Behavioral Health and Response for COVID-19

Psychometric Validation of the Portuguese Obsession with COVID-19 Scale (PT-OCS)

The psychological effects of the COVID-19 pandemic on the Portuguese population are quite relevant and partially related to their repetitive and disruptive thinking about the disease. The successive periods of lockdown contributed to an additional burden on the family-work-life balance for parents. This study aims to validate the Portuguese version of the Obsession with COVID-19 Scale (PT-OCS), which was developed using a general sample from several regions of the country (n = 531) together with a specific sample of Portuguese parents (n = 109). The confirmatory factor analysis results indicate that the PT-OCS includes a set of excellent psychometric properties concerning both the general sample (χ2(1) = 0.446, p = 0.504; CFI = 1.0; GFI = 1.0; RMSEA = 0.0; standardised RMR = 0.003) and the parent group (χ2(2) = 1.816, p = 0.403; CFI = 1.0; GFI = 0.99; RMSEA = 0.0; standardised RMR = 0.016; Bollen-Stine bootstrap p = 0.65). The scale shows very good reliability (0.84 < α/ω < 0.88). As expected, obsession with COVID-19 was highly correlated with COVID-19 anxiety, and women had higher PT-OCS scores. The findings suggest that the PT-OCS is a reliable and valid measure for both persistent and disruptive thinking about COVID-19 in different groups of the Portuguese population, with potential for studying future epidemic events.

Psychological and social determinants of adaptation: the impact of finances, loneliness, information access and chronic stress on resilience activation

Background

Many people who face adversity, such as disasters, demonstrate resilience. However, less is known about reactions to large scale disasters with longer recovery periods. The concern is that protracted disasters may result in more chronic or accumulated stressors with an uncertain or unknown end point and can exhaust the natural coping methods and ability to rebound. Thus, understanding patterns of longer-term disaster recovery, inclusive of resilience, is needed. Further resilience is not individual specific rather social determinants, such as support networks and available resources, are contributing factors.

Methods

The purpose of this study is to improve understanding of mental health and resilience during increased stress, we aim to identify profiles of adaptation and psychological and social determinants that predict membership within predominant symptom groupings. We conducted an exploratory cross-section study (N = 334) with two phases of multivariate analysis. Latent profile models were estimated to identify groups based on depression, anxiety, and resilience scores. The second phase included a step-wise multinomial logistic regression to predict class membership.

Results

We identified four distinct groups: 33% of participants were categorized as anxious, 18% depressed, 9% comorbid, and 40% with above average levels of resilience. Psychosocial factors such as demographics, trauma history, information access, loneliness, and lack of financial resources predicted poorer mental health outcomes and lower resilience.

Conclusion

This study identified factors that contribute to overall wellbeing despite chronic stressors. Social determinants of adaptation, found in this study population, include loneliness, finances, and information access. The findings from this study support the need for both psychological and social adaption supports, inclusive of mental health treatment, to strengthen resilience activation.

Resilience and Wellbeing Strategies for Pandemic Fatigue in Times of Covid-19

The COVID-19 pandemic is truly one of the greatest collective health crises in history which have altered our life and living. For years, people have felt fatigued from following public health directives such as social distancing, wearing masks, washing hands frequently, and working or studying remotely without in-person interactions. In this paper, we explore strategies for resilience and wellbeing which can mitigate pandemic-caused stress and behavioural fatigue. We start with individual level strategies including reworking stress appraisals, the importance of psychological flexibility, reducing loneliness through adaptive online platform use, optimizing familial relationships when living in close quarters for a prolonged period, reducing symptoms of burnout and using adaptive distractions, using specific evidence-based resilience strategies. We discuss specific considerations which tap on our shared identities and shared responsibilities which can enhance a sense of community, especially for individuals from marginalized backgrounds and how suicide risks can be minimized.

Mental health and well-being for aging adults during the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic remains a significant mental health crisis. Although empirical research works to better understand the impact of COVID-19 on the mental health of the general population, some groups remain at greater risk for adverse mental health consequences. The purpose of this study is to better understand how COVID-19 experiences, food insecurities, and social support are associated with mental health and well-being for aging populations.

METHODS

Data collection began April 1, 2020 and continued through May 22, 2020. Study participants were recruited via website and media promotion and completed an anonymous survey. A sample of adults age 50 years and older (N = 136) were selected for the current analysis. Measures included scales of anxiety, depression, resilience, quality of life, COVID-19 experiences, interdependence, and insecurities. Three stepwise linear regression models were conducted using forward selection were estimated.

RESULTS

The first model found food insecurity, community closeness, and COVID-19 experiences predicted 23% of the variance in mental health. The second model found having enough money to meet needs, COVID-19 interdependence, and age predicted 20% of the variance in resilience. The final model found having enough money to meet needs, COVID-19 experiences, community closeness, and information access predicted 45% of the variance in quality of life.

DISCUSSION

Our discussion highlights the role of COVID-19 experiences, tangible resource losses, and community connection in mental health outcomes for aging populations during COVID-19. We suggest areas of future research and highlight the important role of technology in both scholarship and practice.

Virtual training and technical assistance: a shift in behavioral health workforce access and perceptions of services during emergency restrictions

BACKGROUND

To respond to the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration-funded Technology Transfer Centers had to rapidly adapt to ensure that the behavioral health workforce had continuous access to remote training and technical assistance (TTA). Although the Technology Transfer Centers have historically relied partially upon virtual methods for delivering TTA, the shift to a strictly virtual approach necessitated by COVID-19 restrictions has raised new questions for how to best proceed with services when social distancing guidelines are relaxed. The objective of this exploratory paper was to compare TTA provision in the six-month period prior to (9/1/19 thru 2/28/20) and during (4/1/20 thru 9/30/20) early COVID-19 restrictions to determine the extent to which the shift to virtual service provision impacted the behavioral health and medical workforce. Specifically, we examined participants' access to TTA, geographic reach of TTA, and workforce perceptions of satisfaction and utility with TTA provision.

METHOD

Participant and event-level data were analyzed to compare the following metrics before and during the COVID pandemic: number of events and attendees; participant demographics; zip codes reached; coverage of rural, suburban, and urban areas; and perceptions of satisfaction with and utility of training.

RESULTS

Findings showed a 40% increase in the number of events delivered (p < .001) and a 270% increase in the number of attendees (p < .001) during the COVID period when TTCs relied exclusively on virtual delivery. Geospatial analyses linking zip codes to a schematic of rural, suburban, and urban classifications throughout the United States revealed significant increases in the number of zip codes reached during the COVID time period. Satisfaction levels were comparable before and during the pandemic.

CONCLUSIONS

Findings show that expanded access to TTA services via virtual formats resulted in reach to more diverse attendees and regions, and did not come at the expense of satisfaction. Results suggest that virtual TTA should continue to be an important component of TTA offerings post-pandemic.

Untapped Potential: Local Health Departments' Involvement in Behavioral Health Preparedness Planning and Recovery Through a Population Behavioral Health Framework

Due to the COVID-19 pandemic, there is an increased demand for behavioral health services in an already strained public health system. Thus, there is a critical need to shift to a population behavioral health framework to address the scope and magnitude of the behavioral health crisis. Local health departments (LHDs) are positioned and purposed to assist in this work by implementing behavioral health surveillance, prevention, and early intervention strategies. Two surveys conducted by the National Association of County and City Health Officials (NACCHO) were used for this analysis, the 2018 Preparedness Profile survey and the 2020 Forces of Change survey. In 2018, a little over half of LHDs involved behavioral health groups in their planning coalitions, and three-quarters of LHDs addressed behavioral health in preparedness planning. However, in 2020, LHDs implementing a behavioral health response during COVID-19 was substantially lower than the planning phases: strategy to support the public health system, including behavioral health (20%); specific initiative for individuals with behavioral health needs (48%); or targeted messaging for people with behavioral health needs (25%). The findings of this analysis indicate that as of 2020, LHDs’ involvement in behavioral health is still minimal and the potential for LHDs to reduce burden on the public health system is not being maximized. For LHDs to provide more behavioral health services they will require support in the form of funds, technical assistance, education on best practices, and the support and authority to expand services in behavioral health.

Care Management Intervention to Address Determinants of Health for Individuals With Multiple Behavioral Health Readmission

PURPOSE OF STUDY

To examine the effectiveness of a care management intervention to decrease readmissions and to better understand clinical and social determinants associated with readmission.

PRIMARY PRACTICE SETTING

Inpatient mental health (MH) and substance use disorder (SUD) facilities, nonhospital SUD withdrawal management and rehabilitation facilities.

METHODOLOGY AND SAMPLE

The authors identified 3,950 Medicaid-enrolled individuals who received the intervention from licensed clinical staff of a behavioral health managed care organization; 2,182 individuals were eligible but did not receive the intervention, for treatment as usual (TAU). We used logistic regression to examine factors associated with readmission. Determinants of readmission were summarized through descriptive tests.

RESULTS

The intervention was associated with lower readmissions to SUD facilities compared with TAU (6.0% vs. 8.6%, p = .0002) and better follow-up to aftercare. Controlling for clinical differences between groups, regression results found increased odds of readmission for male gender (odds ratio [OR]: 1.33; 95% confidence interval [CI]: 1.16-1.52, p < .0001) and dual MH and SUD diagnoses (OR: 1.52; CI: 1.29-1.79, p < .0001). Prior inpatient and case management services were also associated with increased odds for readmission. In the regression model, the intervention was not associated with decreased odds for readmission. Individuals with readmission (n = 796) were more likely to report being prescribed psychotropic medication and having housing difficulties and less likely to report having a recovery plan than those without readmission.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

Characteristics of Medicaid populations with hospitalization may contribute to readmission, which may be mitigated through care management intervention.

COVID-19 behavioral health and quality of life

In addition to concern about physical health consequences of COVID-19, many researchers also note the concerning impact on behavioral health and quality of life due to disruption. The purpose of this paper is to explore pathways of COVID-19 behavioral health and quality of life. We found increased anxiety, depression, and alcohol misuse and that the pandemic exacerbated prior problems. Further community indicators also lead to poorer behavioral health and overall decreased quality of life. The nature of COVID-19 and vast reach of the virus suggests that behavioral health concerns should take a primary role in pandemic recovery.

Is social isolation during the COVID-19 pandemic a risk factor for depression?

ABSTRACT Objective: To assess factors associated with depression among higher education students and professionals during the peak of the COVID-19 pandemic. Method: quantitative study with a cross-sectional design. 550 students and professionals participated. The data were collected by means of a digital questionnaire that included Patient Health Questionnaire-9 to assess depressive symptoms. Results: The factors related to depression and social isolation outcomes were significantly associated with the female gender (n= 149; 37,8%; Odds Ratio OR=2,0), white (n=127; 37,2%; OR=1,60), young people (n=130; 39,4%; OR=2,0), without religion (n=70; 40,2%; OR=1,64), with financial problems (n=80; 53,0%; OR=2,40) and family problems (n=98; 47,3%; OR=1,77); who suffered violence during the quarantine (n=28; 58,3%; OR=2,33), increased the use of illicit drugs (n=16; 59,3%; OR=2,69), used sedatives without a medical prescription (n=75; 54,0%; OR=2,94), lived in conflicting relationships (n=33; 54,1%;OR=2,14), lost their job during the pandemic (n=32; 59,3%; OR=1,99) and presented symptoms of anxiety related to COVID-19 (n=155; 45,2%; OR=3,91). Conclusion: there is a meaningful relationship between vulnerability and adopting risk behaviors during the pandemic-imposed social isolation with depressive symptoms. We suggest that health professionals be attentive to the need to adjust their psychosocial interventions when promoting strategies when promoting strategies to mitigate the effects and risks to mental health.

The Mediating Effect of Coping Strategies Between Psychological Capital and Small Tourism Organization Resilience: Insights From the COVID-19 Pandemic, Malaysia

Amid difficulty, the psychological capital of small tourism firm owners/managers has been given less attention. In the coronavirus disease-2019 (COVID-19) pandemic, this research examined how psychological capital (self-efficacy, hope, optimism, and resilience) affects organizational resilience. By structural equation modeling (AMOS 21.0), 644 small tourism firm owners in Malaysia were randomly selected to investigate the relationship between psychological capital and organizational resilience, and the mediating effect of problem-focused and emotion-focused coping strategies on this relationship. The findings of the study supported hypothesized relationships, as the psychological capital of small tourism firm owners in Malaysia significantly affects organizational resilience. Furthermore, the study discovered that problem-focused and emotion-focused coping strategies have partial mediating effects on the association between psychological capital and organizational resilience. In the context of small tourism businesses sector, the findings of the study have implications, as the firms identify the recovery procedure in the COVID-19 pandemic.

The Use of ICT-Based Applications to Support the Implementation of Smart Cities during the COVID-19 Pandemic in Indonesia

The COVID-19 pandemic has resulted in compulsion and encouragement of actions that have enabled changes to occur globally that have then been adapted to current conditions. For their highly dense populations, it is difficult to control the spread of the virus in cities. As a result, activities that draw large crowds together so that people can access public services are inevitable. Several cities that have been declared as smart cities in Indonesia have made a breakthrough by making use of information and communication technology (ICT)-based applications. This can be of great help for societies during pandemics. ICT has been able to help citizens perform various activities from home with the help of applications. This study aims to identify various applications that support the implementation of the concept of a smart city. This applies particularly to those applications that are based on ICT that can tackle the unique conditions of the COVID-19 pandemic and make recommendations regarding future developments. The data collected for this study were analyzed using secondary sources obtained from various clusters of literature, the internet, and social media. In addition, primary data was gathered from discussion forums. This paper employs a qualitative approach with qualitative descriptive data analysis techniques and hierarchical cluster analysis. Qualitative descriptive analysis was utilized to explore the conditions of smart cities, the regional conditions of the pandemic, and smart city applications more generally. The results show that during the COVID-19 pandemic, cities and regions, including the 100 smart cities in Indonesia, have developed many innovative solutions through ICT-based applications that can help people maintain an active social life and access public services. In the future, when everything is allegedly back to normal, cities need to implement the use of various ICT-based applications to increase efficiency in their planning and management. Therefore, it has become increasingly necessary to improve people’s digital literacy and to develop a type of ICT infrastructure that enables more people to access the internet.

Effects of the COVID-19 pandemic and lockdown on alcohol use disorders and complications

PURPOSE OF REVIEW

To understand the effect of COVID-19 pandemic and lockdown on persons with alcohol use disorders.

RECENT FINDINGS

From a total of 455 titles on COVID-19 and alcohol, 227 abstracts were screened, and 95 articles were reviewed (on November 25th, 2020). The immediate effect was an increase in alcohol related emergencies including alcohol withdrawal, related suicides, and methanol toxicity. Although there are mixed findings with respect to changes in the quantity of drinking, there are reports of binge/heavy drinking during the lockdown as well as relapse postlockdown. Psychological, social, biological, economic and policy-related factors appear to influence the changes in drinking. Although preliminary data suggest no change in alcohol use among persons with comorbid mental illness, findings in this population are presently limited. Among patients with alcohol related liver disease, outcomes appear worse and caution is warranted with the use of medications. Alcohol also appears to increases the risk of COVID-19 infection and complicates its course.Although some nations banned alcohol sales completely during lockdown, others declared it as an essential commodity, resulting in different problems across countries. Alcohol use has added to the burden of the problem particularly among vulnerable groups like the adolescents, elderly, patients with cancer, as well as health professionals. Services for patients with alcohol use disorders have been affected.

SUMMARY

The COVID-19 pandemic has had considerable impact on alcohol use, with an increase in alcohol related emergencies, changes in alcohol use patterns, increased risk of contracting COVID-19, effect on alcohol policies and sales, and an effect on vulnerable groups. It is essential to understand and respond to the current situation, intervene early, and prevent further repercussions of the pandemic.Video abstract link: https://drive.google.com/file/d/1IJWtIs6e554PryKWhdma4VB--mjSZq1C/view?usp=sharing.

Medication for Opioid Use Disorder Service Provision and Telephone Counseling: A Concurrent Mixed-Methods Approach

Using quantitative and qualitative evidence, this study triangulates counselors' perspectives on the use of telemedicine in the context of Opioid Use Disorder (OUD) treatment. A concurrent mixed-methods design examined counselors' experiences with telephone counseling during the COVID-19 pandemic. N = 42 counselors who provided OUD counseling services completed a close-ended, quantitative survey examining their experiences in addressing clients' anxiety, depression, anger, substance use, therapeutic relationship, and substance use recovery using telephone counseling. The survey also assessed comfort, convenience, and satisfaction with telephone counseling. Counselors also completed open-ended responses examining satisfaction, convenience, relationship with patients, substance use, and general feedback with telephone counseling. The synthesis of quantitative and qualitative evidence indicated that a majority of counselors had positive experiences with using telephone counseling to provide services to clients undergoing OUD treatment. Convenience, greater access to clients, and flexibility were among the reasons cited for their positive experience. However, counselors also expressed that the telephone counseling was impersonal, and that some clients may have difficulties accessing appropriate technology for telehealth adoption. Findings suggest that further research with counselors is needed to identify the key elements of an effective integration of telephone counseling with traditional in-person treatment approaches in the post-pandemic era.

COVID-19 Mental Health Disparities

Communities of color in the United States have been disproportionately impacted by the COVID-19 pandemic. Studies exploring the mental health implications of these disparities have only just begun to emerge. The purpose of this study is to better understand mental health concerns and test whether social determinants of health and COVID-19-related experiences influence these concerns. In April 2020, we launched a community-based survey for adults across the United States. A total of 341 respondents completed the survey, which included questions about demographics, depression, social isolation, work environment, and preexisting mental health conditions. We generated matched controls by adding county data from the Robert Wood Johnson Foundation to our survey. Chi square, Pearson product-moment correlation, point biserial correlation, and logistic regression were estimated. Our analysis revealed that respondents who identified as Latinx, Latin@, or Hispanic were 10 times more likely to meet the threshold score for depression. Similarly, individuals with prior mental health conditions and those who expressed feelings of social isolation due to COVID-19 were 3 times more likely to meet the threshold score for depression. These results confirm our hypothesis that communities of color will likely experience disproportionate mental health impacts of COVID-19-specifically, the mental health sequela that emerge from exposure, cumulative burden, and social isolation. We discuss the implications for expanding access and quality of health and mental health services to address current inequities.

Feeling Uncertainty during the Lockdown That Commenced in March 2020 in Greece

The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant uncertainty for the global population. However, since not all population groups experience the impacts of the pandemic in the same way, the objective of this study was to identify the individual characteristics associated with the feeling of uncertainty during the lockdown that commenced in March 2020 in Greece. The study used data from the "Public Opinion in the European Union (EU) in Time of Coronavirus Crisis" survey. The sample consisted of 1050 individuals aged between 16 and 54 years. According to the analysis, which was based on a logistic regression model, the emotional status of older individuals, those who experienced income and job losses since the beginning of the pandemic, and middle-class and high-class individuals, is more likely to be described as a feeling of uncertainty. In addition, the emotional status of individuals with less concern for their own health and that of family and friends is less likely to be described as a feeling of uncertainty. Although the results related to age, income, and job losses, as regards concern for health, agree with the international literature, the limited health literacy of lower-class individuals may explain the reduced likelihood of their experiencing feelings of uncertainty. The results confirm the international literature describing several aspects of uncertainty due to the COVID-19 crisis.

A cross-sectional population-based study on the influence of the COVID-19 pandemic on incomes in Greece

The Coronavirus Disease 2019 (COVID-19) pandemic induced economic shock in Greece, which translated into a decrease in household income. Thus, the objective of this study is to measure social inequality with regard to income loss due to the COVID-19 pandemic in Greece. In addition, we aim to identify the characteristics of those experiencing income loss due to the pandemic. The study uses data from the "Public Opinion in the European Union (EU) in Time of Coronavirus Crisis. Third Round" survey. The sample consists of 1036 individuals aged between 16 and 54 years. To measure inequality, the Erreygers' Concentration Index (CI) is calculated, using social class as the ranking variable. To identify the characteristics of those experiencing income loss, a logistic regression model is fitted using the region of residence and several demographic and socioeconomic variables as potential predictors. According to the results, social inequality does not exist with regard to income loss due to the COVID-19 pandemic. Thus, our findings indicate the negative influence of the pandemic on the incomes of individuals from all social classes in Greece. According to the results of the logistic regression model, the odds of experiencing income loss are higher for residents of the Aegean Islands and Crete but also for self-employed, part-time employed, and unemployed individuals. These findings indicate the negative influence of the pandemic on Greek tourism and on sectors employing a large proportion of non-standard workers. Although inequality does not exist, a substantial proportion of those losing income due to the pandemic is in line with the global picture.

Are older adults more optimistic? Evidence from China, Israel and the US

Objectives

Optimistic bias refers to the phenomenon that individuals believe bad things are less likely to happen to themselves than to others. However, whether optimistic bias could vary across age and culture is unknown. The present study aims to investigate: 1) whether individuals exhibit optimistic bias in the context of COVID-19 pandemic; 2) and whether age and culture would moderate such bias.

Method

1051 participants recruited from China, Israel and the US took the online survey. Risk perceptions consists of three questions: estimating the infected probability of different social distance groups (i.e., self, close others, and non-close others), the days that it would take for the number of new infections to decrease to zero and the trend of infections in regions of different geographical distances (i.e., local place, other places inside participants’ country and other countries). Participants in China and the US also reported their personal communal values measured by Schwartz’s Value Survey.

Results

Results from HLM generally confirmed that 1) all participants exhibited optimistic bias to some extent, and 2) with age, Chinese participants had a higher level of optimistic bias than Israeli and US participants. Compared to their younger counterparts, older Chinese are more likely to believe that local communities are at lower risk of COVID-19 than other countries.

Discussion

These findings support the hypothesis that age differences in risk perceptions might be influenced by cultural context. Further analysis indicated that such cultural and age variations in optimistic bias were likely to be driven by age-related increase in internalized cultural values.

The influences of the COVID-19 pandemic on medical service behaviors

The outbreak of the novel coronavirus (COVID-19) has greatly impacted medical services worldwide. In addition to changing the processes used by hospital medical services, it has also changed the behaviors of medical staff, resulting in a completely different appearance. Fear of being infected with COVID-19 makes patients fear entering hospitals, and hospitals must repeatedly screen patients prior to entry in order to confirm that they are not infected. Patients are then separated according to their symptoms and travel, occupation, contact and cluster histories (TOCC), which seriously affects them. In addition, hospitals have invested a lot of money into the whole visiting process and into the equipment required to prevent the spread or lessen the impact of COVID-19.

Evaluation of Risk Perception of COVID-19 Disease: A Community-Based Participatory Study

OBJECTIVE

How people behave in a crisis depends on their understanding and evaluation of risk and vulnerability. Therefore, this study was conducted to investigate the Iranians' risk perception of coronavirus disease (COVID-19).

METHODS

An online survey was applied, which resulted in the collection of information on demographics, the 5 dimensions of risk perception (cognitive, political, social, cultural, and emotional), and trust in the government among the Iranian users of social networks. Data were analyzed by descriptive and analytical tests of SPSS (IBM Corp, Armonk, NY) software, and confirmatory factor analysis of Amos software.

RESULTS

A total of 364 persons from 20 provinces completed the questionnaire during February 25 to March 2, 2020. More than 80% of the participants believed that negligence and lack of close supervision of the authorities have led to the spread of COVID-19. The mean (SD) risk perception was 58.77 (± 10.11), indicating the medium level of risk perception of people. The second-order confirmatory factor analysis also indicated that cultural dimension had the highest positive correlation (0.96), emotional dimension had the highest negative correlation (-0.65), and social dimension had the least correlation with the risk perception model (0.08).

CONCLUSION

Iranians' risk perception of the COVID-19 outbreak is not optimal, and it seems necessary to improve it.