The long-term effects of consecutive COVID-19 waves on mental health

BACKGROUND

Although several studies have documented the impact of the COVID-19 pandemic on mental health, the long-term effects remain unclear.

AIMS

To examine longitudinal changes in mental health before and during the consecutive COVID-19 waves in a well-established probability sample.

METHOD

An online survey was completed by the participants of the COVID-19 add-on study at four time points: pre-COVID-19 period (2014-2015, n = 1823), first COVID-19 wave (April to May 2020, n = 788), second COVID-19 wave (August to October 2020, n = 532) and third COVID-19 wave (March to April 2021, n = 383). Data were collected via a set of validated instruments, and analysed with latent growth models.

RESULTS

During the pandemic, we observed a significant increase in stress levels (standardised β = 0.473, P < 0.001) and depressive symptoms (standardised β = 1.284, P < 0.001). The rate of increase in depressive symptoms (std. covariance = 0.784, P = 0.014), but not in stress levels (std. covariance = 0.057, P = 0.743), was associated with the pre-pandemic mental health status of the participants. Further analysis showed that secondary stressors played a predominant role in the increase in mental health difficulties. The main secondary stressors were loneliness, negative emotionality associated with the perception of COVID-19 disease, lack of resilience, female gender and younger age.

CONCLUSIONS

The surge in stress levels and depressive symptoms persisted across all three consecutive COVID-19 waves. This persistence is attributable to the effects of secondary stressors, and particularly to the status of mental health before the COVID-19 pandemic. Our findings reveal mechanisms underlying the surge in mental health difficulties during the COVID-19 waves, with direct implications for strategies promoting mental health during pandemics.

Pharmacogenomic profile of a central European urban random population-Czech population

The genetic basis of variability in drug response is at the core of pharmacogenomics (PGx) studies, aiming at reducing adverse drug reaction (ADR), which have interethnic variability. This study used the Kardiovize Brno 2030 random urban Czech sample population to analyze polymorphisms in a wide spectrum of genes coding for liver enzymes involved in drug metabolism. We aimed at correlating real life drug consumption with pharmacogenomic profile, and at comparing these data with the SUPER-Finland Finnish PGx database. A total of 250 individuals representative of the Kardiovize Brno 2030 cohort were included in an observational study. Blood DNA was extracted and 59 single nucleotide polymorphisms within 13 genes (BCHE, CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A5, F2, F5, IFNL3, SLCO1B1, TPMT, UGT1A1, VKORC1), associated to different drug metabolizing rates, were characterized by genotyping using a genome wide commercial array. Widely used drugs such as anti-coagulant warfarin and lipid lowering agent atorvastatin were associated to an alarmingly high percentage of users with intermediate/poor metabolism for them. Significant differences in the frequency of normal/intermediate/poor/ultrarapid/rapid metabolizers were observed for CYPD26 (p<0.001), CYP2C19 (p<0.001) and UGT1A1 (p<0.001) between the Czech and the Finnish study populations. Our study demonstrated that administration of some popular drugs to a Czech random sample population is associated with different drug metabolizing rates and therefore exposing to risk for ADRs. We also highlight interethnic differentiation of some common pharmacogenetics variants between Central (Czech) and North European (Finnish) population studies, suggesting the utility of PGx-informed prescription based on variant genotyping.

Health literacy in phases of health information processing in the Czech population

Background

Low level of health literacy (HL), defined as an individual's ability to process health information, is strongly associated with higher mortality and morbidity. In earlier analysis of cross-sectional survey in Czechia in 2014, 59% of subjects showed a low level of HL, with particularly worrying results in area of health promotion (64% with low levels of HL). The levels of HL in phases of health information processing, however, were not included.

Aim

To describe the level of HL in phases of obtaining, understanding, evaluating, and applying health information, and to assess social determinants of HL in these phases.

Methods

18 to 65 years old subjects from a random population-based Czech sample from 2014 were evaluated using a cross-sectional design. The level of HL was determined by Health Literacy Index (HLI, range 0-50). A low level of HL was defined as HLI &lt;33. Logistic regression was used to assess the association between a low level of HL and social status.

Results

In total, 996 participants (51% females) were included. The prevalence of low level of HL was 64% in obtaining, 56% in understanding, 70% in evaluating and 64% in applying. A low level of HL was associated with a low perceived social status in all phases of information processing even after adjustment for age, gender, education, self-reported health condition, physical activity, BMI and smoking status (ORs 3.2, 2.0, 3.4 and 2.8, respectively, for obtaining, understanding, evaluating and applying, all p-values&lt;0.05).

Conclusions

People with lower social status have a higher risk of a low level of HL in all phases, with the highest risk in the phase of health information evaluation which was determined as the most problematic. Further intervention should aim to support individual skills in decision making and actions in fields of healthcare, disease prevention, and health promotion including the availability of relevant understandable information for all social groups in the population.

Key messages

The most problematic area of health literacy is health information evaluation. People with lower social status have a higher risk of a low level of health literacy.

Risk Factors Underlying COVID-19 Lockdown-Induced Mental Distress

Recent reports suggest that the COVID-19 lockdown resulted in changes in mental health, however, potential age-related changes and risk factors remain unknown. We measured COVID-19 lockdown-induced stress levels and the severity of depressive symptoms prior to and during the COVID-19 lockdown in different age groups and then searched for potential risk factors in a well-characterized general population-based sample. A total of 715 participants were tested for mental distress and related risk factors at two time-points, baseline testing prior to COVID-19 and follow-up testing during COVID-19, using a battery of validated psychological tests including the Perceived Stress Scale and the Patient Health Questionnaire. Longitudinal measurements revealed that the prevalence of moderate to high stress and the severity of depressive symptoms increased 1.4- and 5.5-fold, respectively, during the COVID-19 lockdown. This surge in mental distress was more severe in women, but was present in all age groups with the older age group exhibiting, cross-sectionally, the lowest levels of mental distress prior to and during the lockdown. Illness perception, personality characteristics such as a feeling of loneliness, and several lifestyle components were found to be associated with a significant increase in mental distress. The observed changes in mental health and the identified potential risk factors underlying these changes provide critical data justifying timely and public emergency-tailored preventive, diagnostic, and therapeutic mental health interventions, which should be integrated into future public health policies globally.