 DOI: 10.1080/07347332.2023.2238192] [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] [Indexed: 07/25/2023]
Abstract
PURPOSE To assess the impact of the COVID-19 pandemic on depression, anxiety, and loneliness between those with and without a history of cancer. DESIGN This prospective observational study used a quantitative approach. PARTICIPANTS Adult members of the Kaiser Permanente Research Bank (N = 104,640). METHODS Participants completed a series of surveys from May to December 2020. The difference in score of depression, anxiety, and loneliness were estimated using linear mixed regression. FINDINGS Among cancer survivors, 21% and 19% met the thresholds for increased risk of depression and anxiety. Among cancer survivors, younger age groups and females reported increased depression, anxiety, and loneliness scores. CONCLUSIONS This study highlights the continued necessity of addressing mental health needs and social support in cancer survivors during and after a public health emergency. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Cancer survivors may need particular resources after cancer treatment to strengthen resilience and improve quality of life.
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Affiliation(s)
- Larissa Lee White
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Shauna R Goldberg
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
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14
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Cho G, Hagen D, Goldmann E. Pre-pandemic mental health and coping strategy usage during the COVID-19 pandemic: a cross-sectional analysis of the Southern Cities Study. BMC Psychiatry 2023; 23:530. [PMID: 37480034 PMCID: PMC10362574 DOI: 10.1186/s12888-023-04987-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/27/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Little is known about the usage of coping strategies recommended by the World Health Organization and the Centers for Disease Control and Prevention during the COVID-19 pandemic and whether coping strategy usage varies by pre-pandemic mental health. This study examined the prevalence of different coping strategies and associations of their usage with pre-pandemic mental health. METHODS Data were collected from adults residing in metropolitan areas of the U.S. South in May/June 2020 using random-digit-dialing and web-based surveys (n = 1,644). We estimated the prevalence of each coping strategy: (1) keeping up-to-date about COVID-19; (2) taking breaks from the news or social media; (3) taking care of physical health; (4) engaging in relaxing activities; (5) reaching out to and spending time with others; and (6) trying to find comfort in religious or spiritual beliefs. We examined the association between the use of each strategy and pre-pandemic mental health using modified Poisson regression, adjusting for covariates. We also analyzed the association between pre-pandemic mental health and the number of coping strategies employed using ordered logistic regression. RESULTS The most prevalent strategies were: "keeping up-to-date about COVID-19" (53%), "taking care of physical health" (52%), and "reaching out to and spending time with others" (52%). Good pre-pandemic mental health was associated with an increased prevalence of "reaching out to and spending time with others" (adjusted prevalence ratio, 1.43; 95% confidence interval, 1.07-1.91). The use of other coping strategies and the number of coping strategies used during the pandemic did not vary by pre-pandemic mental health. CONCLUSIONS Our findings suggest that people who had good pre-pandemic mental health were more likely to connect with other people during the COVID-19 pandemic. Given the well-documented impact of social support on mental health in disaster contexts, efforts to promote safe social connections for those with pre-existing mental health concerns are needed.
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Affiliation(s)
- Gawon Cho
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, USA
| | - Daniel Hagen
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
| | - Emily Goldmann
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA.
- Center for Drug Use and HIV|HCV Research, School of Global Public Health, New York University, New York, NY, USA.
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15
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Lin SY, Schleider JL, Nelson BD, Richmond LL, Eaton NR. Gender and Racial/Ethnic Disparities in Undergraduate and Graduate Students' Mental Health and Treatment Use Amid the COVID-19 Pandemic. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:552-562. [PMID: 36802042 PMCID: PMC9937864 DOI: 10.1007/s10488-023-01256-z] [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] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/20/2023]
Abstract
The COVID-19 pandemic has negatively impacted numerous people?s mental health and created new barriers to services. To address the unknown effects of the pandemic on accessibility and equality issues in mental health care, this study aimed to investigate gender and racial/ethnic disparities in mental health and treatment use in undergraduate and graduate students amid the COVID-19 pandemic. The study was conducted based on a largescale online survey (N = 1,415) administered during the weeks following a pandemic-related university-wide campus closure in March 2020. We focused on the gender and racial disparities in current internalizing symptomatology and treatment use. Our results showed that in the initial period of the pandemic, students identified as cis women (p < .001), non-binary/genderqueer (p < .001), or Hispanic/Latinx (p = .002) reported higher internalizing problem severity (aggregated from depression, generalized anxiety, intolerance of uncertainty, and COVID-19-related stress symptoms) compared to their privileged counterparts. Additionally, Asian (p < .001) and multiracial students (p = .002) reported less treatment use than White students while controlling for internalizing problem severity. Further, internalizing problem severity was associated with increased treatment use only in cisgender, non-Hispanic/Latinx White students (pcis man = 0.040, pcis woman < 0.001). However, this relationship was negative in cis-gender Asian students (pcis man = 0.025, pcis woman = 0.016) and nonsignificant in other marginalized demographic groups. The findings revealed unique mental health challenges faced by different demographic groups and served as a call that specific actions to enhance mental health equity, such as continued mental health support for students with marginalized gender identities, additional COVID-related mental and practical support for Hispanic/Latinx students and promotion of mental health awareness, access, and trust in non-White, especially Asian, students are desperately needed.
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Affiliation(s)
- Sin-Ying Lin
- Department of Psychology, Stony Brook University, 100 Nicolls Road, 11794, Stony Brook, NY, USA.
| | - Jessica L Schleider
- Department of Psychology, Stony Brook University, 100 Nicolls Road, 11794, Stony Brook, NY, USA
| | - Brady D Nelson
- Department of Psychology, Stony Brook University, 100 Nicolls Road, 11794, Stony Brook, NY, USA
| | - Lauren L Richmond
- Department of Psychology, Stony Brook University, 100 Nicolls Road, 11794, Stony Brook, NY, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, 100 Nicolls Road, 11794, Stony Brook, NY, USA
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16
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Zhu K, Wang S, Yue Y, Smith BA, Zhang ZF, Freudenheim JL, Niu Z, Zhang J, Smith E, Ye J, Cao Y, Zhang J, Hennessy DA, Lei L, Mu L. Disparities in insecurity, social support, and family relationships in association with poor mental health among US adults during the COVID-19 pandemic. Sci Rep 2023; 13:9731. [PMID: 37322075 PMCID: PMC10272217 DOI: 10.1038/s41598-023-35981-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
The COVID-19 pandemic has had a significant impact on mental health. Identifying risk factors and susceptible subgroups will guide efforts to address mental health concerns during the pandemic and long-term management and monitoring after the pandemic. We aimed to examine associations of insecurity (concerns about food, health insurance, and/or money), social support, and change in family relationships with poor mental health and to explore disparities in these associations. An online survey was collected from 3952 US adults between May and August 2020. Symptoms of anxiety, depression, stress, and trauma-related disorders were assessed by the Generalized Anxiety Disorder 7-item scale, the Patient Health Questionnaire-9, the Perceived Stress Scale-4, and the Primary Care Post-Traumatic Stress Disorder Screen, respectively. Social support was measured by the Oslo Social Support Scale. Logistic regression was used and stratified analyses by age, race/ethnicity, and sex were performed. We found a higher prevalence of poor mental health among those who were younger, female, with lower socioeconomic status, and racial/ethnic minorities. Participants who were worried about money, health insurance, or food had higher odds of symptoms of anxiety (OR = 3.74, 95% CI: 3.06-4.56), depression (OR = 3.20, 95% CI: 2.67-3.84), stress (OR = 3.08, 95% CI: 2.67-3.57), and trauma-related disorders (OR = 2.93, 95% CI: 2.42-3.55) compared to those who were not. Compared to poor social support, moderate and strong social support was associated with lower odds of all four symptoms. Participants who had changes in relationships with parents, children, or significant others had worse mental health. Our findings identified groups at higher risk for poor mental health, which offers insights for implementing targeted interventions.
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Affiliation(s)
- Kexin Zhu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Siyi Wang
- Department of Psychology, Vassar College, Poughkeepsie, NY, USA
| | - Yihua Yue
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Beth A Smith
- Department of Psychiatry and Pediatrics, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Zuo-Feng Zhang
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jo L Freudenheim
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Zhongzheng Niu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | | | | | - Joshua Ye
- The Quarry Lane School, Dublin, CA, USA
| | - Ying Cao
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Jie Zhang
- Department of Sociology, State University of New York Buffalo State, Buffalo, NY, USA
| | - Dwight A Hennessy
- Department of Psychology, State University of New York Buffalo State, Buffalo, NY, USA
| | - Lijian Lei
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Lina Mu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA.
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17
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Ludwig VU, Crone D, Clifton JDW, Rebele RW, Schor J, Platt ML. Resilience of primal world beliefs to the initial shock of the COVID-19 pandemic. J Pers 2023; 91:838-855. [PMID: 36156253 PMCID: PMC9538916 DOI: 10.1111/jopy.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 09/08/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION People hold general beliefs about the world called primals (e.g., the world is Safe, Intentional), which are strongly linked to individual differences in personality, behavior, and mental health. How such beliefs form or change across the lifespan is largely unknown, although theory suggests that beliefs become more negative after disruptive events. The COVID-19 pandemic provided an opportunity to test whether dramatic world changes and personal adversity affect beliefs. METHOD In a longitudinal, quasi-experimental, pre-registered design, 529 US participants (51% female, 76% White) provided ratings of primals before and several months after pandemic onset, and information about personal adversity (e.g., losing family, financial hardship). Data were compared to 398 participants without experience of the pandemic. RESULTS The average person in our sample showed no change in 23 of the 26 primals, including Safe, in response to the early pandemic, and only saw the world as slightly less Alive, Interactive, and Acceptable. Higher adversity, however, was associated with slight declines in some beliefs. One limitation is that participants were exclusively American. CONCLUSION Primals were remarkably stable during the initial shock wrought by a once-in-a-century pandemic, supporting a view of primals as stable lenses through which people interpret the world.
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Affiliation(s)
- Vera U. Ludwig
- Present address:
Department of NeurosciencePerelman School of Medicine, University of Pennsylvania
- Wharton Neuroscience InitiativeUniversity of Pennsylvania
| | - Damien Crone
- Present address:
Department of NeurosciencePerelman School of Medicine, University of Pennsylvania
- Positive Psychology CenterUniversity of Pennsylvania
| | | | - Reb W. Rebele
- Melbourne School of Psychological SciencesThe University of Melbourne
- Wharton People AnalyticsThe Wharton School, University of Pennsylvania
| | - Jordyn Schor
- Present address:
Department of NeurosciencePerelman School of Medicine, University of Pennsylvania
| | - Michael L. Platt
- Present address:
Department of NeurosciencePerelman School of Medicine, University of Pennsylvania
- Wharton Neuroscience InitiativeUniversity of Pennsylvania
- Marketing DepartmentWharton School of Business, University of Pennsylvania
- Department of Psychology, School of Arts and SciencesUniversity of Pennsylvania
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18
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Wen M, Shi L, Zhang D, Li Y, Chen Z, Chen B, Chen L, Zhang L, Li H, Li J, Han X, Su D. Racial-ethnic disparities in psychological distress during the COVID-19 pandemic in the United States: the role of experienced discrimination and perceived racial bias. BMC Public Health 2023; 23:957. [PMID: 37231401 DOI: 10.1186/s12889-023-15912-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Research on mental health disparities by race-ethnicity in the United States (US) during COVID-19 is limited and has generated mixed results. Few studies have included Asian Americans as a whole or by subgroups in the analysis. METHODS Data came from the 2020 Health, Ethnicity, and Pandemic Study, based on a nationally representative sample of 2,709 community-dwelling adults in the US with minorities oversampled. The outcome was psychological distress. The exposure variable was race-ethnicity, including four major racial-ethnic groups and several Asian ethnic subgroups in the US. The mediators included experienced discrimination and perceived racial bias toward one's racial-ethnic group. Weighted linear regressions and mediation analyses were performed. RESULTS Among the four major racial-ethnic groups, Hispanics (22%) had the highest prevalence of severe distress, followed by Asians (18%) and Blacks (16%), with Whites (14%) having the lowest prevalence. Hispanics' poorer mental health was largely due to their socioeconomic disadvantages. Within Asians, Southeast Asians (29%), Koreans (27%), and South Asians (22%) exhibited the highest prevalence of severe distress. Their worse mental health was mainly mediated by experienced discrimination and perceived racial bias. CONCLUSIONS Purposefully tackling racial prejudice and discrimination is necessary to alleviate the disproportionate psychological distress burden in racial-ethnic minority groups.
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Affiliation(s)
- Ming Wen
- Faculty of Social Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong
- Department of Sociology, University of Utah, Salt Lake City, UT, 84112, USA
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA
| | - Donglan Zhang
- Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, NY, 11501, USA
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, 30602, USA
| | - Baojiang Chen
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, 1616 Guadalupe, Suite 6.300, Austin, TX, 78701, USA
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Lu Zhang
- Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA
| | - Hongmei Li
- Department of Media, Journalism and Film, Miami University, Oxford, OH, 45056, USA
| | - Jian Li
- Department of Environmental Health Sciences, Fielding School of Public Health, School of Nursing, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, 30303, USA
| | - Dejun Su
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
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19
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Figas K, Giannouchos TV, Crouch E. Child and Adolescent Anxiety and Depression Prior to and During the COVID-19 Pandemic in the United States. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01536-7. [PMID: 37093526 PMCID: PMC10123555 DOI: 10.1007/s10578-023-01536-7] [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] [Accepted: 04/11/2023] [Indexed: 04/25/2023]
Abstract
Childhood anxiety and depression have been increasing for years, and evidence suggests the COVID-19 pandemic has exacerbated this trend. However, research has examined anxiety and depression primarily as exclusive conditions, overlooking comorbidity. This study examined relationships between the COVID-19 pandemic and anxiety and depression to clarify risk factors for singular and comorbid anxiety and depression in children. Using 2018-2019 and 2020-2021 samples from the National Survey of Children's Health, a nationally representative survey of children aged 0-17 in the United States, associations between the COVID-19 pandemic and child anxiety and depression were examined via survey-weights' adjusted bivariate and multiple regression analyses, controlling for demographic characteristics. The COVID-19 pandemic was associated with higher odds of having comorbid anxiety and depression but not singular anxiety or depression. Female sex, older age, having special healthcare needs, more frequent inability to cover basic needs on family income, and poorer caregiver mental health were associated with having been diagnosed with singular and comorbid anxiety and depression. Children that witnessed or were victims of violence in the neighborhood were also more likely to have comorbid anxiety and depression. Implications for prevention, intervention, and policy are discussed.
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Affiliation(s)
- Kristen Figas
- Department of Psychology, University of South Carolina, Columbia, SC, USA.
| | - Theodoros V Giannouchos
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Elizabeth Crouch
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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20
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Racial and Ethnic Disparities in Mental Health and Mental Health Care During The COVID-19 Pandemic. J Racial Ethn Health Disparities 2023; 10:961-976. [PMID: 35318615 PMCID: PMC8939391 DOI: 10.1007/s40615-022-01284-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 12/28/2022]
Abstract
During the pandemic, the overall mental health of the US population declined. Given higher rates of COVID-19 infections and deaths experienced by communities of color along with greater exposure to pandemic-related stressors (e.g., unemployment, food insecurity), we expect that the decline in mental health during the pandemic was more pronounced among Black, Hispanic, and Asian adults, with these groups also having less access to mental health services. We examine two nationally representative US surveys: the 2019 National Household Interview Survey (NHIS; N = 30,368) and the 2020-2021 Household Pulse Survey (HPS; N = 1,677,238). We find mental health of Black, Hispanic, and Asian respondents worsened relative to White respondents during the pandemic, with significant increases in depression and anxiety among racialized minorities compared to Whites. There is also evidence of especially high mental health burden for Black adults around the murder of George Floyd by police and for Asian adults around the murder of six Asian women in Atlanta. White respondents are most likely to receive professional mental health care before and during the pandemic, and Black, Hispanic, and Asian respondents demonstrate higher levels of unmet mental health care needs during the pandemic than White respondents. Our results indicate that within the current environment, White adults are at a large and systemic advantage buffering them from unexpected crises-like the COVID-19 pandemic. Without targeted interventions, the long-term social consequences of the pandemic and other co-occurring events (e.g., death of Black and Hispanic people by police) will likely include widening mental health disparities between racial/ethnic groups.
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21
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Rahman R, Azhar S, Wernick LJ, Huang D, Maschi T, Rosenblatt C, Patel R. COVID-19 stigma and depression across race, ethnicity and residence. SOCIAL WORK IN HEALTH CARE 2023; 62:121-142. [PMID: 36934345 DOI: 10.1080/00981389.2023.2193263] [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: 06/15/2022] [Revised: 03/02/2023] [Accepted: 03/16/2023] [Indexed: 06/18/2023]
Abstract
Our cross-sectional study seeks to understand how COVID-19 stigma, race/ethnicity [Asian, Black, Hispanic/Latinx, white] and residency [New York City (NYC) resident vs. non-NYC resident] associated with depression. Our sample includes 568 participants: 260 (45.77%) were NYC residents and 308 (54.3%) were non-NYC residents. A series of multiple linear regression were run to examine the relationship between race/ethnicity, COVID-19 stigma, and depressive symptoms. Irrespective of residency, older age and ever being diagnosed with COVID-19 were negatively associated with depressive symptoms. Stigma and thinking less of oneself significantly associates with depressive symptoms across residency. Our study expects to benefit mental health care providers and public health professionals in designing best practices to mitigate stigma in ongoing or future pandemics.
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Affiliation(s)
- Rahbel Rahman
- Graduate School of Social Service, Fordham University, New York, New York, United States
| | - Sameena Azhar
- Graduate School of Social Service, Fordham University, New York, New York, United States
| | - Laura J Wernick
- Graduate School of Social Service, Fordham University, New York, New York, United States
| | - Debbie Huang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Tina Maschi
- Graduate School of Social Service, Fordham University, New York, New York, United States
| | - Cassidy Rosenblatt
- Graduate School of Social Service, Fordham University, New York, New York, United States
| | - Rupal Patel
- Graduate School of Social Service, Fordham University, New York, New York, United States
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Asfaw A. Association between reasons for not working and reporting of major depression and anxiety symptoms among U.S. adult population during the COVID-19 pandemic. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2023; 38:293-320. [PMID: 37608841 PMCID: PMC10440807 DOI: 10.1080/15555240.2023.2181178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/05/2023] [Indexed: 02/27/2023]
Abstract
COVID-19 continues to take a large toll on the mental health of the not working population, particularly of those who were unable to work. This study, using the Household Pulse Survey, estimated the association between reasons for not working and major depression and anxiety symptoms (MDAS). The lowest MDAS was reported by retirees. Individuals who were unable to work because of transportation problems, layoffs, COVID-19 concerns, and sickness or disability reported the highest MDAS. Mediation analysis showed that the direct and indirect effects of reasons for not working were much higher for those individuals who were unable to work than for individuals who were working or decided not to work.
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Affiliation(s)
- Abay Asfaw
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Washington, DC, USA
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23
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Fernandez JR, Sherchan JS, Cho YJ, Nanaw J, Joseph NT, Forde AT. College students' underlying perceptions of COVID-19 threat, healthcare discrimination, and healthcare system inequities associated with self-rated health across racial/ethnic groups in the U.S. Front Public Health 2023; 10:1028344. [PMID: 36684993 PMCID: PMC9853174 DOI: 10.3389/fpubh.2022.1028344] [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: 08/25/2022] [Accepted: 11/23/2022] [Indexed: 01/09/2023] Open
Abstract
Background COVID-19-related health perceptions may differentially impact college students' stress, and in turn, their mental and physical health. This study examined racial/ethnic differences in college students' underlying perceptions of COVID-19 threat, healthcare discrimination, and U.S. healthcare system inequities and their associations with self-rated mental and physical health. Methods Four-hundred-thirty-two university students completed an online survey (December 2020-December 2021). Latent class analyses identified classes of perceived COVID-19 threat (i.e., severity, susceptibility), healthcare discrimination, and U.S. healthcare system inequities. Regression analyses examined whether class membership varied by race/ethnicity and was associated with self-rated mental and physical health. Results Class 1 members (27.3% of the sample) were more likely to identify as Hispanic or Latino, Non-Hispanic Asian, Non-Hispanic Black or African American, and Non-Hispanic Multiracial vs. Non-Hispanic White (vs. Class 4). Class 1 had high perceived COVID-19 threat, medium perceived healthcare discrimination, and high perceived U.S. healthcare system inequities, as well as higher odds of poorer mental and physical health (vs. Class 4). Conclusions College students' underlying perceptions of COVID-19 threat, healthcare discrimination, and U.S. healthcare system inequities were associated with poorer health. Given that students with these perceptions were more likely to belong to minoritized racial/ethnic groups, concerns over COVID-19 risk and healthcare may partially explain racial/ethnic disparities in college students' health. This study contributes to a limited body of evidence on college students' perceptions of the U.S. healthcare system and suggests important ways that structural inequalities and racial/ethnic disparities in COVID-19 risk, healthcare discrimination, and concerns over U.S. healthcare system inequity may affect college students' health.
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Affiliation(s)
- Jessica R. Fernandez
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Juliana S. Sherchan
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
- Department of Psychology, University of Maryland, College Park, MD, United States
| | - Yong Ju Cho
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Judy Nanaw
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Nataria T. Joseph
- Division of Social Science, Seaver College, Pepperdine University, Malibu, CA, United States
| | - Allana T. Forde
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
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24
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Villas-Boas SB, White JS, Kaplan S, Hsia RY. Trends in depression risk before and during the COVID-19 pandemic. PLoS One 2023; 18:e0285282. [PMID: 37195921 DOI: 10.1371/journal.pone.0285282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/19/2023] [Indexed: 05/19/2023] Open
Abstract
Using 11 years of the U.S. Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System survey data set for 2011 to 2021, we track the evolution of depression risk for U.S. states and territories before and during the COVID-19 pandemic. We use these data in conjunction with unemployment and COVID case data by state and by year to describe changes in the prevalence of self-reported diagnosis with a depressive disorder over time and especially after the onset of COVID in 2020 and 2021. We further investigate heterogeneous associations of depression risk by demographic characteristics. Regression analyses of these associations adjust for state-specific and period-specific factors using state and year-fixed effects. First, we find that depression risk had been increasing in the US in years preceding the pandemic. Second, we find no significant average changes in depression risk at the onset of COVID in 2020 relative to previous trends, but estimate a 3% increase in average depression risk in 2021. Importantly, we find meaningful variation in terms of changes in depression risk during the pandemic across demographic subgroups.
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Affiliation(s)
- Sofia B Villas-Boas
- Department of Agricultural and Resource Economics, University of California Berkeley, Berkeley, CA, United States of America
| | - Justin S White
- Department of Epidemiology & Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States of America
| | - Scott Kaplan
- Department of Economics, United States Naval Academy, Annapolis, MD, United States of America
| | - Renee Y Hsia
- Department of Emergency Medicine and the Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States of America
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Ikram M, Shaikh NF, Vishwanatha JK, Sambamoorthi U. Leading Predictors of COVID-19-Related Poor Mental Health in Adult Asian Indians: An Application of Extreme Gradient Boosting and Shapley Additive Explanations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:775. [PMID: 36613095 PMCID: PMC9819341 DOI: 10.3390/ijerph20010775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
During the COVID-19 pandemic, an increase in poor mental health among Asian Indians was observed in the United States. However, the leading predictors of poor mental health during the COVID-19 pandemic in Asian Indians remained unknown. A cross-sectional online survey was administered to self-identified Asian Indians aged 18 and older (N = 289). Survey collected information on demographic and socio-economic characteristics and the COVID-19 burden. Two novel machine learning techniques-eXtreme Gradient Boosting and Shapley Additive exPlanations (SHAP) were used to identify the leading predictors and explain their associations with poor mental health. A majority of the study participants were female (65.1%), below 50 years of age (73.3%), and had income ≥ $75,000 (81.0%). The six leading predictors of poor mental health among Asian Indians were sleep disturbance, age, general health, income, wearing a mask, and self-reported discrimination. SHAP plots indicated that higher age, wearing a mask, and maintaining social distancing all the time were negatively associated with poor mental health while having sleep disturbance and imputed income levels were positively associated with poor mental health. The model performance metrics indicated high accuracy (0.77), precision (0.78), F1 score (0.77), recall (0.77), and AUROC (0.87). Nearly one in two adults reported poor mental health, and one in five reported sleep disturbance. Findings from our study suggest a paradoxical relationship between income and poor mental health; further studies are needed to confirm our study findings. Sleep disturbance and perceived discrimination can be targeted through tailored intervention to reduce the risk of poor mental health in Asian Indians.
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Affiliation(s)
- Mohammad Ikram
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Robert C. Byrd Health Sciences Center [North], P.O. Box 9510, Morgantown, WV 26506-9510, USA
| | - Nazneen Fatima Shaikh
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Robert C. Byrd Health Sciences Center [North], P.O. Box 9510, Morgantown, WV 26506-9510, USA
| | - Jamboor K. Vishwanatha
- Department of Microbiology, Immunology and Genetics, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
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26
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Community Initiated Care: A blue-print for the practical realization of contextual behavioral science. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Tran S, Wormley AS, Louie P, Sheehan C. Increasing psychological distress among Californians from 2013 to 2020: Race/ethnic differences. SSM - MENTAL HEALTH 2022; 2:100101. [PMID: 36590986 PMCID: PMC9792130 DOI: 10.1016/j.ssmmh.2022.100101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/24/2022] [Accepted: 04/19/2022] [Indexed: 01/13/2023] Open
Abstract
The influence of the COVID-19 pandemic on mental health is of mounting concern to population-health researchers. While early reports indicated increases in mental health problems, noticeably absent from these studies is how mental health has changed in 2020 compared to previous years (2013-2019) and whether such trends vary by race/ethnicity. The present study used repeated cross-sectional data from the California Health Interview Survey (n = 168,216) to systematically document trends in psychological distress scores (Kessler-6 scale; K6) and severe psychological distress scores (K6; 13+) from 2013 to 2020 and by race/ethnicity over the same period. Among all Californians we find that the reported average psychological distress scores increased by 22% between 2013 and 2020. Reported severe psychological distress scores increased 61% from 2013 to 2020. These increases were largely concentrated in the years 2017-2020. Increases in psychological distress were also especially pronounced among non-Latino/a White Californians (29% increase in K6 from 2013 to 2020), Latino/a Californians (14% increase in K6 from 2013 to 2020), and Asian Californians (35% increase in K6 from 2013 to 2020). Multiple and logistic regression models that accounted for sociodemographic and behavioral health covariates echoed these findings. Future research should continue to investigate secular trends in mental health that coincided with the COVID-19 pandemic and carefully situate the shifts into broader temporal perspective.
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Affiliation(s)
- Sydney Tran
- Department of Psychology, Arizona State University, USA
| | | | | | - Connor Sheehan
- School of Social and Family Dynamics, Arizona State University, USA,Corresponding author. P.O. Box 873701, Tempe, AZ, 85287-3701, USA
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Luo Y, Li Q, Jeong H, Cheatham L. The association between social determinants of health and psychological distress during the COVID-19 pandemic: a secondary analysis among four racial/ethnic groups. BMC Public Health 2022; 22:2193. [PMID: 36443734 PMCID: PMC9702892 DOI: 10.1186/s12889-022-14486-x] [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: 04/22/2022] [Accepted: 10/29/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Racial disparities in psychological distress associated with COVID-19 remain unclear in the U.S. This study aims to investigate the associations between social determinants of health and COVID-19-related psychological distress across different racial/ethnic groups in the US (i.e., non-Hispanic Whites, Hispanic, non-Hispanic Asians, and non-Hispanic African Americans). METHODS This study used cross-sectional data from the 2020 California Health Interview Survey Adult Data Files (N = 21,280). Adjusting for covariates-including age, gender, COVID-19 pandemic challenges, and risk of severe illness from COVID-19-four sets of weighted binary logistic regressions were conducted. RESULTS The rates of moderate/severe psychological distress significantly varied across four racial/ethnic groups (p < 0.001), with the highest rate found in the Hispanic group. Across the five domains of social determinants of health, we found that unemployment, food insecurity, housing instability, high educational attainment, usual source of health care, delayed medical care, and low neighborhood social cohesion and safety were associated with high levels of psychological distress in at least one racial/ethnic group (p < 0.05). CONCLUSION Our study suggests that Hispanic adults face more adverse social determinants of health and are disproportionately impacted by the pandemic. Public health practice and policy should highlight social determinants of heath that are associated with different racial/ethnic groups and develop tailored programs to reduce psychological distress.
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Affiliation(s)
- Yan Luo
- grid.411015.00000 0001 0727 7545School of Social Work, The University of Alabama, Tuscaloosa, AL 35401 USA ,grid.410445.00000 0001 2188 0957The University of Hawaiʻi at Mānoa, HI Honolulu, USA
| | - Qingyi Li
- grid.5386.8000000041936877XDepartment of Psychology, Cornell University, Ithaca, NY 14850 USA
| | - Haelim Jeong
- grid.411015.00000 0001 0727 7545School of Social Work, The University of Alabama, Tuscaloosa, AL 35401 USA
| | - Leah Cheatham
- grid.411015.00000 0001 0727 7545School of Social Work, The University of Alabama, Tuscaloosa, AL 35401 USA
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29
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Patel MI, Ferguson JM, Castro E, Pereira-Estremera CD, Armaiz-Peña GN, Duron Y, Hlubocky F, Infantado A, Nuqui B, Julian D, Nortey N, Steck A, Bondy M, Maingi S. Racial and Ethnic Disparities in Cancer Care During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2222009. [PMID: 35834248 PMCID: PMC9284331 DOI: 10.1001/jamanetworkopen.2022.22009] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE The full effect of the COVID-19 pandemic on cancer care disparities, particularly by race and ethnicity, remains unknown. OBJECTIVES To assess whether the race and ethnicity of patients with cancer was associated with disparities in cancer treatment delays, adverse social and economic effects, and concerns during the COVID-19 pandemic and to evaluate trusted sources of COVID-19 information by race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS This national survey study of US adults with cancer compared treatment delays, adverse social and economic effects, concerns, and trusted sources of COVID-19 information by race and ethnicity from September 1, 2020, to January 12, 2021. EXPOSURES The COVID-19 pandemic. MAIN OUTCOMES AND MEASURES The primary outcome was delay in cancer treatment by race and ethnicity. Secondary outcomes were duration of delay, adverse social and economic effects, concerns, and trusted sources of COVID-19 information. RESULTS Of 1639 invited respondents, 1240 participated (75.7% response rate) from 50 US states, the District of Columbia, and 5 US territories (744 female respondents [60.0%]; median age, 60 years [range, 24-92 years]; 266 African American or Black [hereafter referred to as Black] respondents [21.5%]; 186 Asian respondents [15.0%]; 232 Hispanic or Latinx [hereafter referred to as Latinx] respondents [18.7%]; 29 American Indian or Alaska Native, Native Hawaiian, or multiple races [hereafter referred to as other] respondents [2.3%]; and 527 White respondents [42.5%]). Compared with White respondents, Black respondents (odds ratio [OR], 6.13 [95% CI, 3.50-10.74]) and Latinx respondents (OR, 2.77 [95% CI, 1.49-5.14]) had greater odds of involuntary treatment delays, and Black respondents had greater odds of treatment delays greater than 4 weeks (OR, 3.13 [95% CI, 1.11-8.81]). Compared with White respondents, Black respondents (OR, 4.32 [95% CI, 2.65-7.04]) and Latinx respondents (OR, 6.13 [95% CI, 3.57-10.53]) had greater odds of food insecurity and concerns regarding food security (Black respondents: OR, 2.02 [95% CI, 1.34-3.04]; Latinx respondents: OR, 2.94 [95% CI, [1.86-4.66]), financial stability (Black respondents: OR, 3.56 [95% CI, 1.79-7.08]; Latinx respondents: OR, 4.29 [95% CI, 1.98-9.29]), and affordability of cancer treatment (Black respondents: OR, 4.27 [95% CI, 2.20-8.28]; Latinx respondents: OR, 2.81 [95% CI, 1.48-5.36]). Trusted sources of COVID-19 information varied significantly by race and ethnicity. CONCLUSIONS AND RELEVANCE In this survey of US adults with cancer, the COVID-19 pandemic was associated with treatment delay disparities and adverse social and economic effects among Black and Latinx adults. Partnering with trusted sources may be an opportunity to overcome such disparities.
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Affiliation(s)
- Manali I. Patel
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California
- Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Jacqueline M. Ferguson
- Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Eida Castro
- Department of Psychology, Ponce Health Sciences University, Ponce Research Institute, Ponce, Puerto Rico
| | | | - Guillermo N. Armaiz-Peña
- Department of Psychology, Ponce Health Sciences University, Ponce Research Institute, Ponce, Puerto Rico
| | - Ysabel Duron
- The Latino Cancer Institute, San Jose, California
| | - Fay Hlubocky
- Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - Bles Nuqui
- St Peter’s Health Partners Cancer Care, Albany, New York
| | - Donna Julian
- St Peter’s Health Partners Cancer Care, Albany, New York
| | - Nii Nortey
- St Peter’s Health Partners Cancer Care, Albany, New York
| | | | - Melissa Bondy
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Shail Maingi
- Dana Farber Cancer Institute, Boston, Massachusetts
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30
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Wagenknecht LE, Chao AM, Wadden TA, McCaffery JM, Hayden KM, Laferrère B, Clark JM, Johnson KC, Howard MJ, Yanovski SZ, Wing RR. Impact of COVID-19 on life experiences reported by a diverse cohort of older adults with diabetes and obesity. Obesity (Silver Spring) 2022; 30:1268-1278. [PMID: 35277935 PMCID: PMC9088617 DOI: 10.1002/oby.23429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/11/2022] [Accepted: 03/06/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to measure the impact of the COVID-19 pandemic on self-reported life experiences in older adults with diabetes and obesity. METHODS Participants were surveyed in 2020 regarding negative and positive impacts of the pandemic across domains of personal, social, and physical experiences. A cumulative negative risk index (a count of all reported negative impacts of 46 items) and a positive risk index (5 items) were characterized in relation to age, sex, race/ethnicity, BMI, and multimorbidity. RESULTS Response rate was high (2950/3193, 92%), average age was 76 years, 63% were women, and 39% were from underrepresented populations. Women reported more negative impacts than men (6.8 vs. 5.6; p < 0.001 [of 46 items]) as did persons with a greater multimorbidity index (p < 0.001). Participants reporting African American/Black race reported fewer negative impacts than White participants. Women also reported more positive impacts than men (1.9 vs. 1.6; p < 0.001 [of 5 items]). CONCLUSIONS Older adults with diabetes and obesity reported more positive impacts of the pandemic than negative impacts, relative to the number of positive (or negative) items presented. Some subgroups experienced greater negative impacts (e.g., for women, a greater multimorbidity index). Efforts to reestablish personal, social, and physical health after the pandemic could target certain groups.
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Affiliation(s)
| | - Ariana M. Chao
- Department of Biobehavioral Health SciencesUniversity of Pennsylvania School of NursingPhiladelphiaPennsylvaniaUSA
| | - Thomas A. Wadden
- Department of PsychiatryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | | | | | | | - Karen C. Johnson
- Department of Preventive MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
| | | | - Susan Z. Yanovski
- National Institute of Diabetes and Digestive and Kidney DiseasesBethesdaMarylandUSA
| | - Rena R. Wing
- Warren Alpert Medical School of Brown UniversityMiriam HospitalProvidenceRhode IslandUSA
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Venegas-Murillo AL, Bazargan M, Grace S, Cobb S, Vargas R, Givens S, Li-Sarain S, Delgado C, Villatoro J, Goodall A, Tesimale R, Ramirez S, Brown M, Uyanne J, Assari S. Mitigating COVID-19 Risk and Vaccine Hesitancy Among Underserved African American and Latinx Individuals with Mental Illness Through Mental Health Therapist-Facilitated Discussions. J Racial Ethn Health Disparities 2022; 10:1358-1370. [PMID: 35534682 PMCID: PMC9083473 DOI: 10.1007/s40615-022-01321-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/18/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
Abstract
Background Underserved ethnic minorities with psychiatric disorders are at an increased risk of COVID-19. This study aims to examine the effectiveness of one-to-one counseling on COVID-19 vaccination and vaccination readiness among underserved African American and Latinx individuals with mental illnesses and adult caregivers of children with mental illness. Methods Through an academic-community partnered collaboration, a multidisciplinary and culturally sensitive training on COVID-19 was co-developed and delivered to 68 therapists from January to March 2021. Mental health clients and their caregivers were recruited to participate in pre- and post-intervention surveys to evaluate the impact of the intervention on their perceptions of COVID-19 public health guidelines, testing, and vaccination. Mental health therapists delivered four lessons of the COVID-19 educational intervention with 254 clients from March to June 2021, when vaccine availability was widely available. Of those clients, we collected 180 baseline and 115 follow-up surveys. The main outcome was the uptake in COVID-19 vaccine. Results There was a positive shift in participant vaccine acceptance and receptivity. Pre-intervention survey shows that only 56% of adult clients and 48% of caregivers had indicated a likelihood of getting the vaccine for themselves at baseline. Post-intervention documented that more than 57% of each group had been vaccinated, with another 11–15% of the unvaccinated individuals reporting that they were somewhat or very likely to get the vaccine. Conclusion This study demonstrated that multidisciplinary academic-community and theoretical-based educational intervention delivered by mental health therapists is an effective strategy in increasing COVID-19 vaccine acceptance and reducing the negative impact and disruption that COVID-19 caused in the daily life of mental health patients and caregivers.
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Affiliation(s)
| | - Mohsen Bazargan
- Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA USA
- Department of Family Medicine, UCLA, Los Angeles, CA USA
| | - Stephen Grace
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - Sharon Cobb
- Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA USA
| | - Roberto Vargas
- Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA USA
| | - Shronda Givens
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - Sheila Li-Sarain
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - Carissa Delgado
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - Jeffry Villatoro
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - Asia Goodall
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - Rylan Tesimale
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - Sylvia Ramirez
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - Monica Brown
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - John Uyanne
- Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA USA
| | - Shervin Assari
- Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA USA
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
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Wong CL, Leung AWY, Chan DNS, Chow KM, Chan CWH, Ng MSN, So WKW. Psychological Wellbeing and Associated Factors Among Ethnic Minorities During the COVID-19 Pandemic. J Immigr Minor Health 2022; 24:1435-1445. [PMID: 35220516 PMCID: PMC8882315 DOI: 10.1007/s10903-022-01347-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 12/30/2022]
Abstract
This study assessed the psychological wellbeing and its associated factors amongst ethnic minorities during the coronavirus disease 2019 (COVID-19) pandemic. A total of 310 Hong Kong South Asians aged 41.3 (SD 13.7) years completed an anonymous online survey between July 2020 and February 2021. The results showed an overall moderate level of stress and high levels of depression, anxiety and post-traumatic stress disorder (PTSD) symptoms amongst South Asian minorities. Multivariable regression analyses suggested that being single/divorced, following Hinduism or other non-Muslim religions, having lower perceived knowledge of COVID-19 and having worried about losing job were significant predictors of higher levels of depression, anxiety and/or stress; additionally, being male, having a low monthly household income, having worried about losing job and healthcare collapse were significant predictors of a higher level of PTSD symptoms. The findings suggest an urgent need to alleviate the psychological impacts of the COVID-19 pandemic on ethnic minorities, specifically for those most vulnerable to these impacts.
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Coronavirus Disease 2019 Pandemic Associated with Anxiety and Depression among Non-Hispanic Whites with Chronic Conditions in the US. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022; 8:100331. [PMID: 35224528 PMCID: PMC8861147 DOI: 10.1016/j.jadr.2022.100331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/08/2021] [Accepted: 02/14/2022] [Indexed: 01/04/2023] Open
Abstract
Objectives During the coronavirus 2019 (COVID-19) pandemic, increased anxiety and depression were reported, with mixed findings among individuals of different races/ethnicities. This study examines whether anxiety and depression increased during the COVID-19 pandemic compared to the pre-COVD-19 period among different racial/ethnic groups in the US. Methods The Health Information National Trend Surveys 5 (HINTS 5) Cycle 4 data was analyzed. We used the time when the survey was administered as the pre-COVID-19 period (before March 11, 2020, weighted N = 77,501,549) and during the COVID-19 period (on and after March 11, 2020, weighted N = 37,222,019). The Patient Health Questionnaire (PHQ) was used to measure anxiety/depression and further compared before and during COVID-19. Separate multivariable logistic regression analyses were used to determine the association of the COVID-19 pandemic with anxiety/depression after adjusting for age, sex, insurance, income, and education. Result A higher percentage of Non-Hispanic whites (NHW) with chronic conditions reported anxiety (24.3% vs. 11.5%, p = 0.0021) and depression (20.7% vs. 9.3%, p = 0.0034) during COVID-19 than pre-COVID-19. The adjusted odds ratio (AOR) of anxiety and depression for NHWs with chronic conditions during the COVID-19 pandemic was 2.02 (95% confidence interval of 1.10–3.73, p = 0.025) and 2.33 (1.17–4.65, p = 0.018) compared to NHWs who participated in the survey before the COVID-19. Limitations Limited to the NHW US population. PHQ can only be used as the initial screening tool. Conclusion The COVID-19 pandemic was associated with an increased prevalence of anxiety and depression among NHW adults with chronic conditions, but not among people of color.
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Decker AN, Fischer AR, Gunn HE. Socio-Ecological Context of Sleep: Gender Differences and Couples' Relationships as Exemplars. Curr Psychiatry Rep 2022; 24:831-840. [PMID: 36401678 PMCID: PMC9676909 DOI: 10.1007/s11920-022-01393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE OF REVIEW We summarized recent findings on insufficient sleep and insomnia, two prominent sleep issues that impact public health. We demonstrate the socio-ecologial impact of sleep health with findings on gender and couples' relationships as exemplars. RECENT FINDINGS Robust gender differences in sleep duration and insomnia are due to biological and socio-ecological factors. Gender differences in insufficient sleep vary by country of origin and age whereas gender differences in insomnia reflect minoritized identities (e.g., sexual, gender). Co-sleeping with a partner is associated with longer sleep and more awakenings. Gender differences and couples' sleep were affected by intersecting social and societal influences, which supports a socio-ecological approach to sleep. Recent and seminal contributions to sleep health highlight the importance of observing individual sleep outcomes in a socio-ecological context. Novel methodology, such as global measures of sleep health, can inform efforts to improve sleep and, ultimately, public health.
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Affiliation(s)
- Andrea N. Decker
- Department of Psychology, The University of Alabama, 505 Hackberry Lane, Tuscaloosa, AL 35401 USA
| | - Alexandra R. Fischer
- Department of Psychology, The University of Alabama, 505 Hackberry Lane, Tuscaloosa, AL 35401 USA
| | - Heather E. Gunn
- Department of Psychology, The University of Alabama, 505 Hackberry Lane, Tuscaloosa, AL 35401 USA
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Stamatis CA, Broos HC, Hudiburgh SE, Dale SK, Timpano KR. A longitudinal investigation of COVID-19 pandemic experiences and mental health among university students. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:385-404. [PMID: 34850405 DOI: 10.1111/bjc.12351] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/09/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Previous studies have established a link between the COVID-19 pandemic and poor mental health. They further suggest that young adults may be especially vulnerable to worsened mental health during the pandemic, but few studies have investigated which specific aspects of the COVID-19 experience affect psychological well-being over time. To better understand concrete predictors of poor mental health outcomes in this population, we identified several pandemic-related experiences and evaluated their effects on mental health symptoms (depression, anxiety, stress, alcohol, and substance use) in a sample of U.S. college students (N = 176). METHODS Both mental health symptoms and pandemic-related experiences were evaluated at the start of quarantine (March/April 2020, Time 1) and the end of the Spring 2020 semester (May 2020, Time 2). Given the limited literature on specific predictors of mental health during a pandemic, we used elastic net regression, a novel analytic method that helps with variable selection when theoretical background is limited, to narrow our field of possible predictors. RESULTS While mental health symptoms were elevated at both timepoints, there were no clinically significant changes from Time 1 to Time 2 and few differences between sociodemographic groups. Both disruption due to the pandemic (β = .25, p = .021) and limited confidence in the federal government's response (β = -.14, p = .038) were significant predictors of depression symptoms at the end of the semester, even when controlling for baseline depression. Further, predictions that the pandemic would continue to impact daily life further into the future were linked with pandemic stress response symptoms (β = .15, p = .032) at Time 2, beyond the effects of baseline symptoms. Alcohol (β = -.22, p = .024) and substance use (β = -.26, p = .01) were associated with reduced adherence to COVID-19 guidelines. CONCLUSIONS Our findings indicate that specific aspects of the pandemic experience may be influencing internalizing symptoms and alcohol/substance use in college students, pointing to potential avenues for targeted support and intervention. PRACTITIONER POINTS A range of factors may influence university student mental health during the COVID-19 pandemic. Students who expect the pandemic will continue to impact daily life further into the future maybe more likely to report stress symptoms. Disruption due to the pandemic and limited confidence in the federal government's response may be associated with depression symptoms. Alcohol and substance use are associated with lower COVID-19 guideline adherence in university students.
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Affiliation(s)
- Caitlin A Stamatis
- Department of Psychology, University of Miami, Coral Gables, Florida, USA.,NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.,Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hannah C Broos
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | | | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Kiara R Timpano
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
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Comparison of the Mental Health Impact of COVID-19 on Vulnerable and Non-Vulnerable Groups: A Systematic Review and Meta-Analysis of Observational Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010830. [PMID: 34682574 PMCID: PMC8535316 DOI: 10.3390/ijerph182010830] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/01/2021] [Accepted: 10/13/2021] [Indexed: 12/16/2022]
Abstract
Vulnerable populations may be more vulnerable to mental health problems posed by the coronavirus disease 2019 (COVID-19) pandemic. A systematic review was performed to compare the mental health impact of COVID-19 between vulnerable and non-vulnerable groups. Five electronic databases were searched for observational studies reporting the psychological outcomes of both vulnerable populations and healthy controls during the COVID-19 era. The primary outcomes are the severity of depression and anxiety, and secondary outcomes include other aspects of mental health such as stress or sleep disturbance. Meta-analysis was performed for the severity of mental health symptoms, and the results were presented as standardized mean difference and 95% confidence intervals. A total of 25 studies were included. According to the findings, the elderly generally experienced significantly lower levels of psychological symptoms including depression, anxiety, and perceived stress. Pregnant women, patients with chronic diseases, and patients with pre-existing severe mental disorders showed mixed results according to each mental health outcome. The results indicate that vulnerable groups have been affected differently in the COVID-19 era. Though the insufficient number and heterogeneity of included studies leave the results inconclusive, our findings may contribute to identifying priorities of mental health needs among various vulnerable populations and allocating health resources with efficiency.
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