Spillover health losses of COVID-19 in China: evidence from non-COVID-19-related mortality

OBJECTIVES

With the seeming end of the COVID-19 epidemic, international focus is rethinking its spillover consequences, such as on the routine provision and usage of healthcare. This study uses China's national death records to estimate the potential spillover effects of the COVID-19 pandemic on the mortality of non-COVID diseases in China, such as chronic diseases and mental disorders.

STUDY DESIGN

A longitudinal study.

METHODS

Using the difference-in-difference strategy, our results showed a sizeable increase in total non-COVID deaths and mortality from cardiovascular diseases, chronic kidney disease, diabetes, mental diseases, and suicide.

RESULTS

Notably, the deaths from diabetes and suicide increased by 4.60% and 7.08%, respectively, relative to the regions without pandemic cases in the first outbreak and escalated by 3.57% and 5.00%, respectively, when the control group switched to the same period in 2019.

CONCLUSIONS

These results documented adverse spillover effects of COVID-19 on mortality of non-COVID diseases, suggesting inadequate provision and utilization of regular healthcare. The government and healthcare industry should adopt expedient policies for non-epidemic diseases and reallocate health resources to mitigate future pandemics like COVID-19.

Prevalence of psychological and mental health symptoms among nursing professionals during the COVID-19 pandemic in the Americas: Systematic review and meta-analysis

To assess the prevalence of mental health symptoms in nursing professionals during the COVID-19 pandemic on the American continent. A systematic review and meta-analysis of observational studies that estimated the prevalence of mental health symptoms in nursing professionals during the COVID-19 pandemic was performed through bibliographic database searches. A three-level meta-analysis model was used with the inverse variance method, tau was estimated via restricted maximum likelihood and logistic transformation, and heterogeneity was presented as tau2 and I2. Of the 7467 studies obtained, 62 were included in the meta-analysis, which involved 52 270 nursing professionals. The overall prevalence for at least one mental health symptom was 56.3% (50.4%, 62.1%; I2 = 98.6%, p < 0.001). Eight mental health symptoms were found; among them, the most prevalent were burnout (52.1%, 37.1%, 88.8%; I2 = 98.5%, p < 0.001) and fear (52.1%, 30.1%, 73.3%; I2 = 98.1%, p < 0.001). The prevalence of mental health symptoms in nursing professionals during the COVID-19 pandemic on the American continent was high, and strategies should be developed and implemented by managers and government agencies to promote the well-being, physical and mental health of nursing professionals. Studies like this one are necessary to highlight the need for efforts in the implementation of promotion and prevention actions to be developed by health organisations, managers and leaders with a view to improving the quality of life of nursing workers.

Quantifying diagnosis and treatment practices of opioid use disorder in primary care practices using chart review data

BACKGROUND

Opioid misuse is a significant public health crisis. The aim sought to identify potential gaps in opioid care in primary care practices.

METHODS

American Academy of Family Physicians (AAFP) offered a monthly online educational series to seven U.S. practices. Practices were asked to complete up to 50 chart reviews for visits during two periods: February-April, 2019, and February-April, 2022. Each chart had to have an ICD-10 diagnosis of opioid misuse, opioid dependence, or opioid use. Chart reviews consisted of 14 questions derived from an American Academy of Addiction Psychiatry (AAAP) Performance in Practice activity, and then, scored based on practices' responses. Descriptive statistics and binary logistic and multinomial regressions were used.

RESULTS

Both periods had 173 chart reviews (total: 346) from the six practices. Most chart reviews were for patients with a diagnosis of opioid dependence (2019: 90.2%; 2022: 83.2%). Three questions for assessing OUD treatment behaviors had high levels of documentation across both time periods (>85%): other drug use, treatment readiness, and treatment discussion.

DISCUSSION

Results show a gap in the treatment of patients with OUD in primary care across several clinical practice recommendations.

CONCLUSIONS

Expanding OUD treatment integration to primary care remains the most promising effort to combat the opioid crisis.

Mental Health and Care Utilization Among Ethiopian-Israeli Immigrants During the Period of COVID-19

As well as affecting physical health, COVID-19 can impact mental health. Despite this, Israelis may not be getting needed mental health care because of culture-related barriers such as stigma and lack of knowledge about mental health and appropriate care. This is especially likely among vulnerable populations, such as Ethiopian immigrants, yet the topic has been understudied. This study aimed to examine to what extent COVID-19-related mental health stressors and issues are found among Ethiopian-Israelis and the extent of stigma and mental health literacy among Ethiopian-Israelis during the COVID-19 period. It also examined differences between the 1.5th and 2nd generations and potential interventions to improve their mental health. Online surveys were filled out by a convenience sample of 225 Ethiopian-Israelis recruited from a variety of sources in the fall of 2020. Over 40% expressed greater mental distress since COVID-19 started. Stigma and lack of mental health-related knowledge were found among many in this population, serving as potentially important barriers to getting appropriate mental health care. For example, only 52% disagreed with the statement that people with mental illness should not be given any responsibility and only 66% felt confident they could identify having a mental health problem requiring treatment. Variations were found by types of stressors, stigma, and lack of knowledge, as well as by immigration generation, for at least some measures. COVID-19 can negatively impact mental health and appropriate mental health care utilization, especially for a racial/ethnic minority group of immigrants such as Ethiopian-Israelis. Interventions are needed, such as increased education about mental health from a variety of sources, which can help decrease stigma and improve mental health care utilization among this group, especially when appropriately tailored.

Dual pandemics? Assessing associations between area racism, COVID-19 case rates, and mental health among U.S. adults

Mental health worsened during the COVID-19 pandemic, especially among racially minoritized adults. Population-level racial attitudes, or area racism, may be associated with mental health, particularly during this historical moment, but this possibility has not been tested in prior research. In the present study, we use nationally representative data from the Household Pulse Survey (April-October 2020) to document associations between area racism and depression/anxiety in the United States among non-Hispanic Black, non-Hispanic Asian, Hispanic, non-Hispanic White, and other racial/ethnic minority adults. We further consider the national COVID-19 case rate to examine an additional macro-level stressor. Findings indicate that area racism was positively associated with depression and/or anxiety for Black, Hispanic, White, and other racial/ethnic minority adults. Moreover, COVID-19 cases posed an additional, independent mental health threat for most groups. This study points to area racism as a macro-level stressor and an antecedent of mental health for racially diverse groups of Americans.

Natural language processing analysis of the psychosocial stressors of mental health disorders during the pandemic

Over the past few years, the COVID-19 pandemic has exerted various impacts on the world, notably concerning mental health. Nevertheless, the precise influence of psychosocial stressors on this mental health crisis remains largely unexplored. In this study, we employ natural language processing to examine chat text from a mental health helpline. The data was obtained from a chat helpline called Safe Hour from the "It Gets Better" project in Chile. This dataset encompass 10,986 conversations between trained professional volunteers from the foundation and platform users from 2018 to 2020. Our analysis shows a significant increase in conversations covering issues of self-image and interpersonal relations, as well as a decrease in performance themes. Also, we observe that conversations involving themes like self-image and emotional crisis played a role in explaining both suicidal behavior and depressive symptoms. However, anxious symptoms can only be explained by emotional crisis themes. These findings shed light on the intricate connections between psychosocial stressors and various mental health aspects in the context of the COVID-19 pandemic.

Telehealth Utilization Among Adult Medicaid Beneficiaries in North Carolina with Behavioral Health Conditions During the COVID-19 Pandemic

OBJECTIVE

We examined factors associated with telehealth utilization during COVID-19 among adult Medicaid beneficiaries with behavioral health conditions.

DATA SOURCES AND STUDY SETTING

NC Medicaid 2019-2021 beneficiary and claims data.

STUDY DESIGN

This retrospective cohort study examined and compared behavioral health service use pre-COVID-19 (03/01/2019 to 02/28/2020) and during COVID-19 (04/01/2020 to 03/31/2021). Telehealth users included those with at least one behavioral health visit via telehealth during COVID-19. Descriptive statistics were calculated for overall sample and by telehealth status. Multilevel modified Poisson generalized estimating equation examined associations between telehealth use and patient- and area-level characteristics.

DATA COLLECTION/EXTRACTION METHODS

We identified individuals ages ≥ 21-64, diagnosed with a behavioral health condition, and had at least one behavioral-health specific visit before COVID-19.

PRINCIPAL FINDINGS

Almost two-thirds of the cohort received behavioral health services during COVID-19, with half of these beneficiaries using telehealth. Non-telehealth users had steeper declines in service use from pre- to during COVID-19 compared to telehealth users. Beneficiaries identifying as Black, multiracial or other were significantly less likely to use telehealth (ARR = 0.86; 95% CI: (0.83, 0.89)); (ARR = 0.92; 95% CI: (0.87, 0.96)) compared to White beneficiaries. Those eligible for Medicaid through the blind/disabled programs and who qualified for a state-specific specialized behavioral health plan were more likely to use telehealth (17% and 20%, respectively).

CONCLUSIONS

During the pandemic, telehealth facilitated continuity of care for beneficiaries with behavioral health conditions. Future research should aim to investigate how to reduce the digital divide and ensure equitable access to telehealth.

Racial and Ethnic Disparities in Mental Health and Mental Health Care During The COVID-19 Pandemic

During the pandemic, the overall mental health of the US population declined. Given higher rates of COVID-19 infections and deaths experienced by communities of color along with greater exposure to pandemic-related stressors (e.g., unemployment, food insecurity), we expect that the decline in mental health during the pandemic was more pronounced among Black, Hispanic, and Asian adults, with these groups also having less access to mental health services. We examine two nationally representative US surveys: the 2019 National Household Interview Survey (NHIS; N = 30,368) and the 2020-2021 Household Pulse Survey (HPS; N = 1,677,238). We find mental health of Black, Hispanic, and Asian respondents worsened relative to White respondents during the pandemic, with significant increases in depression and anxiety among racialized minorities compared to Whites. There is also evidence of especially high mental health burden for Black adults around the murder of George Floyd by police and for Asian adults around the murder of six Asian women in Atlanta. White respondents are most likely to receive professional mental health care before and during the pandemic, and Black, Hispanic, and Asian respondents demonstrate higher levels of unmet mental health care needs during the pandemic than White respondents. Our results indicate that within the current environment, White adults are at a large and systemic advantage buffering them from unexpected crises-like the COVID-19 pandemic. Without targeted interventions, the long-term social consequences of the pandemic and other co-occurring events (e.g., death of Black and Hispanic people by police) will likely include widening mental health disparities between racial/ethnic groups.

Family Engagement in Services During COVID-19: A Mixed-Methods Study of Caregiver and Staff Perspectives

INTRODUCTION

We examined changes in family engagement before versus during the pandemic in pediatric and family services and perceived facilitators and barriers to family engagement.

METHOD

We employed a mixed-methods assessment of staff and caregiver perspectives related to pediatric and family medicine clinics and family resource centers in rural northern New England. We used narrative synthesis to analyze qualitative interviews (n = 29) and descriptive statistics for quantitative surveys (n = 108).

RESULTS

Staff felt they were not doing as well at engaging families during versus prepandemic, identifying numerous facilitators and barriers. We found differences in resources used by families before versus during the pandemic. We identified discordant perspectives between caregivers and staff regarding how well clinics and centers identified and responded to family needs.

DISCUSSION

Leaders in pediatrics, advanced practice nursing, and related fields can draw on our findings to decide what services and modalities they provide for postpandemic.

E-mental health implementation in inpatient care: Exploring its potential and future challenges

Background

There is a great evidence base today for the effectiveness of e-mental health, or the use of technology in mental healthcare. However, large-scale implementation in mental healthcare organisations is lacking, especially in inpatient specialized mental healthcare settings.

Aim

The current study aimed to gain insights into the factors that promote or hinder the implementation of e-mental health applications on organisational, professional and patient levels in Belgium.

Methods

Four Belgian psychiatric hospitals and psychiatric departments of general hospitals invited their professionals and patients to use Moodbuster, which is a modular web-based platform with a connected smartphone application for monitoring. The platform was used in addition to treatment as usual for three to four months. The professionals and patients completed pre- and post-implementation questionnaires on their reasons to participate or to decline participation and experiences with the Moodbuster platform.

Results

Main reasons for the organisations to participate in the implementation study were a general interest in e-mental health and seeing it is a helpful add-on to regular treatment. The actual use of Moodbuster by professionals and patients proved to be challenging with only 10 professionals and 24 patients participating. Implementation was hindered by technical difficulties and inpatient care specific factors such as lack of structural facilities to use e-mental health and patient-specific factors. Professionals saw value in using e-mental health applications for bridging the transition from inpatient to outpatient care. Twenty-two professionals and 31 patients completed the questionnaire on reasons not to participate. For the patients, lack of motivation because of too severe depressive symptoms was the most important reason not to participate. For professionals, it was lack of time and high workload.

Conclusions

The current implementation study reveals several important barriers to overcome in order to successfully implement e-mental health in inpatient psychiatric care.

Key features of a trauma-informed public health emergency approach: A rapid review

COVID-19 is a major threat to public safety, and emergency public health measures to protect lives (e.g., lockdown, social distancing) have caused widespread disruption. While these measures are necessary to prevent catastrophic trauma and grief, many people are experiencing heightened stress and fear. Public health measures, risks of COVID-19 and stress responses compound existing inequities in our community. First Nations communities are particularly at risk due to historical trauma, ongoing socio-economic deprivation, and lack of trust in government authorities as a result of colonization. The objective of this study was to review evidence for trauma-informed public health emergency responses to inform development of a culturally-responsive trauma-informed public health emergency framework for First Nations communities. We searched relevant databases from 1/1/2000 to 13/11/2020 inclusive, which identified 40 primary studies (and eight associated references) for inclusion in this review. Extracted data were subjected to framework and thematic synthesis. No studies reported evaluations of a trauma-informed public health emergency response. However, included studies highlighted key elements of a "trauma-informed lens," which may help to consider implications, reduce risks and foster a sense of security, wellbeing, self- and collective-efficacy, hope and resilience for First Nations communities during COVID-19. We identified key elements for minimizing the impact of compounding trauma on First Nations communities, including: a commitment to equity and human rights, cultural responsiveness, good communication, and positive leadership. The six principles guiding trauma-informed culturally-responsive public health emergency frameworks included: (i) safety, (ii) empowerment, (iii) holistic support, (iv) connectedness and collaboration, (v) compassion and caring, and (vi) trust and transparency in multi-level responses, well-functioning social systems, and provision of basic services. These findings will be discussed with First Nations public health experts, together with data on the experiences of First Nations families and communities during COVID-19, to develop a trauma-integrated public health emergency response framework or "lens" to minimize compounding trauma for First Nations communities.

A Longitudinal Cohort Study of Youth Mental Health and Substance use Before and During the COVID-19 Pandemic in Ontario, Canada: An Exploratory Analysis

BACKGROUND

Youth mental health appears to have been negatively impacted by the COVID-19 pandemic. The impact on substance use is less clear, as is the impact on subgroups of youth, including those with pre-existing mental health or substance use challenges.

OBJECTIVE

This hypothesis-generating study examines the longitudinal evolution of youth mental health and substance use from before the COVID-19 pandemic to over one year into the pandemic among youth with pre-existing mental health or substance use challenges.

METHOD

A total of 168 youth aged 14-24 participated. Participants provided sociodemographic data, as well as internalizing disorder, externalizing disorder, and substance use data prior to the pandemic's onset, then every two months between April 2020-2021. Linear mixed models and Generalized Estimating Equations were used to analyze the effect of time on mental health and substance use. Exploratory analyses were conducted to examine interactions with sociodemographic and clinical characteristics.

RESULTS

There was no change in internalizing or externalizing disorder scores from prior to the pandemic to any point throughout the first year of the pandemic. Substance use scores during the pandemic declined compared to pre-pandemic scores. Exploratory analyses suggest that students appear to have experienced more mental health repercussions than non-students; other sociodemographic and clinical characteristics did not appear to be associated with mental health or substance use trajectories.

CONCLUSIONS

While mental health remained stable and substance use declined from before the COVID-19 pandemic to during the pandemic among youth with pre-existing mental health challenges, some youth experienced greater challenges than others. Longitudinal monitoring among various population subgroups is crucial to identifying higher risk populations. This information is needed to provide empirical evidence to inform future research directions.

Experiences, concerns, and needs of pregnant and postpartum women during the Covid-19 pandemic in Cyprus: a cross-sectional study

BACKGROUND

The current COVID-19 pandemic is a unique stressor with potentially challenging and negative consequences on the experiences of pregnant and postpartum women. International literature highlights the pandemic's negative impact on women's perinatal experiences. This is the first study in the scientific literature reporting on the impact of the COVID-19 pandemic, on the perinatal experiences of a large sample of women living in Cyprus.

AIM

To examine the impact of the COVID-19 pandemic on the experiences, concerns and needs of pregnant and postpartum women in Cyprus.

METHOD

The cross-sectional study was conducted from July 2020 to January 2021. A total of 695 women, 355 pregnant and 340 postpartum women (with infants up to 6 months of age), residing in Cyprus were surveyed.

RESULTS

The great majority of the participants (80.9%) perceived the impact of the COVID-19 pandemic on their life as negative. The greatest sources of stress were identified and quantified for their impact on the participants. Our findings indicate that 74.1% of the pregnant women were concerned about changes due to COVID-19 measures impacting the presence of their family at the time of delivery, 57.2% about their newborn's health, and 43.1% about changes related to perinatal care. Postpartum women's concerns were mainly related to the welfare and health of their child (70.3%), whilst half of them (49.1%) expressed concerns about how they were going to care for their baby because of pandemic-related changes. Qualitative data revealed emerging themes as the basis of the pregnant and postpartum women's concerns and needs.

CONCLUSIONS

The COVID-19 pandemic and the associated imposed measures and restrictions had adverse effects on pregnant and postpartum women's perinatal experiences in Cyprus. The women's concerns emphasized the need for the development of specialized, evidenced-based support systems which are essential particularly in pandemic-like situations, when pregnant and postpartum women are more vulnerable to isolation.

Evaluating the Implementation of a Multi-Technology Delivery of a Mental Health and Wellbeing System of Care Within a Youth Sports Development Program During the COVID-19 Pandemic

The COVID-19 pandemic presents challenges to the provision of community programs and access to mental health services for young people. We examined the feasibility, reach, and acceptability of multi-technology delivery of an integrated system that assesses and provides feedback on youth mental health and wellbeing and connects them to care within the context of a youth sports development program. The system was delivered via computer, telephone, and teleconference with 66 adolescent boys participating in a rugby league development program in three communities in Australia. Young people completed online wellbeing and mental health measures (Assess step), parents were provided with telephone feedback on results, support, and referral options (Reflect step), and youth received teleconferenced workshops and online resources (Connect step). The multi-technology delivery was feasible to implement, and reach was high, with barriers experienced at the Assess step but minimally experienced at the Reflect and Connect steps. Delivering the system via multiple forms of technology was rated as highly beneficial and enjoyable by young people. Players improved in self-reported prosocial behaviour, gratitude, and anxiety symptoms from pre- to post-program. Strong collaboration between researchers, organisational personnel, and community members is important for achieving these outcomes.

Sociodemographic and Policy Factors Associated with the Transmission of COVID-19: Analyzing Longitudinal Contact Tracing Data from a Northern Chinese City

To examine how sociodemographic characteristics and non-pharmaceutical interventions affect the transmission of COVID-19, we analyze patient profiles and contact tracing data from almost all cases in an outbreak in Shijiazhuang, China, from January to February 2021. Because of universal testing and digital tracing, the data are of high quality. Results from negative binomial models indicate that the counts of close contacts and secondary infections vary with the cases' age and occupation. Notably, cases under age 18 are causing an increased infection rate among their close contacts and leading to more within-neighborhood secondary infections than adults aged 18-49. Also, county-wide interventions and lockdown are found to be effective at containing the spread of COVID-19. These measures can reduce the number of close contacts that each case has and largely restrict the remaining infections to the case's neighborhood. These results suggest that transmission risks of COVID-19 are associated with the case's sociodemographic characteristics and can be reduced with interventions at the county level. Implications on mitigation measures and reopening plans are discussed.

Neoliberal and pandemic subjectivation processes: Clapping and singing as affective (re)actions during the Covid-19 home confinement

During the Covid-19 pandemic, the restriction of free movement and the sheltering-in-place became worldwide strategies to manage the virus spread. Especially at the beginning of the pandemic, community-based affective events helped people feel less isolated and support each other. In this manuscript, we explore how two of these social practices—clapping and singing—were useful to counter the emotions entailed in the subjectivation processes that accompanied the pandemic. We then argue that, seen as affective happenings, singing and clapping heightened emotions and affects that were already implicit in neoliberalism, mainly anxiety, loneliness, and a sense of precariousness, disposability, and inadequacy. On one hand, singing and clapping were liberatory practices of solidarity and resistance against the changes induced by the pandemic and its biopolitics. On the other hand, they contributed to the primary narratives on social resilience, docile bodies, and biopolitics that informed the crisis management. Singing and clapping also operated as neoliberal technologies of the self by bringing the focus on individual agency, behavioral control, and the sacrifice of specific subjects (e.g., the healthcare workers described as heroes). In short, singing and clapping were affective happenings that instantiated an entanglement of subjectivation practices in which the power to affect and the power to resist coincided.

Prior sleep-wake behaviors are associated with mental health outcomes during the COVID-19 pandemic among adult users of a wearable device in the United States

Objectives

To characterize objective sleep patterns among U.S. adults before and during the COVID-19 pandemic, and to assess for associations between adverse mental health symptoms and (1) sleep duration and (2) the consistency of sleep timing before and during the pandemic.

Design

Longitudinal objective sleep-wake data during January-June 2020 were linked with mental health and substance use assessments conducted during June 2020 for The COVID-19 Outbreak Public Evaluation (COPE) Initiative.

Setting

Adult users of WHOOP—a commercial, digital sleep wearable.

Participants

Adults residing in the U.S. and actively using WHOOP wearable devices, recruited by WHOOP, Inc.

Intervention

The COVID-19 pandemic and its mitigation.

Measurements

Anxiety or depression symptoms, burnout symptoms, and new or increased substance use to cope with stress or emotions.

Results

Of 4912 participants in the primary analytic sample (response rate, 14.9%), we observed acutely increased sleep duration (0.25 h or 15 m) and sleep consistency (3.51 points out of 100) and delayed sleep timing (onset, 18.7 m; offset, 36.6 m) during mid-March through mid-April 2020. Adjusting for demographic and lifestyle variables, participants with persistently insufficient sleep duration and inconsistent sleep timing had higher odds of adverse mental health symptoms and substance use in June 2020.

Conclusions

U.S. adult wearable users displayed increased sleep duration, more consistent sleep timing, and delayed sleep onset and offset times after the COVID-19 pandemic onset, with subsample heterogeneity. Associations between adverse mental health symptoms and pre- and mid-pandemic short sleep duration and inconsistent sleep timing suggest that these characteristics warrant further investigation as potential modifiable mental health and substance use risk factors.

OUP accepted manuscript

In several countries, governments have implemented so-called ‘COVID passport’ schemes, which restrict access to venues such as bars or sports events to those who are vaccinated against COVID-19 and/or exempt vaccinated individuals from public health measures such as curfews or quarantine requirements. These schemes have been the subject of a heated debate. Concerns about inequality have played an important role in the opposition to such schemes. This article highlights that determining how COVID passports affect equality requires a much more nuanced analysis than is typically assumed. I identify a range of broadly egalitarian considerations that could be affected by the introduction of COVID passport schemes. While these schemes could undermine certain aspects of equality, I argue that they could also be used to promote equality. The magnitude and severity of these different effects, both promoting and undermining equality, depend on how precisely these schemes are framed and the local context in which they are implemented.

Association of Delayed Sleep/Wake Rhythm with Depression During the First COVID-19 Lockdown in France

PURPOSE

The containment of the population during the COVID-19 pandemic led to the emergence or recurrence of psychiatric conditions and sleep disorders. The influence of sleep/wake rhythm on mental health is well known. The objective of our study was to evaluate the link between the shift in sleep/wake rhythm and the presence of depressive symptoms during the March to May 2020 lockdown in the French population.

PARTICIPANTS AND METHODS

Participants (n = 2513) were recruited via newspapers and social networks in March 2020. We evaluated i) the chronotype before and during the lockdown, assessed by the change in mid-sleep time on work-free days corrected for sleep debt on workdays (delta MSFsc); ii) morningness-eveningness circadian preference (Horne & Ostberg questionnaire); iii) depressive symptoms (Patient Health Questionnaire-9, PHQ-9). The delta MSFsc and the PHQ-9 score were compared between circadian preference types. A multivariate model adjusted for age, sex, circadian preference, housing type, and marital status was used to assess the influence of delta MSFsc on the PHQ-9 score in the whole population.

RESULTS

The population consisted of 77% women, of median (IQR) age 39 (30-48) years. Compared with the pre-lockdown period, the median (IQR) MSFsc was shifted by 30 (0-66) min during the lockdown, with a significant difference between evening [60 (15-120) min], morning [15 (0-46) min] and neutral [30 (0-70) min] circadian type individuals, p < 0.001. One-third of all participants had moderate to severe depressive symptoms (PHQ-9 ≥ 10). A 1-hour shift in MSFsc was associated with a 0.50-point increase [95% CI (0.28; 0.72), p < 0.001] in the PHQ-9.

CONCLUSION

A phase delay in the chronotype was observed in the general population during lockdown. Such disruption was associated with depressive symptoms but the direction of the relationship remains hypothetical. The impact on mental health of preventive measures targeting the sleep/wake rhythm in this context needs further evaluation.

Crisis response among essential workers and their children during the COVID-19 pandemic

Limited research has been conducted on the mental health concerns of frontline and essential workers and their children during the COVID-19 pandemic in the United States (U.S.). This study examined the association between working on the frontlines in the U.S. during the COVID-19 pandemic (March to July 2020) and personal crisis text concerns (e.g., self-harm, suicidal thoughts, anxiety/stress, and substance abuse) for frontline essential workers and the children of frontline workers. We used a novel data set from a crisis texting service, Crisis Text Line (CTL), that is widely used throughout the U.S. Generalized Estimating Equations examined the individual association between eight specific crisis types (Depression, Stress/Anxiety, Self-Harm, Suicidal Thoughts, Substance Abuse, Isolation, Relationship Issues, and Abuse) and being in frontline work or being a child of a frontline worker during the early phase of the pandemic. Using CTL concerns as a proxy for the prevalence of mental health issues, we found that children of workers, specifically the youngest demographic (13 years and under), females, and non-conforming youth had a higher risk of specific crisis events during the COVID-19 pandemic. Additionally, Hispanic children of workers reported higher rates of stress/anxiety, whereas African American children of workers had higher rates of abuse and depression. Frontline workers had a higher risk of suicidal thoughts, and the risk of crisis events was generally highest for non-binary, transgender, and male users. Increases in CTL usage among frontline workers were noted across 7-28 days after spikes in local COVID-19 cases. The research to date has focused on the mental health of frontline essential workers, but our study highlights troubling trends in psychological stress among children of these workers. Supportive interventions and mental health resources are needed not only for frontline essential workers, but for their children too.

Narratives of Dreams and Waking Thoughts: Emotional Processing in Relation to the COVID-19 Pandemic

The Coronavirus-19 (COVID-19) pandemic posed a significant challenge to the physical, mental, and emotional well-being of each individual. It also brought the importance of daily emotional management for survival to the forefront of every human being. Our study aims to explore whether emotional processes perform different functions during waking thoughts and night dreams during the first lockdown in Italy. Utilizing Multiple Code Theory (MCT), our goal is to verify whether waking thoughts facilitate a functional disconnection in order to manage the trauma caused by COVID-19. Two online forms were distributed to random participants in the general population, presenting a total of 49 reports of night dreams (23 males; mean age 33.45 ds. 10.12; word mean 238.54 ds. 146.8) and 48 reports of waking thoughts (25 males; mean age 34.54 ds. 12.8; word mean M. 91 words ds. 23). The Referential Process linguistic measures and Affect Salience Index were utilized. It was found that Affect Salience is present in both dreams and in waking thoughts; however, Referential Activity was higher in dreams and Reflection and Affect words were higher in waking thoughts. Two different processes of emotional elaboration emerged. The results highlight the use of greater symbolization processes during dreams and a higher emotional distance in waking thoughts. These results confirm that during the nocturnal processes, there is greater contact with the processing of trauma, while during the diurnal processes, defensive strategies were activated to cope with and manage life via a moment of the defensive disruption of daily activities.

Evening-types show highest increase of sleep and mental health problems during the COVID-19 pandemic - Multinational study on 19,267 adults

Study Objectives

Individual circadian type is a ubiquitous trait defining sleep, with eveningness often associated with poorer sleep and mental health than morningness. However, it is unknown whether COVID-19 pandemic has differentially affected sleep and mental health depending on the circadian type. Here, the differences in sleep and mental health between circadian types are examined globally before and during the COVID-19 pandemic.

Methods

The sample collected between May and August 2020 across 12 countries/regions consisted of 19 267 adults with information on their circadian type. Statistical analyses were performed by using Complex Sample procedures, stratified by country and weighted by the number of inhabitants in the country/area of interest and by the relative number of responders in that country/area.

Results

Evening-types had poorer mental health, well-being, and quality of life or health than other circadian types during the pandemic. Sleep–wake schedules were delayed especially on working days, and evening-types reported an increase in sleep duration. Sleep problems increased in all circadian types, but especially among evening-types, moderated by financial suffering and confinement. Intermediate-types were less vulnerable to sleep changes, although morningness protected from most sleep problems. These findings were confirmed after adjusting for age, sex, duration of the confinement, or socio-economic status during the pandemic.

Conclusions

These findings indicate an alarming increase in sleep and mental health problems, especially among evening-types as compared to other circadian types during the pandemic.

COVID-19, social isolation and the mental health of autistic people and their families: A qualitative study

LAY ABSTRACT

In this study, we show that autistic people and their families have found it very difficult to deal with the lockdowns during the COVID-19 pandemic. Autistic and non-autistic researchers spoke to 144 people, including 44 autistic adults, 84 parents of autistic children and 16 autistic young people (12-18 years old). We asked them about their everyday lives and mental health during lockdown. People told us that they enjoyed having fewer obligations and demands compared to pre-COVID-19 life. They felt that life was quieter and calmer. But people also told us again and again how much they missed meeting people in real life, especially their friends, and their therapists and support workers. People told us that their mental health suffered because they did not have contact with their friends and services. Importantly, many people (including researchers) think that autistic people do not want friends or to be around people. But our results show that is not true. Many autistic people do want friends and to be around other people. Some people's mental health has been damaged by not being able to see people during COVID-19. Autistic people need support in many areas of life so they can keep socialising and seeing their friends even through difficult times, like pandemics.

Has COVID-19 lockdown improved glycaemic control in pediatric patients with type 1 diabetes? An analysis of continuous glucose monitoring metrics

AIMS

Our observational study aimed to evaluate the impact of the lockdown period due to 2019 Coronavirus disease pandemic on glycaemic control in a cohort of paediatric patients with type 1 diabetes (T1D).

METHODS

Eighty-five patients with T1D aged 5-18 years using continuous glucose monitoring (CGM) systems were enrolled. Demographic and clinical data, including glucose metrics generated by CGM-specific web-based cloud platforms, were collected in three different periods (pre-lockdown phase, lockdown phase, and post-lockdown phase) of 90 days each and were statistically analysed.

RESULTS

During the lockdown period, a clear improvement in almost all CGM metrics (time in range, time above range, coefficient of variation, and glucose management indicator) was observed in our study population, regardless of age and insulin type treatment. In the months following lockdown, maintaining satisfactory diabetes outcomes was confirmed only in younger patients (aged 5-9 years) and in those individuals on hybrid closed loop therapy.

CONCLUSIONS

The increasing use of innovative technological devices together with data sharing systems and interaction with multidisciplinary diabetes team through telemedicine allowed paediatric patients with T1D to improve glucose metrics during the lockdown period. However, our findings showed that the achievement of better glycaemic control was transient for most patients.

Bereavement from COVID-19, Gender, and Reports of Depression among Older Adults in Europe

Objectives

The coronavirus disease 2019 (COVID-19) pandemic has left older adults around the world bereaved by the sudden death of relatives and friends. We examine if COVID-19 bereavement corresponds with older adults’ reporting depression in 27 countries and test for variations by gender and country context.

Method

We analyze the Survey of Health, Ageing and Retirement in Europe COVID-19 data collected between June and August 2020 from 51,383 older adults (age 50–104) living in 27 countries, of whom 1,363 reported the death of a relative or friend from COVID-19. We estimate pooled multilevel logit regression models to examine if COVID-19 bereavement is associated with self-reported depression and worsening depression, and we test whether national COVID-19 mortality rates moderate these associations.

Results

COVID-19 bereavement is associated with significantly higher probabilities of both reporting depression and reporting worsened depression among older adults. Net of one’s own personal loss, living in a country with the highest COVID-19 mortality rate is associated with women’s reports of worsened depression but not men’s. However, the country’s COVID-19 mortality rate does not moderate associations between COVID-19 bereavement and depression.

Discussion

COVID-19 deaths have lingering mental health implications for surviving older adults. Even as the collective toll of the crisis is apparent, bereaved older adults are in particular need of mental health support.

Early public adherence with and support for stay-at-home COVID-19 mitigation strategies despite adverse life impact: a transnational cross-sectional survey study in the United States and Australia

BACKGROUND

Governments worldwide recommended unprecedented measures to contain the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As pressure mounted to scale back measures, understanding public priorities was critical. We assessed initial public adherence with and support for stay-at-home orders in nations and cities with different SARS-CoV-2 infection and COVID-19 death rates.

METHODS

Cross-sectional surveys were administered to representative samples of adults aged ≥18 years from regions with different SARS-CoV-2 prevalences from April 2-8, 2020. Regions included two nations [the United States (US-high prevalence) and Australia (AU-low prevalence)] and two US cities [New York City (NY-high prevalence) and Los Angeles (LA-low prevalence)]. Regional SARS-CoV-2 and COVID-19 prevalence (cumulative SARS-CoV-2 infections, COVID-19 deaths) as of April 8, 2020: US (363,321, 10,845), AU (5956, 45), NY (81,803, 4571), LA (7530, 198). Of 8718 eligible potential respondents, 5573 (response rate, 63.9%) completed surveys. Median age was 47 years (range, 18-89); 3039 (54.5%) were female.

RESULTS

Of 5573 total respondents, 4560 (81.8%) reported adherence with recommended quarantine or stay-at-home policies (range of samples, 75.5-88.2%). Additionally, 29.1% of respondents screened positive for anxiety or depression symptoms (range of samples, 28.6-32.0%), with higher prevalences among those of younger age, female gender, and those in quarantine or staying at home most of the time versus those who did not report these behaviours. Despite elevated prevalences of adverse mental health symptoms and significant life disruptions, 5022 respondents (90.1%) supported government-imposed stay-at-home orders (range of samples, 88.9-93.1%). Of these, 90.8% believed orders should last at least three more weeks or until public health or government officials recommended, with support spanning the political spectrum.

CONCLUSIONS

Public adherence with COVID-19 mitigation policies was highly prevalent, in both highly-affected (US, NY) and minimally-affected regions (AU, LA). Despite disruption of respondents' lives, the vast majority supported continuation of extended stay-at-home orders. Despite common support, these two countries diverged in stringent mitigation implementation, which may have contributed to subsequent outcomes. These results reveal the importance of surveillance of public support for and adherence with such policies during the COVID-19 pandemic and for future infectious disease outbreaks.

Early public adherence with and support for stay-at-home COVID-19 mitigation strategies despite adverse life impact: a transnational cross-sectional survey study in the United States and Australia

BACKGROUND

Governments worldwide recommended unprecedented measures to contain the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As pressure mounted to scale back measures, understanding public priorities was critical. We assessed initial public adherence with and support for stay-at-home orders in nations and cities with different SARS-CoV-2 infection and COVID-19 death rates.

METHODS

Cross-sectional surveys were administered to representative samples of adults aged ≥18 years from regions with different SARS-CoV-2 prevalences from April 2-8, 2020. Regions included two nations [the United States (US-high prevalence) and Australia (AU-low prevalence)] and two US cities [New York City (NY-high prevalence) and Los Angeles (LA-low prevalence)]. Regional SARS-CoV-2 and COVID-19 prevalence (cumulative SARS-CoV-2 infections, COVID-19 deaths) as of April 8, 2020: US (363,321, 10,845), AU (5956, 45), NY (81,803, 4571), LA (7530, 198). Of 8718 eligible potential respondents, 5573 (response rate, 63.9%) completed surveys. Median age was 47 years (range, 18-89); 3039 (54.5%) were female.

RESULTS

Of 5573 total respondents, 4560 (81.8%) reported adherence with recommended quarantine or stay-at-home policies (range of samples, 75.5-88.2%). Additionally, 29.1% of respondents screened positive for anxiety or depression symptoms (range of samples, 28.6-32.0%), with higher prevalences among those of younger age, female gender, and those in quarantine or staying at home most of the time versus those who did not report these behaviours. Despite elevated prevalences of adverse mental health symptoms and significant life disruptions, 5022 respondents (90.1%) supported government-imposed stay-at-home orders (range of samples, 88.9-93.1%). Of these, 90.8% believed orders should last at least three more weeks or until public health or government officials recommended, with support spanning the political spectrum.

CONCLUSIONS

Public adherence with COVID-19 mitigation policies was highly prevalent, in both highly-affected (US, NY) and minimally-affected regions (AU, LA). Despite disruption of respondents' lives, the vast majority supported continuation of extended stay-at-home orders. Despite common support, these two countries diverged in stringent mitigation implementation, which may have contributed to subsequent outcomes. These results reveal the importance of surveillance of public support for and adherence with such policies during the COVID-19 pandemic and for future infectious disease outbreaks.