Findings from an online survey on the mental health effects of COVID-19 on Canadians with disabilities and chronic health conditions

BackgroundAlthough the COVID-19 pandemic has led to worsening mental health outcomes throughout the Canadian population, its effects have been more acute among already marginalized groups, including people with disabilities and chronic health conditions. This paper examines how heightened fears of contracting the virus, financial impacts, and social isolation contribute to declining mental health among this already vulnerable group.Objective/hypothesisThis paper investigates how increases in anxiety, stress, and despair are associated with concerns about getting infected, COVID-19-induced financial hardship, and increased social isolation as a result of adhering to protective measures among people with disabilities and chronic health conditions.MethodsThis study uses original national quota-based online survey data (n = 1027) collected in June 2020 from people with disabilities and chronic health conditions. Three logistic regression models investigate the relationship between COVID-19’s effects on finances, concerns about contracting the virus, changes in loneliness and belonging, and measures taken to combat the spread of COVID-19 and reports of increased anxiety, stress, and despair, net of covariates.ResultsModels show that increased anxiety, stress, and despair were associated with negative financial effects of COVID-19, greater concerns about contracting COVID-19, increased loneliness, and decreased feelings of belonging. Net of other covariates, increased measures taken to combat COVID-19 was not significantly associated with mental health outcomes.ConclusionsFindings address how the global health crisis is contributing to declining mental health status through heightened concerns over contracting the virus, increases in economic insecurity, and growing social isolation, speaking to how health pandemics exacerbate health inequalities.     

Economic Hardships and Self-reported Deterioration of Physical and Mental Health Under the COVID-19 Pandemic: A Cross-sectional Study, 2020, Japan

BackgroundCoronavirus disease 2019 (COVID-19) has disproportionately affected the most vulnerable populations. We assessed the prevalence and disparities of economic hardships and their impact on health deterioration in Japan.MethodsData were obtained from a nation-wide, cross-sectional, internet-based, self-reported survey conducted during August–September, 2020 with individuals aged 15–79 years in Japan (n = 25,482). Economic hardships and changes in various physical and mental health status were measured using sample-weighted data. Adjusted prevalence ratios (APRs) were estimated to investigate the associations between economic hardships and health outcomes.ResultsDuring April–September, 2020 in Japan, 25.0%, 9.6%, 7.9%, and 3.1% of the respondents experienced income loss, money shortage, financial anxiety and financial exploitation, respectively, with higher prevalence among workers (vs non-workers). Stratifying by sex and working status, income loss was associated with physical health deterioration (APRs ranged from 1.45–1.95), mental health deterioration (APRs ranged from 1.47–1.68), and having serious psychological distress (APRs ranged from 1.41–2.01) across all strata. Shortage of money and financial anxiety were also associated with increased likelihood of all adverse health outcomes assessed, regardless of whether the hardships were pre-existing or experienced first time. Among non-working individuals, financial exploitation was associated with physical health deterioration among males (APR 1.88) and mental health deterioration among both males (APR 1.80) and females (APR 2.23), while such associations were not observed among working individuals.ConclusionsDuring the early phase of the COVID-19 epidemic, COVID-19-related economic hardships were associated with physical and mental health deterioration in Japan, particularly among the vulnerable populations. Timely and prompt responses are warranted to mitigate both economic and health burdens.Key words: mental health, self-rated health, health disparities, social determinants of health     

COVID-19 News and Its Association With the Mental Health of Sexual and Gender Minority Adults: Cross-sectional Study

BackgroundSexual and gender minority (SGM; people whose sexual orientation is not heterosexual or whose gender identity varies from what is traditionally associated with the sex assigned to them at birth) people experience high rates of trauma and substantial disparities in anxiety and posttraumatic stress disorder (PTSD). Exposure to traumatic stressors such as news related to COVID-19 may be associated with symptoms of anxiety and PTSD.ObjectiveThis study aims to evaluate the relationship of COVID-19 news exposure with anxiety and PTSD symptoms in a sample of SGM adults in the United States.MethodsData were collected between March 23 and August 2, 2020, from The PRIDE Study, a national longitudinal cohort study of SGM people. Regression analyses were used to analyze the relationship between self-reported news exposure and symptoms of anxiety using the Generalized Anxiety Disorder-7 and symptoms of COVID-19–related PTSD using the Impact of Events Scale-Revised.ResultsOur sample included a total of 3079 SGM participants. Each unit increase in COVID-19–related news exposure was associated with greater anxiety symptoms (odds ratio 1.77, 95% CI 1.63-1.93; P<.001) and 1.93 greater odds of PTSD (95% CI 1.74-2.14; P<.001).ConclusionsOur study found that COVID-19 news exposure was positively associated with greater symptoms of anxiety and PTSD among SGM people. This supports previous literature in other populations where greater news exposure was associated with poorer mental health. Further research is needed to determine the direction of this relationship and to evaluate for differences among SGM subgroups with multiple marginalized identities.     

A Wake-up Call for Burnout in Portuguese Physicians During the COVID-19 Outbreak: National Survey Study

BackgroundThe COVID-19 outbreak has imposed physical and psychological pressure on health care professionals, including frontline physicians. Hence, evaluating the mental health status of physicians during the current pandemic is important to define future preventive guidelines among health care stakeholders.ObjectiveIn this study, we intended to study alterations in the mental health status of Portuguese physicians working at the frontline during the COVID-19 pandemic and potential sociodemographic factors influencing their mental health status.MethodsA nationwide survey was conducted during May 4-25, 2020, to infer differences in mental health status (depression, anxiety, stress, and obsessive compulsive symptoms) between Portuguese physicians working at the frontline during the COVID-19 pandemic and other nonfrontline physicians. A representative sample of 420 participants stratified by age, sex, and the geographic region was analyzed (200 frontline and 220 nonfrontline participants). Moreover, we explored the influence of several sociodemographic factors on mental health variables including age, sex, living conditions, and household composition.ResultsOur results show that being female (β=1.1; t=2.5; P=.01) and working at the frontline (β=1.4; t=2.9; P=.004) are potential risk factors for stress. In contrast, having a house with green space was a potentially beneficial factor for stress (β=–1.5; t=–2.5; P=.01) and anxiety (β=–1.1; t=–2.4; P=.02).ConclusionsIt is important to apply protective mental health measures for physicians to avoid the long-term effects of stress, such as burnout.     

The deterioration of mental health among healthcare workers during the COVID-19 outbreak: A population-based cohort study of workers in Japan

Objectives:This study compared the longitudinal change in the mental health of healthcare and non-healthcare workers during two months of the COVID-19 outbreak in Japan.Methods:Data were derived from a prospective online cohort study of 1448 full-time employees in Japan. Participants were surveyed at baseline from 19–22 March 2020 (T1) and at follow-up from 22–26 May 2020 (T2). A self-administered online questionnaire was used to assess participants’ fear and worry of COVID-19, psychological distress, and physical symptoms at T1 and T2. A series of generalized linear models were created to assess changes in outcomes between healthcare and non-healthcare workers. Demographic variables (ie, sex, age, marital status, child[ren], education, and residential area) were included in the models as covariates.Results:A total of 1032 participants completed the follow-up questionnaire at T2 (follow-up rate, 72.6%). After excluding unemployed respondents (N=17), the final sample comprised 1015 full-time employees (111 healthcare and 904 non-healthcare workers). After adjusting for the covariates, psychological distress (and subscales of fatigue, anxiety, and depression) as well as fear and worry of COVID-19 increased statistically significantly more among healthcare than non-healthcare workers from T1 to T2.Conclusions:Psychological distress, together with fear and worry of COVID-19, increased more among healthcare compared to non-healthcare workers during the COVID-19 outbreak. The study confirmed that healthcare workers are an important target for mental healthcare during the COVID-19 outbreak.     

“My problems aren't severe enough to seek help”: Stress levels and use of mental health supports by Canadian hospital employees during the COVID-19 pandemic

Due to the unique set of stressors associated with the COVID-19 pandemic, healthcare workers in acute care settings may be facing elevated rates of mental health symptomatology. The purpose of this study was to assess levels of depression, anxiety, and stress in a sample of healthcare employees working in hospitals and their use of formal and informal mental health supports. Data was gathered over a three-week period in December 2020 as COVID cases began to rise sharply in Ontario, Canada. Results from an online survey of 650 healthcare employees suggested that overall levels of depression, anxiety, and stress were mild. However, a significant minority of participants reported severe or extremely severe levels of depression (14.4%), anxiety (21.8%), and stress (13.5%). Levels of distress were higher among women, younger participants, those who did not work directly with COVID+ patients, and those who were redeployed. Use of formal mental health supports (e.g., Employee Assistance Plans, teletherapy) was very low (<10%), with the most frequently-reported reason for not using supports being “problems not severe enough to require this service”. Implications are considered for healthcare policy decisions as hospital systems attempt to address the mental health needs of their employees.     

新型冠状病毒肺炎隔离病房护士与普通护士心理状态差异及影响因素分析

目的 比较在新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)隔离病房工作的护士与在普通门诊或病房工作的护士之间的心理健康状况差异,为开展更具针对性的护理人员心理健康促进工作,提高疫情期间各类护理人员的心理健康水平提供科学参考.方法 运用方便取样及在线问卷答题方式,通过健康问卷抑郁症...     

Adolescents' Perceived Socio-Emotional Impact of COVID-19 and Implications for Mental Health: Results From a U.S.-Based Mixed-Methods Study

PurposeCOVID-19 has disrupted many aspects of adolescents' lives, yet little data are available that document their subjective experiences of the pandemic. In a mixed-methods study of U.S. adolescents, we examined (1) adolescents' perceptions of how their social and emotional lives had changed during COVID-19; and (2) associations between these perceived changes and indices of their mental health, above and beyond their prepandemic mental health status.MethodsFour hundred seven U.S. adolescents (M_age = 15.24, standard deviation = 1.69; 50% female; 52%, 20% African American, 17% Hispanic/Latinx) completed surveys before (October 2019) and during (April 2020) the COVID-19 pandemic. They provided qualitative and quantitative responses on their experiences with COVID-19 and reports of their mental health.ResultsAdolescents perceived various changes in their relationships with family and friends (e.g., less perceived friend support) during COVID-19. They also perceived increases in negative affect and decreases in positive affect. These perceived social and emotional changes were associated with elevated depressive symptoms, anxiety symptoms, and loneliness in April 2020, controlling for mental health problems before the pandemic.ConclusionsOur findings sensitize clinicians and scholars to the vulnerabilities (changes in friendship dynamics), as well as resiliencies (supportive family contexts), presented to U.S. adolescents during the early months of COVID-19.     

Natural Language Processing Insight into LGBTQ+ Youth Mental Health During the COVID-19 Pandemic: Longitudinal Content Analysis of Anxiety-Provoking Topics and Trends in Emotion in LGBTeens Microcommunity Subreddit

BackgroundWidespread fear surrounding COVID-19, coupled with physical and social distancing orders, has caused severe adverse mental health outcomes. Little is known, however, about how the COVID-19 crisis has impacted LGBTQ+ youth, who disproportionately experienced a high rate of adverse mental health outcomes before the COVID-19 pandemic.ObjectiveWe aimed to address this knowledge gap by harnessing natural language processing methodologies to investigate the evolution of conversation topics in the most popular subreddit for LGBTQ+ youth.MethodsWe generated a data set of all r/LGBTeens subreddit posts (n=39,389) between January 1, 2020 and February 1, 2021 and analyzed meaningful trends in anxiety, anger, and sadness in the posts. Because the distribution of anxiety before widespread social distancing orders was meaningfully different from the distribution after (P<.001), we employed latent Dirichlet allocation to examine topics that provoked this shift in anxiety.ResultsWe did not find any differences in LGBTQ+ youth anger and sadness before and after government-mandated social distancing; however, anxiety increased significantly (P<.001). Further analysis revealed a list of 10 anxiety-provoking topics discussed during the pandemic: attraction to a friend, coming out, coming out to family, discrimination, education, exploring sexuality, gender pronouns, love and relationship advice, starting a new relationship, and struggling with mental health.ConclusionsDuring the COVID-19 pandemic, LGBTQ+ teens increased their reliance on anonymous discussion forums when discussing anxiety-provoking topics. LGBTQ+ teens likely perceived anonymous forums as safe spaces for discussing lifestyle stressors during COVID-19 disruptions (eg, school closures). The list of prevalent anxiety-provoking topics in LGBTQ+ teens’ anonymous discussions can inform future mental health interventions in LGBTQ+ youth.     

Women's Substance Use and Mental Health During the COVID-19 Pandemic

PurposeWomen are experiencing greater unemployment and increased stress from childcare responsibilities than men during the COVID-19 pandemic. Women with these experiences may be at particular risk for mental illness and increased substance use during the COVID-19 pandemic. The purpose of the study was to assess women's substance use, mental health, and experiences of COVID-19 pandemic impacts.MethodsA national online survey was administered to adult women from September to November 2020. The survey included questionnaires assessing mental health, loneliness, intolerance for uncertainty, social support, substance use, and intimate partner violence (IPV).ResultsA total of 499 women responded; most were White, college educated, and in their mid-30s. Of the 20.24% who acknowledged at least one IPV problem, 29.7% stated that their IPV problems have gotten worse since the pandemic began, and 16.83% said that they have increased their drug or alcohol use to cope with their relationship problems. Anxiety, perceived daily impact of COVID-19, and lower self-efficacy were significant predictors of COVID-19 anxiety. Those with risky alcohol use had significantly higher anxiety (p = .028) and depression (p = .032) than those with low-risk alcohol use.ConclusionsGreater anxiety about COVID-19, greater reported changes in daily life due to the pandemic, and high-risk alcohol use are related to greater mental health–related distress among women. For some, IPV has gotten worse during the pandemic and drug or alcohol use is a coping mechanism.     

COVID-19 Surveillance in the Biobank at the Colorado Center for Personalized Medicine: Observational Study

BackgroundCharacterizing the experience and impact of the COVID-19 pandemic among various populations remains challenging due to the limitations inherent in common data sources, such as electronic health records (EHRs) or cross-sectional surveys.ObjectiveThis study aims to describe testing behaviors, symptoms, impact, vaccination status, and case ascertainment during the COVID-19 pandemic using integrated data sources.MethodsIn summer 2020 and 2021, we surveyed participants enrolled in the Biobank at the Colorado Center for Personalized Medicine (CCPM; N=180,599) about their experience with COVID-19. The prevalence of testing, symptoms, and impacts of COVID-19 on employment, family life, and physical and mental health were calculated overall and by demographic categories. Survey respondents who reported receiving a positive COVID-19 test result were considered a “confirmed case” of COVID-19. Using EHRs, we compared COVID-19 case ascertainment and characteristics in EHRs versus the survey. Positive cases were identified in EHRs using the International Statistical Classification of Diseases, 10th revision (ICD-10) diagnosis codes, health care encounter types, and encounter primary diagnoses.ResultsOf the 25,063 (13.9%) survey respondents, 10,661 (42.5%) had been tested for COVID-19, and of those, 1366 (12.8%) tested positive. Nearly half of those tested had symptoms or had been exposed to someone who was infected. Young adults (18-29 years) and Hispanics were more likely to have positive tests compared to older adults and persons of other racial/ethnic groups. Mental health (n=13,688, 54.6%) and family life (n=12,233, 48.8%) were most negatively affected by the pandemic and more so among younger groups and women; negative impacts on employment were more commonly reported among Black respondents. Of the 10,249 individuals who responded to vaccination questions from version 2 of the survey (summer 2021), 9770 (95.3%) had received the vaccine. After integration with EHR data up to the time of the survey completion, 1006 (4%) of the survey respondents had a discordant COVID-19 case status between EHRs and the survey. Using all longitudinal EHR and survey data, we identified 11,472 (6.4%) COVID-19-positive cases among Biobank participants. In comparison to COVID-19 cases identified through the survey, EHR-identified cases were younger and more likely to be Hispanic.ConclusionsWe found that the COVID-19 pandemic has had far-reaching and varying effects among our Biobank participants. Integrated data assets, such as the Biobank at the CCPM, are key resources for population health monitoring in response to public health emergencies, such as the COVID-19 pandemic.     

Role of neighborhood social support in stress coping and psychological wellbeing during the COVID-19 pandemic: Evidence from Hubei,China

The COVID-19 pandemic that emerged in Wuhan, the capital city of Hubei province in China, has caused severe health problems and imposed a tremendous psychological impact on the public. This study investigated the risk and protective factors associated with psychological distress among Hubei residents during the peak of the outbreak. Data were obtained from a combined online and telephone survey of 1,682 respondents. Various COVID-19-related stressors, including risk exposure, limited medical treatment access, inadequate basic supplies, reduced income, excessive exposure to COVID-19-related information, and perceived discrimination, were associated with psychological distress. Neighborhood social support can reduce psychological distress and buffer the effect of COVID-19-related stressors, whereas support from friends/relatives affected stress coping limitedly. Interventions to reduce stressors and promote neighborhood support are vital to reduce psychological distress during infectious disease outbreaks.     

The Protective Roles of Exercise and Maintenance of Daily Living Routines for Chinese Adolescents During the COVID-19 Quarantine Period

PurposeAdolescents are particularly vulnerable during the COVID-19 quarantine periods and may be at risk for developing psychological distress symptoms that extend beyond a crisis, including depression. This study examined adolescents’ postquarantine depressive symptoms associated with pandemic stressors. The primary aim was to identify potential protective factors that may buffer the association between the presence of COVID-19 cases in adolescents’ communities and their postquarantine depressive symptoms.MethodsAdolescents from public schools were recruited from Zhengzhou city, Henan, China (N = 1,487, M_age=13.14 years, 50% girls). Adolescents reported the presence of confirmed or suspected COVID-19 cases in their communities, their daily activities and routines during the 2-month quarantine period, and depressive symptoms after the quarantine period.ResultsThe presence of cases in adolescents’ communities during the quarantine contributed to more depressive symptoms in adolescents after the quarantine. This association was buffered by adolescents’ spending more time on physical activities and better maintenance of daily living routines during the quarantine period. The presence of community infection was also more strongly associated with depressive symptoms in older adolescents.ConclusionsThe presence of COVID-19 cases in communities contributed to adolescents’ poorer mental health, and the association was stronger for older adolescents. Spending time on physical activities and maintaining daily living routines during the quarantine appear to be practical strategies that can be used by adolescents to mitigate the association between pandemic stressors and their diminishing mental health.     

Nursing Home Workers’ Mental Health During the COVID-19 Pandemic in France

ObjectivesThe present study sought to examine mental health problems among nursing home workers in the context of the COVID-19 pandemic, to investigate COVID-19–related fears, and to identify prepandemic factors associated with current mental health issues.DesignA cross-sectional, online survey was used.Setting and ParticipantsAll employees among 6 nursing homes in southwestern France (N = 455) were solicited between November, 2020 and June, 2021.MethodsThe survey instrument was developed within the World Mental Health consortium to screen for COVID-related fears, probable generalized anxiety, panic attacks, depression, posttraumatic stress and substance use disorders in the past 30 days.ResultsThe survey was completed by 127 workers (89.0% female, mean age = 43.42 years, SD = 11.29), yielding a 28.5% response rate. Overall, 48.03% reported experiencing fear of infecting others at least most of the time. One in 8 (14.96%) indicated that close others feared being infected by them. One-third of the sample (34.65%) met criteria for at least 1 probable current mental disorder. Panic attacks (22.05%) were the most frequently reported mental health problem, followed by depression (16.54%). In multivariate analyses, the only factor associated with having a current probable mental disorder was the presence of any prepandemic mental health problem (adjusted odds ratio 4.76, 95% CI 2.08-10.89). Type of employment contract, full-time status, and medical vs nonmedical staff status were not significantly associated with mental health status.Conclusions and ImplicationsThe study reveals that one-third of nursing home workers in the sample report current probable mental disorders, and these were largely associated with prepandemic mental health status. Screening for common mental health problems and facilitating access to appropriate care should be prioritized in nursing homes.     

Symptoms,complications and management of long COVID: a review

Globally, there are now over 160 million confirmed cases of COVID-19 and more than 3 million deaths. While the majority of infected individuals recover, a significant proportion continue to experience symptoms and complications after their acute illness. Patients with ‘long COVID’ experience a wide range of physical and mental/psychological symptoms. Pooled prevalence data showed the 10 most prevalent reported symptoms were fatigue, shortness of breath, muscle pain, joint pain, headache, cough, chest pain, altered smell, altered taste and diarrhoea. Other common symptoms were cognitive impairment, memory loss, anxiety and sleep disorders. Beyond symptoms and complications, people with long COVID often reported impaired quality of life, mental health and employment issues. These individuals may require multidisciplinary care involving the long-term monitoring of symptoms, to identify potential complications, physical rehabilitation, mental health and social services support. Resilient healthcare systems are needed to ensure efficient and effective responses to future health challenges.     

Association between work-related changes caused by the COVID-19 pandemic and severe psychological distress among Japanese workers

This study aimed to evaluate the association between work-related changes caused by COVID-19 and psychological distress among Japanese workers. The cross-sectional study was conducted from August 25 to September 30, 2020. The participants were 15,454 employees who were registered as panelists with an online survey company. The Kessler psychological distress scale with a 13-point cutoff was used to measure psychological distress. Multiple logistic regression was performed. Of the respondents, 8.9% were evaluated as having severe psychological distress. Among five examined work-related changes, being laid off and changing jobs (adjusted odds ratio [aOR] = 5.43; 95% confidence interval [CI]: 4.18–7.05), experiencing temporary workplace closure (aOR = 1.94; 95% CI: 1.67–2.25), being forced to visit the workplace for paperwork (aOR = 1.84; 95% CI: 1.58–2.15), and starting telework from home (aOR = 1.18; 95% CI: 1.01–1.37) were associated with increased psychological distress; no significant association was found for participation in work-related online meetings. The impact on psychological distress was greater among men, especially for being laid off and changing jobs because of COVID-19. It is important to assess and reduce negative mental health effects among workers experiencing work-related changes caused by the COVID-19 pandemic, taking gender differences into account.