Will Nothing Be the Same Again?: Changes in Lifestyle during COVID-19 Pandemic and Consequences on Mental Health

Post-COVID social engagement and depression among Chinese older adults: exploring rural/urban and gender differences

PURPOSE

This study investigates the impact of post-COVID social engagement on depression levels among Chinese older adults, with a focus on rural/urban and gender differences.

METHODS

Using the year 2018 and year 2020 data from the China Health and Retirement Longitudinal Study (CHARLS), this study analyzed pre- and post-COVID depression levels and social engagement indicators, including going-out, activities and networking among Chinese older adults (N = 8,793).

RESULTS

Results showed a significant increase in depression levels across all demographic groups post-COVID, with rural females exhibiting the highest levels of depression. Reduced social engagement was associated with increased depression, particularly among rural males and females. Subgroup analyses highlighted nuanced patterns: rural males suffered from decreased intense activities and online contacts, while urban males experienced heightened depression with reduced visiting and light activities. Rural females reported increased depression with decreased moderate activities and dancing outdoors but decreased levels with reduced online contacts. Conversely, urban females experience decreased depression with reduced social engagements, suggesting areevaluation of priorities amidst pandemic challenges.

CONCLUSION

This study has underscored the importance of considering individual, cultural, and contextual factors in understanding mental health outcomes among Chinese older adults. Findings inform targeted interventions aimed at promoting psychological well-being and resilience among Chinese older adults in the post-COVID era, including community-based programs and mental health screenings, to foster social connection and emotional support.

Changes in internalizing and externalizing problems in Dutch children and adolescents receiving outpatient youth care before and during the COVID-19 pandemic

The COVID-19 pandemic significantly impacted the mental health of children and adolescents, but its effects on treatment outcomes in youth care remain unclear. This study examines whether the pandemic influenced treatment outcomes for internalizing and externalizing problems in children receiving outpatient youth care. We analyzed data from three groups of children who received outpatient youth care (N = 1090, Mage = 12.85): those treated entirely before the pandemic, those who transitioned into pandemic-related measures during treatment, and those treated entirely during the pandemic. The Child Behavior Checklist was used to assess internalizing and externalizing problems at the start and end of treatment. Repeated measures ANCOVAs and χ2 tests of independence were conducted to evaluate changes in problem severity and clinical status, and ANCOVAs were used to compare between-group differences. The results suggest that while overall treatment outcomes were not directly affected by the pandemic, fewer children treated during the pandemic recovered from externalizing problems compared to those treated before the pandemic. Additionally, children treated entirely during the pandemic exhibited higher levels of internalizing and externalizing problems at both the start and end of treatment, and those transitioning into the pandemic also had elevated externalizing problems at both time points. Although the pandemic did not affect the change in problems during treatment, the increased severity of issues at both the start and end of treatment indicates a deterioration in child mental health since the pandemic. Appropriate support, preventive interventions, and regular monitoring of mental health problems may mitigate future impacts.

Examination of factors associated with physical activity among medical students pre and post-COVID-19 in Serbia

The association of physical activity (PA) with the prevention and treatment of various diseases is well known. The issue of insufficient physical activity among university students has worsened due to the effects of the COVID-19 pandemic. The aim of this research is to examine the social, lifestyle, and health factors associated with moderate and high levels of PA in two cross-sectional studies conducted before and after COVID-19 involving 1,266 medical students from five universities in Serbia. Two cross-sectional studies were conducted on the population of fifth-year medical students from five different universities in Serbia before and after the COVID-19 pandemic (in 2019 and 2023). The research instrument was a questionnaire specially designed based on similar research. The mean energy expenditure in MET-minutes per week increased from 2,265.26 ± 1,930.67 in 2019 to 2,871.65 ± 2,301.99 in 2023 (p < 0.001). Multivariate logistic regression analysis with high PA as an outcome variable for the entire sample showed the association of high PA with the University of Kosovska Mitrovica and score on the Zung anxiety scale. Multivariate logistic regression analysis with high PA as an outcome variable for 2019 showed the association of high PA with the University of Kosovska Mitrovica, number of meals per day, and score on the Zung anxiety scale. Multivariate logistic regression analysis with high PA as an outcome variable for 2023 showed the association of high PA with the University of Kosovska Mitrovica, number of meals per day, and score on the Zung anxiety scale. The average energy expenditure was significantly higher in 2023. Factors such as studying in Kosovska Mitrovica, scores on the Zung Anxiety Scale, alcohol consumption, binge drinking in the past month, and the number of meals consumed per day were associated with either moderate or high levels of PA or both.

Sleep Alterations in the Population of the Metropolitan Area of Mexico and Their Association with Lifestyle Changes During COVID-19 Confinement

Home confinement due to Coronavirus Disease 2019 (COVID-19) led to lifestyle changes that increased sleep disturbances, particularly in areas with higher infection and mortality rates. This study is a retrospective study based on data collected through an online survey conducted during the COVID-19 confinement. It aims to analyze changes in sleep quantity and quality and their association with lifestyle changes in the metropolitan area of Mexico City. A total of 899 adults from this area completed an online questionnaire between June 2020 and February 2021. This study assessed sleep quantity, sleep quality, insomnia symptoms, and lifestyle changes during the confinement period. Results showed that sleep quantity increased (7.10 ± 1.37 vs. 7.43 ± 1.42 h, p < 0.0001), with more participants, especially young adults and women, reporting later bed and wake-up times. The Pittsburgh Sleep Quality Index increased by 1.4 units, with poor sleep quality associated with lifestyle during confinement. Insomnia symptoms, sleep latency, and poor sleep quality also increased, particularly in women. Males and those without chronic comorbidities were less likely to experience poor sleep quality, while tobacco use and later bedtimes increased this risk. This study concludes that, while sleep quantity increased, sleep quality declined, particularly among young adults, women, and those with unhealthy lifestyles. These findings could guide sleep health initiatives tailored to specific lifestyle changes in different population groups.

Neurological sequelae of long COVID: a comprehensive review of diagnostic imaging, underlying mechanisms, and potential therapeutics

One lingering effect of the COVID-19 pandemic created by SARS-CoV-2 is the emergence of Long COVID (LC), characterized by enduring neurological sequelae affecting a significant portion of survivors. This review provides a thorough analysis of these neurological disruptions with respect to cognitive dysfunction, which broadly manifest as chronic insomnia, fatigue, mood dysregulation, and cognitive impairments with respect to cognitive dysfunction. Furthermore, we characterize how diagnostic tools such as PET, MRI, EEG, and ultrasonography provide critical insight into subtle neurological anomalies that may mechanistically explain the Long COVID disease phenotype. In this review, we explore the mechanistic hypotheses of these neurological changes, which describe CNS invasion, neuroinflammation, blood-brain barrier disruption, and gut-brain axis dysregulation, along with the novel vascular disruption hypothesis that highlights endothelial dysfunction and hypoperfusion as a core underlying mechanism. We lastly evaluate the clinical treatment landscape, scrutinizing the efficacy of various therapeutic strategies ranging from antivirals to anti-inflammatory agents in mitigating the multifaceted symptoms of LC.

Changes in Alcohol Consumption During and After the Covid-19 Pandemic From 2020 to 2023 in a Prospective Cohort of Italian Adults

BACKGROUND

The lockdowns imposed by the government during coronavirus disease 2019 (COVID-19) pandemic have had a significant impact on the Italian population habits.

METHODS

LOckdown and lifeSTyles in Italy and in Tuscany studies collected data on a representative sample of the Italian adult population in 2020 (n = 6,003) followed up through 2023 via four additional surveys (3,000 ≤ n ≤ 6,600) through an online self-administered questionnaire. The Alcohol Use Disorders Identification Test-Concise was used to identify at-risk drinkers. Considering the cohort of individuals who took part to the first and at least one other wave (n = 5,378), a multilevel logistic model was used to derive odds ratios (ORs) and corresponding 95% confidence intervals (CIs) of being at-risk drinkers.

RESULTS

The prevalence of at-risk drinkers was 26.4% before, 23.4% during the first lockdown, and stabilized around 30.0% thereafter. Being at-risk alcohol consumers decreased with decreasing economic status (P for trend <0.001), was less frequent among middle-aged compared to younger (OR 0.73; 95% CI, 0.60-0.89) and among divorced/separated (OR 0.77; 95% CI, 0.60-0.99) or single (OR 0.75; 95% CI, 0.64-0.89) compared to married individuals. It was more frequent among individuals with anxiety or depressive symptoms (OR 1.24; 95% CI, 1.12-1.37), those using psychotropic drugs (OR 1.99; 95% CI, 1.69-2.35) and users of conventional and/or alternative nicotine products (OR 3.67; 95% CI, 3.00-4.48).

CONCLUSION

The long-term trends in alcohol consumption after the COVID-19 pandemic are unfavorable in Italy. The results point to an increased vulnerability for at-risk alcohol consumption among younger individuals, women with higher economic status, and married individuals. At-risk drinking is strongly related to mental health symptoms and nicotine consumption.

Triangulated evidence provides no support for bidirectional causal pathways between diet/physical activity and depression/anxiety

BACKGROUND

Previous studies (various designs) present contradicting insights on the potential causal effects of diet/physical activity on depression/anxiety (and vice versa). To clarify this, we employed a triangulation framework including three methods with unique strengths/limitations/potential biases to examine possible bidirectional causal effects of diet/physical activity on depression/anxiety.

METHODS

Study 1: 3-wave longitudinal study (n = 9,276 Dutch University students). Using random intercept cross-lagged panel models to study temporal associations. Study 2: cross-sectional study (n = 341 monozygotic and n = 415 dizygotic Australian adult twin pairs). Using a co-twin control design to separate genetic/environmental confounding. Study 3: Mendelian randomization utilizing data (European ancestry) from genome-wide association studies (n varied between 17,310 and 447,401). Using genetic variants as instrumental variables to study causal inference.

RESULTS

Study 1 did not provide support for bidirectional causal effects between diet/physical activity and symptoms of depression/anxiety. Study 2 did provide support for causal effects between fruit/vegetable intake and symptoms of depression/anxiety, mixed support for causal effects between physical activity and symptoms of depression/anxiety, and no support for causal effects between sweet/savoury snack intake and symptoms of depression/anxiety. Study 3 provides support for a causal effect from increased fruit intake to the increased likelihood of anxiety. No support was found for other pathways. Adjusting the analyses including diet for physical activity (and vice versa) did not change the conclusions in any study.

CONCLUSIONS

Triangulating the evidence across the studies did not provide compelling support for causal effects of diet/physical activity on depression/anxiety or vice versa.

Comparative Analysis of Healthy Lifestyles in Peruvian University Students During and After the COVID-19 Pandemic

The COVID-19 pandemic has provoked a worldwide mental health crisis, affecting university students in an exacerbated way, exposing them to the risk of emotional isolation and development of eating disorders. The present study aimed to examine the quality of healthy lifestyle practices in university students from the Faculty of Human Medicine and the Faculty of Education of a Peruvian university during and after the COVID-19 pandemic. This study was conducted during the academic period 2020 and 2023. Data collection was performed between July and August 2020, during the first wave of the COVID-19 pandemic (M1) and between November and December 2023, post-pandemic (M2). In M1 and M2, 370 and 82 students participated, respectively. The results of the Mann-Whitney test revealed significant differences between the total healthy lifestyle score of students in M1 and M2. In the nutrition domain, there are significant differences between the scores obtained in M1 and M2, revealing a decrease in nutritional care. Significant differences were also found between both faculties in substance use in M1 and physical activity practice in M2. Although a trend toward the adoption of healthy habits was observed in the initial stages, the longitudinal analysis reveals a generalized decrease in concern for health and well-being. Medical students, on the other hand, showed greater resilience and more successful adaptation to new circumstances, evidencing the importance of academic training in the promotion of healthy lifestyles. These results underscore the need to implement intervention strategies aimed at promoting healthy habits in the student population, especially in contexts of health crisis.

Association between physical activity practice and sleep quality of older people in social isolation during the COVID-19 pandemic and Health Guidelines and future studies for the post-COVID period: a systematic review

PURPOSE

Physical activity (PA) is considered an alternative to mitigate the negative impacts of the COVID-19 pandemic on the sleep of older adults. The objective was to verify the association between physical activity and the sleep quality of older people in social isolation during the COVID-19 pandemic, to analyze the Health Guidelines, and suggest future studies for the post-COVID period.

METHODS

This systematic review followed PRISMA recommendations, and the protocol was registered in PROSPERO (CRD 42023406471). The search for articles occurred in April 2024 in the databases PubMed, Web of Science, SCOPUS, and gray literature. Data were extracted and checked in a Microsoft Excel® spreadsheet. The quality assessment was performed using tools from the National Institutes of Health.

RESULTS

In total, 1582 studies were found in the databases, of which nine were included in the analyses. Four studies reported a negative association of reduced levels of PA during the pandemic with sleep quality, while one study showed a positive association of PA with sleep quality. Four studies demonstrated no association.

CONCLUSIONS

PA was associated with the sleep quality of older adults during the COVID-19 pandemic and reduced levels of PA during this period demonstrated a negative association with sleep quality. Practice of PA is recommended for this post-COVID scenario, as a measure to reduce social isolation and its negative effects and improve the quality of sleep in older adults.

Lifestyle and Health Behavior Changes in the COVID-19 Pandemic: A Role for Mental Health Symptoms and Diagnosis and Daily Life Difficulties During Lockdown in Lebanon

Several studies report significant changes in lifestyle habits during the COVID-19 pandemic, yet results are largely heterogeneous across populations. We examined changes in lifestyle and health behaviors during the first COVID-19 lockdown in Lebanon and assessed whether mental and physical health indicators and outbreak- and lockdown-related factors are related to these changes. Data come from a cross-sectional online survey (May-June 2020) which assessed changes in smoking, alcohol, diet, eating behavior, physical activity, sleep hours, sleep satisfaction, social media use, self-rated health, and life satisfaction (n = 494). We examined these changes' association with current depressive and anxiety symptoms, presence of physical and mental disorders, outbreak-related worries, and lockdown-related factors using regression models adjusted for sociodemographic and socioeconomic covariates. Most prevalent changes were increased social media use (63.2%) and decreased life satisfaction (54.9%) and physical activity (53.4%). Higher depressive and anxiety symptoms, higher daily life difficulties, and presence of diagnosed mental disorder were related to worsening of almost all behaviors. Participants with higher outbreak worries had less healthy diet and increased social media use. Higher adherence to lockdown and preventive measures were associated with increased social media use and lower life satisfaction, respectively. Results show a clear clustering of negative lifestyle and health behavioral changes with current mental health symptoms, existing mental health disorder, and daily life challenges during lockdowns. Findings highlight the importance of tracking higher-risk mental health subgroups to mitigate further adverse impact on mental and physical health.

Lifestyle changes among older adults during and after COVID-19 pandemic in Lithuania

The aim of this study

to analyze lifestyle changes among older adults during and after COVID-19 pandemic in Lithuania, with a particular focus on eating habits, physical activity, social engagement and harmful habits.

Methods

The representative sample of Lithuanian population over 65 years old (1,503 individuals) was involved in the questionnaire survey, performed in January 2024.

Results

Most of the eating habits and the body weight of the older adults did not change during the COVID-19 pandemic in Lithuania. Respondents noted that their physical activity decreased, face-to-face communication became rarer, while remote communication increased. During pandemic, the increased frequency of snacking was more often indicated by persons with lower than secondary education, working, receiving higher incomes, as well as increased snacking and body weight were more prevalent among younger, single or overweight persons; increased body weight during the pandemic was more often mentioned by the persons who assessed their health poorly. Physical activity decreased more often among rural residents and groups with higher or college education; face-to-face communication has become rarer among younger people, rural residents, pensioners, disabled, people with higher income and those with overweight, while remote communication has increased among women, respondents with a university education and those with an average income (p < 0.05). Nearly half of the respondents indicated that the changes in food consumption and smoking frequency that occurred during the pandemic remained after it. After the pandemic, the habits of consuming fast food, confectionery or other sweets and changes in body weight mostly remained, while the patterns of communication returned to the pre-pandemic level. Most of the healthy lifestyle habits formed during the pandemic persisted after the pandemic. The lifestyle habits formed during the pandemic remained more stable in the groups of older persons, residents of smaller towns, respondents with lower than secondary education, higher income, singles, disabled, obese, and those who assessed their health poorly (p < 0.05).

Conclusion

During the COVID-19 pandemic in Lithuania, there were various changes in eating habits, physical activity, communication patterns, and harmful habits. Certain habits formed during the pandemic continued afterward, particularly among specific groups of the older Lithuanian adults.

Measuring influencing factors affecting mortality rates during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has revealed clear deficiencies in global public health policies and healthcare systems when confronted with the emergence of a novel and deadly infectious disease.

OBJECTIVES

With 4 years elapsed since the onset of the pandemic, ample data now exist to analyse the associations between the implementation of diverse public health policies, sociodemographic factors and COVID-19 mortality rates.

METHODS

This study utilised the dataset compiled by 'Our World in Data' spanning the period of the COVID-19 pandemic from 2020 to 2022. Stochastic frontier analysis was employed to assess the influencing factors and their relationship with mortality rates resulting from COVID-19 infections across 156 countries or regions.

RESULTS

This study yielded several key findings: (1) There remains a 33% margin for improvement in the global mortality rate concerning the COVID-19 pandemic; (2) During the initial stage of the pandemic, when an effective vaccine was not yet available, implementing public health control policies could reduce both the infection and mortality rates; (3) Areas characterised by higher population densities, a greater proportion of individuals aged 65 and over, and elevated prevalence rates of diabetes demonstrated higher mortality rates; and (4) Increasing vaccination coverage emerged as an effective strategy for reducing mortality rates.

CONCLUSIONS

As our understanding of the COVID-19 virus improves, global economies and social interactions have gradually returned to normality. It is anticipated that the findings of this study can serve as a valuable reference in combating potential future pandemics caused by unknown viruses.

The PROMIS-10 Global Mental Health T-Score: An Independent Predictor of In-Hospital Recovery Following a Total Hip Arthroplasty

BACKGROUND

Currently, few investigations explore the connection between global mental health and recovery following total hip arthroplasty (THA). The increased utilization of patient-reported outcomes tools provides an opportunity to assess a patient's mental health without undue survey burden. The purpose of this study was to explore how mental health is associated with a patient's immediate in-hospital recovery regardless of a formally diagnosed mental illness.

METHODS

This retrospective study consisted of patients undergoing elective primary THA. Patients were grouped by both their PROMIS 10 Global Mental Health T-score (MHT) and whether they had a formally diagnosed mental illness. The resulting four patient groups were compared using multivariate regression analyses to determine differences in in-hospital pain reporting, opioid consumption, and discharge disposition.

RESULTS

One thousand four hundred and twenty nine patients were included in this study. MHT was an independent predictor of pain reporting at discharge (P < 0.001) and inpatient opioid consumption (P = 0.002). Regardless of the presence of mental illness, patients self-reporting poor mental health (MHT<40) reported higher pain levels, consumed more opioids, and were more likely to be discharged to a facility than those with an MHT >50.

CONCLUSION

Mental illness was not an independent predictor of immediate postoperative outcomes, but self-reported global mental health assessed using the MHT was. Therefore, surgeons should be aware of their patient's global mental health status before surgery because it is associated with in-hospital recovery following THA.

Physical Activity and Sedentary Behavior on Well-Being and Self-Rated Health of Italian Public Health Medical Residents During the COVID-19 Pandemic: The PHRASI Study

High workloads and extended work shift greatly limit the opportunities for medical residents to adopt a healthy lifestyle by practicing regular physical exercise. Using data from the Public Health Residents' Anonymous Survey in Italy (PHRASI), this research assessed the associations between physical activity levels and sedentary behavior, well-being, and self-rated health among Italian public health residents (PHRs) during the COVID-19 pandemic. Employing a cross-sectional design, this study utilized the International Physical Activity Questionnaire, the WHO-5 Well-being Index, and the single-item self-rated health to measure physical activity, sedentary behavior, self-rated health, and well-being among PHRs. The study included 379 PHRs. Multiple logistic regressions adjusted for age and sex were applied to explore the associations among the variables of interest. While 74% of PHRs were sufficiently active, 50% reported good well-being. We found a positive association between physical activity (specifically walking and intense activities) and well-being (aOR 1.292, p = 0.032). At the same time, sedentary behavior was negatively associated with self-rated health (aOR 0.948, p = 0.022) and well-being (aOR 0.945, p = 0.005). This study contributes valuable insights into the role of physical activity and sedentary behavior in PHRs' mental health, calling for targeted public health strategies to support their well-being.

Non-attendance in randomized remote mental health clinical trial during the COVID-19 pandemic

During the COVID-19 pandemic, a significant increase in psychiatric symptoms was found among essential service professionals (professionals or interns from the health and educational sector) who were exposed to high-risk contamination areas. These symptoms impair functionality, impacting quality of life, work, autonomy, and relationships. Recent data show that brief interventions are effective; however, between 20 and 30% of those individuals often do not attend their scheduled appointments. This study aimed to identify variables related to non-attendance for remote telepsychotherapy among participants with COVID-19-related emotional distress compared to those who initiated treatment. We included 2097 essential service professionals with PROMIS (Patient-Reported Outcomes Measurement Information System) T-scores ≥70 for anxiety, depression, or irritability who scheduled a remote mental health appointment. Participants completed clinical and sociodemographic data, mental health risk and protective factors, and PROMIS subscales. We conducted a binary logistic regression, using attendance vs. non-attendance as the dependent variable and these demographic and clinical characteristics as independent variables. Of the 2097 participants, 230 (11%) did not attend the first session despite three rescheduling attempts. Non-attendance was associated with the presence of irritability and seeking treatment during the second COVID-19 wave. In contrast, anxious symptoms, older age, and coping mechanisms that typically include intellectual and reading activities were associated with attendance. Our findings shed light on non-attendance patterns in mental health services, revealing that personal characteristics and environmental factors significantly contribute to missed appointments. Understanding these dynamics can improve patient engagement and adherence to mental health treatments, particularly in the context of telepsychotherapy during the COVID-19 pandemic.

Informatics assessment of COVID-19 data collection: an analysis of UK Biobank questionnaire data

BACKGROUND

There have been many efforts to expand existing data collection initiatives to include COVID-19 related data. One program that expanded is UK Biobank, a large-scale research and biomedical data collection resource that added several COVID-19 related data fields including questionnaires (exposures and symptoms), viral testing, and serological data. This study aimed to analyze this COVID-19 data to understand how COVID-19 data was collected and how it can be used to attribute COVID-19 and analyze differences in cohorts and time periods.

METHODS

A cohort of COVID-19 infected individuals was defined from the UK Biobank population using viral testing, diagnosis, and self-reported data. Changes over time, from March 2020 to October 2021, in total case counts and changes in case counts by identification source (diagnosis from EHR, measurement from viral testing and self-reported from questionnaire) were also analyzed. For the questionnaires, an analysis of the structure and dynamics of the questionnaires was done which included the amount and type of questions asked, how often and how many individuals answered the questions and what responses were given. In addition, the amount of individuals who provided responses regarding different time segments covered by the questionnaire was calculated along with how often responses changed. The analysis included changes in population level responses over time. The analyses were repeated for COVID and non-COVID individuals and compared responses.

RESULTS

There were 62 042 distinct participants who had COVID-19, with 49 120 identified through diagnosis, 30 553 identified through viral testing and 934 identified through self-reporting, with many identified in multiple methods. This included vast changes in overall cases and distribution of case data source over time. 6 899 of 9 952 participants completing the exposure questionnaire responded regarding every time period covered by the questionnaire including large changes in response over time. The most common change came for employment situation, which was changed by 74.78% of individuals from the first to last time of asking. On a population level, there were changes as face mask usage increased each successive time period. There were decreases in nearly every COVID-19 symptom from the first to the second questionnaire. When comparing COVID to non-COVID participants, COVID participants were more commonly keyworkers (COVID: 33.76%, non-COVID: 15.00%) and more often lived with young people attending school (61.70%, 45.32%).

CONCLUSION

To develop a robust cohort of COVID-19 participants from the UK Biobank population, multiple types of data were needed. The differences based on time and exposures show the important of comprehensive data capture and the utility of COVID-19 related questionnaire data.

Exploring the Linkages Among Chronic Illness, Substance Use, and COVID-19 Infection in Adults Aged 50 Years and Older: Retrospective Cross-Sectional Analysis of National Representative Data

BACKGROUND

The co-occurrence of chronic illnesses and substance use presents complex challenges for health care systems. Understanding the interplay between these factors, compounded by the context of the COVID-19 pandemic, is essential for effective intervention strategies.

OBJECTIVE

This study aims to investigate the relationships among chronic illness, substance use, and COVID-19 infection in adults aged 50 years and older.

METHODS

Participants were 1196 adults aged 50 years and older. Descriptive statistics were used to describe demographic information. Logistic regressions and multiple regression analyses were used to determine associations between chronic illnesses, substance use, and COVID-19 infection. Mediation analysis was used to determine the effect of chronic illness mediators in the association between COVID-19 concerns and substance use.

RESULTS

The mean age was 68 (SD 10.3) years, with 58.6% (701/1196) being women. Adjusted analysis revealed that age and sex (women) significantly predicted a lower level of substance use (P<.05). However, marital status (separated or widowed) and chronic illness significantly predicted a higher level of substance use (P<.05). Furthermore, having dementia, arthritis, and high cholesterol significantly predicted a higher level of concern about the COVID-19 pandemic (P<.05). Logistic regression analysis indicated that individuals with hypertension (odds ratio [OR] 1.91, 95% CI 1.37-2.66; P<.001), lung disease (OR 2.42, 95% CI 1.23-4.75; P=.01), heart condition (OR 1.99, 95% CI 1.28-3.10; P=.002), stroke (OR 2.35, 95% CI 1.07-5.16; P=.03), and arthritis (OR 1.72, 95% CI 1.25-2.37; P=.001) were more likely to have their work affected by the COVID-19 pandemic. The mediation analysis showed a significant effect of COVID-19 concern on substance use through the mediation of chronic illness, with a 95% CI of -0.02 to -0.01 and an indirect effect of -0.01.

CONCLUSIONS

Our study reveals complex associations among chronic illnesses, substance use, and COVID-19 infection among adults aged 50 years and older. It underscores the impact of demographics and specific chronic conditions on substance use behaviors and COVID-19 concerns. In addition, certain chronic illnesses were linked to heightened vulnerability in employment status during the pandemic. These findings emphasize the need for targeted interventions addressing physical health and substance use in this population during the COVID-19 pandemic.

Leveraging a Global Partnership to Address COVID-19-Related Mental Health Challenges

INTRODUCTION

The COVID-19 pandemic profoundly affected nurses globally. As frontline workers, nurses faced increased responsibilities amid challenges such as isolation, infection risks, family obligations and disrupted social support systems. Coping with these challenges was associated with adverse mental health outcomes.

AIM/QUESTION

This perspective paper examines a collaboration between two schools of nursing in the United States and India to address these mental health challenges.

METHODS

Faculty from both institutions identified key mental health topics, leading to five webinars that delved into topics such as acute and long-term impacts of COVID-19 on nurse mental health, coping mechanisms, caregiving responsibilities and children's needs during the pandemic.

RESULTS

Impressively, over 11,000 nurses from 60 countries engaged, fostering a global platform for sharing evidence-based knowledge, experiences and strategies.

IMPLICATIONS FOR PRACTICE

This partnership exemplifies the value of international collaboration. By pooling resources and expertise across cultural contexts, the initiative not only disseminated crucial knowledge but also cultivated a sense of global community among nurses. The success of this collaboration underscores the potential of such global partnerships for healthcare institutions worldwide, offering avenues to share best practices and enhance support systems for nurses confronting similar crises globally.

Effect of COVID-19 pandemic on bioimpedance health indicators in young adults

OBJECTIVES

Herein, we investigate the relationships between the COVID-19 pandemic and overcoming the virus, and its effects on body composition parameters in young adults from Slovakia.

METHODS

We assessed 773 adults aged 18 to 30 years in pandemic-status sub-groups. Individual lifestyles and overcoming the COVID-19 effects were evaluated by a detailed questionnaire, and body composition parameters were analyzed using the InBody 770 bioimpedance analyzer.

RESULTS

Statistically significant lower values were observed in the male group during the pandemic for the following parameters; proteins and minerals, fat free mass (FFM), skeletal muscle mass (SMM), lean body mass (LBM) and its values in the right and left arm and trunk, total body water (TBW) and its values in the right and left arm and trunk, body cell mass (BCM), basal metabolic rate (BMR) and phase angle (PA). The regression analysis confirmed the negative pandemic effect and the negative impact of COVID-19 on men in the following parameters: proteins (p = .027 for pandemic and p = .005 for COVID-19), FFM (p = .023 for pandemic and p = .005 for COVID-19), LBM (p = .022 for pandemic and p = .004 for COVID-19), SMM (p = .028 for pandemic and p = .005 for COVID-19), TBW (p = .020 for pandemic and p = .004 for COVID-19), BMR (p = .024 for pandemic and p = .005 for COVID-19) and PA (p = .009 for pandemic). Physical activity was a further significant predictor in men for all the above parameters.

CONCLUSIONS

We observed significantly lower body composition parameters associated with fat free mass in young adult men during the pandemic than before it. However, future research is warranted to determine if these effects have long-term significance.

The impact of the COVID-19 pandemic on the socioeconomic gradient of hypertension

The COVID-19 pandemic has brought into sharp focus the impact of socioeconomic factors on hypertension outcomes. This review examines the implications of the pandemic on the socioeconomic gradient of hypertension and explores the physiological and pathophysiological processes underlying this relationship. Changes in socioeconomic factors have disproportionately affected individuals with lower socioeconomic status, leading to adverse hypertension outcomes. The pandemic-related stressors, coupled with social isolation and disrupted daily routines, have contributed to elevated stress levels among individuals, particularly those with lower socioeconomic status. Equitable access to healthcare, enhancing health literacy and patient empowerment, and addressing social determinants of health are essential components of hypertension management strategies. By recognizing the specific challenges faced by individuals with lower socioeconomic status and implementing targeted interventions, public health efforts can help reduce the socioeconomic gradient of hypertension.

Impact of the COVID-19 Pandemic on the Diagnosis of Malignant Neoplasia of the Bronchus and Lung in the Burgos Region

PURPOSE

To retrospectively analyze the impact of the COVID-19 pandemic on the diagnosis, mortality rate, and survival period of malignant bronchial and lung neoplasms in the Burgos region, with the aim of promoting the development of strategies to improve cancer care management during health crises, highlighting the importance of non-pharmacological approaches to mitigate the negative impacts of future pandemics on lung cancer patients.

METHODS

This retrospective, longitudinal, single-center study was conducted in Burgos from 2019 to 2021. Participants included all patients diagnosed with malignant bronchial and lung neoplasms by the Pneumology unit of Complejo Asistencial Universitario de Burgos during the year immediately before and the year immediately after 31 March 2020, the official start date of the pandemic. Inclusion criteria encompassed patients diagnosed through histological or clinicoradiological methods, who provided informed consent. Data were systematically gathered using a specific template that included demographic information, disease stage, death, and survival time. Statistical analysis involved descriptive methods, ANOVA, and chi-square tests to assess differences in survival time and associations between categorical variables.

RESULTS

The results reveal a decrease in the number of patients diagnosed during the pandemic period (154 vs. 105), which could indicate delays in detection. However, there were no significant differences between the two periods, in which more than 60% of cases were detected in stage IV, being incompatible with survival. Although fewer patients died during the pandemic than expected (p = 0.015), patients diagnosed after the onset of the pandemic had a shorter survival time (182.43 ± 142.63 vs. 253.61 ± 224.30; p = 0.038). Specifically, those diagnosed in stage I during the pre-pandemic had a much longer survival time (741.50 days) than the rest of the patients (p < 0.05). In addition, among those diagnosed in stage IV, those diagnosed after the beginning of the pandemic had a shorter survival time (157.29 ± 202.36 vs. 241.18 ± 218.36; p = 0.026).

CONCLUSIONS

Understanding these changes can support both medical strategies and non-pharmacological therapies to improve cancer care management during health crises, thus contributing to the optimization of public health.

Differences in the prevalence of allergy and asthma among US children and adolescents during and before the COVID-19 pandemic

BACKGROUND

The increasing prevalence of allergies and asthma has led to a growing global socioeconomic burden. Since the outbreak of the COVID-19 pandemic, the health and lifestyles of children and adolescents have changed dramatically. It's unclear how this shift impacted allergy and asthma, with limited studies addressing this question. We aim to explore the difference of the prevalence of allergies and asthma among US children and adolescents during and before the COVID-19 pandemic using a nationally representative sample of US children and adolescents.

METHODS

This cross-sectional study included 31,503 participants in the National Health Interview Survey (NHIS) between 2018 and 2021. Allergies and asthma were defined on an affirmative response in the questionnaire by a parent or guardian. Chi-square tests were used to compare baseline characteristics with allergies and asthma for categorical variables. Differences in prevalence during and before the COVID-19 pandemic were estimated with weighted logistic regression, adjusting for demographic factors. Interaction analyses explored variations across strata.

RESULTS

In US children and adolescents aged 0 to 17, prevalence of any allergy was 26.1% (95% CI, 24.8%- 27.4%) in 2018 and 27.1% (95% CI, 25.9%- 28.2%) in 2021. Thereinto, in 2018, prevalence of respiratory allergies, food allergies and skin allergies were 14.0% (95% CI, 13.1%- 15.0%), 6.5% (95% CI, 5.8%- 7.1%) and 12.6% (95% CI, 11.6%- 13.5%), respectively, and in 2021, 18.8% (95% CI, 17.8%- 19.9%), 5.8% (95% CI, 5.2%- 6.4%) and 10.7% (95% CI, 9.9%- 11.5%), respectively. And prevalence of asthma was 11.1% (95% CI, 10.5%- 11.7%) in 2018-2019 and 9.8% (95% CI, 9.2%- 10.4%) in 2020-2021. Prevalence of respiratory allergies, skin allergies and asthma during and before the COVID-19 pandemic in children and adolescents had statistically significant differences. The differences persisted after adjusting for demographic and socioeconomic variables.

CONCLUSION

Prevalence of respiratory allergies increased and the prevalence of both skin allergies and asthma decreased among US children and adolescents during the COVID-19 pandemic compared with the pre-COVID-19 pandemic. Further research is required to explore the association between allergic diseases and the pandemic, with a particular emphasis on the impact of lifestyle changes resulting from measures to prevent COVID-19 infection.

Bibliometric Mapping of Psychological Flexibility Research: Trends and Future Directions

In this article, we offer an exhaustive analysis of academic work on psychological flexibility using bibliometric techniques. We identify emerging trends in a dataset of 3535 scholarly articles from the Web of Science database. We highlight key publications, map out the field's intellectual framework, and anticipate future research avenues through co-citation and co-word analytics. The co-citation assessment revealed five distinct clusters, while the co-word analysis showed three. Although research regarding psychological flexibility has gained recent popularity, there remains a need for more scholarly initiatives to achieve a nuanced understanding of this subject.

Consumption of illicit drugs and benzodiazepines in six Spanish cities during different periods of the COVID-19 pandemic

Wastewater-based epidemiology (WBE) can provide objective and real time information about the use of addictive substances. A national study was conducted by measuring the most consumed illicit drugs, other drugs whose consumption is not so widespread but has increased significantly in recent years, and benzodiazepines in untreated wastewater from seven wastewater treatment plants (WWTPs) in six Spanish cities. Raw composite wastewater samples were collected from December 2020 to December 2021, a period in which the Spanish and regional governments adopted different restriction measures to contain the spread of the COVID-19 pandemic. Samples were analyzed using a validated analytical methodology for the simultaneous determination of 18 substances, based on solid-phase extraction and liquid-chromatography tandem mass spectrometry. Except for heroin, fentanyl, 6-acetylmorphine and alprazolam, all the compounds were found in at least one city and 9 out of 18 compounds were found in all the samples. In general, the consumption of illicit drugs was particularly high in one of the cities monitored in December 2020, when the restrictions were more severe, especially for cannabis and cocaine with values up to 46 and 6.9 g/day/1000 inhabitants (g/day/1000 inh), respectively. The consumption of MDMA, methamphetamine and mephedrone was notably higher in June 2021, after the end of the state of alarm, in the biggest population investigated in this study. Regarding the use of benzodiazepines, the highest mass loads corresponded to lorazepam. This study demonstrates that WBE is suitable for complementing epidemiological studies about the prevalence of illicit drugs and benzodiazepines during the COVID-19 pandemic restrictions.

Biochemical and Anthropometric Outcomes in Paediatric Patients with Heterozygous Familial Hypercholesterolemia after COVID-19 Pandemic Lockdowns: An Exploratory Analysis

The COVID-19 pandemic lockdowns affected the lifestyles of children and adolescents, leading to an increase in childhood obesity. Paediatric patients with familial hypercholesterolemia (FH) may be more susceptible to lockdown effects due to their increased cardiovascular risk. However, data are lacking. We investigated the effect of lockdowns on the metabolic profile of paediatric patients with FH. Blood lipids and anthropometry measured in September 2021-April 2022 were retrospectively compared with pre-pandemic values. Thirty participants were included (1-16 years; 57% female). From baseline to post-pandemic, median [P25, P75] blood LDL-C concentration was 125 [112, 150] mg/dL vs. 125 [100, 147] mg/dL (p = 0.894); HDL-C was 58 [52, 65] mg/dL vs. 56 [51, 61] mg/dL (p = 0.107); triglycerides were 64 [44, 86] mg/dL vs. 59 [42, 86] mg/dL (p = 0.178). The BMI z-score did not change significantly (0.19 [-0.58, 0.89] vs. 0.30 [-0.48, 1.10], p = 0.524). The lack of deterioration in metabolic profiles during lockdowns is positive, as some deterioration was expected. We speculate that patients and caregivers were successfully educated about healthy lifestyle and dietary habits. Our results should be interpreted with caution since the study sample was small and heterogeneous. Multicentre research is needed to better understand the impact of lockdowns on this population.

Effects of Ayurvedic practices on quality of life of health professionals in Brazil: trends from a quasi experimental study

Integral health encompasses the way individuals live, considering their quality of life. An inadequate lifestyle can harm human health, increasing the risk of developing chronic non-communicable diseases, which represent 71% of the causes of death worldwide and 54.7% in Brazil. The COVID-19 pandemic has led to impacts on quality of life, resulting from lifestyle changes, especially among health professionals. This constitutes an important factor in the health-disease relationship and the core of the healthcare approach embraced by Ayurveda. The present study evaluated the role of daily Ayurvedic practices in improving the quality of life of health professionals working in the Family Health Strategy of SUS in Paty do Alferes/RJ, Brazil. Ayurveda practices based on Trayopastamba were introduced to 30 health professionals through lectures and guided activities from July to October 2021, spanning three months. Quality of life was assessed using the WHOQOL-BREF questionnaire before and after the intervention. An improvement in perceived quality of life was observed in the physical, psychological, and environmental domains (p > 0.05), while the social domain did not show statistically significant results. The physical domain demonstrated the most substantial score increase (10.95). Conversely, the social domain displayed the smallest rise in scores (5.83). In conclusion, the daily Ayurvedic practices demonstrated the potential to enhance the quality of life in this group, contributing to health promotion in a practical and economically accessible manner.

Impact of COVID-19-Induced Academic Stress on Insomnia and Suicidal Ideation among Taiwanese Health Trainees and Junior Doctors

BACKGROUND Clinical training for allied health trainees (AHTs) and postgraduate-year (PGY) doctors needed to go online during the outbreak of coronavirus disease 2019 (COVID-19), which may have caused academic stress and consequent outcomes among this cohort. MATERIAL AND METHODS To evaluate academic-related stress, clinical confidence, psychological distress, and insomnia, an online survey-based study was conducted among Taiwanese AHTs and PGY doctors between July and December, 2022, during the COVID-19 pandemic. The survey included the 21-item Depression, Anxiety, and Stress Scale (DASS-21), the Insomnia Severity Index (ISI), and self-designed questions. It was distributed using convenience sampling and snowball sampling and was completed by 522 participants. RESULTS Structural equational modelling showed that academic stress was negatively associated with clinical confidence (standardized coefficient [ß]=-0.382, p<0.001). Clinical confidence was negatively associated with psychological distress (ß=-0.397, p<0.001), which was associated with insomnia (ß=0.648, p<0.001). Additionally, clinical confidence and psychological distress were the significant mediators. Results indicated that higher academic stress was associated with higher level of insomnia via the mediation of clinical confidence and psychological distress. CONCLUSIONS Academic stress related to changes in clinical training may have led to insomnia among AHTs and PGY doctors during the pandemic. Factors to reduce academic stress should be investigated to promote good mental health while providing sufficient clinical training, especially during events that can cause increased stress (eg, epidemics, pandemics).

Psychological Factors Associated with General Quality of Life in the Context of COVID-19 Pandemic: A Cross-Sectional Study on a Multicultural Sample of Romanian Medical Students

The COVID-19 pandemic had a significant impact on the general quality of life (GQOL) of a large number of individuals, including those in the academic environment. This study investigated GQOL in a sample of 613 Romanian medicine students (81.57% were female; mean age = 21.40 ± 1.749 years) in relation to their Big Five personality characteristics, Perceived Stress and Fear of COVID-19. The study was conducted between June 2020 and March 2022. These variables were investigated with the Big Five Inventory-2: Extra-Short Form, the Fear of COVID-19 Scale (FCV-19S), the Perceived Stress Scale-10 and the Satisfaction with Life Scale (SWLS). Statistical analysis included hierarchical linear regression and t-tests. The results indicated a significant direct relationship between GQOL and the personality traits of Conscientiousness, Extraversion and Agreeableness. However, a significant inverse relationship was observed between GQOL and Perceived Stress and Neuroticism. Fear of COVID-19 was significantly higher in women, while no other socio-demographic variables were associated with GQOL. A total of 61.7% of the studied population returned to their original residency during the pandemic years. These results could be important for better understanding the vulnerability to significant epidemiological events in academic populations and for planning adequate preventive or interventional measures.

The relationship between physical activity and anxiety in college students: exploring the mediating role of lifestyle habits and dietary nutrition

Background

Physical activity has been shown to be effective in treating and improving anxiety in college students. However, no studies have been conducted to examine the relationship between physical activity and anxiety in college students through mediating factors such as dietary nutrition and lifestyle habits. Therefore, the aim of this study was to examine the mediating role of lifestyle and dietary nutrition in the relationship between physical activity and anxiety.

Methods

This study used a stratified random sampling method to survey 498 college students from three universities in Fujian, China. Data on participants' demographic characteristics, physical activity, lifestyle habits, and dietary nutrition were collected and analyzed using SPSS software. The proposed structural equation model was analyzed using Amos software.

Results

The results of the study showed that dietary nutrition and lifestyle habits had significant independent mediating effects and continuous multiple mediating effects (p < 0.01) in the effects of physical activity on college students' anxiety. Dietary nutrition and lifestyle habits played an independent mediating role, accounting for 24.9% of the total effect; there was also a continuous multiple mediating effect between dietary nutrition and lifestyle habits, accounting for 13.27% of the total effect value. In addition, physical activity had a direct effect value on anxiety in college students, accounting for 36.93% of the total effect value.

Conclusion

By increasing the behavior and awareness of college students to participate in physical activity, supplemented by guiding them to develop regular lifestyle habits and correct dietary nutritional patterns, the anxiety level of college students can be effectively improved and reduced. This type of regulation is an important reference for the self-management and rehabilitation of college students with anxiety disorders. Future studies can experimentally develop a combined intervention of physical activity, lifestyle habits, and dietary nutritional to help college students better cope with anxiety.

Self-perception of health and physical activity levels among the youth and adults before and amidst the COVID-19 pandemic

Background

Emerging research indicates that the COVID-19 pandemic and associated restrictions led to decreased physical activity levels and poorer health globally. However, most studies on this topic have focused on advanced countries, leaving a gap in understanding the impact in countries like Ghana. This study aimed to fill this gap by assessing self-perceived health status and physical activity levels among youth and adults in Ghana before, during, and after the COVID-19 restrictions. Understanding these dynamics is crucial for informing public health interventions and policies to promote well-being during and beyond the pandemic.

Methods

A cross-sectional survey using online data collection methods was conducted, involving 937 participants. Data included demographic information, and International Physical Activity Questionnaire-Short Form (IPAQ-SF). Analysis was done using SPSS version 25, with descriptive statistics and multinomial regression.

Results

Most participants (89.6%) reported good health. Male participants were significantly more likely to engage in moderate (1.78 times) and high (3.17 times) physical activity during the COVID-19 period compared to females.

Conclusion

This study highlights gender disparities in physical activity levels during the pandemic in Ghana. Addressing these disparities and promoting healthier lifestyles, especially during crises, is crucial for general and mental health. Further research should explore socio-demographic factors' role in health behaviors during pandemics.

Assessment of lifestyle changes in combating the COVID-19 pandemic among people of Karachi, Pakistan

Aim: COVID-19 arose as a pandemic that wreaked havoc all over the world. Study determines lifestyle changes adopted by people of Karachi in response to COVID-19 pandemic. Methods: This was the cross-sectional study and carried out at public sector hospital and 218 participants were selected through random sampling method. Results: Lifestyle changes a statistically significant difference in nutrition (p = 0.000), physical activity (p = 0.000), workout (p = 0.000), smoking (p = 0.000), sleep hours (p = 0.000), and supplements (p = 0.000) before and during lockdown. Face masks were utilized by 38% of individuals, gloves by 19%, and social isolation was observed by 26%. 11% of participants did not follow any protocols. Conclusion: Study found significant differences in lifestyle habits such as diet, sleep, smoking and physical activity.

Prevalence and correlates of mental disorders among Chinese overseas students during the COVID-19: A multi-regional cross-sectional analysis

BACKGROUND

The global impact of the COVID-19 pandemic extends beyond physical health, significantly affecting mental health. Chinese overseas students are particularly susceptible to the adverse psychological effects of the pandemic. Understanding the prevalence and correlates of mental disorders in this population is essential for developing targeted interventions and support systems.

METHODS

Employing a snowball sampling technique, this study recruited Chinese overseas students from diverse regions. The 50-item Self-evaluation Table was utilized to assess the presence of mental disorders. Descriptive statistics, including percentages, 95% confidence intervals, means, and standard deviations, characterized the survey population. The chi-square test identified disparities among categorical variables, while logistic regression explored risk factors for mental disorders among Chinese overseas students.

RESULTS

Out of the total sample size of 10,864 Chinese overseas students, a staggering 7,090 (65.4%) met the diagnostic criteria for mental disorders. Furthermore, the degree of mental disorder varied significantly across different regions (p < 0.001), education levels (p < 0.05), the duration of anti-epidemic measures (p < 0.05), and age (p < 0.05), while no significant differences were observed in terms of gender (p > 0.05). Several risk factors contributing to the mental disorder burden among Chinese overseas students during the pandemic were identified, including the seriousness of the epidemic in their residential area, the apprehension of getting infected, anxieties regarding academic performance, the infection control policies implemented by the host government, preventive measures taken locally to counter the epidemic, and challenges encountered in returning to their home country.

CONCLUSION

Given the significant challenges in mental health faced by Chinese overseas students during the COVID-19 crisis, addressing their specific needs and implementing tailored measures is imperative. Future public health emergencies should consider the potential mental disorders and disease risks faced by Chinese overseas students. By providing comprehensive support and targeted interventions, policymakers, educational institutions, and healthcare providers can help mitigate the adverse psychological effects and promote the well-being of this vulnerable population.

Wilson Disease and the COVID-19 pandemic: exploring patients' mental health and vaccination attitudes in a longitudinal study

Introduction

The COVID-19 pandemic significantly impacted the mental health of individuals with chronic conditions such as Wilson's Disease (WD). This study investigates stress, anxiety, depression, quality of life, cognitive function, vaccination rates, infection rates, and perceptions related to the pandemic and vaccines among WD patients.

Methods

The study analyzed COVID-19 perceptions and vaccine attitudes of 62 adult WD patients enrolled in the international multisite WD Registry. A subgroup of 33 participants completed a series of mental health scales. The effect of working essentially, income loss, wellness activity initiation, and infection of COVID-19 during the pandemic was observed.

Results

Results indicate that, overall, the pandemic did not exacerbate anxiety or cognitive function in WD patients but did lead to increased depression among essential workers. Patients experiencing income loss exhibited higher levels of stress and anxiety. Despite these challenges, WD patients showed high vaccination rates and positive attitudes towards vaccines.

Discussion

The findings underscore the significant impact of the pandemic on the mental health of WD patients.

Cross-cultural differences in prefrontal cortex activity in moral judgment: A functional near-infrared spectroscopy (fNIRS) study based on the CNI model

BACKGROUND

In the past, comparative cultural neurological studies of moral judgments have mainly focused on Eastern and Western groups. We initially examined Japanese and Chinese groups, both East Asian cultures. We utilized a recently proposed polynomial model known as the "consequences, norms, and generalized inaction" (CNI) model to investigate the variations in the overall prefrontal cortex activity between these two groups during moral judgment.

METHODS

We employed functional near-infrared spectroscopy (fNIRS) to analyze the prefrontal cortex (PFC) activity within a CNI model of moral judgment among 23 healthy Japanese and 26 healthy Chinese adults.

RESULTS AND CONCLUSIONS

Our study revealed significant differences in the PFC activation between Japanese and Chinese individuals in the CNI moral judgment task context. Specifically, during the CNI task, Chinese men exhibited higher right dorsolateral prefrontal cortex (R-DLPFC) activity than Chinese women. In contrast, Japanese women showed greater left dorsolateral prefrontal cortex (L-DLPFC) activity than Japanese men. In an international comparison, R-DLPFC activity was higher in Chinese men than in Japanese men. Conversely, the left ventrolateral prefrontal cortex activity was higher in Japanese men compared to Chinese men. Additionally, among women, the right ventromedial prefrontal cortex activity was higher in Japanese women than in Chinese women. In conclusion, our findings support the perspective of cultural psychology and identify cultural and sex differences in PFC activity between Japanese and Chinese individuals.

Disclosing Strain: How Psychosocial Risk Factors Influence Work-Related Musculoskeletal Disorders in Healthcare Workers Preceding and during the COVID-19 Pandemic

Healthcare workers, particularly nurses, engage in a daily work routine that takes a toll on their emotional well-being, rendering them vulnerable to psychosocial risk factors. This research seeks to analyse the influence of psychosocial risk factors on the occurrence of work-related musculoskeletal disorders among nurses. An additional analysis was performed to understand the role of age in work-related musculoskeletal disorders and the perception of psychosocial risk factors. The study was conducted during two separate periods-pre-pandemic and pandemic times-involving a sample of 456 nurses from both public and private hospitals in Portugal. The INSAT-Health and Work Survey-was used as measuring instrument. The primary observations indicated a consistency between psychosocial risk factors and the occurrence of work-related musculoskeletal disorders. The findings revealed a significant exposure to psychosocial risk factors, with work pace, intensity, work relationships, and emotional demands exhibiting higher global average percentages during both periods, pre-pandemic and pandemic. Nonetheless, we find that the psychosocial risk factors change when we analyse the pre-pandemic and pandemic results. During the period before the pandemic, the psychosocial risk factors that were most commonly reported included the demanding pace of work, long working hours, and emotional demands. Through the pandemic, the most pronounced psychosocial risk factors were work relationships, employment relationships, and ethical and values conflicts. Therefore, research in this domain is essential to understanding psychosocial risk factors and assessing the less obvious links between work and health.

The Padel phenomenon after the COVID-19: an Italian cross-sectional survey of post-lockdown injuries

The impact of COVID-19 on sport and physical activity has been a subject of considerable interest and concern. Padel satisfies the desire for social interaction and a return to sport after a period of inactivity. The aim of this study is to show a correlation between return to sport and related injuries in a population of Padel players. The study was carried out in a survey mode, consisting of a questionnaire with four sections and fifty questions on the biographical data of the individual, lifestyle before and after the pandemic, knowledge and playing level of Padel and injuries. The self-administered online questionnaire was developed and validated by a panel of physiotherapists, orthopaedic surgeons, and physiatrists with experience in clinical practice and/or musculoskeletal research. The study was conducted in a survey mode from a smartphone or computer via a link to a multiple-choice document. The link to the questionnaire was distributed via mailing lists, social media, and chat applications.

Development and validation of the core life activities scale

Life activities profoundly influence well-being, mental health, and quality of life. The COVID-19 pandemic has heightened the importance of monitoring these activities for psychological and emotional health. However, existing measurement tools are limited, particularly for assessing psychological health. To address this gap, we developed and validated the Core Life Activities (CORE) scale, comprising five key factors (sleep, exercise, learning, diet, and social relationships) identified in neuroscience, cognitive psychology, and gerontology. In Study 1 (n = 1,137), exploratory and confirmatory factor analyses supported a single-factor structure with good model fit (χ2 = 6.377, df = 3, TLI = 0.992, CFI = 0.998, RMSEA = 0.031), demonstrating robust internal consistency (Cronbach's alpha = 0.776) and test-retest reliability (intraclass correlation coefficient = 0.522, p < 0.001). The CORE exhibited significant convergent validity with mental health screening tools for depressive and anxiety disorders and suicidality. Study 2 (n = 684) confirmed a significant correlation between CORE and the World Health Organisation Quality of Life Brief Version, complementing the convergent validity found in Study 1. In addition, discriminant validity was confirmed by a non-significant correlation with the COVID-19 Preventive Behavior Scale. The findings establish the CORE as a reliable and valid tool, offering a simple yet comprehensive measure for assessing core life activities with potential applications in diverse environments.

Impact of the COVID-19 pandemic on clinical and psychological aspects of temporomandibular disorders

BACKGROUND

The Coronavirus 2019 disease (COVID-19) caused drastic changes in people's lifestyle that affected TMD characteristics through its physical and psychological influences. The aim of this study was to define the clinical and psychological characteristics of a large group of well-defined TMD patients and seek their differences between before and during the COVID-19 pandemic to establish points of care to be emphasized in the post-pandemic era.

METHODS

TMD patients diagnosed by the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) aged ≥ 18 were analyzed. Samples between September, 2017 to July, 2019 (n = 455) and March, 2021 to June, 2022 (n = 338) were collected to represent before and during COVID-19, respectively. The Graded Chronic Pain Scale (GCPS) and Symptom Checklist-90-Revision (SCL-90-R) were used to evaluate disability levels and psychological status. Clinical indices were compared between COVID periods and factors related to higher pain levels were investigated according to pandemic period.

RESULTS

More patients reported pain on palpation of the masticatory muscles during the pandemic (p = 0.021) while the number decreased for neck muscles (p = 0.001) and TMJ (p < 0.001) areas. Patients reporting nocturnal bruxism (23.3-29.6%) and clenching (45.1-54.7%) significantly increased during the pandemic. TMD patients with pain without disability were more common during the pandemic regardless of pain intensity (p < 0.001). The number of patients expressing interference in daily activities decreased drastically during COVID-19 regardless of disability level (p < 0.001). Factors associated with higher than moderate pain intensity (CPI ≥ 50) were insomnia (odds ratio [OR] = 1.603, p = 0.047) and somatization (OR = 1.082, p < 0.001) before the pandemic. During the pandemic, age (OR = 1.024, p = 0.007), somatization (OR = 1.070, p = 0.006), and paranoid ideation (OR = 1.117, p = 0.003) were significantly associated with higher pain intensity.

CONCLUSIONS

The results of our study underline the importance of evaluating psychological profiles of TMD patients, especially somatization, paranoid ideation and psychoticism, in exceptional situations that may cause a change in individual mental status. This will lead to a better understanding of the individual TMD patient and help in planning personalized treatment strategies that will assist the patient in adjusting to changes occurring in special environments such as the COVID-19 pandemic.

Effects of Gender and Social Network Use on High School Students’ Emotional Well-Being during COVID-19

Various studies conducted during the COVID-19 pandemic have confirmed changes in online behaviour, with young people increasingly using social networks. This trend appears to correlate with a heightened risk of various psychological and emotional problems. The main aim of this study is to explore the patterns of social network use among high school students amidst the pandemic, particularly focusing on the presence of specific emotional problems and potential gender differences. In addition, this study aims to contribute to the existing body of knowledge on the influence of lockdown measures on adolescents. A probabilistic sample of N = 825 students from 20 high schools in Zagreb participated in this study. Alongside basic sociodemographic variables, this study assessed social network habits and emotional problems using the Depression Anxiety Stress Scales 21 (DASS-21). The findings indicate intensive social media engagement during the pandemic. The results of the MANOVA analysis (gender x daily time on social media) show significant effects of both the time spent on social networks and gender on mental health, while no interaction effect was observed. Female students and those who spend more time on social media have higher levels of depression, anxiety, and stress symptoms. These findings underscore the need for addressing emotional problems and habits in the virtual environment of high school students and implementing appropriate preventive and treatment interventions.

Sex Differences in Clustering Unhealthy Lifestyles Among Survivors of COVID-19: Latent Class Analysis

BACKGROUND

The COVID-19 pandemic has underscored the significance of adopting healthy lifestyles to mitigate the risk of severe outcomes and long-term consequences.

OBJECTIVE

This study focuses on assessing the prevalence and clustering of 5 unhealthy lifestyle behaviors among Vietnamese adults after recovering from COVID-19, with a specific emphasis on sex differences.

METHODS

The cross-sectional data of 5890 survivors of COVID-19 in Vietnam were analyzed from December 2021 to October 2022. To examine the sex differences in 5 unhealthy lifestyle behaviors (smoking, drinking, unhealthy diet, physical inactivity, and sedentary behavior), the percentages were plotted along with their corresponding 95% CI for each behavior. Latent class analysis was used to identify 2 distinct classes of individuals based on the clustering of these behaviors: the "less unhealthy" group and the "more unhealthy" group. We examined the sociodemographic characteristics associated with each identified class and used logistic regression to investigate the factors related to the "more unhealthy" group.

RESULTS

The majority of individuals (male participants: 2432/2447, 99.4% and female participants: 3411/3443, 99.1%) exhibited at least 1 unhealthy behavior, with male participants being more susceptible to multiple unhealthy behaviors. The male-to-female ratio for having a single behavior was 1.003, but it escalated to 25 for individuals displaying all 5 behaviors. Male participants demonstrated a higher prevalence of combining alcohol intake with sedentary behavior (949/2447, 38.8%) or an unhealthy diet (861/2447, 35.2%), whereas female participants tended to exhibit physical inactivity combined with sedentary behavior (1305/3443, 37.9%) or an unhealthy diet (1260/3443, 36.6%). Married male participants had increased odds of falling into the "more unhealthy" group compared to their single counterparts (odds ratio [OR] 1.45, 95% CI 1.14-1.85), while female participants exhibited lower odds (OR 0.65, 95% CI 0.51-0.83). Female participants who are underweight showed a higher likelihood of belonging to the "more unhealthy" group (OR 1.11, 95% CI 0.89-1.39), but this was not observed among male participants (OR 0.6, 95% CI 0.41-0.89). In both sexes, older age, dependent employment, high education, and obesity were associated with higher odds of being in the "more unhealthy" group.

CONCLUSIONS

The study identified notable sex differences in unhealthy lifestyle behaviors among survivors of COVID-19. Male survivors are more likely to engage in unhealthy behaviors compared to female survivors. These findings emphasize the importance of tailored public health interventions targeting sex-specific unhealthy behaviors. Specifically, addressing unhealthy habits is crucial for promoting post-COVID-19 health and well-being.

Social Isolation, Brain Food Cue Processing, Eating Behaviors, and Mental Health Symptoms

Importance

Perceived social isolation is associated with negative health outcomes, including increased risk for altered eating behaviors, obesity, and psychological symptoms. However, the underlying neural mechanisms of these pathways are unknown.

Objective

To investigate the association of perceived social isolation with brain reactivity to food cues, altered eating behaviors, obesity, and mental health symptoms.

Design, Setting, and Participants

This cross-sectional, single-center study recruited healthy, premenopausal female participants from the Los Angeles, California, community from September 7, 2021, through February 27, 2023.

Exposure

Participants underwent functional magnetic resonance imaging while performing a food cue viewing task.

Main Outcomes and Measures

The main outcomes included brain reactivity to food cues, body composition, self-reported eating behaviors (food cravings, reward-based eating, food addiction, and maladaptive eating behaviors), and mental health symptoms (anxiety, depression, positive and negative affect, and psychological resilience).

Results

The study included 93 participants (mean [SD] age, 25.38 [7.07] years). Participants with higher perceived social isolation reported higher fat mass percentage, lower diet quality, increased maladaptive eating behaviors (cravings, reward-based eating, uncontrolled eating, and food addiction), and poor mental health (anxiety, depression, and psychological resilience). In whole-brain comparisons, the higher social isolation group showed altered brain reactivity to food cues in regions of the default mode, executive control, and visual attention networks. Isolation-related neural changes in response to sweet foods correlated with various altered eating behaviors and psychological symptoms. These altered brain responses mediated the connection between social isolation and maladaptive eating behaviors (β for indirect effect, 0.111; 95% CI, 0.013-0.210; P = .03), increased body fat composition (β, -0.141; 95% CI, -0.260 to -0.021; P = .02), and diminished positive affect (β, -0.089; 95% CI, -0.188 to 0.011; P = .09).

Conclusions and Relevance

These findings suggest that social isolation is associated with altered neural reactivity to food cues within specific brain regions responsible for processing internal appetite-related states and compromised executive control and attentional bias and motivation toward external food cues. These neural responses toward specific foods were associated with an increased risk for higher body fat composition, worsened maladaptive eating behaviors, and compromised mental health. These findings underscore the need for holistic mind-body-directed interventions that may mitigate the adverse health consequences of social isolation.

An Importance-Performance Analysis of Korean Middle School Students' Health Management Awareness during the Post-COVID-19 Era Depending on Sex

This study aimed to conduct importance-performance analyses (IPAs) based on Korean middle school students' health management awareness during the post-coronavirus disease 2019 (COVID-19) era. Data were collected from 867 Korean middle school students (13-15 years old) via online and offline surveys between May and June 2023. Frequency analysis, reliability analysis, IPA based on the entire student group, and IPA depending on sex were carried out with the collected data, which revealed the following. First, regardless of sex, the IPA results indicated that four factors of mental health were located in the third quadrant, with one factor of the same variable in the fourth quadrant. The three factors of disease management were located in the third quadrant. Regarding physical activity, two factors were located in the first quadrant, one in the second quadrant, and one in the third quadrant. Regarding sleep management, two factors were located in the second quadrant, one in the third quadrant, and one in the first quadrant. Regarding eating management, two factors were located in the third quadrant and one in the fourth quadrant. Regarding the social distancing variable, all four factors were located in the third quadrant. Regarding hygiene management, two factors were located in the first quadrant, one in the third quadrant, and one in the fourth quadrant. Furthermore, the IPA results indicated sex differences in regular sports and vigorous movement activities associated with physical activity. Additionally, a sex difference was observed in regular diet associated with eating management. This study proposed possible measures for encouraging middle school students to recognize the importance of health and increase their health-related performance during the COVID-19 endemic phase.

Evolution of the profiles of new psychotropic drug users before and during the COVID-19 crisis: an original longitudinal approach through multichannel sequence analysis using the French health-care database

The COVID-19 pandemic has had a substantial impact on mental health. An increase in the use of anxiolytic, hypnotic, and antidepressant drugs has been highlighted in France, but with no information at the individual level (trajectories) or concerning patient characteristics. The objective of this study was to describe the profile of new psychotropic drug users since the beginning of the pandemic. We formed two historical cohorts using the Pays-de-la-Loire regional component of the National Health Data System (SNDS): a "COVID-19 crisis cohort" (2020-2021) and a "control cohort" (2018-2019). We analyzed reimbursements for psychotropic medications (anxiolytics, antidepressants, hypnotics, mood stabilizers, and antipsychotics) using a multichannel sequence analysis and performed clustering analysis of sequences. The proportion of new consumers of psychotropic drugs was higher in the COVID-19 crisis cohort (18.0%) than that in the control cohort (16.0%). In the COVID-19 cohort, three clusters of psychotropic drug users were identified, whereas four clusters were identified in the control cohort. A time lag in treatment initiation was observed in the COVID-19 crisis cohort (September) compared with the control cohort (July). This study is one of the first to analyze the profile of psychotropic treatment users during the COVID-19 crisis. Our analysis sheds light on changes in patterns of psychotropic drug use during the COVID-19 pandemic, possibly associated with changes in prescribing conditions and mental health conditions during the crisis. This study also provides an example of the application of an innovative longitudinal analysis methodology in the field of pharmacoepidemiology.

Quality of Life and Emotional Problems of COVID-19 Patients after Discharge: A One-Month Longitudinal Study

AIM

The first coronavirus disease 2019 (COVID-19) outbreak in Taiwan occurred in May 2021 and many individuals were infected. All COVID-19 patients were quarantined in designated facilities until they fully recovered to prevent the spread of the disease. Prolonged quarantine could adversely affect these patients. In this study, we focused on investigating changes in the quality of life and mental health of individuals discharged from hospital after recovering from COVID-19.

METHODS

This study employed a longitudinal design and surveyed individuals discharged from a teaching hospital in northern Taiwan in 2021 within one week of their discharge and again after one month. An online questionnaire comprising the participants' background, respiratory function (COPD Assessment Test), quality of life (WHOQoL-BREF), and emotional problems (DASS-21) was administered to the participants.

RESULTS

A total of 56 participants actively took part in both surveys. We observed that participants with abnormal respiratory function had a lower physical and psychological quality of life, especially those with severe symptoms requiring endotracheal intubation during the treatment period of COVID-19. Additionally, approximately 30% of participants experienced anxiety problems throughout this study period. Finally, patients with COVID-19 symptoms exhibited a lower quality of life and higher levels of severe emotional problems.

CONCLUSIONS

According to our findings, it is necessary to monitor and provide appropriate interventions for individuals who have recovered from COVID-19, especially those who experienced severe symptoms that required endotracheal intubation during COVID-19 treatment. These interventions, such as symptom management and psychological support, can help improve their quality of life and reduce emotional problems. Therefore, after the participants are discharged, hospitals should regularly track the patients' status and provide appropriate support or referrals to help these individuals. Otherwise, future research could include more participants and follow up with them for longer to investigate the longitudinal impact of COVID-19.

Exercising healthy behaviors: A latent class analysis of positive coping during the COVID-19 pandemic and associations with alcohol-related and mental health outcomes

OBJECTIVE

To identify latent classes of positive coping behaviors during the COVID-19 pandemic and examine associations with alcohol-related and mental health outcomes across participants with and without a history of alcohol use disorder (AUD).

METHODS

Baseline data from 463 participants who were enrolled in the NIAAA COVID-19 Pandemic Impact on Alcohol (C19-PIA) Study were analyzed. Latent class analysis (LCA) was applied to five positive coping behaviors during COVID-19: taking media breaks, taking care of their body, engaging in healthy behaviors, making time to relax, and connecting with others. Latent class differences and the moderating role of history of AUD on six alcohol-related and mental health outcomes were examined using multiple regression models.

RESULTS

LCA revealed two latent classes: 83.4% High Positive Coping and 16.6% Low Positive Coping. Low Positive Coping was associated with higher levels of perceived stress, anxiety symptoms, and loneliness. A history of AUD was consistently associated with higher levels of alcohol-related and mental health outcomes. Significant interactions between Coping Latent Classes and history of AUD indicated that the associations of Low Positive Coping with problematic alcohol use, depressive symptoms, and drinking to cope motives were either stronger or only significant among individuals with a history of AUD.

CONCLUSIONS

Individuals with a history of AUD may be particularly vulnerable to depressive symptoms and alcohol-related outcomes, especially when they do not utilize positive coping strategies. The promotion of positive coping strategies is a promising avenue to address alcohol-related and mental health problems during a public health crisis and warrants future research.

Have Incidence and Severity of Craniomaxillofacial Fractures Changed Since SARS-CoV-2?

BACKGROUND

An increase in severity and a decrease in incidence of craniomaxillofacial fractures (CMFs) were identified during the first several months of the SARS-CoV-2 pandemic. It is unclear if these changes have persisted in the current timeframe.

PURPOSE

The investigators hypothesize that the incidence and severity of CMF will not return to baseline prepandemic (control) levels as the pandemic stabilizes and becomes endemic.

STUDY DESIGN, SETTING, SAMPLE

This retrospective cohort study enrolled subjects who presented to Harborview Medical Center a Level 1 trauma center for the evaluation and management of CMF. Inclusion criteria were 1) Presentation timeline 2018 through 2022, 2) CMF identified by the 10th International Classification of Disease. Exclusion criteria were: 1) Undocumented etiology of facial fracture and 2) inadequate/unclear documentation otherwise.

PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE

The predictor variable was year of injury relating to the start of the pandemic. The groups were the prepandemic (2018, 2019) and postpandemic (2020, 2021. 2022).

MAIN OUTCOME VARIABLES

The primary outcome variable was the CMF diagnosis identified using the corresponding International Classification of Disease, 10th Edition codes. The secondary outcome variables were mechanism of injury and injury severity.

COVARIATES

The covariates were age, sex, race/ethnicity, admission status, alcohol intoxication, toxicology screen, reimbursement source, abuse reported, and abuse investigated.

ANALYSES

Univariate and bivariate analyses were performed with statistical significance at P < .05.

RESULTS

The sample was composed of 5203 subjects. The annual volumes of subjects presenting with CMF were consistent over the study period (2018, 2019, 2020, 2021, 2022 n = 1018, 963, 1020, 1062, 1140, respectively). The incidence of Hispanics increased (2018, 2019, 2020, 2021, 2022: 11.1, 9.6, 12.2, 13.9, 13.2% (P < .05)) as did firearm CMF injuries (2018, 2019, 2020, 2021, 2022: 4.13, 4.98, 4.71, 7.16, 6.75% (P < .05)). The Injury Severity Score and Abbreviated Injury Scale were both lower postpandemic compared to prepandemic; mean Injury Severity Score post [18.27 ± 12.46] versus pre [19.25 ± 12.89] (P < .05), mean Abbreviated Injury Scale post [2.94 ± 1.15] versus pre [3.04 ± 1.14] (P < .05).

CONCLUSIONS AND RELEVANCE

While the severity of CMF decreased postpandemic, Hispanic and firearm CMF increased. The overall CMF incidence remained the same. The significant rise in firearm injuries warrants further study.

Using the life course health development model to address pediatric mental health disparities

TOPIC

Early-life experiences, the transmission of health and disease within families, and the influence of cumulative risks as well as protective factors throughout life shape the trajectory of health, including mental health. Long-term health trajectories established early in life are influenced by biologic, social, and environmental factors. Negative trajectories may be more salient if exposures to adversity occur during critical developmental periods.

PURPOSE

The purpose of this brief is to (a) review pediatric health disparities related to depression and the intergenerational transmission of pediatric depression using a Life Course Health Development (LCHD) model and (b) provide recommendations for pediatric mental health research.

SOURCES

Peer-reviewed papers available for PubMed, CINAL, and Medline. Other sources include published books, papers, and gray materials.

CONCLUSIONS

The LCHD model is a perspective to guide and foster new scientific inquiry about the development of mental health outcomes over the life course. The model enables synthesis of mental health, nursing, and public health, linking mental health prevention, risk reduction, and treatment in children.

Australian adults cooked more and tried new recipes during COVID-19 restrictions and lockdowns

The lockdowns and restrictions due to COVID-19 caused changes in both food accessibility and availability for people around the globe resulting in changes in food habits and behaviours. To enable a better public health response to the next pandemic, lessons must be learnt from this most recent emergency. This study aimed to examine self-reported changes in food habits and behaviours, of Australian adults during COVID-19 restrictions in 2020. A cross-sectional, convenience, Australia-wide survey, with open-ended and closed-ended questions was conducted online. Respondents were asked to report their demographic characteristics, positive food habit development, worst food-related experiences, changes in food habits and behaviours and cooking and food preparation practices during the COVID-19 restriction period. Adult Australian residents, recruited through social media advertising of the survey. Respondents (n = 764) were mostly female (86%), over 55 years of age (57%, mean age (SD) 53.4 (18.1) years), and half (51%) were not in paid employment. Nearly two-thirds (63%) developed positive food habits, including trying new recipes (54%), eating less take-away (53%) and cooking from scratch (46%) during the COVID-19 restrictions. Furthermore, respondents reported including family members in food preparation and eating together as a family. Negative experiences included being unable to buy certain foods (due to lack of stock and store limits), cooking at home, and being unable to access some food outlets. Australians experienced both positive and negative food experiences during the COVID-19 pandemic and associated lockdown periods, with most experiencing positive changes such as cooking at home from scratch and trying new recipes and relying on less take-away. Females and those who experienced a change in employment status were more likely to develop positive new food habits.

How Did Breast Cancer Patients Fare during Different Phases of the COVID-19 Pandemic in Norway Compared to Age-Matched Controls?

Little is known about how health-related quality of life (HRQoL) in breast cancer cases differed from that of controls during and after the COVID-19 pandemic. This study used data from an ongoing, nationwide HRQoL survey of 4279 newly diagnosed breast cancer cases and 2911 controls to investigate how breast cancer patients fared during different phases of the pandemic compared to controls. Responders during 2020-2022 were categorized into three COVID-19-related phases: the social restrictions phase, the high infection rate phase, and the post-pandemic phase. Across phases, breast cancer cases had significantly worse scores in most HRQoL domains compared to controls. Apart from slightly more insomnia in the high infection rate phase for both cases and controls, and better social functioning for young cases in the post-COVID-19 phase, the case-control differences in HRQoL remained consistent across phases. When the phases were assessed as one period, young women and those living with children <18 years of age fared the worst among breast cancer cases, while single women fared the worst among controls. In contrast, controls living with children <18 years of age exhibited better HRQoL than controls without children. In summary, women with breast cancer did not appear to fare differently than controls in terms of HRQoL across COVID-19 phases. However, breast cancer cases with young children fared worse in their HRQoL than other breast cancer cases.

Smartphone-delivered multicomponent lifestyle medicine intervention for improving mental health in a nonclinical population: a randomized controlled trial

Objective

To prevent the exacerbation of mental health burdens, a growing body of research has recommended a balanced approach that emphasizes both the delivery of mental health treatments to individuals with common mental disorders (CMDs) and the strengthening of protective factors for CMDs among nonclinical populations. This randomized controlled trial (RCT) evaluated the efficacy of a smartphone-delivered multicomponent lifestyle medicine (LM) intervention, Lifestyle Hub, for improving mental health among a nonclinical population of Chinese adults.

Methods

A total of 106 participants with Patient Health Questionnaire-9 total score < 10 and Generalized Anxiety Disorder 7-Item Scale <8 were randomly assigned to either the Lifestyle Hub intervention group (LH, n = 53) or the waitlist control group (WL, n = 53). Lifestyle Hub is an 8-week smartphone-delivered multicomponent LM intervention developed based on the transtheoretical model. The intervention components included lifestyle psychoeducation, physical activity, diet and nutrition, stress management, sleep management, and motivation and goal-setting techniques. Assessments were conducted at baseline, immediate post-intervention, and 1-month follow-up (LH only).

Results

The linear mixed effect model based on the intention-to-treat principle indicated that Lifestyle Hub significantly improved overall mental health, depressive symptoms, anxiety symptoms, stress, insomnia severity, overall health-promoting behaviors, dietary quality, and stress management compared to the WL group at immediate post-intervention (d = 0.13-0.56). No significant between-group differences were observed in terms of functional impairment, health-related quality of life, health responsibility, physical activity level, spiritual growth, and interpersonal relations. The intervention gains in the LH group were maintained at 1-month follow-up. The LH participants indicated that Lifestyle Hub was an acceptable intervention for improving mental health, although a significantly higher level of study attrition was observed in the LH group (20.8%) relative to the WL group (5.7%).

Conclusion

Lifestyle Hub may serve as an efficacious and acceptable intervention for improving mental health in nonclinical adult populations. To extend the benefits of LM interventions at the population level, future studies are warranted to examine a stepped-care approach to delivering LM interventions.Trial registration: This randomized controlled trial was pre-registered with ClinicalTrials.gov (NCT04295369).