Potential impact of physical distancing on physical and mental health: a rapid narrative umbrella review of meta-analyses on the link between social connection and health

Social distancing stress, anxiety/depression, COVID-19 diagnosis, gender identity, and immigration status

BACKGROUND

Strict social distancing public health measures to decrease COVID-19 spread increased social distancing stress. However, differences in social distancing stress by anxiety/depression symptoms are understudied, especially based on COVID-19 diagnosis status, gender identity, and immigration status. We examined whether the association between social distancing stress and anxiety/depression symptoms was moderated by COVID-19 diagnosis status, gender identity, and immigration status. We further examined the associations of social distancing stress with anxiety/depression symptoms, gender identity, and immigration status among individuals with and without COVID-19.

METHODS

We utilized data from a national cross-sectional survey among adults aged ≥ 18 years in the United States between May 13, 2021, and January 9, 2022 (n = 5,255). Multivariable logistic regression models were used to examine the associations.

RESULTS

The prevalence of social distancing stress was higher among individuals with COVID-19 (79.23%) than among those without COVID-19 (67.51%). We observed significant associations between social distancing stress and anxiety/depression symptoms, moderated by COVID-19 diagnosis status, immigration status, and gender identity, respectively. Anxiety/depression symptoms were associated with social distancing stress among both individuals with and without COVID-19. Gender identity and immigration status were associated with social distancing stress among only individuals without COVID-19.

CONCLUSIONS

Our findings revealed that the association between social distancing stress and anxiety/depression varied by COVID-19 diagnosis status, gender identity, and immigration status. The findings underscore the need for more targeted psychological distress strategies to reduce social distancing stress and anxiety/depression among diverse US populations, while considering the impacts of COVID-19 diagnosis status, gender identity, and immigration status.

SIR+ models: accounting for interaction-dependent disease susceptibility in the planning of public health interventions

Avoiding physical contact is regarded as one of the safest and most advisable strategies to follow to reduce pathogen spread. The flip side of this approach is that a lack of social interactions may negatively affect other dimensions of health, like induction of immunosuppressive anxiety and depression or preventing interactions of importance with a diversity of microbes, which may be necessary to train our immune system or to maintain its normal levels of activity. These may in turn negatively affect a population's susceptibility to infection and the incidence of severe disease. We suggest that future pandemic modelling may benefit from relying on 'SIR+ models': epidemiological models extended to account for the benefits of social interactions that affect immune resilience. We develop an SIR+ model and discuss which specific interventions may be more effective in balancing the trade-off between minimizing pathogen spread and maximizing other interaction-dependent health benefits. Our SIR+ model reflects the idea that health is not just the mere absence of disease, but rather a state of physical, mental and social well-being that can also be dependent on the same social connections that allow pathogen spread, and the modelling of public health interventions for future pandemics should account for this multidimensionality.

A longitudinal cohort study on the use of health and care services by older adults living at home with/without dementia before and during the COVID-19 pandemic: the HUNT study

BACKGROUND

Older adults and people with dementia were anticipated to be particularly unable to use health and care services during the lockdown period following the COVID-19 pandemic. To better prepare for future pandemics, we aimed to investigate whether the use of health and care services changed during the pandemic and whether those at older ages and/or dementia experienced a higher degree of change than that observed by their counterparts.

METHODS

Data from the Norwegian Trøndelag Health Study (HUNT4 70 + , 2017-2019) were linked to two national health registries that have individual-level data on the use of primary and specialist health and care services. A multilevel mixed-effects linear regression model was used to calculate changes in the use of services from 18 months before the lockdown, (12 March 2020) to 18 months after the lockdown.

RESULTS

The study sample included 10,607 participants, 54% were women and 11% had dementia. The mean age was 76 years (SD: 5.7, range: 68-102 years). A decrease in primary health and care service use, except for contact with general practitioners (GPs), was observed during the lockdown period for people with dementia (p < 0.001) and those aged ≥ 80 years without dementia (p = 0.006), compared to the 6-month period before the lockdown. The use of specialist health services decreased during the lockdown period for all groups (p ≤ 0.011), except for those aged < 80 years with dementia. Service use reached levels comparable to pre-pandemic data within one year after the lockdown.

CONCLUSION

Older adults experienced an immediate reduction in the use of health and care services, other than GP contacts, during the first wave of the COVID-19 pandemic. Within primary care services, people with dementia demonstrated a more pronounced reduction than that observed in people without dementia; otherwise, the variations related to age and dementia status were small. Both groups returned to services levels similar to those during the pre-pandemic period within one year after the lockdown. The increase in GP contacts may indicate a need to reallocate resources to primary health services during future pandemics.

TRIAL REGISTRATION

The study is registered at ClinicalTrials.gov, with the identification number NCT04792086.

Hierarchy of demographic and social determinants of mental health: analysis of cross-sectional survey data from the Global Mind Project

OBJECTIVES

To understand the extent to which various demographic and social determinants predict mental health status and their relative hierarchy of predictive power in order to prioritise and develop population-based preventative approaches.

DESIGN

Cross-sectional analysis of survey data.

SETTING

Internet-based survey from 32 countries across North America, Europe, Latin America, Middle East and North Africa, Sub-Saharan Africa, South Asia and Australia, collected between April 2020 and December 2021.

PARTICIPANTS

270 000 adults aged 18-85+ years who participated in the Global Mind Project.

OUTCOME MEASURES

We used 120+ demographic and social determinants to predict aggregate mental health status and scores of individuals (mental health quotient (MHQ)) and determine their relative predictive influence using various machine learning models including gradient boosting and random forest classification for various demographic stratifications by age, gender, geographical region and language. Outcomes reported include model performance metrics of accuracy, precision, recall, F1 scores and importance of individual factors determined by reduction in the squared error attributable to that factor.

RESULTS

Across all demographic classification models, 80% of those with negative MHQs were correctly identified, while regression models predicted specific MHQ scores within ±15% of the position on the scale. Predictions were higher for older ages (0.9+ accuracy, 0.9+ F1 Score; 65+ years) and poorer for younger ages (0.68 accuracy, 0.68 F1 Score; 18-24 years). Across all age groups, genders, regions and language groups, lack of social interaction and sufficient sleep were several times more important than all other factors. For younger ages (18-24 years), other highly predictive factors included cyberbullying and sexual abuse while not being able to work was high for ages 45-54 years.

CONCLUSION

Social determinants of traumas, adversities and lifestyle can account for 60%-90% of mental health challenges. However, additional factors are at play, particularly for younger ages, that are not included in these data and need further investigation.

The online world as a means of connection and disconnection during the COVID-19 pandemic: A test of the interpersonal-connections-behaviour framework

BACKGROUND

The interpersonal-connections-behaviour framework proposes that social media is helpful/unhelpful to the individual to the extent that it facilitates/hinders satisfaction of core needs for acceptance and belonging (connecting and disconnecting pathways). However, little research has, to date, explicitly tested this framework.

METHODS

Both pathways were explored in a cross-sectional sample of UK adults at the start of the pandemic (N = 632) and in longitudinal (cross-lagged) analyses (N = 227-240). Participants completed measures of online and offline socialising with friends and family (connecting pathway), and online and offline social comparisons (disconnecting pathway), anxiety, depression and loneliness.

RESULTS

In cross-sectional analyses higher levels of online comparisons were associated with poorer mental health, an effect that survived after controlling for offline comparisons, and was partially mediated by loneliness. Counter to our predictions, online socialising was also associated with poorer mental health. Longitudinal analyses did not support predicted directions of causality.

LIMITATIONS

Limitations include a lack of testing of individual-level moderators, the use of single item questions to probe some constructs, and an inability to test for effects potentially operating at different time-scales.

CONCLUSIONS

The findings reported partially support the interpersonal-connections-behaviour framework in highlighting a disconnecting (but not connecting) pathway between online engagement and mental health. From a clinical perspective they highlight the importance of including people's online lives when considering mental health risk and resilience, particularly (one might argue) during periods of social isolation.

Participants' perspectives of "NeuroSask: Active and Connect"-a virtual chronic disease management program for individuals with a neurological condition

Introduction

Neurological conditions account from more than half of Canadians requiring chronic care. Both physical activity and the development of a self-management skillset are critical components supporting individuals with chronic health conditions. "NeuroSask: Active and Connected" is a virtual chronic disease management program offering twice weekly neuro-physiotherapist directed "active" exercise sessions, followed by weekly knowledge-exchange "connect" sessions with invited guest experts. NeuroSask was launched April 2020 in response to the restricted services and supports for people with neurological conditions. The program aimed to provide seated physical activity, social interaction, and access to expertise in neurological conditions and neurorehabilitation. A program evaluation of NeuroSask was conducted to gain participants' perspectives.

Methods

All participants registered for the NeuroSask program were invited to complete optional online surveys (SurveyMonkey) circulated by email at 3 occasions post-program launch: 10 weeks, 1 year, and 2 years. Participants could complete any one or all of the surveys, at their discretion. The number of potential respondents changed dependent on the total number of participants registered for NeuroSask at the time the survey was circulated. Questions were co-designed by multi-stakeholder team members. Descriptive statistics were used for closed-ended questions and a reflexive thematic analysis was completed with coding conducted in NVivo 12 Plus for open-ended text.

Results

Response rates (participants/registrants) were as follows: 10-week survey 260/793, one year survey 326/1224, and 2-year survey 434/1989. 90% of participants reported being in either the age categories of 40-59 years or above 60 years. 75% of both survey respondents and program registrants were female. 70% of both survey respondents and program registrants reported a diagnosis of multiple sclerosis and 30% reported other neurological conditions. Survey respondents were from all ten Canadian provinces, with 45% reporting living outside of large cities. Respondents reported preferring online vs. in person format for this type of programming. Three main themes, and eight corresponding subthemes were identified highlighting the perceived impact and key components of the NeuroSask program: Theme 1 "together in a positive and encouraging environment" (subthemes 1a: connection, 1b: empowerment); Theme 2 "access to enthusiastic qualified leaders from home" (subthemes 2a: leader characteristics, 2b: accessibility, 2c: program logistics); Theme 3 "being able to enjoy everyday life" (subthemes 3a: symptom benefits and beyond, 3b: carry-over, 3c: keep going, please do not cancel).

Conclusion

NeuroSask is an example of an accessible and meaningful virtual approach to providing ongoing support for some individuals with neurological conditions. It was perceived as beneficial for fostering community and connection in a positive environment with perceived benefits extending beyond symptom management to participant reported improvements in function, daily life, and disease experience.

The association between loneliness or social isolation and food and eating behaviours: A scoping review

Loneliness or social isolation and food/eating behaviours have important health consequences and there are rationales for why they could interact. Loneliness and dietary behaviours are recognised as health determinants and targets for interventions at individual, group and population levels. However, there are currently no research reviews investigating associations between these areas. This scoping review synthesized evidence investigating loneliness or social isolation and food/eating behaviours in people aged over 16 years in high-income countries. A systematic search of five databases from 2000 was conducted using predetermined search terms. Dissertation database and backwards citation searches were also conducted. Full text screening of 254 articles/theses resulted in inclusion of three qualitative and 26 quantitative studies, with eight conducted in COVID-19 lockdowns. Almost all studies reported a relationship between loneliness/social isolation and eating behaviours usually considered harmful such as low fruit and vegetable intake and lower diet quality. Qualitative research also supports the detrimental influence of loneliness or social isolation on eating. Study quality was considered, and interpretation and comparison of results was complicated by use of varying methods. Better awareness and understanding of the relationship between these complex aspects of health is needed to inform the development of interventions and practice of nutrition and mental health practitioners, policymakers, researchers and end-users.

Web-Based Presence for Social Connectedness in Long-Term Care: Protocol for a Qualitative Multimethods Study

BACKGROUND

The COVID-19 pandemic and resultant restrictions on social gatherings significantly impacted many peoples' sense of social connectedness, defined as an individual's subjective sense of having close relationships with others. Older adults living in long-term care homes (LTCHs) experienced extreme restrictions on social gatherings, which negatively impacted their physical and mental health as well as the health and well-being of their family caregivers. Their experiences highlighted the need to reconceptualize social connectedness. In particular, the pandemic highlighted the need to explore novel ways to attain fulfilling relationships with others in the absence of physical gatherings such as through the use of a hybridized system of web-based and in-person presence.

OBJECTIVE

Given the potential benefits and challenges of web-based presence technology within LTCHs, the proposed research objectives are to (1) explore experiences regarding the use of web-based presence technology (WPT) in support of social connectedness between older adults in LTCHs and their family members, and (2) identify the contextual factors that must be addressed for successful WPT implementation within LTCHs.

METHODS

This study will take place in south western Ontario, Canada, and be guided by a qualitative multimethod research design conducted in three stages: (1) qualitive description with in-depth qualitative interviews guided by the Technology Acceptance Model (TAM) and analyzed using content analysis; (2) qualitative description and document analysis methodologies, informed by content and thematic analysis methods; and (3) explicit between-methods triangulation of study findings from stages 1 and 2, interpretation of findings and development of a guiding framework for technology implementation within LTCHs. Using a purposeful, maximum variation sampling approach, stage 1 will involve recruiting approximately 45 participants comprising a range of older adults, family members (30 participants) and staff (15 participants) within several LTCH settings. In stage 2, theoretical sampling will be used to recruit key LTCH stakeholders (directors, administrators, and IT support). In stage 3, the findings from stages 1 and 2 will be triangulated and interpreted to develop a working framework for WPT usage within LTCHs.

RESULTS

Data collection will begin in fall 2023. The findings emerging from this study will provide insights and understanding about how the factors, barriers, and facilitators to embedding and spreading WPT in LTCHs may benefit or negatively impact older adults in LTCHs, family caregivers, and staff and administrators of LTCHs.

CONCLUSIONS

The results of this research study will provide a greater understanding of potential approaches that could be used to successfully integrate WPTs in LTCHs. Additionally, benefits as well as challenges for older adults in LTCHs, family caregivers, and staff and administrators of LTCHs will be identified. These findings will help increase knowledge and understanding of how WPT may be used to support social connectedness between older adults in LTCHs and their family members.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/50137.

Parent-reported child's close contact with non-household family members and their well-being during the COVID-19 pandemic: A cross-sectional survey

In England (UK), at the start of the COVID-19 pandemic the public were required to reduce their physical contacts to slow the spread of COVID-19. We investigated the factors associated with children having: 1) close contact with family members from outside their household ('non-adherent behaviour'); and 2) low well-being (Revised Child Anxiety and Depression Scale). We conducted an online cross-sectional survey, completed at any location of the participant's choice between 8 and 11 June 2020 in parents (n = 2,010) who were aged eighteen years or over and had a school-aged child (4-18 years old). Parents reported that 15% (n = 309) of children had non-adherent contact and that 26% (n = 519) had low well-being. We used a series of binary logistic regressions to investigate associations between outcomes and child and parent characteristics. Children had higher odds of having non-household contact when they had special educational needs [adjusted odds ratio, 2.19 (95% CI, 1.47 to 3.27)], lower well-being [2.65 (95% CI, 2.03 to 3.46)], were vulnerable to COVID-19 [2.17 (95% CI, 1.45 to 3.25)], lived with someone who was over 70 years old [2.56 (95% CI, 1.55 to 4.24)] and their parent had low well-being [1.94 (95% CI, 1.45 to 2.58)]. Children had higher odds of lower well-being when they had special educational needs [4.13 (95% CI, 2.90 to 5.87)], were vulnerable to COVID-19 [3.06 (95% CI, 2.15 to 4.36)], lived with someone else who was vulnerable to COVID-19 [2.08 (95% CI, 1.64 to 2.64)], or lived with someone who was over 70 years old [2.41 (95% CI, 1.51 to 3.83)]. Many children came into contact with non-household family members, mainly for childcare. Factors relating to COVID-19, children's well-being and education were also important. If school closures are needed in future, addressing these issues may help reduce contact.

Communication to promote and support physical distancing for COVID-19 prevention and control

BACKGROUND

This review is an update of a rapid review undertaken in 2020 to identify relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control. The rapid review was published when little was known about transmission, treatment or future vaccination, and when physical distancing measures (isolation, quarantine, contact tracing, crowd avoidance, work and school measures) were the cornerstone of public health responses globally. This updated review includes more recent evidence to extend what we know about effective pandemic public health communication. This includes considerations of changes needed over time to maintain responsiveness to pandemic transmission waves, the (in)equities and variable needs of groups within communities due to the pandemic, and highlights again the critical role of effective communication as integral to the public health response.

OBJECTIVES

To update the evidence on the question 'What are relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control?', our primary focus was communication approaches to promote and support acceptance, uptake and adherence to physical distancing.

SECONDARY OBJECTIVE

to explore and identify key elements of effective communication for physical distancing measures for different (diverse) populations and groups.

SEARCH METHODS

We searched MEDLINE, Embase and Cochrane Library databases from inception, with searches for this update including the period 1 January 2020 to 18 August 2021. Systematic review and study repositories and grey literature sources were searched in August 2021 and guidelines identified for the eCOVID19 Recommendations Map were screened (November 2021).

SELECTION CRITERIA

Guidelines or reviews focusing on communication (information, education, reminders, facilitating decision-making, skills acquisition, supporting behaviour change, support, involvement in decision-making) related to physical distancing measures for prevention and/or control of COVID-19 or selected other diseases (sudden acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, Ebola virus disease (EVD) or tuberculosis (TB)) were included. New evidence was added to guidelines, reviews and primary studies included in the 2020 review.

DATA COLLECTION AND ANALYSIS

Methods were based on the original rapid review, using methods developed by McMaster University and informed by Cochrane rapid review guidance. Screening, data extraction, quality assessment and synthesis were conducted by one author and checked by a second author. Synthesis of results was conducted using modified framework analysis, with themes from the original review used as an initial framework.

MAIN RESULTS

This review update includes 68 studies, with 17 guidelines and 20 reviews added to the original 31 studies. Synthesis identified six major themes, which can be used to inform policy and decision-making related to planning and implementing communication about a public health emergency and measures to protect the community. Theme 1: Strengthening public trust and countering misinformation: essential foundations for effective public health communication Recognising the key role of public trust is essential. Working to build and maintain trust over time underpins the success of public health communications and, therefore, the effectiveness of public health prevention measures. Theme 2: Two-way communication: involving communities to improve the dissemination, accessibility and acceptability of information Two-way communication (engagement) with the public is needed over the course of a public health emergency: at first, recognition of a health threat (despite uncertainties), and regularly as public health measures are introduced or adjusted. Engagement needs to be embedded at all stages of the response and inform tailoring of communications and implementation of public health measures over time. Theme 3: Development of and preparation for public communication: target audience, equity and tailoring Communication and information must be tailored to reach all groups within populations, and explicitly consider existing inequities and the needs of disadvantaged groups, including those who are underserved, vulnerable, from diverse cultural or language groups, or who have lower educational attainment. Awareness that implementing public health measures may magnify existing or emerging inequities is also needed in response planning, enactment and adjustment over time. Theme 4: Public communication features: content, timing and duration, delivery Public communication needs to be based on clear, consistent, actionable and timely (up-to-date) information about preventive measures, including the benefits (whether for individual, social groupings or wider society), harms (likewise) and rationale for use, and include information about supports available to help follow recommended measures. Communication needs to occur through multiple channels and/or formats to build public trust and reach more of the community. Theme 5: Supporting behaviour change at individual and population levels Supporting implementation of public health measures with practical supports and services (e.g. essential supplies, financial support) is critical. Information about available supports must be widely disseminated and well understood. Supports and communication related to them require flexibility and tailoring to explicitly consider community needs, including those of vulnerable groups. Proactively monitoring and countering stigma related to preventive measures (e.g. quarantine) is also necessary to support adherence. Theme 6: Fostering and sustaining receptiveness and responsiveness to public health communication Efforts to foster and sustain public receptiveness and responsiveness to public health communication are needed throughout a public health emergency. Trust, acceptance and behaviours change over time, and communication needs to be adaptive and responsive to these changing needs. Ongoing community engagement efforts should inform communication and public health response measures.

AUTHORS' CONCLUSIONS

Implications for practice Evidence highlights the critical role of communication throughout a public health emergency. Like any intervention, communication can be done well or poorly, but the consequences of poor communication during a pandemic may mean the difference between life and death. The approaches to effective communication identified in this review can be used by policymakers and decision-makers, working closely with communication teams, to plan, implement and adjust public communications over the course of a public health emergency like the COVID-19 pandemic. Implications for research Despite massive growth in research during the COVID-19 period, gaps in the evidence persist and require high-quality, meaningful research. This includes investigating the experiences of people at heightened COVID-19 risk, and identifying barriers to implementing public communication and protective health measures particular to lower- and middle-income countries, and how to overcome these.

Factors associated with perceived fear of future pandemics and/or epidemics: a cross-sectional study in Cyprus

This study aims to understand the levels of fear experienced by individuals regarding future pandemics and/or epidemics among the general population of Cyprus and comprehensively examine the diverse factors that influence this perceived fear. The cross-sectional study was conducted from October 1st, 2022, to February 19th, 2023. A proportionate quota sampling method was used for the recruitment, by recruiting a fixed number of participants from each age group, sex, and place of residence. The study collected information on sociodemographic and health-related characteristics, health literacy, trust, COVID-19 vaccination information, and perceived fear of future epidemics and/or pandemics using a self-administered questionnaire. The survey included 1075 participants, with 53.7% of them reporting fear of future pandemics. Logistic regression analysis revealed that women (OR = 2.37, 95% CI 1.78, 3.16) and individuals vaccinated against COVID-19 (OR = 1.57, 95% CI 1.02, 2.43) were significantly more likely to experience fear of future pandemics. Moreover, higher levels of trust (OR = 1.04, 95% CI 1.02, 1.06) and higher health literacy (OR = 1.05, 95% CI 1.03, 1.08) were associated with an increased likelihood of fearing future pandemics. Conversely, unemployment (OR = 0.30, 95% CI 0.13, 0.65) and having a postgraduate education decreased the likelihood of fearing future pandemics (OR = 0.56, 95% CI 0.34, 0.90). The linear regression model revealed that older age (β = - 0.10, 95% CI - 0.14, - 0.05) was negatively associated with a higher score of fear regarding future pandemics. Conversely, being in a vulnerable group (β = 2.02, 95% CI 0.75, 3.28) and having at least one chronic disease (β = 1.76, 95% CI 0.68, 2.84) showed positive associations with increased fear of future epidemics and/or pandemics. The findings emphasize the need for relevant authorities to prioritize mental health and disseminate information in a manner that avoids spreading fear and panic, particularly among vulnerable population groups.

Physical and mental health impact of the COVID-19 pandemic at first year in a Spanish adult cohort

The COVID-19 pandemic and the political and health measures have profoundly affected the health of our populations. However, very few studies have been published assessing its impact using a prospective cohort. The aim of this study is to describe the impact on physical and mental health due to the COVID-19 pandemic in the general population in Spain, and according to COVID-19 clinical status, during the first year of the pandemic. A longitudinal cohort study with two online surveys were performed on a representative sample of the adult Spanish population before (N = 2005, October/November 2019) and during the pandemic (N = 1357, November/December 2020). We assessed disability using the World Health Organisation Disability Assessment Schedule (WHODAS), major depressive episode (MDE) and suicidal thoughts and behaviours (STB), using an adapted version of the Composite International Diagnostic Interview (CIDI 3.0); generalised anxiety disorder (GAD) using the GAD-7 scale; post-traumatic stress disorder (PTSD) symptoms using the PTSD checklist for DSM-5 (PCL-5). For physical health, there was a statistically significant loss of weight (mean/SD) (T0, 73.22/15.56 vs. T1, 71.21/11.94), less use of tobacco (T0, 11.4% vs. T1, 9.0%) and decreased disability (mean/SD) (T0, 21.52/9.22 vs. T1, 19.03/7.32). For mental health, there was a significant increase in MDE (T0, 6.5% vs. T1, 8.8%) and in the prevalence of GAD (T0, 13.7% vs. T1, 17.7%). The prevalence of STB (T0, 15.1% vs. T1, 7.1%) significantly decreased. Individuals who declared they had been diagnosed with COVID-19 (3.6%) showed a worsening in physical health and an increase in mental health problems and PTSD symptoms. Although suicide risk during the first year of the pandemic was significantly less, many suicide risk factors increased: such as the incidence and persistence of MDE and GAD, the presence of PTSD symptoms in those diagnosed with COVID-19, and a worsening in self-assessed health status. We expect an increase in STB in the population in the long-term. Future research should gather information about the long-term impact of the pandemic.

Trends in emergency department visits for suicide attempts before and during the COVID-19 pandemic in Korea: A nationwide study, 2016-2021

BACKGROUND

There is increasing concern that the effects of the COVID-19 pandemic will result in excess suicides by increasing known risk factors, such as suicide attempts. However, evidence on the long-term impacts of COVID-19 on suicide attempts is lacking. We aimed to assess the short- and long-term effects of the COVID-19 pandemic on patients with suicide attempts in emergency departments (EDs) and to evaluate age- and sex-specific differences.

METHOD

We conducted nationwide cross-sectional study among patients with suicide attempts in the ED from 2016 to 2021. The trend test were used to determine whether study subjects were affected by changes in ED visits for suicide attempts. We estimated the average annual percentage change (APC) stratified by sex and age groups.

RESULTS

The number of ED visits related to suicide attempts increased from 27,581 in 2016 to 37,719 in 2021. In particular, it decreased immediately after the COVID-19 pandemic but increased again in 2021. We identified that the average APC increased by 6.8 % overall, 1.6 % among males, and 10.8 % among females. Moreover, the APC of trend sharply increased in patients aged 10s and 20s. The in-hospital mortality was 3.6 % for females, compared to 9.5 % for males, which showed sex differences.

LIMITATIONS

Other information such as severity of injury, interpersonal relationships were not available. This study was limited to confirming causal relationship based on a descriptive study.

CONCLUSIONS

The incidence of suicide attempts in ED has increased in Korea. In particular, there was a sharp increase among women, adolescents and young adults. Patient-tailored treatment and preventive medical system for suicide attempts is important.

Assessment of the psycho-emotional state of patients after COVID-19-associated pneumonia in relationship with laboratory indicators

The aim. To study peculiarities and association of psychological and laboratory indicators in patients with cardiovascular diseases (CVD) who underwent COVID-19 to clarify the factors affecting the possibility of developing delayed psychological and cardiovascular adverse events.

Methods. The study enrolled 350 patients with COVID-19. Group 1 consisted of 92 patients without CVD, Group 2 – of 258 patients with CVD. Indicators of laboratory and psychological parameters were assessed according to the data of psychological questionnaire using GAD-7 (General Anxiety Disorder-7), PHQ-9 (Patient Health Questionnaire-9), PSS (Perceived Stress Scale) screening scales and SF-36. Parameters of complete blood count and biochemical blood tests were measured during hospitalization and three months after discharge from the monohospital.

Results. After three months, in the general group of patients, signs of anxiety and depression were detected in more than 30 % of the examined patients, signs of stress – in 10.4 %. In the group with CVD, psycho-emotional disorders were identified in 1/4 of the patients, and severe stress – in 8 % of those included in the study. In addition, it was registered that the indicators of erythrocyte sedimentation rate, fibrinogen, high-sensitivity C-reactive protein (CRP), homocysteine and IL-6 remained at a higher level in the second group.

Correlation analysis showed that the psychological component of health is interconnected with the level of neutrophils (p = 0.044) and fibrinogen (p = 0.050); the physical component of health is correlated with the level of erythrocytes (p = 0.030), hemoglobin (p = 0.015), CRP (p = 0.002), creatine phosphokinase (p = 0.036) and glucose (p = 0.017). Regression analysis revealed that in patients with CVD three months after hospitalization, an increased glucose index contributes to deterioration, and increased hematocrit and mean hemoglobin concentration improve the quality of life of patients.

Conclusion. Laboratory markers that maintain the duration of a prolonged vascular reaction, violation of the rheological and metabolic properties of blood, determine the nature of the development of both psychological and cardiovascular complications.

Time trends in mental health indicators in Germany's adult population before and during the COVID-19 pandemic

Background

Times of crisis such as the COVID-19 pandemic are expected to compromise mental health. Despite a large number of studies, evidence on the development of mental health in general populations during the pandemic is inconclusive. One reason may be that representative data spanning the whole pandemic and allowing for comparisons to pre-pandemic data are scarce.

Methods

We analyzed representative data from telephone surveys of Germany's adults. Three mental health indicators were observed in ~1,000 and later up to 3,000 randomly sampled participants monthly until June 2022: symptoms of depression (observed since April 2019, PHQ-2), symptoms of anxiety (GAD-2), and self-rated mental health (latter two observed since March 2021). We produced time series graphs including estimated three-month moving means and proportions of positive screens (PHQ/GAD-2 score ≥ 3) and reports of very good/excellent mental health, as well as smoothing curves. We also compared time periods between years. Analyses were stratified by sex, age, and level of education.

Results

While mean depressive symptom scores declined from the first wave of the pandemic to summer 2020, they increased from October 2020 and remained consistently elevated throughout 2021 with another increase between 2021 and 2022. Correspondingly, the proportion of positive screens first decreased from 11.1% in spring/summer 2019 to 9.3% in the same period in 2020 and then rose to 13.1% in 2021 and to 16.9% in 2022. While depressive symptoms increased in all subgroups at different times, developments among women (earlier increase), the youngest (notable increase in 2021) and eldest adults, as well as the high level of education group (both latter groups: early, continuous increases) stand out. However, the social gradient in symptom levels between education groups remained unchanged. Symptoms of anxiety also increased while self-rated mental health decreased between 2021 and 2022.

Conclusion

Elevated symptom levels and reduced self-rated mental health at the end of our observation period in June 2022 call for further continuous mental health surveillance. Mental healthcare needs of the population should be monitored closely. Findings should serve to inform policymakers and clinicians of ongoing dynamics to guide health promotion, prevention, and care.

Impact of the COVID-19 Pandemic on the Perceived Physical and Mental Health and Healthy Lifestyle Behaviors of People With Disabilities: A Quantitative Analysis of the International Community Survey

OBJECTIVE

This study aims to determine the perceived impact of the coronavirus pandemic on physical and mental health and healthy lifestyle behaviors in community-dwelling persons with disabilities, as compared with those without disabilities.

DESIGN

A prospective cross-sectional study was conducted with a web-based global survey.

RESULTS

Over 3 mos, 3550 responses were collected from 65 countries. The study included 2689 responses without skipped questions as full data for analysis. Most respondents were women (82.82%), and approximately half (52.81%) were between the ages of 25 and 39 yrs, followed by those between the ages of 40 and 60 yrs (38.6%). Among the participants, 52% indicated physical activity levels decreased and 20% reported eating less fruit and vegetables than before. Furthermore, 45% noted that they slept less than before. Perceived physical and mental health and changes to eating habits during the pandemic showed a significant difference in people with and without disabilities. Furthermore, perceived effects on physical health had a significant effect on the reported degree of disability.

CONCLUSIONS

This study indicates that the pandemic had a larger impact on perceived physical and mental health and changes in eating habits and tobacco use among people with disabilities than people without disabilities.

Social media use and adolescents' well-being: A note on flourishing

Background

Several large-scale studies and reviews have reported both negative and positive associations of social media use with well-being, suggesting that the findings are more complex and need more nuanced study. Moreover, there is little or no exploration of how social media use in adolescence influences flourishing, a more all-encompassing construct beyond well-being, including six sub-domains (i.e., happiness, meaning and purpose, physical and mental health, character, close social relationships, and financial stability). This paper aims to fill this gap by understanding how adolescents might flourish through social media activities by fulfilling the basic needs pointed out by the Self-Determination Theory, i.e., relatedness, autonomy, and competence.

Methods

The study is drawn on cross-sectional data collected from 1,429 Swiss adolescents (58.8% females, M_age = 15.84, SD_age = 0.83) as part of the HappyB project in Spring 2022. Self-reported measures included the Harvard Adolescent Flourishing scale, positive and negative online social experiences, self-disclosure on social media, and social media inspiration. Control variables included, among others, self-esteem, ill-being, and personality.

Results

After applying Bonferroni's correction, results of the hierarchical regression analyses showed that positive social media experiences (β = 0.112, p < 0.001) and social media inspirations from others (β = 0.072, p < 0.001) and for others (β = 0.060, p = 0.003) were positively associated with flourishing. Flourishing was inversely associated with negative social media experiences (β = -0.076, p < 0.001). Among covariates, self-esteem (β = 0.350, p < 0.001), ill-being (β = -0.252, p < 0.001), perceived school environment (β = 0.138, p < 0.001), self-reported level of physical activity (β =0.109, p < 0.001), and perceived socio-economic status (β = -0.059, p = 0.001) were all related to flourishing. In contrast, gender, high school year, age, perceived stress, and personality (extraversion and neuroticism) were not.

Conclusion

Using a well-being framework to investigate social media use in adolescents is needed to go beyond the ill-being perspective. Our results align with the needs pointed out by the Self-Determination Theory. Carrying out social media activities in a way that promotes-rather than diminishes-flourishing should be included as an additional good habit influencing adolescents' development. We suggest that interventions aiming to foster adolescents' flourishing should include curricula aiming to promote a good use of social media through positive online social relationships and inspirational contents.

Association between social connectedness and stress or anxiety among older cancer survivors during the 2020-2021 winter surge of the COVID-19 pandemic

INTRODUCTION

Our goal was to estimate a relative decreased rate of social connectedness to family and friends, increased rate of stress or anxiety during the 2020-2021 winter surge of the COVID-19 pandemic, and investigate the association between social connectedness and stress or anxiety among a nationally representative sample of older adults with cancer history.

MATERIALS AND METHODS

We used population-based, nationally representative cross-sectional data from the Medicare Current Beneficiary Survey COVID-19 Winter 2021 Community Supplement. The study cohort included community-living Medicare beneficiaries aged 65 years and older who self-reported cancer history (other than skin cancer) (n = 1650). Sample weights were applied to account for the complex survey design, with results generalizable to 8.5 million Medicare beneficiaries with cancer history. The outcome was self-reported feelings of stress or anxiety during the 2020-2021 winter surge of the COVID-19 pandemic. The independent variable was social connectedness, defined as feeling less socially connected to family and friends during the 2020-2021 winter surge of the COVID-19 pandemic. We conducted weighted descriptive statistics and multivariable logistic regression analyses.

RESULTS

Overall, 42.5% of beneficiaries reported decreased social connectedness to family and friends, and 37.8% reported increased feelings of stress or anxiety during the 2020-2021 winter surge of the COVID-19 pandemic. After adjusting for all covariates, participants who reported decreased social connectedness had 154% higher odds of increased feelings of stress or anxiety (adjusted odds ratio [AOD] = 2.54, 95% confidence interval [CI] = 2.00-3.20, p ≤0.001) compared to those who reported more or about the same social connectedness to family and friends. The odds of increased feelings of stress or anxiety were also higher for those who self-reported as Hispanic vs. non-Hispanic White beneficiaries (AOR = 1.35, 95% CI = 1.10-1.73, p = .016), women vs. men (AOR = 1.85, 95%CI = 1.43-2.38, p ≤0.001), and those who reported depression history vs. not reporting depression history (AOR = 2.55, 95% CI = 1.86-3.48, p ≤0.000).

DISCUSSION

An estimated 3.6 million older adults with cancer history reported decreased social connectedness to family and friends, and 3.2 million reported increased feelings of stress or anxiety during the 2020-2021 winter surge of the COVID-19 pandemic. Identifying these adults and referring them to appropriate supportive care resources and services are essential to help them cope with negative feelings.

[Public health measures during the COVID-19 pandemic in institutions for the protection of children and adolescents in two departments in ColombiaMedidas de saúde pública em instituições de proteção de crianças e adolescentes em dois departamentos da Colômbia durante a pandemia de COVID-19]

Objective

Analyze facilitating processes, obstacles, and effects of the implementation of non-pharmacological public health measures for the prevention of COVID-19 in child and adolescent protection centers in two departments (Antioquia and La Guajira) in Colombia during the period 2020-2021.

Methods

Mixed methods study with a convergent parallel design in 13 residential child/adolescent protection facilities in Colombia (11 in Antioquia and two in La Guajira). A questionnaire was given to 145 children and adolescents, and 23 interviews were held with persons responsible for the implementation of measures in the national family welfare system.

Results

The implemented non-pharmacological public health measures did not differ by department; the most complex to implement were physical distancing and restriction of family visits.

Conclusions

In centers for the protection of children and adolescents in Antioquia and La Guajira, non-pharmacological public health measures helped mitigate the spread of the virus in environments considered at-risk.

Poor mental health is associated with loneliness and boredom during Covid-19-related restriction periods in patients with pre-existing depression

BACKGROUND

In 2020-2021, many European countries put in place temporary lockdown measures due to the increase in COVID-19 cases, although such measures have negative psychological effects. As pre-existing mental disorders are a risk factor of negative psychological consequences during pandemics, it is important to identify specific predictors of psychological distress caused by restrictive measures in patients with history of depressive episodes. The aims of this study were i) to determine whether depressive, anxious symptomatology and suicidal ideation (i.e. mental health outcomes) were influenced by stay-at-home orders, and ii) to identify the psychosocial dimensions that influenced these mental health outcomes in patients with pre-existing depression during/after COVID-19-related restrictions.

METHODS

This study concerned 296 psychiatric patients with history of depressive episode in the 2 years before the COVID-19 outbreak. Participants received a computerized form to self-measure depression, suicidal ideation, and anxiety (5 times during 2020-2021, two lockdown periods and three non- lockdown periods). Loneliness, boredom, habits, substance consumption, and access to psychiatric care also were self-reported.

RESULTS

Loneliness and boredom were independent risk factors of anxiety and depression, and their changes dynamically affected the psychological state. Suicidal ideation was mostly driven by depressive symptomatology.

CONCLUSIONS

Our results highlight the need to target these dimensions in the most vulnerable patients in order to prevent the psychological consequences of the repeated COVID-19-related restrictions.

Frailty and the impacts of the COVID-19 pandemic on community-living middle-aged and older adults: an analysis of data from the Canadian Longitudinal Study on Aging (CLSA)

BACKGROUND

frailty imparts a higher risk for hospitalisation, mortality and morbidity due to COVID-19 infection, but the broader impacts of the pandemic and associated public health measures on community-living people with frailty are less known.

METHODS

we used cross-sectional data from 23,974 Canadian Longitudinal Study on Aging participants who completed a COVID-19 interview (Sept-Dec 2020). Participants were included regardless of whether they had COVID-19 or not. They were asked about health, resource, relationship and health care access impacts experienced during the pandemic. Unadjusted and adjusted prevalence of impacts was estimated by frailty index quartile. We further examined if the relationship with frailty was modified by sex, age or household income.

RESULTS

community-living adults (50-90 years) with greater pre-pandemic frailty reported more negative impacts during the first year of the pandemic. The frailty gradient was not explained by socio-demographic or health behaviour factors. The largest absolute difference in adjusted prevalence between the most and least frail quartiles was 15.1% (challenges accessing healthcare), 13.3% (being ill) and 7.4% (increased verbal/physical conflict). The association between frailty and healthcare access differed by age where the youngest age group tended to experience the most challenges, especially for those categorised as most frail.

CONCLUSION

although frailty has been endorsed as a tool to inform estimates of COVID-19 risk, our data suggest it may have a broader role in primary care and public health by identifying people who may benefit from interventions to reduce health and social impacts of COVID-19 and future pandemics.

Security motives and negative affective experiences during the early months of the COVID-19 pandemic

OBJECTIVE

Self-regulation can help individuals cope during stressful events, but little is known about why and when this might occur. We examined if being more focused on prevention was linked to negative affective experiences during the COVID-19 pandemic. We also examined possible underlying mechanisms for this association, and whether social support buffered it.

DESIGN

Pre-registered longitudinal study, with surveys every 2 weeks over one month (N = 1269).

MAIN OUTCOME MEASURES

Regulatory focus and worry for health (T1), adherence to self-isolation and preventive health behaviours (T2), negative affective experiences, positive affect, frequency of online interactions, and perceived social support (T3).

RESULTS

Prevention focus was associated with health worries at baseline and linked to greater adherence to preventive health behaviours (T2). Only adherence to self-isolation was linked to more negative affective experiences (T3). Exploratory analyses showed that prevention focus was linked to more negative affective experiences (T3), but only for participants with fewer online interactions with their family and less perceived social support from family and friends.

CONCLUSIONS

Prevention motives in threatening times can be a double-edged sword, with benefits for health behaviours and consequences for negative affective experiences. Having a strong social network during these times can alleviate these consequences.

Examining the Complex (Curvilinear and Contingent) Associations between Social Distancing Compliance and Subjective Health during a Global Health Crisis

OBJECTIVES

This study investigated a potential curvilinear link between social distancing behavior and subjective health in later life. It also evaluated whether food insecurity and community social capital moderated the focal relationship.

METHODS

Data were drawn from three waves of the COVID Impact Survey (N = 19,234). Mixed-effects models were fitted.

RESULTS

Social distancing has a non-monotonic (U-shaped) relationship with subjective health, i.e., individuals with low and high levels of social distancing show relatively better health. Moreover, the negative linear relationship between social distancing and health is weaker among people suffering from food insecurity as well as those living in communities with lower stocks of social capital.

DISCUSSION

This study sheds new light on the health implications of social distancing during the pandemic. Our findings dovetail with the steeling hypothesis, i.e., that social distancing is less harmful for U.S. older adults exposed to prior stressful or vulnerable conditions.

Differential impacts of COVID-19 and associated responses on the health, social well-being and food security of users of supportive social and health programs during the COVID-19 pandemic: A qualitative study

The effects of the coronavirus disease-2019 (COVID-19) pandemic on the lives of underserved populations are underexplored. This study aimed to identify the impacts of the COVID-19 pandemic and associated public health responses on the health and social well-being, and food security of users of Housing First (HF) services in Toronto (Canada) during the first wave of the COVID-19 pandemic. This qualitative descriptive study was conducted from July to October 2020 in a subsample of 20 adults with a history of homelessness and serious mental disorders who were receiving HF services in Toronto. A semi-structured interview guide was used to collect narrative data regarding health and social well-being, food security and access to health, social and preventive services. A thematic analysis framework guided analyses and interpretation of the data. The COVID-19 pandemic and response measures had a variable impact on the health, social well-being and food security of participants. Around 40% of participants were minimally impacted by the COVID-19 pandemic. Conversely, among the remaining participants (impacted group), some experienced onset of new mental health problems (anxiety, stress, paranoia) or exacerbation of pre-existing mental disorders (depression, post-traumatic stress disorder and obsessive-compulsive disorder). They also struggled with isolation and loneliness and had limited leisure activities and access to food goods. The pandemic also contributed to disparities in accessing and receiving healthcare services and treatment continuity for non-COVID-19 health issues for the negatively impacted participants. Overall, most participants were able to adhere to COVID-19 public health measures and get reliable information on COVID-19 preventive measures facilitated by having access to the phone, internet and media devices and services. In conclusion, the COVID-19 pandemic and associated response measures impacted the health, social well-being, leisure and food security of people with experiences of homelessness and mental disorders who use supportive social and housing services in diverse ways.

Effects of widespread community use of face masks on communication, participation, and quality of life in Australia during the COVID-19 pandemic

The objective was to document the influence of face mask use by other people on communication experiences, participation in activities, and quality of life. Australian adults (n = 665) completed an online survey; 90.8% resided in a state with mandatory mask use outside the home and 44.1% self-reported hearing difficulties. Mask use was reported as negatively affecting communication quality in the community (90.2%) and workplace (91.8%), and with household members (59.1%), including an increased requirement for clarification and repetition, increased difficulty communicating, and decreased understanding. Masks influenced feelings when communicating in the community (74.1%) and workplace (76.7%), and with household members (43.6%), including increased fatigue and frustration, and decreased connection to others. Masks influenced the time spent communicating in the community (68.8%) and workplace (67.9%), and with household members (42.3%), including a decrease in the number of individuals communicated with, and the time spent communicating with each individual. Masks influenced participation in activities in the community (50.9%) and workplace (59.7%), and with household members (41.3%), including reduced participation in health-related activities, shopping, and socialising. Influences on quality of life included reduced physical and mental health, including increased loneliness. Female gender and greater self-reported hearing difficulties were significantly associated with increased influence of mask use. The wide-ranging influences of face mask use have implications for physical health and mental health, including social connectedness, and for employers and the economy. As an important measure for combatting disease spread, the negative impacts of mask use must be considered during policy formulation, and appropriate mitigating measures, such as educational campaigns, enacted.

Communication challenges in social isolation, subjective cognitive decline, and mental health status in older adults: A scoping review (2019-2021)

PURPOSE

Through an evolutionary concept analysis, social isolation (SI) was defined as lack of social belonging and engagement with others, minimal number of social contacts, and insufficient quality relationships. This definition represents broader understanding of most contributing factors to SI and supports the concepts of reduced communication and socialization experienced during the COVID-19 pandemic. The COVID-19 pandemic served to heighten this problem, including communication challenges, and brought negative outcomes of SI to light. The overall research question examined the impact of communication challenges and SI on OAs with Alzheimer's disease, related dementias, and subjective cognitive changes (2020-2021). This scoping literature review was developed to compare the psychosocial and mental health of older adults between prepandemic and pandemic lockdown of 2020-2021.

DESIGN AND METHODS

This review followed the procedures for scoping review reporting as stated by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews (PRISMA-ScR). In collaboration with an expert scientific information specialist assigned to the college of nursing, the literature was queried through MEDLINE(R) and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations and Daily 1946 to September 02, 2021; APA PsycInfo 1806 to August Week 5 2021; and Embase Classic+Embase 1947 to 2021 September 02. Search terms included social isolation; nursing home; home for the aged; long-term care; old age homes or convalescent home or nursing home; long-term care, or long-term care; aged or elders or seniors, dementia, Alzheimer's or dementia; osteoporosis; and fragility fracture.

FINDINGS

Quantitative data informed outcomes through increased depression and anxiety, higher rates of depression during the pandemic than prepandemic, and increased symptomology in neuropsychiatric profiles. Further, COVID19-related restrictions, including impaired communication streams, seemed to be the origin of stress-related cognitive changes and symptomology. Communication challenges in residents with dementia may lead to feelings of social isolation. Qualitative evidence supports that dementia has a social, psychological, material, and socio-demographic impact. Further, the lockdown disrupted the existing flow of communication between all stakeholders and residents, resulting in heightened perceptions of SI and a profound sense of loss.

PRACTICE IMPLICATIONS

The results include a diverse and complex characterization of negative outcomes. Further, strong evidence indicates that communication and human contact can ameliorate negative outcomes.

Effects of physical distancing by COVID-19 pandemic on diet quality, neurological and immunological markers, and fecal microbiota of Brazilian older women

Physical distancing was used to prevent transmission of COVID-19, however there are concerns that this may promote harmful impacts on health, such as reduced levels of physical practice and changes in food intake and gut microbiota composition. This study evaluated the impacts of 6 months physical distancing on Brazilian older women upon body mass index (BMI), strength, physical activity level (IPAQ), eating habits, neurological markers (brain-derived neurotrophic factor-BDNF and cortisol), cytokines (IL-2, IL-5, IL-6, IL-10, interferon-IFN-γ, tumor necrosis factor-TNF-α), aging-associated markers (vascular endothelial growth factor-VEGF, insulin-like growth factor-IGF-1, klotho and thymic stromal lymphopoietin-TSLP), besides specific groups of fecal microbiota. Fifteen women, over 60 years old, residents of São Paulo state (Brazil), were evaluated in March and in September 2020. The older adult women, with a mean age 66 ± 6.2 years presented significantly increased BMI and high effect size for non-protective foods consumption, reduced light physical activity and strength 6 months following the physical distancing. Furthermore, the serum concentration of IFN-γ, IGF-1, and IFN-γ/IL-5 were significantly higher, while lower concentration of IL-2 and IL-5 were observed 6 months after the physical distancing. Significant increase was noted only to Blautia spp. abundance after 6 months of physical distancing. Several correlations were observed at both before and after physical distancing, however, interestingly, many of them were lost or inverted 6 months following, while new ones emerged. Taken together, these results showed that lifestyle changes and stress conditions addressed by physical distancing from the COVID-19 pandemic impacted the health of older women included in the present study. Therefore, future follow-up studies are essential to propose interventions in order to restore the health conditions observed before the pandemic period, and thus to maintain the quality of life of older adults in different socioeconomic contexts.

The COVID-19 pandemic as experienced by adults with congenital heart disease from Belgium, Norway, and South Korea: impact on life domains, patient-reported outcomes, and experiences with care

AIMS

The coronavirus disease-2019 (COVID-19) pandemic poses significant challenges to many groups within societies, and especially for people with chronic health conditions. It is, however, unknown whether and how the pandemic has thus far affected the physical and mental health of patient populations. Therefore, we investigated how the pandemic affected the lives of adults with congenital heart disease (CHD), compared pre- and peri-pandemic patient-reported outcome measures (PROMs) and a patient-reported experience measure (PREM), and investigated whether having had COVID-19 impacted pre-/peri-pandemic differences of the PROMs and PREM.

METHODS AND RESULTS

As part of the ongoing APPROACH-IS II project, we longitudinally surveyed 716 adults with CHD from Belgium, Norway, and South Korea. Pre-pandemic measures were administered from August 2019 to February 2020 and the peri-pandemic surveys were completed September 2020-April 2021. The majority of patients indicated that their social lives (80%), mental health (58%), and professional lives/education (51%) were negatively impacted by the pandemic. Patients felt worried (65%), were afraid (55%), reported the pandemic felt 'close' to them (53%), and were stressed (52%). However, differences between pre- and peri-pandemic scores on the PROMs and PREM were negligibly small (Cohen's d < 0.20). Across measures, 5.8-15.8% of patients demonstrated changes (improved or worsened scores) that exceeded the minimal clinically important difference. There were no difference-in-differences for PROMs and PREM between patients who did vs. did not have COVID-19.

CONCLUSIONS

Although the COVID-19 pandemic has been disruptive in many ways, pre- to peri-pandemic changes in PROMs and PREM of adults with CHD were negligibly small.

Social support, perceived stigma, and depression among PLHIV on second-line antiretroviral therapy using structural equation modeling in a multicenter study in Northeast Ethiopia

Background

Depression has a multitude of clinical and public health consequences for HIV patients. The magnitude of HIV patients who failed first-line antiretroviral treatment and switched to second-line therapy is becoming a growing public health concern. However, unlike first-line therapy, to date, little attention has been given to mental health problems in such patients, particularly in the era of the COVID-19 pandemic. Thus, this research was conducted to determine the magnitude of depression and its determinants among HIV patients on second-line antiretroviral therapy.

Methods

A multi-centered cross-sectional study was conducted on 714 HIV patients on second-line therapy who were selected via systematic random sampling. Data were collected in personal interviews as well as document reviews. The nine-item patient health questionnaire score was used to assess depression, while the three-item Oslo Scale was used to assess social support. The associations between exogenous, mediating, and endogenous variables were identified simultaneously using structural equation modeling. Statistical significance was declared at a P-value less than 0.05, and the effect sizes were presented using 95% CI.

Results

Depression was reported in 27.7% of HIV patients on second-line therapy [95% CI: 24.7–31.1%]. Social support has a direct [\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\widehat{\beta }$$\end{document}β^ = − 0.9, (95% CI: − 1.11 to − 0.69)] and indirect [\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\widehat{\beta }$$\end{document}β^ = − 0.22, (95% CI: − 0.31 to − 0.13)] negative effect on depression. Perceived stigma was a mediator variable and significantly associated with depression [\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\widehat{\beta }$$\end{document}β^ = 0.40, (95% CI: 0.23–0.57)]. Co-morbid illness [\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\widehat{\beta }$$\end{document}β^ = 0.49, (95% CI: 0.35–0.63)], high viremia [\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\widehat{\beta }$$\end{document}β^ = 0.17, (95% CI: 0.08–0.26], moderate and high-risk substance use [\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\widehat{\beta }$$\end{document}β^ = 0.29, (95% CI: 0.18–0.39)], and not-workable functional status [\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\widehat{\beta }$$\end{document}β^ = 0.2, (95% CI: 0.1–0.31)] were all positively associated with depression.

Conclusions

This study revealed that there was a high prevalence of depression among HIV patients on second-line antiretroviral therapy. Social and clinical factors were associated with depression risk. As a result, screening, prevention, and control strategies, including psychosocial support, should be strengthened in routine clinical care.

Depression and loneliness may predict work inefficiency among professionally active adults

Purpose

Both depression and loneliness have been recognized as major public health issues, yet investigation into their role among young and middle-aged, professionally active persons is still required. The aim of the present study was to evaluate whether depression and loneliness may independently predict inefficiency at work among professionally active adults.

Methods

This is a cross-sectional study on a representative, nationwide sample. 1795 questionnaires were gathered from among professionally active adults from Poland from 1 to 31 July 2018 with a direct pen-and-paper interview. The sample was chosen by means of the stratified random method. The survey included a Patient Health Questionnaire (PHQ-9) to measure depression and questions, devised by the authors, relating to loneliness and inefficiency at work. Regression models were constructed with depression and loneliness as predictors of inefficiency at work, unadjusted and adjusted for selected sociodemographic, health- and work-related factors.

Results

In the unadjusted models, both depression and loneliness were independently associated with an increase of work inefficiency and absence from work, with effect sizes being higher for loneliness than for depression. After accounting for the control variables (i.e., sociodemographic, work- and health-related factors), the PHQ-9 score, but not the loneliness score, was associated with an increased probability of frequent thoughts about changing or leaving a job.

Conclusion

Depression and loneliness independently predicted occupational functioning and differentially affect its various aspects. Counteracting depression and loneliness among employees should be regarded as a public health priority.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-022-01869-1.

COVID 19 pandemic challenges and their management: A review of medicines, vaccines, patents and clinical trials with emphasis on psychological health issues

The SARS‐CoV‐2 (COVID 19) paroxysm is a dominant health exigency that caused significant distress, affecting physical and mental health. Increased mortality, a stressed healthcare system, financial crisis, isolation, and new living and working styles enhanced societal commiseration leading to poor health outcomes. Though people try to maintain good physical health but unfortunately the mental affliction is still ignored. Poor psychological health has emerged as a burgeoning social issue and demands attention. Henceforth, the fundamental objective of this review article is to collate information about COVID-linked physical and psychological agony in diverse population groups with related symptoms and accessible diagnosis techniques. Recent studies have unraveled the fragile mental states of people who have either contracted COVID 19 or had near and dear ones falling prey to it. The impact of the epidemic on the human mind both in short and long-term, with possible risk and preventive factors together with suggested solutions for maintaining good health have also been discussed here. It also enlists the available medications, vaccines and investigational research in the form of patents and clinical trials. This article can be taken as an updated information sheet for COVID 19, accompanied by its management techniques with special emphasis on coping strategies for mental health. Further, it may also assist the policymakers to devise approaches that could enable the public to overcome the pandemic-driven adversity not only in the given situation but also futuristically.

The effect of social network strain on suicidal ideation among middle-aged adults with adverse childhood experiences in the US: A twelve-year nationwide study

Objective

Building on literature that measured the association between social network strain (SNS) and suicidal ideation using conventional regression analyses, we examined the effect of SNS, due to adverse childhood experiences (ACEs), on suicidal ideation using instrumental variables (IV) to eliminate the potential biases that may have occurred in earlier studies due to residual confounding.

Methods

This retrospective cohort study linked longitudinal data from the National Survey of Midlife Development in the United States (MIDUS) Refresher Biomarker Project (2012–2016), the MIDUS Refresher Project (2011–2014), the MIDUS 2 Biomarker Project (2004–2009), and the MIDUS 2 Project (2004–2006). Participants completed a phone interview, self-administered survey, and biomarker data collection. Exposure indicators included self-reported suicidal ideation, ACEs, and SNS from family, spouse, and friends. IV analysis was used to evaluate the continuous local average treatment effect of SNS on suicidal ideation when SNS only varied due to variation in ACEs.

Results

Our sample included 1703 middle-aged adults (52.9% females), which were followed up for 12 years. An IV probit model controlling for sociodemographic characteristics found a one-standard-deviation reduction in SNS reduced suicidal ideation by 22.6% (p < 0.01). A comprehensively controlled IV probit model found that a one-standard-deviation reduction in SNS is associated with a 21.4% (p = 0.05) decrease in suicidal ideation.

Conclusions

The causal pathway from SNS (due to ACEs) to suicidal ideation among middle-aged adults was established using IV analysis in this large-scale longitudinal study. The magnitude of this effect is sufficient to warrant the development of programs to improve social network relationships among family, friends, and spouses/partners. Suicide prevention programs addressing SNS may significantly reduce suicidal ideation among middle-aged Americans who have experienced ACEs.

•

Social Network Strain (SNS) from family, spouse, and friends is common.

•

SNS derives from demands, criticisms, disappointments, and irritations.

•

SNS varies strongly with Adverse Childhood Experiences (ACEs).

•

Reductions in SNS due to fewer ACEs decrease suicidal ideation.

•

A one standard-deviation reduction in SNS lowers suicidal ideation by 20%.

Mental Health and Quality of Life among Patients with Cancer during the SARS-CoV-2 Pandemic: Results from the Longitudinal ONCOVID Survey Study

Simple Summary

Although the SARS-CoV-2 pandemic is likely to have created or aggravated mental health symptoms in cancer patients, high-quality longitudinal data on this topic are scarce. The aim of our prospective survey study was to assess cancer patient-reported mental health and quality of life (QOL) at four time points during the first two waves of the pandemic. We found that an important proportion of the 355 participants reported symptoms of COVID-19 peritraumatic distress (34.2% to 39.6%), depression (27.6% to 33.5%), anxiety (24.9% to 32.7%), and stress (11.4% to 15.7%) at any time point during the study period. However, we did not find clinically meaningful mental health and QOL changes during the study period. Additionally, we found no factors associated with better or worse mental health or QOL. In conclusion, the cancer patients who participated in this study showed considerable resilience against mental health and QOL deterioration during the pandemic.

Abstract

Purpose: This longitudinal survey study aimed to investigate the self-reported outcome measures of COVID-19 peritraumatic distress, depression, anxiety, stress, quality of life (QOL), and their associated factors in a cohort of cancer patients treated at a tertiary care hospital during the SARS-CoV-2 pandemic. Methods: Surveys were administered at four time points between 1 April 2020 and 18 September 2020. The surveys included the CPDI, DASS-21, and WHOQOL-BREF questionnaires. Results: Survey response rates were high (61.0% to 79.1%). Among the 355 participants, 71.3% were female, and the median age was 62.2 years (IQR, 53.9 to 69.1). The majority (78.6%) were treated with palliative intention. An important proportion of the participants reported symptoms of COVID-19 peritraumatic distress (34.2% to 39.6%), depression (27.6% to 33.5%), anxiety (24.9% to 32.7%), and stress (11.4% to 15.7%) at any time point during the study period. We did not find clinically meaningful mental health and QOL differences during the study period, with remarkably little change in between the pandemic’s first and second wave. We found no consistent correlates of mental health or QOL scores, including cancer type, therapy intention, and sociodemographic information. Conclusion: This cohort of cancer patients showed considerable resilience against mental health and QOL deterioration during the SARS-CoV-2 pandemic.

Social Connection as a Public Health Issue: The Evidence and a Systemic Framework for Prioritizing the "Social" in Social Determinants of Health

There is growing interest in and renewed support for prioritizing social factors in public health both in the USA and globally. While there are multiple widely recognized social determinants of health, indicators of social connectedness (e.g., social capital, social support, social isolation, loneliness) are often noticeably absent from the discourse. This article provides an organizing framework for conceptualizing social connection and summarizes the cumulative evidence supporting its relevance for health, including epidemiological associations, pathways, and biological mechanisms. This evidence points to several implications for prioritizing social connection within solutions across sectors, where public health work, initiatives, and research play a key role in addressing gaps. Therefore, this review proposes a systemic framework for cross-sector action to identify missed opportunities and guide future investigation, intervention, practice, and policy on promoting social connection and health for all. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Association of Different Restriction Levels With COVID-19-Related Distress and Mental Health in Somatic Inpatients: A Secondary Analysis of Swiss General Hospital Data

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic and related countermeasures hinder health care access and affect mental wellbeing of non-COVID-19 patients. There is lack of evidence on distress and mental health of patients hospitalized due to other reasons than COVID-19-a vulnerable population group in two ways: First, given their risk for physical diseases, they are at increased risk for severe courses and death related to COVID-19. Second, they may struggle particularly with COVID-19 restrictions due to their dependence on social support. Therefore, we investigated the association of intensity of COVID-19 restrictions with levels of COVID-19-related distress, mental health (depression, anxiety, somatic symptom disorder, and mental quality of life), and perceived social support among Swiss general hospital non-COVID-19 inpatients.

METHODS

We analyzed distress of 873 hospital inpatients not admitted for COVID-19, recruited from internal medicine, gynecology, rheumatology, rehabilitation, acute geriatrics, and geriatric rehabilitation wards of three hospitals. We assessed distress due to the COVID-19 pandemic, and four indicators of mental health: depressive and anxiety symptom severity, psychological distress associated with somatic symptoms, and the mental component of health-related quality of life; additionally, we assessed social support. The data collection period was divided into modest (June 9 to October 18, 2020) and strong (October 19, 2020, to April 17, 2021) COVID-19 restrictions, based on the Oxford Stringency Index for Switzerland.

RESULTS

An additional 13% (95%-Confidence Interval 4-21%) and 9% (1-16%) of hospital inpatients reported distress related to leisure time and loneliness, respectively, during strong COVID-19 restrictions compared to times of modest restrictions. There was no evidence for changes in mental health or social support.

CONCLUSIONS

Focusing on the vulnerable population of general hospital inpatients not admitted for COVID-19, our results suggest that tightening of COVID-19 restrictions in October 2020 was associated with increased COVID-19-related distress regarding leisure time and loneliness, with no evidence for a related decrease in mental health. If this association was causal, safe measures to increase social interaction (e.g., virtual encounters and outdoor activities) are highly warranted.

TRIAL REGISTRATION

www.ClinicalTrials.gov, identifier: NCT04269005.

The Impact of COVID-19 on Older Adults: Results from an Annual Survey

Objectives

Assess well-being among older adults through secondary analysis measured during an annual survey in 2018, 2019, and 2020, to determine trends from before and during the COVID-19 pandemic.

Methods

Mailed surveys sent annually included measures related to various psychosocial factors.

Main findings

Response rates were 29% in 2018, 25% in 2019, and 24% in 2020. Most respondents reported average or high resilience (89% 2018-2020), high purpose (64% in 2018 and 2019, 63% in 2020), moderate optimism (46% in 2019, 44% in 2020) and low stress (88% in 2019 and 2020). Reported loneliness increased 13% from 2018 to 2020. In 2020, only 45% reported high comfort with technology, decreasing with age (>75).

Principal conclusion

Psychosocial well-being of respondents were doing well despite changes related to COVID-19. However, increased loneliness may negatively impact long-term health outcomes; thus, a focus on technology options to stay socially connected and access healthcare are needed.

Caring in the time of COVID-19, longitudinal trends in well-being and mental health in carers in Ireland: Evidence from the Irish Longitudinal Study on Ageing (TILDA)

BACKGROUND

The COVID-19 pandemic in 2020 resulted in the older population being asked to remain at home and avoid other people outside their household. This could have implications for both receipt and provision of informal caring.

OBJECTIVE

To determine if informal care provision by older carers changed during the first wave of the COVID-19 pandemic from pre-pandemic care and if this was associated with a change in mental health and well-being of carers.

DESIGN AND SETTING

Longitudinal nationally representative study of community dwelling adults from The Irish Longitudinal Study on Ageing (TILDA) (Waves 3-COVID-Wave 6).

METHODS

We studied a cohort of 3670 adults aged ≥60 in Ireland during the COVID-19 pandemic (July-November 2020) and compared with previous data collections from the same cohort between 2014-2018. Independent variables were caregiving status and caregiving intensity, outcome measures included depressive symptoms (CES-D8), Perceived Stress (PSS4) and Quality of life (CASP12). Mixed models adjusting for socio-demographics and physical health were estimated.

RESULTS

Caregiving increased from 8.2% (2014) to 15.4% (2020). Depression, and stress scores increased while quality of life decreased for all participants. Carers reported poorer mental health, and higher caring hours were associated with increased depression and stress and decreased quality of life scores on average, and increased depression was higher for women.

CONCLUSIONS

Informal caregiving increased during the pandemic and family caregivers reported increased adverse mental health and well-being and this continued throughout the early months of the pandemic. The disproportionate burden of depression was highest in women providing higher caring hours.

Impact of COVID-19 on Medical Supply in Adults With Congenital Heart Disease

INTRODUCTION

In March 2020, the World Health organization declared COVID-19 a global pandemic. One year later, the direct and indirect burden of the COVID-19 pandemic become more visible. In this context, there is concern about the allocation of medical resources and medical treatment of other diseases than COVID-19. Particularly, patients with chronic diseases need constant medical and pharmacological treatment. Therefore, we evaluated a large cohort of patients with adult congenital heart disease (ACHD) regarding postponed medical appointments and their possibilities to receive medical treatment during the COVID-19 pandemic.

METHODS

This cross-sectional study included 559 patients with ACHD (mean age 37.32 ± 11.98; 47% female). Clinical characteristics, answers to questionnaires concerning lifestyle, psychological well-being, addictive behavior and adherence were related to postponed medical appointments and limited access to medical care.

RESULTS

One hundred and nine patients (19.5%) reported problems getting necessary medical treatment or visiting a physician. Higher anxiety levels (p = 0.004) emerged as the main factor associated with medical undertreatment. The main risk factors for postponement of least one medical appointment (n = 91) were higher depression (p = 0.013) and anxiety (p = 0.05) symptoms as well as female sex (p ≤ 0.0001) and documented arrhythmias (p = 0.007) indicating a particular risk group of cardiovascular complications. In contrast, frequent physical activity identified patients at lower risk.

CONCLUSION

In ACHD anxiety and depressive symptoms handicap patients to receive medical care. Postponement of medical appointments additionally relates to female sex and documented arrhythmias. The latter indicates that patients at high risk of adverse cardiac outcome avoid routine medical care. Our data may lead policy makers to develop strategies for the provision of medical services to particular vulnerable patient groups, and to optimize management of both future pandemics and daily routine.

Preventing the Growing Transmission of COVID Clusters: An Integration of the Maslow's Hierarchy of Needs in the Risk Chain

PURPOSE

China's success in containing the coronavirus is an ongoing process of identifying loopholes and refining the management in the COVID-19 risk chain. This article discusses the role of personal needs in epidemic control and linked psychological needs with management measures to propose intervention advice on curbing viral transmission in a systematic way.

METHODS

Based on case studies, we showed the integration of the Maslow's Hierarchy of Needs in the COVID-19 risk chain. The analysis combined the micro-view from individual needs and macro influences from governmental measures. The proposed chain of vulnerabilities could help identify critical links of COVID-19 crisis management in case that cascading effects such as super-spread can be intercepted in time.

RESULTS

The article mainly focused on curbing the viral transmission timely whenever cluster of cases resurge. Considering the triggered activities from personal needs may facilitate the spread, minimizing the impact scale while managing the crisis could start with protecting vulnerable population, well governing potential hotspots, and necessary restrictions on group activities. Besides, "individual" protections combined with "institutional" solutions are strongly advocated. The worst scenario would be the governance link slackened or made mistakes, together with delayed identification, plus unprotected way of living and gathering. In order to cut the transmission in time, besides virus-blocking strategies and vaccination approach, screening measures in combination with the satisfaction of personal needs would help identify confirmed cases earlier. Publicizing the model citizen of being responsible could show needs' satisfaction can live with the virus elimination. At the emergency response stage, it is also crucial to secure fewer loopholes in the health system and strengthen the self-protection barrier by all means.

CONCLUSION

China's experience offers a reference for the balance between the resurgence of clustered cases and sustained recovery. As long as the global pandemic continues, its impact on personal activities will not stop, and vice versa. The chain of vulnerabilities integrating psychological needs into the COVID-19 risk management can provide clear clues for cutting further transmission in an efficient and more socially acceptable way.

Regional Characteristics of the Second Wave of SARS-CoV-2 Infections and COVID-19 Deaths in Germany

(1) Background: In the absence of individual level information, the aim of this study was to identify the regional key features explaining SARS-CoV-2 infections and COVID-19 deaths during the upswing of the second wave in Germany. (2) Methods: We used COVID-19 diagnoses and deaths from 1 October to 15 December 2020, on the county-level, differentiating five two-week time periods. For each period, we calculated the age-standardized COVID-19 incidence and death rates on the county level. We trained gradient boosting models to predict the incidence and death rates by 155 indicators and identified the top 20 associations using Shap values. (3) Results: Counties with low socioeconomic status (SES) had higher infection and death rates, as had those with high international migration, a high proportion of foreigners, and a large nursing home population. The importance of these characteristics changed over time. During the period of intense exponential increase in infections, the proportion of the population that voted for the Alternative for Germany (AfD) party in the last federal election was among the top characteristics correlated with high incidence and death rates. (4) Machine learning approaches can reveal regional characteristics that are associated with high rates of infection and mortality.

Interpersonal violence: Serious sequelae for heart disease in women

Experiencing various forms of violence in either childhood or adulthood has been associated with cardiovascular disease, both shortly after the event and during follow-up, particularly in women. The coronavirus disease 2019 pandemic has heightened the risk of domestic violence with serious sequelae for mental and cardiovascular health in women, possibly due to several contributing factors, ranging from lockdown, stay at home regulations, job losses, anxiety, and stress. Accordingly, it remains paramount to enforce proactive preventive strategies, at both the family and individual level, maintain a high level of attention to recognize all forms of violence or abuse, and guarantee a multidisciplinary team approach for victims of interpersonal or domestic violence in order to address physical, sexual, and emotional domains and offer a personalized care.

Mental Health Status of Healthcare Workers During the COVID-19 Outbreak

Abstract. Background: The COVID-19 pandemic is a massive health crisis that has exerted enormous physical and psychological pressure. Mental healthcare for healthcare workers (HCWs) should receive serious consideration. This study served to determine the mental-health outcomes of 1,556 HCWs from 45 countries who participated in the COVID-19 IMPACT project, and to examine the predictors of the outcomes during the first pandemic wave. Methods: Outcomes assessed were self-reported perceived stress, depression symptom, and sleep changes. The predictors examined included sociodemographic factors and perceived social support. Results: The results demonstrated that half of the HCWs had moderate levels of perceived stress and symptoms of depression. Half of the HCWs ( n = 800, 51.4%) had similar sleeping patterns since the pandemic started, and one in four slept more or slept less. HCWs reported less perceived stress and depression symptoms and higher levels of perceived social support than the general population who participated in the same project. Predictors associated with higher perceived stress and symptoms of depression among HCWs included female sex, not having children, living with parents, lower educational level, and lower social support. Discussion: The need for establishing ways to mitigate mental-health risks and adjusting psychological interventions and support for HCWs seems to be significant as the pandemic continues.

Do people with mental health problems have lower adherence to precautionary measures in COVID-19 pandemic? A cross-sectional observational study in Hong Kong

OBJECTIVES

Mental health problems are prevalent during the COVID-19 pandemic, but their effect on adherence to precautionary measures is not well understood. Given that psychological morbidities are associated with lower treatment adherence, and that precautionary measures are important in containing the spread of COVID-19, this study aims to determine if people with mental health problems have lower adherence to precautionary measures against COVID-19.

DESIGN

We conducted a cross-sectional territory-wide online survey between 17 June and 31 July 2020 during the COVID-19 pandemic. Clinically significant mental health problems, adherence to precautionary behaviours, and confounding factors such as sociodemographic factors and self-reported physical health were assessed.

SETTING

The link to the questionnaire was disseminated to the general population in all 18 districts of Hong Kong using various social media platforms.

PARTICIPANTS

1036 individuals completed the survey. Of them, 1030 met the inclusion criteria of being adult Hong Kong residents.

PRIMARY OUTCOME

Adherence to precautionary measures against COVID-19, including wearing face mask, frequent handwashing, household disinfection, social distancing, minimising unnecessary travel, and stocking up on food and daily essentials.

RESULTS

Of the 1030 participants, 166 (16.1%) had clinically significant mental health problems. Interestingly, they were more likely to stock up on food and daily essentials during the pandemic (7 (4.2%) vs 15 (1.7%), p=0.04; unadjusted OR=2.49, 95% CI=1.00 to 6.21, p<0.05) and had a lesser tendency to stop social distancing even if the pandemic subsides (86 (51.8%) vs 513 (59.4%), p=0.07; unadjusted OR=0.74, 95% CI=0.53 to 1.03, p=0.07). The latter association remained significant after adjusting for the confounding factors (adjusted OR=0.68, 95% CI=0.48 to 0.96, p=0.03).

CONCLUSIONS

Contrary to our hypothesis, people who are mentally unwell might go beyond the recommended precautionary measures. Our findings highlight the need to identify mental health problems and provide care and support for those who might go too far with precautionary measures.

TRIAL REGISTRATION NUMBER

ChiCTR 2000033936.

Increase in Social Isolation during the COVID-19 Pandemic and Its Association with Mental Health: Findings from the JACSIS 2020 Study

The coronavirus disease 2019 (COVID-19) pandemic is assumed to have caused an increase in the number of socially isolated people. However, the prevalence of social isolation during the pandemic has not been well studied, particularly among Asian populations. This study investigated changes in the prevalence of social isolation caused by the COVID-19 pandemic and examined its association with mental health among the general Japanese population. Data were obtained from a large-scale, web-based nationwide survey conducted from August to September 2020 (n = 28,000; aged 15–79 years). Social isolation was defined as less frequent contact with people other than co-residing family members. We assessed the participants’ frequency of contact in January (before the pandemic) and August 2020 (during the pandemic). Mental health outcomes included psychological distress, suicidal ideation, loneliness, and fear of COVID-19. We analyzed the data of 25,482 respondents. The weighted prevalence (95% confidence interval) of social isolation was 21.2% (20.7–21.7%) and 27.9% (27.3–28.4%) before and during the pandemic, respectively. The prevalence of social isolation increased by 6.7 (6.3–7.0) percentage points during the pandemic. Older people and men had the greatest increase in the prevalence of social isolation. People who became socially isolated during the pandemic had greater loneliness and fear of COVID-19 than those who were consistently not socially isolated since before the pandemic. This study suggested that social isolation had increased during the COVID-19 pandemic in Japan. Our findings highlight the importance of developing immediate measures against social isolation to maintain good mental health.

Extra-Curricular Activities and Well-Being: Results From a Survey of Undergraduate University Students During COVID-19 Lockdown Restrictions

Participation in extra-curricular activities has been found to associate with increased well-being. Here we investigated in a survey (n = 786) what activities university students at a Canadian university engaged in during the stressful COVID-19 pandemic lockdown in April, 2020, which coincided with a novel online exam period, and how these activities related to perceived well-being, anxiety (STAI-S), social aspects of activities, and personality. Sixty-five percentage of students scored in the high anxiety category of the STAI-S, an alarming statistic given that only 24% had reached out for professional supports. This is consistent with reports that current supports on university campuses are inadequate. Listening to music (92%) and watching movies/series (92%) were engaged in most frequently, followed by socializing virtually (89%) and engaging in social media (85%). The activities students rated as most helpful to their well-being were somewhat different, with outdoor exercise rated highest, followed by socializing virtually and listening to music. While all activities were rated as beneficial, those with a social component tended to have high ratings, consistent with students attempting to replace lost social interactions. Linear regression models found few associations between STAI-S scores and other measures, likely because of large individual differences and lack of a pre-pandemic baseline needed to assess changes in anxiety. The importance of individual differences was evident in that those higher in conscientiousness or extraversion or emotional stability were more likely to engage in exercise, while those higher in openness to experience were more likely to engage in journaling, playing a musical instrument, or singing, with a trend for higher engagement in song writing. Individual differences were also evident in that equal numbers of students gave positive and negative comments related to their well-being during the pandemic. The individual differences uncovered here suggest that having a variety of proactive interventions would likely reach more students. Indeed, 52% indicated an interest in online group music therapy, 48% in art therapy and 40% in verbal therapy, despite music and art therapies being virtually non-existent on campuses. In sum, the findings highlight the importance of choice in extra-curricular activities and therapies that support well-being.

Prevalence, New Incidence, Course, and Risk Factors of PTSD, Depression, Anxiety, and Panic Disorder during the Covid-19 Pandemic in 11 Countries

We aimed to evaluate the prevalence and incidence of post-traumatic stress disorder (PTSD), depression, anxiety, and panic disorder (PD) among citizens in 11 countries during the Covid-19 pandemic. We explored risks and protective factors most associated with the development of these mental health disorders and their course at 68 days follow up. We acquired 9543 unique responses via an online survey that was disseminated in UK, Belgium, Netherlands, Bulgaria, Czech Republic, Finland, India, Latvia, Poland, Romania, and Sweden. The prevalence and new incidence during the pandemic for at least one disorder was 48.6% and 17.6%, with the new incidence of PTSD, anxiety, depression, and panic disorder being 11.4%, 8.4%, 9.3%, and 3%, respectively. Higher resilience was associated with lower mental health burden for all disorders. Ten to thirteen associated factors explained 79% of the variance in PTSD, 80% in anxiety, 78% in depression, and 89% in PD. To reduce the mental health burden, governments should refrain from implementing many highly restrictive and lasting containment measures. Public health campaigns should focus their effort on alleviating stress and fear, promoting resilience, building public trust in government and medical care, and persuading the population of the measures' effectiveness. Psychosocial services and resources should be allocated to facilitate individual and community-level recovery from the pandemic.