Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science

Psychological treatments for mental health symptoms associated with COVID-19 infection: A scoping review

The aim of this scoping review was to synthesize published studies and ongoing clinical trials of psychological interventions for mental health problems associated with COVID-19 infection. The study protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. We conducted systematic searches for studies published or registered between January 2020 and October 2022 using eight scientific databases and clinical trial registries, which identified 40 complete published studies and 53 ongoing clinical trials. We found that most studies were randomized controlled trials (74%) while the remaining used study designs of lower methodological quality. Most studies investigated interventions for acute COVID-19 patients (74%) and others explored post-COVID conditions (PCC) or recovered patients. Cognitive and behavioral therapies were the main intervention approaches (31%), followed by multidisciplinary programs (21%) and mindfulness (17%). The most frequently evaluated outcomes were anxiety (33%), depression (26%), quality of life (13%), and insomnia (10%). No studies on youths, older people, or marginalized communities were found. These findings summarize the burgeoning research on a range of psychological interventions for individuals infected with COVID-19. However, the field is in its infancy and further research to develop an evidence base for targeted care is necessary. The gaps identified in the current study also highlight the need for more research on youths, older people, and members of marginalized communities, and PCC patients. It is important to ascertain interventions and delivery strategies that are not only effective and affordable but also allow high scalability and accessibility.

Longitudinal changes in depression and anxiety during the COVID-19 pandemic and the impact of COVID-related factors

OBJECTIVE

This study is an investigation of five specific COVID-related stressors and their longitudinal impact on adult depression and anxiety.

METHOD

A total of 592 adults comprised the initial sample at Time 1 in April/May 2020. Follow-ups were conducted about a month later, again in March 2021 and then in March 2022.

RESULTS

Applied linear mixed effect models showed a significant decrease in mean depression scores and anxiety scores from Time 1 to both Times 3 and 4. Neither change over time in anxiety or depression were found to be related to COVID diagnosis, COVID hospitalization, or COVID death. Self-quarantine was related to changes over time in both depression and anxiety, and household quarantine was related to changes over time in depression.

CONCLUSION

While the fallout of the pandemic continues, it is important to understand how these factors may be affecting mental health to better understand where intervention is necessary.

Impact of COVID-19 restrictive measures during lockdown period on eating disorders: An umbrella review

The COVID-19 pandemic has sparked or amplified many mental health problems. The aim of this study was to compile evidence from existing systematic reviews to provide an overall assessment of the impact of social restrictions during the COVID-19 pandemic on people affected by eating disorders (EDs). PubMed and Scopus were searched up to August 16, 2023. Systematic reviews and meta-analyses were selected using the PRISMA 2020 statement. The quality assessment of the included studies was conducted using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Eleven studies were included in this umbrella review. Six main categories emerged from the studies described in the review: dietary changes and psychopathological effects showed an overall worsening of symptomatology; in studies concerning the impact of isolation and restrictive measures, it was found that social distancing was associated with feelings of loneliness, anxiety, and depression; limited access to direct care was found and therapeutic changes were made; the influence of mass media negatively impacted people with ED; several studies reported positive findings regarding symptomatology; finally, studies regarding 'impact on vulnerable populations showed that vulnerable people are more at risk of reporting body image distortion and eating disorders. The COVID-19 pandemic has negatively impacted most of the population with ED leading to a worsening of specific symptomatology. In addition, this worsening of the condition may be caused by limited access to care and treatment, changes in routine, or to the negative influence of the media.

Predictors of COVID-Related stress in a community sample in Turkey: a cross-sectional study

The distinctive mental health features associated with COVID-19 have gained importance as the psychological effects of the pandemic on the community become more visible. This study aims to assess the COVID-related stress status and associated factors in the community sample of Turkey. The sample of this cross-sectional study is composed of 2.065 people between the ages of 18-90. Data were collected through an online survey prepared by Google.docs between October-December, 2020. Mild to moderate stress was found in the community with the most common symptoms of the fear of contamination and danger. Some variables, such as being female and the severity of COVID-19 illness, were associated with higher COVID-related stress. Vulnerable groups associated with high stress should be monitored during the pandemic. The findings of this study will guide the practices of professionals working in the field of public health, healthcare, or mental health in possible future pandemics.

Patient-Reported Outcomes in COVID-19 Treatment with Monoclonal Antibodies Reveal Benefits in Return to Usual Activities

INTRODUCTION

This study aimed to assess the effects of a monoclonal antibody (mAb) combination on symptoms, daily function, and overall health-related quality of life.

METHODS

We analyzed patient-reported outcomes data from symptomatic outpatients in a phase 1/2/3 trial. Patients with confirmed SARS-CoV-2 infection and ≥ 1 risk factor for severe COVID-19 received mAb treatment (casirivimab plus imdevimab 1200 mg) or placebo. Prespecified exploratory assessments included time to sustained symptoms resolution, usual health, and return to usual activities (assessed daily for 29 days). The trial was conducted from September 2020 to February 2021, prior to widespread COVID-19 vaccination programs and Omicron-lineage variants against which casirivimab + imdevimab is not active.

RESULTS

In this analysis 736 outpatients received mAb and 1341 received placebo. Median time to sustained symptoms resolution was consistently shorter with mAb versus placebo (≥ 2 consecutive days: 14 vs 17 days, [nominal p = 0.0017]; ≥ 3 consecutive days: 17 vs 21 days, [nominal p = 0.0046]). Median time to sustained return to usual health and usual activities were both consistently shorter with mAb versus placebo (≥ 2 consecutive days: 12 vs 15 days [nominal p = 0.0001] and 9 vs 11 days [nominal p = 0.0001], respectively; ≥ 3 consecutive days: 14 vs 18 days [nominal p = 0.0003] and 10 vs 13 days [nominal p = 0.0041], respectively).

CONCLUSIONS

mAb treatment against susceptible SARS-CoV-2 strains improved how patients feel and function, as evidenced by shortened time to sustained symptoms resolution and return to usual health and activities. Future studies are warranted to assess the patient experience with next generation mAbs.

CLINICALTRIALS

GOV: Registration number, NCT04425629; Submission date June 11, 2020.

Engaging Communities in Emerging Infectious Disease Mitigation to Improve Public Health and Safety

The COVID-19 pandemic highlighted the need for potent community-based tools to improve preparedness. We developed a community health-safety climate (HSC) measure to assess readiness to adopt health behaviors during a pandemic. We conducted a mixed-methods study incorporating qualitative methods (e.g., focus groups) to generate items for the measure and quantitative data from a February 2021 national survey to test reliability, multilevel construct, and predictive and nomologic validities. The 20-item HSC measure is unidimensional (Cronbach α = 0.87). All communities had strong health-safety climates but with significant differences between communities (F = 10.65; p<0.001), and HSC levels predicted readiness to adopt health-safety behaviors. HSC strength moderated relationships between HSC level and behavioral indicators; higher climate homogeneity demonstrated stronger correlations. The HSC measure can predict community readiness to adopt health-safety behaviors in communities to inform interventions before diseases spread, providing a valuable tool for public health authorities and policymakers during a pandemic.

Effect of robot-assisted stair climbing training as part of a rehabilitation program to improve pulmonary function, gait performance, balance, and exercise capacity in a patient after severe coronavirus disease 2019: a case report

BACKGROUND

Severe coronavirus disease 2019 (COVID-19) infection may decrease respiratory and physical functions.

OBJECTIVE

To evaluate whether robot-assisted stair climbing training (RASCT) would improve pulmonary and physical functions in a patient post-severe COVID-19 infection.

CASE DESCRIPTION

A 48-year-old woman who had experienced severe COVID-19 underwent a 6-week inpatient rehabilitation. She persistently exhibited impaired pulmonary and physical functions, including walking and balance impairment. We provided a 30-min outpatient RASCT biweekly for 6 weeks.

OUTCOMES

After training, maximal inspiratory and maximal expiratory pressures improved from 81 and 74 cmH2O to 104 and 81 cmH2O, respectively. The walking speed improved from 1.15 to 1.21 m/s. In balance ability, physical performance battery score and timed up-and-go test improved from 8 to 11 s and 10.89 to 9.95 s, respectively. Regarding exercise capacity, the 6-min walk test distance improved from 453 to 482 m, and the number of 1-min sit-to-stand test improved from 20 to 23, with improved pulse rate and saturation level. The physical and psychological domain scores of the World Health Organization Quality-of-Life Scale-BREF improved from 44 to 63 and 69 to 81, respectively; Falls Efficacy Scale-International scores improved from 38 to 21.

CONCLUSION

RASCT, as part of a rehabilitation plan, was feasible and effective for this patient after severe COVID-19 infection.

A secondary analysis examining the performance of the State Optimism Measure (SOM) compared to the Life Orientation Test-Revised (LOT-R) in measuring optimism over time

Objective: Optimism is an important factor impacting health and human functioning. Originally conceptualized as a trait, increasing evidence indicates that optimism can change over time and could be an intervention target. Measures are needed that can capture changes in optimism.

Design: In this secondary analysis, we compared the performance of a newly developed state measure, the State Optimism Measure (SOM), to the widely used trait measure, the Life Orientation Test-Revised (LOT-R), in detecting changes over time during a disruptive life event: the onset of the COVID-19 pandemic in the United States.

Main Outcome Measures: Participants (n = 81) were nondaily smokers participating in a smoking cessation intervention, who completed the SOM and LOT-R before and after the initial COVID-19 outbreak.

Results: Optimism declined from pre- to post-COVID-19 outbreak, as assessed by both scales (LOT-R: p=.0147,gav=0.23; SOM: p<.0001,gav=0.56). The change detected was greater when measured by the SOM (p<.0001). Changes in optimism were correlated with concurrent changes in perceived stress, positive affect, and negative affect.

Conclusion: Our results suggest that the SOM has a greater sensitivity to detect within-person changes in optimism than the LOT-R and highlight the SOM's utility for longitudinal studies assessing changes in optimism.

Psychometric properties of anxiety sensitivity Index-3 among Chinese college students and its preliminary application among this population experiencing campus lockdown

PURPOSE

Anxiety sensitivity (AS) refers to fear of anxiety-related sensory arousal and has been revealed to be associated with increased psychological distress and mental problems. Although Anxiety Sensitivity Index-3 (ASI-3) has been confirmed to be effective in evaluating this construct, whether it is consistently applicable in college students is still elusive. The present study aimed to examine the psychometric properties and measurement invariance of Chinese version of ASI-3 (C-ASI-3) among college students experiencing campus lockdown due to novel coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A total of 1532 Chinese college students (397, 25.9% males) aged between 16 and 25 were included in this study. Confirmatory factor analysis (CFA) was used to verify the factor structure of C-ASI-3. Multi-group CFA was conducted for analysis of measurement invariance with regard to gender. McDonald's omega values were computed for examination of scale reliability. For criterion, convergent, and divergent validity, average variance extracted (AVE) values for C-ASI-3 subscales, difference between square root of AVE for each factor and inter-factor correlation, as well as pearson correlation and partial correlation between the C-ASI-3 and other three scales, including the Depression, Anxiety, and Stress Scale-21 (DASS-21), the State-Trait Anxiety Inventory (STAI), and the Fear of COVID-19 scale (FCV-19 S) were evaluated.

RESULTS

The C-ASI-3 presented a three-factor scale structure with fit indices being as follows: χ2/df = 11.590, CFI = 0.938, RMSEA = 0.083, SRMR = 0.042. Strict measurement invariance was reached across gender. Regarding convergent validity, the C-ASI-3 had a high correlation with the DASS-21 (r = 0.597, p < 0.01) and the STAI (r = 0.504, p < 0.01). All AVE values for C-ASI-3 subscales were above 0.5. In terms of divergent validity, the C-ASI-3 had medium correlation with the FCV-19 S (r = 0.360, p < 0.01). Square of root of AVE for each factor was higher that inter-factor correlation. McDonald's omega values of the three dimensions ranged from 0.898 ~ 0.958.

CONCLUSION

The C-ASI-3 has acceptable psychometric properties among college students. College students with different gender have consistent understanding on the scale construct.

The protective effect of physical activity on mental health of middle school students at different stages during the COVID-19 outbreak

This study aims to further understand the changes in physical activity level(PAL) and mental health among adolescents before and after the outbreak of COVID-19 and explore the protective role of physical activity (PA) on the mental health of adolescents during major disasters. A convenient sampling method was used to conduct a cross-sectional survey. The cross-sectional data from 2838 Chinese middle school students (mean age = 14.91 ± 1.71 years, 49.54% female) were used, of which 1,471 and 1,367 were in 2021 and 2022, respectively. The PAL was collected using the Physical Activity Questionnaire for Children (PAQ-CN), mental health status was collected using the Mental Health Inventory of Middle School Students (MMHI-60), sociodemographic information was collected using a self-reported questionnaire. Before and after the outbreak of COVID-19, the PAL of adolescents was 2.36 ± 0.74 and 2.50 ± 0.66, respectively, with a significant difference (p < 0.01, 95% CI: 0.09, 0.19). The mental health scores were 1.71 ± 0.60 and 1.86 ± 0.73, respectively, with a significant difference (p < 0.01, 95% CI: - 0.20, - 0.10). The detection rates of mental health problems were 27.50% and 35.50%, respectively. The rates of achieving PAL standards were 30.20% and 18.00% among adolescents, while the rates of not achieving PAL standards were 39.60% and 18.00%. PA is a protective factor for the mental health of adolescents during major disasters.

Short- and long-term neuropsychiatric outcomes in long COVID in South Korea and Japan

We investigated whether SARS-CoV-2 infection is associated with short- and long-term neuropsychiatric sequelae. We used population-based cohorts from the Korean nationwide cohort (discovery; n = 10,027,506) and the Japanese claims-based cohort (validation; n = 12,218,680) to estimate the short-term (<30 days) and long-term (≥30 days) risks of neuropsychiatric outcomes after SARS-CoV-2 infection compared with general population groups or external comparators (people with another respiratory infection). Using exposure-driven propensity score matching, we found that both the short- and long-term risks of developing neuropsychiatric sequelae were elevated in the discovery cohort compared with the general population and those with another respiratory infection. A range of conditions including Guillain-Barré syndrome, cognitive deficit, insomnia, anxiety disorder, encephalitis, ischaemic stroke and mood disorder exhibited a pronounced increase in long-term risk. Factors such as mild severity of COVID-19, increased vaccination against COVID-19 and heterologous vaccination were associated with reduced long-term risk of adverse neuropsychiatric outcomes. The time attenuation effect was the strongest during the first six months after SARS-CoV-2 infection, and this risk remained statistically significant for up to one year in Korea but beyond one year in Japan. The associations observed were replicated in the validation cohort. Our findings contribute to the growing evidence base on long COVID by considering ethnic diversity.

Exploration of the COVID-19 mental health implications in elite disabled athletes

The COVID-19 pandemic influenced the way individuals conducted their lives, with consequences relating to mental health deterioration. Whilst researchers explored this outcome in the general population and athletic populations, less focus was on athletes with disabilities. The aim of this study was to investigate how the pandemic influenced the mental health of elite para-athletes in the United Kingdom. Nine elite-level athletes with disabilities participated in semi-structured interviews. Three broad themes were interpreted from the data using reflexive thematic analysis, two themes reflected the negative impact of COVID-19 on mental health and one theme reflected positive outcomes of the pandemic. Athletes explained that losing face-to-face interactions and delays in major sporting events were significant factors in their mental health decline. This population group reported different challenges to able-bodied communities. Differences included increased susceptibility to contract the virus, difficulties in communication where face masks and online interactions became necessary and perceptions of vulnerability relating to shielding protocols. Finally, positive outcomes related to the additional time to recover, to prepare for major events and time to reassess their values. Exploring experiences of a pandemic on this population group warrants further exploration to enhance the effectiveness of mental health support services in para-sporting organisations.

Unveiling the lockdown effects: exploring behavior, dietary habits and weight changes in rural Egypt during COVID-19 lockdown: a cross-sectional retrospective study

BACKGROUND

The COVID-19 lockdown significantly impacted dietary habits and body weights globally, particularly in Egypt, where 57.03% of the population resides in rural areas, despite lack of information. The study examines the impact of COVID-19 lockdown on the weight changes of the rural Egyptian population through behavioral, physical, and dietary changes.

METHODS

A cross-sectional online survey using Microsoft Forms was distributed in Delta regions in Egypt. The questionnaire used a modified version of the validated 14- items PREDIMED MedDiet Adherence Screener (MEDAS). The first part of the questionnaire addressed sociodemographic variables whereas the second one included questions related to dietary, behavioral and weight changes of participants. These changes were statistically tested for significance in relation to BMI, gender, home living, current job and family history of obesity.

RESULTS

A total of 306 participated in the study (70% females, 13% obese, 95% living with family, 56% university students, and 36% with family history of obesity). Obese showed a significant increase in sweet intake whereas underweight and normal weight people displayed a significant decrease in eating desire. Both females and males showed significant increase in consumption of fruits and vegetables with significant decrease in soft drink. However, women showed a significant decrease in sport activity relative to men. Participants living with family showed an increase in sweet intake while those living alone explored an increase in meal frequency. Employers revealed a significant decrease in sport activities and people with family history of obesity reported more sleeping times than those without family history of obesity.

CONCLUSION

During Covid-19 quarantine, Egyptians' eating habits improved, but daily routines were disrupted. Raising awareness about obesity and providing guidance on maintaining activity, energy, and mood is crucial for future quarantine situations.

The impact of mindfulness training on alleviating COVID-19 fear among international students in China: A quasi-experimental study

This study investigated the effects of mindfulness training on alleviating fear of the COVID-19 epidemic among international students in China during the academic year 2020. The training group participants (N = 41) and the control group participants (N = 44) were surveyed pre-and post-training with the two English questionnaires: The Five-Facet Mindfulness Questionnaire (FFMQ) and the fear of the COVID-19 scale (FCV-19S). The results showed that, regarding the relationship between the two main variables in the study, mindfulness is related negatively to the COVID-19 epidemic. Moreover, compared to the control group, results showed that individuals in the training group demonstrated significant improvements in mindfulness levels and decreased Fear of COVID-19. Thus, findings suggest that a short online mindfulness meditation training may reduce fear of the COVID-19 epidemic.

Re-engaging with arts and cultural activities at the Life Rooms: 'It's given me spring'

BACKGROUND

Mersey Care NHS Foundation Trust's Life Rooms initiative is an established and successful model of integrating arts and culture within NHS provision. In the face of COVID-19, the Life Rooms was restructured to provide a full suite of online resources. Following the lifting of restrictions, in-person arts provision returned to the Life Rooms sites. Additional evidence in respect of the impact on mental health and wellbeing of the return to in-person arts and cultural activities provided by the Life Rooms, as well as the relative merits of online and in-person arts and cultural activities, is needed to inform future planning around in-person, online, and/or hybrid provision.

METHODS

Interviews with practitioners delivering cultural and creative courses at the Life Rooms (n = 8) and users of the Life Rooms (n = 5) were conducted to explore the impact of the return to in-person arts provision at the Life Rooms, as well as the merits of online and in-person arts provision. Data were analysed using thematic analysis.

RESULTS

Three overarching themes were identified: 'Provision, access, and reach'; 'Value of arts and creativity'; and 'Challenges with the Life Rooms model in the new normal'. The findings demonstrate the critical role of arts and cultural provision in providing stigma-free environments to reconnect the vulnerable and isolated. As re-engagement remained slow, there is a need to be responsive to hesitation around re-engaging in-person. The Life Rooms online learning offer remained vital for those who are vulnerable or otherwise unable to access in-person activities.

CONCLUSIONS

As our findings show a demand for maintaining online provision that enables accessibility together with in-person provision that boosts community connectedness, ensuring continued online access alongside in-person delivery should be prioritised. As mental health demands could continue to grow in coming years as the pandemic evolves, in-person arts engagement could have an important role in meeting mental health needs.

Social media users' attitudes toward cyberbullying during the COVID-19 pandemic: associations with gender and verification status

Introduction

Social media platforms such as Twitter and Weibo facilitate both positive and negative communication, including cyberbullying. Empirical evidence has revealed that cyberbullying increases when public crises occur, that such behavior is gendered, and that social media user account verification may deter it. However, the association of gender and verification status with cyberbullying is underexplored. This study aims to address this gap by examining how Weibo users' gender, verification status, and expression of affect and anger in posts influence cyberbullying attitudes. Specifically, it investigates how these factors differ between posts pro- and anti-cyberbullying of COVID-19 cases during the pandemic.

Methods

This study utilized social role theory, the Barlett and Gentile Cyberbullying Model, and general strain theory as theoretical frameworks. We applied text classification techniques to identify pro-cyberbullying and anti-cyberbullying posts on Weibo. Subsequently, we used a standardized mean difference method to compare the emotional content of these posts. Our analysis focused on the prevalence of affective and anger-related expressions, particularly examining variations across gender and verification status of the users.

Results

Our text classification identified distinct pro-cyberbullying and anti-cyberbullying posts. The standardized mean difference analysis revealed that pro-cyberbullying posts contained significantly more emotional content compared to anti-cyberbullying posts. Further, within the pro-cyberbullying category, posts by verified female users exhibited a higher frequency of anger-related words than those by other users.

Discussion

The findings from this study can enhance researchers' algorithms for identifying cyberbullying attitudes, refine the characterization of cyberbullying behavior using real-world social media data through the integration of the mentioned theories, and help government bodies improve their cyberbullying monitoring especially in the context of public health crises.

The "supercompensation" effect of children's lockdown during COVID-19: based on the analysis of changes in physical activity, sleep, and psychology

OBJECTIVE

To investigate the "supercompensation" effect of preschoolers during the coronavirus disease 2019 lockdown by comparing the changes in physical activity (PA), psychological, and sleep indicators before and after the lockdown.

METHODS

A total of 127 children (aged 3-6 years) were recruited. Before and after the lockdown, the children's PA levels were measured using the ActiGraph GT3X+, and their psychological and sleep indicators were measured using the Strengths and Difficulties Questionnaire (SDQ) and Child Sleep Habit Questionnaire (CSHQ), respectively.

RESULTS

Regarding PA, the children's total physical activity, low-intensity physical activity, and medium-intensity physical activity (MVPA) were higher after the lockdown than before the lockdown, with significant differences in MVPA (p < 0.05). Regarding psychology, the children's SDQ and multidimensional scores were better after the lockdown than before the lockdown, with a significant difference in SDQ scores (p < 0.05). Regarding sleep, the children's CSHQ scores were better after the lockdown than before the lockdown, with a highly significant difference in CSHQ scores (p < 0.01).

CONCLUSION

After lockdown, children's PA, psychological, and sleep effects were "supercompensated." In particular, the PA of preschoolers before, during, and after the lockdown may show a "baseline-inhibition-supercompensation" process.

Advantages and disadvantages of digital mental health initiatives in Nigeria - a qualitative interview study

BACKGROUND

The impact of COVID-19 and its mitigation measures have exacerbated the global mental health crisis. Digital mental health interventions (DMHIs) may have the potential to address health system gaps and global health inequalities in low- and middle-income countries (LMICs).

AIMS

This thesis aims to map the current state of DMHIs in Nigeria and illustrate their progress, limitations, and challenges.

METHODS

Twenty interviews were conducted with researchers, healthcare providers, and digital health experts. Interviews were recorded and transcribed. Then data were coded and analyzed using thematic analysis.

RESULTS

The majority of DMHIs in Nigeria are private mental health service delivery platforms that connect directly to mental health professionals. The target audience encompasses all mental health conditions and ages. Advantages of DMHIs include increasing efficiency, accessibility, addressing stigma, and filling the mental health service gap. Disadvantages include skepticism, limitations of applicability, lack of accessibility to internet and technology, lack of sustainability and infrastructure, and lack of funding and policies.

CONCLUSION

The lessons learned in the Nigerian context can inform the delivery of DMHIs in other low-resource settings. Future research should examine user and provider feedback of DMHIs to allow for comparative analysis, more conclusive and replicable results to inform DMHI design and implementation.

Suicide mortality rates in Japan before and beyond the COVID-19 pandemic era

Statistical analyses from Japan reported increasing suicides in 2020, first in the world, proving the severity of the public health crisis during the COVID-19 pandemic; however, so far, international suicides have not been shown to be objectively increasing at population level. Followed studies reported the existence of a substantial heterogeneity of suicides among subgroups and time-lag impacts. Against public health crisis in Japan, policymakers, psychiatrists and public health personnel should prioritize improving suicide prevention programs following evidence-based policymaking. Understanding how/what factors relate to the COVID-19 pandemic and what other factors have shaped the increasing suicide numbers since 2020 through objectively well-controlled/fine-grained analyses of high-quality longitudinal/cross-sectional data at the individual, regional, and national levels is important for identifying the reasons for the recent trend. For this purpose, this study examined suicide statistics, statistical analysis methods, and their interpretations. Recent analyses suggest an increased suicide risk among females <50 years and males <30 years in 2020-2022. Notably, time-series analyses revealed that adolescent suicides began increasing before the pandemic, while working-age female suicides sharply increased synchronously with the pandemic outbreak. Causality analyses suggest that social issues facing Japan and recent global psychosocial and socioeconomic transformations are risk factors for suicide in high-risk groups. Finally, this report demonstrates the importance of providing appropriate support based on an objective understanding of individuals who are at risk for suicide, without being bound by traditional established knowledges.

Social isolation, social media use, and poor mental health among older adults, California Health Interview Survey 2019-2020

BACKGROUND

Older adults' engagement on social media may be a resource to reduce loneliness and improve mental health.

PURPOSE

This study aimed to examine loneliness and social media use and its association with severe psychological distress among older adults and whether social media use moderated the association of loneliness on severe psychological distress among older adults.

METHODS

This study is a secondary analysis of the 2019-2020 California Health Interview Survey. The Kessler 6-item Psychological Distress Scale (K6) assessed symptoms of psychological distress, with a K6 score ≥ 13 associated with severe mental illness. Loneliness was measured using a revised Three Item Loneliness Scale (TILS) score. Multiple regression analyses were conducted to examine associations between loneliness and severe psychological distress.

RESULTS

Loneliness, health status, and identification as Asian, remained strong predictors of severe psychological distress among older adults when adjusting for other factors. In bivariate analysis, high-frequent social media users, but did not remain significant when accounting for covariates. Social media use did not moderate the association between loneliness and severe psychological distress.

CONCLUSION

This study underscores the significant impact of loneliness on poor mental health among older adults, emphasizing that while frequent social media use correlates with severe psychological distress, it may not alleviate the association of loneliness on poor mental health, thus highlighting the urgent need to address social isolation and promote genuine social connectedness, particularly among Asian older adults.

Covid-19 pandemic, social normative compliance, and sustainable consumption: Evidence from experiments

This research aims to investigate the causal effects of consumers' Covid-19 pandemic experiences on their preferences for sustainable consumption. Drawing on social identity theory, we argue that pandemic experiences heighten consumers' awareness of the importance of adhering to collective social norms, subsequently motivating them to adopt sustainable consumption practices that promote collective interests. Through three preregistered experiments, we demonstrate that: (i) Covid-19 pandemic experiences increase consumers' preferences for sustainable consumption; (ii) this effect is more pronounced for individuals with severer pandemic experiences and females; (iii) pandemic experiences influence sustainable consumption preferences by enhancing consumers' social normative compliance. This study contributes to the understanding of Covid-19's consequences from a micro-level perspective of consumer behavior and offers insights into the factors driving consumers' sustainable consumption preferences.

Suicidal thoughts and behavior of adolescents with depression in Reunion Island - evolution before and after the initial Covid-19 lockdown

BACKGROUND

The number of patients consulting with suicidal thoughts and behavior in the health care centers have increased since the Covid-19 pandemic. This increase has been particularly important among adolescents. Most often these patients are diagnosed with anxiety or depressive symptoms. We only have a limited amount of information on depression and STB in adolescents since epidemiological monitoring in health care institutions is based on computerized coding derived from ICD-10. This coding system is very specific for the different forms of depression yet fails to provide accurate coding for suicidal thoughts and behavior. The objectives of this study were to compare the numbers of adolescents with depression who were admitted with suicidal thoughts and behavior before and after the initial Covid-19 lockdown and to highlight possible gender disparities.

METHODS

Patients' medical charts for this retrospective research were obtained from the Department of Adolescent Psychiatry at the University Hospital Centre of Reunion Island, manually screened, and then analyzed. We included all adolescents diagnosed with depression who had had their first consultation between January 1, 2019 and July 31, 2021. The number of patients presenting suicidal thoughts, self-harm and suicide attempts were compared before and after the initial Covid-19 lockdown.

RESULTS

Three hundred and sixty-one adolescents diagnosed with depression participated in the study (33.5% males, 66.5% females). Their average age was 16 (SD=1.7). The number of admitted patients increased from 9 to 16 new adolescents with depression and STB each month between the period before and after the first lockdown, with a large proportion of female patients (increase of 74.1%).

CONCLUSION

This study showed an increase in the number of adolescents consulting for suicidal thoughts or behavior in an adolescent psychiatry department in Reunion Island after the initial Covid-19 lockdown. They were mainly female. This increase has strained an already overburdened mental health system by doubling the number of adolescents that each health care provider has had to help which increases the risk of inadequate care by rapidly increasing the workload but with constant resources.

Differential effects of perigestational consumption of sucrose-sweetened beverages on anxiety and depression-related behaviors in adult offspring: Sex disparity in a mouse model

Consumption of sucrose-sweetened drinks (SSDs) during pregnancy and breastfeeding can lead to various health and metabolism issues, but the potential impact on neurodevelopment and long-term effects remains unclear. This study aims to examine how maternal consumption of SSDs during gestation and lactation influences anxiety and depression-related behavior in adult offspring. Adult female CD-1 mice were randomly assigned to a control group (CG) or a sucrose group (SG) 2 weeks before gestation. The SG had 2 h of access to an SSD (15% w/w, 0.6 kcal/ml) for 2 weeks before mating, during pregnancy, and throughout lactation, totaling 8 weeks. Adult offspring were then evaluated for depressive-related behaviors and anxiety-related behaviors. Our findings reveal that perigestational consumption of SSDs does not lead to offspring presenting behaviors related to depression, but it does increase swimming behavior. However, maternal consumption of SSDs could impact the fighting response due to a diminished motivational component. In contrast, perigestational consumption of SSDs has apparent effects on anxiety-related behavior. Furthermore, female offspring appeared to be particularly vulnerable, exhibiting a higher anxiety index compared with controls. These findings indicate that females could be more vulnerable to the effects of maternal consumption of SSDs, being more susceptible to the presence of anxiety-related behaviors.

Factors associated with an increased risk of anxiety among adolescents during the COVID-19 lockdown in the French Grand Est area

The COVID-19 pandemic has impacted adolescent mental health worldwide. The current study aims to assess the feelings of French adolescents and the factors related to anxiety among these adolescents during the first lockdown due to COVID-19. A sample of 284 French adolescents from the Grand Est region aged 12-18 years completed an online survey evaluating their pandemic-related anxiety symptoms, behaviors, and feelings regarding the contingent strategies of lockdown that were taken and their living and learning conditions, family relationships, and social support. The Generalized Anxiety Disorder Scale (GAD-6) was used to assess anxiety. Data on parents' mental health status were also collected. A word cloud was generated to visualize respondents' feelings according to word use frequency. Cross-sectional analysis with linear regression was performed to identify the factors associated with a higher level of anxiety in adolescents. Higher anxiety scale scores were observed among females than among males (β = 1.2; P = 0.0005), among adolescents experiencing conflicts at home (β = 0.9; P = 0.03) and difficulties in isolation (β = 1.1; P = 0.02) than among those who did not report any difficulty, and among those working less than 2 h a day (β = 1.1; P = 0.003) than among those working more. Anxiety scale scores were lower in adolescents with higher family social support (β = -0.66; P < 0.001) and those with parents with no anxiety (β = -2.28; P < 0.001), lower anxiety (β = -1.38; P = 0.018), and higher mental health-related quality of life (β = -0.04; P = 0.03). These findings suggest a need to support interventions targeting parents' anxiety, develop strategies to increase family support, and establish consistent work schedules for children.

A 2-year longitudinal study examining the change in psychosocial factors under the COVID-19 pandemic in Japan

To examine changes in individuals' psychosocial variables (e.g., psychological distress, social isolation, and alcohol use) during the prolonged COVID-19 pandemic, a two-year longitudinal survey was conducted at approximately one-year intervals between May 2020 and May 2022, after the first COVID-19-related state of emergency was announced in Japan. The online survey was conducted on May 11-12, 2020 (Phase 1), June 14-20, 2021 (Phase 2), and May 13-30, 2022 (Phase 3). The survey in Phase 1 was conducted during the first emergency declaration period, the survey in Phase 2 was conducted during the third emergency declaration period, and the survey in Phase 3 was conducted at a time when there was no state of emergency but many COVID-19 positive cases. Notably, 3,892 participants responded to all three surveys. In addition to psychosocial inventories often used worldwide, survey items included lifestyle and stress management indicators related to COVID-19 and various sociodemographic items including occupation (e.g., healthcare workers) or income, history of medical treatment for mental problems, severe physical illnesses, and COVID-19.

The dynamic relationships between well-being, behavioral restrictions, and health behaviors during the COVID-19 pandemic: A large-scale intensive longitudinal network study

The behavioral restrictions disrupting daily life during the COVID-19 pandemic have profoundly impacted well-being, and health behaviors have been advocated to prevent decline. To understand how processes related to fluctuation in well-being unfold within individuals, analyses on the within-person level are required. In this preregistered intensive longitudinal study, 1,709 individuals from the Norwegian adult population provided data daily over 40 consecutive days during the pandemic. The responses were modeled in a multilevel vector autoregressive model to estimate within-person networks, across and within-day, and a between-person network. All three networks revealed productivity, relatedness, and optimism as positively associated. Social distancing was contemporaneously negatively associated with productivity and relatedness. Among behavioral factors, being physically active predicted lower relatedness across days but displayed positive associations with relatedness, productivity, and optimism contemporaneously. Alcohol consumption predicted lower productivity across and within-day, although revealing a positive association with optimism within-day. Being social online and feeling related to others displayed a temporal negative bidirectional relationship. In contrast, being social online was positively associated with optimism, productivity, and relatedness contemporaneously. Our study emphasizes the dynamic nature of well-being and its complex associations with behavioral factors during the pandemic. The study shed light on opposing associations of behavioral factors at the within- and between-person level.

Comparing frequencies of adolescent suicide attempters pre- and during COVID-19 pandemic school terms

BACKGROUND

The COVID-19 pandemic had and still have a major impact on adolescent mental health and consequently on suicidal behavior. However, few studies have investigated whether the pandemic has changed the patterns and the triggers of suicidality peaks in adolescents, e.g., seasonal patterns or family conflicts. We hypothesized that the pandemic modified suicidality rates: an increment of suicide attempts would be observed in the first semester of the academic year during COVID-19 pandemic compared to the same period of previous academic year; and the precipitating factors would be more related to social stressors during the pandemic school year.

METHODS

A retrospective cross-sectional study was conducted to assess the precipitating factors, also including school-related factors and cognitive skills, of adolescent suicide attempters occurred in the first and second semesters of the year before the pandemic lockdown (study periods 1 and 2) and the year after (study periods 3 and 4).

RESULTS

The sample consisted of 85 adolescents aged between 12 and 17 recruited consecutively from March 2019 to March 2021 at emergency ward because of suicide attempt. Forty-eight adolescents (55.3% of the sample) were attended before the lockdown (pre-pandemic group) and 38 (44.7%) the year after. The results showed a higher proportion of female suicide attempters in period 4 (Sept 2020-Feb 2021) respect to period 3 (Mar 2020-Aug 2020), i.e., pandemic semesters compared with the increment observed between period 2 and 1 (prepandemic semesters; Fisher's exact test = 4.73; p = 0.026). The multinomial regression models showed a significant effect in the frequency of adolescents who attempted suicide (ratio χ2 = 15.19, p = 0.019), accounted by the differences between period 4 (Sept 2020-Feb 2021) and period 1 (Mar 2019-Aug 2019), with depressive symptoms being a significant contributing factor (Exp(b) = 0.93; p = 0.04). Additionally, social triggers and age were found to be significant risk factors for suicide attempts in the first semester of the pandemic academic year (period 4) compared to the same semester of the pre-pandemic year (period 2; Exp(b) = 0.16, p = 0.01, and Exp(b) = 1.88, p = 0.006, respectively).

CONCLUSIONS

During the pandemic, the decrement between first and second semester of the number of females attempting suicide was more pronounced than in the prepandemic school year -though this findings lacked statistical power due to very limited sample size-. Change in the frequency of adolescent attempting suicide in the different school periods was associated with greater severity of depressive symptoms. Social relations in back-to-school after the lockdown were also associated with the number of adolescents attempting suicide.

Infodemic and sources of information about COVID-19 in a Brazilian population: what are the associated factors?

BACKGROUND

With the COVID-19 pandemic, social isolation, and information search have increased dramatically. This increased search for information about the Coronavirus, called infodemic, was greatly affected by fake news and information without scientific evidence. This article aimed to assess the infodemic amid the COVID-19 pandemic and its association with sociodemographic and pandemic-related variables, as well as describe the main sources from which people obtained information about COVID-19.

METHODS

A cross-sectional population-based study was performed in Criciúma, Brazil. All individuals aged 18 years or older, residing in the 607 households systematically selected, were invited to answer the questionnaire. Infodemic and sources to seek information about COVID-19 were evaluated, as well as sociodemographic and pandemic-related variables. Adjusted Poisson regression with robust variance was used to evaluate associations.

RESULTS

A total of 863 individuals participated in the study. The prevalence of infodemic was 22.1%, and television was the main source of information (58.9%). Three groups presented a higher prevalence of infodemic: older adults (PR: 1.65), individuals with low income (PR: 2.97), and those who had had contact with someone infected (PR: 2.20).

CONCLUSIONS

The findings reflect how some groups are more exposed to infodemic, and underline the responsibility and importance of intersectoral actions for dissemination of information about COVID-19.

Implementing Foundry: A cohort study describing the regional and virtual expansion of a youth integrated service in British Columbia, Canada

AIM

Integrated youth services (IYS) have been identified as a national priority in response to the youth mental health and substance use (MHSU) crisis in Canada. In British Columbia (BC), an IYS initiative called Foundry expanded to 11 physical centres and launched a virtual service. The aim of the study was to describe the demographics of Foundry clients and patterns of service utilization during this expansion, along with the impact of the COVID-19 pandemic.

METHODS

Data were analysed for all youth (ages 12-24) accessing both in-person (April 27th, 2018-March 31st, 2021) and virtual (May 1st, 2020-March 31st, 2021) services. Cohorts containing all clients from before (April 27th, 2018-March 16th, 2020) and during (March 17th, 2020-March 31st, 2021) the COVID-19 pandemic were also examined.

RESULTS

A total of 23 749 unique youth accessed Foundry during the study period, with 110 145 services provided. Mean client age was 19.54 years (SD = 3.45) and 62% identified as female. Over 60% of youth scored 'high' or 'very high' for distress and 29% had a self-rated mental health of 'poor', with similar percentages seen for all services and virtual services. These ratings stayed consistent before and during the COVID-19 pandemic.

CONCLUSIONS

Foundry has continued to reach the target age group, with a 65% increase in number of clients during the study period compared with the pilot stage. This study highlights lessons learned and next steps to promote youth-centred data capture practices over time within an integrated youth services context.

Digital Mental Health for Schizophrenia and Other Severe Mental Illnesses: An International Consensus on Current Challenges and Potential Solutions

BACKGROUND

Digital approaches may be helpful in augmenting care to address unmet mental health needs, particularly for schizophrenia and severe mental illness (SMI).

OBJECTIVE

An international multidisciplinary group was convened to reach a consensus on the challenges and potential solutions regarding collecting data, delivering treatment, and the ethical challenges in digital mental health approaches for schizophrenia and SMI.

METHODS

The consensus development panel method was used, with an in-person meeting of 2 groups: the expert group and the panel. Membership was multidisciplinary including those with lived experience, with equal participation at all stages and coproduction of the consensus outputs and summary. Relevant literature was shared in advance of the meeting, and a systematic search of the recent literature on digital mental health interventions for schizophrenia and psychosis was completed to ensure that the panel was informed before the meeting with the expert group.

RESULTS

Four broad areas of challenge and proposed solutions were identified: (1) user involvement for real coproduction; (2) new approaches to methodology in digital mental health, including agreed standards, data sharing, measuring harms, prevention strategies, and mechanistic research; (3) regulation and funding issues; and (4) implementation in real-world settings (including multidisciplinary collaboration, training, augmenting existing service provision, and social and population-focused approaches). Examples are provided with more detail on human-centered research design, lived experience perspectives, and biomedical ethics in digital mental health approaches for SMI.

CONCLUSIONS

The group agreed by consensus on a number of recommendations: (1) a new and improved approach to digital mental health research (with agreed reporting standards, data sharing, and shared protocols), (2) equal emphasis on social and population research as well as biological and psychological approaches, (3) meaningful collaborations across varied disciplines that have previously not worked closely together, (4) increased focus on the business model and product with planning and new funding structures across the whole development pathway, (5) increased focus and reporting on ethical issues and potential harms, and (6) organizational changes to allow for true communication and coproduction with those with lived experience of SMI. This study approach, combining an international expert meeting with patient and public involvement and engagement throughout the process, consensus methodology, discussion, and publication, is a helpful way to identify directions for future research and clinical implementation in rapidly evolving areas and can be combined with measurements of real-world clinical impact over time. Similar initiatives will be helpful in other areas of digital mental health and similarly fast-evolving fields to focus research and organizational change and effect improved real-world clinical implementation.

Evaluation of an online arts-based platform to support the health and well-being of older adults during the COVID-19 pandemic: a cross-sectional survey

OBJECTIVES

The objective of this study was to conduct a formative evaluation of the Art Your Service (AYS) arts-based program to determine the program's potential for improving the social and physical well-being of older adults during the COVID-19 pandemic.

DESIGN, SETTINGS AND PARTICIPANTS

An online questionnaire was administered to the AYS members who consented to be invited to participate in the study. Questionnaire items consisted of a Likert scale and open-ended questions delivered using an online platform (SurveyMonkey). Participants provided feedback on their perceptions and experiences of the AYS program, such as its impact on their health and well-being during the COVID-19 pandemic, the benefits and challenges of participating, and any suggestions for program improvement.

OUTCOME MEASURES AND ANALYSIS

Quantitative data were analyzed using descriptive statistics (frequencies, means with standard deviations), and open-ended questions (qualitative data) were analyzed using content analysis. Outcomes included participant demographics, perceptions about the program, usability (System Usability Scale [SUS]), eHealth literacy (eHealth Literacy Scale), and social isolation (Lubben Social Network Scale; LSNS-6).

RESULTS

Program participants revealed consistent patterns of their perceptions and experiences about the program, including a high satisfaction rate (95%) and a perceived positive impact on participants' health and well-being. The program sessions were perceived to be a well-organized, convenient, and safe way to engage with one another socially during the COVID-19 pandemic. The program usability was also perceived to be high (SUS mean score 86.2). Participants felt a sense of connectedness and had reduced feelings of social isolation. Most participants (75%) reported that the program improved their physical health.

CONCLUSIONS

Findings from this formative evaluation study identified key strengths and opportunities to improve the Art Your Service arts-based program, which can be used to help enhance the program's functioning and long-term sustainability potential.

The effectiveness of an online short-format Recovery College model: a co-learning model to support mental health

BACKGROUND

Our societies are facing mental health challenges, which have been compounded by the Covid-19. This event led people to isolate themselves and to stop seeking the help they needed. In response to this situation, the Health and Recovery Learning Center, applying the Recovery College (RC) model, modified its training program to a shorter online format. This study examines the effectiveness of a single RC training course delivered in a shortened online format to a diverse population at risk of mental health deterioration in the context of Covid-19.

METHODS

This quasi-experimental study used a one-group pretest-posttest design with repeated measures. Three hundred and fifteen (n = 315) learners agreed to take part in the study and completed questionnaires on wellbeing, anxiety, resilience, self-management, empowerment and stigmatizing attitudes and behaviors.

RESULTS

Analyses of variance using a linear mixed models revealed that attending a RC training course had, over time, a statistically significant effect on wellbeing (p = 0.004), anxiety (p < 0.001), self-esteem/self-efficacy (p = 0.005), disclosure/help-seeking (p < 0.001) and a slight effect on resilience (p = 0.019) and optimism/control over the future (p = 0.01).

CONCLUSIONS

This study is the first to measure participation in a single online short-format RC training course, with a diversity of learners and a large sample. These results support the hypothesis that an online short-format training course can reduce psychological distress and increase self-efficacy and help-seeking.

TRIAL REGISTRATION

This study was previously approved by two certified ethics committees: Comité d'éthique de la recherche du CIUSSS EMTL, which acted as the committee responsible for the multicenter study, reference number MP-12-2021-2421, and Comité d'éthique avec les êtres humains de l'UQTR, reference number CER-20-270-07.01.

[A Continuous Literature Review for Mental Health Surveillance during the Covid-19 Pandemic in Germany - Method, Selected Results and Lessons Learned]

In order to provide an up-to-date overview on changes in population's mental health during the COVID-19 pandemic, a continuous literature review was conducted. Building on a rapid review, systematic and hand searches were conducted monthly until December 31, 2022. Studies were assessed for observation periods, risk of bias and outcomes. Trends in depressive symptoms in adults were summarized by vote counting. 102 publications were included from 62 studies in the adult population. Studies declined over the course of the pandemic. Overall, 37% of the studies and 56% of the publications can assess trends in the population reliably. Among evidence for changes in depressive symptoms deteriorations predominated at last. The heterogeneity of results published by the end of 2022 limits evidence syntheses. Evidence of deterioration requires further surveillance. A continuous review can indicate evidence gaps at an early stage.

A Randomized Clinical Trial of Online Social Intelligence Training With Custodial Grandmothers

BACKGROUND AND OBJECTIVES

In this study, we investigated the efficacy of a self-administered, online Social Intelligence Training (SIT) program aimed at enhancing psychological and relational well-being among a nationwide U.S. sample of custodial grandmothers.

RESEARCH DESIGN AND METHODS

A two-arm randomized clinical trial (RCT) was conducted, where 349 grandmothers raising grandchildren aged 11-18 years were assigned to either SIT or an attention control condition (ACC). Participants self-completed online surveys at baseline and immediately postintervention, in addition to follow-ups at 3-, 6-, and 9-month postintervention. First-order latent difference score models were used to compare SIT to ACC, across all times of measurement, along key indicators of psychological and relational well-being on an intent-to-treat basis.

RESULTS

Although SIT was largely superior to ACC at yielding positive results, it appears that it attenuated longitudinal declines that occurred among ACC participants. SIT also exerted stronger effects on relational than psychological outcomes, with perceived relations with grandchildren being the most positively affected.

DISCUSSION AND IMPLICATIONS

Given that the historical time of this RCT unpredictably corresponded with the coronavirus disease 2019 pandemic, we suspect that SIT helped offset declines in psychological and relational well-being that are widely documented to have resulted from the pandemic. Our overall positive findings support future use of the inexpensive and easily delivered SIT program under normal environmental conditions, with the vulnerable and geographically disperse population of custodial grandmothers.

CLINICAL TRIALS REGISTRATION NUMBER

NCT03239977.

How Did COVID-19 Impact Smoking Habits in the Saudi Community?

Background/aims Most countries have gone through lockdowns to varying degrees during the COVID-19 pandemic to reduce the spread of the disease. The successive pandemic waves have impacted the health system, imposing restrictions set by the government. This changed people's daily life routines and they felt more socially isolated, which in turn had an impact on their mental health. Some factors were linked to the severity and outcome of COVID-19 on patients. One of these factors was smoking. This study was carried out to investigate the prevalence and impact of lockdown on smoking habits, as well as the changes in attitudes, behavior, and the rate of consumption before and after the government restrictions in the general population of Saudi Arabia. Materials and methods The present cross-sectional study was conducted on a sample of 921 participants from the general population of Saudi Arabia. Data were collected via an online questionnaire. A structured self-response questionnaire was given to the participants after institutional research ethical approval was obtained for the study. Results A total of 921 participants from the smoker population of Saudi Arabia were included in the study. The majority of participants were male (72.9%), and more than half were aged between 18 and 34 years (53.7%). Single individuals had a higher prevalence of increased smoking and a lower rate of quitting compared to married individuals. Participants with higher education levels were more likely to continue smoking at the same rate. While 40.5% of participants reported no change in their smoking rate during the pandemic, 15.4% reported a decrease, 39.0% reported an increase, and 5.1% reported quitting smoking. Participants who reported feeling more stressed during the pandemic had a higher prevalence of increased smoking. The majority of participants believed that smoking increased the risk of COVID-19 infection. Conclusion The study highlights the need for targeted smoking cessation interventions and support services during the pandemic, considering demographic factors, living arrangements, and psychological impact. Efforts should be made to raise awareness about the negative health consequences of smoking during the pandemic and provide resources for stress management and alternative coping strategies. These findings have important implications for public health interventions and policies in Saudi Arabia.

Mentally healthy living after pandemic social distancing: a study of older Canadians reveals helpful anxiety reduction strategies

BACKGROUND

Throughout the COVID-19 pandemic, older Canadians were the most at risk of severe physical harm, including death, and their return to post-COVID life was expected to be especially anxiety-provoking. A study was conducted to obtain nationally representative evidence of older Canadians' self-perceived anxiety levels and their strategies to manage or mitigate it as public health restrictions were lifting.

MATERIALS AND METHODS

This study had a cross-sectional descriptive design. An e-survey was used to collect data from 1327 Canadians aged 60+ stratified by age, sex, and education to resemble the larger general population. Participants completed the Geriatric Anxiety Scale (GAS-10) and indicated which of the 16 Centre for Addictions and Mental Health's (2022) Coping with Stress and Anxiety strategies they were using to manage or mitigate their anxiety when social distancing was lifting. Descriptive statistics, Pearson correlation, and multiple regression analysis were used to explore the data.

RESULTS

While, on average, older Canadians were mildly anxious, nearly one-quarter of responders rated their anxiety as severe. Age, sex, perceived health, were statistically significant correlates of anxiety. Six coping strategies were associated with significantly lower anxiety scores. Moreover, accepting some fear and anxiety as normal, challenging worries and anxious thoughts, and practising relaxation/meditation appeared to increase anxiety.

CONCLUSION

Older Canadians used multiple strategies to manage or mitigate their anxiety, and seemingly, with more successful than detrimental tries. Practitioners have much to learn and understand about older people's mental health promotion efforts after social distancing, now and for future pandemics.

COVID-19 and mental health services in Sub-Saharan Africa: A critical literature review

BACKGROUND

The COVID-19 pandemic has wrought a profound impact on mental health in Sub- Saharan Africa, exacerbating existing disparities and rendering individuals undergoing treatment particularly susceptible. This comprehensive critical review delves into the scope, nature, and extent of COVID-19 impact on mental health services in Sub- Saharan Africa, while concurrently elucidating pivotal lessons and exemplary practices learnt from periods of lockdown.

METHODS

The methodology was guided by Jesson & Laccy's guide on how to conduct critical literature reviews. Articles were comprehensively sought through two academic databases (PubMed and Google Scholar), complemented by targeted searches on the WHO website and official public health websites of relevant Sub-Saharan African countries.

RESULTS

The investigation reveals a surge in mental health challenges, notably marked by a significant escalation in anxiety, depression, and post-traumatic stress disorder. Disruptions to care services, financial hardships, and the pervasive effects of social isolation further compound this escalation. The pre-existing inequalities in access to and quality of care were accentuated during this crisis, with marginalized groups encountering heightened impediments to essential services. In navigating this unprecedented challenge, communities emerged as integral agents in establishing supportive networks and implementing culturally sensitive interventions. Technology, such as telemedicine and online resources, played a pivotal role in bridging access gaps, particularly in remote areas. The synthesis of best practices for supporting mental health patients during lockdowns encompasses targeted interventions for vulnerable groups, including adolescents and pregnant women. Empowering communities through economic support and mental health literacy programs was identified as crucial. The integration of technology, such as the development of robust telemedicine frameworks, virtual training in curricula, and the utilization of digital platforms for interventions and public messaging, emerged as a cornerstone in addressing access disparities. Community engagement and resilience-building strategies gained prominence, emphasizing the necessity of collaboration between healthcare providers and communities. Promotion of peer support groups, home-based care, and the preservation of traditional healing practices were underscored as essential components.

CONCLUSION

The study underscores the need to adapt and optimize mental health services during emergencies. This entails prioritizing mental health within emergency response frameworks, exploring alternative service delivery methods, and fortifying data collection and research efforts.

Associations of problematic smartphone use with depressive symptoms and suicidal ideation in university students before and after the COVID-19 outbreak: A meta-analysis

BACKGROUND AND AIM

Problematic smartphone use (PSU) has been suggested to present with depressive symptoms and suicidal ideation (SI) as well as sleep disturbance, lack of social support, and emotional isolation. The aim of this systematic review and meta-analysis was to evaluate the association between PSU with depressive symptoms and SI in university students, and to determine the potential influence of the coronavirus disease 2019 (COVID-19) outbreak.

METHODS

Observational studies pertinent to our research were identified through comprehensive searches of the PubMed, Embase, Cochrane Library, and Web of Science databases. To account for potential heterogeneity, the random-effects models were employed to aggregate the findings.

RESULTS

Eighteen datasets from 17 case-control studies, including 24,019 university students, were included. Among them, 8,775 (36.5 %) had PSU. A higher prevalence of depressive symptoms (odds ratio [OR]: 2.40, 95 % confidence interval [CI]: 2.19 to 2.63, p < 0.001; prediction interval: 1.95 to 2.96) was observed in university students with higher scores for PSU measures. A subgroup analysis showed a stronger association between PSU and depressive symptoms after the COVID-19 outbreak as compared to that before the outbreak (OR: 2.76 versus 2.16, p for subgroup difference = 0.002), which explained the heterogeneity. The association between PSU and depressive symptoms in university students was similar to those reported in studies from China and other countries, and in studies with different quality scores. Finally, a meta-analysis of three studies suggested that PSU was also associated with the prevalence of SI (OR: 2.18, 95 % CI: 1.77 to 2.68, p < 0.001; I2 = 0 %).

CONCLUSION

In university students, PSU may be a risk factor for depressive symptoms and SI, and the association between PSU and depressive symptoms became stronger after the COVID-19 outbreak.

The Role of Insomnia and Exercise in COVID-19 Worries for Psychological Distress in Hong Kong Chinese: A Moderated Mediation Model

OBJECTIVE

To examine the role of insomnia as a mediator between worrying and mental health and whether the association between worrying and insomnia is moderated by the levels of exercise frequency.

METHODS

A cross-sectional online survey was conducted during the fourth wave of the COVID-19 outbreak in Hong Kong (n = 988). Participants' insomnia, psychological distress, and exercise frequency were evaluated. A mediation analysis was performed to examine the direct effect of COVID-19 worries and their indirect effect through insomnia on psychological distress.

RESULTS

A significant indirect effect of COVID-19 worries through insomnia was found on psychological distress (beta = 0.18, SE = 0.02, 95% CI = 0.14-0.22, p < .001). The significant index of moderated mediation supported the moderating effect of exercise frequency on the indirect effect of COVID-19 worries on psychological distress (IMM = 0.06, SE = 0.02, 95% CI = 0.02-0.10, p = .006). The conditional indirect effects of insomnia on psychological distress were significant in individuals with mean and higher exercise frequency but not in those with lower exercise frequency.

CONCLUSION

COVID-19 worries increased psychological distress through the worsening of sleep, and such an array of COVID-19 worries on insomnia was moderated by exercise frequency. Engaging more frequent exercise could reduce insomnia in people with less COVID-19 worries.

Increase in Linguistic Complexity in Older Adults During COVID-19

The reported psychological impact of the COVID-19 pandemic and related public health measures included a decline in cognitive functioning in older adults. Cognitive functioning is known to correlate with the lexical and syntactic complexity of an individual's linguistic productions. We examined written narratives from the CoSoWELL corpus (v 1.0), collected from over 1,000 U.S. and Canadian older adults (55+ y.o.) before and during the first year of the pandemic. We expected a decrease in the linguistic complexity of the narratives, given the oft-reported reduction in cognitive functioning associated with COVID-19. Contrary to this expectation, all measures of linguistic complexity showed a steady increase from the pre-pandemic level throughout the first year of the global lockdown. We discuss possible reasons for this boost in light of existing theories of cognition and offer a speculative link between the finding and reports of increased creativity during the pandemic.

In the pandemic from the womb. Prenatal exposure, maternal psychological stress and mental health in association with infant negative affect at 6 months of life

For mother-infant health especially, the pandemic has brought multiple stressors inside a susceptible psychobiological system. We study the longitudinal associations between maternal prenatal and postpartum: (a) COVID-19 stressful events exposure, (b) pandemic psychological stress, and (c) mental health and infants' negative affect. A sample of 643 Italian pregnant women completed a web-based survey from April 8th to May 4th, 2020 and a follow-up at 6 months after delivery. Maternal assessment covered prenatal and postpartum measures for: COVID-19 stressful events exposure, pandemic psychological stress, mental health symptoms (i.e., depression, anxiety, posttraumatic stress disorder) and postpartum, social support and report of infants' negative affect. Maternal mental health symptoms during pregnancy, at the peak of pandemic, is longitudinally associated with infant negative affect, with postpartum mental health mediating this association. Also, maternal COVID-19 stressful events exposure in postpartum is associated with negative affect at 6 months mediated by postpartum mental health symptoms. Maternal pandemic psychological stress during pregnancy predicted mental health symptoms in postpartum. The study supports the association between pandemic-related maternal health across pregnancy and postpartum and offspring's development (i.e., negative affect). It also puts the spotlight on mental health risk in women experiencing lockdown during pregnancy, especially when feeling high psychological stress in pregnancy or when directly exposed to COVID-19 stressful events postpartum.

Longitudinal Assessment of Hair Cortisol as a Predictor of Psychological Symptoms During COVID-19

BACKGROUND

There is a lack of evidence regarding enduring psychoneuroendocrine changes following an initial traumatic event, particular in the presence of an ongoing stressor. The coronavirus pandemic presents an opportunity to explore this matter. Consequently, the purpose of the present study was to investigate the impact of the ongoing pandemic (2021) on individuals, who experienced a first-time motor vehicle crash (MVC) at least 6 years earlier. To this end, we hypothesized that hair cortisol concentrations (HCC) following a first-time traumatic event positively predict symptoms of depression.

METHOD

We investigated N = 69 individuals (18 - 65 yrs.), who were victims of a MVC during 2010 - 2014. Hair strands were collected 10 days (t1) and 3 months after the MVC (t2), as well during the pandemic in 2021 (t3). To assess symptoms of depression, the participants filled out the Beck Depression Inventory at t1 - t3 and were additionally interviewed (Structured Clinical Interview for DSM-IV Axis I) at t1 and t2. Exclusion criteria conveyed a lifetime or acute mental disorder (incl. past trauma exposure).

RESULTS

Elevated pre-pandemic HCC following adversity (i.e., MVC) significantly predicted symptoms of depression in adults during the coronavirus pandemic (BDI: ß =.44, p =.010, R2 =.20), even after controlling for confounders. HCC significantly decreased over time, while in average psychological symptoms remained consistent.

CONCLUSION

Cortisol dysregulation in the past presents an enduring vulnerability to ongoing stress. In this regard, vulnerable groups may benefit from preventive measures. This finding validates the predictive power of HCC and extended past evidence in this regard, at the same time reinforcing the concept of the diathesis-stress model.

Outcomes and Management After COVID-19 Critical Illness

TOPIC IMPORTANCE

COVID-19 has caused > 7 million deaths worldwide since its onset in 2019. Although the severity of illness has varied throughout the pandemic, critical illness related to COVID-19 persists. Survivors of COVID-19 critical illness can be left with sequelae of both the SARS-CoV-2 virus and long-term effects of critical illness included within post-intensive care syndrome. Given the complexity and heterogeneity of COVID-19 critical illness, the biopsychosocial-ecological model can aid in evaluation and treatment of survivors, integrating interactions among physical, cognitive, and psychological domains, as well as social systems and environments.

REVIEW FINDINGS

Prolonged illness after COVID-19 critical illness generally can be classified into effects on physical, cognitive, and psychosocial function, with much interaction among the various effects, and includes a wide range of symptoms such as ICU-acquired weakness, prolonged respiratory symptoms, cognitive changes, post-traumatic stress disorder post-traumatic stress disorder, anxiety, and depression. Risk factors for COVID-19 critical illness developing are complex and include preexisting factors, disease course, and specifics of hospitalization in addition to psychological comorbidities and socioenvironmental factors. Recovery trajectories are not well defined, and management requires a comprehensive, interdisciplinary, and individualized approach to care.

SUMMARY

The onset of vaccinations, new therapeutics, and new strains of SARS-CoV-2 virus have decreased COVID-19 mortality; however, the number of survivors of COVID-19 critical illness remains high. A biopsychosocial-ecological approach is recommended to guide care of COVID-19 critical illness survivors.

A Comprehensive Review on Navigating the Neurological Landscape of COVID-19: Insights Into Etiopathogenesis and Clinical Management

The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a global health crisis with significant neurological implications. While initially characterized by respiratory symptoms, COVID-19 has been increasingly recognized for its diverse neurological manifestations, including encephalopathy, stroke, peripheral neuropathies, and neuropsychiatric disorders. Understanding the neurological landscape of COVID-19 is essential for elucidating its pathophysiology, optimizing clinical management, and improving patient outcomes. This comprehensive review provides insights into the etiopathogenesis, clinical manifestations, diagnostic approaches, management strategies, and prognostic implications of neurological involvement in COVID-19. Mechanistic insights highlight the multifactorial nature of neurological complications involving direct viral invasion, immune-mediated mechanisms, and thrombotic events. Diagnostic challenges underscore the importance of a multidisciplinary approach to patient care, while management strategies emphasize early recognition and appropriate intervention. Long-term neurological sequelae and prognostic factors are also examined, emphasizing the need for comprehensive follow-up and rehabilitation services. Finally, recommendations for future research prioritize efforts to elucidate underlying mechanisms, identify biomarkers, and evaluate rehabilitative interventions. By addressing these challenges, we can better understand and mitigate the neurological consequences of the ongoing COVID-19 pandemic.

The impact of COVID-19 changes and disruptions on generalized anxiety disorder among young adults living with HIV (YLHIV) in Uganda

In the context of the COVID-19 pandemic, we investigated associations between specific COVID-19-related changes and its impact on generalized anxiety disorder (GAD) levels among vulnerable young adults living with HIV (YALHIV) in a low-resource setting in Southern Uganda. This research utilized data from 500 YALHIV aged 19 to 25 from the Suubi+Adherence-R2 COVID-19 Supplement study. Disruptions were assessed using an 8-item modified Coronavirus Impact Scale, while anxiety was measured with the GAD-7 questionnaire. Hierarchical logistic regression analysis and multivariate linear regression were employed, guided by the Social Determinants of Health framework. Key findings highlighted changes in routines, family income, stress from the pandemic, changes in family stress and discord, and reduced access to mental health services heightened levels of probable GAD for YALHIV during the pandemic. Additionally, female young adults showed greater levels than males. These results underscore the urgency to develop tailored support mechanisms for YALHIV, especially during challenging and unprecedented times.

A comparative analysis of stress, anxiety, and social well-being of working mothers and stay-at-home mothers during the covid pandemic

BACKGROUND

The role of mental health is crucial in maintaining the dynamism and productivity of any given society. In contemporary times, a significant proportion of the workforce is comprised of women and mothers. Working in healthcare facilities, where exposure to pathogenic agents is an everyday nuisance, can have detrimental effects on mothers' stress and anxiety levels. Furthermore, such exposure can also endanger the health of both the family and society. Conversely, the employment of mothers could positively impact their social well-being. The primary objective of this study is to assess and compare the stress, anxiety, and social well-being scores of mothers employed in healthcare facilities and stay-at-home mothers during the COVID pandemic.

MATERIALS AND METHODS

This study is a cross-sectional analysis of 246 mothers, equally divided into two groups: Mothers who work in health centers and stay-at-home mothers (123 individuals in each group). The study was conducted from 2021 to 2022, a multistage sampling method was utilized and two questionnaires were administered: The DASS 21 (21 questions) and the social well-being questionnaire (48 questions). The data were analyzed using SPSS 18, and descriptive and analytical tests (Independent Samples T-Test, Mann-Whitney) were employed.

RESULTS

The mean age was 35.7 ± 7.1 for working mothers and 34.3 ± 6.3 for stay-at-home mothers. The average stress score for employed mothers was 5.72 ± 4.7, and for stay-at-home mothers, it was 7.16 ± 4.3, which indicates a statistically significant difference in stress levels between the two groups (P = 0.04). However, the two groups had no significant difference in the mean anxiety score (P = 0.08). The mean score for social well-being was 165.5 ± 18.4 for working mothers and 162.17 ± 21.2 for stay-at-home mothers. This difference was not statistically significant (P = 0.18). Except for the social acceptance dimension (P = 0.003), no statistically significant differences were observed in the social well-being dimension between the two groups.

CONCLUSION

The social acceptance of working mothers appears to be greater than that of stay-at-home mothers. Higher social acceptance suggests that they hold a more positive outlook on people and are at ease in social situations, which may have helped to alleviate their stress and anxiety.

Lessons Learned From Telephone-Based Data Collection for Health and Demographic Surveillance Systems During the COVID-19 Pandemic in Indonesia

The Sleman Health and Demographic Surveillance System (HDSS) is a longitudinal survey held routinely since 2014 to collect demographic, social, and health changes in Sleman Regency, Special Region of Yogyakarta, Indonesia. During the COVID-19 pandemic in Indonesia, we needed to adjust our method of conducting data collection from in-person to telephone interviews. We describe the Sleman HDSS data collection strategy used and the opportunities it presented. First, the Sleman HDSS team completed a feasibility study and adjusted the standard operational procedures to conduct telephone interviews. Then, the Sleman HDSS team collected data via a telephone interview in September-October 2020. Ten interviewers were equipped with an e-HDSS data collection application installed on an Android-based tablet to collect data. The sample targeted was 5,064 households. The telephone-based data collection successfully interviewed 1,674 households (33% response rate) in 17 subdistricts. We changed the data collection strategy so that the Sleman HDSS could still be conducted and we could get the latest data from the population. Compared to in-person interviewing, data collection via telephone was sufficiently practical. The telephone interview was a safe and viable data collection method. To increase the response rate, telephone number activation could be checked, ways of building rapport could be improved, and engagement could be improved by using social capital.

Prevalence of and risk factors for suicidal ideation in adolescents during the COVID-19 pandemic: a cross-sectional study

BACKGROUND AND OBJECTIVES

Pandemic-related life changes may have had a deleterious impact on suicidal behaviours. Early detection of suicidal ideation and identification of subgroups at increased risk could help prevent suicide, one of the leading causes of death among adolescents worldwide. Here, we aimed to investigate the prevalence of and risk factors for suicidal ideation in adolescents using a population-based sample from Switzerland, two years into the pandemic.

METHODS

Between December 2021 and June 2022, adolescents aged 14 to 17 years already enrolled in a population-based cohort study (State of Geneva, Switzerland) were asked about suicidal ideation over the previous year. In addition to a regression model, we conducted a network analysis of exposures which identified direct and indirect risk factors for suicidal ideation (i.e. those connected through intermediate risk factors) using mixed graphical models.

RESULTS

Among 492 adolescents, 14.4% (95% CI: 11.5-17.8) declared having experienced suicidal ideation over the previous year. Using network analysis, we found that high psychological distress, low self-esteem, identifying as lesbian, gay or bisexual, suffering from bullying, extensive screen time and a severe COVID-19 pandemic impact were major risk factors for suicidal ideation, with parent-adolescent relationship having the highest centrality strength in the network.

CONCLUSION

Our results show that a significant proportion of adolescents experience suicidal ideation, yet these rates are comparable with pre-pandemic results. Providing psychological support is fundamental, with a focus on improving parent-adolescent relationships.

Cognitive performance of post-covid patients in mild, moderate, and severe clinical situations

BACKGROUND

Studying individuals with varying symptoms, from mild to severe, can provide valuable insights into the spectrum of cognitive outcomes after COVID-19. We investigated the cognitive performance of adults who recovered from the novel coronavirus disease (COVID-19) without prior cognitive complaints, considering mild (not hospitalized), moderate (ward), and severe (intensive care unit) symptoms.

METHODS

This cross-sectional study included 302 patients who recovered from COVID-19 (mild, n = 102; moderate, n = 102; severe, n = 98). We assessed intellectual quotient (IQ), attention, memory, processing speed, visual-constructive ability, as well as symptoms of depression, anxiety, and stress, at least eighteen months after infection. The mean length of hospitalization was Mdays=8.2 (SD = 3.9) and Mdays=14.4 (SD = 8.2) in the moderate and severe groups, respectively.

RESULTS

Cognitive difficulties were present in all three groups: mild (n = 12, 11.7%), moderate (n = 40, 39.2%), and severe (n = 48, 48.9%). Using Multinomial Logistic Regression and considering the odds ratio, our results indicated that a one-point increase in sustained attention, visual memory, and working memory might decrease the odds of being categorized in the severe group by 20%, 24%, and 77%, respectively, compared to the mild group.

CONCLUSIONS

Our findings provide empirical evidence regarding the long-term cognitive effects of COVID-19, particularly in individuals experiencing severe manifestations of the disease. We also highlighted the need for a comprehensive, multidimensional approach in rehabilitation programs to address the enduring cognitive impacts of COVID-19.

Prevalence and predictors of prenatal depression during the COVID-19 pandemic: A multistage observational study in Beijing, China

OBJECTIVE

While growing psychological health issues among pregnant women during the COVID-19 pandemic have been clearly validated, most research was conducted in countries with relatively lax quarantine measures. This study aimed to compare the prevalence of prenatal depression among pre-, peak-, and post-COVID-19 in Beijing, the region with a stringent response policy in China. We also explore predictors of prenatal depression throughout the outbreak.

METHODS

We investigated prenatal depression among 742 pregnant women who received antenatal checkups in Beijing from March 28, 2019 to May 07, 2021 using the Edinburgh Postnatal Depression Scale and associative demographic, pregnancy-related, and psychosocial characteristics were measured. The phase was divided into pre-, peak-, and post-COVID-19 in light of the trajectory of COVID-19. Pearson's Chi-square test was used after the examination of confounders homogeneity. The bivariable and multivariable logistic regression was conducted to explore predictors.

RESULTS

The pooled prevalence of prenatal depression was 11.9% throughout the COVID-19 pandemic. Rates at different phases were 10.6%, 15.2%, and 11.1% respectively and no significant difference was observed. Multivariable logistic regression revealed that history of mental illness, number of boy-preference from both pregnant women and husband's family, social support, occupation, and living space were independent predictors of prenatal depression in Beijing.

CONCLUSION

Our data suggested that the impact of this pandemic on prenatal depression in Beijing appears to be not significant, which will strengthen confidence in adhering to current policy for decision-makers and provide important guidance for the development of major outbreak control and management policies in the future. Our findings may also provide a more efficient measure to identify high-risk pregnant women for professionals and help raise gender equity awareness of pregnant women and their husbands' families. Future studies should focus on the value of targeted care and family relations on the mental health of pregnant women.