Impact of the coronavirus 2019 (COVID-19) pandemic on anxiety diagnosis in general practices in Germany

Covid-19 psychological distress: Analysis of antipsychotic drugs' use in an Italian population sample

BACKGROUND

The current pandemic, in addition to putting a strain on healthcare systems and global economies, has exacerbated psychiatric problems and undermined the mental health of many individuals. In an Italian cohort, this phenomenon has been assessed through a retrospective study aimed at evaluating the consumption and costs of antipsychotic drugs between 2020 and 2022.

METHODS

All dispensations made in local pharmacies accessible to the public have been extracted from a database called 'Sistema Tessera Sanitaria', which covers a population of approximately one million people residents in the ASL Napoli 3 Sud. Consumption data expressed in defined daily dose (DDD) and expenditure data expressed in Euro have been extrapolated.

RESULTS

The results in the years 2020-2021 were relatively consistent, with consumption and expenditure decreasing slightly from 2020 to 2021. In 2022, the results showed a decrease in consumption and expenditure (2,706,951.07 DDD and €1,700,897.47) representing the reduced accessibility of patients to the healthcare facilities due to the pandemic. However, it should be noted that the antipsychotic drug aripiprazole showed an upward trend, registering an increase in consumption.

CONCLUSION

Despite expectations of increased consumption of antipsychotic medications, real-world evidence indicated a different phenomenon, with the pandemic seemingly not affecting the consumption of these drugs. The difficulty in accessing care and medical appointments has probably influenced this data, masking the therapeutic needs of citizens. It will be necessary to assess in the coming years, as normal clinical activity resumes, whether there will be a growing consumption of these medications, which represent one of the main expenditure categories for the National Healthcare System.

Enhancing fear extinction

Gradually reducing a source of fear during extinction treatments may weaken negative memories in the long term.

Changes in prescribing of psychotropic vs some physical health medication in primary care through the COVID-19 pandemic in England: a national-level survey

INTRODUCTION

The COVID-19 pandemic globally impacted healthcare provision. Prescribing changes in common medications can be used as a marker for new diagnoses. We describe how the prescribing of specific psychotropics was impacted by the pandemic.

METHODS

Primary Care Prescribing data for different classes of drugs from March 2017 to February 2022 were considered. To capture the impact during periods of restricted access to health services for new diagnoses/existing conditions, repeat prescriptions/episodic prescribing were included with account taken of historical trends. The pre-pandemic prescriptions issued each month from March 2018 to February 2020 were linearly extrapolated forward to give an expected annual growth (EAG). The monthly average expected prescriptions for the pandemic period (March 2020-February 2022) were compared.

RESULTS

Physical health medications had lower monthly prescriptions during the pandemic, most markedly for antibiotics - 12.5% (EAG - 1.3%). Bronchodilator prescribing showed a marked increase in the early pandemic months from March 2020 of 5% (EAG 0.1%). Mental health medication prescribing increased above trend for hypnotics/anxiolytics by 0.2% (EAG - 2.3%), while antidepressants fell by - 0.2% (EAG 5.0%), with no net change for antipsychotics (EAG 2.8%), but a temporary increase in antipsychotic prescribing in the early pandemic period. For all the main antidepressants prescribed in England (Sertraline, Mirtazapine, Venlafaxine, Fluoxetine and Citalopram), prescribing actually decreased in the main pandemic period vs historical trend.

CONCLUSIONS

The increase in anxiolytic/hypnotic prescribing above trend links to pandemic effects on anxiety/worry. If anything, there was a slight fall in prescribing of the main antidepressants prescribed, which given prevailing circumstances at the time, suggests that access to services may have restricted access to timely assessment.

Impact of the COVID-19 pandemic on well-being and quality of life of patients with alpha-1-antitrypsin deficiency

BACKGROUND

Alpha-1-antitrypsin deficiency (AATD) is a genetic disorder characterized by mutations in the SERPINA1 gene, primarily affecting the lungs and liver. The COVID-19 pandemic has raised questions about the susceptibility of individuals with AATD to COVID-19 and whether patients with rare lung disease might experience increased stress-related symptoms and mental health challenges. This study aims to investigate the impact of the COVID-19 pandemic on the quality of life of individuals living with AATD.

METHODS

The study enrolled participants from the German registry for individuals with AATD. Questionnaires were sent to the 1250 participants, and a total of 358 patients were included in the analysis. The primary objective was to examine the influence of sociodemographic and disease-related factors on the occurrence of stress-related symptoms. This was accomplished through correlation and regression analyses. We also investigated the role of baseline quality of life (QoL), as measured by the St. George's Respiratory Questionnaire (SGRQ), as a mediator of this relationship.

RESULTS

Stress-related symptoms were predicted by young age, female gender, psychological disorders, and a history of exacerbations of lung disease, as determined by multiple regression analysis. QoL as measured by the SGRQ mediated the relationship between poor lung function, stress, and a decline in overall well-being.

CONCLUSION

The presented data demonstrate that the COVID-19 pandemic significantly affects the psychological well-being of patients with rare diseases, leading to increased levels of anxiety and stress. Disease-related factors can exacerbate stress manifestations, especially when compounded by sociodemographic and contextual factors. Thus, our study emphasizes the crucial role of taking these factors into account when managing individuals with AATD in pandemic situations.

Psychosocial predictors of distress in East and West Germans during the COVID-19 pandemic

BACKGROUND

Psychological (meaning in life, science attitude, internal locus of control, religiosity), and social factors (social support, cohesion) can counteract stressor-related distress. We investigated these factors' links with peri-pandemic distress (depression, anxiety, intrusions) and whether they weakened the impact of being affected by the COVID-19 pandemic. We compared prior East and West Germans on predictors and distress to investigate if their different backgrounds created lasting differences.

METHODS

A population-representative German sample aged 45 to 70 (N = 380) in terms of age, sex, and school education completed online questionnaires in May-July 2020 and June-July 2021. We examined the predictive relations with correlation, forward inclusion regression, and moderation analyses.

RESULTS

Social support predicted lower distress, also prospectively. Meaning in life predicted lower distress cross-sectionally. Religiosity predicted greater distress. Life meaning and social support partly weakened the link between being affected by the pandemic and distress, religiosity and science attitude strengthened this link. The only significant East/West difference was in religiosity, which was higher in the West.

CONCLUSION

Social resources appeared particularly important in adjusting to the pandemic. The identified predictors may inform interventions. East and West Germans' similarity might indicate that their post-war separation did not create lasting differences in the investigated factors.

Depressive and anxiety symptoms in the course of the COVID-19 pandemic among physicians in hospitals: results of the longitudinal, multicenter VOICE-EgePan survey over two years

BACKGROUND

This longitudinal, multicenter web-based study explored the trajectories of depressive and anxiety symptoms during the COVID-19 pandemic among physicians over two years.

METHODS

At four measurement points between 4/2020 and 5/2022 depressive (Patient Health Questionnaire-2, PHQ-2) and anxiety symptoms (Generalized Anxiety Disorder Scale-2, GAD-2) among physicians in German hospitals were assessed. Time, gender and age effects were analyzed with linear mixed regression models. Comparisons with norm values for the German population during the COVID-19 pandemic were also performed and frequencies of probable depression and anxiety are reported.

RESULTS

The physicians (N = 340) showed a significant increase of depressive symptoms from T1 (M = 1.35, SD = 1.33) to T4 (M = 1.64, SD = 1.34) (p < .001) and of anxiety symptoms from T1 (M = 1.35, SD = 1.42) to T2 (M = 1.59, SD = 1.43) (p = .024). The main effect of gender was only significant for anxiety symptoms (p = .001): women demonstrated higher scores than men. A significant age class difference was observed only for depressive symptoms: the youngest age group (18-40 years) revealed higher values than the oldest group (> 50 years, p = .003). As compared to the general population, the physicians reported significantly elevated PHQ-2 (T1: M = 1.35, SD = 1.33; T2: M = 1.53, SD = 1.37; T3: M = 1.55, SD = 1.40; T4: M = 1.64, SD = 1.34) and GAD-2 scores (T1: M = 1.35, SD = 1.42; T2: M = 1.59, SD = 1.43; T3: M = 1.61, SD = 1.57; T4: M = 1.49, SD = 1.46) for all measurement points (all p < .001). The frequencies of probable depression (PHQ-2 ≥ 3) and anxiety (GAD-2 ≥ 3) were: 14.1% and 17.0% (T1), 16.5% and 21.9% (T2), 17.8% and 22.6% (T3) and 18.5% and 17.3% (T4), respectively.

CONCLUSIONS

Mental distress of physicians in German hospitals has increased in the course of the COVID-19 pandemic with gender and age-related differences. Possible causes should be explored and regular monitoring of mental health and prevention programmes for physicians should be established.

TRIAL REGISTRATION

The study was registered on ClinicalTrials (DRKS-ID: DRKS00021268) on 9.4.2020.

Psychological impact of COVID-19 containment on CADASIL patients

INTRODUCTION

COVID-19 restrictive containment was responsible for major psychological distress and alteration of quality of life (QoL) in the general population. Their impact in a group of patients having cerebral small vessel disease (SVD) and at high risk of stroke and disability was unknown.

OBJECTIVE

We aimed to determine the potential psychological impact of strict containment during the COVID-19 pandemic in a sample of CADASIL patients, a rare SVD caused by NOTCH3 gene mutations.

METHODS

Interviews of 135 CADASIL patients were obtained just after the end of the strict containment in France. Depression, QoL and negative subjective experience of the containment were analysed, as well as predictors of posttraumatic and stressor-related manifestations, defined as an Impact Event Scale-Revised score ≥ 24, using multivariable logistic analysis.

RESULTS

Only 9% of patients showed a depressive episode. A similar proportion had significant posttraumatic and stressor-related disorder manifestations independently associated only with socio-environment factors, rather than clinical ones: living alone outside a couple (OR 7.86 (1.87-38.32), unemployment (OR 4.73 (1.17-18.70)) and the presence of 2 or more children at home (OR 6.34 (1.35-38.34).

CONCLUSION

Psychological impact of the containment was limited in CADASIL patients and did not appear related to the disease status. About 9% of patients presented with significant posttraumatic and stressor-related disorder manifestations which were predicted by living alone, unemployment, or exhaustion related to parental burden.

Hereditary Angioedema: Impact of COVID-19 pandemic stress upon disease related morbidity and well-being

Background: Individuals with hereditary angioedema (HAE) experience stress-related sequelae, including enhanced disease morbidity and reduced quality of life. The pervasive societal strain that surround the coronavirus disease 2019 (COVID-19) pandemic may theoretically pose a disproportionate risk for patients with HAE. Objective: To dissect the interrelationship(s) among the COVID-19 pandemic, stress, and HAE disease-related morbidity and overall well-being. Methods: Subjects with HAE (either due to C1-inhibitor deficiency or with normal C1 inhibitor) as well as non-HAE household members (normal controls) completed online questionnaires that covered the impact of the COVID-19 pandemic on attack frequency, observed effectiveness of HAE medications, stress, and perceived quality of life and/or well-being. The subjects scored each of the questions to reflect their current status as well as their status before being aware of the pandemic. Results: Disease morbidity and psychologic stress outcomes were significantly worse in patients with HAE during the pandemic compared with before they were aware of the pandemic. A COVID-19 infection further increased attack frequency. Control subjects also experienced deterioration of well-being and optimism. A comorbid diagnosis of anxiety, depression, or posttraumatic stress disorder (PTSD) was generally associated with worse outcomes. Women consistently showed greater decrements in wellness during the pandemic compared with men. Women also reported higher levels of comorbid anxiety, depression, or PTSD than men and experienced a higher rate of job loss during the pandemic. Conclusion: The results implicated a deleterious impact of stress in the aftermath of COVID-19 awareness on HAE morbidity. The female subjects were universally more severely affected then were the male subjects. Overall well-being and/or quality of life, and optimism for the future deteriorated after awareness of the COVID-19 pandemic for the subjects with HAE and non-HAE household controls.

Utilization of antidepressants, anxiolytics, and hypnotics during the COVID-19 pandemic in Scandinavia

OBJECTIVE

To study patterns of antidepressant, anxiolytic, and hypnotic drug utilization in Denmark, Norway, and Sweden during the first year of the COVID-19 pandemic.

METHODS

The monthly observed number of prescription fills of antidepressants, benzodiazepines and benzodiazepine-related hypnotics (BZ), and other anxiolytics and hypnotics (OAH) per population in 2020 were compared with predicted numbers based on analysis of covariance of prescription fills during 2015-2019.

RESULTS

In March 2020, there was an increased number of prescription fills for antidepressants, anxiolytics, and hypnotics in youths and adults aged 20-59 years in Denmark, Norway, and Sweden. Antidepressant prescription fills increased between 13.5 % and 31.3 % at the end of 2020 in all age groups in Denmark and 17.4 % in youths in Norway. BZ drug prescription fills increased by 20.8 % at the end of 2020 in the 20-59 year age group in Denmark and decreased by 16.7 % in youths in Sweden. A general increase of prescription fills of OAH at the end of 2020 was observed in all countries (range 24.0-80.0 % in Denmark, 11.5-30.8 % in Norway, and 9.1-12.1 % in Sweden). Increases of prescription fills of OAH occurred earlier in Denmark.

LIMITATIONS

Aggregated data with lack of information on indications.

CONCLUSIONS

Peaks of utilization of antidepressants, anxiolytics, and hypnotics observed in March 2020 may reflect medication stock piling. Increased antidepressant drug utilization in Denmark and in Norwegian youths together with the general increase in OAH utilization in the Scandinavian countries in late 2020 may indicate an increase of symptoms of depression and anxiety, as well as disturbed sleep.

Trends in incident diagnoses and drug prescriptions for anxiety and depression during the COVID-19 pandemic: an 18-month follow-up study based on the UK Biobank

Serious concerns have been raised about the negative effects of the COVID-19 pandemic on population psychological well-being. However, limited data exist on the long-term effects of the pandemic on incident psychiatric morbidities among individuals with varying exposure to the pandemic. Leveraging prospective data from the community-based UK Biobank cohort, we included 308,400 participants free of diagnosis of anxiety or depression, as well as 213,757 participants free of anxiolytics or antidepressants prescriptions, to explore the trends in incident diagnoses and drug prescriptions for anxiety and depression from 16 March 2020 to 31 August 2021, compared to the pre-pandemic period (i.e., 1 January 2017 to 31 December 2019) and across populations with different exposure statuses (i.e., not tested for COVID-19, tested negative and tested positive). The age- and sex-standardized incidence ratios (SIRs) were calculated by month which indicated an increase in incident diagnoses of anxiety or depression among individuals who were tested for COVID-19 (tested negative: SIR 3.05 [95% confidence interval 2.88-3.22]; tested positive: 2.03 [1.76-2.34]), especially during the first six months of the pandemic (i.e., March-September 2020). Similar increases were also observed for incident prescriptions of anxiolytics or antidepressants (tested negative: 1.56 [1.47-1.67]; tested positive: 1.41 [1.22-1.62]). In contrast, individuals not tested for COVID-19 had consistently lower incidence rates of both diagnoses of anxiety or depression (0.70 [0.67-0.72]) and prescriptions of respective psychotropic medications (0.70 [0.68-0.72]) during the pandemic period. These data suggest a distinct rise in health care needs for anxiety and depression among individuals tested for COVID-19, regardless of the test result, in contrast to a reduction in health care consumption for these disorders among individuals not tested for and, presumably, not directly exposed to the disease.

Changes in antidepressant use in Australia: A nationwide analysis (2015-2021)

BACKGROUND

Depression and anxiety affect 4-14% of Australians every year; symptoms may have been exacerbated during the COVID-19 pandemic. We examined recent patterns of antidepressant use in Australia in the period 2015-2021, which includes the first year of the pandemic.

METHODS

We used national dispensing claims for people aged ⩾10 years to investigate annual trends in prevalent and new antidepressant use (no antidepressants dispensed in the year prior). We conducted stratified analyses by sex, age group and antidepressant class. We report outcomes from 2015 to 2019 and used time series analysis to quantify changes during the first year of the COVID-19 pandemic (March 2020-February 2021).

RESULTS

In 2019, the annual prevalence of antidepressant use was 170.4 per 1000 women and 101.8 per 1000 men, an increase of 7.0% and 9.2% from 2015, respectively. New antidepressant use also increased for both sexes (3.0% for women and 4.9% for men) and across most age groups, particularly among adolescents (aged 10-17 years; 46-57%). During the first year of the COVID-19 pandemic, we observed higher than expected prevalent use (+2.2%, 95% CI = [0.3%, 4.2%]) among females, corresponding to a predicted excess of 45,217 (95% CI = [5,819, 84,614]) females dispensed antidepressants. The largest increases during the first year of the pandemic occurred among female adolescents for both prevalent (+11.7%, 95% CI = [4.1%, 20.5%]) and new antidepressant use (+15.6%, 95% CI = [8.5%, 23.7%]).

CONCLUSION

Antidepressant use continues to increase in Australia overall and especially among young people. We found a differential impact of the COVID-19 pandemic in treated depression and anxiety, greater among females than males, and greater among young females than other age groups, suggesting an increased mental health burden in populations already on a trajectory of increased use of antidepressants prior to the pandemic. Reasons for these differences require further investigation.

Effects of the COVID-19 pandemic and previous pandemics, epidemics and economic crises on mental health: systematic review

BACKGROUND

A rise in mental illness is expected to follow the COVID-19 pandemic, which has also been projected to lead to a deep global economic recession, further adding to risk factors.

AIMS

The aim of this review was to assess the impact of the COVID-19 pandemic and previous pandemics, epidemics and economic crises on mental health.

METHOD

Searches were conducted in PubMed, Web of Science, PsycINFO and Sociological Abstracts. We included studies of all populations exposed to the COVID-19 pandemic, and other similar pandemics/epidemics and economic crises, compared with non-exposed time periods or regions. The outcome was mental health.

RESULTS

The 174 included studies assessed mental health impacts of the COVID-19 pandemic (87 studies), 2008 economic crisis (84 studies) and severe acute respiratory syndrome (SARS) epidemic (three studies). Outcomes were divided into affective disorders, suicides, mental healthcare utilisation and other mental health. COVID-19 pandemic studies were of lesser quality than those for the economic crisis or SARS epidemic. Most studies for all exposures showed increases in affective disorders and other mental health problems. For economic crisis exposure, increases in mental healthcare utilisation and suicides were also found, but these findings were mixed for COVID-19 pandemic exposure. This is probably because of quarantine measures affecting help-seeking and shorter follow-ups of studies of COVID-19 pandemic exposure.

CONCLUSIONS

Our findings highlight the importance of available, accessible and sustainable mental health services. Also, socioeconomically disadvantaged populations should be particular targets of policy interventions during the COVID-19 pandemic.

The impact of the COVID-19 pandemic on pain and psychological functioning in young adults with chronic pain

ABSTRACT

Data are equivocal on the consequences of COVID-19 pandemic on pain and well-being for individuals with chronic pain. Furthermore, little is known regarding its impact on the health of young adults with chronic pain. We conducted a longitudinal study to compare pain, psychological functioning, and substance use before and during the pandemic of 196 young adults with chronic pain. Participants aged 18 to 24 years (M = 21.1 years; 79.6% females) reported on pain, anxiety, depression, and substance use before (October 2018-August 2019) and during the pandemic (October 2020-November 2020), in addition to the assessment of COVID-19 exposure and its impact. Before the pandemic, young adults experienced mild-to-moderate pain intensity (M = 3.75, SD = 2.33) and pain interference (M = 3.44, SD = 2.69). Findings were that pain intensity, pain interference, and depression symptoms remained stable during the pandemic. In contrast, anxiety symptoms increased significantly (M = 8.21, SD = 5.84 vs M = 8.89, SD = 5.95, P = 0.04). Tobacco, alcohol, and cannabis use were unchanged. Mixed linear models revealed that COVID-19 exposure and impact were not associated with changes in pain intensity or interference, with female sex associated with increased pain intensity (β = 0.86, P = 0.02) and pain interference (β = 0.87, P = 0.02). Our findings indicated relative stability of pain symptoms experienced by young adults with chronic pain. However, the increases in anxiety highlight the need to facilitate treatment access for mental health services to mitigate downstream impact.

COVID-19 Geçirmiş Bireylerde Kinezyofobi, Fiziksel Aktivite, Depresyon, Anksiyete ve Stres Düzeyleri: Kesitsel Bir Çalışma

Objective: Kinesiophobia, inactivity and mood disturbances in post-COVID-19 individuals are poorly investigated. Therefore, the aim of this study was to compare measures of kinesiophobia, physical activity, depression, anxiety and stress in post-COVID-19 individuals and healthy individuals. Methods: This cross-sectional study was conducted between 25 November 2021 and 30 December 2021. The individuals were recruited from the general community. Kinesiophobia was assessed with the Tampa Scale of Kinesiophobia, physical activity levels with the International Physical Activity Questionnaire Short-Form, and mood (depression, anxiety, and stress) with the Depression Anxiety Stress-21 Scale in all individuals. Results: There were 29 volunteer individuals who had COVID-19 with a mean age of 33.41±7.95 years. Healthy controls consisted of 20 volunteers with a mean age of 31.3±7.81 years. Anxiety (55.2% versus 20%) and stress (34.5% versus 5%) were observed more frequently in the post-COVID-19 group. The scores for kinesiophobia and anxiety were significantly higher in post-COVID-19 individuals than healthy individuals (p&lt;0.05). The scores for physical activity, depression and stress were similar between groups (p&gt;0.05). Significant correlations were found among post-COVID-19 individuals for i) the scores for kinesiophobia and stress, and ii) the scores for physical activity, stress, and depression (p&lt;0.05). There was no relationship between kinesiophobia and other outcomes in healthy individuals (p&gt;0.05). Conclusion: Although a high degree of kinesiophobia is observed in both post-COVID-19 and healthy individuals, kinesiophobia, anxiety and stress measures were higher in people exposed to COVID-19 than others. In post-COVID-19 individuals, kinesiophobia increased as stress increased, and physical activities decreased while stress and depression increased. Hence, exercises, physical activities and psychological counseling should be recommended to individuals exposed to COVID-19.

Increased antidepressant use during the COVID-19 pandemic: Findings from the Friuli Venezia Giulia region, Italy, 2015-2020

BACKGROUND

Few studies investigated the impact of the pandemic on antidepressant (AD) use.

METHODS

The Social and Health Information System of Friuli Venezia Giulia region, Italy, provided data on AD use. Sex, age, AD class and month used the amount of AD prescriptions, measured by defined daily doses (DDD) per 1000 inhabitants per day, to compare AD use in 2020 with the period 2015-2019. A linear trend model predicted AD use for 2020, based on years 2015-2019.

RESULTS

AD use was on average 20% higher in each month of 2020 when compared with the same month for the period 2015-2019, with an increase of more than 30% in the first four and in the last two months of 2020. The observed AD use in 2020 was higher than predicted, particularly in men, and in the 30-59 years age group.

LIMITATIONS

Descriptive study of AD use without analysis of data at the individual level. No information on psychiatric diagnoses of AD users.

CONCLUSION

AD use was higher in the first year of the COVID-19 pandemic. Further research is warranted to understand if this may be related to a rise in mental disorders in the general population during the COVID-19 pandemic.

Placebo: a brief updated review

Our aims were to provide updated information on placebo/nocebo effect and the potential use of placebo in clinical practice. This article can only provide a rough overview on the placebo and nocebo effect and is intended to serve as a starting point for the reader to go deeper into the corresponding literature. The placebo effect has been observed in multiple medical conditions, after oral administration, with manual therapies as well as with surgery and invasive procedures. The use of placebo in clinical trials is fundamental, although the ethics of its use is under discussion. The placebo may behave like a drug from the pharmacokinetic and pharmacodynamic point of view and can also be associated with adverse events (nocebo effect). Placebo can modify treatment by increasing or decreasing the effects of drugs. The factors associated with the occurrence of placebo effect are multiple, but in addition to those that depend on the placebo itself, the doctor-patient relationship would be the most important. As a result of findings that were published in the last two decades, the psycho-neurobiological basis of placebo is becoming better understood, although further studies are needed. In conclusion, the placebo effect in the clinic exhibits weak to moderate intensity. Placebo, in addition to its use in the clinical trial, should be considered another therapeutic remedy either as stand alone or in association with treatment, and could be useful in certain circumstances. The use of placebo should be regulated by the European health authorities through a guide in clinical practice that will improve patient care.

Impact of COVID-19 Pandemic on the Use of Antidepressant and Antianxiety Pharmaceuticals as Well as Sick Leave in Poland

The COVID-19 pandemic caused a major upheaval to the lives of people and placed a strain on societal mental health. The aim of this research is to estimate the impact of the pandemic on the mental condition of the Polish population measured through the consumption of relevant medication and medical leave of absence from the workplace. Methods: We analyzed national-level data on the consumption of pharmaceuticals used in clinical practice in Poland in the treatment of depression and anxiety alongside medical absence in the workplace using the Interrupted Time Series model to estimate the significance of the pandemic. Results: We found no significant change regarding the consumption of pharmaceuticals with the development of the pandemic. Conversely, medical leaves of absence for psychiatric reasons increased significantly with the onset of COVID-19. The influence was strongest in the diagnosis of anxiety or reaction to severe stress and weakest in recurrent depression. Conclusion: The pandemic had a significant influence on the ability to work for psychiatric patients in Poland but did not change pharmaceutical use. Physicians should consider the mental health of patients impacted by the anti-epidemic measures. Further study is needed to fully understand the long-term impact of the pandemic on mental health in Poland.

Development and Content Validation of a Comprehensive Health Literacy Survey Instrument for Use in Individuals with Asthma during the COVID-19 Pandemic

Individuals with chronic conditions have been faced with many additional challenges during the COVID-19 pandemic. Individual health literacy (HL) as the ability to access, understand, evaluate, and apply pandemic-related information has thus become ever more important in these populations. The purpose of this study was to develop and content-validate a comprehensive HL survey instrument for people with asthma based on an integrated framework, and on previous surveys and other instruments for use in the general population and vulnerable groups. Beside HL, assumed determinants, mediators, and health outcomes were embraced in the framework. A mixed-method design was used. A comprehensive examination of the available literature yielded an initial pool of 398 single items within 20 categories. Based on content validity indices (CVI) of expert ratings (n = 11) and the content analysis of cognitive interviews with participants (n = 9), the item pool was reduced, and individual items/scales refined or modified. The instrument showed appropriate comprehensibility (98.0%), was judged relevant, and had an acceptable CVI at scale level (S-CVI/Ave = 0.91). The final version comprises 14 categories measured by 38 questions consisting of 116 single items. In terms of content, the instrument appears a valid representation of behavioural and psychosocial constructs pertaining to a broad HL understanding and relevant to individuals with asthma during the COVID-19 pandemic. Regular monitoring of these behavioural and psychosocial constructs during the course of the pandemic can help identify needs as well as changes during the course of the pandemic, which is particularly important in chronic disease populations.

Antidepressants Drug Use during COVID-19 Waves in the Tuscan General Population: An Interrupted Time-Series Analysis

In Italy, during the COVID-19 waves two lockdowns were implemented to prevent virus diffusion in the general population. Data on antidepressant (AD) use in these periods are still scarce. This study aimed at exploring the impact of COVID-19 lockdowns on prevalence and incidence of antidepressant drug use in the general population. A population-based study using the healthcare administrative database of Tuscany was performed. We selected a dynamic cohort of subjects with at least one ADs dispensing from 1 January 2018 to 27 December 2020. The weekly prevalence and incidence of drug use were estimated across different segments: pre-lockdown (1 January 2018–8 March 2020), first lockdown (9 March 2020–15 June 2020), post-first lockdown (16 June 2020–15 November 2020) and second lockdown (16 November 2020–27 December 2020). An interrupted time-series analysis was used to assess the effect of lockdowns on the observed outcomes. Compared to the pre-lockdown we observed an abrupt reduction of ADs incidence (Incidence-Ratio: 0.82; 95% Confidence-Intervals: 0.74–0.91) and a slight weekly decrease of prevalence (Prevalence-Ratio: 0.997; 0.996–0.999). During the post-first lockdown AD use increased, with higher incidence- and similar prevalence values compared with those expected in the absence of the outbreak. This pandemic has impacted AD drug use in the general population with potential rebound effects during the period between waves. This calls for future studies aimed at exploring the mid–long term effects of this phenomenon.

Effect of the COVID-19 pandemic on the psychotropic drug consumption

IMPORTANCE

Although the COVID-19 pandemic has had a negative impact on mental health, there is no comprehensive longitudinal study of the entire population of a country without selection bias.

OBJECTIVE

The objective of this study was to evaluate the prescription of psychotropic drugs during the COVID-19 pandemic, using data from the French national health data system (SNDS).

DESIGN SETTINGS AND PARTICIPANTS

Prescriptions for psychotropic drugs (antidepressants, anxiolytics, hypnotics, and antipsychotics) from 1 January 2015 to 30 September 2021 were collected from administrative data provided by the SNDS. This database includes more than 99% of the French population, i.e., 67 million people. The data were analyzed using an interrupted time series analysis (ITSA) model.

MAIN OUTCOMES AND MEASURES

Consumption of psychotropic drugs was aggregated in months and expressed in number of boxes per thousand inhabitants.

RESULTS

During the study period, more than 1.3 billion boxes of psychotropic medications were dispensed. Comparison of psychotropic drug dispensing before and after the pandemic showed a relative increase of 0.76 (95 CI 0.57 to 0.95, p<0.001) boxes per month per thousand inhabitants, all classes of psychotropic drugs combined. Three classes saw their consumption increase in an almost similar proportion, respectively, by 0.23 (0.15 to 0.32, p<0.001) boxes for antidepressants, 0.27 (0.20 to 0.34, p<0.001) boxes for anxiolytics and 0.23 (0.17 to 0.30, p<0.001) boxes for hypnotics. The change in antipsychotic consumption was very small, with an increase of 0.04 boxes (0.02 to 0.06, p = 0.001) per month per thousand population.

CONCLUSION AND RELEVANCE

The COVID-19 pandemic had led to an increase in the consumption of psychotropic drugs, confirming the significant impact of the pandemic on the mental health of the general population.

General Stress Among Young Adults with Asthma During the COVID-19 Pandemic

Background

The coronavirus disease 2019 (COVID-19) pandemic has profoundly affected the lives of the global population.

Objective

To explore anxiety and stress in relation to COVID-19 among young adults, and the potential influence of asthma and allergic rhinitis.

Methods

This cross-sectional study included 1644 participants from the population-based birth cohort BAMSE (Swedish abbreviation for Children, Allergy, Milieu, Stockholm, Epidemiology), participating in a follow-up at age 24 years and a COVID-19 follow-up conducted in August-November 2020 (mean age, 25.3 years). Anxiety and concern related to COVID-19 were analyzed as general anxiety, concern of own health and health of family members, and contact with online health care providers due to concern about COVID-19. Stress was measured with the perceived stress scale.

Results

Around half the participants reported increased anxiety due to COVID-19, and this was more common among females (57.0%, compared with 42.6% in males; P < .001). Young adults with asthma reported more concern about their own health (adjusted odds ratio, 1.50; 95% CI, 1.12-2.02) and perceived stress (adjusted regression coefficient [adjusted β], 1.49; 95% CI, 0.52-2.45) compared with peers without asthma, and this was more pronounced among females and those with uncontrolled asthma. Symptoms of allergic rhinitis were not associated with increased concern or anxiety in relation to COVID-19.

Conclusions

Young adults with asthma experience more COVID-19–related health concerns, compared with those without asthma, especially females and participants with uncontrolled asthma This needs to be considered in the care of young people with asthma.

Risks and Resources for Depressive Symptoms and Anxiety in Children and Adolescents During the COVID-19 Pandemic - Results of the Longitudinal COPSY Study

BACKGROUND

Mental health during the COVID-19 pandemic is of particularly high relevance. Especially for children and adolescents, the pandemic and its restrictions represent a significant burden. The present study aims to identify risks and resources for depressive symptoms and anxiety in children and adolescents during the pandemic in Germany.

MATERIALS AND METHODS

Self-reported data from the first wave of the longitudinal COVID-19 and Psychological Health (COPSY) study were used to investigate risks and resources among n = 811 children and adolescents aged 11-17 years. Depressive symptoms and anxiety were measured at the first follow-up 6 months later. Multivariate linear regression analyses were performed to investigate the effects of risks and resources on depressive symptoms and anxiety.

RESULTS

Parental depressive symptoms predicted depressive symptoms and anxiety in children and adolescents 6 months later. Female gender was identified as a risk factor for anxiety during the pandemic. None of the potential resources were associated with depressive symptoms or anxiety at the follow-up.

CONCLUSION

The findings provide evidence of risk factors for depressive symptoms and anxiety during the COVID-19 pandemic. Children and adolescents who face risk factors need to be identified early and monitored during the pandemic. Family-based intervention programs are needed to help vulnerable children and adolescents cope with the challenges of the pandemic.

COVID-19 Infection and Psychotic Experiences: Findings From the Healthy Minds Study 2020

Background

Clinical reports from across the world have documented psychosis in the context of COVID-19 infection; however, there has yet to be a large-scale epidemiological study to confirm this association.

Methods

We analyzed data from the Healthy Minds Study (N = 15,935; conducted between September and December 2020), which was administered online to students attending one of 28 colleges in the United States. Using multivariable logistic regression, we examined the associations between COVID-19 infection/severity and psychotic experiences over the past 12 months, adjusting for age, gender, race/ethnicity, and international student status as well as anxiety and depression.

Results

More than one fifth of the analytic sample reported COVID-19 infection, and about one in six students with COVID-19 infection reported psychotic experiences over the past 12 months. In weighted multivariable logistic regression models, COVID-19 infection was associated with significantly greater odds of having psychotic experiences (adjusted odds ratio 1.36, 95% CI 1.19–1.48). Compared with being asymptomatic, having moderate (adjusted odds ratio 1.85, 95% CI 1.03–3.31) or severe (adjusted odds ratio 1.76, 95% CI 1.11–2.77) symptoms was associated with significantly greater odds of having psychotic experiences. These associations became statistically nonsignificant when adjusting for depression and anxiety. Hospitalization was not significantly associated with psychotic experiences among students with COVID-19 infection.

Conclusions

Psychotic experiences are associated with COVID-19 infections, though much of the association is attenuated when accounting for anxiety and depression. Findings based on this sample of college students should be replicated outside of the college context to determine whether psychosis is a neuropsychiatric symptom during and after COVID-19 infection.

Impact of the COVID-19 pandemic in the Portuguese population: Consumption of alcohol, stimulant drinks, illegal substances, and pharmaceuticals

Background

The measures implemented by governments worldwide to control and prevent the spread of the COVID-19 have impacted the populations and directly influenced individuals’ quality of life and consumption habits.

Objective

This work investigates the Portuguese population’s changes in alcohol, stimulants drinks, illegal substances, and pharmaceutical consumptions habits during the COVID-19 pandemic.

Methods

An online questionnaire comprising seven groups of questions–with one group referring to alcohol, stimulant drinks, illegal substances, and pharmaceuticals consumption habits–was made available to the general adult population of mainland Portugal from the 26^th January through the 31^st of March 2021. After applying the inclusion criteria, 1666 questionnaires were selected and analysed using descriptive and inferential statistics.

Results

Our results show that 48.9% of the participants have alcohol drinking habits and increased their alcohol consumption by 16% after the beginning of the COVID-19 pandemic lockdown. Furthermore, 8.7% of the respondents felt the need to increase their consumption of stimulant drinks, especially coffee, the most consumed stimulant drink (77.9%). We also observed that of the 3.1% of respondents who are usual consumers of illegal substances, 26.9% increased their consumption of these substances during the COVID-19 pandemic. Concerning pharmaceuticals, 23.2% of the respondents expressed their need to take a therapeutic drug after the start of the COVID-19 pandemic. The profile of common consumers of alcohol, stimulant drinks, illegal substances, and pharmaceuticals in the COVID-19 pandemic context is contrasting and varies according to gender, age, and employment status.

Conclusions

The COVID-19 pandemic led to an increase in the consumption of alcohol, stimulant drinks, illegal substances, and pharmaceuticals prescribed to treat anxiety, depression, and sleep changes in the Portuguese population. These new consumption patterns have probably aggravated domestic violence, mental diseases, and impairment of family quality of life in the Portuguese population.

Mental health of the adult population in Germany during the COVID-19 pandemic. Rapid Review

This rapid review examines how the mental health of adults in the general population in Germany changed during the COVID-19 pandemic. We conducted a systematic literature search and included 68 publications as of July 30 2021. The underlying studies were classified according to their suitability for representative statements for the general population and for estimating changes in mental health over time. In addition, the observation period and operationalisation of outcomes were considered.

The first wave of infection and the summer plateau were mapped by 65% of the studies. Studies that were particularly suitable for representative statements due to their research design showed mixed results, which tend to indicate a largely resilient adult population with a proportion of vulnerable individuals. A predominantly negative development of mental health was described by results from more bias-prone study designs. Routine data analyses showed decreases in outpatient and especially inpatient care, increased use of a crisis service, mixed results for outpatient diagnoses, incapacity to work and mortality as well as indications of shifts in the spectrum of diagnoses. As the current evidence is ambiguous, generalised statements should be reflected in favour of a differentiated view. There is a need for research on the further course of the pandemic, specific risk groups and the prevalence of mental disorders.

Mental health of the adult population in Germany during the COVID-19 pandemic. Rapid Review

This rapid review examines how the mental health of adults in the general population in Germany changed during the COVID-19 pandemic. We conducted a systematic literature search and included 68 publications as of July 30 2021. The underlying studies were classified according to their suitability for representative statements for the general population and for estimating changes in mental health over time. In addition, the observation period and operationalisation of outcomes were considered. The first wave of infection and the summer plateau were mapped by 65% of the studies. Studies that were particularly suitable for representative statements due to their research design showed mixed results, which tend to indicate a largely resilient adult population with a proportion of vulnerable individuals. A predominantly negative development of mental health was described by results from more bias-prone study designs. Routine data analyses showed decreases in outpatient and especially inpatient care, increased use of a crisis service, mixed results for outpatient diagnoses, incapacity to work and mortality as well as indications of shifts in the spectrum of diagnoses. As the current evidence is ambiguous, generalised statements should be reflected in favour of a differentiated view. There is a need for research on the further course of the pandemic, specific risk groups and the prevalence of mental disorders.

COVID-19 dimensions are related to depression and anxiety among US college students: Findings from the Healthy Minds Survey 2020

BACKGROUND

The COVID-19 pandemic has brought about tremendous social and economic turmoil, which has been associated with increased levels of depression and anxiety.

METHODS

We analyzed data from the Healthy Minds Study (Fall Semester Cohort 2020), a non-probability sample of students across multiple colleges who completed an online survey between September - December 2020. Using multivariable logistic regression, we examined the associations between COVID-19 dimensions (concern, racial/ethnic discrimination, financial distress, infection, illness of loved one, death of loved one, caregiving) and mental health outcomes (depression, anxiety), adjusting for age, gender, race/ethnicity, and international student status.

RESULTS

Nearly a fifth of the sample reported moderately severe or severe depression, and nearly a third reported moderately severe or severe anxiety over the past two weeks. When accounting for all COVID-19 dimensions in the same model, COVID-19 concern, racial/ethnic discrimination, financial distress, and infection were significantly associated with moderately severe or severe depression; COVID-19 concern, financial distress, and infection were significantly associated with moderately severe or severe anxiety.

CONCLUSIONS

This study showed that the COVID-19 pandemic may have shaped mental health through a range of potential social and environmental dimensions. Interventions are required that consider multiple dimensions of COVID-19 to improve mental health during and after the pandemic.

[Impact of the COVID-19 pandemic on consultations and diagnosis in ENT practices in Germany]

OBJECTIVE

During the first months of the COVID-19 pandemic, there was a significant reduction in the frequency of visits to healthcare institutions. This circumstance influenced the timely diagnosis and subsequential initiation of therapy in almost all specialties. The aim of the present study is to evaluate a hypothetical change in health awareness with regard to outpatient consultations of ENT physicians in Germany.

MATERIAL AND METHODS

This study used anonymized data from 146 ENT practices in Germany and included 162,724 patients in Q2 2019, 158,077 in Q3 2019, 128,342 in Q2 2020, and 149,153 in Q3 2020. The first outcome was the difference in the number of patients with at least one visit to these practices between the second and third quarters of 2019 and the second and third quarters of 2020. The second outcome was the number of patients with new diagnoses per practice, defined as diagnoses not previously documented in the database for a given patient.

RESULTS

The number of patients per practice was significantly lower in Q2 2020 compared to Q2 2019 (879 versus 1108, p<0.001). There were no significant differences when comparing Q3 2020 to Q3 2019 (1022 versus 1083, p=0.261). Diagnoses of otitis media (-43%), acute upper respiratory tract infections (-42%), chronic upper respiratory tract diseases: (-21%), hearing loss (-20%) decreased significantly in Q2 2020 compared to Q2 2019. There was still a significant decrease in patient numbers for acute upper respiratory tract infections (-26%) and otitis media (-25%) in Q3 2020 compared to Q3 2019.

CONCLUSIONS

The presented results are attributable to several facts. Avoidance of doctor´s visits by the patients, reduction of allocation of appointments by practices and consistent obeying of distance and hygiene measures in terms of wearing filtering face masks (e.g. FFP2/KN95).

Impact of the COVID-19 Pandemic on Consultations and Diagnoses in Gastroenterology Practices in Germany

The COVID-19 pandemic has been a major burden for healthcare systems worldwide and has caused multiple changes and problems in outpatient care. The aim of this study was to investigate the impact of the COVID-19 pandemic on consultations and diagnoses in gastroenterology practices in Germany. To this end, we retrospectively analyzed data from the Disease Analyzer database (IQVIA) using the International Classification of Diseases, 10th revision (ICD-10). We included all patients aged ≥18 years with at least one visit to one of 48 gastroenterology practices in Germany between April and September 2019 and April and September 2020. A total of 63,914 patients in the 2nd quarter of 2019, 63,701 in the 3rd quarter of 2019, 55,769 in the 2nd quarter of 2020, and 60,446 in the 3rd quarter of 2020 were included. Overall, a clear downward trend in the number of visits to gastroenterologists was observed in the 2nd quarter of 2020 compared to 2019 (-13%, p = 0.228). The decrease in consultations was particularly pronounced in patients >70 years of age (-17%, p = 0.096). This trend was evident for all gastrointestinal diagnoses except for tumors. Most notably, rates of gastrointestinal infections (-19%) or ulcers (-43%) were significantly lower in this period than in the same quarter of 2019. Reflecting the course of the pandemic, the differences between the 3rd quarter of 2020 and that of 2019 were less pronounced (-5%, p = 0.560). Our data show that the pandemic changed patients' behavior with respect to the health care system. Using the example of German gastroenterology practices, we show that the number of consultations as well as the number and range of diagnoses have changed compared to the same period in 2019.

Impact of the COVID-19 Pandemic on the General Mental Health in Sweden: No Observed Changes in the Dispensed Amount of Common Psychotropic Medications in the Region of Scania

Some first investigations have focused on the consequences of the COVID-19 pandemic for the general mental health after its outbreak in 2020. According to multiple self-reporting surveys, symptoms of stress, anxiety, and depression have risen worldwide. Even some studies based on health care records start to be published, providing more objective and statistically reliable results. Additionally, concerns have been raised, to what extend the access to mental health care has been compromised by the COVID-19 outbreak. The aim of this study was to detect changes in prescription trends of common psychotropic medications in the Swedish region of Scania. The monthly dispensed amounts of selected pharmaceuticals were compared from January 2018 until January 2021, regarding the prescription trends before and after the outbreak of COVID-19. Using an interrupted time series analysis for each medication, no general trend changes were observed. On the one hand, a possible deterioration of the general mental health could not be confirmed by these results. On the other hand, the access to mental health care did not seem to be impaired by the pandemic. When interpreting findings related to the COVID-19 pandemic, regional differences and country-specific approaches for coping with the pandemic should be considered. The Swedish population, for instance, never experienced a full "lock-down" and within Sweden the time point of the outbreak waves differed regionally. In general, the effects of the COVID-19 outbreak on mental health are still unclear and need to be investigated further in an international comparison.