1
|
Williams A, Alwan NA, Taylor E, Smith D, Ziauddeen N. The COVID-19 pandemic and food insecurity in households with children: A systematic review. PLoS One 2024; 19:e0308699. [PMID: 39116160 PMCID: PMC11309481 DOI: 10.1371/journal.pone.0308699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Food insecurity is defined as not having safe and regular access to nutritious food to meet basic needs. This review aimed to systematically examine the evidence analysing the impacts of the COVID-19 pandemic on food insecurity and diet quality in households with children <18 years in high-income countries. METHODS EMBASE, Cochrane Library, International Bibliography of Social Science, and Web of Science; and relevant sites for grey literature were searched on 01/09/2023. Observational studies published from 01/01/2020 until 31/08/2023 in English were included. Systematic reviews and conference abstracts were excluded. Studies with population from countries in the Organisation for Economic Co-Operation and Development were included. Studies were excluded if their population did not include households with children under 18 years. The National Heart, Lung, and Blood institute (NIH) tool for observational cohort and cross-sectional studies was used for quality assessment. The results are presented as a narrative review. RESULTS 5,626 records were identified and 19 studies were included. Thirteen were cross-sectional, and six cohorts. Twelve studies were based in the USA, three in Canada, one each in Italy and Australia and two in the UK. Twelve studies reported that the COVID-19 pandemic worsened food insecurity in households with children. One study reported that very low food security had improved likely due to increase in benefits as part of responsive actions to the pandemic by the government. CONCLUSION Although studies measured food insecurity using different tools, most showed that the pandemic worsened food security in households with children. Lack of diversity in recruited population groups and oversampling of high-risk groups leads to a non-representative sample limiting the generalisability. Food insecure families should be supported, and interventions targeting food insecurity should be developed to improve long-term health.
Collapse
Affiliation(s)
- Anna Williams
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Nisreen A. Alwan
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Elizabeth Taylor
- NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
- School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Dianna Smith
- NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
- School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Nida Ziauddeen
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
| |
Collapse
|
2
|
Hoven CW, Krasnova A, Bresnahan M, Sun X, Musa G, Geronazzo-Alman L, Ryan M, Skokauskas N, Amsel L, Svob C, Goodwin RD, Zemeck H, Cheslack-Postava K. Racial, Ethnic, and Socioeconomic Disparities in COVID-19 Pandemic Worries. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02093-y. [PMID: 39017774 DOI: 10.1007/s40615-024-02093-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/03/2024] [Accepted: 07/07/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Racial, ethnic, and socioeconomic health disparities became evident during the COVID-19 pandemic. This study explores whether these disparities extend to the content of worries. METHODS We surveyed 1,222 participants from three metropolitan New York City (NYC) based cohorts through telephone interviews conducted from March to September 2020. Worries were assessed using 37 dichotomous questionnaire items, and exploratory factor analysis derived ten categories of worry. Factor scores were analyzed in generalized linear mixed models to examine their associations with race/ethnicity and household income, adjusting for covariates. RESULTS The most prevalent worry items pertained to U.S. and world politics, American values, health concerns, and return to normalcy. Higher household income was associated with lower worry about economic needs, job/employment, and violence/victimization, while violence/victimization worries were strongly associated with Asian, Hispanic, Black, and multiracial or other race/ethnicity. CONCLUSIONS During early COVID-19, lower-income and minoritized race and ethnic groups were disproportionately affected by economic and violence/victimization worries, while other worries showed minor variations by income or race/ethnicity.
Collapse
Affiliation(s)
- Christina W Hoven
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY, 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Anna Krasnova
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY, 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Michaeline Bresnahan
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY, 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Xiaoxiao Sun
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY, 10032, USA
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - George Musa
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY, 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lupo Geronazzo-Alman
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Megan Ryan
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Norbert Skokauskas
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lawrence Amsel
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Connie Svob
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY, 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Renee D Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA
| | - Heather Zemeck
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Keely Cheslack-Postava
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY, 10032, USA.
| |
Collapse
|
3
|
Chan JK, Marzuki AA, Vafa S, Thanaraju A, Yap J, Chan XW, Harris HA, Todi K, Schaefer A. A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain. BMC Psychol 2024; 12:237. [PMID: 38671542 PMCID: PMC11046828 DOI: 10.1186/s40359-024-01715-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Covid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)-a multifaceted construct that measures a person's socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders. METHODS Following PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into 'actual versus perceived' and 'static versus fluid' classes to explore their differential effects on emotional health. RESULTS Out of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed 'expected' results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst. CONCLUSIONS This review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.
Collapse
Affiliation(s)
- Jee Kei Chan
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia.
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia.
- Sunway University Malaysia, Room: 4-4-11, Jalan Lagoon Selatan, Bandar Sunway, Petaling Jaya, 47500, Selangor, Malaysia.
| | - Aleya A Marzuki
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Samira Vafa
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Arjun Thanaraju
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Jie Yap
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Xiou Wen Chan
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Hanis Atasha Harris
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Khushi Todi
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Alexandre Schaefer
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| |
Collapse
|
4
|
Anthony MG, Hoddinott G, Van Niekerk M, Dewandel I, McKenzie C, Bekker C, Rabie H, Redfern A, van der Zalm MM. The socioeconomic impact of the COVID-19 lockdown on families affected by childhood respiratory illnesses in Cape Town, South Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003020. [PMID: 38547177 PMCID: PMC10977803 DOI: 10.1371/journal.pgph.0003020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 02/22/2024] [Indexed: 04/12/2024]
Abstract
The COVID-19 pandemic impacted families globally, directly and indirectly. Children presenting with respiratory illnesses are affected by emerging health systems and socioeconomic changes in the COVID-19 era. We explored the socioeconomic impacts of the COVID-19 lockdown on families with a respiratory illness diagnosed in their child in Cape Town, South Africa. This study was nested in a prospective observational cohort of children presenting with respiratory symptoms presumptive of COVID-19. We conducted 21 semi-structured interviews to explore the socioeconomic impact of the COVID-19 pandemic on families with a child affected by respiratory illnesses. We used case descriptive analysis and thematically organised common and divergent experiences. We found that socioeconomic challenges in low-income communities were exacerbated: 1) loss of pre-COVID sources of income (loss of income, employment and working hours), 2) shrinking employment opportunities due to business closures and strict preventative measures, 3) family network dependence to cope with financial pressures, 4) impact on education, implicating additional pressures due to lack of resources for adequate home schooling and 5) caregivers' mental health and wellbeing being impacted, causing stress and anxiety due to loss of income. This study shows that the COVID-19 lockdown impacted the socioeconomic aspects of families caring for a child with a respiratory illness. Care became more complicated and adversely impacted the family's emotional well-being and health-seeking behaviour. These impacts should be more carefully considered in order to strengthen health services and global health messaging in future pandemics.
Collapse
Affiliation(s)
- Michaile G. Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Margaret Van Niekerk
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Isabelle Dewandel
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Carla McKenzie
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Carien Bekker
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Helena Rabie
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Andrew Redfern
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Marieke M. van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
5
|
Zeidan RK, Shukla A, Hussein A, AlZubaidi H, Temsah MH, AlHajjaj MS, Al-Bluwi N, Awad M, Alsayed HAH, Saheb Sharif-Askari N, AlHano Z, Agha R, Hamid Q, Halwani R, Saddik B. Assessment of Knowledge, Perceptions, and Attitudes During the Global Mpox Outbreak in June 2022: A Cross-Sectional Study From the United Arab Emirates. Int J Public Health 2023; 68:1606080. [PMID: 38024212 PMCID: PMC10657881 DOI: 10.3389/ijph.2023.1606080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives: To examine knowledge, worry, anxiety, and vaccine acceptance for mpox among UAE adults. Methods: An online survey, advertised on academic and social media platform in June 2022 collected data from 959 participants (aged 18 and above) on mpox beliefs, risks, knowledge, worry, anxiety, COVID-19 infection, vaccination, and willingness to receive the mpox vaccine. Bivariate and logistic regression analysis identified associations and predictors between variables. Results: 56% had optimal knowledge of mpox transmission and symptoms. 54% were worried, and 27% experienced anxiety related to the outbreak. Knowledge scores were higher among women, healthcare workers, and those with reliable information sources. High perceived infection risk, changes in precautionary measures, and belief in difficult treatment predicted more worry and anxiety. Higher worry and two or more doses of the COVID-19 vaccine predicted higher likelihood of taking the mpox vaccine. Conclusion: The UAE population showed low knowledge and high worry and anxiety during the global mpox outbreak. Increasing public awareness through targeted educational campaigns is vital. Promoting better understanding of infectious diseases, addressing concerns, and encouraging vaccine uptake can prepare for future outbreaks.
Collapse
Affiliation(s)
- Rouba Karen Zeidan
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Ankita Shukla
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Amal Hussein
- Department of Family and Community Medicine and Behavioural Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Hamzah AlZubaidi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- School of Medicine, Deakin Rural Health, Deakin University Faculty of Health, Warrnambool, VIC, Australia
| | - Mohamad-Hani Temsah
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed S. AlHajjaj
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Najlaa Al-Bluwi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Manal Awad
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Narjes Saheb Sharif-Askari
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Family and Community Medicine and Behavioural Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Zahraa AlHano
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Razan Agha
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Qutayba Hamid
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Meakins-Christie Laboratories, Research Institute, McGill University Health Center, Montréal, QC, Canada
| | - Rabih Halwani
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Basema Saddik
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Family and Community Medicine and Behavioural Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
6
|
May T, Aughterson H, Fancourt D, Burton A. Financial adversity and subsequent health and wellbeing during the COVID-19 pandemic in the UK: A qualitative interview study. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100224. [PMID: 36742992 PMCID: PMC9883074 DOI: 10.1016/j.ssmqr.2023.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/22/2022] [Accepted: 01/23/2023] [Indexed: 01/30/2023]
Abstract
Aims There are concerns that the economic impacts of the COVID-19 pandemic, including employment inactivity and job loss, will have consequences for the UK population's health and wellbeing. However, there is limited qualitative research into how financial adversity contributes to poor health outcomes in this context. This study aimed to explore forms of financial adversity experienced during the pandemic and their subsequent impacts for health and wellbeing. Methods Qualitative semi-structured interviews with 20 people who experienced a form of financial adversity during the pandemic and six service providers employed in social welfare support services. Data were analysed using reflexive thematic analysis. Results Two main sources of financial adversity were identified: reductions in household incomes and increased living costs which engendered emotional and physical burdens. Coping strategies included increased financial borrowing, support from informal and formal networks and cutting back on energy use, food and non-essential items. Conclusion Our study highlighted exposure to multiple financial adversities because of the pandemic and how these experiences led to poor mental and physical health. The findings underline the importance of measures attending to the immediate needs of individuals, including accessible, co-located financial and psychological services, as well as broader measures that seek to reduce social and economic inequalities.
Collapse
|
7
|
Gagné T, McMunn A. Mental health inequalities during the second COVID-19 wave among Millennials who grew up in England: Evidence from the Next Steps cohort study. J Affect Disord 2023; 327:23-30. [PMID: 36738995 PMCID: PMC9893840 DOI: 10.1016/j.jad.2023.01.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is relatively little evidence on socioeconomic inequalities in mental health among young adults after the end of the first COVID-19 wave in the UK, despite this group having faced the worse mental health and economic shocks across age groups at the start of the pandemic. METHODS We examined differences in mental health across two points - September 2020 and February 2021 - in a cohort of 4167 Millennials aged 30-31 using life dissatisfaction, psychological distress (GHQ-12), anxiety (GAD-2), and depressive symptoms (PHQ-2). We report adjusted prevalence ratios (aPR) from random-intercept models, testing differences by educational attainment and time-varying conditions (relationship status, living arrangements with adults and children, work status, and financial changes compared with before the outbreak), adjusting for baseline covariates at ages 13-14 and health covariates at ages 25-26. RESULTS Only dissatisfaction with life changed between time points (PR = 1.26, 95%CI 1.02-1.55). Educational attainment was not significantly associated with mental health. Being single (aPRs from 1.36 to 1.89) and being financially worse off since the start of the pandemic (aPRs from 1.58 to 1.76) were each associated with worse mental health. These associations did not further vary by educational attainment. CONCLUSION Among Millennials who grew up in England, educational attainment was not associated with mental health whereas negative social and financial conditions were associated with worse mental health during the second COVID-19 wave. Mental health inequalities in this generation are likely to have continued increasing after the end of the first COVID-19 wave.
Collapse
Affiliation(s)
- T. Gagné
- Corresponding author at: Dept. of Epidemiology and Public Health, UCL, 1-19 Torrington Place, Office 346, WC1E 7HB London, United Kingdom
| | | |
Collapse
|
8
|
Driessens C, Mills L, Patel R, Culliford D, Gbesemete D, Lee E, Shaunak M, Chappell H, Faust SN, de Graaf H. Psychological distress experienced by parents caring for an immunosuppressed child during the COVID-19 pandemic. J Psychiatr Res 2023; 161:273-281. [PMID: 36947958 PMCID: PMC10017167 DOI: 10.1016/j.jpsychires.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/23/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
The COVID-19 pandemic has proved unique in both its unpredictability and the extent to which it has continued to impact on daily life since March 2020. Among the immunosuppressed population the challenges of the COVID-19 pandemic are cumulative to the ever-present challenges of living with a long-term condition. This prospective longitudinal study explored patterns of concern experienced by 467 British parents caring for an immunosuppressed child during the first 2 years of the COVID-19 pandemic and related this to parental mental wellbeing. Most parents slowly adapted or were resilient to the ever-changing stressors of the COVID-19 pandemic. However, 12% experienced high levels of concern throughout the first 2 years of the pandemic. This group was also more likely to report emotional mental health problems towards the end of this period. The experience of emotional mental health problems among parents caring for an immunosuppressed child was related to low household income, single parenting, difficult access to greenspace, and higher level of exposure to COVID positive cases and COVID restrictions (North of England). Parents reported that optimism, reduction of isolation, and support promoted coping and management of the challenges of the COVID-19 pandemic. More reliable COVID information and periodic medical-condition-specific guidance would have been appreciated. These findings can increase clinical awareness of high-risk parental groups and make an important contribution to the planning of appropriate targeted psychological family interventions.
Collapse
Affiliation(s)
- Corine Driessens
- NIHR Applied Research Collaboration Wessex, University of Southampton, 2 Venture Rd, Chilworth, Southampton, SO16 7NP, UK.
| | - Lynne Mills
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Ravin Patel
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - David Culliford
- NIHR Applied Research Collaboration Wessex, University of Southampton, 2 Venture Rd, Chilworth, Southampton, SO16 7NP, UK
| | - Diane Gbesemete
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, SO16 6YD, UK
| | - Emma Lee
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Meera Shaunak
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Harry Chappell
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Saul N Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, SO16 6YD, UK
| | - Hans de Graaf
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, SO16 6YD, UK
| | | |
Collapse
|
9
|
COVID-19-related mental health difficulties among marginalised populations: A literature review. Glob Ment Health (Camb) 2023; 10:e2. [PMID: 36843877 PMCID: PMC9947635 DOI: 10.1017/gmh.2022.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/07/2022] [Accepted: 09/29/2022] [Indexed: 12/13/2022] Open
Abstract
The COVID-19 pandemic has had negative consequences on the mental health of the population, which has been documented. Marginalised groups that are at risk of poor mental health overall have been particularly impacted. The purpose of this review is to describe the mental health impact of the COVID-19 pandemic on marginalised group (i.e. persons who are socio-economically disadvantaged, migrants and members of ethno-racial minorities, experience homelessness) and identified interventions which could be well-suited to prevent and address mental health difficulties. We conducted a literature review of systematic reviews on mental health difficulties since the beginning of the COVID-19 epidemic and appropriate interventions among marginalised groups published from January 1, 2020 to May 2, 2022, using Google Scholar and PubMed (MEDLINE). Among 792 studies on mental health difficulties among members of marginalised groups identified by keywords, 17 studies met our eligibility criteria. Twelve systematic reviews examining mental health difficulties in one or several marginalised groups during the COVID-19 pandemic and five systematic reviews on interventions that can mitigate the mental health impact of the COVID-19 pandemic were retained in our literature review. The mental health of marginalised groups was severely affected during the COVID-19 pandemic. Most frequently reported mental health difficulties included symptoms of anxiety and depression. Additionally, there are interventions that appear effective and well-suited for marginalised populations, which should be disseminated on a large scale to mitigate the psychiatric burden in these groups and at the population level.
Collapse
|
10
|
Dyer ML, Sallis HM, Khouja JN, Dryhurst S, Munafò MR. Associations between COVID-19 Risk Perceptions and Mental Health, Wellbeing, and Risk Behaviours. JOURNAL OF RISK RESEARCH 2022; 25:1372-1394. [PMID: 37872962 PMCID: PMC7615237 DOI: 10.1080/13669877.2022.2127849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 06/16/2022] [Accepted: 09/02/2022] [Indexed: 10/25/2023]
Abstract
Background Mental health has worsened, and substance use has increased for some people during the coronavirus (COVID-19) pandemic. Some cross-sectional studies suggest that higher COVID-19 risk perceptions are related to poorer mental health and greater risk behaviours (e.g., substance use). However, longitudinal and genetic data are needed to help to reduce the likelihood of reverse causality. Methods We used cross-sectional, longitudinal, and polygenic risk score (PRS; for anxiety, depression, wellbeing) data from the Avon Longitudinal Study of Parents and Children (ALSPAC). We examined cross-sectional and prospective longitudinal associations between COVID-19 risk perceptions (i.e., cognitive, affective, self, other, and a combined 'holistic' measure) and mental health (i.e., anxiety, depression), wellbeing, and risk behaviours. Pandemic (April-July 2020) and pre-pandemic (2003-2017) data (ns = 233-5,115) were included. Results Higher COVID-19 risk perceptions (holistic) were associated with anxiety (OR 2.78, 95% confidence interval [CI] 2.20 to 3.52), depression (OR 1.65, 95% CI 1.24 to 2.18), low wellbeing (OR 1.76, 95% CI 1.45 to 2.13), and increased alcohol use (OR 1.46, 95% CI 1.24 to 1.72). Higher COVID-19 risk perceptions were also associated with self-isolating given a suspected COVID-19 infection (OR 1.74, 95% CI 1.13 to 2.68), and less face-to-face contact (OR 0.83, 95% CI 0.70 to 0.98) and physical contact (OR 0.83, 95% CI 0.68 to 1.00). Pre-pandemic anxiety (OR 1.64, 95% CI 1.29 to 2.09) and low wellbeing (OR 1.41, 95% CI 1.15 to 1.74) were associated with higher COVID-19 risk perceptions. The depression PRS (b 0.21, 95% CI 0.02 to 0.40) and wellbeing PRS (b -0.29, 95% CI -0.48 to -0.09) were associated with higher and lower COVID-19 risk perceptions, respectively. Conclusions Poorer mental health and wellbeing are associated with higher COVID-19 risk perceptions, and longitudinal and genetic data suggest that they may play a causal role in COVID-19 risk perceptions.
Collapse
Affiliation(s)
- Maddy L. Dyer
- School of Psychological Science, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Hannah M. Sallis
- School of Psychological Science, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jasmine N. Khouja
- School of Psychological Science, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Sarah Dryhurst
- Winton Centre for Risk and Evidence Communication, University of Cambridge, Cambridge, UK
| | - Marcus R. Munafò
- School of Psychological Science, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| |
Collapse
|
11
|
Badinlou F, Lundgren T, Jansson-Fröjmark M. Mental health outcomes following COVID-19 infection: impacts of post-COVID impairments and fatigue on depression, anxiety, and insomnia - a web survey in Sweden. BMC Psychiatry 2022; 22:743. [PMID: 36447183 PMCID: PMC9708120 DOI: 10.1186/s12888-022-04405-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The negative impact of the COVID-19 pandemic on the mental health is now clearly established. However, information on the levels of mental ill health of people infected with COVID-19 and potential correlates of poor mental health is still limited. Therefore, the current study aimed to study indicative of potential mental health problems in individuals with a history of probable or confirmed SARS CoV-2 infection/infections and address the impacts of post-COVID impairments and fatigue following COVID-19 infection/infections on depression, anxiety, and insomnia. METHODS A web-survey including demographics, questions related to COVID-19 status and post-COVID impairments, and standardized measures of depression, anxiety, insomnia, and fatigue was completed by 507 individuals with a history of probable or confirmed SARS CoV-2 infection/infections. RESULTS We found significant rates of significant depression, anxiety, and insomnia in our sample, with more than 70% experiencing levels above the clinical cut offs for at least one psychological health problems. Higher levels of depression, anxiety, and insomnia were associated with the severity of COVID-19 infection in the acute phase, hospitalization because of COVID-19, and higher levels of post-COVID impairments and fatigue. Reduced motivation emerged as the strongest predictor for mental ill health. CONCLUSIONS These findings highlight that individuals infected with COVID-19, especially those who still have experienced post-COVID impairments, are more likely to suffer from mental ill-health and may be more vulnerable for poor mental health outcomes. Therefore, more effective actions are needed to take in order to promote and protect mental health of individuals with a history of COVID-19 infection.
Collapse
Affiliation(s)
- Farzaneh Badinlou
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, and Stockholm Health Care Services, Region of Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden.
| | - Tobias Lundgren
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, and Stockholm Health Care Services, Region of Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden
| | - Markus Jansson-Fröjmark
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, and Stockholm Health Care Services, Region of Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden
| |
Collapse
|
12
|
Driessens C, Mills L, Culliford D, Patel R, Lee E, Gbesemete D, Chappell H, Shaunak M, Faust SN, de Graaf H. Parental concern for clinically vulnerable child during first 18 months of the COVID pandemic. Pediatr Res 2022:10.1038/s41390-022-02371-7. [PMID: 36418484 PMCID: PMC9684768 DOI: 10.1038/s41390-022-02371-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 08/26/2022] [Accepted: 09/18/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The uncertainties surrounding the COVID-19 pandemic have been associated with increased parental concern. The aim of this study is to explore if this increased level of concern is associated with certain individual/household characteristics or if parents adapted to the ever-changing realities of the COVID-19 pandemic over time. METHODS This prospective study explored COVID-19 concern trajectories and associated family characteristics of 765 UK parents caring for an immunosuppressed child during the first 18 months of the pandemic using growth mixture modelling. Qualitative analysis was performed to examine in more detail the source of concern. RESULTS Four different trajectories of parental COVID-19 concern were identified. Ongoing very high concern was associated with caring for children with nephrotic or respiratory disease; having a child on an organ transplant waiting list; residency in the North of England; or parental vocational inactivity. Explicit concerns voiced by the parents generally followed national trends, but vulnerable status specific concerns were also reported. CONCLUSION Diagnosis and prescribed medication of the immunosuppressed child, geographical location, household composition, and employment status of parent were associated with the different concern trajectories. This information can be helpful in targeting psychological family care where it is most needed. IMPACT Many British parents caring for a clinically vulnerable child during the first 18 months of the COVID-19 pandemic showed high levels of concern with little sign of psychological adaptation. Consistent with findings from non-vulnerable populations, parents mentioned the impact of shielding and repeated isolation on their child's education, social life, and mental health. Unique to the clinically vulnerable population, parents were worried about child's health status, impact of delayed healthcare, and were confused by the contradictory information received from government, doctors, and media. Psychological family care can be targeted to those parents at greater risk for high levels of concern.
Collapse
Affiliation(s)
- Corine Driessens
- grid.5491.90000 0004 1936 9297NIHR Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
| | - Lynne Mills
- grid.430506.40000 0004 0465 4079NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David Culliford
- grid.5491.90000 0004 1936 9297NIHR Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
| | - Ravin Patel
- grid.430506.40000 0004 0465 4079NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Emma Lee
- grid.430506.40000 0004 0465 4079NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Diane Gbesemete
- grid.430506.40000 0004 0465 4079NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Harry Chappell
- grid.430506.40000 0004 0465 4079NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Meera Shaunak
- grid.430506.40000 0004 0465 4079NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Saul N. Faust
- grid.430506.40000 0004 0465 4079NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Southampton, UK ,grid.5491.90000 0004 1936 9297Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Hans de Graaf
- grid.430506.40000 0004 0465 4079NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Southampton, UK ,grid.5491.90000 0004 1936 9297Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | | |
Collapse
|
13
|
van den Broek N, Larsen JK, Verhagen M, Burk WJ, Vink JM. Adolescents' food intake changes during the COVID-19 pandemic: The moderating role of pre-pandemic susceptibility, COVID-19 related stressors, and the social food context. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2022; 20:616-634. [PMID: 37377464 PMCID: PMC10292123 DOI: 10.1080/17405629.2022.2115999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/22/2022] [Indexed: 11/03/2022]
Abstract
Although insight in how adolescents' food intake is affected by the COVID-19 pandemic is critical, knowledge is limited. Hence, this longitudinal study (N = 691, Mage = 14.30, SDage = 0.62; 52.5% female) investigated changes in adolescents' unhealthy (sugar-sweetened beverages, sweet snacks, savoury snacks) and healthy (fruit and vegetables) food intake (in total, obtained from home, and from outside the home) from pre-pandemic (Spring 2019) to the first lockdown (Spring 2020) and to six months later (Fall 2020). Moreover, several moderating factors were assessed. Results showed that the intake of unhealthy and healthy food in total and obtained from outside the home decreased during the lockdown. Six months later, unhealthy food intake returned to pre-pandemic levels, while healthy food intake remained lower. COVID-19 stressful life events and maternal food intake further qualified these longer-term changes in intake of sugar-sweetened beverages and fruit and vegetables, respectively. Future work is warranted to elucidate longer-term COVID-19 effects on adolescents' food intake.
Collapse
Affiliation(s)
- Nina van den Broek
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Junilla. K. Larsen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Maaike Verhagen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - William J. Burk
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Jacqueline M. Vink
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| |
Collapse
|
14
|
Wang H, Smith-Greenaway E, Bauldry S, Margolis R, Verdery AM. Mourning in a Pandemic: The Differential Impact of COVID-19 Widowhood on Mental Health. J Gerontol B Psychol Sci Soc Sci 2022; 77:2306-2316. [PMID: 35753008 PMCID: PMC9278192 DOI: 10.1093/geronb/gbac085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The death of a spouse is an established predictor of mental health decline that foreshadows worsening physical health and elevated mortality. The millions widowed by COVID-19 worldwide may experience even worse health outcomes than comparable pre-pandemic widows given the particularities of dying, mourning, and grieving during a pandemic defined by protracted social isolation, economic precarity, and general uncertainty. If COVID-19 pandemic bereavement is more strongly associated with mental health challenges than pre-pandemic bereavement, the large new cohort of COVID-19 widow(er)s may be at substantial risk of downstream health problems long after the pandemic abates. METHODS We pooled population-based Survey of Health, Ageing and Retirement in Europe data from 27 countries for two distinct periods: (1) pre-pandemic (Wave 8, fielded October 2019-March 2020; N = 46,266) and (2) early pandemic (COVID Supplement, fielded June-August 2020; N = 55,796). The analysis used a difference-in-difference design to assess whether a spouse dying from COVID-19 presents unique mental health risks (self-reported depression, loneliness, and trouble sleeping), compared with pre-pandemic recent spousal deaths. RESULTS We find strong associations between recent spousal death and poor mental health before and during the pandemic. However, our difference-in-difference estimates indicate those whose spouses died of COVID-19 have higher risks of self-reported depression and loneliness, but not trouble sleeping, than expected based on pre-pandemic associations. DISCUSSION These results highlight that the millions of COVID-19 widow(er)s face extreme mental health risks, eclipsing those experienced by surviving spouses pre-pandemic, furthering concerns about the pandemic's lasting impacts on health.
Collapse
Affiliation(s)
- Haowei Wang
- Population Research Institute, Department of Sociology and Criminology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Emily Smith-Greenaway
- Department of Sociology, University of Southern California, Los Angeles, California, USA
| | - Shawn Bauldry
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
| | - Rachel Margolis
- Department of Sociology, University of Western Ontario, London, Ontario, Canada
| | - Ashton M Verdery
- Address correspondence to: Ashton M. Verdery, PhD, Population Research Institute, Department of Sociology and Criminology, The Pennsylvania State University, Oswald Tower, University Park, PA 16802, USA. E-mail:
| |
Collapse
|
15
|
Cheng GJ, Wagner AL, O’Shea BQ, Joseph CA, Finlay JM, Kobayashi LC. Multimorbidity and Mental Health Trajectories Among Middle-Aged and Older U.S. Adults During the COVID-19 Pandemic: Longitudinal Findings From the COVID-19 Coping Study. Innov Aging 2022; 6:igac047. [PMID: 36035631 PMCID: PMC9403728 DOI: 10.1093/geroni/igac047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives This study aimed to examine the associations between multimorbidity at the COVID-19 pandemic onset and subsequent longitudinal trajectories of depressive symptoms, anxiety symptoms, and loneliness in middle-aged and older adults over a 12-month follow-up. Research Design and Methods Data were from monthly online questionnaires in the COVID-19 Coping Study of U.S. adults aged ≥55 from April/May 2020 through April/May 2021 (N = 4,024). Multimorbidity was defined as having ≥2 versus <2 chronic conditions at baseline. Mental health outcomes were assessed monthly as depressive symptoms (8-item Center for Epidemiologic Studies Depression scale), anxiety symptoms (5-item Beck Anxiety Inventory), and loneliness (3-item UCLA Loneliness Scale). We used multivariable-adjusted population- and attrition-weighted mixed-effects linear models to examine the longitudinal associations between multimorbidity and mental health symptoms. Results Multimorbidity at the pandemic onset was associated with elevated depressive (b = 0.37; 95% CI: 0.16–0.59) and anxiety (b = 0.39; 95% CI: 0.15–0.62) symptoms at baseline. Changes in symptoms for all three mental health outcomes were nonlinear over time, with worsening symptoms over the first 6 months of the pandemic (April/May to September/October 2020), followed by improvement in symptoms over the subsequent 6 months (September/October 2020 to April/May 2021). Middle-aged and older adults with multimorbidity experienced faster rates of change in anxiety symptoms and loneliness than those without multimorbidity, with persistently elevated mental health symptomatology throughout the follow-up. Discussion and Implications Results highlight the unique and persistent mental health risks experienced by middle-aged and older adults with multimorbidity during the COVID-19 pandemic. The observed improvements in symptoms underscore the mental resilience of these individuals, indicating their adaptation to the ongoing pandemic.
Collapse
Affiliation(s)
- Greta Jianjia Cheng
- Department of Epidemiology, University of Michigan School of Public Health , Ann Arbor, Michigan , USA
- Brain, Environment, Aging, and Mobility (BEAM) Lab, Department of Epidemiology, University of Pittsburgh School of Public Health , Pittsburgh, PA , USA
| | - Abram L Wagner
- Department of Epidemiology, University of Michigan School of Public Health , Ann Arbor, Michigan , USA
| | - Brendan Q O’Shea
- Department of Epidemiology, University of Michigan School of Public Health , Ann Arbor, Michigan , USA
| | - Carly A Joseph
- Department of Epidemiology, University of Michigan School of Public Health , Ann Arbor, Michigan , USA
| | - Jessica M Finlay
- Social Environment and Health Program, Institute for Social Research, University of Michigan , Ann Arbor, Michigan , USA
| | - Lindsay C Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health , Ann Arbor, Michigan , USA
| |
Collapse
|
16
|
Longitudinal associations between going outdoors and mental health and wellbeing during a COVID-19 lockdown in the UK. Sci Rep 2022; 12:10580. [PMID: 35732816 PMCID: PMC9216298 DOI: 10.1038/s41598-022-15004-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/16/2022] [Indexed: 11/09/2022] Open
Abstract
The COVID-19 pandemic led to national lockdowns in countries around the world. Whilst lockdowns were shown to be effective in reducing the spread of disease, they were also associated with adverse effects on people’s mental health and wellbeing. Previous studies have suggested that time spent outside may have played a role in mitigating these negative effects, but research on this topic remains limited. Therefore, this study was designed to explore the longitudinal associations between going outdoors and people’s mental health and wellbeing during the first national lockdown (March–May 2020) in the UK. Data from 35,301 participants from the COVID-19 Social Study were analysed. Fixed effects regression was used to explore the longitudinal association between changes in going outdoors (the number of days spent outside) and changes in depressive symptoms, anxiety symptoms, life satisfaction and loneliness. A range of household and neighbourhood moderators were examined. Results show that an increase in the number of days spent outside was associated with decreases in depressive and anxiety symptoms and an increase in life satisfaction. Associations were more salient amongst people living with others, and those with greater satisfaction with their neighbourhood walkability and green spaces. No longitudinal association was found with loneliness. Overall, our analyses showed a positive association between going outdoors and improved mental health and wellbeing during the first COVID-19 lockdown in the UK. These findings are important for formulating guidance for people to stay well at home during pandemics and for the on-going nature-based social prescribing scheme.
Collapse
|
17
|
The Role of Personalization in the User Experience, Preferences and Engagement with Virtual Reality Environments for Relaxation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127237. [PMID: 35742483 PMCID: PMC9223778 DOI: 10.3390/ijerph19127237] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 12/10/2022]
Abstract
Virtual Reality Environments (VREs) are widely deployed in mental health treatments, often associated with relaxation techniques. The personalization of natural VR-based scenarios is a key element that can further facilitate users’ sense of presence and relaxation. This study explored the role of VREs’ personalization in the user experience with an environment supporting relaxation, by deploying mixed methods. Methods: A non-clinical sample of 20 individuals participated in exposure to a supportive body-scan-guided relaxation VRE. In the personalized conditions, the participants had the option of choosing the context (e.g., sea, mountain, or countryside) and including in the scenario different types of sounds, visual elements, and changing the time of day and weather. In the standard conditions, individuals were exposed to a relaxing VRE, but they could choose neither the context nor the auditory and visual elements. The order of presentation of the personalized vs non-personalized environments was randomized. Measures regarding relaxation, state-anxiety perceived levels, VRE-related symptoms, the usability of the Virtual Reality (VR) setting, sense of presence, pleasure, activation, engagement, and level of immersion experienced were collected before and after exposure to the VR environments. Results: Findings showed that personalized VREs were preferred by users. Participants generally preferred to experience a greater immersivity, pleasure, engagement, and relaxation in the personalized virtual settings. Conclusion: The study further confirms the role of personalization as a component positively contributing to relaxation and engagement. Future research may further assess this effect in the context of large-scale controlled studies involving clinical and non-clinical populations.
Collapse
|
18
|
Yong X, Zhang L. COVID-19 Worry and Mental Health Among the Economically Active Population in Guangdong, China. Front Public Health 2022; 10:882177. [PMID: 35586016 PMCID: PMC9108278 DOI: 10.3389/fpubh.2022.882177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background The rapid spread of the coronavirus disease 2019 (COVID-19) pandemic has caused people to worry, which has affected their mental health. This study aimed to access the impact of COVID-19 worry on the mental health of the economically active population (EAP) in a province of China. Methods An online cross-sectional survey study was conducted during an outbreak of COVID-19 in Guangdong, China. The survey used the 12-item General Health Questionnaire (GHQ-12) to evaluate participants' mental health status and was completed by 1,584 of the 1,708 participants (a response rate of 92.74%). Ordinary least squares (OLS) regression models were used to identify the correlation between COVID-19 worry and mental health. Results Approximately 42.05% of participants reported that they were very worried or extremely worried about the COVID-19 pandemic. COVID-19 worry was negatively correlated with mental health (p < 0.01) and exhibited a stronger influence on the mental health of participants who were male, younger (aged 16–45), or unemployed than on the mental health of participants who were women, older (aged over 45), or employed. Conclusion The findings suggest that COVID-19 worry has generated new inequalities in mental health among the EAP of China. The government should provide more public reassurance and psychological support to the EAP to mitigate the effects of COVID-19 worry and prevent mental health disorders.
Collapse
Affiliation(s)
- Xin Yong
- School of Public Administration, Xiangtan University, Xiangtan, China
| | - Li Zhang
- School of Economics and Trade, Hunan University, Changsha, China
- *Correspondence: Li Zhang
| |
Collapse
|
19
|
Araki S. The Resilience Divide Among Older Adults Under Uncertainty: A Positive Sociological Study of Life Satisfaction During the COVID-19 Crisis. J Appl Gerontol 2022; 41:1792-1801. [PMID: 35471951 PMCID: PMC9047606 DOI: 10.1177/07334648221089284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
While recent research has detected older adults’ resilience during the global
pandemic, its unequal distribution is inadequately examined. Using the panel
survey data in Japan (N = 3,725), this positive sociological
study investigated who were more/less resilient under COVID-19, with attention
to the heterogeneity in life satisfaction (LS). It was first confirmed that
older adults’ LS had substantially improved during the pandemic, indicating
their resilience on average. However, the multinomial logistic regression and
the fixed effects model revealed that the shift in LS was associated with age,
gender, income, family/social relationships, and heath in a nuanced way. This
suggests, while older adults who have access to economic, social, and
health-related resources can maintain/enhance their LS under the global crisis,
those without such assets face the risk of being penalized. In these uncertain
times, it is therefore imperative to shed light on the resilience divide among
older adults alongside their average strength.
Collapse
Affiliation(s)
- Satoshi Araki
- Department of Sociology and Social Policy, 34743Lingnan University, Hong Kong
| |
Collapse
|
20
|
Public opinion about the UK government during COVID-19 and implications for public health: A topic modeling analysis of open-ended survey response data. PLoS One 2022; 17:e0264134. [PMID: 35421112 PMCID: PMC9009625 DOI: 10.1371/journal.pone.0264134] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/03/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Confidence in the central UK Government has declined since the beginning of the COVID-19 pandemic, and while this may be linked to specific government actions to curb the spread of the virus, understanding is still incomplete. Examining public opinion is important, as research suggests that low confidence in government increases the extent of non-compliance with infection-dampening rules (for instance, social distancing); however, the detailed reasons for this association are still unclear. METHODS To understand public opinion on the central UK government during the first phase of the COVID-19 pandemic, we used structural topic modeling, a text mining technique, to extract themes from over 4000 free-text survey responses, collected between 14 October and 26 November 2020. RESULTS We identified eleven topics, among which were topics related to perceived government corruption and cronyism, complaints about inconsistency in rules and messaging, lack of clear planning, and lack of openness and transparency. Participants reported that elements of the government's approach had made it difficult to comply with guidelines (e.g., changing rules) or were having impacts on mental wellbeing (e.g., inability to plan for the future). CONCLUSIONS Results suggested that consistent, transparent communication and messaging from the government is critical to improving compliance with measures to contain the virus, as well as protecting mental health during health emergencies.
Collapse
|
21
|
Fukase Y, Ichikura K, Murase H, Tagaya H. Age-related differences in depressive symptoms and coping strategies during the COVID-19 pandemic in Japan: A longitudinal study. J Psychosom Res 2022; 155:110737. [PMID: 35124526 PMCID: PMC8786398 DOI: 10.1016/j.jpsychores.2022.110737] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The coronavirus 2019 (COVID-19) pandemic has particularly influenced the mental health of younger adults; accordingly, this study investigated age-related factors related to mental health and provided suggestions related to mental health recovery. METHODS A web-based longitudinal survey was conducted from 2020 to 2021 in Japan. The survey consisted of the Patient Health Questionnaire-9 (PHQ-9), used to measure depressive symptoms as a response variable, and an anger questionnaire and coping strategy scale to assess explanatory variables. RESULTS A total of 1468 participants were analyzed (valid response rate = 54.2%); 368 were younger adults (age range = 20-39), 667 were middle-aged adults (age range = 40-64), and 433 were aged adults (age range = 65-79). The PHQ-9 scores in the younger adults worsened over the three survey timepoints. State anger was strongly related to PHQ-9 scores in all age groups (standardized beta = 0.39-0.47), and state anger in the younger group was highest at all survey times, In the younger group, only nonadaptive coping strategies were related to PHQ-9 scores. Emotional support, venting, and humor adaptive strategies used by middle-aged and aged adults were most commonly used by younger adults; however, there were no significant relationships of these strategies with PHQ-9 scores in the younger group. CONCLUSION The level of depressive symptoms among the younger adults might be considerably worse than the middle-aged and aged adult. The younger adults might not make use of strategies, hence, they might need advice and skill training of strategies.
Collapse
Affiliation(s)
- Yuko Fukase
- Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa 2520373, Japan.
| | - Kanako Ichikura
- Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa 2520373, Japan.
| | - Hanako Murase
- Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa 2520373, Japan.
| | - Hirokuni Tagaya
- Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa 2520373, Japan.
| |
Collapse
|
22
|
Carr E, Davis K, Bergin-Cartwright G, Lavelle G, Leightley D, Oetzmann C, Polling C, Stevelink SAM, Wickersham A, Razavi R, Hotopf M. Mental health among UK university staff and postgraduate students in the early stages of the COVID-19 pandemic. Occup Environ Med 2022; 79:259-267. [PMID: 34675129 PMCID: PMC8550872 DOI: 10.1136/oemed-2021-107667] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/06/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To characterise the baseline King's College London Coronavirus Health and Experiences of Colleagues at King's cohort and describe patterns of probable depression and anxiety among staff and postgraduate research students at a large UK university in April/May 2020. METHODS An online survey was sent to current staff and postgraduate research students via email in April 2020 (n=2590). Primary outcomes were probable depression and anxiety, measured with the Patient Health Questionnaire-9 and Generalised Anxiety Disorder-7, respectively. Secondary outcomes were alcohol use and perceived change in mental health. Outcomes were described using summary statistics and multivariable Poisson regression was used to explore associations with six groups of predictors: demographics and prior mental health, living arrangements, caring roles, healthcare, occupational factors and COVID-19 infection. All analyses were weighted to account for differences between the sample and target population in terms of age, gender, and ethnicity. RESULTS Around 20% of staff members and 30% of postgraduate research students met thresholds for probable depression or anxiety on the questionnaires. This doubled to around 40% among younger respondents aged <25. Other factors associated with probable depression and anxiety included female gender, belonging to an ethnic minority group, caregiving responsibilities and shielding or isolating. Around 20% of participants were found to reach cut-off for hazardous drinking on Alcohol Use Disorders Identification Test, while 30% were drinking more than before the pandemic. CONCLUSIONS Our study shows worrying levels of symptoms of depression, anxiety and alcohol use disorder in an occupational sample from a large UK university in the months following the outbreak of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Ewan Carr
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katrina Davis
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Gabriella Bergin-Cartwright
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Grace Lavelle
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Leightley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK
| | - Carolin Oetzmann
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Catherine Polling
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sharon A M Stevelink
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK
| | - Alice Wickersham
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Reza Razavi
- King's College London School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
23
|
Jia R, Ayling K, Chalder T, Massey A, Gasteiger N, Broadbent E, Coupland C, Vedhara K. The prevalence, incidence, prognosis and risk factors for symptoms of depression and anxiety in a UK cohort during the COVID-19 pandemic. BJPsych Open 2022; 8:e64. [PMID: 35256024 PMCID: PMC8914134 DOI: 10.1192/bjo.2022.34] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has had profound consequences for population mental health. However, it is less clear for whom these effects are sustained. AIMS To investigate the prevalence, incidence, prognosis and risk factors for symptoms of depression and anxiety in a UK cohort over three distinct periods in the pandemic in 2020. METHOD An online survey was completed by a UK community cohort at three points (n = 3097 at baseline, n = 878 completed all surveys): April (baseline), July to September (time point 2) and November to December (time point 3). Participants completed validated measures of depression and anxiety on each occasion, and we prospectively explored the role of sociodemographic and psychological factors (loneliness, positive mood and perceived risk of and worry about COVID-19) as risk factors. RESULTS Depression (Patient Health Questionnaire-9 means: baseline, 7.69; time point 2, 5.53; time point 3, 6.06) and anxiety scores (Generalised Anxiety Disorder-7 means: baseline, 6.59; time point 2, 4.60; time point 3, 4.98) were considerably greater than pre-pandemic population norms at all time points. Women reported greater depression and anxiety symptoms than men. Younger age, history of mental health disorder, more COVID-19-related negative life events, greater loneliness and lower positive mood at baseline were all significant predictors of poorer mental health at time point 3. CONCLUSIONS The negative impact of the COVID-19 pandemic on mental health has persisted to some degree. Younger people and individuals with prior mental health disorders are at greatest risk. Easing of restrictions and resumption of social interaction could mitigate the risk factors of loneliness and positive mood.
Collapse
Affiliation(s)
- Ru Jia
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, UK
| | - Kieran Ayling
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Adam Massey
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, UK
| | - Norina Gasteiger
- Department of Psychological Medicine, University of Auckland, New Zealand
| | | | - Carol Coupland
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, UK
| | - Kavita Vedhara
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, UK
| |
Collapse
|
24
|
Goldberg X, Castaño-Vinyals G, Espinosa A, Carreras A, Liutsko L, Sicuri E, Foraster M, O’Callaghan-Gordo C, Dadvand P, Moncunill G, Dobaño C, Cortés B, Pleguezuelos V, Straif K, Garcia-Aymerich J, de Cid R, Cardis E, Kogevinas M. Mental health and COVID-19 in a general population cohort in Spain (COVICAT study). Soc Psychiatry Psychiatr Epidemiol 2022; 57:2457-2468. [PMID: 35633398 PMCID: PMC9142833 DOI: 10.1007/s00127-022-02303-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/05/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Mental health conditions may affect outcome of COVID-19 disease, while exposure to stressors during the pandemic may impact mental health. The purpose of this study was to examine these factors in relation to ocurrence of depression and anxiety after the first outbreak in Spain. METHODS We contacted 9515 participants from a population-based cohort study in Catalonia between May and October 2020. We drew blood samples to establish infection to the virus. Pre-pandemic mental health conditions were confirmed through Electronic Health Registries. We used the Hospital Anxiety and Depression Scale to assess severe depression and anxiety post-pandemic. Exposure to proximal, financial and wider environment stressors during the lockdown were collected. We calculated Relative Risks (RR), adjusting for individual- and contextual covariates. RESULTS Pre-pandemic mental health disorders were not associated with SARS-CoV-2 infection , but were associated with severity of COVID-19 disease. People with pre-existing mental health disorders showed higher prevalence of severe depression (25.4%) and anxiety (37.8%) than those without prior mental disorders (4.9% and 10.1%). Living alone was a strong predictor of severe depression among mental health patients (RR = 1.6, 95% CI 1.2-2.2). Among those without prior mental health disorders, post-lockdown depression and anxiety were associated with household interpersonal conflicts (RR = 2.6, 95% CI 2.1-3.1; RR = 2.1, 95% CI 1.9-2.4) and financial instability (RR = 2.2, 95% CI 1.8-2.9; 1.9, 95% CI 1.6-2.2). CONCLUSIONS The COVID-19 pandemic and the lockdown were associated with increased post-lockdown depression and anxiety. Patients with pre-existing mental health conditions are a vulnerable group for severe COVID-19 disease.
Collapse
Affiliation(s)
- X. Goldberg
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona, Spain, Barcelona, Spain ,grid.488873.80000 0004 6346 3600Mental Health Department, Institut d’Investigació I Innovació Parc Taulí I3PT, Sabadell, Spain ,grid.512890.7CIBER Salud Mental (CIBERSAM), Madrid, Spain ,grid.5612.00000 0001 2172 2676Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - G. Castaño-Vinyals
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona, Spain, Barcelona, Spain ,grid.411142.30000 0004 1767 8811IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain ,grid.5612.00000 0001 2172 2676Universitat Pompeu Fabra (UPF), Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - A. Espinosa
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona, Spain, Barcelona, Spain ,grid.411142.30000 0004 1767 8811IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain ,grid.5612.00000 0001 2172 2676Universitat Pompeu Fabra (UPF), Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - A. Carreras
- grid.429186.00000 0004 1756 6852Genomes for Life-GCAT Lab, Germans Trias I Pujol Research Institute (IGTP), Badalona, Spain
| | - L. Liutsko
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona, Spain, Barcelona, Spain ,grid.5612.00000 0001 2172 2676Universitat Pompeu Fabra (UPF), Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain ,grid.412761.70000 0004 0645 736XUrFU, Yekaterinburg, Russia
| | - E. Sicuri
- grid.410458.c0000 0000 9635 9413ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - M. Foraster
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona, Spain, Barcelona, Spain ,grid.5612.00000 0001 2172 2676Universitat Pompeu Fabra (UPF), Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain ,grid.6162.30000 0001 2174 6723PHAGEX Research Group, Universitat Ramon Llull, Blanquerna School of Health Science, Barcelona, Spain
| | - C. O’Callaghan-Gordo
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona, Spain, Barcelona, Spain ,grid.5612.00000 0001 2172 2676Universitat Pompeu Fabra (UPF), Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain ,grid.36083.3e0000 0001 2171 6620Universitat Oberta de Catalunya, Barcelona, Spain
| | - P. Dadvand
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona, Spain, Barcelona, Spain ,grid.5612.00000 0001 2172 2676Universitat Pompeu Fabra (UPF), Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - G. Moncunill
- grid.410458.c0000 0000 9635 9413ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - C. Dobaño
- grid.410458.c0000 0000 9635 9413ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - B. Cortés
- grid.429186.00000 0004 1756 6852Genomes for Life-GCAT Lab, Germans Trias I Pujol Research Institute (IGTP), Badalona, Spain
| | | | - K. Straif
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona, Spain, Barcelona, Spain ,grid.208226.c0000 0004 0444 7053Boston College, Chestnut Hill, MA USA
| | - J. Garcia-Aymerich
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona, Spain, Barcelona, Spain ,grid.5612.00000 0001 2172 2676Universitat Pompeu Fabra (UPF), Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - R. de Cid
- grid.429186.00000 0004 1756 6852Genomes for Life-GCAT Lab, Germans Trias I Pujol Research Institute (IGTP), Badalona, Spain
| | - E. Cardis
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona, Spain, Barcelona, Spain ,grid.411142.30000 0004 1767 8811IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain ,grid.5612.00000 0001 2172 2676Universitat Pompeu Fabra (UPF), Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - M. Kogevinas
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona, Spain, Barcelona, Spain ,grid.411142.30000 0004 1767 8811IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain ,grid.5612.00000 0001 2172 2676Universitat Pompeu Fabra (UPF), Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| |
Collapse
|
25
|
Paul E, Fancourt D. The interaction between social factors and adversities on self-harm during the COVID-19 pandemic: longitudinal analysis of 49 227 UK adults. BJPsych Open 2022; 8:e12. [PMID: 34931147 PMCID: PMC8674193 DOI: 10.1192/bjo.2021.1071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 11/01/2021] [Accepted: 11/19/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Little is known about which factors exacerbate and buffer the impact of coronavirus disease 2019 (COVID-19)-related adversities on changes in thinking about and engaging in self-harm over time. AIMS To examine how changes in four social factors contribute to changes in self-harm thoughts and behaviours over time and how these factors in turn interact with adversities and worries about adversities to increase risk for these outcomes. METHOD Data from 49 227 UK adults in the UCL COVID-19 Social Study were analysed across the first 59 weeks of the pandemic. Fixed-effects logistic regressions examined time-varying associations between social support quality, loneliness, number of days of face-to-face contact for >15 min and number of days phoning/video calling for ≥15 min with self-harm thoughts and behaviours. We then examined how these four factors in turn interacted with the total number of adversities and worries about adversity and how this affected outcomes. RESULTS Increases in the quality of social support were associated with decreases in the likelihood of both outcomes, whereas greater loneliness was associated with an increase in their likelihood. Associations were less clear for telephone/video contact and face-to-face contact with outcomes. Social support buffered and loneliness exacerbated the impact of adversity experiences on self-harm behaviours. CONCLUSIONS These findings suggest the importance of the quality of one's social support network, rather than the mere presence of contact, for reducing the likelihood of self-harm behaviours in the context of COVID-19 pandemic-related adversity and worry.
Collapse
Affiliation(s)
- Elise Paul
- Department of Behavioural Science and Health, University College London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, UK
| |
Collapse
|
26
|
Gagné T, Nandi A, Schoon I. Time trend analysis of social inequalities in psychological distress among young adults before and during the pandemic: evidence from the UK Household Longitudinal Study COVID-19 waves. J Epidemiol Community Health 2021; 76:jech-2021-217266. [PMID: 34716130 PMCID: PMC8561821 DOI: 10.1136/jech-2021-217266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite concerns about mental health problems among those aged 16-24 in England, which social groups have been most at risk, both over the past decade and during the COVID-19 pandemic, remains unclear. METHODS We examined trends in psychological distress among young adults 16-24 years old in England using data from the UK Household Longitudinal Study. Using longitudinal data as repeated cross-sectional waves, we examined differences over time in mean General Health Questionnaire (GHQ) scores from wave 1 (2009-2010) to wave 10 (2018-2019) and six COVID-19 waves collected between April and November 2020, by economic activity, cohabitation with parents, parental education, area deprivation, ethnicity, age and sex. RESULTS Compared with 2009-2010, increases in GHQ scores in 2018-2019 were higher in women than men (2.1 vs 1.3), those aged 16-18 than aged 22-24 (2.6 vs 0.9), those from white UK group versus other ethnic minorities, and those out of the labour force (3.6) or employed part time (2.2) than those employed full time (0.8). Compared with 2018-2019, psychological distress in 2020 also further increased among young adults residing in the most deprived areas (4.1 vs 1.2 in the least deprived areas). In 2020, losing one's job or most of one's work hours was associated with higher psychological distress and attenuated the differences between deprivation quartiles by 17%. CONCLUSION In England, inequalities in psychological distress among young adults may have changed and increased during the COVID-19 pandemic. Investing in opportunities for young adults, particularly in more deprived areas, may be key to improve population levels of mental health.
Collapse
Affiliation(s)
| | - Alita Nandi
- Institute for Social and Economic Research, University of Essex, Colchester, UK
| | | |
Collapse
|
27
|
Ellwardt L, Präg P. Heterogeneous mental health development during the COVID-19 pandemic in the United Kingdom. Sci Rep 2021; 11:15958. [PMID: 34354201 PMCID: PMC8342469 DOI: 10.1038/s41598-021-95490-w] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/26/2021] [Indexed: 11/09/2022] Open
Abstract
The COVID-19 pandemic and the mitigation measures by governments have upended the economic and social lives of many, leading to widespread psychological distress. We explore heterogeneity in trajectories of psychological distress during the pandemic in the United Kingdom and relate this heterogeneity to socio-demographic and health factors. We analyze nine waves of longitudinal, nationally representative survey data from the UK Household Longitudinal Study ([Formula: see text]), covering the period from early 2020 to mid-2021. First, latent class mixture modelling is used to identify trajectories of psychological distress. Second, associations of the trajectories with covariates are tested with multinomial logistic regressions. We find four different trajectories of distress: continuously low, temporarily elevated, repeatedly elevated, and continuously elevated distress. Nearly two fifths of the population experienced severely elevated risks of distress during the pandemic. Long-term distress was highest among younger people, women, people living without a partner, those who had no work or lost income, and those with previous health conditions or COVID-19 symptoms. Given the threat of persistent stress on health, policy measures should be sensitized to the unintended yet far-reaching consequences of non-pharmaceutical interventions.
Collapse
Affiliation(s)
- Lea Ellwardt
- Institute of Sociology and Social Psychology, University of Cologne, Albert-Magnus-Platz, 50935, Cologne, Germany.
| | - Patrick Präg
- Center for Research in Economics and Statistics, ENSAE, Institut Polytechnique de Paris, 91120, Palaiseau, France
| |
Collapse
|
28
|
Pierre M, Keller M, Altschul D, Fawns-Ritchie C, Hartley L, Nangle C, Edwards R, Dawson R, Campbell A, Flaig R, Porteous DJ. Socioeconomic position and mental health during the COVID-19 pandemic: a cross-sectional analysis of the CovidLife study. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16820.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has been linked to an increase in mental health problems. This study examined their association with socioeconomic position (SEP), as well as potential confounding and mediating factors. Methods: We analysed data from the CovidLife study (N=14,387; 66.4% female; mean [SD] age, 57.4 [13.9] years). Data were collected in an online survey of UK adults (aged 18 years or over) between 17 April and 7 June 2020. SEP measures included area deprivation (the Scottish Index of Multiple Deprivation [SIMD]), education level, household income, and employment status. Mental health was measured using the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7) scale. Worry indices were derived using principal component analysis. Logistic regression was used to estimate the associations between SEP and mental health. Results: Low SEP was associated with increased odds of depression and anxiety (odds ratio [OR] range 1.18-2.69). These associations remained significant after adjusting for age, sex, relationship status, and psychiatric history. Multivariable adjustment for medical worry and isolation during the pandemic had the largest attenuating effects (ranges 18-60% and 4-46%, respectively) on mental health outcomes. When adding further adjustment for the remaining SEP markers and all potential confounding and mediating factors, depression was associated with high area deprivation and low education level and income, whilst anxiety was only associated with low education level. No dose-response relationship was observed. Conclusions: SEP was inversely associated with mental health, which was mostly explained by medical worry and isolation during the COVID-19 pandemic. Mental health interventions might target these factors to prevent widening inequalities in mental health. Future studies should use longitudinal data to investigate the association.
Collapse
|
29
|
Wakui N, Abe S, Shirozu S, Yamamoto Y, Yamamura M, Abe Y, Murata S, Ozawa M, Igarashi T, Yanagiya T, Machida Y, Kikuchi M. Causes of anxiety among teachers giving face-to-face lessons after the reopening of schools during the COVID-19 pandemic: a cross-sectional study. BMC Public Health 2021; 21:1050. [PMID: 34078343 PMCID: PMC8171231 DOI: 10.1186/s12889-021-11130-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Coronavirus infections are spreading rapidly worldwide, and primary and middle schools are closed in many countries. After the state of emergency was lifted in Japan, schools have reopened, and teachers are conducting face-to-face classes while maintaining safety precautions. This study aimed to assess the factors contributing to infection-related anxiety and educational anxiety among teachers conducting face-to-face classes during the COVID-19 pandemic after schools reopened. METHODS This questionnaire-based cross-sectional study was conducted with 263 primary and middle school teachers in the Shinagawa area of Tokyo (October 10-30, 2020). The questionnaire assessed the type of school (primary or middle school), sex, age, and factors contributing to infection-related anxiety and educational anxiety that arose from the pandemic. The levels of anxiety and the factors contributing to anxiety were assessed using a 5-point Likert scale ranging from 1 (not at all) to 5 (very anxious). RESULTS In an analysis of the data of 237 participants excluding the missing data, many teachers reported feeling infection- and education-related anxiety. A majority of the participants were women (n = 152, 64.1%), and the mean age of the participants was 39.8 ± 11.3 years. A stepwise multiple regression analysis identified six factors for infection-related anxiety as significant (R2 = 0.61, p < 0.001). Among these variables, the largest partial regression coefficient value was reported for the following reason: "I feel anxious because we cannot ensure the safety of teachers themselves or of their families" (β = 0.37, p < 0.001). For educational anxiety, four of six reasons were identified as significant (R2 = 0.64, p < 0.001). Among these, "anxiety about the students' home situations" (β = 0.41, p < 0.001) and "delay in education (students' side)" (β = 0.27, p < 0.001) had stronger associations with anxiety compared to the others. CONCLUSION In-person education during the COVID-19 pandemic has caused teachers to experience anxiety. This report provides useful information by highlighting the reasons for infection-related anxiety and educational anxiety that teachers experience in face-to-face classes during a pandemic. Even if the coverage of a COVID-19 vaccine becomes widespread worldwide, we will still be combating COVID-19 infections for at least a few years. Given concerns regarding such infections, to ensure students' right to education, it is essential to understand why teachers feel anxious and to determine appropriate measures to decrease such anxiety.
Collapse
Affiliation(s)
- Nobuyuki Wakui
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, Tokyo, 142-8501, Japan.
| | - Shinichiro Abe
- Shinagawa Pharmaceutical Association, 2-4-2 Nakanobu, Shinagawa-ku, Tokyo, 142-0053, Japan
| | - Shunsuke Shirozu
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, Tokyo, 142-8501, Japan
| | - Yuuki Yamamoto
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, Tokyo, 142-8501, Japan
| | - Miho Yamamura
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, Tokyo, 142-8501, Japan
| | - Yasuyo Abe
- Shinagawa Pharmaceutical Association, 2-4-2 Nakanobu, Shinagawa-ku, Tokyo, 142-0053, Japan
| | - Souichi Murata
- Shinagawa Pharmaceutical Association, 2-4-2 Nakanobu, Shinagawa-ku, Tokyo, 142-0053, Japan
| | - Mizue Ozawa
- Shinagawa Pharmaceutical Association, 2-4-2 Nakanobu, Shinagawa-ku, Tokyo, 142-0053, Japan
| | - Takahiro Igarashi
- Shinagawa Pharmaceutical Association, 2-4-2 Nakanobu, Shinagawa-ku, Tokyo, 142-0053, Japan
| | - Takahiro Yanagiya
- Shinagawa Pharmaceutical Association, 2-4-2 Nakanobu, Shinagawa-ku, Tokyo, 142-0053, Japan
| | - Yoshiaki Machida
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, Tokyo, 142-8501, Japan
| | - Mayumi Kikuchi
- Shinagawa Pharmaceutical Association, 2-4-2 Nakanobu, Shinagawa-ku, Tokyo, 142-0053, Japan
| |
Collapse
|
30
|
Wright L, Steptoe A, Fancourt D. Are adversities and worries during the COVID-19 pandemic related to sleep quality? Longitudinal analyses of 46,000 UK adults. PLoS One 2021; 16:e0248919. [PMID: 33765097 PMCID: PMC7993810 DOI: 10.1371/journal.pone.0248919] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/08/2021] [Indexed: 12/19/2022] Open
Abstract
Background There are concerns that both the experience of adversities during the COVID-19 pandemic and worries about experiencing adversities will have substantial and lasting effects on mental health. One pathway through which both experience of and worries about adversity may impact health is through effects on sleep. Methods We used data from 46,284 UK adults in the COVID-19 Social Study assessed weekly from 01/04/2020-12/05/2020 to study the association between adversities and sleep quality. We studied six categories of adversity including both worries and experiences of: illness with COVID-19, financial difficulty, loss of paid work, difficulties acquiring medication, difficulties accessing food, and threats to personal safety. We used random-effect within-between models to account for all time-invariant confounders. Results Both the total number of adversity experiences and total number of adversity worries were associated with lower quality sleep. Each additional experience was associated with a 1.16 (95% CI = 1.10, 1.22) times higher odds of poor quality sleep while each additional worry was associated with a 1.20 (95% CI = 1.17, 1.22) times higher odds of poor quality sleep. When considering specific experiences and worries, all worries and experiences were significantly related to poorer quality sleep except experiences relating to employment and finances. Having a larger social network offered some buffering effects on associations but there was limited further evidence of moderation by other social or psychiatric factors. Conclusion Poor sleep may be a mechanism by which COVID-19 adversities are affecting mental health. This highlights the importance of interventions that support adaptive coping strategies during the pandemic.
Collapse
Affiliation(s)
- Liam Wright
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- * E-mail:
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| |
Collapse
|
31
|
Wright L, Steptoe A, Fancourt D. Are adversities and worries during the COVID-19 pandemic related to sleep quality? Longitudinal analyses of 46,000 UK adults. PLoS One 2021. [PMID: 33765097 DOI: 10.1101/2020.06.02.20120311v2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND There are concerns that both the experience of adversities during the COVID-19 pandemic and worries about experiencing adversities will have substantial and lasting effects on mental health. One pathway through which both experience of and worries about adversity may impact health is through effects on sleep. METHODS We used data from 46,284 UK adults in the COVID-19 Social Study assessed weekly from 01/04/2020-12/05/2020 to study the association between adversities and sleep quality. We studied six categories of adversity including both worries and experiences of: illness with COVID-19, financial difficulty, loss of paid work, difficulties acquiring medication, difficulties accessing food, and threats to personal safety. We used random-effect within-between models to account for all time-invariant confounders. RESULTS Both the total number of adversity experiences and total number of adversity worries were associated with lower quality sleep. Each additional experience was associated with a 1.16 (95% CI = 1.10, 1.22) times higher odds of poor quality sleep while each additional worry was associated with a 1.20 (95% CI = 1.17, 1.22) times higher odds of poor quality sleep. When considering specific experiences and worries, all worries and experiences were significantly related to poorer quality sleep except experiences relating to employment and finances. Having a larger social network offered some buffering effects on associations but there was limited further evidence of moderation by other social or psychiatric factors. CONCLUSION Poor sleep may be a mechanism by which COVID-19 adversities are affecting mental health. This highlights the importance of interventions that support adaptive coping strategies during the pandemic.
Collapse
Affiliation(s)
- Liam Wright
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| |
Collapse
|