COVID-19 and loneliness: A rapid systematic review

Context Matters: Internet Usage and Loneliness Among Middle-Aged and Older Adults During the COVID-19 Pandemic

OBJECTIVES

Later life is often categorized by higher-than-average levels of loneliness, but individual differences are vast and not well understood. Emerging evidence indicates that broad-based contextual factors such as the coronavirus disease 2019 (COVID-19) pandemic-and the use of the internet throughout-are differentially associated with the experience of loneliness. We, therefore, target internet usage and loneliness among middle-aged and older adults during the pandemic and examine the moderating role of age, gender, and limiting illness therein.

METHODS

We applied hierarchical regression models to data from the COVID-19 substudy Wave 1 (June/July 2020) of the English Longitudinal Study of Ageing (N = 4,790; Mage = 70.2; standard deviation = 9.0; range: 50-90; 43.5% male).

RESULTS

Infrequent internet use was associated with less loneliness compared with very frequent users-an association that strengthened with age. Conversely, the purpose of internet use was associated with more loneliness, with higher levels exhibited by those searching for health-related information-an effect stronger among those with a limiting illness.

DISCUSSION

Findings imply that infrequent internet use may reduce loneliness, while health-related internet searches may increase loneliness among older adults with different physical capacities. Findings are contrary to prepandemic reports, underscoring the importance of broad-based contextual factors for understanding loneliness across adulthood and old age.

The cumulative impact of trauma, chronic illness, and COVID-19 stress on mental health in a case-control study of adults with psychotic disorders in Ethiopia

BACKGROUND

The COVID-19 pandemic has profoundly impacted the economic, psychological, and social well-being of people in Ethiopia. Pandemic-related fears can exacerbate anxiety and depression symptoms among those with pre-existing physical and mental health conditions as well as those with prior exposure to traumatic events.

METHODS

We used data from the Ethiopia NeuroGAP-Psychosis study (898 cases and 941 controls with and without a diagnosis of psychosis respectively, 66% male, mean age = 37 years). Data was collected between November 2021 and June 2022 during the COVID-19 pandemic from four hospitals in Ethiopia (three in Addis Ababa and one in Jimma city). Structural equation modeling analysis was conducted to examine the associations between trauma exposure, physical health conditions (like arthristis, neurological disorders, diabetes), COVID-19 stress, and psychological distress (depression and anxiety symptoms). We assessed direct and indirect effects for mediation, and conducted multigroup analysis to examine moderation by case control status.

RESULTS

We found evidence that the impact of greater trauma exposure and physical health conditions on higher psychological distress was mediated through higher COVID-19 stress. Sociodemographic characteristics (older age and being maried) were associated with higher psychological distress, with these associations mediated through greater trauma, physical health conditions, and COVID-19 stress. Case-control status also moderated the associations between these variables, with the mediation effects being stronger in cases and weaker in controls. Further, cases reported greater trauma and psychological distress, while controls reported more physical health conditions and COVID-19 stress.

IMPLICATIONS

Our findings uniquely assess the interaction of health and emergency related factors in understudied settings like Ethiopia. They underscore the importance of including daily hardships and environmental stressors, along with prior trauma exposure, as risk factors for the assessment of mental health symptoms. This study has key implications for mental health screening and intervention research in response to complex emergency contexts like Ethiopia with a history of armed conflict in addition to the COVID-19 pandemic. Our findings can aid the development of targeted services that address the mental health of at-risk groups with pre-existing mental and physical health conditions.

Comparing cognitive behavioral therapy and social prescribing in patients with loneliness on long-term opioid therapy to reduce opioid misuse: protocol for a randomized controlled trial

BACKGROUND

Patients with chronic pain on opioids frequently experience loneliness, which is associated with poorer health outcomes and higher risk for opioid misuse and opioid use disorder. Given that almost half of opioids are prescribed in primary care, a critical need exists for the development and testing of interventions to reduce loneliness in primary care patients at risk for opioid misuse. Cognitive behavioral therapy and social prescribing have been shown to be efficacious in reducing loneliness and improving outcomes in other populations but have not been tested in patients at risk for substance use disorder. The overall objective of our study is to reduce opioid misuse and opioid use disorder by addressing loneliness in patients on long-term opioid therapy in real-world primary care settings.

METHODS

We will conduct a 3-arm pragmatic, randomized controlled trial to compare the effectiveness of two group-based, telehealth-delivered interventions with treatment as usual: (1) cognitive behavioral therapy to address maladaptive thought patterns and behaviors around social connection and (2) a social prescribing intervention to connect participants with social opportunities and develop supportive social networks. Our primary outcome is loneliness as measured by the UCLA Loneliness Scale and our dependent secondary outcome is opioid misuse as measured by the Common Opioid Misuse Measure. We will recruit 102 patients on long-term opioid therapy who screen positive for loneliness from 2 health care systems in Washington State. Implementation outcomes will be assessed using the RE-AIM framework.

DISCUSSION

Our study is innovative because we are targeting loneliness, an under-addressed but critical social risk factor that may prevent opioid misuse and use disorder in the setting where most patients are receiving their opioid prescriptions for chronic pain. If successful, the project will have a positive impact in reducing loneliness, reducing opioid misuse, improving function and preventing substance use disorder.

TRIAL REGISTRATION

NCT06285032, issue date: February 28, 2024, original.

Comparing Loneliness, Social Inactivity, and Social Isolation: Associations with Health-Related Quality of Life and Mortality among Home-Dwelling Older Adults

INTRODUCTION

Loneliness, social inactivity, and social isolation are intertwined concepts. When assessed separately, they indicate poor well-being, adverse health effects, and increased mortality. Studies exploring overlapping and comparing the prognosis of these concepts are scarce. We investigated (1) overlapping of concepts of loneliness, social inactivity, and social isolation, (2) characteristics of groups: group 0 (not lonely, socially inactive, or socially isolated), group 1 (lonely), group 2 (not lonely but socially inactive and/or socially isolated), and (3) the health-related quality of life (HRQoL), psychological well-being (PWB), and 3.6-year mortality of these groups.

METHODS

The home-dwelling older adults (n = 989; 75 y+) of the Helsinki Aging Study in 2019-2022 completing all required questionnaires were assessed. Group 0 included 494, group 1 included 280, and group 2 included 215 participants. Variables studied were demographics, diagnoses, mobility, physical functioning (Barthel index), and cognition (Mini-Mental State Examination). Outcomes were HRQoL (15D) and PWB. Mortality was retrieved from central registers.

RESULTS

Half of the sample was lonely, socially inactive, or socially isolated, but only 2% were simultaneously lonely, socially inactive, and socially isolated. Of lonely participants, 38% were also socially inactive and/or socially isolated. The lonely participants were significantly more often widowed or lived alone and had the lowest HRQoL and poorest PWB compared with the other groups. After adjustments (age, sex, Charlson Comorbidity Index), mortality did not statistically differ between the groups.

CONCLUSION

Loneliness is an independent determinant of poor HRQoL and PWB, and it should be considered separately from social inactivity and social isolation.

Evaluation of the effects of pandemic-related fears on anxiety and depression: the mediating roles of traumatic stress and loneliness

BACKGROUND

The detrimental mental health effects which emerged from COVID-19 have profoundly affected healthcare workers (HCWs) worldwide. The aim of this study was to investigate the mediating effects of traumatic stress and loneliness on the fears of contracting and dying from COVID-19, and anxiety and depression of HCWs during the pandemic.

METHODS

A cross-sectional online survey was completed by HCWs in a province of Turkey. The Hospital Anxiety Depression Scale, Impact of Events Scale-Revised and numerical rating scales (for fears of COVID-19 and loneliness) were used and a bootstrap approach was used in the analyses with SPSS PROCESS macro software.

RESULTS

Of the HCWs evaluated, 150 (34.4%) were doctors, with a mean duration of work experience of 10.6 ± 7.5 years. The results indicated that fear of contracting COVID-19 was directly related to anxiety (β = 0.244, p < 0.001) and depression (β = 0.135, p < 0.01) and that traumatic stress and loneliness mediated the relationships between the fear of contracting COVID-19 and anxiety (β = 0.435, p < 0.001; β = 0.235, p < 0.001, respectively) and depression (β = 0.365, p < 0.001; β = 0.294, p < 0.001, respectively). The fear of dying from COVID-19 was determined to be directly associated with anxiety (β = 0.190, p < 0.001) but not with depression (β = 0.066, p = 0.116), and traumatic stress and loneliness mediated the relationships between the fear of dying from COVID-19 and anxiety (β = 0.476, p < 0.001; β = 0.259, p < 0.001, respectively) and depression (β = 0.400, p < 0.001; β = 0.311, p < 0.001, respectively).

CONCLUSIONS

The study results demonstrated the important roles of traumatic stress and loneliness in exacerbating the negative consequences of fears of COVID-19 on anxiety and depression, and provide insights for identifying HCWs at greater risk.

Exploring the effects of COVID-19-related traumatic events on the mental health of university students in Brazil: A cross-sectional investigation

University students are vulnerable to mental health issues during their academic lives. During the COVID-19 pandemic, university students faced mental distress due to lockdowns and the transition to e-learning. However, it is not known whether these students were also affected specifically by COVID-19-related traumatic events. This study examined the impact of COVID-19-related traumatic events on 2277 university students from two federal institutions of higher education in Brazil. The university students completed an online questionnaire covering demographics, lifestyle habits, health characteristics, COVID-19-related traumatic events, and depression, anxiety, and stress symptoms. The results showed that an increased intensity of COVID-19-related traumatic events was positively associated with stress, anxiety, and depressive symptoms, and each specific type of event was associated with these symptoms. In addition, we found a negative association between these symptoms and male sex and age and a positive association with having or having had a history of cardiovascular, respiratory, neurological, or mental disorders or another disease diagnosed by a physician. In conclusion, this study emphasizes the heightened risk of mental health issues in university students in the face of COVID-19-related traumatic events. Women, young people and people who have or have had a history of disease were the most vulnerable to mental health issues during the COVID-19 pandemic.

The effect of job and personal demands and resources on healthcare workers' wellbeing: A cross-sectional study

The COVID-19 pandemic presented many psychological stressors which affected healthcare worker wellbeing. The aim of this study was to understand the factors that affect the wellbeing of healthcare professionals in the Kingdom of Saudi Arabia using Job-Demand and Resource (JD-R) Model. The proposal model consisted of demand factors (Work load-job demand, loneliness-personal demand), support factors (organizational support-job resource, and resilience-personal resource), mediators (burnout and work engagement), and outcome (wellbeing) A cross-sectional, descriptive study was conducted across 276 healthcare workers from hospitals and primary healthcare centers, including healthcare professionals, health associate professionals, personal care workers, health management and support personnel, and health service providers, and others between February-March 2022. The proposed model was tested using partial least squares structural equation modeling. Among the respondents, the majority were female (198, 71,7%), married (180, 65.2%), healthcare professionals (206, 74.6%), being more than 10 years in the profession (149, 51.6%), and non-Saudi nationality (171, 62.0%). Burnout accounted for a significant effect on wellbeing. Of the demands (workload and loneliness) and the resources (organizational support and resilience), workload had the greatest impact on burnout. Healthcare organizations should invest in reducing workloads and promoting resilience to reduce burnout and increase healthcare worker wellbeing.

Health and Wellbeing of Regional and Rural Australian Healthcare Workers during the COVID-19 Pandemic: Baseline Cross-Sectional Findings from the Loddon Mallee Healthcare Worker COVID-19 Study-A Prospective Cohort Study

BACKGROUND

Coronavirus 19 (COVID-19) has created complex pressures and challenges for healthcare systems worldwide; however, little is known about the impacts COVID-19 has had on regional/rural healthcare workers. The Loddon Mallee Healthcare Worker COVID-19 Study (LMHCWCS) cohort was established to explore and describe the immediate and long-term impacts of the COVID-19 pandemic on regional and rural healthcare workers.

METHODS

Eligible healthcare workers employed within 23 different healthcare organisations located in the Loddon Mallee region of Victoria, Australia, were included. In this cohort study, a total of 1313 participants were recruited from November 2020-May 2021. Symptoms of depression, anxiety, post-traumatic stress, and burnout were measured using the Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7), Impact of Events Scale-6 (IES-6), and Copenhagen Burnout Inventory (CBI), respectively. Resilience and optimism were measured using the Brief Resilience Scale and Life Orientation Test-Revised (LOT-R), respectively. Subjective fear of COVID-19 was measured using the Fear of COVID-19 Scale.

RESULTS

These cross-sectional baseline findings demonstrate that regional/rural healthcare workers were experiencing moderate/severe depressive symptoms (n = 211, 16.1%), moderate to severe anxiety symptoms (n = 193, 14.7%), and high personal or patient/client burnout with median total scores of 46.4 (IQR = 28.6) and 25.0 (IQR = 29.2), respectively. There was a moderate degree of COVID-19-related fear. However, most participants demonstrated a normal/high degree of resilience (n = 854, 65.0%). Based on self-reporting, 15.4% had a BMI from 18.5 to 24.9 kgm2 and 37.0% have a BMI of 25 kgm2 or over. Overall, 7.3% of participants reported they were current smokers and 20.6% reported alcohol consumption that is considered moderate/high-risk drinking. Only 21.2% of the sample reported consuming four or more serves of vegetables daily and 37.8% reported consuming two or more serves of fruit daily. There were 48.0% the sample who reported having poor sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI).

CONCLUSION

Regional/rural healthcare workers in Victoria, Australia, were experiencing a moderate to high degree of psychological distress during the early stages of the pandemic. However, most participants demonstrated a normal/high degree of resilience. Findings will be used to inform policy options to support healthcare workers in responding to future pandemics.

The impact of COVID-19 on the peer relationships of adolescents around the world: A rapid systematic review

The main objective of this rapid systematic review was to examine how the COVID-19 pandemic impacted peer relationships for adolescents (10-25 years of age) around the globe. We focused on four indices of peer relationships: (1) loneliness, (2) social connectedness, (3) social support, and (4) social media use. In addition, we examined gender and age differences. Four databases (APA PsychInfo, PubMed, Scopus, and Web of Science) were searched for articles published from January 2020 to November 2022. A total of 96 studies (cross-sectional: n = 66, longitudinal: n = 30, quantitative: n = 67, qualitative: n = 12, mixed-methods: n = 17) met our inclusion criteria (empirical observational studies with data on at least one of the indices of interest, cross-sectional data on COVID-19-related experiences or longitudinal data collected during the pandemic, age range of 10-25 years, typically developing adolescents). We extracted data and conducted a narrative synthesis. Findings suggest that COVID-19 disruptions negatively impacted peer relationships for youth. Most studies reported either an increase in loneliness over the course of the pandemic or a positive association between loneliness and COVID-19-related experiences. Similar findings were observed for increased social media use as a means of continued communication and connection. Fewer studies focused on social support but those that did reported a decrease or negative association with COVID-19-related experiences. Lastly, findings suggest a mixed impact on social connectedness, which might be due to the strengthening of closer ties and weakening of more distant relationships. Results for gender differences were mixed, and a systematic comparison of differences across ages was not possible. The heterogeneity in measures of COVID-19-related experiences as well as timing of data collection prevented a more nuanced examination of short and more long-term impacts.

A controlled evaluation of social prescribing on loneliness for adults in Queensland: 8-week outcomes

Introduction

There have been few controlled evaluations of Social Prescribing (SP), in which link workers support lonely individuals to engage with community-based social activities. This study reports early outcomes of a trial comparing General Practitioner treatment-as-usual (TAU) with TAU combined with Social Prescribing (SP) in adults experiencing loneliness in Queensland.

Methods

Participants were 114 individuals who were non-randomly assigned to one of two conditions (SP, n = 63; TAU, n = 51) and assessed at baseline and 8 weeks, on primary outcomes (loneliness, well-being, health service use in past 2 months) and secondary outcomes (social anxiety, psychological distress, social trust).

Results

Retention was high (79.4%) in the SP condition. Time × condition interaction effects were found for loneliness and social trust, with improvement observed only in SP participants over the 8-week period. SP participants reported significant improvement on all other outcomes with small-to-moderate effect sizes (ULS-8 loneliness, wellbeing, psychological distress, social anxiety). However, interaction effects did not reach significance.

Discussion

Social prescribing effects were small to moderate at the 8-week follow up. Group-based activities are available in communities across Australia, however, further research using well-matched control samples and longer-term follow ups are required to provide robust evidence to support a wider roll out.

COVID-19 pandemic stress and cancer symptom burden

OBJECTIVES

In a sample of patients with cancer (n=1145) who were assessed during the height of the COVID-19 pandemic, latent profile analysis was used to identify subgroups of patients with distinct stress profiles and to evaluate for differences in demographic and clinical characteristics and symptom severity scores among these subgroups.

METHODS

Patients completed measures of cancer-specific and COVID-19 stress, global stress, social isolation, loneliness, depression, state and trait anxiety, morning and evening fatigue, morning and evening energy, sleep disturbance, cognitive function, and pain. Latent profile analysis was used to identify subgroups of patients with distinct stress profiles. Differences among the subgroups in study measures were evaluated using parametric and non-parametric tests.

RESULTS

Using clinically meaningful cut-off scores for the stress measures, four distinct stress profiles were identified (ie, none class (51.3%); low stress and moderate loneliness class (24.4%), high stress and moderate loneliness class (14.0%), and very high stress and moderately high loneliness class (high, 10.3%)). Risk factors associated with membership in the high class included: younger age, lower annual household income, lower functional status and higher comorbidity burden. The two worst stress profiles reported clinically meaningful levels of all of the common symptoms associated with cancer and its treatments.

CONCLUSION

Findings from this study, obtained prior to the availability of COVID-19 vaccines and anti-viral medications, provide important 'benchmark data' to evaluate for changes in stress and symptom burden in patients with cancer in the postvaccine era and in patients with long COVID-19.

Individual Differences on Wellbeing Indices during the COVID-19 Quarantine in Greece: A National Study

The impact of COVID-19 and the associated lockdown measures on people's physical and mental wellbeing, as well as their daily lives and functioning, has been extensively studied. This study takes the approach of investigating the consequences of COVID-19 on a national scale, considering sociodemographic factors. The main objective is to make a contribution to ongoing research by specifically examining how age, gender, and marital status influence the overall impact of COVID-19 and wellbeing indicators during the second lockdown period that was implemented in response to the COVID-19 pandemic in the Greek population. The study involved a sample of 16,906 individuals of all age groups in Greece who completed an online questionnaire encompassing measurements related to personal wellbeing, the presence and search for meaning in life, positive relationships, as well as symptoms of depression, anxiety, and stress. Additionally, to gauge the levels of the perceived COVID-19-related impact, a valid and reliable scale was developed. The results reveal that a higher perception of COVID-19 consequences is positively associated with psychological symptoms and the search for meaning in life, while being negatively correlated with personal wellbeing and the sense of meaning in life. In terms of individual differences, the findings indicate that unmarried individuals, young adults, and females tend to report higher levels of psychological symptoms, a greater search for meaning in life, and a heightened perception of COVID-19-related impact. These findings are analyzed in depth, and suggestions for potential directions for future research are put forth.

The Integrated Health Monitor COVID-19: A Protocol for a Comprehensive Assessment of the Short- and Long-Term Health Impact of the Pandemic in the Netherlands

BACKGROUND

The global COVID-19 pandemic has profoundly affected public health. Directly, the pandemic resulted in over 6.6 million deaths, numerous hospitalizations, and widespread illness. The pandemic has also affected health indirectly through government-imposed protective measures, causing decline in mental well-being and increasing social isolation. Unlike previous disasters or crises, the pandemic's worldwide and enduring impact necessitates a unique research approach. The Network for Health Research in Disasters in the Netherlands responded by initiating a longitudinal, extensive research project called the Integrated Health Monitor COVID-19. The Integrated Health Monitor COVID-19 explores both the direct and indirect health effects of the pandemic at the population level.

METHODS

The Integrated Health Monitor COVID-19 employs a dual-pronged monitoring strategy alongside an annual literature review. This strategy comprises short-cycle monitoring (conducted quarterly) and long-cycle monitoring (conducted once every one or two years). This comprehensive approach enables the evaluation of health trends during the pandemic, facilitating comparisons with pre-pandemic levels and identification of risk and protective factors. Both monitoring methods incorporate data from surveys and general practice registries. The integration of annual literature reviews with these measurements enables iterative research, while dialogues on policy and practice improvements enhance the knowledge-to-action process.

DISCUSSION

Much of the existing knowledge about the potential impact of the COVID-19 pandemic is derived from research on sudden-onset disasters limited to specific geographical areas. This study is anticipated to provide valuable fresh insights into the evolving dynamics of population health and specific vulnerabilities within the ongoing pandemic context.

Can Resilience Buffer the Effects of Loneliness on Mental Distress Among Working-Age Adults in the United States During the COVID-19 Pandemic? A Latent Moderated Structural Modeling Analysis

BACKGROUND

The profound health consequences of loneliness are well-established. However, less is known about the protective factors which may alleviate the effects of loneliness on mental health especially among working-age adults amidst the COVID-19 pandemic. We draw on the social ecology of resilience and examine whether resilience factors can buffer the effects of loneliness on mental distress.

METHODS

Data came from the National Well-being Survey-a national study of a demographically representative sample of U.S. working-age adults (N = 4014). We used (a) structural equation models with latent variables to examine the main effects of loneliness, psychological resilience, and perceived social support on mental distress, and (b) latent moderated structural equations to estimate the latent interaction effects.

RESULTS

Results revealed that (a) loneliness was positively associated with mental distress and psychological resilience was negatively related to mental distress, and (b) psychological resilience and perceived social support moderated the strength of the relationship between loneliness and mental distress.

CONCLUSIONS

Our study highlights the importance of psychological resilience and perceived social support as two protective factors in the relationship between loneliness and mental distress. Given that loneliness significantly predicts worse mental and physical health and higher mortality, identifying protective factors that might disrupt these connections is vital. As such, public health efforts to strengthen and expand familial and community social support networks and foster psychological resilience are urgently needed to support mental health among working-age adults during additional waves of the pandemic or future similar stressors.

Attitudes and perceptions towards public health safety measures during a global health crisis: Social and personal consequences

The COVID-19 pandemic that spread throughout the globe has significantly altered our social and personal relationships. During the early phase of the pandemic, pharmaceutical interventions such as vaccine research and production were still in development, with international health agencies and governments promoting public health safety measures such as limiting mobility, school and work closures, lockdowns, economic incentives, mask-wearing, social distancing, quarantine, and hygiene to reduce the spread and flatten the curve regarding transmission and hospitalization. During the early wave (May 2020 through July 2020), we utilized a qualitative longitudinal research design coupled with weekly Zoom diary entries to investigate participant (n = 14) experiences. In doing so, we captured participant attitudes towards public health safety measures, as well as perceptions of social and interpersonal relationships during the pandemic. The main themes that emerged in our findings include feelings of safety and preparedness, personal accountability and collective responsibility, and changes to social life and relationships. While individuals have learned how to live with the pandemic, and have a new sense of normalcy, lessons learned from the impact of public health measures and social relationships have applicability moving forward post-pandemic. In particular, how to best protect against the deleterious effects of isolation during a future public health crisis.

Pain Trajectories among U.S. Veterans During COVID-19

Physical pain is highly prevalent among military veterans. As stress can impact pain, COVID-19-related stressors may have heightened pain among veterans. A prospective analysis of pain could advance understanding of how veterans fared during COVID-19 and lend knowledge of risk factors important beyond the pandemic. The present study employs growth mixture modeling with a sample of U.S. veterans high in pain (N = 1,230) followed from just before COVID-19 (February 2020) to 12 months later (February 2021; 81.7% retention). We explored heterogeneous pain trajectories as well as baseline and COVID-19-related predictors of pain. Results revealed 4 pain trajectory classes: 1) Chronic Pain (17.3% of the sample); 2) Decreasing Pain (57.2% of the sample); 3) Stable Mild Pain (19.8% of the sample); and 4) Increasing Pain (5.7% of the sample). Those with childhood trauma exposure were especially likely to report chronic pain. Female and racial/ethnic minority veterans were also relatively likely to fare poorly in pain. Loneliness was associated with subsequent pain among several classes. Most veterans in our sample fared better than expected in terms of pain. However, as those with childhood trauma and certain disadvantaged groups were less likely to fare well, we add to the important literature on disparities in pain. Clinicians should identify whether loneliness and other factors impacted pain during COVID-19 among their patients to inform ongoing, person-centered pain management approaches. PERSPECTIVE: This article presents pain trajectories and correlates of pain among a high-pain sample of U.S. veterans surveyed prior to and during COVID-19. Pain clinicians should screen for childhood trauma and remain vigilant in addressing health disparities.

A Rapid Systematic Review of the Prevalence of Suicide and Self-Harm Behaviors in Adolescents During the COVID-19 Pandemic

Background: COVID-19 has caused psychological, social, and physical isolation in adolescents resulting in varying rates of suicidal behavior and self-harm. Aims: We investigated the pandemic's impact on adolescent suicidal behavior and self-harm by reviewing the existing literature. Methods: We searched PubMed using keywords: adolescent, suicide, suicidal behavior, self-harm, prevalence, and COVID-19 and included studies reporting primary data only. Results: Of the 551 studies identified, we included 39 studies in the final analysis. Two of the six high-quality population-based suicide registry studies reported increased suicide rates during the pandemic. Seven of fifteen emergency department-based studies out of which four were of high quality and three high-quality population-based health registry studies reported increased self-harm. A few school and community-based surveys and national helpline data also reported an increase in suicidal behavior or self-harm. Limitations: Methodological heterogeneity of the included studies. Conclusions: There is wide variation in study methodology, population, settings, and age groups in the included studies. Suicidal behavior and self-harm were increased in specific study settings and adolescent populations during the pandemic. More methodologically rigorous research is needed to evaluate the impact of COVID-19 on adolescent suicidal behavior and self-harm.

Deepening Depression in Women Balancing Work-Life Responsibilities and Caregiving during the COVID-19 Pandemic: Findings from Gender-Specific Face-to-Face Street Interviews Conducted in Italy

PURPOSE

This study investigated the impact of the COVID-19 pandemic on mental health, quality of life, and family functioning in a sample of the general female population, exploring difficulties encountered in managing family and work responsibilities and burden of care when taking care of a loved one. This study was, moreover, aimed at investigating factors capable of influencing severe depressive symptomatology in the context of socio-demographics, traumatic events, individual vulnerability, and family functioning.

METHOD

The sampling method used in this research was non-probability sampling. The survey took place during a Hospital Open Weekend (8-10 October 2021) organized by the National Gender Observatory on Women's Health "Fondazione Onda" on the occasion of the World Mental Health Day.

RESULTS

A total of 211 women were interviewed (mean age = 35.6, 53% living alone, more than 15% with financial difficulties, 47% exposed to the 2009 L'Aquila earthquake). More than 50% of the sample reported a higher complexity in managing their lives during the COVID-19 pandemic compared to their previous routine, with no statistically significant differences between working women and non-workers, although the latter obtained higher scores for depressive symptomatology and poorer quality of life. Compared to non-caregivers, female caregivers (22.3%) in charge of the care of loved ones affected by physical (10.9%) or psychiatric disabilities (11.4%) complained of a poorer quality of life, especially in general health perception (p = 0.002), physical function (p = 0.011), role limitations related to physical problems (p = 0.017), bodily pain (p = 0.015), mental health (p = 0.004), and social functioning (p = 0.007). Women caring for people affected by mental disorders seemed to experience a more significant worsening in vitality (p = 0.003) and social functioning (p = 0.005). Approximately 20% of the total sample reported severe depressive symptomatology. Previous access to mental health services (O.R. 10.923; p = 0.000), a low level of education (O.R. 5.410; p = 0.021), and difficulties in management of everyday lives during the COVID-19 pandemic (O.R. 3.598; p = 0.045) were found to be the main variables predictive of severe depressive psychopathology. Old age, good problem-solving skills, and ability to pursue personal goals were identified as protective factors.

CONCLUSIONS

The COVID-19 pandemic underlined the need for support amongst emotionally vulnerable women with pre-existing mental health conditions, partly reflecting the cumulative effects of traumas.

Correlates of anxiety and depressive symptoms in inpatients with COVID-19 in Taiwan

Objectives

Inpatients with COVID-19 may experience high levels of anxiety and depressive symptoms during the pandemic. No prior study has examined these symptoms with COVID-19 inpatients in Taiwan. Using data from a tertiary hospital in Northern Taiwan, we investigated anxiety and depressive symptoms and the associated sociodemographic or clinical characteristics in these patients.

Methods

Data of anxiety and depressive symptoms by the Hospital Anxiety and Depression Scale (HADS) as well as the sociodemographic and clinical correlates were retrospectively retrieved and analyzed for COVID-19 patients admitted to Far Eastern Memorial Hospital from June 4 to June 28, 2021.

Results

In total, 152 patients with COVID-19 were included. Among all the COVID-19 inpatients, 9.9 % (n = 15) had an HADS anxiety score of ≥8 and 7.2 % (n = 11) had an HADS depression score of ≥8. COVID-19 inpatients with HADS anxiety score ≥8 or HADS depression score ≥8 were found to have a longer length of hospital stay compared to the respective comparison group. The female patients, patients aged >55 years, and patients hospitalized for >15 days had significantly higher anxiety scores than did the corresponding comparison groups.

Conclusion

COVID-19 inpatients with either anxiety or depression were associated with longer length of hospital stay. Age, sex, and hospitalization length were found to be associated with anxiety symptoms in inpatients with COVID-19. Future studies are warranted to elucidate differential mechanisms potentially related to anxiety and depressive symptoms in patients with COVID-19.

Perceptions of everyday life during lenient COVID-19 restrictions in Sweden- an interview study

BACKGROUND

Both COVID-19 and its associated societal restrictions have affected individuals' health and everyday life. In Sweden, more lenient public health restrictions were implemented, with individuals asked to act responsibly in terms of reducing spread of disease. The majority of studies reporting on experiences of Covid-19 restrictions have been in the context of more substantial mandatory rules aimed at reducing social contact, therefore it is important to describe how more lenient restrictions have impacted individuals' well-being. This study aims to describe perceptions of everyday life during the first wave of the COVID-19 pandemic, perceived by individuals with no underlying medical condition, and living with more lenient public health restrictions in Sweden.

METHOD

The participants were recruited from individuals who originally had participated in an online survey about life satisfaction, health, and physical activity. Fifteen individuals (median age 49, range 26-76 years, seven women) in various social situations, such as living alone/cohabiting, having children at home, geographical area and size of city were interviewed. Qualitative content analysis was applied to the data.

RESULTS

An overall theme "Both hindrances and opportunities in important life domains were experienced within the same person during lenient Covid-19 restrictions" was derived and covered three categories: "New possibilities of flexibility in work and better health", "Life went on as usual with minor adjustments" and "Everyday life changed and became more difficult" together with eight subcategories. For most participants, both facilitating and hindering important domains in life were described. Unexpected findings were positive experiences regarding working from home, physical activities, leisure time activities and the balance between work and leisure time. In areas where only minor adjustments were made, life was perceived as going on as before. On the other hand, restrictions increased worries and were perceived to have negative effects on social participation.

CONCLUSION

The impact of the pandemic and lenient restrictions in Sweden on the participants´ everyday life was multifaceted. Both hindrances and opportunities in important life domains were experienced within the same person. An increased flexibility in work- and leisure activities were perceived having positive effects for health and wellbeing and led to a better balance in life.

Green and blue spaces, COVID-19 lockdowns, and mental health: An Australian population-based longitudinal analysis

Australia experienced some of the world's longest and most stringent lockdowns during the COVID-19 pandemic. While lockdown measures had consequences for mental health, investigation is lacking on the potential for green and blue space coverage within people's local environments to ameliorate the impact of lockdowns with varied lengths using longitudinal cohorts. This study examined the impact of lockdown durations on population mental health and tests the effect modification of neighbourhood green and inland and coastal blue space coverage in metropolitan areas. We merged population-based longitudinal data on more than 11,000 individuals collected over a ten-year period from 2012 to 2021 with national land use data describing green and blue space coverage. We used fixed effect models to estimate the relationship between lockdowns (with different durations and staggered introduction) and mental health, controlling for sociodemographic, health, and geographical confounders, and tested the significance of effect modification of green and blue space. Results show that extended lockdowns led to considerably larger decreases in mental health (COVID-y1: -2.66, 95%CI: -3.43, -1.89; COVID-y2: -2.65, 95%CI: -3.33, -1.97) relative to short lockdowns. The mental health effect of lockdowns was smaller where green spaces and inland and coastal blue spaces were available. Effect modification was statistically significant for green space, with smaller negative mental health effects observed where there was sizeable green space coverage, particularly during long lockdowns (COVID-y1: -2.69, 95%CI: -3.63, -1.76 for coverage <5%; -3.27, 95%CI: -4.70, -1.84 for coverage 5%-10%; -0.60, 95%CI: -2.03, 0.83 for coverage ≥30%; COVID-y2: -2.74, 95%CI: -3.62, -1.87 for coverage <5%, -2.95, 95%CI: -3.98, -1.92 for coverage 5%-10%; -2.08, 95%CI: -3.28, -0.88 for coverage ≥30%). Findings support the consideration of nature exposure to improve people's mental wellbeing and resilience when designing lockdown measures in response to future public health emergencies.

Association of loneliness and social isolation with mental disorders among medical residents during the COVID-19 pandemic: A multi-center cross-sectional study

BACKGROUND

Loneliness and social isolation usually increase the risk of mental disorders. However, this association among Chinese medical residents during the COVID-19 pandemic remains unclear.

METHODS

This study was conducted in September 2022; 1,338 medical residents from three hospitals in Northeastern China were included in the final analysis. The data were collected via online self-administered questionnaires. Adjusted odds ratios and 95% confidence intervals were determined for adjusting for potential confounders by binary logistic regression.

RESULTS

Among the 1,338 participants, 12.93% (173), 9.94% (133), and 9.72% (130) had experienced major depression, major anxiety, and suicidal ideation, respectively. Further, 24.40% (327) and 44.50% (596) of the total participants had experienced loneliness and social isolation. Loneliness increased the risk of major depression, major anxiety, and suicidal ideation (all p<0.001); Compared with the lowest quartile, the odds ratios of the highest quartile were 4.81, 4.63, and 5.34. The same result was obtained in relation to social isolation (all p<0.001).

CONCLUSIONS

The findings of this study revealed a considerable prevalence of loneliness, social isolation, and mental disorders among Chinese medical residents during the COVID-19 pandemic. Both loneliness and social isolation increased the risk of major depression, major anxiety, and suicidal ideation.

Quality of life of a healthy polish population due to sociodemographic factors during the COVID-19 pandemic - a cross-sectional study

Introduction

The quality of life should be studied in every person, both among the sick and healthy. Sociodemographic factors affect the level of the perceived quality of life (QoL), and especially in the situation of the COVID-19 pandemic, which forced the enforcement of certain behaviours in society, such as social distancing, as well as introduced panic and fear for one's own health and life. The main aim of the study was to assess the quality of life in the group of people without the disease, to assess the impact of sociodemographic factors on QoL during the pandemic.

Material and method

3,511 healthy people were included in the study. The inclusion criteria of the study were: age of respondents over 18 years, no continuously administered medicaments, no diagnosed chronic diseases and no treatment in specialist clinics as well as lack of positive COVID-19 test in 4 weeks before the examination. The SF-36 questionnaire was used to assess the quality of life. The student's t-test and intergroup comparisons were used in 7 age groups. Factors such as age, gender, place of residence, education, civil status, employment status, smoking, and physical activity were assessed.

Results

The lowest average QoL level in the studied population was recorded in the Mental Component Summary (MCS) dimension (X = 47.9;Cl:47.6-48.3). A high correlation between age and the SF-36 spheres was noted in the following spheres: physical functioning (PF), role physical (RP), Physical Component Summary (PCS), and ILQ (p < 0.001). The highest chance of a better QoL in the PCS dimension among men was recorded in the 30-39 age group (OR = 3.65;Cl:1.13-11.79). In the group of people over 50 years of age living in the village, there was a greater chance of a better QoL in the PCS dimension in each age group. Practicing physical activity was significantly more often conditioned by a higher chance of developing a better QoL (p < 0.05). In the group of people ≥80 years of age, there was a greater than 4 times higher chance of developing a better quality of life in terms of MCS among physically active people (OR = 4.38;Cl:1.62-11.83).

Conclusion

With age, QoL decreases among people with disabilities. Men are more likely to assess their health better. A better QoL among women occurs at age 80 and later. A higher level of education often determined a significantly higher level of QoL felt. The practising of recreational physical activity and the lack of smoking habit determined a higher level of QoL more often. Smoking provided a greater chance of a better QoL in ILQ in the group of people ≥80 years.

Mental health across two years of the COVID-19 pandemic: a 5-wave longitudinal study in Germany

The COVID-19 pandemic has been negatively associated with mental health. However, little is known about the temporal dynamics of mental health in the longer term of the pandemic. We aimed to investigate symptom levels and changes of depression, anxiety, posttraumatic stress, and loneliness spanning two years of the pandemic; and to examine associated risk factors. This five-wave, longitudinal online study from May 2020 to April 2022 included 636 adults (Mage = 39.5 years, SD = 16.11; 84.1% female) from the German general population who completed the international COVID-19 Mental Health Survey. Symptoms of anxiety (Generalized Anxiety Disorder-7; GAD-7), depression (Patient Health Questionnaire-9; PHQ-9), posttraumatic stress (PTSD Checklist for DSM-5; PCL-5), and loneliness ("Do you feel lonely?") were assessed using mixed-effects models. Associations with anxiety and depressive symptoms were examined with having children, student status, financial worries, contamination fear, and loneliness. PHQ-9, GAD-7, PCL-5, and loneliness scores overall decreased throughout the two-year period of the pandemic but exhibited an increase during two national lockdowns. Controlled for significant associations with female gender and younger age, increased PHQ-9 and GAD-7 scores were associated with contamination fear, financial worries, and loneliness. No associations were found with having children and student status. Symptoms of depression, anxiety, posttraumatic stress, and loneliness decreased over time but varied along with the dynamics of the pandemic. Longitudinal monitoring of mental health in vulnerable subgroups is required, especially those of younger age, females, and the financially insecure.

Sociodemographic effects on pandemic fatigue are multifaceted and context-specific: A longitudinal analysis of physical distancing adherence

Background

Pandemic fatigue emerged early during the COVID-19 pandemic and remains a concern as new variants emerge and ongoing public health measures are needed to control them. A wide range of factors can affect pandemic fatigue, but empiric research indicating which may be most important to adherence in specific populations is lacking.

Design & Methods

We conducted a longitudinal study of changes in physical distancing in two cohorts: adults living with children <18 years and adults ≥50 years old. Six types of non-work, non-household contacts were ascertained at six times from April to October 2020. We used generalized estimating equations Poisson regression to estimate the one-week change in contact rate and how this differed based on sociodemographic characteristics.

Results

The rate of all contact types increased during the middle of the study period and decreased toward the end. Changes in contact rates over time differed according to several sociodemographic characteristics, including age, gender, race/ethnicity, education, household composition, and access to transportation. Furthermore, the factors influencing the rate of change in contact rates differed by the type or setting of the contact, for example contacts as a result of visiting another person's home versus during a retail outing.

Conclusions

These results provide evidence for potential mechanisms by which pandemic fatigue has resulted in lower physical distancing adherence.

The Impact of Loneliness and Social Isolation on Cognitive Aging: A Narrative Review

Social concepts such as loneliness and social isolation are fairly new factors that have been recently gaining attention as to their involvement in changes in cognitive function and association with dementia. The primary aim of this narrative review was to describe the current understanding of how loneliness and social isolation influence cognitive aging and how they are linked to dementia. Studies have shown that there is an association between loneliness, social isolation, and reduced cognitive function, in older adults, across multiple cognitive domains, as well as a heightened risk of dementia. Numerous changes to underlying neural biomechanisms including cortisol secretion and brain volume alterations (e.g., white/grey matter, hippocampus) may contribute to these relationships. However, due to poor quality research, mixed and inconclusive findings, and issues accurately defining and measuring loneliness and social isolation, more consistent high-quality interventions are needed to determine whether studies addressing loneliness and social isolation can impact longer term risk of dementia. This is especially important given the long-term impact of the COVID-19 pandemic on social isolation in older people is yet to be fully understood.

Eating disorder symptoms among children and adolescents in Germany before and after the onset of the COVID-19 pandemic

Background

Disordered eating is highly prevalent among children and adolescents. Since the outbreak of the COVID-19 pandemic, hospitalizations due to eating disorders have peaked and overweight has risen. The aim of this study was to determine differences in the prevalence of eating disorder symptoms among children and adolescents in Germany before and after the onset of the COVID-19 pandemic and to identify associated factors.

Materials and methods

Eating disorder symptoms and associated factors were examined in a sample of n = 1,001 participants of the nationwide population-based COPSY study in autumn 2021. Standardized and validated instruments were used to survey 11-17-year-olds along with a respective parent. To identify differences in prevalence rates, logistic regression was used to compare results with data from n = 997 participants of the prepandemic BELLA study. Multiple logistic regression analyses were performed to examine associations with relevant factors in the pandemic COPSY sample.

Results

Eating disorder symptoms were reported by 17.18% of females and 15.08% of males in the COPSY study. Prevalence rates were lower overall in the COPSY sample compared to before the pandemic. Male gender, anxiety, and depressive symptoms were associated with increased odds for eating disorder symptoms in the pandemic.

Conclusion

The pandemic underscores the importance of further research, but also prevention and intervention programs that address disordered eating in children and adolescents, with a focus on age - and gender-specific differences and developments. In addition, screening instruments for eating disorder symptoms in youths need to be adapted and validated.

It turned into something else: patients' long-term experiences of transitions to or from telepsychotherapy during the COVID-19 pandemic

Introduction

The shift from in-person therapy to telepsychotherapy during the COVID-19 pandemic was unprepared for, sudden, and inevitable. This study explored patients' long-term experiences of transitions to telepsychotherapy and back to the office.

Methods

Data were collected approximately two years after the declaration of COVID-19 as a pandemic. Eleven patients were interviewed (nine women and two men, aged 28 to 56, six in psychodynamic psychotherapy, five in CBT). Treatments switched between in-person and video/telephone sessions. Interview transcripts were analyzed applying the qualitative methodology of inductive thematic analysis.

Results

(1) The patients experienced the process in telepsychotherapy as impeded. Interventions were difficult to understand and lost impact. Routines surrounding the therapy sessions were lost. Conversations were less serious and lost direction. (2) Understanding was made more difficult when the nuances of non-verbal communication were lost. (3) The emotional relationship was altered. Remote therapy was perceived as something different from regular therapy, and once back in the therapy room, the patients felt that therapy started anew. The emotional presence was experienced as weakened, but some of the patients found expressing their feelings easier in the absence of bodily co-presence. According to the patients, in-person presence contributed to their security and trust, whereas they felt that the therapists were different when working remotely, behaving in a more easygoing and familiar way, as well as more solution-focused, supportive and unprofessional, less understanding and less therapeutic. Despite this, (4) telepsychotherapy also gave the patients an opportunity to take therapy with them into their everyday lives.

Discussion

The results suggest that in the long run, remote psychotherapy was seen as a good enough alternative when needed. The present study indicates that format alternations have an impact on which interventions can be implemented, which can have important implications for psychotherapy training and supervision in an era when telepsychotherapy is becoming increasingly common.

Instruments for Assessing Loneliness in Older People in Portugal: A Scoping Review: Instrumentos de avaliação da solidão em adultos mais velhos em Portugal: uma scoping review

Background

Loneliness is a public health problem that affects many older adults. The subjective nature of loneliness challenges its assessment. Thus, assessing loneliness with valid and reliable instruments is crucial to characterizing the phenomenon and planning adequate interventions.

Summary

This study mapped the instruments validated for the Portuguese older population that assess loneliness. A scoping review was performed. The search for studies was carried out in SciELO, PsycInfo, Scopus, MEDLINE, MedicLatina, Nursing & Allied Health Collection: Comprehensive, CINAHL, and Open Access Scientific Repositories of Portugal. The findings showed three instruments validated for the Portuguese older population: ULS-16, ULS-6, and SELSA-S.

Key Messages

Future testing of those instruments is required to update and accumulate psychometric evidence. In addition, it is important to translate and validate other instruments to the Portuguese older adults population, namely de Jong Gierveld and UCLA-R (most used internationally), as well as the ALONE scale (new and brief).

Comparing the impact of high versus low lockdown severity on the mental health of young people in Australia during the COVID-19 pandemic

Young Australians have been differentially affected by lockdowns and social restrictions during the COVID-19 pandemic. This study compared the mental health impacts of the COVID-19 pandemic and associated restrictions for young people in two Australian states, Victoria and Queensland, with Victoria experiencing more days in lockdown and greater infection rates. An online survey was completed between 01/04/2021 and 31/07/2021 by 687 young people, aged 16 to 24 years; 337 from Victoria and 350 from Queensland. Levels of negative emotion feelings (as measured by the Depression Anxiety Stress Scale), and COVID-19 risk factors for negative emotions (such as financial hardship, education disruption, loneliness and household conflict), as well as protective factors (resilience and self-esteem) were compared between the Victorian and Queensland samples, also considering some early pandemic data and pre-pandemic norms. No significant differences in negative emotions were found between young people living in the two states, despite substantial differences in pandemic restrictions. The results indicated that young people in Queensland and Victoria had experienced similarly high levels of negative emotions, at levels also seen at the start of the pandemic in Victoria. This is of grave concern, requiring urgent attention as the pandemic continues.

Psychological correlates of perceived loneliness in college students before and during the COVID-19 stay-at-home period: a longitudinal study

BACKGROUND

Loneliness is increasingly acknowledged as a serious public health issue. This longitudinal study aimed to assess the extent to which psychological distress and alexithymia can predict loneliness among Italian college students before and one year after the COVID-19 outbreak.

METHODS

A convenience sample of 177 psychology college students were recruited. Loneliness (UCLA), alexithymia (TAS-20), anxiety symptoms (GAD-7), depressive symptoms (PHQ-9), and somatic symptoms (PHQ-15) were assessed before the COVID-19 outbreak and one year after the spread of COVID-19 worldwide.

RESULTS

After controlling for baseline loneliness, students with high levels of loneliness during lockdown showed worsening psychological distress and alexithymic traits over time. Suffering from depressive symptoms before COVID-19 and the aggravation of alexithymic traits independently predicted 41% of perceived loneliness during the COVID-19 outbreak.

CONCLUSIONS

College students with higher levels of depression and alexithymic traits both before and one year after the lockdown were more at risk of suffering from perceived loneliness and may constitute the target sample for psychological support and intervention.

Impact of COVID-19 lockdown on physical activity, insomnia, and loneliness among Spanish women and men

During COVID-19 pandemic, quality of living was impacted by social isolation, loneliness, and altered sleep habits. The aims of this study were (1) to examine the relationship between physical activity (PA) levels with insomnia and loneliness among adults during Spain's first COVID-19 wave of lockdown and its impact on women and (2) to examine the digital technologic resources used to support both PA and other recreational activities in women. A cross-sectional design was used. An anonymous 15-min online survey was conducted in Spain to adults (≥ 18 years old) during the first COVID-19 lockdown, a 40-day period. A snowball distribution method was employed using personal email and social networks (Facebook, Whatsapp, Linkedin, Twitter). Variables studied included: socio-demographic items, insomnia, loneliness, PA, and digital technologic resources. A total of 996 adults (females = 663, 66.6%) completed the survey. Higher education levels were associated with greater PA levels (p-value < 0.001). Women presented with higher insomnia risk than men with low PA levels (OR = 1.9, CI = 1.25; 2.95). Living with family members or other individuals was related to lower insomnia risk. A strong correlation between medium-high PA levels was found with greater digital technology resources (DTS) than individuals with low PA levels. Females used significantly more DTS than males (p-value < 0.001). No significant associations between DTS were found with age or academic education level. PA levels, sex, and loneliness were related to insomnia risk. A strong correlation between PA and DTS use was observed. Participants with medium-high PA levels and females use them more than those with low PA levels and males. We recommend promoting the PA through digital technologies for women. This recommendation would also improve sleep disorders in women who present higher insomnia risks than men.

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

OBJECTIVE

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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

Workplace infection control measures and romantic activities of workers during COVID-19 pandemic: A prospective cohort study in Japan

Objective

Due to the COVID-19 pandemic, non-married people are at high risk of loneliness. With social interactions restricted, it is important for non-married people to acquire a new romantic partner for their mental health and quality of life. We hypothesized that infection control efforts in the workplace influence people's social interactions, including romantic activities.

Methods

We conducted an internet-based prospective cohort study from December 2020 (baseline) to December 2021, using self-administered questionnaires. Briefly, 27,036 workers completed the questionnaires at baseline, and when followed up after 1 year, 18,560 (68.7%) participated. A total of 6,486 non-married individuals with no romantic relationship at baseline were included in the analysis. At baseline they were asked about the implementation of infection control measures in the workplace, and at follow-up they were asked about activities they performed with a view to romantic relationships during the period from baseline to follow-up.

Results

Compared to workers in workplaces with no infection control measures, the odds ratio (OR) associated with romance-related activities for those in workplaces with seven or more infection control measures was 1.90 (95% CI: 1.45-2.48, p < 0.001), and the OR associated with having a new romantic partner was 1.79 (95% CI: 1.20-2.66, p = 0.004).

Discussion

Under the COVID-19 pandemic, the implementation of infection control measures in the workplace and the expressed satisfaction with those measures promoted romantic relationships among non-married, single individuals.

Community belongingness during COVID-19 predicts anxiety and depression treatment change in college students

OBJECTIVE

Community belongingness has been shown to be related to mental health outcomes in college students; however, little work has evaluated whether community belongingness impacts treatment change, especially during the COVID-19 pandemic, when social isolation and mental health concerns are exacerbated. Accordingly, the current study evaluated community belongingness as a predictor of treatment change for anxiety and depression in a university counseling center.

METHOD

Participants included 516 young adults with clinical levels of anxiety or depression who attended at least two individual therapy sessions at a university counseling center during fall 2020. Participants completed broad measures of psychosocial functioning at each session.

RESULTS

Paired-samples t-tests indicated that students demonstrated significant decreases in anxiety and depression after just one session. Linear stepwise regressions revealed that community belongingness was a significant predictor of symptom improvement for both anxiety and depression.

CONCLUSION

These results suggest improving community belongingness on college campuses may be a way to buffer mental health and improve treatment outcomes for students seeking psychological services. Specific clinical and educational recommendations for ways to improve community belongingness are discussed.

Are social support, loneliness, and social connection differentially associated with happiness across levels of introversion-extraversion?

This study examines whether extraversion moderates the association between subjective happiness and measures of social connectedness using data from Canadian residents, aged 16+, recruited online during the third wave of the COVID-19 pandemic (21 April 2021-1 June 2021). To accomplish this aim we tested the moderating effect of extraversion scores on the association between Subjective Happiness scores and several social health measures: Perceived Social Support, Loneliness, social network size, and time with friends. Among 949 participants, results show that lower social loneliness (p < .001) and higher social support from friends (p = .001) and from family (p = .007) was more strongly correlated with subjective happiness for people with low extraversion compared to those with high extroversion. Anti-loneliness interventions should consider the need to promote social connections among individuals across the introversion-extraversion continuum.

Evaluating an online self-distancing intervention to promote emotional regulation and posttraumatic growth during the COVID-19 pandemic

OBJECTIVES

Three online studies were conducted to elucidate the role of emotional regulation (ER) in posttraumatic growth (PTG), evaluate the ability of an online self-distancing intervention to achieve ER, and test whether increasing the use of ER strategies promotes PTG.

DESIGN

Cross-sectional (Study 1) and longitudinal randomized controlled trials (RCT) (Studies 2 and 3).

METHOD

In Study 1, 626 adults completed measures of ER, PTG, and psychosocial functioning during the COVID-19 pandemic. In Study 2, 149 adults participated in a five-week RCT comparing self-immersed, spatially self-distanced, and temporally self-distanced reflection in their ability to regulate negative affect. In Study 3, 117 adults replicated the RCT of Study 2 and completed the measures from Study 1 a week pre- and post-intervention.

RESULTS

Path analyses confirmed that ER strategies were relevant to COVID-19-related PTG. MANOVAs revealed that self-distancing was effective in regulating state negative affect. However, ANOVAs suggest that this was not due to increased use of ER strategies and did not improve PTG or psychosocial functioning.

CONCLUSIONS

These findings support further research into the relevance of ER to PTG, and provide a foundation to understand PTG and develop PTG-promoting interventions within a broader stress-coping framework.

Impact of the COVID-19 Pandemic on Older People's Loneliness: Findings from a Longitudinal Study between 2019 and 2021 among Older Home-Dwellers in Finland

OBJECTIVES

To investigate the change in feelings of loneliness among Finnish community-dwelling older people from before the COVID-19 pandemic in 2019 to during the pandemic in 2021. Moreover, we explore the changes in other dimensions of psychological well-being (PWB) during the study period.

DESIGN

Questionnaires were mailed in the 2019 Helsinki Aging Study, a repeated cohort study. A follow-up interview was carried on over the telephone during the year 2021.

SETTING AND PARTICIPANTS

A random sample of 2,917 home-dwelling older people aged 75-104 years residing in Helsinki, Finland were mailed the questionnaire. Altogether 898 participated in the follow-up.

MEASUREMENTS

Loneliness was measured using a single item question "Do you suffer from loneliness?". Other items of psychological well-being were measured: "Are you satisfied with your life?" (yes/no), "Do you feel useful?" (yes/no), "Do you have a zest for life?" (yes/no),"Do you have plans for the future?" (yes/no), and "Do you feel depressed?"("rarely or never"/ "sometimes"/ "often or always").

RESULTS

Altogether 898 people participated both in 2019 and 2021. The subjects' mean age was 83 years and 66% were women. Between 2019 and 2021, the prevalence of experienced loneliness increased among older home-dwellers from 26% to 30%. During two years of the pandemic feelings of loneliness (RR 1.79, 95% CI: 1.30 to 2.46) and depression (RR 1.37, 95% CI: 1.12 to 1.67) increased even adjusted with various confounders.

CONCLUSION

Considering the impact loneliness has on health and well-being, the finding of increased feelings of loneliness among older people is alarming. Actions to combat loneliness need to be taken.

The gender dimensions of mental health during the Covid-19 pandemic: A path analysis

BACKGROUND

The Covid-19 pandemic has had a substantial population mental health impact, with evidence indicating that mental health has deteriorated in particular for women. This gender difference could be explained by the distinct experiences of women during the pandemic, including the burden of unpaid domestic labour, changes in economic activity, and experiences of loneliness. This study investigates potential mediators in the relationship between gender and mental health during the first wave of the Covid-19 pandemic in the UK.

METHODS

We used data from 9,351 participants of Understanding Society, a longitudinal household survey from the UK. We conducted a mediation analysis using structural equation modelling to estimate the role of four mediators, measured during the first lockdown in April 2020, in the relationship between gender and mental health in May and July 2020. Mental health was measured with the 12-item General Health Questionnaire (GHQ-12). Standardized coefficients for each path were obtained, as well as indirect effects for the role of employment disruption, hours spent on housework, hours spent on childcare, and loneliness.

RESULTS

In a model controlling for age, household income and pre-pandemic mental health, we found that gender was associated with all four mediators, but only loneliness was associated with mental health at both time points. The indirect effects showed strong evidence of partial mediation through loneliness for the relationship between gender and mental health problems; loneliness accounted for 83.9% of the total effect in May, and 76.1% in July. No evidence of mediation was found for housework, childcare, or employment disruption.

CONCLUSION

The results suggest that the worse mental health found among women during the initial period of the Covid-19 pandemic is partly explained by women reporting more experiences of loneliness. Understanding this mechanism is important for prioritising interventions to address gender-based inequities that have been exacerbated by the pandemic.

The Intertwining of Posttraumatic Stress Symptoms, Alcohol, Tobacco or Nicotine Use, and the COVID-19 Pandemic: A Systematic Review

BACKGROUND

Posttraumatic stress symptoms (PTSSs) and alcohol, tobacco, or nicotine use are frequently associated conditions. The COVID-19 pandemic has been a stressful situation globally and has worsened mental health conditions and addictions in the population. Our systematic review explores the links between PTSSs and (1) alcohol use and (2) tobacco or nicotine use during the COVID-19 pandemic.

METHODS

We searched the PubMed, PsycINFO, and Web of Science databases for studies published between January 2020 and 16 December 2021. We included studies published in English concerning adults or adolescents. Included articles dealt simultaneously with the COVID-19 pandemic, PTSSs, and alcohol, tobacco, or nicotine use. The reports included were cross-sectional, longitudinal, or cohort studies. We categorized the reports according to the population explored. Our main outcomes are the impacts of PTSSs on (1) alcohol use and (2) tobacco and nicotine use and their relation to COVID-19-related stressors (worries, exposure, lockdown, and infection, either of self or relatives).

RESULTS

Of the 503 reports identified, 44 were assessed for eligibility, and 16 were included in our review, encompassing 34,408 participants. The populations explored were the general population, healthcare workers, war veterans, patients with substance use disorders, and other vulnerable populations. Most studies were online surveys (14) with cross-sectional designs (11). Every study explored alcohol use, while only two assessed tobacco use. In most populations explored, a high level of PTSSs was associated with alcohol use increase. COVID-19-related stress was frequently correlated with either high PTSSs or alcohol use. In healthcare workers, PTSSs and alcohol use were not associated, while COVID-19 worries were related to both PTSSs and alcohol use.

DISCUSSION

1. PTSSs and increased alcohol use are frequently associated, while COVID-19 worries might trigger both conditions and worsen their association. Alcohol use increase may represent either an inadequate way of coping with PTSSs or a vulnerability amid the COVID-19 pandemic, leading to PTSSs. As most studies were cross-sectional online surveys, longitudinal prospective studies are needed to ascertain the direction of the associations between these conditions. These studies need to be sufficiently powered and control for potential bias and confounders. 2. Our review highlighted that research about PTSSs and tobacco or nicotine use is scarce.

Psychotic-like experiences in the lonely predict conspiratorial beliefs and are associated with the diet during COVID-19

The COVID-19 pandemic has increased the occurrence of conspiracy theories. It has been suggested that a greater endorsement of these theories may be associated with psychotic-like experiences (PLEs), as well as with social isolation. In this preregistered study, we investigated whether both PLEs and measures of social isolation (e.g., loneliness) can predict conspiratorial beliefs and, if so, which of these variables can mediate the association with conspiratorial beliefs. Furthermore, based on previous studies on schizophrenia, we explored whether the diet is associated with PLEs and conspiratorial beliefs. Participants (N = 142) completed online questionnaires measuring PLEs, social isolation, mental well-being, and conspiratorial beliefs. They also submitted their daily food intake for a week using a smartphone app. We found that loneliness predicted the endorsement of conspiracy theories during the COVID-19 lockdown. Strikingly, the proneness to experience subclinical psychotic symptoms played an underlying mediating role. In addition, these subclinical symptoms were associated with lower fruit, carbohydrate, and iron intakes, as well as with higher fat intake. Our results add insights into how conspiratorial beliefs can affect individuals’ mental health and relationships. Moreover, these results open the avenue for potential novel intervention strategies to optimize food intake in individuals with PLEs.

Loneliness and quality of life: Perceived online and offline social support among Sub-Saharan African students in China during the COVID-19 lockdowns

<b>Objective/background: </b>The COVID-19 pandemic disrupted education globally, triggering fear and uncertainties for students. However, there is currently no research evidence to document the loneliness experience of Sub-Saharan African (SSA) students in China and how social support influenced their quality of life (QoL). This study explored the effect of COVID-19-induced loneliness and social support on the QoL of SSA students in China.<br /> <b>Method:</b> The study adopted an institutional-based cross-sectional survey through an online questionnaire on social media platforms to investigate the QoL of SSA students in Chinese universities. Pearson correlation matrix and regression analysis were conducted to validate the association of loneliness, social support (online and offline), and socio-demographic attributes on the student’s QoL.<br /> <b>Result: </b>In the population of 358 SSA students appraised in the study, loneliness experience was negatively associated with QoL. Online social support and offline social support were positively associated with QoL. The linear regression shows that loneliness, social support, and socio-demographic attributes explain 25.7% (psychological health), 26.6% (physical health), 24.9% (environmental health), and 30.3% (social relation) of the variance in the QoL domains. By evaluating the EUROHIS subjective QoL, loneliness independently accounts for 24.5% of the variance in the subjective QoL of the SSA students examined in the study (model 1). In comparison, the added effects of social supports and socio-demographic attributes on model 3 explained 32% of the subjective QoL.<br /> <b>Conclusion: </b>It is strongly recommended that loneliness eradication programs be implemented in these universities among SSA students who experience loneliness that negates their QoL. Interventions should focus on how these students can integrate and build social networks (online and offline) to improve social interaction and support for better QoL.

Too many lemons to make lemonade? Disentangling mental health during the third wave of COVID-19 infections in Spain

The study aimed to analyze the longitudinal change in mental health during the third wave of COVID-19 infections in Spain. Negative (e.g., emotional distress) and positive (e.g., positive functioning variables) outcomes were analyzed. Protective factors (e.g., resilience) as predictors of psychological adjustment (i.e., positive mental health, openness to the future, and low burden due to COVID-19) after ten months of the pandemic were also examined. The sample consisted of 164 participants, and self-reported questionnaires were administered at the beginning of the lockdown (March 2020), at the end of the lockdown (June 2020), and during the third wave (January 2021). Linear mixed models showed that individuals' emotional distress increased, and positive functioning variables (i.e., meaning in life, gratitude, resilience, and life satisfaction) decreased over time, but an increase was observed in some dimensions of posttraumatic growth. Regression analyses showed that resilience scores at all three data collection time points were significant predictors of positive mental health, openness to the future, and burden during the third wave. Mediation analyses showed that positive mental health and openness to the future were mediators of the effect of resilience on burden. The prolonged situation of the COVID-19 crisis had an important impact on positive and negative mental health. However, resilience may help to build up resources that can act as a buffer against adverse psychological effects.

Relationships between Individual and Social Resources, Anxiety and Depression in the Early Lockdown Stage by the COVID-19 in Chile

The coronavirus disease has exposed the population to psychosocial threats that could increase mental health problems. This research analyzed the relationships between emotional states (negative [−EWB] and positive [+EWB] experienced well-being), personal resources (resilient coping [RC]), dispositional resources (control beliefs about stress [BAS]), and social resources (social support [SS]), and anxiety and depressive symptoms in a sample of the Chilean population (n = 592), who answered an online questionnaire. Multiple and moderated multiple regression analyses were carried out. Depressive symptoms showed a positive relationship with −EWB (β = 0.805; p < 0.001) and negative relationship with +EWB (β = −0.312; p < 0.001), RC (β = −0.089; p < 0.01), BAS (β = −0.183; p < 0.001) and SS (β = −0.082; p < 0.001). Anxiety symptoms showed a positive relationship with −EWB (β = 0.568; p < 0.001), and a negative relationship with +EWB (β = −0.101; p < 0.03) and BAS (β = −0.092; p < 0.001). BAS moderated the relationship between experienced well-being and depression symptoms, and RC moderated the relationship between experienced well-being with both depression and anxiety symptoms. Findings confirm the buffering effect of personal and dispositional resources when facing a sanitary and social crisis. Moreover, they help to understand the role of internal psychological processes during a crisis and how to cope with life-threatening events.

Psychosocial Determinants of Loneliness in the Era of the COVID-19 Pandemic-Cross-Sectional Study

BACKGROUND

The COVID-19 pandemic affected the mental health and social behavior of people around the world. Due to epidemiological restrictions, the period of forced isolation contributed to the feeling of loneliness. The aim of the research is to identify factors and conditions associated to the feeling of loneliness in the era of the COVID-19 pandemic.

METHODS

The survey was conducted among 262 people from the north-eastern Polish area, using an online survey. The diagnostic survey method was used, using the De Jong Gierveld Loneliness Measurement Scale, the Generalized Self-Efficacy Scale (GSES), the WHOQoL-Bref questionnaire.

RESULTS

A statistically significant relationship was observed between the feeling of loneliness and areas of quality of life, especially psychological and social, generalized self-efficacy and marital status and way of living (p < 0.05). Higher levels of stress, social distancing, restrictions at work, health status were significantly correlated with an increase in loneliness. Remote work was associated with a lower assessment of the quality of life in the psychological field (p < 0.05).

CONCLUSIONS

Higher levels of loneliness were significantly more likely to affect people living alone and not in a relationship. Higher levels of loneliness were significantly associated with lower quality of life in the social and psychological domains, lower levels of self-efficacy, and remote work.

A systematic review of the international evolution of online mental health strategies and recommendations during the COVID-19 pandemic

INTRODUCTION

The global health crisis caused by the COVID-19 pandemic has had a negative impact on mental health (MH). As a response to the pandemic, international agencies and governmental institutions provided an initial response to the population's needs. As the pandemic evolved, the population circumstances changed, and some of these international agencies updated their strategies, recommendations, and guidelines for the populations. However, there is currently a lack of information on the attention given to response strategies by the different countries throughout the beginning of the pandemic.

OBJECTIVES

1) To evaluate the evolution of online MH strategies and recommendations of selected countries to cope with the MH impact of COVID-19 from the early stages of the pandemic (15 April 2020) to the vaccination period (9 June 2021) and 2) to review and analyse the current structures of these online MH strategies and recommendations.

METHODOLOGY

An adaptation of the PRISMA guidelines to review online documents was developed with a questionnaire for MH strategies and recommendations assessment. The search was conducted on Google, including documents from April 2020 to June 2021. Basic statistics and Student's t test were used to assess the evolution of the documents, while a two-step cluster analysis was performed to assess the organisation and characteristics of the most recent documents.

RESULTS

Statistically significant differences were found both in the number of symptoms and mental disorders and MH strategies and recommendations included in the initial documents and the updated versions generated after vaccines became available. The most recent versions are more complete in all cases. Regarding the forty-six total documents included in the review, the cluster analysis showed a broad distribution from wide-spectrum documents to documents focusing on a specific topic.

CONCLUSIONS

Selected governments and related institutions have worked actively on updating their MH online documents, highlighting actions related to bereavement, telehealth and domestic violence. The study supports the use of the adaptation, including the tailor-made questionnaire, of the PRISMA protocol as a potential standard to conduct longitudinal assessments of online documents used to support MH strategies and recommendations.

The physical and mental health consequences of social isolation and loneliness in the context of COVID-19

PURPOSE OF REVIEW

Social isolation and loneliness are known contributors to all-cause mortality as well as a range of physical and mental health conditions. Therefore, this article reviews current literature pertaining to the effects of social isolation and loneliness on physical and mental health during the current COVID-19 pandemic.

RECENT FINDINGS

Social isolation and loneliness contribute to a myriad of physical and mental health conditions. Specifically social isolation and loneliness contribute to the development of cardiovascular disease, diabetes mellitus, and cancer. However, most research indicated that poor lifestyle factors explained most of the association. Social isolation and loneliness are also associated with cognitive problems including dementia, immune system problems, and mental health conditions. Further social isolation and loneliness also spur behavioral issues that significantly affect physical and mental health.

SUMMARY

Evidence suggests that social isolation and loneliness have significant consequences on the physical and mental health of the individual and that the move toward ending all protections against COVID-19 has significant implications for the vulnerable. Further the similarities between the effects of social isolation and loneliness are compared to some of the conditions evident in long-COVID.

Life Satisfaction and Instagram Addiction among University Students during the COVID-19 Pandemic: The Bidirectional Mediating Role of Loneliness

Background: Social isolation during the lockdown, and the greater use of online platforms to connect with other people, can alter the dynamic relationship between loneliness, social media use, and subjective well-being. The study examines the mediating role of loneliness in the bidirectional association between Instagram addiction and life satisfaction. Methods: A sample of 954 university students from Poland were enrolled in a cross-sectional online study during the second wave of the COVID-19 pandemic. Participants aged between 19 and 42 (M = 22.56, SD = 2.36), and most of them were women (86.48%). Standardized questionnaires were used to measure Instagram addiction (BIAS), loneliness (DJGLS), and life satisfaction (SWLS). Results: The prevalence of Instagram addiction, loneliness, and dissatisfaction with life was 17.19%, 75%, and 40.15%, respectively. The mediating effect of loneliness on the relationship between Instagram addiction and life satisfaction was found bidirectionally in women but not among men. Conclusions: Loneliness seems to play a crucial role in the mechanism of social media addiction, so increasing loneliness should be a priority among emerging adults. The target group for intervention and prevention programs at campuses should include lonely and dissatisfied with life university students of the female gender.