Rural/urban differences in mental health and social well-being among older US adults in the early months of the COVID-19 pandemic

Effect of telehealth yoga on loneliness and social isolation among rural older adults: a randomized controlled trial

OBJECTIVES

Loneliness and social isolation are associated with a range of deleterious health outcomes. Yoga is a mind-body physical activity that is used in health care settings and increasingly in a telehealth group format. This trial aimed to determine the effect of a brief course of telehealth yoga on loneliness among rural older adults.

METHOD

In this pragmatic trial among rural-residing Veterans Affairs patients over age 60 (https://clinicaltrials.gov/study/NCT05431166), participants were randomized to eight, 60-minute telehealth yoga classes delivered to their homes or waitlist control. The primary outcome was loneliness at 10 wk. Additional outcomes included measures of social isolation, fidelity, and acceptability, as well as interview findings.

RESULTS

Of 70 participants, 52 completed follow-up (mean [SD] age 67.8 [5.9] years). Loneliness significantly decreased between baseline and follow-up in both groups, but there were no significant between-group differences in loneliness or social isolation. Ratings of fidelity and acceptability were high. Qualitative findings indicated benefits related to the telehealth format and aspects of social connection not captured in quantitative measures.

CONCLUSION

A brief course of weekly telehealth yoga was feasible and acceptable among older rural patients but not effective at reducing loneliness and social isolation.

Psychosocial and mental health status among older adults in China during the COVID-19 pandemic: A cross-sectional study

BACKGROUND

On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. During the virus's spread and subsequent lockdowns, older adults faced heightened risks and significant mental health challenges.

METHODS

A cross-sectional study was conducted in Shandong Province, China, using a custom-designed demographic questionnaire, a COVID-19-related survey, and the Symptom Checklist-90 Revised (SCL-90-R). Correspondence analysis and multiple linear regression models were employed to examine factors influencing the mental health of older adults.

RESULTS

Among 3363 older adults, the total SCL-90-R score was 153.11 ± 36.98, with an average score of 1.70 ± 0.41. Both scores were lower than the Chinese norm and pre-pandemic levels. Factors significantly affecting older adults' mental health included place of residence, age, educational attainment, marital status, fear of COVID-19, understanding of COVID-19 transmission routes, and awareness of preventive measures.

CONCLUSIONS

Greater attention is needed to address the mental health of older adult males, individuals of advanced age, employed individuals, those with lower educational backgrounds, and those without a spouse. Policymakers should implement targeted policies and interventions to enhance mental health support for older adults.

Mental health status of Chinese residents and its associated factors in the aftermath of the COVID-19 pandemic: A cross-sectional study

Background

During the COVID-19 pandemic, numerous studies focused on mental health, but few considered both positive and negative aspects within the dual-factor model of psychological well-being. In China, a highly populous country, limited evidence exists regarding mental health and its associated factors following the surge and decline of COVID-19 cases after the loosening of COVID-19 control measures. This study aims to investigate the mental health status of Chinese residents in the aftermath of the pandemic and factors influencing positive and negative indicators using the System-Based Model of Stress.

Methods

A cross-sectional online survey of 1,026 participants was conducted in China from March 2-31, 2023, using quota sampling. Structural equation modeling (SEM) was performed to test the conceptual model, where social support, perceived susceptibility, perceived severity, pandemic-related events, coping style, and concern about COVID-19 were considered as predictors, and psychological distress and subjective well-being as outcomes.

Results

The results revealed high prevalence rates of psychological distress (23 %) with either of anxiety (15 %) or depression (20 %), and poor subjective well-being (23 %) among Chinese residents after the COVID-19 pandemic. Social support was negatively correlated with psychological distress, and negative coping style, pandemic-related events, and concern about COVID-19 were positively correlated with psychological distress. Moreover, social support was positively correlated with subjective well-being, and negative coping style and pandemic-related events were negatively correlated with subjective well-being.

Conclusions

These findings enhance our understanding of the differing correlates of positive and negative mental health, suggesting targeted psychological interventions for post-pandemic and future public health events.

Rural-urban differences in the perceived impact of COVID-19 on mental health by European women

PURPOSE

Many studies have documented an adverse impact of the pandemic on women´s mental health. This cross-sectional study aims to explore associations between women's perceived impact of lockdowns and curfews on their mental health and their residential location, along with other contextual and individual factors.

METHODS

Using data from the Flash Eurobarometer 2712 "Women in times of COVID-19", conducted between January 25 and February 3, 2022, across the 27 Member States of the European Union (n = 23,671), this study applied bivariate tests and stratified models based on respondent location (rural areas, small or medium-sized towns and urban areas). The exploration sought predictors influencing the perceived mental health impact, encompassing five individual characteristics (age, disability, employment status, educational attainment, and household type), perceptions of violence against women, and country of residence. The dependent variable was assessed subjectively, measured on a scale from 1 (minor negative impact) to 5 (major negative impact).

RESULTS

Women living in urban areas generally reported a higher perceived negative impact on mental health compared to women in rural areas or in small/medium-sized towns. Age and disability were significantly linked to perceiving a negative impact on mental health. Similar adjusted odds ratios for age were observed across rural areas (aOR 0.97, 95% CI = 0.97-0.98), small or medium-sized towns (aOR 0.98, 95% CI = 0.97-0.98), and urban areas (aOR 0.97, 95% CI = 0.97-0.98). In terms of disability, the odds were higher in rural areas (aOR 1.44, 95% CI = 1.20-1.73) than in urban ones (aOR 1.36, 95% CI = 1.15-1.62). Among women residing in urban areas, those in childless couples were less likely to perceive a negative impact on mental health (aOR 0.89, 95% CI = 0.80-0.99) compared to women in couples with children. Respondents perceiving increased violence against women due to COVID-19 were more likely to perceive a negative impact on mental health, with higher odds ratios in rural areas (aOR 1.56, 95% CI = 1.40-1.74) compared to urban areas (aOR 1.29, 95% CI = 1.17-1.41). Differences across countries were also found.

CONCLUSION

The perceived impact of lockdowns and curfews on mental health exhibited variance between urban and rural areas. These disparities were influenced by individual characteristics such as age, disability, or household type, as well as the effects of COVID-19 on violence against women and contextual variables like country of residence.

The Effect of COVID-19 on Mood Disorders in Urban and Suburban Detroit

Introduction

The COVID-19 pandemic has increased the global experience of anxiety and depression owing to social isolation and government-mandated quarantine for transmission reduction. To date, literature surrounding the mental health effects of COVID-19 for the U.S. population is limited.

Methods

This is a retrospective study from a large metropolitan Detroit health system. Patient encounters between December 23, 2018 and June 22, 2021, with March 23, 2020 being the start of Michigan state-wide lockdown, were used to define pre- and post-COVID-19 encounters, respectively. The data were divided into Detroit and non-Detroit on the basis of patient ZIP code. All patients aged ≥13 years with a visit with a family medicine provider were included. Outcome variables included Patient Health Questionnaires-2 and -9 and General Anxiety Disorder-7 scores; diagnoses of depression, anxiety, adjustment, and grief disorders; antidepressant prescriptions; and behavioral health referrals. Logistic regression was used to determine the incidence of composite mood disorder, depression, and anxiety.

Results

A total of 20,970 individuals were included in this study: 10,613 in the Detroit subgroup and 10,357 in the non-Detroit subgroup. A total of 88.2% of the Detroit population were Black, and 70% were female. Logistic regression shows that the incidence of composite mood disorder decreased with increasing age (OR=0.787, 0.608, 0.422, and 0.392; p<0.001). Male sex is a protective factor (OR=0.646, p<0.001). Federal insurance is the only factor presenting a statistically significant increased risk (OR=1.395, p<0.001). There was no statistical difference between residing in urban and suburban areas in the incidence of composite mood disorder (OR=0.996, p=0.953).

Conclusions

This research demonstrates that residing in an urban setting did not increase the risk of developing a mental health disorder during the COVID-19 period.

The longitudinal impact of the COVID-19 pandemic on adolescents' internalizing symptoms, substance use, and digital media use

The present study examined the long-term effects of the COVID-19 pandemic on adolescent internalizing symptoms, substance use, and digital media use before and during the pandemic. A nationally representative longitudinal cohort of 3718 Israeli adolescents aged 12-16 at baseline completed measures of internalizing symptoms (anxiety, depression, and somatization), the prevalence of substance use (i.e., previous 30-day use of tobacco, alcohol, and cannabis), and average daily use of internet/television, video games, and social media. Social support and daily routines were assessed as potential protective factors for mental health. Data were collected in 10 public schools at four measurement points: before the Covid-19 outbreak (September 2019), after the first wave lockdown (May 2020), after the third wave lockdown (May 2021), and after the fifth wave of the pandemic (May 2022). Multi-level mixed models were used to analyze the longitudinal data. The results showed significant increases in internalizing symptoms, substance use (tobacco, alcohol, and cannabis), and daily screen time from the start of the study to the 33-month follow-up. Social support and daily routines moderated the increases in internalizing symptoms and digital media use. These findings highlight the need for public and educational mental health services to address the continuing impact of the pandemic on adolescents.

Altered place engagement since COVID-19: A multi-method study of community participation and health among older americans

Little is known about longer-term changes to community participation since the COVID-19 pandemic onset and potential implications for health and wellbeing in later life. This multi-method investigation analyzes national data from the COVID-19 Coping Study. Statistical analyses of survey data (n = 1,630; mean age 67.9 years; data collected April/May 2022) identified that adults residing in the US still tended to stay inside their homes more often since the pandemic onset. Overall, participants decreased their engagement with amenities such as eateries, gyms, and arts and cultural sites. Reflexive thematic analysis of semi-structured in-depth interviews (n = 57; mean age 70.7 years; data collected May-July 2021) identified altered community participation with perceived long-term impacts on physical, mental, and social health and wellbeing. The results provide novel insights about the critical nature of 'third places' to support later life, and policy implications to strengthen community environments. Investment in outdoor, well-ventilated, and distanced third places may support wellbeing.

Change in mental health during the COVID-19 pandemic: a longitudinal study of residents of Indian metropolitan cities

BACKGROUND

Initial studies have reported an increase in the incidence of mental health problems during the early months of COVID-19. Longitudinal studies of changes in mental health undertaken in Low and Middle Income countries during the pandemic remains an under-researched area.

AIMS

The current study examines changes in mental health among adult residents of metropolitan cities of India, a middle-income country reporting the second-highest COVID cases and third-highest fatalities, during the pandemic.

METHOD

Data was collected, based on a telephonic survey using the internationally accepted abridged Depression Anxiety Stress schedule (DASS-21), in August and September 2020 and July-August 2021. The sample size is 994. The data was analysed using an ordered logit model.

RESULTS

At the onset of the pandemic, high levels of anxiety, stress and depression prevailed; their levels reduced after one year. Respondents who have experienced a decline in economic fortunes, have family members with pre-existing co-morbidity or had COVID in the family are significantly less likely to report improvement in mental health; less-educated respondents are also vulnerable.

CONCLUSIONS

Specific sub-groups, identified as at risk, need monitoring and continued provisioning of tailor-made mental health services addressing their specific needs. Relief measures targeting economically affected households are also required.

Social isolation and loneliness among older adults living in rural areas during the COVID-19 pandemic: a scoping review

BACKGROUND

The causes and consequences of social isolation and loneliness of older people living in rural contexts during the COVID-19 pandemic were systematically reviewed to describe patterns, causes and consequences.

METHODS

Using the Arksey and O'Malley (2005) scoping review method, searches were conducted between March and December 2022, 1013 articles were screened and 29 were identified for data extraction.

RESULTS

Findings were summarized using thematic analysis separated into four major themes: prevalence of social isolation and loneliness; rural-only research; comparative urban-rural research; and technological and other interventions. Core factors for each of these themes describe the experiences of older people during the COVID-19 pandemic and related lockdowns. We observed that there are interrelationships and some contradictory findings among the themes.

CONCLUSIONS

Social isolation and loneliness are associated with a wide variety of health problems and challenges, highlighting the need for further research. This scoping review systematically identified several important insights into existing knowledge from the experiences of older people living in rural areas during the COVID-19 pandemic, while pointing to pressing knowledge and policy gaps that can be addressed in future research.

Psychological Distress Related to the COVID-19 Pandemic: The Protective Role of Hope

The COVID-19 outbreak and the worldwide lockdown measures had an impact on the global mental health and psychological well-being of the general population. Several studies attempted to investigate the protective and risk factors for psychological distress related to the pandemic. However, to date, little is known about the role of hope in this context. The aim of this study was to determine the relationship between hope and psychological distress related to the COVID-19 outbreak in the general population. The sample consisted of 504 Pakistani people who completed cross-sectionally the COVID-19 Peritraumatic Distress Index (CPDI) and the Adult Hope Scale (AHS). Bivariate Pearson correlation analysis was run to measure the relationship between hope and psychological distress; hierarchical regression analysis was run to investigate the association between demographics and hope with psychological distress. Higher levels of hope predicted lower levels of psychological distress. Being female, being older, lower level of education, urban residence, being married and living in nuclear family systems were associated with higher levels of psychological distress. The study highlights the protective role of hope on psychological distress related to COVID-19, contributing to knowledge on factors promoting positive mental health during emergency times and providing useful information for implementing effective public health policies and programmes.

Investigation of factors associated with mental health during the early part of the COVID-19 pandemic in South Korea based on machine learning algorithms: A cohort study

Objective

The coronavirus disease 2019 (COVID-19) pandemic is among the most critical public health problems worldwide in the last three years. We tried to investigate changes in factors between pre- and early stages of the COVID-19 pandemic.

Methods

The data of 457,309 participants from the 2019 and 2020 Community Health Survey were examined. Four mental health-related variables were selected for examination as a dependent variable (patient health questionnaire-9, depression, stress, and sleep time). Other variables without the aforementioned four variables were split into three groups based on the coefficient values of lasso and ridge regression models. The importance of each variable was calculated and compared using feature importance values obtained from three machine learning algorithms.

Results

Psychiatric and sociodemographic variables were identified, both during the pre- and early pandemic periods. In contrast, during the early pandemic period, average sleep time variables ranked the highest with the dependent variables regarding the experience of depression. The difference in sleep time before and after the pandemic was validated by the results of paired t-tests, which were statistically significant (p-value < 0.05).

Conclusions

Changes in the importance of mental health factors in the early pandemic period in South Korea were identified. For each mental health-dependent variable, average sleep time, experience of depression, and experience of accidents or addictions were found to be the most important factors. House type and type of residence were also found in regions with larger populations and a higher number of confirmed cases.

Socio-ecological determinants of older people's mental health and well-being during COVID-19: A qualitative analysis within the Irish context

Background

Evidence indicates that older people with biological and social vulnerabilities are at high risk of short- and long-term consequences related to the COVID-19 pandemic. However, studies have also highlighted that the crisis may present opportunities for personal growth if older individuals are met with appropriate resources and support.

Objective

The aim of this study was to explore the perceptions of older people regarding how individual, social, and environmental factors have supported or hindered their well-being and health during COVID-19.

Methods

We analyzed data collected between April-May and October-November 2021 from the Well-being, Interventions and Support during Epidemics (WISE) study, a qualitative investigation of community-dwellers based in Ireland and aged 65 years or over. Participants (n = 57) completed written submissions, narrative interviews and/or go-along interviews detailing their experiences during the pandemic. Framework analysis was carried out in NVivo 12 to identify determinants, linkages, and explanations within Bronfenbrenner's socio-ecological model.

Results

The mean age of participants was 74.9 years, 53% were female, 45% lived alone, and 86% lived in areas with high urban influence. Our findings highlight the heterogeneous effect of COVID-19 across diverse older individuals who held distinct concerns, capabilities, and roles in society before and during the pandemic. Multi-scalar contextual characteristics such as individual's living arrangements, neighborhood social and built environments, as well as social expectations about aging and help seeking, had an influential role in participants' well-being and available supports. We identified mixed views regarding public health restrictions, but a consensus emerged questioning the suitability of one-size-fits-all approaches based on chronological age.

Conclusions

Our results suggest that some negative pandemic consequences could have been avoided by increasing collaboration with older people and with the provision of clearer communications. The interdependencies identified between individual characteristics and socio-ecological factors that influenced participants' availability of supports and development of adaptive strategies represent areas of opportunity for the development of age-friendly interventions during and beyond public health crises.

A scoping review protocol of age-friendly practices during the COVID-19 pandemic

Background: Actions focused on age-friendly environments contribute to promote and maintain older people’s functional ability and may enable them to contribute to their communities and enjoy life. As such, age-friendly practices require collaboration between diverse stakeholders across multiple sectors responsible for natural, built, and social environments, which can be particularly relevant during public health emergencies when socio-ecological vulnerabilities become more salient and may disproportionally affect older people. This paper presents a protocol for a scoping review aiming to investigate the breadth of evidence concerning the development, implementation, and evaluation of age-friendly practices during the COVID-19 pandemic. The protocol sets out the objectives, methods, and dissemination plans for the review. Methods: The scoping review will be conducted in line with the Joanna Briggs Institute (JBI) scoping review methodology. We will search databases (PubMed, Web of Science, Embase, CINAHL, Scopus, PsychNet) and grey literature sources. Publications relating to practices across the 8 domains of the World Health Organization’s age-friendly cities and communities’ framework will be included. A tabular data extraction tool will be used to facilitate a narrative synthesis of results. Ethics and dissemination: Ethical approval is not required as the methods proposed for this scoping review consist of collecting publicly available data. Findings will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) and submitted to a journal for academic dissemination. Lay dissemination plans include an infographic and a blog-style article presenting our core results. Conclusion: The publication of this protocol allows for transparency in the systematic process of a scoping review focused on age-friendly practices during COVID-19. Findings emerging from the scoping review will provide insights into the evidence available regarding age-friendly activities during COVID-19 and may inform future age-friendly practices during public health emergencies and beyond.