Mental health consequences of COVID-19: a nationally representative cross-sectional study of pandemic-related stressors and anxiety disorders in the USA

Depression and assets during the COVID-19 pandemic: A longitudinal study of mental health across income and savings groups

The prevalence of depression in U.S. adults during the COVID-19 pandemic has been high overall and particularly high among persons with fewer assets. Building on previous work on assets and mental health, we document the burden of depression in groups based on income and savings during the first two years of the COVID-19 pandemic. Using a nationally representative, longitudinal panel study of U.S. adults (N = 1,271) collected in April-May 2020 (T1), April-May 2021 (T2), and April-May 2022 (T3), we estimated the adjusted odds of reporting probable depression at any time during the COVID-19 pandemic with generalized estimating equations (GEE). We explored probable depression-defined as a score of ≥10 on the Patient Health Questionnaire-9 (PHQ-9)-by four asset groups, defined by median income (≥$65,000) and savings (≥$20,000) categories. The prevalence of probable depression was consistently high in Spring 2020, Spring 2021, and Spring 2022 with 27.9% of U.S. adults reporting probable depression in Spring 2022. We found that there were four distinct asset groups that experienced different depression trajectories over the COVID-19 pandemic. Low income-low savings asset groups had the highest level of probable depression across time, reporting 3.7 times the odds (95% CI: 2.6, 5.3) of probable depression at any time relative to high income-high savings asset groups. While probable depression stayed relatively stable across time for most groups, the low income-low savings group reported significantly higher levels of probable depression at T2, compared to T1, and the high income-low savings group reported significantly higher levels of probable depression at T3 than T1. The weighted average of probable depression across time was 42.9% for low income-low savings groups, 24.3% for high income-low savings groups, 19.4% for low income-high savings groups, and 14.0% for high income-high savings groups. Efforts to ameliorate both savings and income may be necessary to mitigate the mental health consequences of pandemics.

Mental Health and U.S. Attitudes Toward Social Determinants of Health Policies

INTRODUCTION

Research has suggested that individual health may influence policy attitudes, yet the relationship between mental health and policy support is understudied. Clarifying this relationship may help inform policies that can improve the population mental health. To address this gap, this study measures national support for 5 social determinants of health policy priorities and their relation to mental health and political affiliation.

METHODS

This study assessed support for 5 policy priorities related to the social determinants of health using a nationally representative survey of US adults (n=2,430) conducted in March-April 2023. Logistic regression was used to estimate the predicted probability of identifying each priority as important, test differences in support by self-rated mental health, and evaluate whether partisanship modified these relationships. Analyses were conducted in 2023.

RESULTS

The majority of US adults, across partisan identities, supported 5 policy priorities related to improving the economy (84%), healthcare affordability (77%), improving K-12 education (76%), housing affordability (68%), and childcare affordability (61%). Worse mental health predicted significantly greater support for addressing housing affordability (73.9% vs 66.2%), and partisanship modified the relationship between mental health and support for improving the economy, improving K-12 education, and housing affordability.

CONCLUSIONS

In 2023, there was substantial bipartisan support for federal policy action to address the social determinants of health, and worse mental health was related to greater policy support, particularly among Democrats. Federal policymakers have a broad consensus to take action to address the social determinants of health, which may improve the population mental health.

Pandemic stressors and mental health indicators in eight countries

PURPOSE

The Covid-19 pandemic has exacted a significant physical, financial, social, and emotional toll on populations throughout the world. This study aimed to document the association between pandemic stressors and mental health during the pandemic across countries that differ in cultural, geographic, economic, and demographic factors.

METHODS

We administered an online survey randomly in Brazil, China, Germany, Egypt, India, Indonesia, Nigeria, and the United States from September 2020 to November 2020. This survey included questions on Covid-19-related stressors as well as the Patient Health Questionnaire-2 and the Primary Care PTSD Checklist to screen for depression and post-traumatic stress disorder (PTSD) symptoms, respectively. We performed bivariable and multivariable regression analyses to assess the prevalence and odds ratios of overall depression symptoms and probable PTSD and in relation to stressors across countries.

RESULTS

Among 8754 respondents, 28.9% (95% CI 27.5-30.0%) experienced depression symptoms, and 5.1% (95% CI 4.5-6.0%) experienced probable PTSD. The highest prevalence of depression symptoms was in Egypt (41.3%, 95% CI 37.6-45.0%) and lowest in the United States (24.9%, 95% CI 22.3-27.7%). The highest prevalence of probable PTSD was in Brazil (7.3%, 95% CI 5.6-9.4%) and the lowest in China (1.2%, 95% CI 0.7-2.0%). Overall, experiencing six or more Covid-19-related stressors was associated with both depression symptoms (OR 1.90, 95% CI 1.46-2.48) and probable PTSD (OR 13.8, 95% CI 9.66-19.6).

CONCLUSION

The association between pandemic related stressors and the burden of adverse mental health indicators early in the Covid-19 pandemic transcended geographic, economic, cultural, and demographic differences between countries. The short-term and long-term impacts of the pandemic on mental health should be incorporated in efforts to tackle the consequences of Covid-19.

Neighborhood-level economic characteristics and depression and PTSD symptoms among Houstonians who have experienced Hurricane Harvey and COVID-19

Little is known about how neighborhood economic characteristics relate to risk of depression and Posttraumatic Stress Disorder (PTSD) in the context of multiple disasters. We sampled 88 super neighborhoods in Houston, Texas and surveyed 872 residents who were living in Houston during Hurricane Harvey and COVID-19 and lived in the same residence since Hurricane Harvey, about their demographics and symptoms of depression and PTSD. Using data from the American Community Survey, we estimated neighborhood-level unemployment, median income, and income inequality (i.e., Gini coefficient). We investigated whether these underlying neighborhood socioeconomic factors were associated with the mental health consequences of mass traumatic events. We examined associations between neighborhood-level constructs and individual-level depression and PTSD, using multilevel linear models. Partially adjusted multilevel models showed that lower neighborhood median income was associated with higher symptom scores of PTSD, while greater neighborhood income inequality was associated with higher symptom scores of depression and PTSD. However, fully adjusted models showed that these associations are better accounted for by event-specific stressors and traumas. These findings suggest that in the context of multiple large scale traumatic events, neighborhood socioeconomic context may structure individual-level exposure to stressful and traumatic events.

Mother-infant postnatal experience and its association with maternal emotion and coping during the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic resulted in a partial lockdown in Malaysia known as Movement-Controlled-Order (MCO), which has affected primary care management and social life norms. Thus, psychological health is a concern for mothers, particularly during the postpartum period. This study aimed to determine factors associated with maternal emotional experiences and coping during the pandemic.

METHODOLOGY

Mothers of infants aged < 18 months (n = 1449) in Malaysia completed an online survey during MCO (July 2020 to February 2021). The survey comprised questions on sociodemographics, pandemic livelihood impact, maternal experiences, and emotions.

RESULTS

More than one-third of mothers expressed feeling worried (54.7%), annoyed (48.1%), and tired (42.2%) to some or a high extent. Mothers who were younger (p = .001), more educated (p = .001), faced difficulty paying rent (p = .002), and whose husbands were unemployed (p < .001) expressed higher negative emotions. In contrast, mothers who received enough support for health (p = .001) and breastfeeding (p = .008), had infants sleep less (p = .042) and had more time to focus on health (p < .001) expressed better emotions. Higher coping was expressed among mothers with a higher household income (p = .004), had more time to focus on their health (p = .010), received additional breastfeeding support (p = 0.039), and practised traditional postpartum care (p < .001). In contrast, difficulty paying for essentials (p = .023) was associated with negative coping.

CONCLUSION

Maternal emotional experiences were significantly associated with sociodemographic characteristics, livelihood impact, postnatal experiences, and infant behaviours. Postpartum mental health screening is recommended to prevent severe distress, especially in first-time mothers. Coping interventions for mothers at risk may include comprehensive support and maternity care.

Symptoms of Posttraumatic Stress During the COVID-19 Pandemic in the Governmental Public Health Workforce and General Population

We aimed to estimate the prevalence of COVID-19-related posttraumatic stress symptoms (PTSS) in the governmental public health workforce and in US adults, assess differences in reporting PTSS within subgroups, and evaluate whether frontline workers reported higher levels of PTSS than persons in other jobs. We used data from 2 nationally representative studies: the 2021 Public Health Workforce Interests and Needs Survey (PH WINS) and the COVID-19 and Life Stressors Impact on Mental Health and Well-being (CLIMB) study. Our study found that the state and local governmental public health workforce was more likely to report PTSS than the general adult population. Almost a quarter of public health agency employees (24.7%) and 21.1% of adults reported at least 3 symptoms of posttraumatic stress. Differences in levels of PTSS appeared within demographic groups for both samples. Personal care and service frontline workers had 4.3 times the odds of reporting symptoms of posttraumatic stress than non-frontline workers.

Prevalence of past-year major depressive episode among young adults between 2005 and 2021: Results from four national representative surveys in France

BACKGROUND

The objectives are to examine time trends in the prevalence of past year major depressive episode (MDE) among young adults, and to identify differences by occupational status comparing students, those employed, and those who are not in employment, education or training (NEET).

METHODS

Data were drawn from the Health Barometer survey, a cross-sectional computer-assisted telephone interview survey on a national representative sample of residents of metropolitan France and conducted approximately every 5 years. The surveys relied on the Composite International Diagnostic Interview-Short Form to determine the presence of DSM-IV past-year major depressive episode. Data from the 2005, 2010, 2017, and 2021 surveys were pooled and respondents aged 18 to 25 were selected (n = 7556) and categorized based on their occupational status: students, those employed, and NEET.

RESULTS

Overall, significant differences in the prevalence of MDE was observed by occupational status: NEET had the highest rate (18.5 %) followed by students (14.3 %) and those employed (11.0 %). The prevalence of MDE among young adults was 10.1 % in 2005, 9.7 % in 2010 and 11.3 % in 2017, reflecting a stable prevalence between 2005 and 2017. The prevalence then nearly doubled in 2021, with 20.9 % of MDE, with a significant increase of 9.6 points between 2017 and 2021.

LIMITATIONS

No assessment of lifetime psychopathology.

CONCLUSIONS

The prevalence of major depression among young adults significantly increased between 2005 and 2021, those at greatest risk are females and those not in employment, education or training. The contribution of pandemic-related factors may be elucidated in future national health surveys.

Depression and PTSD among Houston Residents who Experienced Hurricane Harvey and COVID-19: Implications for Urban Areas Affected by Multiple Disasters

Little is known about the combined impact of the COVID-19 pandemic and other major disasters on mental health. Hurricane Harvey hit the Gulf Coast in 2017, resulting in substantial costs, significant levels of displacement, and approximately 100 deaths, and was followed in 2020 by the COVID-19 pandemic. We randomly sampled 1167 Houstonians from 88 designated super-neighborhoods and surveyed them about their demographics, event-specific traumas and stressors, and symptoms of current depression and post-traumatic stress disorder (PTSD). We estimated the prevalence of depression (5.8%) and PTSD (12.6%) more than three years after Hurricane Harvey, and assessed the relative influence of event-specific stressors and traumas on current mental health. Overall, we observed evidence for two key findings that are salient for residents of urban environments in the context of multiple disasters. First, stressors were primary influences on depression, whereas both stressors and traumas influenced PTSD. Second, the influences of stressors and traumas on depression and PTSD symptoms faded with time.

Networks of pandemic-specific stressors, risk factors, and clinical symptoms: A comparison between women and men during the early phase of the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, female gender was a robust factor associated with mental health problems. This study aimed to investigate associations between pandemic-related risk factors, stressors, and clinical symptoms, with special reference to gender and possible differential gender effects.

METHODS

Participants were recruited from June to September 2020 through an online survey (ESTSS ADJUST study). Women (N = 796) and men (N = 796) were matched on age, education, income, and living community. Symptoms of depression (PHQ-9), anxiety (PHQ-4), adjustment disorder (ADNM-8), and PTSD (PC-PTSD-5) and different risk factors including pandemic-specific stressors (PaSS) were assessed. Separate network analyses for men and women were conducted and compared followed by a joint network analysis including gender.

RESULTS

The networks of women and men did not differ in their structure (M = 0.14, p = .174) or strength of associations (S = 1.22, p = .126). Few relationships differed significantly between genders e.g., the connection between burden through work-related problems and anxiety was stronger in women. In the joint network, single factors were related to gender e.g., men felt more burdened through work-related problems and women through conflicts at home.

LIMITATIONS

We cannot imply causal relationships due to the cross-sectional data of our study. The findings cannot be generalized as the sample is not representative.

CONCLUSION

Men and women seem to show comparable networks of risk factors, stressors, and clinical symptoms, although differences in individual connections and in levels of clinical symptoms and burdens were found.

Correlates of long-COVID-19: the role of demographics, chronic illness, and psychiatric diagnosis in an urban sample

Long-COVID-19 symptoms are an emerging public health issue. This study sought to investigate demographics, chronic illness, and probable psychiatric diagnoses as correlates for long-COVID-19 in an urban adult sample. Self-report Qualtrics surveys were sent to students across City University of New York (CUNY) campuses in New York City in Winter 2021-2022. Binary logistic regressions were used to assess the relation of a range of factors with endorsement of long-COVID-19. Results demonstrated that Latinx participants endorsed higher odds of long-COVID-19, as compared to non-Latinx white participants. Participants who endorsed having a prior chronic illness and those who met the cut-off for probable psychiatric diagnoses all endorsed higher odds of long-COVID-19. Long-COVID-19 may be more likely among specific subpopulations and among persons with other ongoing physical and mental illness.

Analysis of the influences of social isolation on cognition and the therapeutic potential of deep brain stimulation in a mouse model

Background

Social interaction is a fundamental human need. Social isolation (SI) can have negative effects on both emotional and cognitive function. However, it is currently unclear how age and the duration of SI affect emotion and recognition function. In addition, there is no specific treatment for the effects of SI.

Methods

The adolescence or adult mice were individually housed in cages for 1, 6 or 12 months and for 2 months to estabolish SI mouse model. We investigated the effects of SI on behavior in mice at different ages and under distinct durations of SI, and we explored the possible underlying mechanisms. Then we performed deep brain stimulation (DBS) to evaluate its influences on SI induced behavioral abnormalities.

Results

We found that social recognition was affected in the short term, while social preference was damaged by extremely long periods of SI. In addition to affecting social memory, SI also affects emotion, short-term spatial ability and learning willingness in mice. Myelin was decreased significantly in the medial prefrontal cortex (mPFC) and dorsal hippocampus of socially isolated mice. Cellular activity in response to social stimulation in both areas was impaired by social isolation. By stimulating the mPFC using DBS, we found that DBS alleviated cellular activation disorders in the mPFC after long-term SI and improved social preference in mice.

Conclusion

Our results suggest that the therapeutic potential of stimulating the mPFC with DBS in individuals with social preference deficits caused by long-term social isolation, as well as the effects of DBS on the cellular activity and density of OPCs.

Long COVID in the context of social determinants of health

The COVID-19 pandemic has been a challenge for the public health system and has highlighted health disparities. COVID-19 vaccines have effectively protected against infection and severe disease, but some patients continue to suffer from symptoms after their condition is resolved. These post-acute sequelae, or long COVID, continues to disproportionately affect some patients based on their social determinants of health (SDOH). This paper uses the World Health Organization's (WHO) SDOH conceptual framework to explore how SDOH influences long COVID outcomes.

Impact of the COVID-19 pandemic on the mental health and well-being of Veterans' spouses: a cross sectional analysis

BACKGROUND

COVID-19 has negatively impacted the mental health and well-being of both Canadians and the world as a whole, with Veterans, in particular, showing increased rates of depression, anxiety, and PTSD. Spouses and common-law partners often serve as primary caregivers and sources of support for Veterans, which may have a deleterious effect on mental health and increase risk of burnout. Pandemic related stressors may increase burden and further exacerbate distress; yet the effect of the pandemic on the mental health and well-being of Veterans' spouses is currently unknown. This study explores the self-reported mental health and well-being of a group of spouses of Canadian Armed Forces Veterans and their adoption of new ways to access healthcare remotely (telehealth), using baseline data from an ongoing longitudinal survey.

METHODS

Between July 2020 and February 2021, 365 spouses of Veterans completed an online survey regarding their general mental health, lifestyle changes, and experiences relating to the COVID-19 pandemic. Also completed were questions relating to their use of and satisfaction with health-care treatment services during the pandemic.

RESULTS

Reported rates of probable major depressive disorder (MDD), generalized anxiety disorder (GAD), alcohol use disorder (AUD), and PTSD were higher than the general public, with 50-61% believing their symptoms either directly related to or were made worse by the pandemic. Those reporting being exposed to COVID-19 were found to have significantly higher absolute scores on mental health measures than those reporting no exposure. Over 56% reported using telehealth during the pandemic, with over 70% stating they would continue its use post-pandemic.

CONCLUSIONS

This is the first Canadian study to examine the impact of the COVID-19 pandemic specifically on the mental health and well-being of Veterans' spouses. Subjectively, the pandemic negatively affected the mental health of this group, however, the pre-pandemic rate for mental health issues in this population is unknown. These results have important implications pertaining to future avenues of research and clinical/programme development post-pandemic, particularly relating to the potential need for increased support for spouses of Veterans, both as individuals and in their role as supports for Veterans.

Obesity and adverse childhood experiences in relation to stress during the COVID-19 pandemic: an analysis of the Canadian Longitudinal Study on Aging

BACKGROUND

People with obesity are at increased risk of chronic stress, and this may have been exacerbated during the COVID-19 pandemic. Adverse childhood experiences (ACE) are also associated with both obesity and stress, and may modify risk of stress among people with obesity. The objectives of this study were to evaluate the associations between obesity, ACEs, and stress during the pandemic, and to determine if the association between obesity and stress was modified by ACEs.

METHODS

A longitudinal study was conducted among adults aged 50-96 years (n = 23,972) from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Study. Obesity and ACEs were collected pre-pandemic (2015-2018), and stress was measured at COVID-19 Exit Survey (Sept-Dec 2020). We used logistic, Poisson, and negative binomial regression to estimate relative risks (RRs) and 95% confidence intervals (CIs) for the associations between obesity, ACEs, and stress outcomes during the pandemic. Interaction by ACEs was evaluated on the additive and multiplicative scales.

RESULTS

People with obesity were more likely to experience an increase in overall stressors (class III obesity vs. healthy weight RR = 1.19; 95% CI: 1.12-1.27) as well as increased health related stressors (class III obesity vs. healthy weight RR: 1.25; 95% CI: 1.12-1.39) but did not perceive the consequences of the pandemic as negative. ACEs were also associated an increase in overall stressors (4-8 ACEs vs. none RR = 1.38; 95% CI: 1.33-1.44) and being more likely to perceive the pandemic as negative (4-8 ACEs vs. none RR = 1.32; 95% CI: 1.19-1.47). The association between obesity and stress was not modified by ACEs.

CONCLUSIONS

Increased stress during the first year of the COVID-19 pandemic was observed among people with obesity or ACEs. The long-term outcomes of stress during the pandemic need to be determined.

Prevalence of depressive symptoms in U.S. adults during the COVID-19 pandemic: A systematic review

The COVID-19 pandemic has led to a worsening of mental health among U.S. adults. However, no review to date has synthesized the overall prevalence of population depressive symptoms in the U.S. over the COVID-19 pandemic. We aimed to document the population prevalence of depressive symptoms and psychological distress across time since the start of the COVID-19 pandemic, both to identify patterns that emerged in the literature and to assess the data sources, methods, sampling, and measurement used to examine population mental health during the pandemic. In a systematic review of the peer review literature, we identified 49 articles reporting 88 prevalence points of depressive symptoms and related constructs in nationally representative samples of U.S. adults from March 2020 to June 2021. First, we found that the average prevalence of poor mental health across studies was 12.9% for severe depression, 26.0% for at least moderate depression, and 36.0% for at least mild depression. Second, we found that women reported significantly higher prevalence of probable depression than men in 63% of studies that reported depression levels by gender and that results on statistically significant differences between racial and ethnic groups were mixed. Third, we found that the 49 articles published were based on 12 studies; the most common sources were the Household Pulse Survey (n = 15, 31%), the AmeriSpeak panel (n = 8, 16%), the Qualtrics panel (n = 8, 16%), and the Understanding America Study (n = 5, 10%). Prevalence estimates varied based on mental health screening instruments and cutoffs used. The most commonly used instruments were the Patient Health Questionnaire (PHQ) (n = 36, 73%) and the Kessler (n = 8, 16%) series. While the prevalence of population depression varied over time depending on the survey instruments, severity, and constructs reported, the overall prevalence of depression remained high from March 2020 through June 2021 across instruments and severity. Understanding the scope of population mental health can help policymakers and providers address and prepare to meet the ongoing and future mental health needs of U.S. adults in the post-COVID-19 context and beyond.

Prevalence of depression, anxiety, and suicidal ideation during the Shanghai 2022 Lockdown: A cross-sectional study

BACKGROUND

Common mental disorders and suicidal ideation are associated with exposures to COVID-19 pandemic stressors, including lockdown. Limited data is available on the effect of city-wide lockdowns on population mental health. In April 2022, Shanghai entered a city-wide lockdown that sealed 24 million residents in their homes or residential compounds. The rapid initiation of the lockdown disrupted food systems, spurred economic losses, and widespread fear. The associated mental health effects of a lockdown of this magnitude are largely unknown. The purpose of this study is to estimate the prevalence of depression, anxiety, and suicidal ideation during this unprecedented lockdown.

METHODS

In this cross-sectional study, data were obtained via purposive sampling across 16 districts in Shanghai. Online surveys were distributed between April 29 and June 1, 2022. All participants were physically present and residents of Shanghai during the lockdown. Logistic regression was used to estimate the associations between lockdown-related stressors and study outcomes, adjusting for covariates.

FINDINGS

A total of 3230 Shanghai residents who personally experienced the lockdown participated the survey, with 1657 (55.5 %) men, 1563 (44.3 %) women, and 10 (0.02 %) other, and a median age of 32 (IQR 26-39), who were predominately 3242 (96.9 %) Han Chinese. The overall prevalence of depression based on PHQ-9 was 26.1 % (95 % CI, 24.8 %-27.4 %), 20.1 % (18.3 %-22.0 %) for anxiety based on GAD-7, and 3.8 % (2.9 %-4.8 %) for suicidal ideation based on ASQ. The prevalence of all outcomes was higher among younger adults, single people, lower income earners, migrants, those in poor health, and with a previous psychiatric diagnosis or suicide attempt. The odds of depression and anxiety were associated with job loss, income loss, and lockdown-related fear. Higher odds of anxiety and suicidal ideation were associated with being in close contact with a COVID-19 case. Moderate food insecurity was reported by 1731 (51.8 %), and 498 (14.6 %) reported severe food insecurity. Moderate food insecurity was associated with a >3-fold increase in the odds of screening for depression and anxiety and reporting suicidal ideation (aOR from 3.15 to 3.84); severe food insecurity was associated with >5-fold increased odds for depression, anxiety, and suicidal ideation (aOR from 5.21 to 10.87), compared to being food secure.

INTERPRETATION

Lockdown stressors, including food insecurity, job and income loss, and lockdown-related fears, were associated with increased odds of mental health outcomes. COVID-19 elimination strategies including lockdowns should be balanced against the effects on population wellbeing. Strategies to avoid unneeded lockdown, and policies that can strengthen food systems and protect against economic shocks are needed.

FUNDING

Funding was provided by the NYU Shanghai Center for Global Health Equity.

Reducing Loneliness in Undergraduate Students through E-Journaling Intervention: A Pre-Experimental Study

The Covid-19 pandemic in Indonesia has had a devastating psychological impact on society, with the rise of online interaction failing to replace face-to-face interaction, particularly among undergraduate students. Loneliness is a prevalent mental health problem among students during the pandemic. This study aimed to assess the effectiveness of e-journaling intervention in reducing loneliness among undergraduate students. A pre-experimental design was used, with 38 undergraduate students participating in writing activities in the form of journaling every weekday for two weeks. Pre and post-tests were given using the De Jong Giervield Loneliness Scale to evaluate loneliness. The results of a Wilcoxon signed-rank test showed no significant difference in loneliness before and after the intervention, with only 40% of participants showing a decrease in loneliness. This suggests that e-journaling intervention is not an effective way to reduce student loneliness during the pandemic. A randomized controlled study is recommended for further exploration of the efficacy of e-journaling intervention.

Social isolation and the brain: effects and mechanisms

An obvious consequence of the coronavirus disease (COVID-19) pandemic is the worldwide reduction in social interaction, which is associated with many adverse effects on health in humans from babies to adults. Although social development under normal or isolated environments has been studied since the 1940s, the mechanism underlying social isolation (SI)-induced brain dysfunction remains poorly understood, possibly due to the complexity of SI in humans and translational gaps in findings from animal models. Herein, we present a systematic review that focused on brain changes at the molecular, cellular, structural and functional levels induced by SI at different ages and in different animal models. SI studies in humans and animal models revealed common socioemotional and cognitive deficits caused by SI in early life and an increased occurrence of depression and anxiety induced by SI during later stages of life. Altered neurotransmission and neural circuitry as well as abnormal development and function of glial cells in specific brain regions may contribute to the abnormal emotions and behaviors induced by SI. We highlight distinct alterations in oligodendrocyte progenitor cell differentiation and oligodendrocyte maturation caused by SI in early life and later stages of life, respectively, which may affect neural circuit formation and function and result in diverse brain dysfunctions. To further bridge animal and human SI studies, we propose alternative animal models with brain structures and complex social behaviors similar to those of humans.

Mental health symptoms 1 year after the COVID-19 outbreak in Spain: The role of pre-existing mental disorders and their type

BACKGROUND

The type of pre-existing disorder might determine changes in mental health symptoms (i.e., anxiety, depression) during the COVID-19 pandemic and influence the effect of psychological factors (e.g., social support, resilience, stress) on such symptoms.

METHODS

Longitudinal data from two assessments (June-2020 and February/March-2021) collected through telephone interviews (Spanish general population) were analysed. Outcome variables included anxiety (GAD-7) and depressive symptoms (PHQ-8). Psychological factors included COVID-perceived stress (adapted COVID-perceived risk scale), social support (OSSS-3), and resilience (CD-RISC). Pre-existing mental conditions (3 groups: mood, anxiety, and comorbid depression+anxiety) were assessed using the CIDI checklist. Changes in anxiety and depressive symptoms between baseline and follow-up were assessed with the paired samples Wilcoxon test. Tobit regression and interaction models were conducted to test associations between psychological factors and these symptoms in follow-up.

RESULTS

Final sample included 1942 participants (mean age 49.6 yrs., ±16.7; 51.7 % females). Anxiety symptoms increased in all groups except for those with pre-existing mood conditions. Depressive symptoms only increased in those without pre-existing mental disorders and in those with pre-existing anxiety. Higher baseline resilience, increases in social support, and decreases in COVID-perceived stress were associated with lower anxiety and depressive symptoms. The type of pre-existing mental disorder did not modify these associations.

LIMITATIONS

Lack of pre-pandemic data and the limited number of pre-existing mental conditions.

CONCLUSIONS

Having pre-pandemic mental disorders is associated with different patterns of anxiety and depressive symptoms during the pandemic. COVID-related stress, social support, and resilience are key factors in improving mental health regardless of the mental diagnosis.

Long-COVID and comorbid depression and anxiety two years into the COVID-19 pandemic

Long-COVID, or the persistence of COVID-19 symptoms for months after initial infection, has been shown to impact the lives of those affected. The current study sought to investigate the relationships between long-COVID, COVID-19 related stress, depression, anxiety, and comorbid depression and anxiety outcomes. Data were collected in Winter 2021-2022 from a population of adults enrolled in at least one course across multiple City University of New York (CUNY) campuses. Frequencies and chi-square tests were computed to assess for demographics and relationships to probable diagnoses of depression and anxiety, and binary logistic regressions were computed to assess for the odds of probable comorbid depression and anxiety based on demographics, stressors, and long-COVID. Women participants reported higher odds of probable depression outcomes, and stressor levels were significant correlates of probable anxiety outcomes. Women participants, 3.2 [1.5-6.9], as compared to men, lower-SES participants, 2.16 [1.1-4.2], as compared to higher-SES participants, participants with higher COVID-19 related stress levels, 4.8 [2.0-12.0], as compared to those with low levels, and participants with long-COVID, 3.7 [1.9-7.0], as compared to those without, all had higher odds of probable comorbid depression and anxiety. Findings highlight the importance of social location, stress, and long-COVID, in tandem, as correlates of psychological health during the shifting pandemic.

System design of a text messaging program to support the mental health needs of non-treatment seeking young adults

Young adults (ages 18-25) experience the highest levels of mental health problems of any adult age group, but have the lowest mental health treatment rates. Text messages are the most used feature on the mobile phone and provide an opportunity to reach non-treatment engaged users throughout the day in a conversational manner. We present the design of an automated text message-based intervention for symptom self-management. The intervention comprises: (1) psychological strategies (i.e., types of evidence-based techniques leveraged to achieve symptom reduction) and (2) interaction types or the form that intervention content takes as it is delivered to and elicited from users.

The Role of Physical Activity in the Reduction of Generalised Anxiety Disorder in Young Adults in the Context of COVID-19 Pandemic

Physical activity is critically important not only for physical but also for mental health. Exercise may be a beneficial form of therapy for young adults with anxiety disorders. The global outbreak of the COVID-19 pandemic adversely affected the public, including young adults, in terms of their mental well-being and opportunities for physical activity. The study aimed to identify the influence of physical activity (PA) on generalised anxiety in young adults. It also assessed the changes which occurred in the level of PA and in generalised anxiety in young adults as a result of COVID-19 pandemic. A cross-sectional survey was carried out online with 506 young adults aged 18 to 34 years (=24.67 years ± 4.23 years). Respondents provided two answers to each question, i.e., information relating to the last 7 days during the pandemic (first hard lockdown), and to a period of 7 days before the pandemic (retrospective). The levels of physical activity were measured using 7-item International Physical Activity Questionnaire-Short Form (IPAQ-SF), whereas the level of generalised anxiety was assessed using the Generalised Anxiety Disorder 7 (GAD-7) questionnaire. During the pandemic there was a significant correlation between the level of generalised anxiety and the level of physical activity reported by the respondents (p = 0.048). A higher level of physical activity corresponded to lower level of generalized anxiety in young adults. During the pandemic, young adults spent significantly less time performing physical activity (8752.5 vs. 6174.6 metabolic equivalents (MET) min/week, p < 0.001), they spent more time engaging in sedentary behaviours (Me = 240 vs. Me = 300 min/day, p < 0.001), and they walked much less (from Me = 6930.0 (MET) min/week vs. 3861.0 (MET) min/week (44.29% decrease). Furthermore, after the outbreak of the pandemic the level of perceived generalised anxiety increased significantly (p < 0.001). Physical activity may play an important role in reducing anxiety disorder in young adults. During the COVID-19 pandemic young adults were significantly less involved in PA, which adversely affected their physical and mental condition. The importance of sufficient PA should be emphasised during this specific period, particularly among young adults.

The impact of the COVID-19 pandemic on Canadian national team athletes’ mental performance and mental health: The perspectives of mental performance consultants and mental health practitioners

The COVID-19 global pandemic has led to significant disruptions in the lives of high-performance athletes, including the postponement of the Tokyo Olympic and Paralympic Games, the cancellation of many international and national competitions, and drastic changes in athletes’ daily training environment. The purpose of this research was to examine the interplay between the mental health and mental performance of Canadian national team athletes and the impact of the COVID-19 pandemic on these variables from the perspective of mental performance consultants and mental health practitioners. Twelve individuals working in these roles with national team athletes participated in focus groups and interviews during the second wave of the COVID-19 pandemic in Canada. Findings from the inductive reflexive thematic analysis revealed three main themes: (a) factors impacting athlete mental health (i.e., social and environmental, psychological, and public health restrictions), (b) consequences of COVID-19 for athletes (low mood symptoms, anxiety and stress symptoms, maladaptive behaviors, time for life outside of sport, rest, and recovery), and (c) impact of the pandemic on practitioners (roles, preparation and resources, gaps, and well-being). Interestingly, athletes with prior good mental performance skills were perceived to be more equipped to cope with challenges related to the pandemic, which concurrently seemed to facilitate good mental health throughout the pandemic. Furthermore, even though the pandemic had several debilitative consequences on athletes’ mental health, it imposed a break from training and competition that allowed them to rest and enjoy their life outside of sport. Finally, participants discussed the need for more mental health resources and better access to practitioners supporting mental performance and mental health in the Canadian sport system.

Suicidal ideation during COVID-19: The contribution of unique and cumulative stressors

The link between large-scale disasters and population-level risk of suicide remains unclear. The present study sought to investigate suicidal ideation (SI) in relation to COVID-19 related stress, including material and social stress, in a predominantly low-SES ethno-racially diverse sample in New York City during a peak in COVID-19 cases in April 2020. Using binary logistic regressions of data collected with self-report surveys, we found that individuals who identified as Asian, as well as those with high total, material, and social stress levels, and persons without access to primary care providers had significantly higher adjusted odds of SI. These results indicate the specific burden faced by Asian participants due to increases in targeted racism, the importance of cumulative stress and specific stressor type, as well as the role of healthcare access on SI during the pandemic. Such findings suggest the need for specific interventions that target individuals who may be at higher risk of suicide after large-scale traumatic events and during the ongoing pandemic.

Post-traumatic stress disorder in patients with rheumatic disease during the COVID-19 outbreak: a cross-sectional case-control study in China

OBJECTIVE

The COVID-19 pandemic is not only a traumatic event, but a collective stressor unfolding over time, causing devastating implications for the mental health. This study aimed to shed light on the mental health status of patients with rheumatic disease (RD) during the massive outbreak of COVID-19 in China, especially the prevalence and severity of post-traumatic stress disorder (PTSD) compared with healthy individuals.

METHODS

A total of 486 patients with RD and 486 age-matched and sex-matched healthy individuals were recruited into the study. For each participant, we collected demographic and clinical characteristics data. The PTSD Checklist for DSM-5 (PCL-5) and four items from the Pittsburgh Sleep Quality Index (PSQI) were used to investigate the prevalence and severity of PTSD and sleep quality, respectively.

RESULTS

Compared with healthy control subjects (n=486), patients with RD (n=486) had a higher prevalence of PTSD (12.1% vs 4.1%; p<0.001). Higher total scores on the PCL-5 and on all four items from the PSQI (p≤0.001) were also observed. Female, old age, poor sleep quality, long duration of RD, poor subjective evaluation of the disease and pessimistic subjective perception of the epidemic were identified as risk factors of PTSD in patients with RD during the COVID-19 epidemic.

CONCLUSION

During the COVID-19 outbreak, patients with RD presented a higher prevalence and severity of PTSD and showed more sleep disturbances. Our findings confirm the importance of psychological assessment and mental healthcare out of regular clinical care for patients with RD during the pandemic.

Assets, stressors, and symptoms of persistent depression over the first year of the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has been accompanied by an increase in depression in U.S. adults. Previous literature suggests that having assets may protect against depression. Using a nationally representative longitudinal panel survey of U.S. adults studied in March and April 2020 and in March and April 2021, we found that (i) 20.3% of U.S. adults reported symptoms of persistent depression in Spring 2020 and Spring 2021, (ii) having more assets was associated with lower symptoms of persistent depression, with financial assets-household income and savings-most strongly associated, and (iii) while having assets appeared to protect persons-in particular those without stressors-from symptoms of persistent depression over the COVID-19 pandemic, having assets did not appear to reduce the effects of job loss, financial difficulties, or relationship stress on symptoms of persistent depression. Efforts to reduce population depression should consider the role played by assets in shaping risk of symptoms of persistent depression.

Young Adult Adaptability to the Social Challenges of the COVID-19 Pandemic: The Protective Role of Friendships

The continuing COVID-19 pandemic enables assessment of the adaptability of young adults to non-normative stressors threatening their social-emotional wellbeing. Focusing specifically on a developmentally critical social challenge of restricted in-person contact, the goal of the current study was to examine the role of friendships in alleviating social-emotional problems. Data were collected via online surveys from an ethnically diverse sample (n = 1557) of 20 to 24-year-olds (62% cisgender female, 31% male, 7% gender diverse or gender questioning) in spring of 2021. Longitudinal data from an earlier time point involving an age-normative social challenge (transition out of high school) were used as a comparison. The comparisons between the transition from high school and the pandemic showed that whereas social anxiety and depressive symptoms increased, loneliness decreased. Participants also reported having slightly more friends and rated the overall quality of their friendships as somewhat higher. Regression analyses revealed that a greater number of friends over time and greater satisfaction with friend electronic communication during the pandemic were most robustly related to lower social and generalized anxiety as well as depressive symptoms, over and above earlier social-emotional wellbeing and a number of relevant correlates. Loneliness was protected by higher quality of friendships, greater contact with friends, as well as more frequent and satisfying electronic communication with friends. The results suggest that although young adults are facing emotional challenges during the continued pandemic, they are also able to adapt by keeping in touch with friends to decrease subjective sense of isolation. The findings have novel intervention implications to reduce loneliness.

Perceived coping mitigates anxiety symptoms in the context of COVID-19 stress in an urban university student sample

Perceived coping and its two subprocesses, trauma-focused coping (finding meaning in the details and memory of a potential trauma or stressor) and forward-focused coping (focusing on planning for the future) have been shown to be important in the context of potentially traumatic events. The COVID-19 pandemic and its associated stressors have negatively impacted population mental health, and preliminary investigations have demonstrated the importance of perceived abilities to cope during the pandemic. The current study sought to examine the potentially moderating role of each subprocess on the relationship between stress and anxiety symptoms in a low-income student sample during COVID-19 (N = 2364). We computed two hierarchical multiple linear regressions to assess for significant interactions between stress and perceived coping subprocess scores on anxiety outcomes. Our results demonstrated that both trauma-focused coping and forward-focused coping served as effect modifiers in the relationship between COVID-19related stress and anxiety. Such findings highlight the importance of interventions that incorporate both forms of coping for low-income students during a chronic stressor.

Trajectories of common mental disorders symptoms before and during the COVID-19 pandemic: findings from the ELSA-Brasil COVID-19 Mental Health Cohort

AIM

Evidence indicates most people were resilient to the impact of the COVID-19 pandemic on mental health. However, evidence also suggests the pandemic effect on mental health may be heterogeneous. Therefore, we aimed to identify groups of trajectories of common mental disorders' (CMD) symptoms assessed before (2017-19) and during the COVID-19 pandemic (2020-2021), and to investigate predictors of trajectories.

METHODS

We assessed 2,705 participants of the ELSA-Brasil COVID-19 Mental Health Cohort study who reported Clinical Interview Scheduled-Revised (CIS-R) data in 2017-19 and Depression Anxiety Stress Scale-21 (DASS-21) data in May-July 2020, July-September 2020, October-December 2020, and April-June 2021. We used an equi-percentile approach to link the CIS-R total score in 2017-19 with the DASS-21 total score. Group-based trajectory modeling was used to identify CMD trajectories and adjusted multinomial logistic regression was used to investigate predictors of trajectories.

RESULTS

Six groups of CMD symptoms trajectories were identified: low symptoms (17.6%), low-decreasing symptoms (13.7%), low-increasing symptoms (23.9%), moderate-decreasing symptoms (16.8%), low-increasing symptoms (23.3%), severe-decreasing symptoms (4.7%). The severe-decreasing trajectory was characterized by age < 60 years, female sex, low family income, sedentary behavior, previous mental disorders, and the experience of adverse events in life.

LIMITATIONS

Pre-pandemic characteristics were associated with lack of response to assessments. Our occupational cohort sample is not representative.

CONCLUSION

More than half of the sample presented low levels of CMD symptoms. Predictors of trajectories could be used to detect individuals at-risk for presenting CMD symptoms in the context of global adverse events.

Relationship between Psychological Status and Health Behaviors during the Coronavirus Disease Pandemic in Japanese Community-Dwelling Older Adults

The coronavirus disease (COVID-19) continues to be a widespread pandemic. We investigated the relationship between anxiety/stress and health behaviors during the COVID-19 pandemic in homebound Japanese older adults during January and February 2021. We surveyed 1507 community-dwelling, older Japanese adults using a self-administered questionnaire on primary attributes, including family structure, evaluation of psychological anxiety/stress, and health behaviors. Participants were divided into four anxiety/stress groups based on the frequency of experiencing anxiety/stress, and their association with health behaviors was analyzed using bivariate and multivariate analyses. Responses were received from 469 (31.1%) respondents. In the bivariate analysis, age and family structure were significantly associated with anxiety/stress (p < 0.01). The health behaviors significantly associated with anxiety/stress were walking, balanced eating habits, limited snacking, regular lifestyle, and dental visits. Logistic regression analysis was performed using the variables in the bivariate analysis that showed a significant association with anxiety/stress status as independent variables. Finally, age and dietary habits were significantly associated with anxiety/stress status. No significant associations were found between any other variables. Among older adults living in the rural areas of Japan during the COVID-19 pandemic, anxiety/stress status was significantly associated with age and dietary habits but not with other health behaviors.

Research on Posttraumatic Stress Disorder in the Context of the COVID-19 Pandemic: A Review of Methods and Implications in General Population Samples

Increasing concern about the mental health sequelae to the COVID-19 pandemic has prompted a surge in research and publications on the prevalence of posttraumatic stress disorder in general population samples in relation to the pandemic. We examined how posttraumatic stress disorder in the context of the COVID-19 pandemic has been studied to date and found three general themes: (1) assessment of posttraumatic stress disorder and posttraumatic stress disorder symptoms relied on self-report measures and often did not determine direct trauma exposure as required by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Criterion A to diagnose posttraumatic stress disorder; (2) inadequate assessment of pre-existing mental disorders and co-occurring stress; and (3) the use of cross-sectional designs in most studies, often relying on snowball sampling strategies to conduct online surveys. Notwithstanding these methodological limitations, these studies have reported moderate to severe posttraumatic symptoms in 25.8% of the general population on average in relation to the pandemic (ranging from 4.6% to 55.3%). Opportunities for advancing future research that will inform public health planning are discussed.