Keeping well in a COVID-19 crisis: a qualitative study formulating the perspectives of mental health service users and carers

Left Behind: Experiences of Community Mental Health Center Clients with Serious Mental Illness During the COVID-19 Pandemic

While some international qualitative research has interviewed people with serious mental illnesses (SMI) about their experiences in the initial months of the COVID-19 pandemic, few US studies have explored their experiences and perspectives as the pandemic has continued. Drawing from disability studies perspectives, this qualitative study conducted in 2022 explored the experiences of people with SMI seeking services at community mental health centers during the COVID-19 pandemic. Fifteen clients who identified as living with an SMI and were clients during March 2020 were interviewed. Using narrative analysis, we identified an overarching tenor of client experiences: feeling left behind by institutions and society. This feeling of being left behind was conceptualized as three themes. As the literature around the COVID-19 pandemic grows and we attempt to integrate it into community mental health policy and practice, it is essential to include the experiences and perspectives of clients with lived experience of SMI.

Feasibility and acceptability of an ultra-long-term at-home EEG monitoring system (EEG@HOME) for people with epilepsy

BACKGROUND

Recent technological advancements offer new ways to monitor and manage epilepsy. The adoption of these devices in routine clinical practice will strongly depend on patient acceptability and usability, with their perspectives being crucial. Previous studies provided feedback from patients, but few explored the experience of them using independently multiple devices independently at home.

PURPOSE

The study, assessed through a mixed methods design, the direct experiences of people with epilepsy independently using a non-invasive monitoring system (EEG@HOME) for an extended duration of 6 months, at home. We aimed to investigate factors affecting engagement, gather qualitative insights, and provide recommendations for future home epilepsy monitoring systems.

MATERIALS AND METHODS

Adults with epilepsy independently were trained to use a wearable dry EEG system, a wrist-worn device, and a smartphone app for seizure tracking and behaviour monitoring for 6 months at home. Monthly acceptability questionnaires (PSSUQ, SUS) and semi-structured interviews were conducted to explore participant experience. Adherence with the procedure, acceptability scores and systematic thematic analysis of the interviews, focusing on the experience with the procedure, motivation and benefits and opinion about the procedure were assessed.

RESULTS

Twelve people with epilepsy took part into the study for an average of 193.8 days (range 61 to 312) with a likelihood of using the system at six months of 83 %. The e-diary and the smartwatch were highly acceptable and preferred to a wearable EEG system (PSSUQ score of 1.9, 1.9, 2.4). Participants showed an acceptable level of adherence with all solutions (Average usage of 63 %, 66 %, 92 %) reporting more difficulties using the EEG twice a day and remembering to complete the daily behavioural questionnaires. Clear information and training, continuous remote support, perceived direct and indirect benefits and the possibility to have a flexible, tailored to daily routine monitoring were defined as key factors to ensure compliance with long-term monitoring systems.

CONCLUSIONS

EEG@HOME study demonstrated people with epilepsy' interest and ability in active health monitoring using new technologies. Remote training and support enable independent home use of new non-invasive technologies, but to ensure long term acceptability and usability systems will require to be integrated into patients' routines, include healthcare providers, and offer continuous support and personalized feedback.

Lessons of Hope and Resilience: A Co-Produced Qualitative Study of the Experiences of Youth Living with Psychosis During the COVID-19 Pandemic in Nigeria

Much of the emerging evidence on the impact of COVID-19 on people with psychosocial disabilities comes from high-income countries. This study sought to explore the perceptions and experiences of youths living with psychosis during the COVID-19 pandemic in Nigeria. Using a co-produced research process, a facility-based study was conducted among youth with confirmed diagnosis of a psychotic disorder. In-depth interviews were conducted with 20 participants. Data was transcribed, double-coded and analysed with Atlas.ti using a thematic analysis approach. We found that participants were aware of good evidence-based information on the nature of the disease and the pandemic. Many of them described worsening mental health and disruptions to daily routines. Opportunities for deepening family relationships, skill building, helping others, and extended time for previously neglected self-development activities were described. This study benefitted from co-production with persons with lived experience, which could be harnessed for future research on psychosis.

'Turbulence even in a bubble': a reflexive thematic analysis with family caregivers of people with dementia in the United Kingdom during and beyond the COVID-19 pandemic

OBJECTIVE

This study aimed to understand how family caregivers of people with dementia managed changes caused by COVID-19 restrictions and how they adjusted to the lifting of restrictions. A particular focus of the study was on understanding the impact of social isolation, a reduction of social interactions, and reduced access to healthcare services.

METHODS AND MEASURES

Fourteen voluntary caregivers (nine women) were interviewed using a semi-structured interview schedule.

RESULTS

Five themes were identified based on reflexive thematic analysis: (i) Outlets to cope with lockdown; (ii) 'Not all doom and gloom': A silver lining amid COVID-19; (iii) Optimism helps provide resilience; (iv) The challenges and joys of reopening; and (v) Caregiving toward a new normality.

CONCLUSION

The research highlighted difficulties reported by family caregivers and people with dementia during COVID-19, while also showing how such carers coped. Interviews also identified ways that family caregivers often used optimism to help navigate through lockdown and to tackle the reopening stage. Family caregivers in this study reported coping well overall, but welcomed the lifting of restrictions.

COPSYC-19: The impact of early phase lockdown on mental health among people with psychotic disorders

PURPOSE

On March 12th 2020 extensive measures were implemented to prevent spread of the coronavirus disease-19 (COVID-19). These measures were commonly referred to as "lockdown". In this study we investigate the psychological impact associated with living under these circumstances among patients with psychotic disorders receiving care from specialized mental health services in Norway.

METHOD

During early phases of lockdown, patients and clinicians receiving and providing mental health care for psychotic disorders in specialized health services at Oslo University Hospital were asked to fill out questionnaires developed for the study. 129 participants from outpatient clinics (91 patients and 38 clinicians) and 89 from inpatient wards (15 patients and 74 clinicians) were recruited. Data regarding mental health and related symptoms were analysed using Wilcoxon signed rank tests and standard multiple regression.

RESULTS

Outpatients reported significantly less extensive worrying, loneliness and hallucinatory experiences during early phase lockdown compared to the two weeks prior. Reductions in loneliness were predictive of experienced improvement in subjective mental health. However, the majority of clinicians from outpatient clinics believed their patients were experiencing more worrying and loneliness.

CONCLUSION

The result of this study suggests that many patients with psychosis experienced less loneliness, excessive worrying and hallucinations during the first phase of lockdown. This contrasts the clinicians' perceptions, as the patients show signs of resilience during times of uncertainty. The limitation in the study timeframe should be noted.

Caregivers' experiences of caring for non-COVID-19 patients during the pandemic: A qualitative systematic review

OBJECTIVE

To investigate caregivers' experiences of caring for non-coronavirus disease (COVID-19) patients to determine their challenges and needs.

METHODS

Five electronic databases (PubMed, Web of Science, Ovid, CINAHL, and ClinicalKey) were searched from January 2020 to June 2022. Two authors independently reviewed all studies for eligibility and extracted information on the study aim, sample characteristics, study design, data collection, analysis methods, and so on.

RESULTS

Finally, 13 studies were included. Four themes were determined: impacts on physical and psychosocial well-being of caregivers, perceived risk of the virus, negative impacts on employment and financial statuses, and changes in support networks.

CONCLUSION

This is the first qualitative systematic review to describe caregivers' experiences of caring for non-COVID-19 patients during the pandemic. The four themes should be focused on to ease caregivers' physical, psychological, and financial burdens; to provide them with better assistance in terms of formal and informal supports to cope with the epidemic more effectively; and to ensure that their loved ones are much healthier.

PRACTICE IMPLICATIONS

The findings can be used by healthcare policymakers, social policymakers, and governments to better support caregivers of non-COVID-19 patients. Additionally, it provides suggestions for related medical institutions to pay more attention to caregivers' experiences.

Mental health and wellbeing among people with informal caring responsibilities across different time points during the COVID-19 pandemic: a population-based propensity score matching analysis

AIMS

Due to a prolonged period of national and regional lockdown measures during the coronavirus (COVID-19) pandemic, there has been an increase reliance on informal care for informal carers. In light of this, the current study compared the experiences of carers and non-carers on various mental health and wellbeing measures across six key time points during the pandemic.

METHODS

Data analysed were from the University College London (UCL) COVID -19 Social Study. Our study focused on six time points in England: (1) the first national lockdown (March-April 2020); (2) the beginning of first lockdown rules easing (May 2020); (3) the second national lockdown (November 2020); (4) the third national lockdown (January 2021); (5) the easing of the third lockdown (March 2021); and (6) the end of restrictions (July-August 2021). We considered five mental health and wellbeing measures: depressive symptoms, anxiety symptoms, loneliness, life satisfaction, and sense of being worthwhile. Propensity score matching was applied for the analyses.

RESULTS

We found that informal carers experienced higher levels of depressive and anxiety symptoms than non-carers across much of the pandemic. During the first national lockdown, carers also experienced a higher sense of life being worthwhile. No association was found between informal caring responsibilities and levels of loneliness and life satisfaction.

CONCLUSION

Given that carers are an essential national healthcare support, especially during a pandemic, it is crucial to integrate carers' needs into healthcare planning and delivery. These results highlight that there is a pressing need to provide adequate and targeted mental health support for carers during and following this pandemic.

Mental health in Europe during the COVID-19 pandemic: a systematic review

The COVID-19 pandemic caused immediate and far-reaching disruption to society, the economy, and health-care services. We synthesised evidence on the effect of the pandemic on mental health and mental health care in high-income European countries. We included 177 longitudinal and repeated cross-sectional studies comparing prevalence or incidence of mental health problems, mental health symptom severity in people with pre-existing mental health conditions, or mental health service use before versus during the pandemic, or between different timepoints of the pandemic. We found that epidemiological studies reported higher prevalence of some mental health problems during the pandemic compared with before it, but that in most cases this increase reduced over time. Conversely, studies of health records showed reduced incidence of new diagnoses at the start of the pandemic, which further declined during 2020. Mental health service use also declined at the onset of the pandemic but increased later in 2020 and through 2021, although rates of use did not return to pre-pandemic levels for some services. We found mixed patterns of effects of the pandemic on mental health and social outcome for adults already living with mental health conditions.

Impacts of the COVID-19 pandemic on carer-employees' well-being: a twelve-country comparison

The aim of this analysis is to assess the potential ways that the COVID-19 pandemic has impacted Canadian carer-employees (CEs) and identify the needs CEs feel is required for them to continue providing care. We assess the similarities and differences in the stresses CEs faced during COVID-19 globally across countries in the G7, Australia, Spain, Brazil, Taiwan, India, and China. We aim to compare Canada against global trends with respect to the challenges of the COVID-19 pandemic, as well as the supports in place for CEs. The study utilized 2020 Carer Well-Being Index at the country level. Descriptive data on Canadian CEs is first reviewed, followed by comparisons, by country, on responses relating to: (a) time spent caring; (b) sources of support; (c) impact on paid work and career, and; (d) emotional/mental, financial, and physical health. The relationship between government support and emotional/mental health is also explored. When compared to pre-pandemic times, CEs in Canada on average spent more time caregiving, with 34% reporting more difficulty balancing their paid job and caring responsibilities. Seventy-one percent of CEs feel their mental health has deteriorated. Thirty-four percent of Canadian CEs received support from the government, and only 30% received support from their employers. Globally, there was a similar trend, with CEs experiencing deteriorating mental health, work impacts, and unmet needs during the pandemic. Comparing the well-being of Canadian CEs with other countries provides an opportunity to evaluate areas where Canadian policies and programs have been effective, as well as areas needing improvement.

Investigating a psychological model of mental conditions and coping during the COVID-19 pandemic driven by participatory methods

BACKGROUND

There is evidence of increased mental health problems during the early stages of the COVID-19 pandemic. We aimed to identify the factors that put certain groups of people at greater risk of mental health problems.

METHODS

We took a participatory approach, involving people with lived experience of mental health problems and/or carers, to generate a set of risk factors and potential moderators of the effects of COVID on mental health. An online cross-sectional survey was completed by 1464 United Kingdom residents between 24th April and 27th June 2020. The survey had questions on whether respondents were existing mental health service users and or carers, level of depression (PHQ9) and anxiety (GAD7), demographics, threat and coping appraisals, perceived resilience (BRS), and specific coping behaviours (validated as part of this study). The relationship between responses and coping strategies was measured using tetrachoric correlations. Structural equation modelling was used to test the model.

RESULTS

A model significantly fit our data (rel χ² = 2.05, RMSEA = 0.029 95%, CI (0.016, 0.042), CFI = 0.99, TLI = 0.98, SRMR = 0.014). Age and coping appraisal predicted anxiety and depression. Whereas, threat appraisal and ethnicity only predicted anxiety, and resilience only predicted depression. Additionally, specific coping behaviours predicted anxiety and depression, with overlap on distraction.

CONCLUSIONS

Some, but not all, risk factors significantly predict anxiety and depression. While there is a relationship between anxiety and depression, different factors may put people at greater risk of one or the other during the pandemic.

The Experiences of Informal Carers during the COVID-19 Pandemic: A Qualitative Systematic Review

OBJECTIVES

To identify, critically appraise and synthesise the qualitative literature on the experiences of informal carers of people with long-term conditions during the COVID-19 pandemic.

DESIGN

A qualitative systematic literature review.

DATA SOURCES

Eight electronic databases were systematically searched (Medline, Embase, CINAHL, PubMed, PsychINFO, Web of Science, Nursing and Allied Health and ASSIA) along with Google Scholar and handsearching via secondary sources.

STUDY SELECTION

Eligible studies had to include the experiences of informal carers (adults who are 65 or older), use a qualitative methodology and had to be written in English.

DATA EXTRACTION AND SYNTHESIS

Retrieved papers were quality assessed using the Critical Appraisal Skills Programme qualitative checklist and ranked for quality. Thematic analysis was used to synthesise the findings.

RESULTS

Fourteen studies were included, all from medical or nursing journals (n = 5 specifically gerontology). Four main themes were identified: (i) fear, (ii) uncertainty, (iii) burden and (iv) staying connected. Caregiving demands have increased for carers during the pandemic, as well as negative emotions such as fear and uncertainty. At the same time, less social support has been available, leading to concerns about carers' wellbeing and ability to cope.

CONCLUSION

Carers' needs have been exacerbated by the COVID-19 pandemic. Greater practical and emotional support is needed for carers from both formal services and community sources that considers their changing needs and offers educational and emotional support for long-term wellbeing. Strengths and Limitations: (1) This is the first systematic review to explore in depth the experiences of informal carers caring for people with a range of long-term conditions and from an international context. (2) The review includes an analysis of the quality of the studies, as well as a study of their relative contributions. (3) Further research is needed to explore the physical, emotional and financial impact of the pandemic for bereaved carers which is not captured in this review due to the lack of empirical data available at the time of review.

The Impact of the COVID-19 Pandemic on Those Supported in the Community with Long-Term Mental Health Problems: A Qualitative Analysis of Power, Threat, Meaning and Survival

Research suggests that the COVID-19 pandemic has had a significant impact on those already living with mental health problems, though there is also evidence of resilience. However, to date there has been limited in-depth qualitative investigation. We interviewed 15 people living with long-term mental health problems who, before the pandemic, were being supported by third sector organisations, to explore how they experienced lockdowns and accessing services remotely. Template analysis was informed by the Power Threat Meaning Framework and suggested that participants experienced significant threats to their mental wellbeing and recovery which were exacerbated by current or previous powerlessness and inequality. Although participants described positive coping strategies, several described a return of unhelpful behaviours that had contributed to the original difficulties. The findings illustrate the wider contributions of social and economic context to mental health problems and the importance of ensuring that people do not feel abandoned and are proactively supported.

Impact of the COVID-19 pandemic on family carers in the community: A scoping review

The COVID-19 pandemic has led to the closure or reduction in support services for family carers, resulting in increased social isolation and stress for this population. The current scoping review aimed to identify the impact of COVID-19 upon carers and support provided for them during the pandemic. Four online databases (CINAHL, Medline, PsycINFO and PubMed) were systematically searched on 16th December 2020 and updated on 16th July 2021 for articles written in English and published after January 2020, focused on the carer and the impact of COVID-19. Google scholar and reference lists of relevant papers were checked, and key authors were contacted for further relevant information. The database searches identified 976 citations, which resulted in 670 unique articles following the removal of duplicates. Title and abstract screening identified 63 articles for full-text review, 11 of which were subsequently excluded, leaving 52 articles which were subject to inductive thematic analysis. Four key themes were identified. Whilst a number of issues were identified that were exacerbated by the pandemic, others directly resulting from it were revealed. Few studies discussed support measures for carers and only one trial evaluated an intervention. This review identifies the impact of COVID-19 on carers, but there is a dearth of evidence to inform appropriate tailored support. Governments need to identify carers as a priority group in social care reform and commission co-produced, evidence and experience informed pathways to reinstate support services, potentially modelled on pandemic plans following the example currently being considered for the paid healthcare workforce.

Health and health inequalities impact assessment for non-clinical measures to control COVID-19 in the Basque Country and Navarre (Spain)

This article describes the results of a health and health inequalities impact assessment of the COVID-19 pandemic control measures in the regions of the Basque Country and Navarre in Spain. A literature review was conducted on Pubmed and Web of Science (WoS) databases, in addition to individual semi-structured interviews and focus groups with experts, key informants and different profiles of citizens. A wide variety of social determinants of health have been affected by the measures, which included individual health-related behaviors, service disruption in formal care, educational settings, and health care provision. These changes have particularly affected certain population groups including children and adolescents, older people, those with health conditions and disabilities together with caregivers, women, as well as people with low levels of education, income, and resources. In future scenarios it will be necessary to pay attention to the potential impacts of policy responses on health inequalities to avoid an increase in existing health gaps.

Social connections at work and mental health during the first wave of the COVID-19 pandemic: Evidence from employees in Germany

Empirical evidence on the social and psychological impact of the COVID-19 pandemic in the workplace and the resulting consequences for the mental health of employees is lacking. As a result, research on this subject is urgently needed to develop appropriate countermeasures. This study builds on Person-Environment fit theory to investigate social connections at work and mental health during the first wave of the COVID-19 pandemic. It analyses employees’ needs for social connections and how social connections affect different mental health measures. Data were collected in May 2020 in an online survey of employees across Germany and analysed using response surface analysis. Mental health was measured as positive mental health and mental health disorders. Social connections were measured as social support and social interactions. 507 employees participated in the survey and more than one third reported having less social support and social interaction at work than they desired (p < .001). This was associated with a decrease in mental health. In contrast, having more than the desired amount of social support was associated with a decrease, and having more than the desired amount of social interaction with an increase, in mental health. This study provides important early evidence on the impact of the first wave of the COVID-19 pandemic in the workplace. With it, we aim to stimulate further research in the field and provide early evidence on the potential mental health consequences of social distancing–while also opening avenues to combat them.

The COVID-19 pandemic impact on wellbeing and mental health in people with psychotic and bipolar disorders

INTRODUCTION

The COVID-19 pandemic affects people globally, but it may affect people with psychotic and bipolar disorders disproportionally. Our aims were to investigate the pandemic impact on perceived wellbeing and mental health in this population, including which pandemic-related factors have had an impact.

METHODS

People with psychotic and bipolar disorders (N = 520; female = 81%; psychotic disorders n = 75/bipolar disorder n = 445) completed an online survey about wellbeing and mental health in the early phase of the COVID-19 pandemic (June 5-July 5, 2020).

RESULTS

Many participants experienced deteriorated wellbeing and mental health after the pandemic outbreak, especially in life satisfaction, meaning in life, positive feelings, depression, anxiety, and self-harm/suicidal ideation. Experienced recovery from mental health difficulties was significantly lower after compared to before the outbreak. Participants with psychotic disorders had significantly poorer wellbeing and mental health than participants with bipolar disorders, although they experienced significantly more worsening only of psychotic symptoms. Nearly half the participants reported coping with the situation; however, most factors potentially important to wellbeing and mental health changed adversely, including sufficiency and quality of treatment. More loneliness, low coping, insufficient mental health treatment during the COVID-19 pandemic, pandemic worry, more insomnia symptoms, and increased alcohol use predicted poor wellbeing and poor mental health.

CONCLUSIONS

During a pandemic, it is particularly important that mental health services strive to offer the best possible treatment under the current conditions and target loneliness, coping strategies, pandemic worry, insomnia, and increased alcohol use to uphold wellbeing and reduce mental health difficulties. For some, teletherapy is an agreeable substitute for traditional therapy.

The impact of the COVID-19 lockdown on depression sufferers: a qualitative study from the province of Zaragoza, Spain

Background and purpose

The impact of COVID-19 and its control measures have exacerbated existing mental health conditions. Although the deleterious effects of mental health problems are well known, fewer studies have examined the links between the Social Determinants of Health (SDHs) and depression. This study provides insights into the relationship between SDHs and depression during the first strict lockdown in Spain, which lasted for a period of 7 weeks.

Methods

Fifty-two structured interviews were conducted with people diagnosed with depression during June 2020 in the province of Zaragoza (Spain). Interviews were conducted by telephone due to lockdown constraints. Inductive thematic content analysis was used to explore, develop, and define emergent categories of analysis, which were mapped against the SDH framework.

Results

Listening to people’s experiences of living with depression during lockdown provided insights into their concerns and coping strategies, which are greatly influenced by the conditions in which they live, their job and their age. Examples of these factors include access to and quality of physical spaces, including housing conditions and public spaces for socialising, social support, adverse working conditions which include caring responsibilities, and access to digital technologies and healthcare services.

Conclusion

SDHs have played a fundamental role in shaping people’s health and well-being during the COVID-19 pandemic, and this study has shown that they have a considerable effect on depression outcomes. Governments should consider implementing social welfare programs to tackle both psychosocial problems and material need during crisis situations.