Negative Employment Changes During the COVID-19 Pandemic and Psychological Distress: Evidence From a Nationally Representative Survey in the U.S

The Psychological Impact of COVID-19: A Comparative Analysis of Pre-Lockdown and During-Lockdown Periods Among Saudi General Population

Background

Prior research has revealed substantial psychological impacts of COVID-19 among the general population. However, there is a noticeable gap in studies addressing the enduring anxiety levels before and during lockdown periods of the COVID-19 pandemic.

Objective

The study assessed and compared the psychological impact of the COVID-19 pandemic before and during lockdown periods among the general population in Saudi Arabia.

Methods

A validated and reliable General Anxiety Disorder (GAD)-7 instrument was used to quantify stress levels by measuring anxiety. Nonprobability snowball sampling was used to collect data from 516 participants residing in Saudi Arabia. The difference in scores for each of the seven related questions of GAD-7 was determined using a non-parametric Wilcoxon rank test.

Results

A mild level of anxiety was consistently observed both before and during the lockdown, as indicated by GAD-7 scores of 6.17 (SD = 5.5) before the lockdown and 6.42 (SD = 5.7) during the lockdown. There were no differences in GAD-7 scores before 6.17 (SD = 5.5) and during 6.42 (SD = 5.7) the lockdown periods. However, levels of moderate anxiety increased by 5% during the lockdown period. Anxiety levels before and during lockdown were significantly associated with gender (χ2 (3, n = 516) =11.23 p = 0.01) and employment status (χ2 (3, n = 516) = 9.41 p = 0.024). Among the GAD-7 questionnaire items, item number 1 ("Feeling nervous, anxious, or on edge") (p= 0.00) and item number 7 ("Feeling afraid as if something awful might happen") (p= 0.025) showed a significant association with anxiety levels before and during the lockdown periods.

Conclusion

The enduring prevalence of mild anxiety, persisting both before and during the lockdown periods, underscores the profound impact of COVID-19 on the mental health of the general population in Saudi Arabia.

Income or Job Loss and Psychological Distress During the COVID-19 Pandemic

Importance

Given the expiration of expanded unemployment and other benefits during the COVID-19 pandemic, it is important to understand the association between pandemic income or job loss and long-term implications on mental health.

Objective

To evaluate the association between income or job loss due to the COVID-19 pandemic and later psychological distress.

Design, Setting, and Participants

This cohort study used 5 waves of nationally representative, longitudinal survey data (September 16, 2019, through September 18, 2022) from the Pew Research Center's American Trends Panel. Doubly robust propensity score-weighted quasi-Poisson models were used to estimate the association of self or household income or job loss during the early phase of the COVID-19 pandemic with later psychological distress, while controlling for pre-income loss characteristics (demographics, finances, and psychological distress). The study sample comprised US working-age adults (aged 18-64 years) who had not experienced income or job loss due to the COVID-19 pandemic by March 24, 2020.

Exposure

Participant-reported self or household income or job loss (ie, reduced hours or demand for work) due to the COVID19 pandemic between March 24, 2020, and August 16, 2020.

Main Outcome and Measures

Psychological distress was measured using a composite scale of 0 to 15 based on participants' reported frequency of feeling depressed, on edge, sleepless, lonely, and hopeless in the past week in March 2020, February 2021, and September 2022.

Results

Of 1392 working-age adults (survey weighted 52.7% male and 47.7% aged 30-49 years) who had not reported income or job loss before March 24, 2020, a survey weighted 35.7% reported job or income loss between March 24 and August 16, 2020. Early-phase pandemic income or job loss was associated with higher distress in February 2021 (estimated ratio, 1.09; 95% CI, 1.01-1.18; P = .03) and September 2022 (estimated ratio, 1.11; 95% CI, 1.02-1.22; P = .02) among participants who experienced job or income loss between March 24 and August 16, 2020, compared with the propensity score-weighted mean in the group who did not experience income loss.

Conclusions and Relevance

These small but significant within-person associations between early-phase pandemic household income or job loss and psychological distress up to 29 months later suggest that policies are needed to support people with income or job loss to help mitigate the long-term adverse mental health outcomes of economic disruption.

The effects of occupational disruption during COVID-19 lockdowns on health: a cross-sectional study

The disruption in daily activity performance during COVID-19 lockdowns is widely understood to have impacted health, but a better understanding of how restricted performance of specific activities are associated with health is needed. This cross-sectional study answers the following question: How were changes in the performance of 16 daily activities associated with health during COVID-19 lockdowns? A total of 116 participants completed an online survey rating their health before and during COVID-19 lockdowns and comparing their recollection of the performance of 16 activities before COVID-19 with their performance during lockdowns. Multiple stepwise linear regression analysis was used to estimate the relationship between self-reported changes in activities during lockdowns and concurrent (during-lockdown) health status, while controlling for pre-COVID-19 health status. Only changes in activities that were uniquely and significantly associated with lockdown health status were retained in the final model. Health before COVID-19 accounted for 3.7% (P = 0.039) of the variance in health during COVID-19 lockdowns. After controlling for health before COVID-19, five types of activity were significantly and uniquely predictive of health during lockdowns, together accounting for 48.3% of the variance. These activities and the variances they accounted for were rest and sleep (29.5%, P < 0.001), play and recreational activities (8%, P < 0.001), work (4.8%, P = 0.002), personal hygiene (3.2%, P = 0.01), and healthy eating (2.8%, P = 0.013). The study suggests that these five types of activity should be prioritized in policy or interventions when participation in activity is constrained by lockdowns or comparable factors.

The Impact of the COVID-19 Pandemic on Black and Hispanic Americans' Work Outcomes: a Scoping Review

In early 2020, it was hypothesized that COVID-19 would lead to disproportionately negative health and work outcomes for Black and Hispanic adults, but sufficient data had yet been collected to fully support this claim. Now, we have empirical evidence, but little has been done to aggregate this information to fully understand its impact on these communities. Utilizing 44 articles from a scoping review of three databases (PubMed, Web of Science, and Business Source Complete), this study seeks to identify the primary work-related risks that help explain Black and Hispanic adults' disparate COVID-19-related work outcomes (e.g., loss of hours, job disruption, stress). Findings illuminate four primary risks faced by Black and Hispanic workers: (1) being an essential worker, (2) type of work performed, (3) workplace factors; and (4) community and geographic factors. We conclude with policy recommendations that will help inform policy and practice for economic recovery from the pandemic for other marginalized populations.

Demographic and COVID-19-Related Factors Associated with Depressive and Anxiety Symptoms Among African American and Latina Women in a Midwestern State

PURPOSE

The COVID-19 pandemic exacerbated racial and ethnic disparities among Latina and African American (AA) women, including risk factors for depression and anxiety. This study sought to identify demographic- and pandemic-related factors associated with depressive and anxiety symptoms in adult AA and Latina women living in a Midwestern state.

METHODS

Data for this secondary analysis of 1037 AA and Latina women were collected in May 2020 and June/July 2020. Participants completed an online survey about their demographic characteristics, job changes due to COVID-19, general concern about COVID-19, concern about the effects COVID-19 on their mental health, and whether they prayed to cope with COVID-19. Linear regressions with bootstrapping were conducted to determine associations.

RESULTS

Latinas had significantly higher depressive and anxiety symptoms than AA women. Older age was a buffer against depressive and anxiety symptoms. Women who anticipated a reduction in work hours or job loss had significantly higher depressive and anxiety symptoms than those with no job changes. A reduction in work hours was also a risk for higher depressive symptoms. General and specific concerns about the impact of COVID-19 were positively associated with higher depressive and anxiety symptoms. Race/ethnicity moderated the effect of praying to cope with COVID-19 on depressive symptoms.

CONCLUSIONS

As the pandemic continues, mental health resources should be allocated to help AA and Latina women who experienced or anticipate reductions in paid hours and those concerned about its effects. Research is needed to identify how praying increased depressive symptoms in adult Latina women early in the pandemic.

A Statewide Analysis of Self-Inflicted Injuries During COVID-19 Pandemic: Is There Adequate Access to Mental Health?

INTRODUCTION

Many social and behavioral changes occurred during the COVID-19 pandemic. Our objective was to identify changes in incidence of self-inflicted injuries during COVID-19 compared to prepandemic years. Further, we aimed to identify risk factors associated with self-inflicted injuries before and during the pandemic.

METHODS

A retrospective cohort study of patients aged ≥18 y with self-inflicted injuries from 2018 to 2021 was performed using the Pennsylvania Trauma Outcome Study registry. Patients were grouped into pre-COVID Era (pre-CE, 2018-2019) and COVID Era (CE, 2020-2021). Statistical comparisons were accomplished using Wilcoxon rank-sum tests and chi-square or Fisher's exact tests.

RESULTS

There were a total of 1075 self-inflicted injuries in the pre-CE cohort and 482 during the CE. There were no differences in age, gender, race or ethnicity between the two cohorts. Among preexisting conditions, those within the pre-CE cohort had a higher incidence of mental/personality disorder (59.2% versus 52.3%, P = 0.01). There were no significant differences in the mechanism of self-inflicted injuries or place of injury between the two periods. Additionally, there were no differences in discharge destinations or mortality between the two cohorts.

CONCLUSIONS

During the height of social isolation in Pennsylvania, there were no associated increases in self-inflicted injuries. However, there were increased incidences of self-inflicted injuries among those with a prior diagnosis of mental or personality disorder in the pre-CE group. Further investigations are required to study the access to mental health services in future pandemics or public health disasters.

The perceived impact of pandemic scale (PIPS): Initial development and examination among U.S. military veterans

The COVID-19 pandemic has had significant impacts, including increases in mental health problems, distress, interpersonal conflict, unemployment, loss of income, housing instability, and food insecurity. Veterans may be particularly vulnerable to such impacts given their burden of mental and physical health problems. Few existing measures assess pandemic impact, and none have been validated for use with Veterans. We developed such a measure (the Perceived Impact of the Pandemic Scale; PIPS) and examined its psychometric performance in a national sample of US Veterans. Survey data from 567 Veterans were collected between 12/2020 and 2/2021. To examine PIPS factor structure, split sample exploratory/confirmatory factor analyses (EFA/CFA) were conducted to identify and test the most plausible model among an initial set of 18 items. Based on tests of factor extraction and factor loadings, 15 items clearly loaded onto three distinct factors. Internal reliability of all factors was ω > 0.8 and CFA model fit was good (χ2(87) = 167.39, p < .001; SRMR = 0.068; RMSEA = 0.060 [95% CI: 0.05, 0.07], CFI = 0.92). Mean factor scores were significantly positively correlated with measures of depression and loneliness, and negatively correlated with perceived social support. Results suggest the PIPS assesses three internally reliable factors comprised of perceived impact of the pandemic on interpersonal relationships, financial impact, and personal health and well-being. Construct validity with US Veterans was supported. The PIPS may be useful for examining the potentially disparate impact of pandemics on different populations. Research is needed to validate the PIPS in non-Veteran populations.

From economic difficulties to psychological maladjustment in Italian women during the Covid-19 pandemic: does marital dissatisfaction moderate or mediate this association?

Introduction

The empirical study about the negative impact of economic difficulties due to Covid- 19 on the psychological well-being of Italian women by considering perceived stress and marital satisfaction is an area worthy of investigation. The study explored these variables by hypothesizing that marital satisfaction (DAS) could moderate or mediate the links between economic difficulties, perceived stress (PSS), and psychological maladjustment (PGWBI).

Methods

A total of 320 Italian women completed an online survey about the study's variables during the lockdown period. Women's perceptions of economic difficulties due to COVID- 19 restrictions were detected through an ad-hoc specific question. Perceived stress, marital satisfaction and psychological maladjustment were assessed by standardized questionnaires (Perceived Stress Scale 10, Dyadic Satisfaction Scale and Psychological General Well-being Inventory).

Results

39.7% of women who answered the online survey said that the Covid-19 significantly impacted their family income. Results indicated that marital satisfaction did not moderate the associations investigated. Conversely, data showed how economic difficulties (X) predicted lower psychological maladjustment through the mediation of perceived Stress (M1), which, in turn, was associated with higher levels of marital dissatisfaction (M2).

Conclusion

The results of the present study confirm the significant role of marital dissatisfaction in explaining the indirect effects of economic difficulties on psychological maladjustment in women. In particular, they indicated a significant spillover effect which transmitted strains experienced in one domain (economic difficulties) to another (the dissatisfaction of the couple), which in turn affected the psychological maladjustment.

Racial-ethnic disparities in psychological distress during the COVID-19 pandemic in the United States: the role of experienced discrimination and perceived racial bias

BACKGROUND

Research on mental health disparities by race-ethnicity in the United States (US) during COVID-19 is limited and has generated mixed results. Few studies have included Asian Americans as a whole or by subgroups in the analysis.

METHODS

Data came from the 2020 Health, Ethnicity, and Pandemic Study, based on a nationally representative sample of 2,709 community-dwelling adults in the US with minorities oversampled. The outcome was psychological distress. The exposure variable was race-ethnicity, including four major racial-ethnic groups and several Asian ethnic subgroups in the US. The mediators included experienced discrimination and perceived racial bias toward one's racial-ethnic group. Weighted linear regressions and mediation analyses were performed.

RESULTS

Among the four major racial-ethnic groups, Hispanics (22%) had the highest prevalence of severe distress, followed by Asians (18%) and Blacks (16%), with Whites (14%) having the lowest prevalence. Hispanics' poorer mental health was largely due to their socioeconomic disadvantages. Within Asians, Southeast Asians (29%), Koreans (27%), and South Asians (22%) exhibited the highest prevalence of severe distress. Their worse mental health was mainly mediated by experienced discrimination and perceived racial bias.

CONCLUSIONS

Purposefully tackling racial prejudice and discrimination is necessary to alleviate the disproportionate psychological distress burden in racial-ethnic minority groups.

A qualitative study of positive psychological experiences and helpful coping behaviours among young people and older adults in the UK during the COVID-19 pandemic

While much research has focused on challenges that younger and older people have faced during the COVID-19 pandemic, little attention has been given to the capacity for resilience among these groups. We therefore explored positive psychological experiences and coping behaviours that protected mental health and well-being. Participants were 40 young people (aged 13-24) and 28 older adults (aged 70+) living in the UK during the COVID-19 pandemic. Interviews were held between May 2020 and January 2021. We generated six themes using qualitative thematic analysis, including: engagement in self-fulfilling activities, increased sense of social cohesion, personal growth, use of problem-focused strategies to manage pandemic-related stressors, giving and receiving social and community support, and utilising strategies to regulate thoughts and emotions. While all six themes were relevant both to younger and older adults, there were nuances in how each was experienced and enacted. For example, many older adults adjusted their routines given worries about virus vulnerability, while some young people experienced greater personal growth amidst increased awareness of mental health as they navigated the various lockdown restrictions.

Mental Health Treatment Reported by US Workers before and during the COVID-19 Pandemic: United States (2019-2020)

The COVID-19 pandemic introduced a significant and unprecedented exacerbation of community mental health challenges. We compared the prevalence of mental health treatment (MHT) before and during the COVID-19 pandemic among US workers. Self-reported MHT data (N = 30,680) were obtained from the Sample Adult data of the National Health Interview Survey (2019 and 2020). MHT was defined as having taken prescription medications for mental health issues or receiving counseling from a mental health professional in the past 12 months. We calculated age-adjusted prevalence estimates and employed t-tests to compare MHT in 2019 and 2020 using SAS-callable SUDAAN 11.0. The prevalence of MHT significantly increased from 16.3% in 2019 to 17.6% in 2020 (difference = 1.3, p = 0.030). The prevalence of taking prescription medications for mental health issues significantly increased in 2020 compared to 2019 (12.5% to 13.6%, difference = 1.1, p = 0.037). The prevalence of receiving counseling significantly increased but only among those who worked 30-49 h/week, difference = 1.2, p = 0.022. US workers, especially those with typical work hours, appeared to experience higher mental distress during the first year of the pandemic compared to the year prior to the pandemic period. These findings highlight the need for targeted interventions to address mental health issues in these workers.

Associations of COVID-19 Related Work Stressors with Psychological Distress: Racial and Ethnic Disparities in Californian Workers

The COVID-19 pandemic continues to exert immense societal impacts, with recent data showing inequitable distribution of consequences among racial and ethnic groups. The objective of this study was to assess associations between COVID-related work stressors and psychological distress, with special emphasis on differences by race and ethnicity. Data were from the population-based California Health Interview Survey (CHIS) 2020. Associations of individual and cumulative work stressors, including job loss, reduced work hours, and working from home, with psychological distress in 12,113 workers were examined via multivariable linear regression, and stratified analyses were conducted for racial and ethnic subgroups. After adjustment for covariates, compared to workers with no work stressors, those who experienced either one or two/more work stressors had higher psychological distress (βs and 95% CIs were 0.80 [0.51, 1.09] and 1.98 [1.41, 2.56], respectively). Notably, experiencing cumulative (two/more) work stressors had much stronger effects on psychological distress among participants who were Black (β and 95% CI were 3.51 [1.09, 5.93]) or racial minorities (β and 95% CI were 3.57 [1.10, 6.05]). Occupational consequences of the COVID-19 pandemic were associated with increased psychological distress in Californian workers and inequitably distributed, with racial and ethnic minorities suffering the greatest burden.

Unrewarding work and major depressive episode: Cross-sectional and prospective evidence from the U.S. MIDUS study

Depression is a serious mental health condition and is the leading cause of disability worldwide. Previous research has demonstrated that work stress may contribute to the development of depression through psychophysiological pathways. The present study assessed associations of work stress - in terms of the effort-reward imbalance (ERI) model measuring unrewarding work - with major depressive episode (MDE). Data were from the Mid-life in the United States study, a national, population-based sample of U.S. workers with 9-year follow-up prospective cohort design. The cross-sectional sample at baseline had 2204 workers, and the prospective sample had 1591 workers at follow-up (78.7% follow-up rate). Multivariable Bayesian logistic regression and Poisson regression were applied for examining cross-sectional and prospective associations, respectively. ERI was assessed by a validated 17-item scale at baseline, and MDE in the past 12 months was assessed by the Composite International Diagnostic Interview Short Form at both baseline and follow-up. It was found that ERI at baseline was associated with higher odds of prevalent MDE in the cross-sectional sample (OR = 1.47, HPD interval [1.26-1.69]), and with higher risk of MDE at follow-up in the prospective sample (RR = 1.29, HPD interval [1.01-1.60]). In both cross-sectional and prospective analyses, strongest associations were observed among workers with the highest quartile of ERI, after adjusting for demographic, socioeconomic, lifestyle, and other psychosocial factors. The stable and robust findings strengthen and extend previous findings that unrewarding work is a risk factor of mental health. If confirmed by further evidence, intervention targeting work stress reduction is warranted.

The association between social determinants of health and psychological distress during the COVID-19 pandemic: a secondary analysis among four racial/ethnic groups

BACKGROUND

Racial disparities in psychological distress associated with COVID-19 remain unclear in the U.S. This study aims to investigate the associations between social determinants of health and COVID-19-related psychological distress across different racial/ethnic groups in the US (i.e., non-Hispanic Whites, Hispanic, non-Hispanic Asians, and non-Hispanic African Americans).

METHODS

This study used cross-sectional data from the 2020 California Health Interview Survey Adult Data Files (N = 21,280). Adjusting for covariates-including age, gender, COVID-19 pandemic challenges, and risk of severe illness from COVID-19-four sets of weighted binary logistic regressions were conducted.

RESULTS

The rates of moderate/severe psychological distress significantly varied across four racial/ethnic groups (p < 0.001), with the highest rate found in the Hispanic group. Across the five domains of social determinants of health, we found that unemployment, food insecurity, housing instability, high educational attainment, usual source of health care, delayed medical care, and low neighborhood social cohesion and safety were associated with high levels of psychological distress in at least one racial/ethnic group (p < 0.05).

CONCLUSION

Our study suggests that Hispanic adults face more adverse social determinants of health and are disproportionately impacted by the pandemic. Public health practice and policy should highlight social determinants of heath that are associated with different racial/ethnic groups and develop tailored programs to reduce psychological distress.

Association between racial discrimination and delayed or forgone care amid the COVID-19 pandemic

Racial discrimination has intensified in the U.S. during the COVID-19 pandemic, but how it disrupted healthcare is largely unknown. This study investigates the association of racial discrimination with delaying or forgoing care during the pandemic based on data from a nationally representative survey, the Health, Ethnicity and Pandemic (HEAP) study (n = 2552) conducted in October 2020 with Asians, Hispanics and non-Hispanic Blacks oversampled. Racial discrimination during the pandemic was assessed in three domains: experienced racial discrimination, race-related cyberbullying, and Coronavirus racial bias beliefs. Respondents answered whether they had delayed or forgone any type of healthcare due to the pandemic. Overall, 63.7% of respondents reported delaying or forgoing any healthcare during the pandemic. About 20.3% East/Southeast Asians, 18.6% non-Hispanic Blacks and 15.9% Hispanics reported experiences of racial discrimination, compared with 2.8% of non-Hispanic Whites. Experienced racial discrimination was associated with delaying/forgoing care among non-Hispanic Blacks (Adjusted odds ratios[AOR] = 4.58, 95% confidence interval[CI]: 2.22-9.45), Hispanics (AOR = 3.88, 95%CI: 1.51-9.98), and East/Southeast Asians (AOR = 2.14, 95%CI: 1.22-3.77). Experiencing race-related cyberbullying was significantly associated with delaying/forgoing care among non-Hispanic Blacks (AOR = 1.34, 95%CI: 1.02-1.77) and East/Southeast Asians (AOR = 1.51, 95%CI: 1.19-1.90). Coronavirus racial bias was significantly associated with delaying/forgoing care among East/Southeast Asians (AOR = 1.55, 95%CI: 1.16-2.07). The three domains of racial discrimination were consistently associated with delayed or forgone health care among East/Southeast Asians during the COVID-19 pandemic; some of the associations were also seen among non-Hispanic Blacks and Hispanics. These results demonstrate that addressing racism is important for reducing disparities in healthcare delivery during the pandemic and beyond.

Racial Discrimination, Mental Health and Behavioral Health During the COVID-19 Pandemic: a National Survey in the United States

BACKGROUND

While hate crimes rose during the COVID-19 pandemic, few studies examined whether this pandemic-time racial discrimination has led to negative health consequences at the population level.

OBJECTIVE

We examined whether experienced and perceived racial discrimination were associated with mental or behavioral health outcomes during the pandemic.

DESIGN

In October 2020, we conducted a national survey with minorities oversampled that covered respondents' sociodemographic background and health-related information.

PARTICIPANTS

A total of 2709 participants responded to the survey (response rate: 4.2%).

MAIN MEASURES

The exposure variables included (1) experienced and encountered racial discrimination, (2) experienced racial and ethnic cyberbullying, and (3) perceived racial bias. Mental health outcomes were measured by psychological distress and self-rated happiness. Measures for behavioral health included sleep quality, change in cigarette smoking, and change in alcohol consumption. Weighted logistic regressions were performed to estimate the associations between the exposure variables and the outcomes, controlling for age, gender, race and ethnicity, educational attainment, household income, eligibility to vote, political party, COVID-19 infection, and geographic region. Separate regressions were performed in the six racial and ethnic subgroups: non-Hispanic White, non-Hispanic Black, Hispanic, East Asian, South Asian, and Southeast Asian respondents.

KEY RESULTS

Experienced racial discrimination was associated with higher likelihood of psychological distress (adjusted odds ratio [AOR] = 2.18, 95% confidence interval [95% CI]: 1.34-3.55). Experienced racial discrimination (AOR = 2.31, 95% CI: 1.34-3.99) and perceived racial bias (AOR = 1.05, 95% CI: 1.00-1.09) were both associated with increased cigarette smoking. The associations between racial discrimination and mental distress and substance use were most salient among Black, East Asian, South Asian, and Hispanic respondents.

CONCLUSIONS

Racial discrimination may be associated with higher likelihood of distress, and cigarette smoking among racial and ethnic minorities. Addressing racial discrimination is important for mitigating negative mental and behavioral health ramifications of the pandemic.

Gender difference in working from home and psychological distress - A national survey of U.S. employees during the COVID-19 pandemic

The COVID-19 pandemic has precipitated broad and extensive changes in the way people live and work. While the general subject of working from home has recently drawn increased attention, few studies have assessed gender differences in vulnerability to the potential mental health effects of working from home. Using data from 1,585 workers who participated in the Health, Ethnicity, and Pandemic (HEAP) study, a national survey conducted in the U.S. during the COVID-19 pandemic in October 2020, associations of working from home with psychological distress were examined with weighted logistic regression among 1,585 workers and stratified by gender. It was found that workers who worked from home had higher odds of psychological distress (aOR and 95% CI = 2.62 [1.46, 4.70]) compared to workers who did not work from home, adjusting for demographic factors, socioeconomic status, and health behaviors. In gender-stratified analyses, this positive association between working from home and psychological distress was significant in women (aOR and 95% CI = 3.68 [1.68, 8.09]) but not in men. These results have implications for female workers' mental health in the transition towards working from home in the COVID-19 pandemic era.

Associations of employment status with opioid misuse: Evidence from a nationally representative survey in the U.S

The opioid crisis in the United States (U.S.) is widespread and increasing in severity, and psychosocial exposures have been identified as potential risk factors. We examined associations of employment status with opioid misuse in a large, nationally representative, population-based sample in the U.S. Data were from the 2019 National Survey of Drug Use and Health (NSDUH), an annual cross-sectional survey. The association of employment status with opioid misuse in 40,143 participants was examined by multivariable logistic regression, adjusting for age, sex, race/ethnicity, marital status, household income, educational attainment, medical insurance status, physical health conditions and depression. Analyses were weighted to represent a nationally representative sample of adults in the U.S. In NSDUH 2019, 3.82% of American individuals reported past-year opioid misuse. After taking relevant variables into account, compared to workers who were employed with normal working hours (35-40 h/week), those who were currently unemployed had higher odds of opioid misuse (fully adjusted odds ratio and 95% confidence interval were 1.40 [1.09, 1.79]). Compared to workers employed with normal working hours, those who were in school/training or retired had lower odds of opioid misuse. Short or long working hours were not associated with opioid misuse. Government and employer policy interventions may benefit from emphasizing stable employment as a major social determinant of health in the context of the opioid crisis.

The Impact of COVID-19 on Self-Reported Substance Use, Well-Being, and Functioning Among United States Veterans: A Cross-Sectional Study

As the COVID-19 pandemic sweeps the globe, many veterans with substance use issues have faced the closure of treatment facilities, mandates to shelter in place, and social distancing measures. To better understand their pandemic experiences, substance use changes, and functioning, a survey was nationally administered to a sample of United States veterans reporting substance use issues during the pandemic. The purpose of this cross-sectional online survey for veterans (N = 409) was to report on COVID-19 experiences, safety behaviors, and infection experiences while also investigating the relationship among addictive behaviors, mental and physical health, and COVID-19 impact. Measures also assessed specific substance use concerns, pandemic-related loneliness, and functioning. Though few veterans reported personally receiving a confirmed COVID-19 medical diagnosis (10.5%), the impact of pandemic stressors was evident, with a majority reporting anxiety related to contracting COVID-19 (61.4%) or fear of a family member or close friend contracting COVID-19 (58.7%). Participants reported increased use of alcohol (45.3%), sedatives (36.6%), inhalants (35.7%), tobacco (35.0%), and cannabis (34.9%), attributed specifically to the pandemic. Regression analyses revealed that even when controlling for the contribution of problematic substance use issues, negative pandemic impacts and self-reported COVID-19 related loneliness were related to more impaired physical and mental health functioning during the pandemic. Findings from this sample of veterans with addiction issues add to the growing literature suggesting unique and adverse effects of COVID-19 stressors on functioning while also revealing specific pandemic impacts for this group.

COVID-19 Vaccines and SARS-CoV-2 Transmission in the Era of New Variants: A Review and Perspective

Coronavirus disease 2019 (COVID-19) vaccines have yielded definitive prevention and major reductions in morbidity and mortality from severe acute respiratory syndrome coronavirus 2 infection, even in the context of emerging and persistent variants of concern. Newer variants have revealed less vaccine protection against infection and attenuation of vaccine effects on transmission. COVID-19 vaccines still likely reduce transmission compared with not being vaccinated at all, even with variants of concern; however, determining the magnitude of transmission reduction is constrained by the challenges of performing these studies, requiring accurate linkage of infections to vaccine status and timing thereof, particularly within households. In this review, we synthesize the currently available data on the impact of COVID-19 vaccines on infection, serious illness, and transmission; we also identify the challenges and opportunities associated with policy development based on this data.

Modeling recent gun purchases: A social epidemiology of the pandemic arms race

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We consider the social patterning of recent pandemic gun purchases.

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Overall, 6% of the sample reported purchasing a new gun during the pandemic.

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Pandemic gun purchasers tend to be male, younger, US-born, and living in the south.

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Pandemic gun purchasers tend to be less educated and recently unemployed.

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Pandemic gun purchasers tend to be Republicans and experiencing religious change.

In this paper, we document the social patterning of recent gun purchases to advance a contemporary social epidemiology of the pandemic arms race. We employ cross-sectional survey data from the 2020 Health, Ethnicity and Pandemic Study, which included a national sample of 2,709 community-dwelling adults living in the United States. We use binary logistic regression to model recent pandemic gun purchases as a function of age, sex, race/ethnicity, nativity status, region of residence, marital status, number of children, education, household income, pandemic job change, religious service attendance, pandemic religion change, and political party. Overall, 6% of the sample reported purchasing a new gun during the pandemic. Multivariate regression results suggest that pandemic gun purchasers tend to be male, younger, US-born, less educated, recently unemployed, experiencing changes in their religious beliefs, Republicans, and residents of southern states. To our knowledge, we are among the first to formally document a new population of pandemic gun owners that is characterized by youth, US-nativity, and religious volatility. Our analyses underscore the need for public health initiatives designed to enhance gun-related safety during pandemics, including, for example, addressing underlying motivations for recent gun purchases and improving access to training programs.