Association Between Generalized Anxiety Disorder Scores and Online Activity Among US Adults During the COVID-19 Pandemic: Cross-Sectional Analysis

Exploring the influence of behavioral factors on depression and anxiety scores during the COVID-19 pandemic: insights from the Virginia statewide COVIDsmart longitudinal study

BACKGROUND

Amidst the COVID-19 pandemic, there has been growing concern about the declining mental health and healthy behaviors compared to pre-pandemic levels. Despite this, there is a lack of longitudinal studies that have examined the relationship between health behaviors and mental health during the pandemic. In response, the statewide COVIDsmart longitudinal study was launched. The study's main objective is to better understand the effects of the pandemic on mental health. Findings may provide a foundation for the identification of public health strategies to mitigate future negative impacts of the pandemic.

METHODS

Following online recruitment in spring of 2021, adults, ages 18 to 87, filled out social, mental, economic, occupational, and physical health questionnaires on the digital COVIDsmart platform at baseline and through six monthly follow-ups. Changes in the participant's four health behaviors (e.g., tobacco and alcohol consumption, physical activity, and social media use), along with sex, age, loneliness score, and reported social and economic (SE) hardships, were analyzed for within-between group associations with depression and anxiety scores using Mixed Models Repeated Measures.

RESULTS

In this study, of the 669 individuals who reported, the within-between group analysis indicated that younger adults (F = 23.81, p < 0.0001), loneliness (F = 234.60, p < 0.0001), SE hardships (F = 31.25, p < 0.0001), increased tobacco use (F = 3.05, p = 0.036), decreased physical activity (F = 6.88, p = 0.0002), and both positive and negative changes in social media use (F = 7.22, p = 0.0001) were significantly associated with worse depression scores. Additionally, females (F = 6.01, p = 0.015), younger adults (F = 32.30, p < 0.0001), loneliness (F = 154.59, p < 0.0001), SE hardships (F = 22.13, p < 0.0001), increased tobacco use (F = 4.87, p = 0.004), and both positive and negative changes in social media use (F = 3.51, p = 0.016) were significantly associated with worse anxiety scores. However, no significant changes were observed in the within-between group measurements of depression and anxiety scores over time (p > 0.05). Physical activity was not associated with anxiety nor was alcohol consumption with both depression and anxiety (p > 0.05).

CONCLUSIONS

This study demonstrates the longitudinal changes in behaviors within the context of the COVID-19 pandemic. These findings may facilitate the design of preventative population-based health approaches during the COVID-19 pandemic or future pandemics.

A social network analysis: mental health scales used during the COVID-19 pandemic

Introduction

The focus on psychological issues during COVID-19 has led to the development of large surveys that involve the use of mental health scales. Numerous mental health measurements are available; choosing the appropriate measurement is crucial.

Methods

A rule-based named entity recognition was used to recognize entities of mental health scales that occur in the articles from PubMed. The co-occurrence networks of mental health scales and Medical Subject Headings (MeSH) terms were constructed by Gephi.

Results

Five types of MeSH terms were filtered, including research objects, research topics, research methods, countries/regions, and factors. Seventy-eight mental health scales were discovered.

Discussion

The findings provide insights on the scales used most often during the pandemic, the key instruments used to measure healthcare workers' physical and mental health, the scales most often utilized for assessing maternal mental health, the tools used most commonly for assessing older adults' psychological resilience and loneliness, and new COVID-19 mental health scales. Future studies may use these findings as a guiding reference and compass.

Mental Health among African American and Latinx Men who have sex with men after the COVID-19 Lockdown in Los Angeles - Findings from the HOPE cohort

This study aimed to examine the depression and anxiety among men of color (primarily African American and Latinx) who have sex with men after the lockdown due to the COVID-19 pandemic. Outcomes included 21-item Beck Depression Inventory (BDI), 7-item Generalized Anxiety Disorder (GAD), and a 10-item COVID-related anxiety measure using a modified H1N1-related anxiety question. Independent variables were food insecurity and belief in government efficiency. Data were analyzed by Regression models with random cluster effects. Food insecurity experiences were significantly associated with higher depression (p < 0.001), higher anxiety (p < 0.001), and higher pandemic-related anxiety (p < 0.001). Higher levels of belief in government efficiency were significantly associated with lower depression (p < 0.05), less anxiety (p < 0.05), and less pandemic-related anxiety (p-value < 0.001). These findings emphasize the importance of establishing trust between government and at-risk communities when issuing public health policies, especially during unforeseen circumstances, as well as to ensure basic human rights, such as food security.

Associations Between Online Learning, Smartphone Addiction Problems, and Psychological Symptoms in Chinese College Students After the COVID-19 Pandemic

Background

Smartphone-based online education gained popularity during and after the COVID-19 pandemic. Although recent studies have highlighted the association between problematic smartphone use (PSU) and mental health symptoms, the potential role of online learning in this relationship remains unclear. This study aimed to analyze the relationships between higher education modes, PSU, and related psychological symptoms in university students.

Methods

A total of 1,629 Chinese university students from five provinces completed a web-based questionnaire survey between March 2020 and October 2021. Demographic characteristics and learning conditions were recorded. All participants completed the Smartphone Addiction Scale-Short Version, Patient Health Questionnaire, Generalized Anxiety Disorder Scale, and Athens Insomnia Scale. Multiple regressions models and stratified analyses were used to examine the association between online education mode, PSU, and symptoms of depression, anxiety, and insomnia.

Results

The prevalence of PSU was 58.5%. Students who relied primarily on online learning had a higher prevalence of depressive symptoms (29.95% vs. 22.24%), anxiety symptoms (25.13% vs. 18.91%), and insomnia symptoms (75.89% vs. 70.27%) than those who relied on traditional face-to-face learning (Ps < 0.05). After adjusting for covariates, subjects with PSU were more likely to report depressive symptoms (AdjOR = 3.14, 95% CI = 2.26–4.37), anxiety symptoms (AdjOR = 3.73, 95% CI = 2.13–4.59), and insomnia symptoms (AdjOR = 2.96, 95% CI = 2.23–3.92) than those without PSU. Furthermore, the associations of PSU with depressive symptoms (OR = 4.66 vs. 2.33, P for interaction = 0.015) and anxiety symptoms (OR = 6.05 vs. 2.94, P for interaction = 0.021) were more pronounced in the online learning group.

Conclusion

Our study provides preliminary evidence that Chinese university students have serious smartphone addiction problems, which are associated with depressive, anxiety, and insomnia symptoms. Online learning is found to exacerbate PSU and mental health problems. Our findings provide valuable information for targeted psychological interventions in the post-COVID-19 era.

COVID-19 News and Its Association with the Mental Health of Sexual and Gender Minority Adults: A Cross-Sectional Study

Background

Sexual and gender minority (SGM; people whose sexual orientation is not heterosexual or whose gender identity varies from what is traditionally associated with the sex assigned to them at birth) people experience high rates of trauma and substantial disparities in anxiety and posttraumatic stress disorder (PTSD). Exposure to traumatic stressors such as news related to COVID-19 may be associated with symptoms of anxiety and PTSD.

Objective

This study aims to evaluate the relationship of COVID-19 news exposure with anxiety and PTSD symptoms in a sample of SGM adults in the United States.

Methods

Data were collected between March 23 and August 2, 2020, from The PRIDE Study, a national longitudinal cohort study of SGM people. Regression analyses were used to analyze the relationship between self-reported news exposure and symptoms of anxiety using the Generalized Anxiety Disorder-7 and symptoms of COVID-19–related PTSD using the Impact of Events Scale-Revised.

Results

Our sample included a total of 3079 SGM participants. Each unit increase in COVID-19–related news exposure was associated with greater anxiety symptoms (odds ratio 1.77, 95% CI 1.63-1.93; P<.001) and 1.93 greater odds of PTSD (95% CI 1.74-2.14; P<.001).

Conclusions

Our study found that COVID-19 news exposure was positively associated with greater symptoms of anxiety and PTSD among SGM people. This supports previous literature in other populations where greater news exposure was associated with poorer mental health. Further research is needed to determine the direction of this relationship and to evaluate for differences among SGM subgroups with multiple marginalized identities.

Ethical Views on Sharing Digital Data for Public Health Surveillance: Analysis of Survey Data Among Patients

Digital data, including social media, wearable device data, electronic health records, and internet search data, are increasingly being integrated into public health research and policy. Because of the current issues around public distrust of science and other ethical issues in public health research, it is essential that researchers conduct ongoing studies assessing people's perceptions around and willingness to share digital data. This study aims to examine participants' social media use and comfort sharing their data with health researchers. One hundred and sixty-one participants with medical conditions were recruited through social media paid advertisements and referral from a website, and invited to complete surveys on social media use and ethical perspectives on data sharing. Eligibility criteria were adults 18 years old or older, living in the US, self-reported having been diagnosed by a physician with a medical condition, belonging to at least one social media platform, using social media at least twice a week, and owning a smartphone. Study participants were mostly female, White, and with a mean age of 36.31 years. More than one third of participants reported being very comfortable sharing electronic health data and social media data for personalized healthcare and to help others. Findings suggest that participants are very uncomfortable sharing their location and text message data with researchers, with primary concerns centered around loss of privacy, disclosing private information, and that friends, family, and others may find out that they shared text messages with researchers. We discuss the implications of this research before and after the COVID-19 pandemic, along with its potential implications for future collection of digital data for public health.

An online advertising intervention to increase adherence to stay-at-home-orders during the COVID-19 pandemic: An efficacy trial monitoring individual-level mobility data

The COVID-19 pandemic has led public health departments to issue several orders and recommendations to reduce COVID-19-related morbidity and mortality. However, for various reasons, including lack of ability to sufficiently monitor and influence behavior change, adherence to these health orders and recommendations has been suboptimal. Starting April 29, 2020, during the initial stay-at-home orders issued by various state governors, we conducted an intervention that sent online website and mobile application advertisements to people's mobile phones to encourage them to adhere to stay-at-home orders. Adherence to stay-at-home orders was monitored using individual-level cell phone mobility data, from April 29, 2020 through May 10, 2020. Mobile devices across 5 regions in the United States were randomly-assigned to either receive advertisements from our research team advising them to stay at home to stay safe (intervention group) or standard advertisements from other advertisers (control group). Compared to control group devices that received only standard corporate advertisements (i.e., did not receive public health advertisements to stay at home), the (intervention group) devices that received public health advertisements to stay at home demonstrated objectively-measured increased adherence to stay at home (i.e., smaller radius of gyration, average travel distance, and larger stay-at-home ratios). Results suggest that 1) it is feasible to use mobility data to assess efficacy of an online advertising intervention, and 2) online advertisements are a potentially effective method for increasing adherence to government/public health stay-at-home orders.

Public perceptions of psychiatric, justice-involved, and elderly populations during the COVID-19 pandemic

The novel coronavirus disease (COVID-19) has had a significant global impact, with all countries facing the challenge of mitigating its spread. An unprecedented shortage of medical resources has raised concerns regarding allocation and prioritization of supplies, which may exacerbate social discrepancies for already vulnerable populations. As public opinion can impact healthcare policies, we aimed to characterize perceptions of psychiatric, forensic psychiatry, correctional, and elderly populations regarding COVID-19-related issues. This web-based study recruited participants (n = 583) from the general population in North America. The survey included perceptions of the pandemic, hypothetical scenarios on resource prioritization, and Likert scale questions. The majority of participants were cisgender female (72.7%), aged 31-74 years (80.0%), married (48.0%), retired (52.7%), resided in Canada (73.9%), had a college/university degree (50.9%) and had never worked in healthcare (66.21%). Most respondents reported not having a criminal history (95.88%), or a psychiatric disorder (78.73%). Perceptions of vulnerable populations were significantly different for resource allocation and prioritization (e.g., ventilator and vaccine resources, all p < 0.001). Healthcare workers and the elderly were commonly ranked the highest priority for resources, while forensic psychiatry and correctional populations were given the lowest priority. A high rate of disagreement was found for the more stigmatizing questions in the survey (all p < 0.0001). Our results suggest that perception from members of the general public in North America is aligned with current practices for resource allocation. However, individuals that already face social and health disparities may face additional opposition in decision-making for COVID-19 resources.

Increased anxiety from fear of Omicron in China as compared to North America and Western Europe: A cross-sectional Kendall's tau-b analysis using the generalized anxiety disorder 7-item questionnaire

BACKGROUND

Policies dealing with the Coronavirus Disease 2019 (COVID-19) pandemic vary across the globe, the different governmental responses then affect the public perception of COVID-19. Many unofficial Chinese media outlets frequently spread misinformation about COVID-19 and exaggerated reports of rare sequelae of Omicron for monetization and attention seeking, leading to panics in the Chinese public. In comparison the attitudes toward Omicron in other countries around the world, especially in North America and Western Europe have shifted to a more relaxed stance.

OBJECTIVE

This article primarily aims to investigate the association between Chinese people's attitudes toward the potential after-effects of Omicron and their anxiety status, as compared to these of people living in North America or Western Europe.

METHODS

We conducted a questionnaire survey via the Credamo and collected valid data from 500 Chinese (not living in Shanghai), another 500 Chinese (living in Shanghai) and 500 people living in North America or Western Europe in June 2022. Kendall's coefficient of rank correlation tau-sub-b was used to examine this association.

RESULTS

The results suggested that subjective attitudes of Chinese participants toward the sequelae of Omicron were positively and significantly associated with their anxiety status [i.e., the Generalized Anxiety Disorder 7-item (GAD-7) scores] in Shanghai (China) (Tb = 0.44, p < 0.01) and other parts of China outside Shanghai (Tb = 0.37, p < 0.01). However, no such significant correlation was found in North America & Western Europe (Tb = -0.01, p > 0.05).

CONCLUSION

Our findings showed that Chinese participants who were more worried about the after-effects of Omicron had higher levels of anxiety. Although it is true that Long COVID-19 should be a concern, exaggerated media reporting can impact negatively on an individual's mental wellbeing. Only through the dissemination of robust scientific studies, the misinformation and the fears that follow it can be put to rest.

COVID-19 infodemic and adult and elderly mental health: a scoping review

OBJECTIVE

to map scientific knowledge about the repercussions of the infodemic on adult and elderly mental health in the context of the COVID-19 pandemic.

METHOD

this is a scoping review, developed using the Joanna Briggs Institute (JBI) methodology, which included 33 articles. These articles were analyzed according to average age, gender and education level; place and period of the studies; exposure time to COVID-19 information; main signs and symptoms related to mental health; main sources of information; suggestions for mitigating the effects of the infodemic; and knowledge gaps.

RESULTS

the most present repercussions of the infodemic on the adult and elderly mental health were anxiety, depression and stress, and the most affected group was young adults and females.

CONCLUSION

future studies with more robust designs are needed to investigate the repercussions of the infodemic on people's mental health in the medium and long term, as well as to assess the effects, feasibility, cost-benefit and meaning of interventions in population groups, especially in the elderly population.

Generalized anxiety disorder and resilience during the COVID-19 pandemic: evidence from China during the early rapid outbreak

BACKGROUND

Generalized Anxiety Disorder (GAD) is a common but urgent mental health problem during disease outbreaks. Resilience buffers against the negative impacts of life stressors on common internalizing psychopathology such as GAD. This study assesses the prevalence of GAD and examines the protective or compensatory effect of resilience against worry factors during the COVID-19 outbreak.

METHODS

A cross-sectional online survey was conducted among Chinese citizens aged ≥18 years from January 31 to February 2, 2020. A total of 4827 participants across 31 provinces and autonomous regions of the mainland of China participated in this study. The Generalized Anxiety Disorder scale (GAD-7), the Connor-Davidson Resilience Scale (CD-RISC), and a self-designed worry questionnaire were used to asses anxiety disorder prevalence, resilience level, and anxiety risk factors. Multivariable logistic regression was used to identify the associations of resilience and worry factors with GAD prevalence after controlling for other covariates.

RESULTS

The prevalence of anxiety disorder was 22.6% across the 31 areas, and the highest prevalence was 35.4% in Hubei province. After controlling for covariates, the results suggested a higher GAD prevalence among participants who were worried about themselves or family members being infected with COVID-19 (adjusted odds ratio, AOR 3.40, 95%CI 2.43-4.75), worried about difficulty obtaining masks (AOR 1.92, 95%CI 1.47-2.50), worried about difficulty of distinguishing true information (AOR 1.65, 95%CI 1.36-2.02), worried about the prognosis of COVID-19 (AOR 2.41, 95%CI 1.75-3.33), worried about delays in working (AOR 1.71, 95%CI 1.27-.31), or worried about decreased income (AOR 1.45, 95%CI 1.14-1.85) compared with those without such worries. Additionally, those with a higher resilience level had a lower prevalence of GAD (AOR 0.59, 95%CI 0.51-0.70). Resilience also showed a mediating effect, with a negative influence on worry factors and thereby a negative association with GAD prevalence.

CONCLUSION

It may be beneficial to promote public mental health during the COVID-19 outbreak through enhancing resilience, which may buffer against adverse psychological effects from worry factors.

Human information behavior during the Covid-19 health crisis. A literature review

The research carried out on human information behavior (HIB) during the Covid-19 health crisis was reviewed, with the premise that HIB and information practices allow humans to adapt to the changing circumstances of existence. A literature search was run on the LISTA and Google Scholar databases from middle March 2020 up to the end of March 2021. After filtering retrieved results, 52 studies were selected. Results are summarized into seven main themes, including the use of traditional and social media, infoveillance of search engines and social media activity, misinformation, disinformation and infodemics, and uncertainty and emotions. Results point to the need to carry out additional research in specific contexts and addressing vulnerable and marginalized groups. Further areas of inquiry include the interplay of emotions, knowledge and behaviors during the information seeking process, a better understanding of local knowledge and experiential knowledge, and the need to comprehend the limitations of ICT.

Addictions en temps de pandémie

L’Organisation mondiale de la santé a déclaré la maladie causée par le coronavirus 2 comme pandémie en mars 2020. Via les différentes mesures prises, un phénomène stressant psychosocial induit par cette épidémie a, dès lors, émergé en raison des difficultés financières, de l’isolement social et du caractère incertain du futur. L’ensemble des études nationales et internationales a mis en évidence une augmentation des usages de tabac, d’alcool et de substances illicites. Outre les comportements de consommation excessive, voire les décompensations addictives liées aux substances, il faut également prendre en considération l’usage excessif de la pornographie, des jeux de hasard et d’argent, des jeux vidéo essentiellement via Internet et l’exercice physique. La COVID-19 peut être à l’origine d’un certain nombre de conséquences et de complications chez les personnes souffrant de troubles liés à l’usage de substances licites ou illicites, population particulièrement vulnérable. Dans cette revue de la littérature narrative, nous analyserons les données concernant les comportements de consommation excessive et les addictions aux substances psychoactives licites et illicites et à certains types de comportements de la vie quotidienne. Nous avons, pour ce faire, utilisé les combinaisons de mots-clés pour sélectionner les articles scientifiques de langue anglaise et française publiés entre 2019 et 2021 en consultant les bases de données Medline, Embase, PsycInfo, Google Scholar.

Knowledge, Attitude, and Practices Toward SARS-COV-2 Infection in the United Arab Emirates Population: An Online Community-Based Cross-Sectional Survey

Population's preventive practices and self-isolation is determinantal in the prevention and mitigation. This study explored the adult population's knowledge, attitude, and practice toward COVID-19 in UAE between the 4th and 14th of April 2020. The study was a community-based, cross-sectional study using a self-administered electronic questionnaire covering five different aspects: demographics, knowledge, practice, attitude, source, and trust of information, and a patient health questionnaire (PHQ-2) for depression screening. Results were analyzed using frequencies, cross-tabulation, and regression analysis. A total of 1,867 people responded to the survey. The mean age of participants was 36.0 years S.D. 10.8. Males were 19.3% and female (80.7%). Knowledge was significantly better in people with higher educational levels (B 0.17, P-value < 0.001), good preventive practice (B 0.12, P-value < 0.001), and higher perceived risk scores (B 0.053, P-value = 0.025). The best practice scores were shown by participants with older age (B 0.097, P-value < 0.05), with good knowledge (B 0.086, P-value < 0.05), were of non-UAE nationalities (B -0.08, P-value < 0.05), with jobs that cannot be practiced from home, military and health care employees (B -0.104, P-value < 0.05), had a personal history of contact with COVID-19 patients (B 0.053, P-value < 0.05), higher educational levels (B 0.052, P-value < 0.05), and a positive attitude toward taking a vaccine (B 0.088, P-value < 0.05). Depression risk was significantly higher in men, non-UAE nationals, in those with lower knowledge scores, and younger ages. The most followed practices were staying home, handwashing, avoiding social gatherings, limiting three people per vehicle, and avoiding public transportation. The least practiced measures were covering the face while sneezing or coughing and wearing masks. Although staying home was reported by 92.5% of participants, 22.6% mentioned that they were visited by more than two people and visited others in 18.4% during the last week. Social media was the source of information for 82.1% of the participants and most trusted doctors and healthcare providers. Depression risk was present in 18.9% of the participants, and most respondents (89%) agreed that SARS-COV-2 infection would be finally be successfully controlled. An encouraging finding is the willingness of two-third of the participants (64.5%) to take the COVID-19 vaccine and if it was developed, although it was very early in the pandemic. Only 14.6% said they would not take the vaccine, and 20.9% were not sure. The obtained results on knowledge and practices, although satisfactory, could be insufficient to prevent this pandemic from being contained. Therefore, we recommend the intensification of awareness programs and good practices. In addition, mental health is an area worth further studies.

COVID-19 associated psychological symptoms in Turkish population: A path model

We investigated the mediator roles of risk factors (intolerance of uncertainty, negative metacognition, and negative prospections) and protective factors (positive prospections and psychological resilience) together on the link between COVID-19-related feelings and behaviors, thoughts, and precautions taken and psychological symptoms with an integrative approach in Turkey. The online sample consisted of Turkish adults. The results of path analyses indicated that feelings and behaviors related to COVID-19, thoughts about COVID-19, and precautions taken related to COVID-19 are significantly associated with intolerance of uncertainty. Intolerance of uncertainty is significantly associated with negative metacognition, negative and positive prospections, psychological symptoms, and psychological resilience. Negative metacognition, negative and positive prospections, and psychological resilience are significantly associated with psychological symptoms. Mediation analysis demonstrated that intolerance of uncertainty significantly mediated the relationship between feelings and behaviors related to COVID-19, thoughts about COVID-19, and precautions taken related to COVID-19 and negative metacognition, psychological resilience, positive and negative prospections, and psychological symptoms. Lastly, negative metacognition, psychological resilience, positive and negative prospections significantly mediated the relationship between intolerance of uncertainty and psychological symptoms. Implications for mental health providers are discussed.

Applying social norms interventions to increase adherence to COVID-19 prevention and control guidelines

Despite widespread national, state, and local guidelines for COVID-19 prevention, including social distancing and mask orders, many people continue to not adhere to recommendations, including congregating in groups for non-essential activities, putting themselves and others at risk. A social psychological perspective can be used to understand reasons for lack of adherence to policies and methods for increasing adherence based on successes from other behavior change campaigns. This manuscript seeks to describe some of the social psychological research that may be relevant to COVID-19 prevention and behavior change, describe how these theories have been previously applied in various domains to change behavior, and provide examples of how these approaches might be similarly applied to control the pandemic. We provide concrete examples of actions that can be taken based on social psychological research that might help to increase adherence to COVID-19 recommendations and improve prevention and control of the virus.