Depression, Anxiety, and Lifestyle Among Essential Workers: A Web Survey From Brazil and Spain During the COVID-19 Pandemic

The longitudinal patterns of depression subtypes and stressors in depression severity in the Canadian longitudinal study on aging (CLSA)

AIM

The current study aims to characterize the longitudinal patterns of depression subtypes and investigate the associations among the stability of depression subtypes, COVID-19-related stressors, and depression severity.

METHODS

The study utilized data from the Canadian Longitudinal Study on Aging, which is a national, long-term study of Canadian adults aged 45 and older (n = 12,957). Latent profile analysis was used to identify latent depression subtypes. Latent transition analysis was then applied to assess the stability of these subtypes over time. Hierarchical multivariate linear regression was used to explore the relationships among these identified depression subtypes, COVID-19-related stressors, and depression severity among males and females, respectively.

RESULTS

Distinct depression subtypes were identified. Except for atypical depression, other depression subtypes showed greater stability over time. We also found that melancholic depression (B = 9.432) and typical depression (B = 6.677) were strongly associated with depression severity during the pandemic. Health-related stressors (B = 0.840), conflict (B = 3.639), difficulties accessing resources (B = 0.927), separation from family (B = 0.840), and caregiving experience (B = 0.764), were significantly associated with increased depression severity. Sex-specific analyses also revealed differences in the associations between stressors and depression severity between males and females.

CONCLUSIONS

This study contributes valuable insights into the latent clustering of depression subtypes and their stability. Stressors were associated with increased depression severity, with distinct associations observed among males and females. These findings have implications for targeted early interventions and integrated clinical management strategies by providing the evidence base for tailored mental health care during and after the pandemic.

Depression and Substance Use Among Brazilian University Students During the COVID-19 Pandemic

The prevalence of depression and substance use changed significantly during the COVID-19 pandemic. The present study explored the association between the use of psychoactive substances and depression in Brazilian university students. This cross-sectional study was conducted between 2021 and 2022. A sample of 1271 students were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Hierarchical multivariate logistic regression models were used to assess the association between tobacco use, alcohol consumption, illicit substance use, and depression. Among the participants, 424 (33.4%; 95%CI 30.7-36) screened positive for depression (PHQ-9 ≥ 10). Alcohol was the most consumed substance. Recent use of illicit substances was associated with depression (adjusted odds ratio [aOR] 1.59; CI 1.02-2.50). The pattern of moderate or high-risk tobacco use (aOR 2.11; CI 1.31-3.42), alcohol use (aOR 3.40; CI 2.29-5.06), and illicit substances (aOR 1.82; CI 1.15-2.89) were associated with higher chances of depression in adjusted models. Findings highlight the importance of implementing support for mental health among university students. These policies are crucial for addressing maladaptive behaviors, such as substance use, and for mitigating psychological distress, such as depression, which has been exacerbated during the pandemic.

Exploring the Care Experiences Among Clinical Staffing During Emerging Infectious Disease: From the COVID-19 Pandemic Approach

PURPOSE

The coronavirus disease 2019 (COVID-19), one of the most significant recent emerging infectious diseases, has evolved into a global pandemic, resulting in an unprecedented public health crisis with substantial morbidity. The aim of this study was to investigate the care experiences of nursing staff during the COVID-19 pandemic.

METHODS

A qualitative, exploratory interview study. This study was conducted from August 2022 to January 2023. Participants were recruited from a medical center in northern Taiwan. A purposive sampling approach was employed to select the participants, and in-depth interviews were conducted with a total of 30 individuals. The collected data were analyzed using content analysis.

RESULTS

The findings of this study revealed five themes that summarized the care experiences of participants during the COVID-19 pandemic, enhanced nursing competence in pandemic mitigation, adherence to clear safety measures, effective adaptation to the stress of the "unknown," and recognition of the meaning of the pandemic mitigation experience.

CONCLUSION

This study informs pandemic readiness for nurses and policy enhancement. Medical institutions and governments must prioritize policies ensuring staffing, PPE access, and mental health support. Educators and administrators should elevate on-the-job crisis management training. Future planning should cater to Taiwanese nurses' needs during unforeseen crises such as COVID-19.

Association between job lost and mental health outcomes during the COVID-19 pandemic and the role of food insecurity as mediator of this relationship

This study aimed to evaluate the association between employment status and mental health, considering food insecurity as a mediator of this relation. A cross-sectional population-based study was conducted with adults (≥ 18 and < 60 years) during the COVID-19 outbreak in two cities from Southern Brazil. Employment status was categorized into working, not working, and lost job. The mental health outcomes evaluated were depressive symptoms, perceived stress, and sadness. Food insecurity was identified by the short-form version of the Brazilian Food Insecurity Scale. Adjusted analyses using Poisson regression were performed to assess the association between employment status and mental health. Mediation analysis was performed to investigate the direct and indirect effects of employment status on mental health outcomes. In total, 1,492 adults were analyzed. The not working status was associated with 53% and 74% higher odds of perceived stress and of sadness, respectively. Being dismissed during the pandemic increased the odds of depressive symptoms, perceived stress, and sadness by 68%, 123%, and 128%, respectively. Mediation analyses showed that food insecurity was an important mediator of the association between employment status and depressive symptoms and sadness, but not of perceived stress. The complexity of these results highlights economic and nutritional aspects involved in mental health outcomes.

Unraveling the associations between unhealthy lifestyle behaviors and mental health in the general adult Chinese population: A cross-sectional study

BACKGROUND

This study examined the cumulative risk of unhealthy lifestyle behaviors and the associations between overall lifestyle and common mental disorders (CMDs), insomnia, stress, health-related quality of life (HRQOL), and functional impairment. Additionally, the treatment preferences for managing CMDs and insomnia were examined.

METHODS

A survey was conducted on 1487 Chinese Hong Kong adults, assessing their lifestyle behaviors (i.e., diet and nutrition, substance use, physical activity, stress management, restorative sleep, social support, and environmental exposures), mental health-related outcomes, and treatment preferences via a vignette.

RESULTS

The findings revealed significant additive relationships between the number of 'worse' lifestyle domains and the risk of all outcomes. A healthier overall lifestyle was significantly associated with reduced risks of all outcomes (AORs = 0.88 to 0.93). Having healthier practices in diet and nutrition, substance use, stress management, restorative sleep, and social support domains were significantly associated with lower risks of all outcomes (AORs = 0.93 to 0.98), except that substance use was not significantly associated with stress. Physical activity was inversely associated with only depressive symptoms (AOR = 0.98), anxiety symptoms (AOR = 0.99), and stress (AOR = 0.99). Environmental exposures were not significantly associated with functional impairment but with all other outcomes (AORs = 0.98 to 0.99). Besides, lifestyle interventions (55 %) were significantly more preferred for managing CMDs and insomnia relative to psychotherapy (35.4 %) and pharmacotherapy (9.6 %).

CONCLUSIONS

Our findings underscore the importance of considering lifestyle factors when managing CMDs, insomnia, stress, HRQOL, and functional impairment, with a particular emphasis on adopting a multicomponent treatment approach.

Impact of the COVID-19 Pandemic on People Living With Rare Diseases and Their Families: Results of a National Survey

BACKGROUND

With more than 103 million cases and 1.1 million deaths, the COVID-19 pandemic has had devastating consequences for the health system and the well-being of the entire US population. The Rare Diseases Clinical Research Network funded by the National Institutes of Health was strategically positioned to study the impact of the pandemic on the large, vulnerable population of people living with rare diseases (RDs).

OBJECTIVE

This study was designed to describe the characteristics of COVID-19 in the RD population, determine whether patient subgroups experienced increased occurrence or severity of infection and whether the pandemic changed RD symptoms and treatment, and understand the broader impact on respondents and their families.

METHODS

US residents who had an RD and were <90 years old completed a web-based survey investigating self-reported COVID-19 infection, pandemic-related changes in RD symptoms and medications, access to care, and psychological impact on self and family. We estimated the incidence of self-reported COVID-19 and compared it with that in the US population; evaluated the frequency of COVID-19 symptoms according to self-reported infection; assessed infection duration, complications and need for hospitalization; assessed the influence of the COVID-19 pandemic on RD symptoms and treatment, and whether the pandemic influenced access to care, special food and nutrition, or demand for professional psychological assistance.

RESULTS

Between May 2, 2020, and December 15, 2020, in total, 3413 individuals completed the survey. Most were female (2212/3413, 64.81%), White (3038/3413, 89.01%), and aged ≥25 years (2646/3413, 77.53%). Overall, 80.6% (2751/3413) did not acquire COVID-19, 2.08% (71/3413) acquired it, and 16.58% (566/3413) did not know. Self-reported cases represented an annual incidence rate of 2.2% (95% CI 1.7%-2.8%). COVID-19 cases were more than twice the expected (71 vs 30.3; P<.001). COVID-19 was associated with specific symptoms (loss of taste: odds ratio [OR] 38.9, 95% CI 22.4-67.6, loss of smell: OR 30.6, 95% CI 17.7-53.1) and multiple symptoms (>9 symptoms vs none: OR 82.5, 95% CI 29-234 and 5-9: OR 44.8, 95% CI 18.7-107). Median symptom duration was 16 (IQR 9-30) days. Hospitalization (7/71, 10%) and ventilator support (4/71, 6%) were uncommon. Respondents who acquired COVID-19 reported increased occurrence and severity of RD symptoms and use or dosage of select medications; those who did not acquire COVID-19 reported decreased occurrence and severity of RD symptoms and use of medications; those who did not know had an intermediate pattern. The pandemic made it difficult to access care, receive treatment, get hospitalized, and caused mood changes for respondents and their families.

CONCLUSIONS

Self-reported COVID-19 was more frequent than expected and was associated with increased prevalence and severity of RD symptoms and greater use of medications. The pandemic negatively affected access to care and caused mood changes in the respondents and family members. Continued surveillance is necessary.

[Association between mental health, fear of COVID-19, and job insecurity among bus service workers during the COVID-19 pandemic]

OBJECTIVE

The purpose of this study is to examine the association between mental health, fear of COVID-19, and job insecurity among bus service workers during the second wave of the coronavirus disease 2019 (COVID-19) pandemic in Japan.

METHODS

In September 2020, 1,889 employees of three private railway bus companies in the Tokai region were administered an anonymous self-questionnaire to be filled out at their workplace. The survey items were depression, anxiety, fear of COVID-19, job insecurity, demographics, and work characteristics. Logistic regression analysis was used to calculate the odds ratio and 95% confidence interval.

RESULTS

Overall, 1,316 valid responses, excluding those from workers with a history of mental illness and others, were included in the analysis (valid response rate: 69.7%). Multiple logistic regression analysis revealed that the prevalence of depression and anxiety were significantly higher in groups with medium and high levels of fear of COVID-19 or job insecurity than in the group with a low level of fear of COVID-19 or job insecurity.

DISCUSSION AND CONCLUSION

Fear of COVID-19 and job insecurity were found to be risk factors for depression and anxiety among bus service workers during the second wave of the COVID-19 pandemic, the latter being the stronger risk factor. Hence, comprehensive COVID-19 prevention measures as well as mental health-related measures to reduce job insecurity should be implemented in the bus service industry.

COVID-19, SDGs and public health systems: Linkages in Brazil

Background

The global 2030 Agenda covers a range of interconnected issues which need interdisciplinary and holistic approaches to improve human well-being and protect the natural environment. The COVID-19 pandemic has brought to light critical inequities in society and policy gaps in health services. As highlighted through analyses of the interlinkages among the Sustainable Development Goals (SDGs), connections between human health and well-being and the environment, can help support new policy needs in addressing systemic health crises, including widespread pandemics.

Method

We identify links between the COVID-19 crisis and multiple SDGs in the context of Brazil based on a review of the current literature in the health sector.Findings: We identify synergistic connections between 88 out of 169 SDG targets and COVID-19, notably around themes such as City Environment, Contextual Policies and the value created by improved Information and Technology. Using the context of the Brazilian National Health Service (SUS) highlights recurrent interconnections from the focal point of target 3.8. This includes topics such as challenges for universal healthcare coverage, budget allocation, and universalisation.

Conclusions

The framework developed for supporting policy-making decisions and the design of toolkits for dealing with future health-related emergency scenarios offers a practical solution in the health sector. It is worth noting that progress and action on public health systems and policies must go hand in hand with addressing existing socio-economic vulnerabilities in society. This is vital for tackling future pandemics and simultaneously addressing the SDGs.

From Emergence to Endemicity: A Comprehensive Review of COVID-19

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), later renamed coronavirus disease 2019 (COVID-19), was first identified in Wuhan, China, in early December 2019. Initially, the China office of the World Health Organization was informed of numerous cases of pneumonia of unidentified etiology in Wuhan, Hubei Province at the end of 2019. This would subsequently result in a global pandemic with millions of confirmed cases of COVID-19 and millions of deaths reported to the WHO. We have analyzed most of the data published since the beginning of the pandemic to compile this comprehensive review of SARS-CoV-2. We looked at the core ideas, such as the etiology, epidemiology, pathogenesis, clinical symptoms, diagnostics, histopathologic findings, consequences, therapies, and vaccines. We have also included the long-term effects and myths associated with some therapeutics of COVID-19. This study presents a comprehensive assessment of the SARS-CoV-2 virology, vaccines, medicines, and significant variants identified during the course of the pandemic. Our review article is intended to provide medical practitioners with a better understanding of the fundamental sciences, clinical treatment, and prevention of COVID-19. As of May 2023, this paper contains the most recent data made accessible.

Lifestyle in bipolar disorder: A cross-sectional study

BACKGROUND

Modifiable lifestyle behaviors are important factors for improving mental health, yet there has been a lack of research studying lifestyle as a multidimensional construct in bipolar disorder (BD). The aim of this cross-sectional study was to compare the lifestyle patterns of individuals with BD in a current mood episode with healthy controls (HCs) using the Short Multidimensional Inventory Lifestyle Evaluation (SMILE).

MATERIALS AND METHODS

The sample consisted of 46 individuals with BD currently experiencing a depressive or manic episode and 50 HC, assessed using the MINI International Neuropsychiatric Interview, Montgomery-Åsberg Depression Rating Scale (MADRS), and the Young Mania Rating Scale (YMRS). The SMILE scale assesses lifestyle across seven domains: diet and nutrition, substance abuse, physical activity, stress management, restorative sleep, social support, and environmental exposures. Between-groups comparisons were performed based on the presence of a psychiatric diagnosis and the type of BD episode.

RESULTS

We found significant differences in the total SMILE score (r=0.75, p<0.001) and in scores from each domain of the scale between BD and HC (p<0.05), where individuals with BD in a depressive or manic episode with or without mixed features reported worse lifestyle across all domains. Differences between individuals with BD in different mood episodes across domains on the SMILE scale were non-significant.

CONCLUSION

Findings from this study highlight the presence of unhealthy lifestyle patterns in people with BD regardless of the polarity of their mood episode. Implementation of multidimensional lifestyle assessments is an essential step toward detecting the clustering of unhealthy lifestyle patterns in BD.

Lifestyle changes during the COVID-19 pandemic in Brazil: results from three consecutive cross-sectional web surveys

OBJECTIVE

The importance of a healthy lifestyle in preventing morbidity and mortality is well-established. The COVID-19 pandemic brought about significant lifestyle changes globally, but the extent of these changes in the Brazilian population remains unclear. The objective of this study was to evaluate changes in lifestyle among the Brazilian general population during the first year of the pandemic.

DESIGN

Three consecutive anonymous web surveys were carried out: survey 1 (S1)-April 2020, S2-August 2020 and S3-January 2021.

SETTING

Brazil.

PARTICIPANTS

The study included 19 257 (S1), 1590 (S2) and 859 (S3) participants from the general population, who were ≥18 years, of both sexes, with access to the internet, self-reporting living in Brazil and who agreed to participate after reading the informed consent.

PRIMARY OUTCOME

Lifestyle changes were assessed using the Short Multidimensional Instrument for Lifestyle Evaluation-Confinement (SMILE-C). The SMILE-C assesses lifestyle across multiple domains including diet, substance use, physical activity, stress management, restorative sleep, social support and environmental exposures. We used a combination of bootstrapping and linear fixed-effect modelling to estimate pairwise mean differences of SMILE-C scores overall and by domain between surveys.

RESULTS

In all the surveys, participants were mostly women and with a high education level. Mean SMILE-C scores were 186.4 (S1), 187.4 (S2) and 190.5 (S3), indicating a better lifestyle in S3 as compared with S1. The pairwise mean differences of the overall SMILE-C scores were statistically significant (p<0.001). We also observed a better lifestyle over time in all domains except for diet and social support.

CONCLUSIONS

Our findings indicate that individuals from a large middle-income country, such as Brazil, struggled to restore diet and social relationships after 1 year of the pandemic. These findings have implications for monitoring the long-term consequences of the pandemic, as well as future pandemics.

Associations of lifestyle with mental health and well-being in Chinese adults: a nationwide study

Background

A healthy lifestyle is beneficial to individuals' health. However, little is known about the associations of lifestyle factors with mental health and well-being. This study examined the associations of lifestyle factors with mental health (i.e., depression, anxiety, loneliness, perceived pressure, and self-rated health status) and well-being in Chinese adults.

Methods

A nationally representative survey was conducted in China from 20 June 2022 to 31 August 2022. Data from the survey were analyzed using multiple linear regression to determine the associations of lifestyle with mental health and well-being in Chinese adults. Standardized regression coefficients (β) and 95% confidence intervals (CIs) were estimated using multiple linear regression.

Results

The survey included 28,138 Chinese adults. Multiple linear regression results showed that there were significant negative associations of lifestyle scores with scores of depression (β = -0.93, 95% CI: -0.98, -0.88), anxiety (β = -0.71, 95% CI: -0.76, -0.67), loneliness (β = -0.23, 95% CI: -0.24, -0.21), and perceived pressure (β = -0.19, 95% CI: -0.22, -0.16). Moreover, there were significant positive associations of lifestyle with self-rated health status (β = 1.99, 95% CI: 1.79, 2.20) and well-being (β = 0.96, 95% CI: 0.91, 1.02).

Conclusion

This study provides insight into the associations of lifestyle factors with mental health and well-being and highlights the importance of improving and maintaining healthy lifestyle behaviors for favorable mental health and well-being.

Psychological disturbances encountered by the healthcare professionals, military professionals and general public in Sri Lanka during COVID-19 pandemic: a cross-sectional study

BACKGROUND

The COVID-19 pandemic is a serious global health concern, posing a greater risk of psychological vulnerabilities for frontline healthcare workers (HCWs), military professionals and the general public around the globe. These psychological issues appear to be long lasting and heighten the risk of mental health disorders. Therefore, this study aimed to identify psychological problems encountered by HCWs, military professionals, and the general public in Sri Lanka during the COVID-19 pandemic.

METHODS

A descriptive cross-sectional study was undertaken with 367 participants, including frontline HCWs (n = 128), military professionals (n = 102), and the general public (n = 137). Depression and anxiety were assessed using the Peradeniya Depression Scale (PDS) and the Generalized Anxiety Disorder scale (GAD-7), respectively.

RESULTS

Mean (± SD) age of the participants was 35.0 (± 10.6) years. A reasonable proportion of participants experienced depressive symptoms (39.25%, n = 144) and severe anxiety (12.8%, n = 47). Military professionals showed depressive symptoms (73.50%, n = 75) and severe anxiety (32.4%, n = 33) predominantly. Multivariate binary logistic regression revealed that only the level of education and professional engagement affected depressive symptoms and severe anxiety (p < 0.01). Having a high level of education was a protective factor for depressive symptoms (Adjusted OR = 0.34) compared to lower-level education, while being a HCW (Adjusted OR = 4.40) and military professional (Adjusted OR = 5.43) were identified as risk factors for depressive symptoms compared to the general public. Similarly, having a high level of education was a protective factor for severe anxiety (Adjusted OR = 0.29) compared to lower-level education, while being a HCW (Adjusted OR = 3.90) and military professional (Adjusted OR = 4.52) were identified as risk factors for severe anxiety compared to the general public.

CONCLUSION

The current study revealed a greater level of anxiety and depressive symptoms among frontline HCWs and military professionals in Sri Lanka during the pandemic of COVID-19 compared to the general public. Therefore, providing psychological first aid for them to better deal with mental problems and an emergency preparedness plan to deal with sudden outbreaks of infectious situations are important.

Lifestyle Behaviors, Depression, and Anxiety Among Individuals Living in Canada During the COVID-19 Pandemic

The aim of our study was to investigate the association between lifestyle behaviors and symptoms of depression and anxiety during the COVID-19 pandemic in Canada. A web survey was conducted between July 3-August 3, 2020, across Canada. The main outcomes considered were a positive screening for depression, as evaluated by the PHQ-2 and positive screening for anxiety, as evaluated by the GAD-7. Lifestyle behaviors were assessed using the Short Multidimensional Lifestyle Inventory Evaluation-Confinement (SMILE-C), an instrument adapted for lifestyle behaviors during the COVID-19 pandemic. The total sample size included 404 participants, of which 24.3% had a positive screen for depression, 20.5% for anxiety, and 15.5% for both. We found significant differences in SMILE-C scores between individuals with a positive and individuals with a negative screen for depression (P < .001). Likewise, there were significant differences in SMILE-C scores between individuals with a positive and individuals with a negative screen for anxiety (P < .001). We found an association between unhealthy lifestyle behaviors and symptoms of depression and anxiety during the COVID-19 lockdown in Canada. The findings highlight the importance of lifestyle medicine (LM) education and targeted lifestyle interventions to promote healthy behaviors and help reduce the burden of mental disorders.

Brazilian Adaptation of the Coronavirus Anxiety Scale: A Psychometric Investigation of a Measure of Coronaphobia

This study examined the psychometric properties of a Brazilian adapted version of the Coronavirus Anxiety Scale (CAS-BR) in a sample of adults in Brazil. Confirmatory factor analyses demonstrated that the CAS-BR produces a reliable (α = .84), unidimensional construct whose structure was shown to be invariant across gender, race, and age. However, some items of the CAS-BR were stronger indicators of the coronavirus anxiety construct for women and younger adults. Although the CAS-BR demonstrated evidence of discrimination ability for functional impairment (AUC = .77), Youden indexes were low to identify a clinical cut-score. Construct validity was demonstrated with correlations between CAS-BR scores and measures of functional impairment, generalized anxiety, and depression. Exploratory analyses revealed that CAS-BR total scores were higher among women and participants with a history of anxiety disorder. These findings are consistent with previous investigations and support the validity of CAS-BR for measuring coronavirus anxiety with Brazilian adults.

Factors Associated with the Lifestyle of Pediatric Healthcare Professionals during the COVID-19 Pandemic

The objective of this study was to analyze the association between sociodemographic and occupational variables with the lifestyle of health professionals in pediatric units during the COVID-19 pandemic. A cross-sectional study was conducted with 407 health professionals working in four pediatric health units in the State of Bahia, northeast Brazil. The Fantastic Lifestyle Questionnaire and a questionnaire with sociodemographic and employment variables self-applied via Google Forms were used. The final binary logistic regression models revealed significant associations between those who received 3 to 5 minimum wages, without a marital relationship and with more than one employment relationship. Data suggest that these sociodemographic and occupational profiles are more exposed to risky lifestyle behaviors. The findings of this study demonstrated the need for greater attention to the health of health professionals in the pediatric field, as well as the promotion of initiatives that seek to value the work of these professionals and reduce the damage caused to their lifestyle, especially in a pandemic scenario.

Improved lifestyle is associated with improved depression, anxiety and well-being over time in UK healthcare professionals during the COVID-19 pandemic: insights from the CoPE-HCP cohort study

Background

One potential modifiable factor to improve the mental health of healthcare professionals (HCPs) during the pandemic is lifestyle.

Aims

This study aimed to assess whether an improved lifestyle during the pandemic is associated with improved mental health symptoms and mental well-being in HCPs over time.

Methods

This was a cohort study involving an online survey distributed at two separate time points during the pandemic (baseline (July-September 2020) and follow-up (December 2020-March 2021)) to HCPs working in primary or secondary care in the UK. Both surveys assessed for major depressive disorder (MDD) (Patient Health Questionnaire-9 (PHQ-9)), generalised anxiety disorder (GAD) (Generalised Anxiety Disorder-7 (GAD-7)), mental well-being (Short Warwick-Edinburgh Mental Well-being Score (SWEMWBS)) and self-reported lifestyle change (compared with the start of the pandemic) on multiple domains. Cumulative scores were calculated to estimate overall lifestyle change compared with that before the pandemic (at both baseline and follow-up). At each time point, separate logistic regression models were constructed to relate the lifestyle change score with the presence of MDD, GAD and low mental well-being. Linear regression models were also developed relating the change in lifestyle scores from baseline to follow-up to changes in PHQ-9, GAD-7 and SWEMWBS scores.

Results

613 HCPs completed both baseline assessment and follow-up assessment. Consistent significant cross-sectional associations between increased lifestyle change scores and a reduced risk of MDD, GAD and low mental well-being were observed at both baseline and follow-up. Over the study period, a whole unit increase in the change in novel scores (ie, improved overall lifestyle) over 4 months was inversely associated with changes in PHQ-9 (adjusted coefficient: -0.51, 95% confidence interval (CI): -0.73 to -0.30, p<0.001) and GAD-7 scores (adjusted coefficient: -0.32, 95% CI: -0.53 to -0.10, p=0.004) and positively associated with the change in SWEMWBS scores (adjusted coefficient: 0.37, 95% CI: 0.18 to 0.55, p<0.001).

Conclusions

Improved lifestyle over time is associated with improved mental health and mental well-being in HCPs during the pandemic. Improving lifestyle could be a recommended intervention for HCPs to help mitigate the mental health impact during the current and future pandemics.

Trial registration number

NCT04433260.

Pathophysiology of SARS-CoV2 Mediated Depression, Therapeutics, and Consequences: A Comprehensive Narrative

The Coronavirus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2), belongs to emerging and reemerging diseases, which was first identified and reported in Wuhan, China, in December 2019. The genetic sequence of SARS-CoV-2 was similar to the SARS virus, a β-coronavirus. The epidemiological studies suggest that the transmission of SARS-CoV-2 mainly occurs from an infected person to others through close contact with the respiratory droplets or by having contact with SARS-CoV-2 adhering to objects and surfaces. The incubation period ranges from 5 to14 days. The symptoms include fever, dry cough, tiredness, aches, chest pain, conjunctivitis, diarrhea, headache, difficulty in breathing or short breath, loss of taste, smell, rashes on the skin, and sore throat. Some reports indicated that males exhibited lower scores than females, the younger populations displayed increased symptoms, Chinese/Taiwanese people registered only scarce symptoms, and Canadians experienced more symptoms. The results of several studies suggested that while COVID-19 had a significant effect on depression, job instability affected anxiety and depression. The diagnostics to detect the presence of coronavirus involve ELISA and RT-PCR. There is no specific treatment available to eradicate COVID-19. The therapeutics used to treat COVID 19 exhibited severe side effects. Recently, some Indian traditional medicinal plants have shown promise in reducing the risk of viral infection and also boosting the immunity of an individual. This paper presents an overview of the current status of depression in the SARS CoV2 infected people and the measures required to overcome COVID-19 induced depression in patients even after recovery.

Possible substance use disorders among first responders during the COVID-19 era: a quasi-experimental study of personal and residential vulnerability

Background: During the COVID-19 pandemic possible substance use disorders (SUD) were exacerbated from increased stress and isolation. Experiences of symptomology differ widely by occupations.Objectives: The objectives were to determine if there is a temporal relationship between COVID-19 vulnerability and possible SUDs among first responders, and to examine the association with neighborhood vulnerability.Methods: We conducted an analysis with two distinct cohorts dependent on time of entry: 1) First responders that began counseling prior to COVID-19 and 2) First responders that began counseling after the start of COVID-19. Data were collected at intake from first responders seeking mental health services between 2017 and 2021 at an organization in Dallas/Fort Worth, Texas. The study sample included 195 mostly male (75%) first responders (51% law enforcement officers; 49% emergency medical technicians/firefighters). Bivariate models tested unadjusted relationships between covariates and possible SUD. Adjusted models consisted of a two-level multivariable logistic regression models.Results: Nearly 40% (n = 77) screened positive for a possible SUD. Those beginning counseling after COVID-19 did not have higher odds of SUDs. For every unit increase in neighborhood Severe COVID-19 Health Risk Index at a first responder's residential location there was an increase in the odds of a possible SUD (AOR = 3.14, 95% CI: 1.47, 6.75).Conclusions: Our study highlights the degree to which personal and residential vulnerability to COVID-19 impacted first responders. The increased occupational stress of this population, and an established pattern of maladaptive coping, elucidates the need for preventative and clinical approaches to strengthen the resilience of this population.

Destigmatising mental health treatment and increasing openness to seeking treatment: randomised controlled trial of brief video interventions

BACKGROUND

Despite an elevated risk of psychopathology stemming from COVID-19-related stress, many essential workers stigmatise and avoid psychiatric care. This randomised controlled trial was designed to compare five versions of a social-contact-based brief video intervention for essential workers, differing by protagonist gender and race/ethnicity.

AIMS

We examined intervention efficacy on treatment-related stigma ('stigma') and openness to seeking treatment ('openness'), especially among workers who had not received prior mental healthcare. We assessed effectiveness and whether viewer/protagonist demographic concordance heightened effectiveness.

METHOD

Essential workers (N = 2734) randomly viewed a control video or brief video of an actor portraying an essential worker describing hardships, COVID-related anxiety and depression, and psychotherapy benefits. Five video versions (Black/Latinx/White and male/female) followed an identical 3 min script. Half the intervention group participants rewatched their video 14 days later. Stigma and openness were assessed at baseline, post-intervention, and at 14- and 30-day follow-ups. Trial registration: NCT04964570.

RESULTS

All video intervention groups reported immediately decreased stigma (P < 0.0001; Cohen's d = 0.10) and increased openness (P < 0.0001; d = 0.23). The initial increase in openness was largely maintained in the repeated-video group at day 14 (P < 0.0001; d = 0.18), particularly among viewers without history of psychiatric treatment (P < 0.0001; d = 0.32). Increases were not sustained at follow-up. Female participants viewing a female protagonist and Black participants viewing a Black protagonist demonstrated greater openness than other demographic pairings.

CONCLUSIONS

Brief video-based interventions improved immediate stigma and openness. Greater effects among female and Black individuals viewing demographically matched protagonists emphasise the value of tailored interventions, especially for socially oppressed groups. This easily disseminated intervention may proactively increase care-seeking, encouraging treatment among workers in need. Future studies should examine intervention mechanisms and whether linking referrals to psychiatric services generates treatment-seeking.

The different impacts of COVID-19 on the mental health of distinct health care worker categories

The present study sought to explore the factors associated with the odds of having probable depression and posttraumatic stress disorder (PTSD) related to traumatic COVID-19 experiences and their impact on health care workers in distinct categories. In this cross-sectional study, 1843 health care workers (nurses, nurse technicians, physicians, physical therapists, and other healthcare workers) were recruited via convenience sampling. A survey was administered to obtain information regarding sociodemographic, occupational, and mental health status. Descriptive statistics and multivariable logistic regression were used for the analyses. Being a nurse technician was associated with an odds ratio of 1.76 for probable PTSD. No relation was observed between health care worker categories and the odds of probable depression. Additionally, being female and not receiving adequate PPE were related to greater odds of having probable PTSD and depression.

Nervous system manifestations related to COVID-19 and their possible mechanisms

In December 2019, the novel coronavirus disease (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection broke. With the gradual deepening understanding of SARS-CoV-2 and COVID-19, researchers and clinicians noticed that this disease is closely related to the nervous system and has complex effects on the central nervous system (CNS) and peripheral nervous system (PNS). In this review, we summarize the effects and mechanisms of SARS-CoV-2 on the nervous system, including the pathways of invasion, direct and indirect effects, and associated neuropsychiatric diseases, to deepen our knowledge and understanding of the relationship between COVID-19 and the nervous system.

Mental health during the first wave of COVID-19 in Canada, the USA, Brazil and Italy

BACKGROUND

The mental health (MH) burden on healthcare practitioners (HCPs) is emerging as a significant cost of the pandemic, although few studies have compared the MH of HCPs in different countries.

METHODS

A link to an online survey was posted in the Spring of 2020 which included questions regarding perceived impact of the pandemic; current MH symptom severity and impairment was evaluated using validated scales.

RESULTS

Overall, 1315 individuals (74% female, mean age: 42.9 + 16.4) in Canada, the United States, Brazil and Italy completed the survey. Nearly 26% met diagnostic thresholds for GAD and MDD; Italian respondents reported the lowest rates of disorder. Except for Canada, non-HCPs in each country reported higher symptom severity than HCPs. Amongst the HCPs, Canadian HCPs reported the highest rates of anxiety and depression as well as increases in alcohol and cannabis use, lower levels of perceived emotional support and more worry about themselves or their loved ones contracting COVID-19.

CONCLUSION

Despite key infrastructural and COVID-19 mortality differences between the countries, the MH effects appeared to be quite similar. HCPs, with the exception of Canada, reported less impact on their mental health compared to the general population, suggesting resilience in the face of adversity.Key pointsRates of current mental health disorders were similar across Canada, the USA and Brazil but lower in Italy, yet much higher than pre-pandemic ratesNon-Healthcare Practitioners (HCPs) reported significantly higher severity on all MH scales in the overall sample. This was consistent within the USA, Brazil and Italy, however in Canada, HCPs reported higher anxiety, depression and stress symptom severity compared to Canadian non-HCPs.Canadian HCPs reported significantly higher anxiety and depression symptom severity than all other countriesCanadian HCPs also reported significantly greater increases in alcohol and cannabis use, lower levels of perceived emotional support and more worry about themselves or their loved ones contracting COVID-19 compared to HCPs in the other countries.

Lifestyle predictors of depression and anxiety during COVID-19: a machine learning approach

INTRODUCTION

Recent research has suggested an increase in the global prevalence of psychiatric symptoms during the COVID-19 pandemic. This study aimed to assess whether lifestyle behaviors can predict the presence of depression and anxiety in the Brazilian general population, using a model developed in Spain.

METHODS

A web survey was conducted during April-May 2020, which included the Short Multidimensional Inventory Lifestyle Evaluation (SMILE) scale, assessing lifestyle behaviors during the COVID-19 pandemic. Depression and anxiety were examined using the PHQ-2 and the GAD-7, respectively. Elastic net, random forest, and gradient tree boosting were used to develop predictive models. Each technique used a subset of the Spanish sample to train the models, which were then tested internally (vs. the remainder of the Spanish sample) and externally (vs. the full Brazilian sample), evaluating their effectiveness.

RESULTS

The study sample included 22,562 individuals (19,069 from Brazil, and 3,493 from Spain). The models developed performed similarly and were equally effective in predicting depression and anxiety in both tests, with internal test AUC-ROC values of 0.85 (depression) and 0.86 (anxiety), and external test AUC-ROC values of 0.85 (depression) and 0.84 (anxiety). Meaning of life was the strongest predictor of depression, while sleep quality was the strongest predictor of anxiety during the COVID-19 epidemic.

CONCLUSIONS

Specific lifestyle behaviors during the early COVID-19 epidemic successfully predicted the presence of depression and anxiety in a large Brazilian sample using machine learning models developed on a Spanish sample. Targeted interventions focused on promoting healthier lifestyles are encouraged.

Assuring Healthy Populations During the COVID-19 Pandemic: Recognizing Women's Contributions in Addressing Syndemic Interactions

A syndemic framework examines disease interactions and the contributions of structural, social, economic, and environmental factors that synergistically interact to contribute to adverse health outcomes. Populations residing in environments with structural susceptibilities experience health disparities and syndemics to a greater extent than their less vulnerable counterparts. The interactions among the social determinants of health (SDoH) and the COVID-19 pandemic have had different results for marginalized populations and have worsened health outcomes for many in this synergistic pandemic. Also, the exposome, the exposure measures for an individual over their lifetime and how those exposures relate to the individual's health, may help to explain why some populations experience more serious cases of COVID-19 compared to other groups. The purpose of this perspective is to: (1) examine the relationship between the syndemic model and the SDoH-exposome; (2) highlight, via specific examples, the contributions of female health professionals to SDoH and the COVID-19 syndemic in response to the Women in Science Research Topic, and (3) propose health policy to address syndemic-exposome interactions to help mitigate or prevent public health challenges. By investing in policies that assure health for all populations, the investments could pay dividends in the form of a less severe syndemic next time since we are starting from a place of health and not disease. Lastly, due to the magnification of underlying societal inequities laid bare during the COVID-19 syndemic, we support the expansion of the disease-focused syndemic model to include societal syndemics, such as systemic racism.

Mental Health and Well-Being Needs among Non-Health Essential Workers during Recent Epidemics and Pandemics

Essential workers, those who work in a variety of sectors that are critical to sustain the societal infrastructure, were affected both physically and mentally by the COVID-19 pandemic. While the most studied group of this population were healthcare workers, other essential non-health workers such as those working in the law enforcement sector, grocery services, food services, delivery services, and other sectors were studied less commonly. We explored both the academic (using MEDLINE, PsycInfo, CINAHL, Sociological Abstracts, and Web of Science databases) and grey literature (using Google Scholar) to identify studies on the mental health effects of the six pandemics in the last 20 years (2000-2020). We identified a total of 32 articles; all of them pertained to COVID-19 except for one about Ebola. We found there was an increase in depression, anxiety, stress, and other mental health issues among non-health essential workers. They were more worried about passing the infection on to their loved ones and often did not have adequate training, supply of personal protective equipment, and support to cope with the effects. Generally, women, people having lower education, and younger people were more likely to be affected by a pandemic. Exploring occupation-specific coping strategies of those whose mental health was affected during a pandemic using more robust methodologies such as longitudinal studies and in-depth qualitative exploration would help facilitate appropriate responses for their recovery.

Mental disorder symptoms during the COVID-19 pandemic in Latin America - a systematic review and meta-analysis

AIMS

There is a lack of evidence related to the prevalence of mental health symptoms as well as their heterogeneities during the coronavirus disease 2019 (COVID-19) pandemic in Latin America, a large area spanning the equator. The current study aims to provide meta-analytical evidence on mental health symptoms during COVID-19 among frontline healthcare workers, general healthcare workers, the general population and university students in Latin America.

METHODS

Bibliographical databases, such as PubMed, Embase, Web of Science, PsycINFO and medRxiv, were systematically searched to identify pertinent studies up to August 13, 2021. Two coders performed the screening using predefined eligibility criteria. Studies were assigned quality scores using the Mixed Methods Appraisal Tool. The double data extraction method was used to minimise data entry errors.

RESULTS

A total of 62 studies with 196 950 participants in Latin America were identified. The pooled prevalence of anxiety, depression, distress and insomnia was 35%, 35%, 32% and 35%, respectively. There was a higher prevalence of mental health symptoms in South America compared to Central America (36% v. 28%, p < 0.001), in countries speaking Portuguese (40%) v. Spanish (30%). The pooled prevalence of mental health symptoms in the general population, general healthcare workers, frontline healthcare workers and students in Latin America was 37%, 34%, 33% and 45%, respectively.

CONCLUSIONS

The high yet heterogenous level of prevalence of mental health symptoms emphasises the need for appropriate identification of psychological interventions in Latin America.

Effective recommendations towards healthy routines to preserve mental health during the COVID-19 pandemic

Objective:

To assess the adherence to a set of evidence-based recommendations to support mental health during the coronavirus disease 2019 (COVID-19) pandemic and its association with depressive and anxiety symptoms.

Methods:

A team of health workers and researchers prepared the recommendations, formatted into three volumes (1: COVID-19 prevention; 2: Healthy habits; 3: Biological clock and sleep). Participants were randomized to receive only Volume 1 (control), Volumes 1 and 2, Volumes 1 and 3, or all volumes. We used a convenience sample of Portuguese-speaking participants over age 18 years. An online survey consisting of sociodemographic and behavioral questionnaires and mental health instruments (Patient Health Questionnaire-9 [PHQ-9] and Generalized Anxiety Disorder-7 [GAD-7]) was administered. At 14 and 28 days later, participants were invited to complete follow-up surveys, which also included questions regarding adherence to the recommendations. A total of 409 participants completed the study – mostly young adult women holding university degrees.

Results:

The set of recommendations contained in Volumes 2 and 3 was effective in protecting mental health, as suggested by significant associations of adherence with PHQ-9 and GAD-7 scores (reflecting anxiety and depression symptoms, respectively).

Conclusion:

The recommendations developed in this study could be useful to prevent negative mental health effects in the context of the pandemic and beyond.

Association between lifestyle and emotional aspects of food consumption during the COVID-19 pandemic

BACKGROUND AND AIMS

Adequate nutrition during infectious outbreaks require a personal management strategy, especially when there are emotional factors involved. To evaluate the association between lifestyle and emotional aspects of food consumption during the pandemic COVID-19.

METHODS AND RESULTS

Cross-sectional study using online self-applied questionnaire with 15,372 active schoolteachers who worked in primary education (kindergarten, elementary and high school) from Minas Gerais, Brazil. Poisson Regression model with robust variance was used to determine the association between lifestyle and emotional aspects and food consumption. Greater adherence to the healthy consumption profile showed a statistically significant association with decreased weight (PR = 1.58; p = 0.000), decreased physical activity (PR = 1.27; p = 0.000), reduced income, (PR = 1.26; p = 0.000), reduced alcohol consumption (PR = 1.22; p = 0.000), and changes in mental health (PR = 1.19; p = 0.000). Unhealthy consumption profile was significantly correlated with weight gain (PR = 1.54; p = 0.000), consuming more alcohol, or started drinking during the pandemic (PR = 1.44; p = 0.000), increased physical activity (PR = 1.43; p = 0.000); increased cigarette consumption (PR = 1.17; p = 0.000), and being a younger adult (PR = 1.17; p = 0.000).

CONCLUSIONS

The COVID-19 pandemic influenced the food profiles of basic education teachers in the Minas Gerais state education system in a bidirectional manner, favoring the practice of consuming healthy or unhealthy foods.

Alcohol Use and Anxiety in Primary Health Care Patients During the COVID-19 Pandemic: a Phone-Based Study

In March 2020, physical distancing and quarantine measures were implemented in Brazil, which may have affected the physical and mental health of the population. This cross-sectional study used a convenience sample and telephone-based interviews to identify anxiety symptoms and alcohol use patterns among 1,264 Brazilian primary health care (PHC) patients during the COVID-19 pandemic. The State-Trait Anxiety Inventory-State 6 and Alcohol Use Disorders Identification Test (AUDIT-C) questionnaires were used to assess anxiety symptoms and alcohol use patterns, respectively. According to the AUDIT-C results, the prevalence of harmful drinking was 38.5%. Those who reported that their alcohol consumption decreased during the pandemic had high scores on the AUDIT-C, indicating a moderate/severe risk of drinking. Moderate or severe anxiety was observed in 60.1% of participants. These results highlight the needs to assess the pandemic's consequences on the mental health of the population and to encourage the implementation of preventive approaches in PHC settings to address anxiety and harmful alcohol consumption.

A Systematic Review and Meta-Analysis of Symptoms of Anxiety, Depression, and Insomnia in Spain in the COVID-19 Crisis

BACKGROUND

General population, frontline healthcare workers (HCWs), and adult students in Spain are at risk of anxiety, depression, and insomnia symptoms during the COVID-19 crisis. A meta-analysis of the individual studies on these symptoms would provide systematic evidence to aid policymakers and researchers in focusing on prevalence, risk, and best interventions.

OBJECTIVE

This paper aims to be the first meta-analysis and systematic review to calculate the prevalence of anxiety, depression, and insomnia symptoms in Spain's adult population (general population, frontline healthcare workers (HCWs), and adult students) during the Covid-19 epidemic.

METHOD

Random-effect meta-analysis was used to estimate the prevalence of anxiety, depression, and insomnia.

RESULTS

The meta-analysis includes 28 studies with 38 individual samples in Spain. The pooled prevalence of anxiety symptoms in 22 studies comprising a sample population of 82,024 was 20% (95% CI: 15-25%), that of depression symptoms in 22 articles with a total sample comprising 82,890 individuals was 22% (95% CI: 18-28%), and that of insomnia symptoms in three articles with a sample population of 745 was 57% (95% CI: 48-66%.

CONCLUSIONS

The accumulative evidence reveals that adults in Spain suffered higher prevalence rates of mental symptoms during the COVID-19 crisis, with a significantly higher rate relative to other countries such as China. Our synthesis also reveals a relative lack of studies on frontline and general HCWs in Spain.

What Are We Measuring When We Evaluate Digital Interventions for Improving Lifestyle? A Scoping Meta-Review

Background: Lifestyle Medicine (LM) aims to address six main behavioral domains: diet/nutrition, substance use (SU), physical activity (PA), social relationships, stress management, and sleep. Digital Health Interventions (DHIs) have been used to improve these domains. However, there is no consensus on how to measure lifestyle and its intermediate outcomes aside from measuring each behavior separately. We aimed to describe (1) the most frequent lifestyle domains addressed by DHIs, (2) the most frequent outcomes used to measure lifestyle changes, and (3) the most frequent DHI delivery methods. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) Extension for Scoping Reviews. A literature search was conducted using MEDLINE, Cochrane Library, EMBASE, and Web of Science for publications since 2010. We included systematic reviews and meta-analyses of clinical trials using DHI to promote health, behavioral, or lifestyle change. Results: Overall, 954 records were identified, and 72 systematic reviews were included. Of those, 35 conducted meta-analyses, 58 addressed diet/nutrition, and 60 focused on PA. Only one systematic review evaluated all six lifestyle domains simultaneously; 1 systematic review evaluated five lifestyle domains; 5 systematic reviews evaluated 4 lifestyle domains; 14 systematic reviews evaluated 3 lifestyle domains; and the remaining 52 systematic reviews evaluated only one or two domains. The most frequently evaluated domains were diet/nutrition and PA. The most frequent DHI delivery methods were smartphone apps and websites. Discussion: The concept of lifestyle is still unclear and fragmented, making it hard to evaluate the complex interconnections of unhealthy behaviors, and their impact on health. Clarifying this concept, refining its operationalization, and defining the reporting guidelines should be considered as the current research priorities. DHIs have the potential to improve lifestyle at primary, secondary, and tertiary levels of prevention-but most of them are targeting clinical populations. Although important advances have been made to evaluate DHIs, some of their characteristics, such as the rate at which they become obsolete, will require innovative research designs to evaluate long-term outcomes in health.

The Association of Work-related Stress According to the Demand-Control Model With Aggravation of Pre-existing Disease During the First State of COVID-19 Emergency in Japan

BACKGROUND

The job environment has changed a lot during the period of the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to investigate the association between work-related stress and aggravation of pre-existing disease in workers during the first state of COVID-19 emergency in Japan.

METHODS

Data were obtained from a large internet survey conducted between August 25 and September 30, 2020 in Japan. Participants who reported that they had a job as well as current history of disease(s) (ie, pre-existing conditions) were included (n = 3,090). Aggravation of pre-existing disease during the state of emergency was self-reported. Work-related stress from April 2020 (since the state of COVID-19 emergency) was assessed according to a job demand-control model. Multivariable logistic regression models were used to analyze the association.

RESULTS

Aggravation of pre-existing diseases was reported by 334 participants (11%). The numbers of participants with high demand and low control were 112 (18%) and 100 (14%), respectively. Compared to medium demand, high demand was significantly associated with aggravation of pre-existing diseases (odds ratio 1.77; 95% confidence interval, 1.30-2.42). Low control compared to medium control was also significantly associated with aggravation of pre-existing diseases (odds ratio 1.39; 95% confidence interval, 1.02-1.92).

CONCLUSION

Work-related stress during the first state of COVID-19 emergency was associated with aggravation of pre-existing disease during that period.

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.

Lifestyle changes and mental health during the COVID-19 pandemic: A repeated, cross-sectional web survey

BACKGROUND

This study aimed to compare self-reported changes on lifestyle behaviors during two phases of the COVID-19 pandemic in Spain, and to evaluate clinical and sociodemographic factors associated with lifestyles.

METHODS

Two cross-sectional web surveys were conducted during lockdown (April 15-May 15, 2020) and seven months later (November 16-December 16, 2020). Lifestyle behaviors were self-reported by a multidimensional scale (SMILE-C). Two separate samples of respondents were analyzed. A multivariate regression model was performed to evaluate the association of SMILE-C scores with demographic and clinical variables.

RESULTS

The sample comprised, 3412 participants from the first survey (S1) and in the S1 and 3635 from the second (S2). SMILE-C score decreased across surveys (p < 0.001). The rates of positive screenings for depression and anxiety were similar between the surveys, whereas those for alcohol abuse decreased (p < 0.001). Most participants in S2 reported that their lifestyle had not changed compared to those before the pandemic. Variables independently associated with an unhealthier lifestyle were working as an essential worker, lower educational level, previous mental disease, worse self-rated health, totally/moderate changes on diet, sleep or social support, as well as positive screenings for alcohol abuse, anxiety and depression.

LIMITATIONS

The cross-sectional design and recruitment by non-probabilistic methods limit inferring causality and the external validity of the results.

CONCLUSIONS

Overall lifestyle worsened seven months after the lockdown in Spain. Several demographic and clinical factors were associated with lifestyle scores. The contribution of common mental disorders to unhealthier lifestyles should be considered in order to prevent the negative impact of the pandemic.

Changes in Tobacco Use Patterns among Veterans in San Diego during the Recent Peak of the COVID-19 Pandemic

The prevalence of tobacco use increases in times of stress; however, during the initial stage of the COVID-19 pandemic, tobacco use rates stayed the same in most populations. Previous work focused on the initial months of the pandemic, while this study examined the changes in tobacco use during a later peak period of the pandemic. We used data from 61,852 visits to the VA San Diego Healthcare System from November 2019 to February 2021, divided into pre-, early, and peak pandemic periods. Multinomial logistic regression was used to test whether the odds of being a daily or non-daily tobacco user varied over time, by demographic group, or with the presence of specific psychiatric diagnoses. Younger Veterans had a greater reduction in the prevalence of non-daily tobacco use between the early and peak periods, while older Veterans had a rise in daily use from pre- to the early pandemic, which returned to baseline during the peak. Individuals with substance use disorder and serious mental illness diagnoses were more likely to report tobacco use, but psychiatric diagnoses did not predict change over time. These findings demonstrate factors that potentially contribute to changes in tobacco use during a public health crisis and may help guide future targeted cessation efforts.

COVID-19 and Its Repercussions on Oral Health: A Review

In 2019, a new type of coronavirus, SARS-CoV-2, the causing agent of COVID-19, was first detected in Wuhan, China. On 11 March 2020, the World Health Organization declared a pandemic. The manifestations of COVID-19 are mostly age-dependent and potentially more severe in cases with involved co-morbidities. The gravity of the symptoms depends on the clinical stage of the infection. The most common symptoms include runny nose and nasal congestion, anosmia, dysgeusia or hypogeusia, diarrhea, nausea/vomiting, respiratory distress, fatigue, ocular symptoms, diarrhea, vomiting, and abdominal pain. These systemic conditions are often accompanied by skin and mucosal lesions. Oral lesions reported in patients with COVID-19 include: herpex simplex, candidiasis, geographic tongue, aphthous-like ulcers, hemorrhagic ulcerations, necrotic ulcerations, white hairy tongue, reddish macules, erythematous surfaces, petechiae, and pustular enanthema. It is still unclear if these manifestations are a direct result of the viral infection, a consequence of systemic deterioration, or adverse reactions to treatments. Poor oral hygiene in hospitalized or quarantined COVID-19 patients should also be considered as an aggravating condition. This narrative review is focused on presenting the most relevant data from the literature regarding oral manifestations related to SARS-CoV-2, as well as the challenges faced by the dental system during this pandemic. A routine intraoral examination is recommended in COVID-19 patients, either suspected or confirmed, as, in certain cases, oral manifestations represent a sign of severe infection or even of a life-threatening condition. It is our belief that extensive knowledge of all possible manifestations, including oral lesions, in cases of COVID-19 is of great importance in the present uncertain context, including new, currently emerging viral variants with unknown future impact.

The cumulative effect of multiple dimensions of lifestyle on risky drinking during the Covid-19 pandemic

Lifestyle impacts morbidity and mortality worldwide. Herein, we evaluated the association of a multidimensional lifestyle measure and its domains (diet/nutrition, substance use, physical activity, social, stress management, sleep, environmental exposure) with risky drinking. Also, we analyzed the cumulative effect of unhealthy domains in the likelihood of presenting risky drinking. To reach these objectives, data from a web survey conducted in Brazil and Spain was analyzed. The main outcome was risky drinking assessed by the AUDIT-C. Lifestyle was measured using the Short Multidimensional Inventory Lifestyle Evaluation (SMILE). Fixed logistic models were used to evaluate associations between lifestyle and risky drinking. Between April and May 2020, 22,785 individuals answered the survey. The prevalence of risky drinking was 45.6% in Brazil and 30.8% in Spain. The SMILE score was lower (unhealthier lifestyle) among at-risk drinkers. Worse scores on Diet, Substance use, Stress management and Environment were associated with an increased likelihood of risky drinking. The higher the number of unhealthy domains, the higher the likelihood of presenting risky drinking: adjusted odds ratio (aOR) for risky drinking was 1.15 (IC95% 0.98-1.35) and 23.42 (IC95% 3.08-178.02) for those presenting worse lifestyle in 1 and 5 domains, respectively. Finally, interactions suggest that improvement in lifestyle domains would have a larger effect in Spain than in Brazil. Our results suggest that future interventions aiming at reducing Risky drinking may benefit from strategies targeting multiple domains of lifestyle.

Lifestyle in Undergraduate Students and Demographically Matched Controls during the COVID-19 Pandemic in Spain

Few studies have used a multidimensional approach to describe lifestyle changes among undergraduate students during the COVID-19 pandemic or have included controls. This study aimed to evaluate lifestyle behaviors and mental health of undergraduate students and compare them with an age and sex-matched control group. A cross-sectional web survey using snowball sampling was conducted several months after the beginning of COVID-19 pandemic in Spain. A sample of 221 students was recruited. The main outcome was the total SMILE-C score. Students showed a better SMILE-C score than controls (79.8 + 8.1 vs. 77.2 + 8.3; p < 0.001), although these differences disappeared after controlling for covariates. While groups did not differ in the screenings of depression and alcohol abuse, students reported lower rates of anxiety (28.5% vs. 37.1%; p = 0.042). A lower number of cohabitants, poorer self-perceived health and positive screening for depression and anxiety, or for depression only were independently associated (p < 0.05) with unhealthier lifestyles in both groups. History of mental illness and financial difficulties were predictors of unhealthier lifestyles for students, whereas totally/moderate changes in substance abuse and stress management (p < 0.05) were predictors for the members of the control group. Several months after the pandemic, undergraduate students and other young adults had similar lifestyles.

"We shouldn't waste a good crisis": the lived experience of working on the frontline through the first surge (and beyond) of COVID-19 in the UK and Ireland

OBJECTIVE

Frontline workers have shown extraordinary resilience and sustained efforts since the outbreak of COVID-19. The present study used semi-structured interviews with 38 frontline workers in the UK and Ireland to explore the psychological impact of working through COVID-19.

DESIGN

The qualitative data were analysed systematically using thematic analysis.

RESULTS

Four themes were interpreted: 1)) "I've stopped turning the telly on. I've had to because the news was making me ill": An ecosystem of influence; 2) "Dead, dead, dead": The emotional and psychological toll: 3) "It's shone a light on what we're failing on as well": Injustices, hierarchies and heroes: and 4) "I definitely think COVID happened for a reason to stop us in our tracks and to slow us down": Unexpected positives.

CONCLUSION

This research offers insights into how frontline workers make sense of their experiences during periods of enormous societal and occupational stress. The learnings generated have relevance for government and organisational policy-makers who have opportunities to shape future conditions for frontline workers.

Prevalence, New Incidence, Course, and Risk Factors of PTSD, Depression, Anxiety, and Panic Disorder during the Covid-19 Pandemic in 11 Countries

We aimed to evaluate the prevalence and incidence of post-traumatic stress disorder (PTSD), depression, anxiety, and panic disorder (PD) among citizens in 11 countries during the Covid-19 pandemic. We explored risks and protective factors most associated with the development of these mental health disorders and their course at 68 days follow up. We acquired 9543 unique responses via an online survey that was disseminated in UK, Belgium, Netherlands, Bulgaria, Czech Republic, Finland, India, Latvia, Poland, Romania, and Sweden. The prevalence and new incidence during the pandemic for at least one disorder was 48.6% and 17.6%, with the new incidence of PTSD, anxiety, depression, and panic disorder being 11.4%, 8.4%, 9.3%, and 3%, respectively. Higher resilience was associated with lower mental health burden for all disorders. Ten to thirteen associated factors explained 79% of the variance in PTSD, 80% in anxiety, 78% in depression, and 89% in PD. To reduce the mental health burden, governments should refrain from implementing many highly restrictive and lasting containment measures. Public health campaigns should focus their effort on alleviating stress and fear, promoting resilience, building public trust in government and medical care, and persuading the population of the measures' effectiveness. Psychosocial services and resources should be allocated to facilitate individual and community-level recovery from the pandemic.

An App-Based Intervention to Support First Responders and Essential Workers During the COVID-19 Pandemic: Needs Assessment and Mixed Methods Implementation Study

BACKGROUND

The COVID-19 pandemic has created unprecedented challenges for first responders (eg, police, fire, and emergency medical services) and nonmedical essential workers (eg, workers in food, transportation, and other industries). Health systems may be uniquely suited to support these workers given their medical expertise, and mobile apps can reach local communities despite social distancing requirements. Formal evaluation of real-world mobile app-based interventions is lacking.

OBJECTIVE

We aimed to evaluate the adoption, acceptability, and appropriateness of an academic medical center-sponsored app-based intervention (COVID-19 Guide App) designed to support access of first responders and essential workers to COVID-19 information and testing services. We also sought to better understand the COVID-19-related needs of these workers early in the pandemic.

METHODS

To understand overall community adoption, views and download data of the COVID-19 Guide App were described. To understand the adoption, appropriateness, and acceptability of the app and the unmet needs of workers, semistructured qualitative interviews were conducted by telephone, by video, and in person with first responders and essential workers in the San Francisco Bay Area who were recruited through purposive, convenience, and snowball sampling. Interview transcripts and field notes were qualitatively analyzed and presented using an implementation outcomes framework.

RESULTS

From its launch in April 2020 to September 2020, the app received 8262 views from unique devices and 6640 downloads (80.4% conversion rate, 0.61% adoption rate across the Bay Area). App acceptability was mixed among the 17 first responders interviewed and high among the 10 essential workers interviewed. Select themes included the need for personalized and accurate information, access to testing, and securing personal safety. First responders faced additional challenges related to interprofessional coordination and a "culture of heroism" that could both protect against and exacerbate health vulnerability.

CONCLUSIONS

First responders and essential workers both reported challenges related to obtaining accurate information, testing services, and other resources. A mobile app intervention has the potential to combat these challenges through the provision of disease-specific information and access to testing services but may be most effective if delivered as part of a larger ecosystem of support. Differentiated interventions that acknowledge and address the divergent needs between first responders and non-first responder essential workers may optimize acceptance and adoption.

SARS-CoV-2 mediated neuroinflammation and the impact of COVID-19 in neurological disorders

SARS-CoV-2 is a novel coronavirus that severely affects the respiratory system, is the cause of the COVID-19 pandemic, and is projected to result in the deaths of 2 million people worldwide. Recent reports suggest that SARS-CoV-2 also affects the central nervous system along with other organs. COVID-19-associated complications are observed in older people with underlying neurological conditions like stroke, Alzheimer's disease, and Parkinson's disease. Hence, we discuss SARS-CoV-2 viral replication and its inflammation-mediated infection. This review also focuses on COVID-19 associated neurological complications in individuals with those complications as well as other groups of people. Finally, we also briefly discuss the current therapies available to treat patients, as well as ongoing available treatments and vaccines for effective cures with a special focus on the therapeutic potential of a small 5 amino acid peptide (PHSCN), ATN-161, that inhibits SARS-CoV-2 spike protein binding to both integrin α5β1 and α5β1/hACE2.

Changes in Workers' Sedentary and Physical Activity Behaviors in Response to the COVID-19 Pandemic and Their Relationships With Fatigue: Longitudinal Online Study

Background

Sedentary behaviors and physical activity are likely to be affected by the COVID-19 outbreak, and sedentary lifestyles can increase subjective fatigue. The nonpharmaceutical policies imposed as a result of the COVID-19 pandemic may also have adverse effects on fatigue.

Objective

This study has two aims: to examine the changes in sedentary behaviors and physical activity of company workers in response to the COVID-19 pandemic in Japan and to examine relationships between changes in these sedentary behaviors and physical activity and changes in fatigue.

Methods

Data from a nationwide prospective online survey conducted in 2019 and 2020 were used. On February 22, 2019, an email with a link to participate in the study was sent to 45,659 workers, aged 20 to 59 years, who were randomly selected from a database of approximately 1 million individuals. A total of 2466 and 1318 participants, who self-reported their occupation as company workers, answered the baseline and follow-up surveys, respectively. Surveys captured fatigue, workday and daily domain-specific sedentary behaviors and physical activity, and total sedentary behaviors and physical activity. We used multivariable linear regression models to estimate associations of changes in sedentary behaviors and physical activity with changes in fatigue.

Results

Increases in public transportation sitting during workdays, other leisure sitting time during workdays, and other leisure sitting time were associated with an increase in the motivation aspect of fatigue (b=0.29, 95% CI 0-0.57, P=.048; b=0.40, 95% CI 0.18-0.62, P<.001; and b=0.26, 95% CI 0.07-0.45, P=.007, respectively). Increases in work-related sitting time during workdays, total sitting time during workdays, and total work-related sitting time were significantly associated with an increase in the physical activity aspect of fatigue (b=0.06, 95% CI 0-0.12, P=.03; b=0.05, 95% CI 0.01-0.09, P=.02; and b=0.07, 95% CI 0-0.14, P=.04, respectively). The motivation and physical activity aspects of fatigue increased by 0.06 for each 1-hour increase in total sitting time between baseline and follow-up (b=0.06, 95% CI 0-0.11, P=.045; and b=0.06, 95% CI 0.01-0.10, P=.009, respectively).

Conclusions

Our findings demonstrated that sedentary and active behaviors among company workers in Japan were negatively affected during the COVID-19 outbreak. Increases in several domain-specific sedentary behaviors also contributed to unfavorable changes in workers’ fatigue. Social distancing and teleworking amid a pandemic may contribute to the sedentary lifestyle of company workers. Public health interventions are needed to mitigate the negative effects of the COVID-19 pandemic or future pandemics on sedentary and physical activity behaviors and fatigue among company workers.

Translating science into policy: mental health challenges during the COVID-19 pandemic

Several stressors associated with the coronavirus disease 2019 (COVID-19) are expected to affect the mental health of global populations: the effects of physical distancing, quarantine, and social isolation; the emotional suffering of health and other frontline workers; neuropsychiatric sequelae in those affected by the virus; the impact to families of lives lost to the disease; differential effects for those with severe mental disorders; and the consequences of social and economic deterioration.

In this context, we sought: to form a panel of Brazilian experts on child and adolescent health, neurodevelopment, health services, and adult and elderly mental health; and to compile evidence-based interventions to support suggested policy changes in Brazil to mitigate the expected increase in mental health disorders during the pandemic and its mental health consequences. The following actions are recommended: 1) invest in prevention programs for the safe return of students to schools; 2) adopt evidence-based psychosocial interventions to maintain an adequate environment for child and adolescent development; 3) target socially vulnerable populations and those experiencing discrimination; 4) train primary care teams to solve common mental health problems, provide needs-based assessments, and manage long-term, at-home care for older patients; 5) invest in technological advancements (e.g., telemedicine, e-Health, and web-based algorithms) to promote coordinated care; 6) increase access to and literacy in the use of computers and mobile phones, especially among older adults; 7) expand protocols for remote, brief psychotherapy interventions and psychoeducation to manage common mental health problems.

Factors Associated with Symptoms of Depression and Psychological Distress during the COVID-19 Pandemic

The objective of this study was to examine factors associated with symptoms of depression and psychological distress during the COVID-19 pandemic in China. Convenience sampling and snowball sampling were used to recruit a sample of adults in China (n = 2130) from 14 February 2020 to 3 March 2020 to complete an online survey. Linear regression was used to examine the predictors of symptoms of depression and psychological distress. Living in a non-urban area and the number of confirmed cases in their city of residence were positively associated with symptoms of depression. Female gender, not being married, practicing social distancing, the amount of time spent daily on social media searching for and reading information on COVID-19, the number of confirmed cases of COVID-19 in their city of residence, and having confirmed or suspected cases of COVID-19 in personal networks were positively associated with psychological distress. Social distancing is a widely used public health approach for population-wide virus-containment of COVID-19. However, reductions in population-wide psychological well-being are inadvertent consequences of social distancing. There is an emerging need to negate factors that increase adverse mental health vulnerabilities during the COVID-19 pandemic.

Vulnerability and Protective Factors for PTSD and Depression Symptoms Among Healthcare Workers During COVID-19: A Machine Learning Approach

Background: Healthcare workers are at high risk for developing mental health problems during the COVID-19 pandemic. There is an urgent need to identify vulnerability and protective factors related to the severity of psychiatric symptoms among healthcare workers to implement targeted prevention and intervention programs to reduce the mental health burden worldwide during COVID-19. Objective: The present study aimed to apply a machine learning approach to predict depression and PTSD symptoms based on psychometric questions that assessed: (1) the level of stress due to being isolated from one's family; (2) professional recognition before and during the pandemic; and (3) altruistic acceptance of risk during the COVID-19 pandemic among healthcare workers. Methods: A total of 437 healthcare workers who experienced some level of isolation at the time of the pandemic participated in the study. Data were collected using a web survey conducted between June 12, 2020, and September 19, 2020. We trained two regression models to predict PTSD and depression symptoms. Pattern regression analyses consisted of a linear epsilon-insensitive support vector machine (ε-SVM). Predicted and actual clinical scores were compared using Pearson's correlation coefficient (r), the coefficient of determination (r²), and the normalized mean squared error (NMSE) to evaluate the model performance. A permutation test was applied to estimate significance levels. Results: Results were significant using two different cross-validation strategies to significantly decode both PTSD and depression symptoms. For all of the models, the stress due to social isolation and professional recognition were the variables with the greatest contributions to the predictive function. Interestingly, professional recognition had a negative predictive value, indicating an inverse relationship with PTSD and depression symptoms. Conclusions: Our findings emphasize the protective role of professional recognition and the vulnerability role of the level of stress due to social isolation in the severity of posttraumatic stress and depression symptoms. The insights gleaned from the current study will advance efforts in terms of intervention programs and public health messaging.