Psychological distress during the COVID-19 pandemic in Canada

Factors Associated with Older People's Anxiety Symptom Positioning after COVID-19: Cross-Sectional Findings from a Canadian Sample

This study sheds light on the personal characteristics of older Canadians self-identifying as severely anxious and the coping strategies that they gravitated to mitigate their anxiety. Our studied sample consisted of 606 Canadians aged 60 and above who took part in an e-survey across all 10 of Canada's provinces, launched in July 2022, when social distancing was lifted across the country. Participants completed a personal characteristics questionnaire, the Geriatric Anxiety Scale or GAS-10, and a checklist of everyday coping strategies for mitigating anxiety. A seemingly greater number of severely anxious Canadians were born female, self-identified as a cisgender woman, and were in their 60s and in poor to fair health. A univariate logistic regression analysis revealed that all such personal characteristics were associated with statistically significantly greater odds of experiencing severe anxiety. In our multivariate logistic regression analysis, no significant differences were observed between the sexes (AOR = 0.590, p = 0.404), and non-binary and cisgender men (AOR = 0.689, p = 0.441) and women (AOR = 0.657, p = 0.397). Nor were there statistically significant differences in the odds of experiencing severe anxiety for those living with versus without a life partner and chronic illnesses. Older Canadians experiencing severe anxiety were far more likely to normalize their fear and anxiety (AOR = 4.76, p < 0.001), challenge their worries (AOR = 5.21, p < 0.001), and to relax or meditate (AOR = 2.36, p = < 0.001). They were less inclined to decrease other sources of stress in their lives, to stay active, and to get enough sleep. We offer anticipatory guidance for mental health program planners and practitioners, and fruitful avenues of inquiry for researchers.

Relationship between COVID-19 pandemic-related experienced stress and lifestyle habits among university students from Québec, Canada

Whether COVID-19-related experienced stress influenced lifestyle habits remains to be thoroughly evaluated among university students. This study examined the relationship between COVID-19-related experienced stress and subsequent lifestyle habits among undergraduate students. This cross-sectional study included 708 undergraduate students from Université Laval (Québec, Canada) participating in the Expériences Pandémiques (ExPan) cohort. Data on COVID-19-related experienced stress and lifestyle were self-reported using a questionnaire completed between February and April of 2022. A stress index (SI) was computed by summing scores associated with 31 situational statements related to the pandemic (e.g., not being able to see friends, dealing with job loss). A healthy lifestyle score (HLS) ranging from zero to seven was calculated based on seven lifestyle habits: moderate-to-vigorous physical activity, sleep quality, fruit and vegetable intake, tobacco and electronic cigarette use, alcohol consumption, cannabis use, and hard or sedative-hypnotic drugs use. In multivariable-adjusted models, a negative association between the SI and the HLS was found (β10% increment SI = -0.23, 95% CI = -0.30, -0.16 HLS point; P < 0.0001). The SI was also negatively associated with sleep quality, and fruit and vegetable consumption, while being positively associated with at-risk alcohol consumption, cannabis use, and hard or sedative-hypnotic drug use. Subgroup analyses suggested a negative relationship between the SI and HLS among participants who did not receive academic accommodations (e.g., additional time for evaluations, personal notetaker), but not those who received such accommodations. This study suggests that COVID-19-related experienced stress was negatively associated with healthy lifestyle habits in this cohort of undergraduate students.

Easing anxiety symptoms through leisure activities during social isolation: Findings from nationally representative samples

Public health interventions implemented during the COVID-19 pandemic may exacerbate anxiety symptoms for many. We conducted this study to better understand the role of leisure activity in promoting mental wellness during times of social isolation and reduced access to recreation facilities and mental health support services. We analyzed nationally representative survey data collected by Statistics Canada as part of the Canadian Perspectives Survey Series (CPSS) during May 4-10 (CPSS 2) and July 20 to 26, 2020 (CPSS 4). Data related to leisure activity and anxiety symptoms as measured by a score of more than 10 on the General Anxiety Disorder scale were examined using descriptive and log-binomial regression analyses. Survey sampling weights were applied in all analyses, and regression results were adjusted for sociodemographic characteristics. Exercise and communication with friends and loved ones were the most frequently reported leisure activity. Prevalence of moderate to severe anxiety symptoms reported by participants was lower in CPSS 4 compared to CPSS 2. Results of adjusted log-binomial regression analyses revealed lower prevalence of moderate to severe anxiety symptoms in those who engaged in exercise and communication, while those who meditated exhibited higher prevalence. In conclusion, leisure activities, such as exercise and communication with loved ones, can promote mental wellness. Future research should clarify the role of meditation for mental wellness promotion during periods of social isolation.

Adult psychiatric inpatient admissions and length of stay before and during the COVID-19 pandemic in a large urban hospital setting in Vancouver, British Columbia

Introduction

During the COVID-19 pandemic individuals with mental illnesses faced challenges accessing psychiatric care. Our study aimed to describe patient characteristics and compare admissions and length of stay (LOS) for psychiatric-related hospitalizations before and during the COVID-19 pandemic.

Methods

We conducted a retrospective analysis using health administrative data comparing individuals with an acute psychiatric admission between two time periods: 1st March 2019 to 31st December 2019 (pre-COVID) and 1st March 2020 to 31st December 2020 (during-COVID). Multivariable negative binomial regression was used to model the association between most responsible diagnosis type and the two-time periods to hospital LOS, reporting the Rate Ratio (RR) as the measure of effect.

Results

The cohort comprised 939 individuals who were predominately male (60.3%) with a severe mental illness (schizophrenia or mood-affective disorder) (72.7%) and a median age of 38 (IQR: 28.0, 52.0) years. In the multivariable analysis, anxiety disorders (RR: 0.63, CI: 0.4, 0.99) and personality disorders (RR: 0.52, CI: 0.32, 0.85) were significantly associated with a shorter LOS when compared to individuals without those disorders. Additionally, when compared to hospital admissions for non-substance related disorders the LOS for patients with substance-related disorders were significantly shorter during the COVID period (RR: 0.45, CI: 0.30, 0.67) and pre-COVID period (RR: 0.31, CI: 0.21, 0.46).

Conclusions

We observed a significant difference in the type and length of admissions for various psychiatric disorders during the COVID-19 period. These findings can support systems of care in adapting to utilization changes during pandemics or other global health events.

Effectiveness of an eHealth intervention for reducing psychological distress and increasing COVID-19 knowledge and protective behaviors among racialized sexual and gender minority adults: A quasi-experimental study (#SafeHandsSafeHearts)

PURPOSE

Sexual and gender minority and racialized populations experienced heightened vulnerability during the Covid-19 pandemic. Marginalization due to structural homophobia, transphobia and racism, and resulting adverse social determinants of health that contribute to health disparities among these populations, were exacerbated by the Covid-19 pandemic and public health measures to control it. We developed and tested a tailored online intervention (#SafeHandsSafeHearts) to support racialized lesbian, gay, bisexual, transgender, queer, and other persons outside of heteronormative and cisgender identities (LGBTQ+) in Toronto, Canada during the pandemic.

METHODS

We used a quasi-experimental pre-test post-test design to evaluate the effectiveness of a 3-session, peer-delivered eHealth intervention in reducing psychological distress and increasing Covid-19 knowledge and protective behaviors. Individuals ≥18-years-old, resident in Toronto, and self-identified as sexual or gender minority were recruited online. Depressive and anxiety symptoms, and Covid-19 knowledge and protective behaviors were assessed at baseline, 2-weeks postintervention, and 2-months follow-up. We used generalized estimating equations and zero-truncated Poisson models to evaluate the effectiveness of the intervention on the four primary outcomes.

RESULTS

From March to November 2021, 202 participants (median age, 27 years [Interquartile range: 23-32]) were enrolled in #SafeHandsSafeHearts. Over half (54.5%, n = 110) identified as cisgender lesbian or bisexual women or women who have sex with women, 26.2% (n = 53) cisgender gay or bisexual men or men who have sex with men, and 19.3% (n = 39) transgender or nonbinary individuals. The majority (75.7%, n = 143) were Black and other racialized individuals. The intervention led to statistically significant reductions in the prevalence of clinically significant depressive (25.4% reduction, p < .01) and anxiety symptoms (16.6% reduction, p < .05), and increases in Covid-19 protective behaviors (4.9% increase, p < .05), from baseline to postintervention.

CONCLUSION

We demonstrated the effectiveness of a brief, peer-delivered eHealth intervention for racialized LGBTQ+ communities in reducing psychological distress and increasing protective behaviors amid the Covid-19 pandemic. Implementation through community-based organizations by trained peer counselors supports feasibility, acceptability, and the importance of engaging racialized LGBTQ+ communities in pandemic response preparedness. This trial is registered with ClinicalTrials.gov, number NCT04870723.

Mentally healthy living after pandemic social distancing: a study of older Canadians reveals helpful anxiety reduction strategies

BACKGROUND

Throughout the COVID-19 pandemic, older Canadians were the most at risk of severe physical harm, including death, and their return to post-COVID life was expected to be especially anxiety-provoking. A study was conducted to obtain nationally representative evidence of older Canadians' self-perceived anxiety levels and their strategies to manage or mitigate it as public health restrictions were lifting.

MATERIALS AND METHODS

This study had a cross-sectional descriptive design. An e-survey was used to collect data from 1327 Canadians aged 60+ stratified by age, sex, and education to resemble the larger general population. Participants completed the Geriatric Anxiety Scale (GAS-10) and indicated which of the 16 Centre for Addictions and Mental Health's (2022) Coping with Stress and Anxiety strategies they were using to manage or mitigate their anxiety when social distancing was lifting. Descriptive statistics, Pearson correlation, and multiple regression analysis were used to explore the data.

RESULTS

While, on average, older Canadians were mildly anxious, nearly one-quarter of responders rated their anxiety as severe. Age, sex, perceived health, were statistically significant correlates of anxiety. Six coping strategies were associated with significantly lower anxiety scores. Moreover, accepting some fear and anxiety as normal, challenging worries and anxious thoughts, and practising relaxation/meditation appeared to increase anxiety.

CONCLUSION

Older Canadians used multiple strategies to manage or mitigate their anxiety, and seemingly, with more successful than detrimental tries. Practitioners have much to learn and understand about older people's mental health promotion efforts after social distancing, now and for future pandemics.

Assessing the impact of COVID-19 on self-reported levels of depression during the pandemic relative to pre-pandemic among Canadian adults

OBJECTIVES

This study aims to assess the impact of COVID-19 related risk factors on self-reported increases in depression among Canadian adults during the pandemic compared to pre-pandemic levels. We aim to investigate the interactive effects of stressors, including social isolation, financial stress, and fear of catching COVID-19, on mental health outcomes. Our study aims to provide insights for the development of prevention and intervention strategies to address the mental health effects of the pandemic by examining the psychological changes attributable to the pandemic and its impact.

METHODS

This study used data collected from the Mental Health Research Canada online survey during the third wave of COVID-19 (April 20-28, 2021). The study examined the impact of COVID-19 related factors, including social isolation, financial concerns, fear of catching COVID-19, and concerns about paying bills, on self-reported increases in depression. Multivariable logistic regression models were utilized to examine these associations, with adjustments made for potential confounding variables. All statistical analysis was performed using SAS V9.4 (SAS Institute Inc., Cary, NC, USA).

RESULTS

Participants reporting social isolation, financial concerns, and fear of catching COVID-19 were more likely to report increased depression. An interaction was observed between concerns for paying bills and catching COVID-19 in relation to depression (p = 0.0085). In other words, the effect of concerns about paying bills on depression was stronger for individuals who also had a fear of catching COVID-19, and vice versa. Young adults, females, patients with pre-existing depression, and residents of certain provinces reported higher levels of depression during COVID-19.

CONCLUSION

Our study underscores the significant impact of the COVID-19 pandemic on mental health, particularly among certain demographic groups. It emphasizes the need for depression screening and increased support for mental health during the pandemic, with a focus on mitigating financial burdens and reducing negative psychological impacts of social isolation. Our findings highlight the complex interplay between different stressors and the need to consider this when designing interventions to support mental health during times of crisis.

COVID-19 among Black people in Canada: a scoping review

INTRODUCTION

The COVID-19 pandemic exacerbated health inequities worldwide. Research conducted in Canada shows that Black populations were disproportionately exposed to COVID-19 and more likely than other ethnoracial groups to be infected and hospitalized. This scoping review sought to map out the nature and extent of current research on COVID-19 among Black people in Canada.

METHODS

Following a five-stage methodological framework for conducting scoping reviews, studies exploring the effects of the COVID-19 pandemic on Black people in Canada, published up to May 2023, were retrieved through a systematic search of seven databases. Of 457 identified records, 124 duplicates and 279 additional records were excluded after title and abstract screening. Of the remaining 54 articles, 39 were excluded after full-text screening; 2 articles were manually picked from the reference lists of the included articles. In total, 17 articles were included in this review.

RESULTS

Our review found higher rates of COVID-19 infections and lower rates of COVID-19 screening and vaccine uptake among Black Canadians due to pre-COVID-19 experiences of institutional and structural racism, health inequities and a mistrust of health care professionals that further impeded access to health care. Misinformation about COVID-19 exacerbated mental health issues among Black Canadians.

CONCLUSIONS

Our findings suggest the need to address social inequities experienced by Black Canadians, particularly those related to unequal access to employment and health care. Collecting race-based data on COVID-19 could inform policy formulation to address racial discrimination in access to health care, quality housing and employment, resolve inequities and improve the health and well-being of Black people in Canada.

Exploring Clients' Experiences of Transitioning Mental Health Nursing Care from an In-Person to a Virtual Format due to the COVID-19 Pandemic

The onset of the COVID-19 pandemic led mental health professionals to change the way they engaged with clients, often replacing in-person consultations with virtual ones via telephone or videoconferencing. While studies have investigated the delivery of virtual physical health care, only a handful have investigated the delivery of virtual mental health. These specifically focussed on the outcomes of virtual care whether experiential, practical, or empirical. The transition from in-person to virtual care delivery due to the COVID-19 pandemic has been unexplored. Accordingly, the purpose of the study was to: (1) Explore the experiences of clients who had to transition from an in-person to a virtual provision of mental health care due to the COVID-19 pandemic, and; (2) Explore the nurses' experiences of this technological transition. Using an interpretive phenomenology methodology, semi-structured interviews were conducted with nurses and clients who have experienced the in-person to virtual transition of service delivery at a tertiary mental health hospital in Ontario, Canada. In this article, we focus on the results stemming from our interviews with clients. The themes generated from the analysis of client experiences are 1) the psychosocial impact of the COVID-19 pandemic on clients, (2) mixed feelings of clients towards nursing care delivered via technological means and (3) the role of nurses regarding transitioning of in-person care to technology-mediated care. These findings are relevant as mental health care hospitals are considering how they will deliver services once concerns with the transmission of the COVID-19 virus are resolved.

Psychological Distress Associated with Enforced Hospital Isolation Due to COVID-19 during the "Flatten the Curve" Phase in Morocco: A Single-Center Cross-Sectional Study

(1) Background: although much research has highlighted the mental health challenges faced by patients in hospital isolation during the COVID-19 pandemic, data from low-middle-income countries, including Morocco, are lacking. The main objective of this study was to assess the psychological distress of patients undergoing enforced hospital isolation during the initial phase of the COVID-19 pandemic in Morocco. (2) Methods: we conducted a cross-sectional study between 1 April and 1 May 2020, among patients hospitalized in isolation for suspected or confirmed COVID-19 at the Ibn Sina University Hospital of Rabat, Morocco. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Binary logistic regression was performed to identify variables associated with anxiety and depression, with a cutoff of ≥8 used for both scales to create dichotomous variables. (3) Results: among 200 patients, 42.5% and 43% scored above the cut-off points for anxiety and depression, respectively. Multiple logistic regression identified female gender, a higher education level, a longer duration of isolation, and a poor understanding of the reasons for isolation as significant factors associated with anxiety. Conversely, female gender, chronic disease, a longer duration of isolation, and a poor understanding of the reasons for isolation were factors significantly associated with depression. (4) Conclusions: our study underscores high rates of anxiety and depression among patients forced into hospital isolation during the initial phase of COVID-19 in Morocco. We identified several factors associated with patients experiencing psychological distress that may inform future discussions on mental health and psychiatric crisis management.

Enhancing the value of digital health tools for mental health help-seeking in Canadian transitional aged youth during the pandemic: Qualitative study

While the COVID-19 pandemic has greatly exacerbated the mental health challenges of transition-aged youth (TAY) between 17 and 29 years old, it has also led to the rapid adoption of digital tools for mental health help-seeking and treatment. However, to date, there has been limited work focusing on how this shift has impacted perceptions, needs and challenges of this population in using digital tools. The current study aims to understand their perspectives on mental health help-seeking during the pandemic and emerging issues related to digital tools (e.g., digital health equity, inclusivity). A total of 16 TAY were invited from three post-secondary institutions in the Greater Toronto Area. A total of two streams of focus groups were held and participants were invited to share their perceptions, needs and experiences. Five main themes were identified: 1) Helpfulness of a centralized resource encompassing a variety of diverse mental health supports help-seeking; 2) The impact of the shift to online mental health support on the use of informal supports; 3) Digital tool affordability and availability; 4) Importance of inclusivity for digital tools; and 5) Need for additional support for mental health seeking and digital tool navigation. Future work should examine how these needs can be addressed through new and existing digital mental health help-seeking tools for TAY.

Mental health effects of COVID-19 lockdowns: A Twitter-based analysis

We use a distinctive methodology that leverages a fixed population of Twitter users located in France to gauge the mental health effects of repeated lockdown orders. To do so, we derive from our population a mental health indicator that measures the frequency of words expressing anger, anxiety and sadness. Our indicator did not reveal a statistically significant mental health response during the first lockdown, while the second lockdown triggered a sharp and persistent deterioration in all three emotions. Our estimates also show a more severe deterioration in mental health among women and younger users during the second lockdown. These results suggest that successive stay-at-home orders significantly worsen mental health across a large segment of the population. We also show that individuals who are closer to their social network were partially protected by this network during the first lockdown, but were no longer protected during the second, demonstrating the gravity of successive lockdowns for mental health.

Suitability of the Attitudes to Aging Questionnaire Short Form for Use among Adults in Their 50s: A Cross-Sectional e-Survey Study

This cross-sectional e-survey study examines the suitability (reliability and validity) of the 12-item Attitudes to Aging Questionnaire Short Form (AAQ-SF) for use among adults in their 50s. The AAQ-SF instrument was originally designed to capture subjective perceptions of physical change, psychosocial loss, and psychological growth by asking people aged 60 and beyond how they feel about growing older. Our sample comprised 517 people residing in three Canadian provinces. Respondents completed the Attitudes to Aging Questionnaire Short Form, the Rosenberg Self-Esteem Scale, and a short sociodemographic profile. Our findings replicate the original AAQ-SF structure for physical change, psychosocial loss, and psychological growth, with a promising internal consistency range for the third subscale. In our sample, psychological growth is best represented as 'Self' and 'Generativity', with a particularly greater capacity to explain variations in scores for item 18 and item 21. Physical change and psychosocial loss scores strongly differed based on perceived health and chronic illness presence. Psychosocial loss and psychological growth were moderately correlated with two aspects of self-esteem. We relate these patterns of findings within the context of prevailing growth and development theory and their perceived implications within the context of COVID-19 and post-pandemic life.

Age group differences in psychological distress and leisure-time exercise/socioeconomic status during the COVID-19 pandemic: a cross-sectional analysis during 2020 to 2021 of a cohort study in Japan

Objective

This study aimed to determine the association between psychological distress and leisure-time exercise/socioeconomic status by age group, using data from a cohort study in Japan during the COVID-19 pandemic.

Methods

This cross-sectional study was conducted among participants in the ME-BYO cohort, aged 20-85 years, living or working in Kanagawa, Japan. A questionnaire was disseminated to 1,573 participants (51.7% men) between December 2020 and March 2021. The questionnaire items included psychological distress (using the 6-item Kessler Psychological Distress Scale [K6]), leisure-time exercise, and socioeconomic status. Multivariate analyses were conducted using logistic regression analysis for each age group.

Results

We found that 47.4% of 20-39-year-olds, 40.6% of 40-64-year-olds, and 28.3% of 65-85-year-olds experienced psychological distress (K6: ≥5 points). For those aged 20-39 years, leisure-time exercise (odds ratio [OR] (95% confidence interval) = 0.45 (0.28-0.73)) and higher annual household income [0.53 (0.32-0.90)] were associated with less psychological distress. For those aged 40-64 years, older age was associated with less psychological distress, while full-time work [1.98 (1.05-9.71)] was associated with more psychological distress. In the 65-85-year age group, higher education and higher annual income tended to be associated with less psychological distress. For those over 40 years of age, living with other(s) was associated with reduced psychological distress.

Conclusion

In the general population of Japan, not engaging in leisure-time exercise and low income affect psychological distress among young adults. Further detailed studies are needed to consider overall physical activity, job type, and work style.

Identity and COVID-19 in Canada: Gender, ethnicity, and minority status

BACKGROUND

During the COVID-19 pandemic, growing evidence from the United States, the United Kingdom, and China has demonstrated the unequal social and economic burden of this health crisis. Yet, in Canada, studies assessing the socioeconomic and demographic determinants of COVID-19, and how these determinants vary by gender and ethnic minority status, remain scarce. As new strains of COVID-19 emerge, it is important to understand the disparities to be able to initiate policies and interventions that target and prioritise the most at-risk sub-populations.

AIM

The objective of this study is to assess the socioeconomic and demographic factors associated with COVID-19-related symptoms in Canada, and how these determinants vary by identity factors including gender and visible minority status.

METHODS

We implemented an online survey and collected a nationally representative sample of 2,829 individual responses. The original data collected via the SurveyMonkey platform were analysed using a cross-sectional study. The outcome variables were COVID-19-related symptoms among respondents and their household members. The exposure variables were socioeconomic and demographic factors including gender and ethnicity as well as age, province, minority status, level of education, total annual income in 2019, and number of household members. Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were performed to test the associations. The results were presented as adjusted odds ratios (aORs) at p < 0.05 and a 95% confidence interval.

RESULTS

We found that the odds of having COVID-19-related symptoms were higher among respondents who belong to mixed race [aOR = 2.77; CI = 1.18-6.48] and among those who lived in provinces other than Ontario and Quebec [aOR = 1.88; CI = 1.08-3.28]. There were no significant differences in COVID-19 symptoms between males and females, however, we did find a significant association between the province, ethnicity, and reported COVID-19 symptoms for female respondents but not for males. The likelihood of having COVID-19-related symptoms was also lower among respondents whose total income was $100,000 or more in 2019 [aOR = 0.18; CI = 0.07-0.45], and among those aged 45-64 [aOR = 0.63; CI = 0.41-0.98] and 65-84 [aOR = 0.42; CI = 0.28-0.64]. These latter associations were stronger among non-visible minorities. Among visible minorities, being black or of the mixed race and living in Alberta were associated with higher odds of COVID-19-related symptoms.

CONCLUSION

We conclude that ethnicity, age, total income in 2019, and province were significantly associated with experiencing COVID-19 symptoms in Canada. The significance of these determinants varied by gender and minority status. Considering our findings, it will be prudent to have COVID-19 mitigation strategies including screening, testing, and other prevention policies targeted toward the vulnerable populations. These strategies should also be designed to be specific to each gender category and ethnic group, and to account for minority status.