Mental distress during the COVID-19 pandemic among US adults without a pre-existing mental health condition: Findings from American trend panel survey

Associations between mindfulness and mental health after collective trauma: results from a longitudinal, representative, probability-based survey

BACKGROUND/OBJECTIVES

Trait mindfulness (TM) may protect against post-trauma mental health ailments and related impairment. Few studies have evaluated this association in the context of collective traumas using representative samples or longitudinal designs.

DESIGN/METHOD

We explored relationships between TM and collective trauma-related outcomes in a prospective, representative, probability-based sample of 1846 U.S. Gulf Coast residents repeatedly exposed to catastrophic hurricanes, assessed twice during the COVID-19 outbreak (Wave 1: 5/14/20-5/27/20; Wave 2: 12/21/21-1/11/22). Generalized estimating equations examined longitudinal relationships between TM, COVID-19-related fear/worry, hurricane-related fear/worry, global distress, and functional impairment; ordinary least squares regression analyses examined the cross-sectional association between TM and COVID-19-related posttraumatic stress symptoms (PTSS) at Wave 1. Event-related stressor exposure was explored as a moderator.

RESULTS

In covariate-adjusted models including pre-event mental health ailments and demographics, TM was negatively associated with COVID-19-related fear/worry, hurricane-related fear/worry, global distress, and functional impairment over time; in cross-sectional analyses, TM was negatively associated with COVID-19-related PTSS. TM moderated the relationship between COVID-19 secondary stressor exposure (e.g., lost job/wages) and both global distress and functional impairment over time.

CONCLUSIONS

Results suggest TM may buffer adverse psychosocial outcomes following collective trauma, with some evidence TM may protect against negative effects of secondary stressor exposure.

COVID-Related Stressors and Psychological Distress Among Chicago Residents: the Moderating Role of Race

BACKGROUND

Racial and ethnic minorities have been disproportionately affected by the COVID-19 pandemic and have experienced greater financial loss, housing instability, and food insecurity due to COVID-related restrictions. As a result, Black and Hispanic communities may be at greater risk of experiencing psychological distress (PD).

METHODS

Using data collected between October 2020 and January 2021from 906 Black (39%), White (50%), and Hispanic (11%) adults, we assessed racial/ethnic differences in the effect of three COVID-related stressors-employment stress, housing instability, and food insecurity-on PD using ordinary least square regression.

RESULTS

Black adults reported lower PD levels compared to White adults (β =  - 0.23, P < 0.001), but Hispanic adults did not differ significantly from White adults. COVID-related housing instability (β = 0.46, P < 0.001), food insecurity (β = 0.27, P < 0.001), and employment stress (β = 0.29, P < 0.001) were associated with higher PD. Employment stress was the only stressor to differentially affect PD by race/ethnicity. Among those that reported employment stress, Black adults had lower levels of distress compared to Whites (β =  - 0.54, P < 0.001) and Hispanics (β =  - 0.04, P = 0.85).

CONCLUSION

Despite relatively high exposure to COVID-related stressors, Black respondents had lower levels of PD compared to Whites and Hispanics which may reflect differences in race-specific coping mechanisms. Future research is needed to elucidate the nuances of these relationships and identify policies and interventions that prevent and minimize the impact of employment, food, and housing-related stressors and support coping mechanisms that promote mental health among minority populations, such as policies that support easier access to mental health and financial and housing assistance.

Trends in mental health before and after the onset of the COVID-19 pandemic: a longitudinal survey of a conflict-affected population in Colombia

BACKGROUND

Focusing on the Meta region in Colombia, we investigated the relationship between mental health, the COVID-19 pandemic, and social determinants of health influenced by over five decades of civil conflict. We studied the post-2016 peace agreement trends in mental health for the population of Meta, before and after the local onset of the pandemic.

METHOD

We conducted three rounds of a longitudinal health survey in years 2018 with N = 1309 (Women = 709; Men = 600); 2019 with N = 1106 (Women = 597; Men = 509); and 2020 with N = 905 (Women = 499; Men = 406). We measured mental health through the Self-Report Questionnaire (SRQ-20), investigating population trends in the average SRQ score and SRQ-positive frequency (SRQ + , indicating positive tendency towards experiencing mental health disorders).

RESULTS

Between 2018 and 2020, there were reductions in the mean SRQ-20 score by 1.74 points (95% CI -2.30 to -1.18) and in SRQ + frequency by 15 percentage points (95% CI -21.0 to -9.0) for the Meta population. Yet specific subgroups have become more vulnerable to mental illness during the pandemic, for example older age groups (e.g., increase in mean SRQ score among over 60 s by 2.49 points, 95% CI 0.51 to 4.46) and people living with children younger than five years-old (e.g., increase in mean SRQ score by 0.64 points, 95% CI 0.07 to 1.20). Increased mental health vulnerability among specific subgroups may be related to differences in the likelihood of knowing people who tested positive for COVID-19 or died from itf having been in quarantine.

CONCLUSION

Our findings support the importance of public policies in Colombia (and other low- and middle-income countries) that address the social determinants of mental illness whose influence was likely exacerbated by the pandemic, including persistent job insecurity leading to work and financial pressures, and inadequate support networks for isolated individuals and vulnerable caregivers.

Job loss and mental disorders: International evidence from the early stages of COVID-19 outbreak

Using a rich individual level dataset from six countries, we examine the relationship between job loss and mental disorders during the first phase of the COVID-19 pandemic. We consider four indicators of mental disorders based on their severity, viz. anxiety, insomnia, boredom, and loneliness. We draw our conclusions based on two groups of countries that differ by the timing of their peak infections count. Using a logit and a two-stage least squares (TSLS) regression methods, we find that the people who lost their jobs due to the pandemic are more likely to suffer from mental disorders, especially insomnia and loneliness. Additionally, people with financial liabilities, such as housing mortgages, are among those vulnerable to anxiety. Women, urban residents, youth, low-income groups, and tobacco users are more prone to mental disorders. The findings from this research have significant policy implications on infectious disease control measures and mental health conditions due to lockdowns and social distancing.

Mental health effects of social distancing in Switzerland

This analysis examines the effect of COVID-19 on public mental health in Switzerland. Following an event-study framework, we compare helpline call volume and duration before and after the outbreak of the first and second wave. The use of administrative phone-level data allows us to i) decompose the total effects into an intensive and extensive margin and ii) calculate a measure of unmet need. For the first wave, our results show that callers with a history of helpline contacts increase calls substantially. We also identify capacity constraints leading to unmet need for psychological counseling. Finally, we find no effects in the second wave, which might be explained by a number of factors including the absence of a lockdown and less restrictive social distancing measures.

Interrupted time series analysis of drug overdose fatalities in service-related industries versus non-service-related industries during the COVID-19 pandemic, 2018-2021

BACKGROUND

Variation among industries in the association between COVID-19-related closing or reopening orders and drug overdose deaths is unknown. The objectives of this study were to compare drug overdose decedent demographics, annual drug overdose fatality rates and monthly drug overdose fatality rates by specific industry within the service-related industry sector, and to perform an interrupted time series analysis comparing weekly drug overdose mortality counts in service-related and non-service-related industries, examining the COVID-19 pre-pandemic and pandemic phases by Kentucky closing and reopening orders.

METHODS

Kentucky drug overdose death certificate and toxicology testing data for years 2018-2021 were analysed using Χ2 and interrupted time series methods.

RESULTS

Before the pandemic, annual drug overdose fatality rates in service-related industries were higher than in non-service-related industries. However, these trends reversed during the pandemic. Both service-related and non-service-related industry groups experienced increased fatal drug overdoses at change points associated with the gubernatorial business closure orders, although the magnitude of the increase differed between the two groups. Young, female and black workers in service-related industries had higher frequencies of drug overdose deaths compared with decedents in the non-service-related industries.

CONCLUSION

Spikes in drug overdose mortality in both service-related and non-service-related industries during the pandemic highlight the need to consider and include industries and occupations, as well as worker populations vulnerable to infectious diseases, as integral stakeholder groups when developing and implementing drug overdose prevention interventions, and implementing infectious disease surveillance systems.

Factors Associated with Professional Mental Help-Seeking Among U.S. Immigrants: A Systematic Review

Structural and cultural barriers have led to limited access to and use of mental health services among immigrants in the United States (U.S.). This study provided a systematic review of factors associated with help-seeking attitudes, intentions, and behaviors among immigrants who are living in the U.S. This systematic review was performed using Medline, CINAHL, APA PsycInfo, Global Health, and Web of Science. Qualitative and quantitative studies examining mental help-seeking among immigrants in the U.S. were included. 954 records were identified through a search of databases. After removing duplicates and screening by title and abstract, a total of 104 articles were eligible for full-text review and a total of 19 studies were included. Immigrants are more reluctant to seek help from professional mental health services due to barriers such as stigma, cultural beliefs, lack of English language proficiency, and lack of trust in health care providers.

Age Differences in Mental Health During the COVID-19 Pandemic: Assessing the Moderating Role of Attachment to God

Objectives: This study examined age differences in mental health problems (depression and anxiety) during the COVID-19 pandemic using nationally representative data from the United States. Drawing from a life course perspective, we also assessed if a secure attachment to God conditioned the relationship between age and mental health. Methods: Data were from the 2021 Values and Beliefs of the American Public Study (N = 1168), collected roughly 1 year into the pandemic. Results: Older adults (61 years and over) reported lower depression and anxiety than respondents 18-30 years of age. However, stronger perceptions of attachment to God significantly closed the age gap in anxiety between these age groups. Discussion: Though absolute levels of religiosity tend to be higher for older adults, secure attachment to God was more protective of the mental health of younger adults during the pandemic. We reflect on our findings through a life course lens.

Comparison of the safety, effectiveness, and usability of swab robot vs. manual nasopharyngeal specimen collection

Background

Healthcare workers face a risk of infection during aerosol-generating procedures, such as nasal swabbing. Robot-assisted nasopharyngeal sampling aims to minimize this risk and reduce stress for healthcare providers. However, its effectiveness and safety require validation.

Methods

We conducted a controlled trial with 80 subjects at two teaching hospitals and compared robot-collected vs manually-collected nasopharyngeal swabs. The primary outcomes included specimen quality and success rate of nasopharyngeal swab collection. We also recorded the pain index, duration of the collection, and psychological stress using a post-collection questionnaire.

Results

During the study period, from September 23 to October 27, 2020, 40 subjects were enrolled in both the robotic and manual groups. The cycle threshold (Ct) value for nasopharyngeal specimens was statistically higher in the robotic group compared to the manual group (30.9 vs 28.0, p < 0.01). Both groups had Ct values under 35, indicating good quality specimens. In the robotic group, 3 out of 40 subjects required a second attempt at specimen collection, resulting in a success rate of 92.5 %. Further, although the pain levels were lower in the robotic group, the difference was not statistically significant (2.8 vs 3.6, p = 0.07). The manual group had a shorter sampling time, which was 29 s (201 vs 29, p < 0.05). However, when factoring in the time needed to put on personal protective equipment, the average time for the manual group increased to 251 s (201 vs 251, p < 0.05). Participants' questionnaire results show comparable psychological stress in both groups. Medical staff expressed that using a robot would reduce their psychological stress.

Conclusions

We propose a safe and effective robotic technology for collecting nasopharyngeal specimens without face-to-face contact, which may reduce the stress of physicians and nurses. This technology can also be optimized for efficiency, making it useful in situations where droplet-transmitted infectious diseases are a concern.

Impacts of COVID-19 on mental health in the US: evidence from a national survey

BACKGROUND

Studies have reported substantial effects of the COVID-19 pandemic on mental health, but little is known whether the impacts of COVID on individuals, such as being tested for COVID or experiencing disruptions to healthcare utilization, would affect their mental health differently.

AIMS

To examine the impacts of COVID-19 on depression and anxiety disorders among US adults.

METHODS

We included 8098 adults with no prior mental health problems using data from the National Health Interview Survey (2019-2020). We examined two outcomes: current depression and anxiety; and three COVID-related impact measures: ever COVID test, delayed medical care, and no medical care due to COVID. Multinomial logistic regressions were conducted.

RESULTS

Delayed or no medical care were significantly associated with current depression, with adjusted relative risks (aRRs) of 2.17 (95% CI, 1.48-2.85) and 1.85 (95% CI, 1.33-2.38). All three COVID-related impact measures were significantly associated with current anxiety. The aRRs were 1.16 (95% CI, 1.01-1.32) for ever COVID test, 1.94 (95% CI, 1.64-2.24) for no medical care, and 1.90 (95% CI, 1.63-2.18) for delayed medical care.

CONCLUSIONS

Individuals who were affected by COVID were more likely to experience depression or anxiety disorders. Mental health services need to prioritize these high-risk groups.

Psychological resilience matters in the relationship between the decline in economic status and adults' depression half a year after the outbreak of the COVID-19 pandemic

Background/objective

The outbreak of COVID-19 in China since 2019 has had a significant impact on the mental health of people in Hubei Province during the three-year pandemic period. Therefore, studying the prevalence of depression among the population of Hubei Province since the pandemic is of great significance.

Methods

Based on opportunity and stress theory, we collected provincial-level data from Hubei (N = 3,285) to examine the impact of declining economic status on depressive symptoms and to investigate the moderating effect of psychological resilience during the period of economic adjustment.

Results

We used propensity score matching to estimate the treatment effect of economic status decline on depression severity and confirmed the moderating effect of psychological resilience. We found that the more that an individual's economic status declines, the more severe that his or her depressive symptoms become. Specifically, each unit decrease in economic status is associated with an increase of approximately 0.117 units in depression level. In addition, our results indicated that psychological resilience significantly moderated the relationship between economic decline and depression (-0.184*).

Conclusions and implications

Our study confirms the role of economic status in depressive symptoms. Compared with traditional research on the relationship between economic status and mental illness, this paper expands the research regarding the two in the context of a major public health emergency. Furthermore, we suggest ways to improve people's mental health following the pandemic.

Day to Day and Environmental Risk Factors for Psychological Distress Among Healthcare Workers: A Mixed Methods Analysis

OBJECTIVE

Despite a growing literature on mental health among clinical staff during COVID-19, factors shaping distress for nonclinical staff are understudied and may be driven by inequalities at work. We aimed to discuss the role of workplace factors in shaping psychological distress for a diverse group of clinical, nonclinical, and other health and hospital workers (HHWs).

METHODS

This convergent parallel mixed-methods study with HHWs in a US hospital system included an online survey ( n = 1127) and interviews ( n = 73) collected from August 2020 to January 2021. We thematically analyzed interviews; findings informed log binomial regression estimating risk factors for severe psychological distress (Patient Health Questionnaire - 4 item version [PHQ-4] scores of 9 or greater).

RESULTS

Qualitatively, day-to-day stressors fostered fear and anxiety, and concerns about work environments manifest as betrayal and frustration with leadership. Distress was associated with burnout, financial concerns, and feeling betrayed or unsupported by the institution and leadership. Staff in service versus clinical roles had higher risk for severe distress (adjusted prevalence ratio = 2.04, 95% confidence interval = 1.13-2.66); HHWs receiving workplace mental health support had lower risk (adjusted prevalence ratio = 0.52, 95% confidence interval = 0.29-0.92.

CONCLUSIONS

Our mixed-methods study underscores how the pandemic brought inequalities to the surface to increase distress for vulnerable HHWs. Workplace mental health activities can support HHWs now and during future crises.

Extended impact of the COVID-19 pandemic: Trajectories of mental health and substance use among U.S. adults, September 2020-August 2021

Background

Americans reported significant increases in mental health and substance use problems after the COVID-19 pandemic outbreak. This can be a product of the pandemic disruptions in everyday life, with some populations being more impacted than others.

Objectives

To assess the ongoing impact of the COVID-19 pandemic on mental health and substance use in U.S. adults from September 2020 to August 2021.

Methods

Participants included 1056 adults (68.5% women) who participated in a national longitudinal online survey assessing the perceived impact of COVID-19 on daily life, stress, depression and anxiety symptoms, and alcohol and cannabis use at 3-time points from September 2020 to August 2021.

Results

Individuals with lower self-reported social status reported the highest perceived impact. Participants' perceived impact of the COVID-19 pandemic on daily life, stress, anxiety, and alcohol use risk significantly decreased over time but remained high. However, there was no change in depressive symptoms and cannabis use. Higher levels of perceived impact of the pandemic significantly predicted both more baseline mental health concerns and lower decreases over time. Lower self-report social status predicted more baseline mental health concerns and smaller decreases in those concerns. Black adults reported significantly higher cannabis use rates than non-Hispanic White adults.

Conclusion

The impact of COVID-19 on daily life continued to be a risk factor for mental health during the second wave of the pandemic. In addition to infection prevention, public health policies should focus on pandemic-related social factors such as economic concerns and caretaking that continue to affect mental health.

Adaptation to changes in COVID-19 pandemic severity: Across older adulthood and time scales

The COVID-19 pandemic has been observed to negatively affect older adults' psychological health compared with prepandemic levels. However, older adults' coping efficacy may differ depending on their age, and little is known about effects of fluctuations in pandemic severity. Two longitudinal studies tested the hypothesis that pandemic severity would affect psychological health and be moderated by age. In Study 1 (N = 111), older adults (aged 62-96) were assessed semiannually before and after the first United States COVID-19 case over up to 10 years. Depressive symptoms and stress, but not cognitive difficulties, were higher during COVID-19; pandemic severity had little effect. Estimated increases were smaller for a 65-year-old than for an 85-year-old. In Study 2 (N = 221), older adults (aged 51-95) were assessed weekly over up to 8 weeks during the COVID-19 pandemic. Higher national pandemic severity was associated with more cognitive difficulties, more depressive symptoms, and more stress. In an opposite pattern from Study 1, estimated increases were larger for a 65-year-old than for an 85-year-old. Old-old adults might be most susceptible to long-term psychological effects of the pandemic era, as in Study 1, but more resilient to short-term effects, as in Study 2. Coping strategies associated with increasing age may be less efficacious for more chronic and severe problems. Conversely, the same coping strategies may be more efficacious for shorter, less severe problems. Differentiating between reactivity to longer term and shorter term pandemic stressors can identify the most resilient or vulnerable ages within older adulthood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

How did Latinxs near the U.S.-Mexico border fare during the COVID-19 pandemic? A snapshot of anxiety, depression, and posttraumatic stress symptoms

Introduction

The current study documented levels of anxiety, depression, posttraumatic stress, and COVID-19 fears and impacts among Latinxs living near the U.S.-Mexico border during the COVID-19 pandemic.

Methods

Participants of this cross-sectional study were 305 Latinx adults living in the Rio Grande Valley (RGV) who completed an online survey between June and November 2020.

Results

About half of participants scored above the cut-off for anxiety (50.2%; GAD-7 scores ≥10) and depression (48.8%; PHQ-9 scores ≥10), and more than a quarter of participants showed clinical levels of posttraumatic stress (27.3%; PCL-5 scores ≥31). Latinxs reported on average 22 types of negative pandemic life impacts on the Epidemic-Pandemic Impacts Inventory. Endorsement of mental health symptoms, severity of COVID-19 fears, and COVID-related life impacts varied based on several demographic characteristics including gender, marital status, educational attainment, employment, income, insurance coverage, vulnerability to COVID-19, and essential worker status.

Discussion

Overall, the cross-sectional results of this study revealed that RGV Latinx residents experienced high levels of psychological distress during the pandemic. Results suggest that Latinx women were most affected by the psychological consequences of the pandemic. More research is needed with communities living near the U.S.-Mexico border as they may be particularly vulnerable to mental health problems during the pandemic.

Job loss and psychological distress during the COVID-19 pandemic: a national prospective cohort study

BACKGROUND

The COVID-19 pandemic caused substantial increases in unemployment; however, the association between these job losses and psychological distress is not well documented. Our study reports on this association from a cohort study, with a particular focus on educational differences in both the likelihood of job loss and its potential implications for mental health.

METHODS

Utilizing data from a large prospective cohort study of parents in Norway (n = 58,982), we examined changes in psychological distress within four groups of respondents: those who during the first wave of COVID-19 had (i) no change in their employment situation, (ii) worked from home, (iii) been furloughed, or (iv) lost their job.

RESULTS

Psychological distress increased in all groups. In z-scores relative to pre-pandemic levels, the increases were (i) 0.47 [95%-CI: 0.45-0.49] among respondents with no change in their employment situation, (ii) 0.51 [95%-CI: 0.49-0.53] among respondents who worked from home, (iii) 0.95 [95%-CI:0.91-0.99] among those furloughed, and (iv) 1.38 [95%-CI: 1.16-1.59] among those who permanently lost their job, corresponding to increases of 89%, 95%, 170%, and 185%, respectively. While respondents without university education had a 2 to 3 times higher risk of job loss, the negative impact of job loss on psychological distress was similar across educational levels.

CONCLUSIONS

Participants exposed to job loss during the pandemic experienced a stronger increase in symptoms of depression or anxiety compared to those who remained employed. Although higher education lowered the risk of losing work, it did not substantially diminish the impact on mental health from losing work.

Changes in frequency of cannabis use among people with HIV during the COVID-19 pandemic: a multi-methods study to explore the underlying reasons for change

Background: People with HIV (PWH) report higher rates of cannabis use than the general population. It is unclear how cannabis use among PWH has been impacted by the COVID-19 pandemic and the implications for the health and wellbeing of PWH.Objectives: To describe changes in frequency of cannabis use among a sample of PWH during the pandemic, reasons for those changes, and implications of the findings.Methods: The data are cross-sectional and come from questions asked in a follow-up phone survey administered to a prospective cohort of PWH in Florida between May 2020 and March 2021. Participants who used cannabis were asked about changes in their frequency of cannabis use in a quantitative survey and reasons for changes in a qualitative open-ended question. Qualitative data were analyzed using thematic analysis.Results: Among 227 PWH (mean age 50, 50% men, 69% Black/African American, 14% Hispanic/Latino), 13% decreased frequency of cannabis, 11% increased frequency, and 76% reported no change. The most common reasons for increasing frequency of cannabis use were reducing anxiety/stress, trying to relax, coping with grief or reducing symptoms of depression, and reducing boredom during the pandemic. Supply or access issues, health concerns, and having already wanted to reduce cannabis use were common reasons for decreased frequency.Conclusion: Nearly 25% of the sample changed their cannabis use frequency during the pandemic. These findings shed light on the behaviors and motivations of PWH who use cannabis and can inform clinical practice and interventions during public health emergencies and beyond.

Coping with COVID: risk and resilience factors for mental health in a German representative panel study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic might affect mental health. Data from population-representative panel surveys with multiple waves including pre-COVID data investigating risk and protective factors are still rare.

METHODS

In a stratified random sample of the German household population (n = 6684), we conducted survey-weighted multiple linear regressions to determine the association of various psychological risk and protective factors assessed between 2015 and 2020 with changes in psychological distress [(PD; measured via Patient Health Questionnaire for Depression and Anxiety (PHQ-4)] from pre-pandemic (average of 2016 and 2019) to peri-pandemic (both 2020 and 2021) time points. Control analyses on PD change between two pre-pandemic time points (2016 and 2019) were conducted. Regularized regressions were computed to inform on which factors were statistically most influential in the multicollinear setting.

RESULTS

PHQ-4 scores in 2020 (M = 2.45) and 2021 (M = 2.21) were elevated compared to 2019 (M = 1.79). Several risk factors (catastrophizing, neuroticism, and asking for instrumental support) and protective factors (perceived stress recovery, positive reappraisal, and optimism) were identified for the peri-pandemic outcomes. Control analyses revealed that in pre-pandemic times, neuroticism and optimism were predominantly related to PD changes. Regularized regression mostly confirmed the results and highlighted perceived stress recovery as most consistent influential protective factor across peri-pandemic outcomes.

CONCLUSIONS

We identified several psychological risk and protective factors related to PD outcomes during the COVID-19 pandemic. A comparison of pre-pandemic data stresses the relevance of longitudinal assessments to potentially reconcile contradictory findings. Implications and suggestions for targeted prevention and intervention programs during highly stressful times such as pandemics are discussed.

Delayed SARS-COV-2 clearance in infected persons in Ghana

Objective

This study aimed to determine the duration of SARS-CoV-2 clearance in persons in Ghana. The research question was whether the duration of virus clearance in Ghana matched the 14 days recommended by the World Health Organization (WHO); this had direct implications for transmission, which was key in managing the COVID-19 pandemic.

Design

This was a retrospective analytical study.

Setting

All facilities that submitted clinical specimens to Noguchi Memorial Institute for Medical Research (NMIMR) for SARS-CoV-2 diagnosis between March to June 2020 were included in the study.

Interventions

Samples from 480 persons who tested positive for SARS-CoV-2 by RT-PCR from March to June 2020 at NMIMR and submitted at least two follow-up samples were retrospectively analysed. Individuals with two consecutive negative RT-PCR retesting results were considered to have cleared SARS-CoV-2.

Results

The median time from the initial positive test to virus clearance was 20 days (IQR: 5-56 days). This was six days longer than the WHO-recommended 14 days, after which infected persons could be de-isolated. Sputum and nasopharyngeal swabs proved more sensitive for detecting viral RNA as the infection progressed. At a significance level of 0.05, age and sex did not seem to influence the time to SARS-CoV-2 clearance.

Conclusions

The median time to SARS-CoV-2 clearance in this study was 20 days, suggesting that SARS-CoV-2 infected persons in Ghana take longer to clear the virus. This finding calls for further investigations into whether patients who remain PCR positive continue to be infectious and inform isolation practices in Ghana.

Funding

The study was supported by the Ministry of Health/ Ghana Health Service through the provision of laboratory supplies, the US Naval Medical Research Unit #3, the World Health Organization, the Jack Ma Foundation and the Virology Department of Noguchi Memorial Institute for Medical Research, University of Ghana. Research projects within Noguchi Memorial Institute for Medical Research contributed reagents and laboratory consumables. However, the authors alone are responsible for the contents of this manuscript.

Characteristics Associated with Being a High Consumer of Sweet Foods and Sugar-Sweetened Beverages among US Adults during the COVID-19 Pandemic, 2021

BACKGROUND

The COVID-19 pandemic impacted some dietary habits of Americans.

OBJECTIVE

We examined characteristics associated with a high intake of sweet foods and sugar-sweetened beverages (SSB) during the COVID-19 pandemic among US adults.

DESIGN

This was a cross-sectional study.

PARTICIPANTS/SETTINGS

The SummerStyles survey data were collected in 2021 among 4034 US adults (≥18 years).

MAIN OUTCOME MEASURES

The frequencies were measured of consuming various sweet foods (chocolate/candy, doughnuts/sweet rolls/Danish/muffins/Pop-Tarts, cookies/cake/pie/brownies, and ice cream/frozen desserts) and SSB (regular sodas, sweetened coffee/tea drinks fruit drinks, sports drinks, and energy drinks) during the COVID-19 pandemic. The responses were categorized into 0, >0 to <1, 1 to <2, and ≥2 times/day. The descriptive variables were sociodemographics, food insecurity, weight status, metropolitan status, census regions, and eating habit changes during the COVID-19 pandemic.

STATISTICAL ANALYSES PERFORMED

Multinomial regressions were used to estimate adjusted odds ratios (AOR) for being a high consumer of sweet foods and SSB after controlling for characteristics.

RESULTS

During 2021, 15% of adults reported consuming sweet foods ≥2 times/day, and 30% reported drinking SSB ≥2 times/day. The factors that were significantly associated with greater odds of high sweet food intake (≥2 times/day) were lower household income (AOR = 1.53 for <$35,000 vs. ≥$100,000), often/sometimes experiencing food insecurity (AOR = 1.41 vs. never), and eating more sweet foods than usual since start of the pandemic (AOR = 2.47 vs. same as usual). The factors that were significantly associated with greater odds of high SSB intake (≥2 times/day) were males (AOR = 1.51), lower education (AOR = 1.98 for ≤high school; AOR = 1.33 for some college vs. college graduate), currently having children (AOR = 1.65), living in nonmetropolitan areas (AOR = 1.34), and drinking more SSB than usual since the pandemic began (AOR = 2.23 vs. same as usual). Younger age, Black race, and reductions in consumption during COVID-19 were related to lower sweet food and SSB intakes.

CONCLUSIONS

Our findings, which identified high consumers of sweet foods or SSB, can be used to inform efforts to reduce consumers' added sugars intake during pandemic recovery and support their health.

Hospitalization Associated With Comorbid Psychiatric and Substance Use Disorders Among Adults With COVID-19 Treated in US Emergency Departments From April 2020 to August 2021

Importance

During the COVID-19 pandemic, US emergency department (ED) visits for psychiatric disorders (PDs) and drug overdoses increased. Psychiatric disorders and substance use disorders (SUDs) independently increased the risk of COVID-19 hospitalization, yet their effect together is unknown.

Objective

To assess how comorbid PD and SUD are associated with the probability of hospitalization among ED patients with COVID-19.

Design, Setting, and Participants

This retrospective cross-sectional study analyzed discharge data for adults (age ≥18 years) with a COVID-19 diagnosis treated in 970 EDs and inpatient hospitals in the United States from April 2020 to August 2021.

Exposures

Any past diagnosis of (1) SUD from opioids, stimulants, alcohol, cannabis, cocaine, sedatives, or other substances and/or (2) PD, including attention-deficit/hyperactivity disorder (ADHD), anxiety, bipolar disorder, major depression, other mood disorder, posttraumatic stress disorder (PTSD), or schizophrenia.

Main Outcomes and Measures

The main outcome was any hospitalization. Differences in probability of hospitalization were calculated to assess its association with both PD and SUD compared with PD alone, SUD alone, or neither condition.

Results

Of 1 274 219 ED patients with COVID-19 (mean [SD] age, 54.6 [19.1] years; 667 638 women [52.4%]), 18.6% had a PD (mean age, 59.0 years; 37.7% men), 4.6% had a SUD (mean age, 50.1 years; 61.7% men), and 2.3% had both (mean age, 50.4 years; 53.1% men). The most common PDs were anxiety (12.9%), major depression (9.8%), poly (≥2) PDs (6.4%), and schizophrenia (1.4%). The most common SUDs involved alcohol (2.1%), cannabis (1.3%), opioids (1.0%), and poly (≥2) SUDs (0.9%). Prevalence of SUD among patients with PTSD, schizophrenia, other mood disorder, or ADHD each exceeded 21%. Based on significant specific PD-SUD pairs (Q < .05), probability of hospitalization of those with both PD and SUD was higher than those with (1) neither condition by a weighted mean of 20 percentage points (range, 6 to 36; IQR, 16 to 25); (2) PD alone by 12 percentage points (range, -4 to 31; IQR, 8 to 16); and (3) SUD alone by 4 percentage points (range, -7 to 15; IQR, -2 to 7). Associations varied by types of PD and SUD. Substance use disorder was a stronger predictor of hospitalization than PD.

Conclusions and Relevance

This study found that patients with both PD and SUD had a greater probability of hospitalization, compared with those with either disorder alone or neither disorder. Substance use disorders appear to have a greater association than PDs with the probability of hospitalization. Overlooking possible coexisting PD and SUD in ED patients with COVID-19 can underestimate the likelihood of hospitalization. Screening and assessment of both conditions are needed.

A longitudinal study of predictors of serious psychological distress during COVID-19 pandemic

BACKGROUND

The prevalence of serious psychological distress (SPD) was elevated during the COVID-19 pandemic in the USA, but the relationships of SPD during the pandemic with pre-pandemic SPD, pre-pandemic socioeconomic status, and pandemic-related social stressors remain unexamined.

METHODS

A probability-based sample (N = 1751) of the US population age 20 and over was followed prospectively from February 2019 (T1), with subsequent interviews in May 2020 (T2) and August 2020 (T3). Multinomial logistic regression was used to assess prospective relationships between T1 SPD with experiences of disruption of employment, health care, and childcare at T2. Binary logistic regression was then used to assess relationships of T1 SPD, and socioeconomic status and T2 pandemic-related stressors with T3 SPD.

RESULTS

At T1, SPD was associated with age, race/ethnicity, and household income. SPD at T1 predicted disruption of employment (OR 4.5, 95% CI 1.4-3.8) and health care (OR 3.2, 95% CI 1.4-7.1) at T2. SPD at T1 (OR 10.2, 95% CI 4.5-23.3), low household income at T1 (OR 2.6, 95% CI 1.1-6.4), disruption of employment at T2 (OR 3.2, 95% CI 1.4-7.6), and disruption of healthcare at T2 (OR 3.3, 95% CI 1.5-7.2) were all significantly associated with elevated risk for SPD at T3.

CONCLUSIONS

Elevated risk for SPD during the COVID-19 pandemic is related to multiple psychological and social pathways that are likely to interact over the life course. Policies and interventions that target individuals with pre-existing mental health conditions as well as those experiencing persistent unemployment should be high priorities in the mental health response to the pandemic.

Mental Health and Alcohol Use during and before the Early Phases of the COVID-19 Pandemic

The early phases of the coronavirus 19 disease (COVID-19) pandemic were associated with changes in psychological well-being and alcohol use. However, it is unclear whether these changes are artifacts of psychological well-being and alcohol use prior to the pandemic across different sociodemographic groups. We received surveys from 247 adult residents of Allegheny County, Pennsylvania (United States), with an oversampling of sexual- and gender-minority individuals. Responses included measures of psychological well-being, substance use, and sociodemographic characteristics. Unadjusted mean depression scores, anxiety scores, and number of drinking days increased for all age and income groups during COVID-19, while average number of drinks per drinking day and days intoxicated differentially increased or decreased by age and income groups. Using Bayesian seemingly unrelated regression, we assessed depression and anxiety symptoms and alcohol use during the early stages of the pandemic and one month before COVID-19 was first identified in Allegheny County concurrently. Those in the youngest (18-24) group drank on more days during (but not before) the pandemic than those in the 25-44 age group. Compared to cisgender women, gender-minority adults had higher depression scores during the early stages of the pandemic. Employed adults had lower anxiety scores during (but not before) the pandemic than adults who were unemployed. Those with past-year annual incomes above $80,000 had fewer drinks on average drinking occasions than those in the $40,000 or below group before (but not during) the pandemic. Patterns of psychological distress and alcohol use associated with the COVID-19 pandemic differ by subgroup compared to patterns prior to the pandemic. Interventions addressing worsening mental health outcomes and shifting alcohol use patterns must be sensitive to the needs of vulnerable groups, such as younger adults and those experiencing poverty or unemployment.

Experiences of adolescent and young adult cancer survivors during the COVID-19 pandemic

PURPOSE

This study aimed to evaluate the impact of the COVID-19 pandemic on adolescent and young adult (AYA) cancer survivors.

METHODS

We conducted a cross-sectional survey of AYAs aged 18-49 with cancer in Canada between January and February 2021. Data from survivors, defined as AYAs more than one year off cancer treatment, were analysed. Multiple logistic regression was used to identify factors associated with psychological distress, loneliness and insomnia.

RESULTS

The analysis included 384 survivors. Moderate-to-severe psychological distress was reported by 257 (68.9%) survivors and was associated with an income ≥ $60,000 (adjusted odds ratio [AOR] 2.15, 95% CI 1.11-4.17) and the presence of a pre-existing chronic physical health condition (AOR 2.05, 95% CI 1.18-3.56). Loneliness was reported by 204 (54.0%) survivors and was associated with being unemployed (AOR 2.26 95%CI 1.18-4.31), pandemic causing finances to be worse (AOR 1.82, 95%CI 1.08-3.06) and the presence of a pre-pandemic mental health condition (AOR 1.88, 95% CI 1.03-3.42). Clinical insomnia was reported by 74 (19.5%) survivors and was associated with employment status as a student (AOR 3.00, 95% CI 1.08-8.29) or unemployed (AOR 3.97, 95% CI 1.46-10.83), earning $60,000 or more in the year 2020 (AOR 4.36, 95% CI 1.43-13.32), having haematologic cancer (AOR 2.21, 95% CI 1.05-4.70) and being single (AOR 2.52, 95% CI 1.08-5.91). Pandemic negatively affected employment, finances, physical activity, cancer care and substance use for 73.9%, 66.5%, 32.5%, 21.8% and 19.2% of survivors, respectively. Worries about finances, contracting COVID-19, cancer treatment increasing the risk of COVID-19 infection, and having poor health outcomes from contracting COVID-19 were reported by 46.0%, 45.6%, 55.0% and 47.3% of survivors, respectively.

CONCLUSIONS

The COVID-19 pandemic has had a significant impact on AYA cancer survivors, and these individuals report high levels of psychological distress, insomnia and loneliness.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors are at risk for worsening mental and physical health outcomes during the COVID-19 pandemic. Targeted interventions and support programs are urgently needed to support the mental health of AYA cancer survivors and optimize their health outcomes.

The importance of high quality real-life social interactions during the COVID-19 pandemic

The coronavirus pandemic has brought about dramatic restrictions to real-life social interactions and a shift towards more online social encounters. Positive social interactions have been highlighted as an important protective factor, with previous studies suggesting an involvement of the amygdala in the relationship between social embeddedness and well-being. The present study investigated the effect of the quality of real-life and online social interactions on mood, and explored whether this association is affected by an individual's amygdala activity. Sixty-two participants of a longitudinal study took part in a one-week ecological momentary assessment (EMA) during the first lockdown, reporting their momentary well-being and their engagement in real-life and online social interactions eight times per day (N ~ 3000 observations). Amygdala activity was assessed before the pandemic during an emotion-processing task. Mixed models were calculated to estimate the association between social interactions and well-being, including two-way interactions to test for the moderating effect of amygdala activity. We found a positive relationship between real-life interactions and momentary well-being. In contrast, online interactions had no effect on well-being. Moreover, positive real-life social interactions augmented this social affective benefit, especially in individuals with higher amygdala being more sensitive to the interaction quality. Our findings demonstrate a mood-lifting effect of positive real-life social interactions during the pandemic, which was dependent on amygdala activity before the pandemic. As no corresponding effect was found between online social interactions and well-being, it can be concluded that increased online social interactions may not compensate for the absence of real-life social interactions.

Association between reasons for not working and reporting of major depression and anxiety symptoms among U.S. adult population during the COVID-19 pandemic

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.

Mental health impact of the COVID-19 pandemic in U.S. military veterans: a population-based, prospective cohort study

BACKGROUND

The coronavirus disease-2019 (COVID-19) pandemic has caused myriad health, social, and economic stressors. To date, however, no known study has examined changes in mental health during the pandemic in the U.S. military veteran population.

METHODS

Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative, prospective cohort survey of 3078 veterans. Pre-to-peri-pandemic changes in psychiatric symptoms were evaluated, as well as pre-pandemic risk and protective factors and pandemic-related correlates of increased psychiatric distress.

RESULTS

The prevalence of generalized anxiety disorder (GAD) positive screens increased from pre- to peri-pandemic (7.1% to 9.4%; p < 0.001) and was driven by an increase among veterans aged 45-64 years (8.2% to 13.5%; p < 0.001), but the prevalence of major depressive disorder and posttraumatic stress disorder positive screens remained stable. Using a continuous measure of psychiatric distress, an estimated 13.2% of veterans reported a clinically meaningful pre-to-peri-pandemic increase in distress (mean = 1.1 standard deviation). Veterans with a larger pre-pandemic social network size and secure attachment style were less likely to experience increased distress, whereas veterans reporting more pre-pandemic loneliness were more likely to experience increased distress. Concerns about pandemic-related social losses, mental health COVID-19 effects, and housing stability during the pandemic were associated with increased distress, over-and-above pre-pandemic factors.

CONCLUSIONS

Although most U.S. veterans showed resilience to mental health problems nearly 1 year into the pandemic, the prevalence of GAD positive screens increased, particularly among middle-aged veterans, and one of seven veterans experienced increased distress. Clinical implications of these findings are discussed.

Prevalence of Poor Mental Health Days and Adverse Childhood Experience Reporting in U.S. Adults Before and After COVID-19

This is the first study of US adults to examine change in the prevalence of psychological burden (i.e., self-reported poor mental health days in the past 30 days, and ACEs recollections) before compared to after COVID-19 started. We analyzed the prevalence of self-reported poor mental health days, and ACEs recollections from 17 states using the Behavioral Risk Factor Surveillance System. Adjusted models identified an increase in prevalence from before compared to after COVID-19 onset in those married or partnered reporting 48% more poor mental health days in the past 30 days; persons of color reporting living with anyone with mental illness during childhood by 73% and reporting more ACEs by 35%; those employed or self-employed reporting childhood sexual abuse by 45%. This ecological-level analysis revealed population-level changes in psychological well-being reporting of U.S. adults from before compared to after the pandemic onset.

Living with dementia during the COVID-19 pandemic: insights into identity from the IDEAL cohort

The continuing COVID-19 pandemic and social restrictions have impacted on the cognitive decline and mental health of people with dementia. Social isolation and loss of activities due to social restrictions may also have implications as to sense of identity for people with dementia. As part of the INCLUDE (Identifying and Mitigating the Individual and Dyadic Impact of COVID-19 and Life Under Physical Distancing on People with Dementia and Carers) component of the IDEAL (Improving the Experience of Dementia and Enhancing Active Life) cohort study, the overall aim of this subtle realist qualitative study was to explore the perspectives of people with dementia on living through the COVID-19 pandemic within the context of the ‘post-vaccine’ period and the national lockdowns in England and Wales; and to determine perceived challenges to and facilitators of ‘living well’ during the COVID-19 pandemic and beyond as restrictions were eased. In addition, the study findings are considered in relation to understandings of identity in dementia which the broader accounts of living through the pandemic have highlighted. Seven people with mild-to-moderate dementia were interviewed and themes were derived using framework analysis. Themes suggest interviewees' stoic acceptance of the pandemic and social restrictions but also fear of decline related to the temporality of their condition as well as loss of self-confidence to re-engage with the world. Interviewees managed threats to social identity by striving to maintain social and emotional connections, where the importance of a shared, social identity, particularly for people with young-onset dementia, was also apparent. Unlike in previous studies during the pandemic, the relevance of occupation for identity was observed, where maintaining previous or new activities or occupations was important to facilitate identity as well as to keep a sense of purpose. Therefore, as well as supporting people with dementia as the pandemic eases, future research into occupation and identity in dementia is of potential value.

Mental Health Service Utilization Rates Among Commercially Insured Adults in the US During the First Year of the COVID-19 Pandemic

Importance

The COVID-19 pandemic has been associated with an elevated prevalence of mental health conditions and disrupted mental health care throughout the US.

Objective

To examine mental health service use among US adults from January through December 2020.

Design, Setting, and Participants

This cohort study used county-level service utilization data from a national US database of commercial medical claims from adults (age >18 years) from January 5 to December 21, 2020. All analyses were conducted in April and May 2021.

Main Outcomes and Measures

Per-week use of mental health services per 10 000 beneficiaries was calculated for 5 psychiatric diagnostic categories: major depressive disorder (MDD), anxiety disorders, bipolar disorder, adjustment disorders, and posttraumatic stress disorder (PTSD). Changes in service utilization rates following the declaration of a national public health emergency on March 13, 2020, were examined overall and by service modality (in-person vs telehealth), diagnostic category, patient sex, and age group.

Results

The study included 5 142 577 commercially insured adults. The COVID-19 pandemic was associated with more than a 50% decline in in-person mental health care service utilization rates. At baseline, there was a mean (SD) of 11.66 (118.00) weekly beneficiaries receiving services for MDD per 10 000 enrollees; this declined by 6.44 weekly beneficiaries per 10 000 enrollees (β, -6.44; 95% CI, -8.33 to -4.54). For other disorders, these rates were as follows: anxiety disorders (mean [SD] baseline, 12.24 [129.40] beneficiaries per 10 000 enrollees; β, -5.28; 95% CI, -7.50 to -3.05), bipolar disorder (mean [SD] baseline, 3.32 [60.39] beneficiaries per 10 000 enrollees; β, -1.81; 95% CI, -2.75 to -0.87), adjustment disorders (mean [SD] baseline, 12.14 [129.94] beneficiaries per 10 000 enrollees; β, -6.78; 95% CI, -8.51 to -5.04), and PTSD (mean [SD] baseline, 4.93 [114.23] beneficiaries per 10 000 enrollees; β, -2.00; 95% CI, -3.98 to -0.02). Over the same period, there was a 16- to 20-fold increase in telehealth service utilization; the rate of increase was lowest for bipolar disorder (mean [SD] baseline, 0.13 [16.72] beneficiaries per 10 000 enrollees; β, 1.40; 95% CI, 1.04-1.76) and highest for anxiety disorders (mean [SD] baseline, 0.20 [9.28] beneficiaries per 10 000 enrollees; β, 9.12; 95% CI, 7.32-10.92). When combining in-person and telehealth service utilization rates, an overall increase in care for MDD, anxiety, and adjustment disorders was observed over the period.

Conclusions and Relevance

In this cohort study of US adults, we found that the COVID-19 pandemic was associated with a rapid increase in telehealth services for mental health conditions, offsetting a sharp decline in in-person care and generating overall higher service utilization rates for several mental health conditions compared with prepandemic levels.

Perceived discrimination based on the symptoms of covid-19, mental health, and emotional responses-the international online COVISTRESS survey

BACKGROUND

Despite the potential detrimental consequences for individuals' health and discrimination from covid-19 symptoms, the outcomes have received little attention. This study examines the relationships between having personally experienced discrimination based on the symptoms of covid-19 (during the first wave of the pandemic), mental health, and emotional responses (anger and sadness). It was predicted that covid-19 discrimination would be positively related to poor mental health and that this relationship would be mediated by the emotions of anger and sadness.

METHODS

The study was conducted using an online questionnaire from January to June 2020 (the Covistress network; including 44 countries). Participants were extracted from the COVISTRESS database (Ntotal = 280) with about a half declaring having been discriminated due to covid-19 symptoms (N = 135). Discriminated participants were compared to non-discriminated participants using ANOVA. A mediation analysis was conducted to examine the indirect effect of emotional responses and the relationships between perceived discrimination and self-reported mental health.

RESULTS

The results indicated that individuals who experienced discrimination based on the symptoms of covid-19 had poorer mental health and experienced more anger and sadness. The relationship between covid-19 personal discrimination and mental health disappeared when the emotions of anger and sadness were statistically controlled for. The indirect effects for both anger and sadness were statistically significant.

DISCUSSION

This study suggests that the covid-19 pandemic may have generated discriminatory behaviors toward those suspected of having symptoms and that this is related to poorer mental health via anger and sadness.

Trajectories of psychological distress during the COVID-19 pandemic among community-dwelling older adults in Quebec: A longitudinal study

OBJECTIVE

The COVID-19 pandemic and its associated public health measures may increase the risk for psychological distress among vulnerable older adults. This longitudinal study aimed to identify predictors of psychological distress trajectories among community-dwelling older adults in Quebec, Canada.

METHODS

The study spanned four time points across 13 months and three waves of the COVID-19 pandemic. The sample included 645 community-dwelling older adults ages 60 years and older in Quebec. Participants completed telephone-based interviews that included the Kessler 6-item Psychological Distress Scale (K6) to assess psychological distress at each time point as well as information on socioeconomic, medical, psychological and COVID-19 related factors. Group-based trajectory modelling was used to identify distinct trajectories of psychological distress across time.

RESULTS

Three group-based trajectories of psychological distress were identified: the resilient (50.5%), reactive (34.9%), and elevated distress groups (14.6%). Individuals with mobility issues, insomnia symptoms, COVID-19 related acute stress, general health anxiety, increased loneliness symptoms, and those unable to use technology to see others were more likely to be in the reactive and elevated groups than the resilient group. Those with past mental health problems had uniquely increased odds of being in the reactive group compared to the resilient group. Individuals living in poverty and those who reported taking psychotropic medication had increased odds of being in the elevated distress group compared to the resilient group.

CONCLUSION

These findings characterized distinct trajectories of psychological distress in older adults and identified risk factors for elevated distress levels.

Fatal drug use in the COVID-19 pandemic response: Changing trends in drug-involved deaths before and after stay-at-home orders in Louisiana

The effect of disaster events on increasing drug-involved deaths has been clearly shown in previous literature. As the COVID-19 pandemic led to stay-at-home orders throughout the United States, there was a simultaneous spike in drug-involved deaths around the country. The landscape of a preexisting epidemic of drug-involved deaths in the United States is one which is not geographically homogenous. Given this unequal distribution of mortality, state-specific analysis of changing trends in drug use and drug-involved deaths is vital to inform both care for people who use drugs and local policy. An analysis of public health surveillance data from the state of Louisiana, both before and after the initial stay-at-home order of the COVID-19 pandemic, was used to determine the effect the pandemic may have had on the drug-involved deaths within this state. Using the linear regression analysis of total drug-involved deaths, as well as drug-specific subgroups, trends were measured based on quarterly (Qly) deaths. With the initial stay-at-home order as the change point, trends measured through quarter 1 (Q1) of 2020 were compared to trends measured from quarter 2 (Q2) of 2020 through quarter 3 (Q3) of 2021. The significantly increased rate of change in Qly drug-involved deaths, synthetic opioid-involved deaths, stimulant-involved deaths, and psychostimulant-involved deaths indicates a long-term change following the initial response to the COVID-19 pandemic. Changes in the delivery of mental health services, harm reduction services, medication for opioid use disorder (MOUD), treatment services, withdrawal management services, addiction counseling, shelters, housing, and food supplies further limited drug-involved prevention support, all of which were exacerbated by the new stress of living in a pandemic and economic uncertainty.

Potential Impact of the COVID-19 Pandemic on Public Perception of Water Pipes on Reddit: Observational Study

Background

Socializing is one of the main motivations for water pipe smoking. Restrictions on social gatherings during the COVID-19 pandemic might have influenced water pipe smokers' behaviors. As one of the most popular social media platforms, Reddit has been used to study public opinions and user experiences.

Objective

In this study, we aimed to examine the influence of the COVID-19 pandemic on public perception and discussion of water pipe tobacco smoking using Reddit data.

Methods

We collected Reddit posts between December 1, 2018, and June 30, 2021, from a Reddit archive (PushShift) using keywords such as "waterpipe," "hookah," and "shisha." We examined the temporal trend in Reddit posts mentioning water pipes and different locations (such as homes and lounges or bars). The temporal trend was further tested using interrupted time series analysis. Sentiment analysis was performed to study the change in sentiment of water pipe-related posts before and during the pandemic. Topic modeling using latent Dirichlet allocation (LDA) was used to examine major topics discussed in water pipe-related posts before and during the pandemic.

Results

A total of 45,765 nonpromotion water pipe-related Reddit posts were collected and used for data analysis. We found that the weekly number of Reddit posts mentioning water pipes significantly increased at the beginning of the COVID-19 pandemic (P<.001), and gradually decreased afterward (P<.001). In contrast, Reddit posts mentioning water pipes and lounges or bars showed an opposite trend. Compared to the period before the COVID-19 pandemic, the average number of Reddit posts mentioning lounges or bars was lower at the beginning of the pandemic but gradually increased afterward, while the average number of Reddit posts mentioning the word "home" remained similar during the COVID-19 pandemic (P=.29). While water pipe-related posts with a positive sentiment were dominant (12,526/21,182, 59.14% before the pandemic; 14,686/24,583, 59.74% after the pandemic), there was no change in the proportion of water pipe-related posts with different sentiments before and during the pandemic (P=.19, P=.26, and P=.65 for positive, negative, and neutral posts, respectively). Most topics related to water pipes on Reddit were similar before and during the pandemic. There were more discussions about the opening and closing of hookah lounges or bars during the pandemic.

Conclusions

This study provides a first evaluation of the possible impact of the COVID-19 pandemic on public perceptions of and discussions about water pipes on Reddit.

How Has COVID-19 Affected Mental Health and Lifestyle Behaviors after 2 Years? The Third Step of a Longitudinal Study of Italian Citizens

The COVID-19 pandemic and its protective measures had a tremendous effect on the general population's mental health and deeply affected their lifestyle. The present study carried out a longitudinal analysis to evaluate the long-lasting psychological effects of the pandemic and its impact on the general population's day-to-day routine. Three points in time were considered: the initial period of the lockdown (T1; n = 2766; March 2020), the final period of the lockdown (T2; n = 439; May 2020) and two years after the lockdown (T3; n = 268; July 2022). Frequency analyses were carried out to examine which behavioral changes were maintained following the COVID-19 pandemic and lockdown; furthermore, a repeated measures ANOVA test was run to measure differences in depression, stress, and anxiety levels between the three periods considered; lastly, multivariable ordinal logistic regression analyses were carried out to examine which variables were associated with psychological distress more than two years after the lockdown. The results highlighted that depression at T3 was associated with depression at T2 and negative affect, whereas stress at T3 was associated with stress at T2 and detachment. The psychological effects and lifestyle changes are also discussed.

Leading Predictors of COVID-19-Related Poor Mental Health in Adult Asian Indians: An Application of Extreme Gradient Boosting and Shapley Additive Explanations

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.

Comparison of Psychiatric Service Utilization Prior, During, and After COVID-19 Lockdown: A Retrospective Cohort Study

Background COVID-19 pandemic represents a significant risk factor for developing, relapsing, or exacerbating pre-existing mental health conditions. This negative impact on mental health results in increasing demand for psychiatric services. This study aimed to explore the effects of COVID-19 pandemic lockdown on the utilization of mental health services in three periods - prior, during, and after the lockdown - compared to the matched weeks in the previous years 2018 and 2019. Materials and Method In this retrospective cohort, quantitative, single-center study, data were collected from electronic medical records, including all patients with referrals\consultations to the psychiatric section prior, during, and after COVID-19 lockdown. Results In total, 2,454 patients were either referred to psychiatric outpatient clinics or needed consultation as inpatients during the study periods. Only 2,326 patients were included in our study. The total number of inpatient consultations was 1,410, with a statistically significant increase during the lockdown (p-value<0.001) and post-lockdown (p<0.016) in comparison to previous years. A significant reduction in outpatient referrals was observed during the lockdown (p=0.005) and post-lockdown period. Psychiatric disorders were identified in most patients (N=1,599), representing 65%, 54%, and 74% of patients in pre-lockdown, lockdown, and post-lockdown periods compared to 71%, 71%, and 76%, respectively, in the previous years. A total of 821 patients manifested symptoms of depression, constituting the largest proportion among all reasons for referral\consultations. The number of patients referred for substance/alcohol use disorders during the lockdown increased compared to patients in the same period in 2019. Suicidal behavior was identified in 70 patients across all study periods, with the lowest number observed in 2020. Conclusion Our findings indicate that during the COVID-19 lockdown, a significant increase in inpatient psychiatric services utilization was observed. Outpatient psychiatric service utilizations were significantly reduced. Implementation of evidence-based policy and protocol to guide mental health challenges in future health emergencies is needed.

Increasing psychological distress among Californians from 2013 to 2020: Race/ethnic differences

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.

Cardiorespiratory Fitness and Depression Symptoms among Adults During the COVID-19 Pandemic: Cooper Center Longitudinal Study

This study examined the relation between cardiorespiratory fitness (fitness) and depression symptoms prior to and during COVID-19 among adults seeking preventive medical care. Participants consisted of 967 patients attending the Cooper Clinic (Dallas, TX) pre-pandemic (March 2018-December 2019) and during the pandemic (March-December 2020). The outcome, depression symptoms, was based on the Center for Epidemiological Studies-Depression (CES-D). Maximal metabolic equivalents task (MET) levels for fitness were determined from the final treadmill speed and grade. Multiple linear regression models were computed by sex. Analysis revealed that mean fitness decreased from 11.4 METs (SD=2.1) prior to the pandemic to 10.9 METs (SD=2.3) during the pandemic (p-value<0.001). The mean CES-D score increased from 2.8 (SD= 3.1) before to pandemic to 3.1 (SD=3.2) during the pandemic (p-value=0.003). Results from multiple linear regression indicate that increased fitness was associated with a statistically significant decrease in depression scores in men (-0.17 per MET; 95%CI -0.33, -0.02) but not women. This modest decrease may have been tempered by high fitness levels and low depression scores at baseline in this well-educated sample.

Psychological distress during the COVID-19 pandemic in Canada

BACKGROUND

During major pandemics such as COVID-19, the fear of being infected, uncertain prognoses, and the imposition of restrictions may result in greater odds of emotional and psychological distress. Hence, the present study examines the predictors of psychological distress during the COVID-19 pandemic in Canada, and how they differ by gender.

METHODS

Data of 2,756 adults aged 18 years and above from a cross-sectional online survey conducted between July and October 2020 was used for this study. A multivariable logistic regression analysis was carried out. The results were presented as adjusted odds ratio (aOR) with their respective confidence interval (CI).

RESULTS

Lower odds of psychological distress were found among males compared to females and among individuals aged 45-64 or 65-84 years compared to those aged 18-44. The odds of psychological distress decreased with a rise in income, with individuals whose annual income was greater than or equal to $100,000 being less likely to experience psychological distress compared to those whose income was less than $20,000. The odds of psychological distress were higher among residents of Ontario compared to residents of Quebec. Similarly, the odds of psychological distress were higher among individuals who reported experiencing COVID-19 symptoms compared to those who did not report any COVID-19 symptoms. The disaggregated results by gender showed that age, province, and self-reported COVID-19 symptoms had significant associations with psychological distress in both males and females, but these effects were more pronounced among females compared to males. In addition, income was negatively associated with psychological distress for both males and females, with this effect being stronger among males.

CONCLUSION

Five exposure variables (gender, age, province, experiencing COVID-19 symptoms, and total annual income in 2019) significantly predicted the likelihood of reporting psychological distress during the COVID-19 pandemic in Canada. Clearly, there is an imminent need to provide mental health support services to vulnerable groups. Additionally, interventions and policies aimed at combating psychological distress during pandemics such as COVID-19 should be gender specific.

Mortality by cause of death during year 1 of the COVID-19 pandemic in a cohort of older adults from Baltimore Maryland who have injected drugs

BACKGROUND

In 2020, the first year of the COVID-19 pandemic, overdose deaths increased. However, no studies have characterized changes in mortality during the pandemic in a well-characterized cohort of people who use drugs in active follow-up at the time of pandemic onset.

DESIGN

We compared all-cause and cause-specific mortality in the first year of the pandemic (Mar-Dec 2020) to the five years preceding (Jan 2015-Feb 2020), among participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study: a community-recruited cohort of adults from Baltimore who have injected drugs. 3510 participants contributed 17,498 person-years [py] of follow-up time. Cause and dates of death were ascertained through the National Death Index. Comparisons were made for the full cohort and within subgroups with potentially differential levels of vulnerability.

RESULTS

All-cause mortality in 2020 was 39.6 per 1000 py, as compared to 37.2 per 1000 py pre- pandemic (Adjusted Incidence Rate Ratio = 1.09, 95%: confidence interval: 0.84-1.41). Increases were mostly attributable to chronic disease deaths; injury/poisoning deaths did not increase. No pre-post differences were statistically significant.

CONCLUSION

In this exploratory analysis of an older cohort of urban-dwelling adults who have injected drugs, mortality changes during the first year of the pandemic differed from national trends and varied across potentially vulnerable subgroups. More research is needed to understand determinants of increased risk of mortality during the pandemic among subgroups of people who use drugs.

A Scoping Review on the Medical and Recreational Use of Cannabis During the COVID-19 Pandemic

Background/Introduction: The shelter-in-place orders and social distancing regulations on account of the COVID-19 pandemic have impacted lifestyles, including the use of cannabis. The purpose of this scoping review is to summarize both the gray and academic literature on the use of cannabis during the pandemic. Materials and Methods: A total of 11 databases, including 2 medical databases, 7 social science databases, and 2 gray literature databases were searched resulting in 316 titles and abstracts of which 76 met inclusion criteria. Results: Nine themes emerged: (a) prevalence and trends of cannabis use during COVID[1]19; (b) demographics; (c) profile of mode of consumption; (d) context of using cannabis (i.e., solitary use vs. in groups); (e) factors contributing to use; (f) factors inhibiting use; (g) adverse clinical and psychiatric outcomes of cannabis use during the pandemic; (h) similarities between EVALI (E-Cigarette or Vaping Product Use-Associated Lung Injury) and COVID-19 symptoms; (i) implications for policy and practice. Studies published until February 2, 2021 were included in this review. Discussion: Findings have highlighted that feelings of boredom, depression, and anxiety during the pandemic have contributed to an increase in the use of cannabis. Furthermore, accessibility to cannabis was noted to affect use during the pandemic. Adverse psychiatric and clinical outcomes were associated with the increased use of cannabis. Conclusion: Practitioners and policymakers are called to employ harm reduction strategies to respond to increasing cannabis use. There is a need for population-based studies and further examination of factors contributing to the increased use of cannabis during the pandemic and associated negative consequences.

Job loss and psychological distress during the COVID-19 pandemic: Longitudinal Analysis from residents in nine predominantly African American low-income neighborhoods

While psychological distress is a common sequelae of job loss, how that relationship continued during the COVID-19 pandemic is unclear, for example, given higher health risk to working due to disease exposure. This paper examines changes in psychological distress depending on job loss among a cohort of randomly selected residents living in nine predominantly African American low-income neighborhoods in Pittsburgh PA across four waves between 2013 and 2020. Between 2013 and 2016, we found an increase in psychological distress after job loss in line with the literature. In contrast, between 2018 and 2020 we found change in psychological distress did not differ by employment loss. However, residents who had financial concerns and lost their jobs had the largest increases in psychological distress, while residents who did not have serious financial concerns-potentially due to public assistance-but experienced job loss had no increase in distress, a better outcome even than those that retained their jobs. Using partial identification, we find job loss during the pandemic decreased psychological distress for those without serious financial concerns. This has important policy implications for how high-risk persons within low-income communities are identified and supported, as well as what type of public assistance may help.

Financial Distress and Psychological Well-Being During the COVID-19 Pandemic

Objective: We examine the impact of financial distress caused by the COVID-19 pandemic on mental health and psychological well-being.

Methods: We analyze cross-sectional survey data (n = 2,545) from the Life during Pandemic study in Chile. We estimate linear probability models to analyze the relationship between economic fragility, financial distress, and psychological well-being.

Results: Our findings show unemployment and income loss are highly predictive of experiencing a range of financial problems, such as a lack of savings, as well as difficulties paying bills, consumer debt, and mortgage loans. In turn, financial distress leads to a higher prevalence of poor well-being and mental health deterioration, and sleep problems.

Conclusion: Expansion of mental health assistance services are needed, as new diagnosis of mental health conditions has increased, but treatment has not, pointing to a barrier in the access to some mental health care services during the pandemic. Policies designed with the objective of improving financial education are necessary to increase precautionary savings and financial resilience, and alleviate the psychological burden of debt in the future.

The Association between Active Mobility and Subjective Wellbeing during COVID-19 in MENA Countries

Objective: To augment the international scientific approach to raising public mental health through active lifestyle among adults, we added the evidence of the association between physical activity and subjective wellbeing in the Middle East and North Africa region by emphasizing the mediator—COVID-19. This study aimed to identify the correlations between active mobility and subjective wellbeing during the COVID-19 pandemic in a sample from Tabriz, Iran, which has not yet been tackled in previous study. Methods: We finalized an online survey (N = 603) from adults between 5 June and 15 July 2021. This group reported their individual and socio-economic characteristics and their perception features and location (e.g., home, work) during COVID-19. The paper developed three ordinal logistic regression (OLR) models to examine the association between active mobility types such as commute, non-commute, frequency of active travel to parks and services per week, and different subjective wellbeing including: 1- life satisfaction, 2- feeling energetic, and 3- peaceful mind while controlling for socio-economic variables (e.g., age, gender, education, job, and income) and objective commute distance. We also incorporated the most relevant objective (street length, land-use mix, number of intersections, and building and population density) and subjective (perceived distance to different services, perceived walking places, and perceived facilities attractiveness) factors. Results: Positive response relationships between four types of physical activity levels and subjective wellbeing scores were demonstrated in all of the three developed models (with significant levels of 0.05, and 0.1) with appropriate model fits, which confirmed the existing literature. However, these relationships showed different patterns (varied significant levels) for each type of subjective wellbeing. In addition, the factors including street length (p value: 0.004), perceived walkable places (p value: 0.021, 0.068, 0.017, and 0.025) (positively), population density, and perceived distance to shopping malls (p value: 0.076, <0.0001, and 0.059 (negatively) were associated with different indicators of subjective wellbeing. Conclusion: As for the implication of our study, special actions by urban authorities such as increasing mixed-use and creating attractive places will be required to enhance the walkability of the neighborhoods. Moreover, notifying the adults regarding the benefits of physical activity is much more needed.

Mental Health Outcomes and Sleep Status among Patients with Coronavirus Disease 2019

Objective: The immediate impacts of coronavirus disease 2019 (COVID-19) on mental health of affected patients and psychiatric morbidities of these patients has been neglected by researchers. We assessed mental health outcomes and sleep status among inpatients and outpatients with COVID-19 who were initially referred to our COVID-19 clinic in Mashhad, Iran during April-October 2020. Method : In this ethically approved cross-sectional study, 130 patients with confirmed COVID-19 who were referred to outpatient clinics and wards of a referral hospital in Mashhad, Iran were surveyed during April-October 2020. Demographic data were collected after obtaining informed written consent. Validated Persian versions of insomnia severity index (ISI), 9-item patient health questionnaire (PHQ-9), and 7-item generalized anxiety disorder (GAD-7) and revised impact of event scale (IES-R) were used as main outcome measures (i.e. status of anxiety, depression, insomnia, and event-related distress). Analysis was performed with SPSS using binary logistic regression. P-values < 0.05 were considered significant. Results: Overall, 65 inpatients and 65 outpatients were surveyed. The two groups did not significantly defer in terms of insomnia and depression severity, but the outpatients showed higher levels of anxiety (52.3% vs. 24.6%, P = 0.005) and distress compared to inpatients (80.0% vs. 64.6%, P < 0.001). Male sex (OR = 0.017, 95%CI = 0.000-0.708, P = 0.032) exhibited independent and inverse association with depression in COVID-19 patients. Being married (OR = 0.102, 95% CI = 0.018-0.567, P = 0.009) was independently and inversely associated with anxiety. Insomnia was independently associated with event-related distress (OR = 7.286, 95%CI = 2.017-26.321, P = 0.002). Only depression was independently associated with insomnia (OR = 49.655, 95%CI = 2.870-859.127, P = 0.007). Conclusion: We found symptoms of psychological distress and anxiety to be more prevalent among outpatients with COVD-19 than inpatients. Insomnia can be a potential risk factor for adverse mental health outcomes in these patients.

Mediating Effect of Psychological Process Variables on the Relationship between Dysfunctional Coping and Psychopathologies: A Comparative Study on Psychopathologies during COVID-19

The COVID-19 crisis has had repercussions on global mental wellbeing. This study aimed: (1) to identify the mediating role of psychological process variables, namely psychological mindedness, psychological mindfulness, and psychological inflexibility on the relationship between dysfunctional coping and psychopathologies in Indonesian undergraduate students subjected to national quarantine orders throughout July, 2020 and (2) to compare the level of anxiety, depression, and anxiety between Indonesian and Malaysian undergraduate students. A cross-sectional study was performed with 869 Indonesian undergraduate students from Nahdlatul Ulama University of Surabaya (UNUSA) and 515 undergraduate students from Universiti Malaysia Sabah (UMS). The BIPM, MAAS, AAQ-I, DASS-21, and Brief COPE were used to assess the research variables. The proportion who scored "moderate" and above for depression, anxiety, and stress were 20.2%, 25.0%, and 14.2%, respectively, in Malaysian samples and 22.2%, 35.0%, and 23.48% in Indonesian samples. In Study 1, psychological mindedness, psychological mindfulness, and psychological inflexibility significantly mediated the relationship between dysfunctional coping and psychopathologies. In Study 2, Indonesians demonstrated significantly higher anxiety and stress compared to Malaysian samples. Despite the contrasting COVID-19 situations in Malaysia and Indonesia, psychopathologies were more affected in Indonesia. Hence, our study suggests how crucial it is for mental health providers to consider promoting psychological mindedness, psychological mindfulness, and psychological flexibility to alleviate the corresponding psychopathologies among undergraduate students.

Substance use trajectories among urban college students: associations with symptoms of stress, anxiety, and depression before and during COVID-19

This study explored substance use trajectories and associations with mental health among an ethnically/racially diverse college student sample before and during the COVID-19 pandemic. We combined repeated cross-sections and panel data from a total of 3,247 college students assessed with an online survey in 2018, 2019, and in three waves in 2020. We estimated trends in substance use and their relation to mental health over the survey waves using generalized estimating equations (GEE). Our results revealed notable associations between 30-day substance use patterns, time of assessment, and psychological well-being. These findings suggest a complex interplay between access to substances, context of substance use, and mental health. We discuss several initiatives that have been launched in response to the results of this ongoing study. Such initiatives may serve as examples for expanding similar efforts to other commuter colleges to prevent further increases in mental health problems and risky substance use.

COVID-19 hardships and self-reported sleep quality among American adults in March and April 2020: Results from a nationally representative panel study

OBJECTIVE

To analyze the association between coronavirus disease 2019 (COVID-19) hardships and self-reported sleep troubles in a nationally representative sample of adults in the United States.

DESIGN

Prospective study in March and April 2020.

SETTING

Population-based.

PARTICIPANTS

About 8130 respondents who participated in the Pew Research Center's American Trends Panel in March and April of 2020.

MEASUREMENTS

Self-reported sleep troubles were defined as a report of 3 or more days per week with trouble sleeping in March and April (separately). Respondents were asked about COVID-19 stressors such as COVID-19 Threat and COVID-19-specific hardships including pay cuts/hours reductions, job loss, and childcare difficulties. Logistic regression models were fit to test associations between COVID-19 hardships and sleep troubles adjusted for sociodemographic covariates (age, gender, race/ethnicity, region, marital status, nativity, education, income, health insurance, and past diagnosis of mental health problems).

RESULTS

Reported sleep troubles increased from March (29.0%) to April (31.4%). For March, we found that COVID threat, losing a job, getting a pay cut, and difficulty with childcare were separately associated with sleep troubles. In April, COVID-19 threat and difficulty with childcare, but not losing a job or getting a pay cut were associated with sleep troubles even after additionally accounting for reported sleep troubles in March.

CONCLUSIONS

We found that COVID-19-specific stressors, especially a broad measure of COVID-19 Threat and stress over childcare, were associated with sleep troubles in March and April. These findings identified novel stressors related to COVID-19, which may affect the sleep of the American population.