Perceived impacts of COVID-19 on wellbeing among US working-age adults with ADL difficulty

BackgroundThe COVID-19 pandemic has disproportionately impacted people with disabilities. Working-age adults with ADL difficulty may face unique challenges and heightened health risks because of the pandemic. It is critical to better understand the impacts of COVID-19 on social, financial, physical, and mental wellbeing among people with disabilities to inform more inclusive pandemic response policies.ObjectiveThis study compares perceived COVID-19 physical and mental health, social, and financial impacts for US working-age adults with and without ADL difficulty.MethodsWe analyzed data from a national survey of US working-age adults (aged 18–64) conducted in February and March 2021 (N = 3697). We used logistic regression to compare perceived COVID-19-related impacts on physical and mental health, healthcare access, social relationships, and financial wellbeing among those with and without ADL difficulty.ResultsAdults with ADL difficulty were more likely to report negative COVID-19 impacts for many but not all outcomes. Net of covariates, adults with ADL difficulty had significantly greater odds of reporting COVID-19 infection (OR = 2.1) and hospitalization (OR = 6.7), negative physical health impacts (OR = 2.0), and negative impacts on family relationships (OR = 1.6). However, they had significantly lower odds of losing a friend or family member to COVID-19 (OR = 0.7). There were no significant differences in perceived impacts on mental health, ability to see a doctor, relationships with friends, or financial wellbeing.ConclusionsWorking-age adults with ADL difficulty experienced disproportionate health and social harm due to the COVID-19 pandemic. To address these disparities, public health response efforts and social policies supporting pandemic recovery must include disability perspectives.     

The effects of the COVID-19 pandemic on the psychosocial well-being of people with disabilities

BackgroundBefore the COVID-19 pandemic, people with mobility, vision, hearing, and cognitive disabilities were at a higher risk of lower psychosocial well-being than people without disabilities. It is, therefore, of great importance to investigate whether the pandemic has exacerbated this difference.ObjectiveThis study examines whether people with disabilities (categorized as mobility, vision, hearing, cognitive, and any disabilities) report more COVID-19-related negative effects on psychosocial well-being (loneliness, decreased social contact, decreased hope for the future, concerns about being infected) than people without disabilities.MethodsWe analyzed population-based data from the Finnish Health, Welfare, and Services (FinSote) survey carried out in 2020–2021 (N = 22 165, age 20+). Logistic regression models were applied, controlling for the effects of age, sex, partnership, living alone, and education.ResultsAll disability groups, except those with vision disabilities, reported significantly more often that the pandemic increased loneliness than people without disabilities. There were no significant differences between the disability groups and people without disabilities in decreased social contacts. People with only mobility and cognitive disabilities reported significantly more often that the pandemic decreased their hope for the future than those without disabilities. All disability groups were more often concerned about being infected than people without disabilities, but this effect was not significant among people 75 or older.ConclusionThe psychosocial well-being of people with specific types of disabilities should receive special attention during crises like the COVID-19 pandemic.     

The effects of COVID-19 restrictions on physical activity and mental health of children and young adults with physical and/or intellectual disabilities

BackgroundCOVID-19 has caused unprecedented restrictions, significantly affecting the most vulnerable groups in society, such as those with a disability.ObjectiveThe aim of the study was to investigate the effects of COVID-19 lockdown restrictions on physical activity and mental health of children and young adults with physical and/or intellectual disabilities.MethodsThe study was a cross-sectional design. Parents/carers completed an electronic survey in the UK between June–July 2020 on behalf of their child. Through Likert scales and free-text questions, the survey asked about physical activity levels and mental health during lockdown compared to before, access to specialist facilities and equipment to aid with physical activity, and the short- and long-term concerns around ongoing lockdown restrictions.ResultsGenerally, respondents reported negative effects of lockdown restrictions, with 61% reporting a reduction in physical activity levels and over 90% reporting a negative impact on mental health (including poorer behaviour, mood, fitness and social and learning regression). Many respondents cited a lack of access to specialist facilities, therapies and equipment as reasons for this, and raised concerns about the long-term effects of this lack of access on their child’s mental health and physical activity levels.ConclusionsThe survey highlights the negative impact of the COVID-19 lockdown on the physical activity levels and mental health of children and young adults with disabilities and highlights the importance of addressing the needs of the disabled community as restrictions are eased.     

COVID-19 vaccination hesitancy among Americans with disabilities aged 18-65: An exploratory analysis

BackgroundIt is important for people with disabilities to be vaccinated against COVID-19 because, as a group, they are at increased risk of severe outcomes. While there are multiple vaccines available to prevent COVID-19, a considerable proportion of Americans report some hesitancy to becoming vaccinated, including people with disabilities.ObjectiveWe conducted a study to explore what factors may contribute to COVID-19 vaccination hesitancy among Americans with disabilities.MethodsWe used Amazon's Mechanical Turk to survey 439 people with disabilities (ages 18+) about their concerns of the COVID-19 disease, vaccines, and hesitancy toward vaccination to learn more about factors that influence vaccination hesitancy. Concerns about vaccines were analyzed as a composite variable representing different dimensions such as: side effects, too new, developed too quickly, influenced by politics, and effectiveness.ResultsResults from a logistic regression indicate that concern about vaccines was the most significant predictor of hesitancy, even after considering demographic, economic, and geographic factors. Concerns about getting COVID-19, getting tested for COVID-19, trust in experts, education, and being a Democrat were negatively associated with hesitancy.ConclusionsThese findings indicate that some groups of individuals may be more vaccination hesitant because they are more concerned about vaccine safety than COVID-19 infection. Public health messaging that focuses on the risks of vaccines relative to the risks of COVID-19 might be one strategy to reduce hesitancy and increase vaccination uptake. Messaging should also be tailored to specific disabilities (i.e. physical, mental, sensory), written in plain language, and disseminated in accessible formats.     

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.     

Reaching people with disabilities to learn about their experiences of social connection and loneliness

BackgroundPeople with disabilities experience higher rates of social isolation and loneliness than people without disabilities, but there is limited information about how these conditions are manifested in people with specific types of disabilities.ObjectivesUsing data collected as part of the second administration of the National Survey on Health and Disability (n = 2,132), our objectives were to determine if disability type and recruitment method added explanatory power to observed levels of social connectedness, after controlling for socio-demographic and environmental indicators.MethodsWe used hierarchical regression to evaluate how socio-demographic, disability, environmental, and recruitment type explained four outcome variables for different dimensions of social connectedness, including satisfaction with social activity, quantity of social connections, quality of social connections, and loneliness.ResultsAcross all models, employment status (not employed), having mental illness/psychiatric disability, lack of transportation for social needs, and recruitment type (MTurk) significantly predicted lower levels of social connectedness.ConclusionsThe study provides evidence that using alternative methods, such as MTurk, to complement conventional recruitment strategies can improve understanding of social isolation and feelings of loneliness among people with disabilities, particularly those with mental illnesses and/or psychiatric disorders who are less likely to be accessed through group affiliations, but who are at greater risk for experiencing social isolation and feelings of loneliness.     

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.     

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.     

New obstacles and widening gaps: A qualitative study of the effects of the COVID-19 pandemic on U.S. adults with disabilities

BackgroundPrior research has demonstrated that the needs of the disability community have not been met during public health emergencies. The COVID-19 pandemic has exacerbated existing inequities for many populations including people with disabilities, and data is needed to develop inclusive public health response policies.ObjectiveTo identify how COVID-19 has uniquely impacted the lives of adults with disabilities.Methods38 participants were recruited through disability advocacy groups and social media. Semi-structured virtual focus groups were conducted with adults (≥18 years) who self-identified as having a disability. Focus groups were conducted for each of six disability sub-groups: vision, hearing, mobility and physical, mental health, cognitive, intellectual, and developmental, and chronic illness. Using inductive coding, major themes were identified and compared across the disability sub-groups.ResultsThree major themes and thirteen sub-themes were identified from the focus groups. The three major themes comprised: new problems created by the pandemic, obstacles in daily life that were exacerbated by the pandemic, and broader changes to accessibility and disability identity. Sub-themes such as difficulty with COVID-19 testing and regular medical care were reported by participants of all disability sub-groups, while other sub-themes like direct care needs and medical rationing were reported by participants from a subset of the disability sub-groups.ConclusionsThese results indicate how the COVID-19 pandemic unequally impacts disabled people. The participants indicated that to fully address their needs, disability perspectives must be included in the public health pandemic response. As new research shows that COVID-19 can cause long-term disability, the urgency to ensure the disability community is part of public health policies will increase.     

Impact of COVID-19 on people with physical disabilities: A rapid review

BackgroundThe COVID-19 pandemic caused drastic changes in the lives of the general population. People with physical disabilities, who commonly encounter daily challenges such as barriers to community mobility, reduced access to healthcare services and higher risk of suffering from depression, may face additional challenges in the context of the pandemic.ObjectiveThis study aims to review the impact of the COVID-19 pandemic, and associated isolation and protective measures, among people with physical disabilities.MethodsA rapid review of the published literature was conducted on August 10, 2020 through a search in six online databases to synthesize results from original studies regarding the impact of the COVID-19 pandemic on people with physical disabilities. The International Classification of Functioning, Disability and Health was used to describe the population and the personal and environmental factors with a unified and standard health language.ResultsEleven records were extracted from 1621 individual papers retrieved from the search strategy. Various impacts on daily functioning such as a decrease in access to healthcare have been noted during the pandemic. Changes in social and lifestyle habits, mood changes and decreased levels of physical activity were also noted.ConclusionsOur results highlighted the lack of early research about the impacts of COVID-19 experienced by people with physical disabilities. Future studies should focus on specific consequences and needs of this vulnerable population to ensure their inclusion in public health recommendations and consideration by policy makers.     

The working conditions for personal support workers in the Greater Toronto Area during the COVID-19 pandemic: a mixed-methods study

ObjectiveDuring the height of the COVID-19 pandemic, personal support workers (PSWs) were heralded as healthcare ‘heroes’ as many of them cared for high-risk, vulnerable older populations, and worked in long-term care, which experienced a high number of COVID-19 outbreaks and deaths. While essential to the healthcare workforce, there is little understanding of PSW working conditions during the pandemic. The aim of our study was to examine the working conditions (including job security, work policies, and personal experiences) for PSWs in the Greater Toronto Area during the COVID-19 pandemic from the perspectives of PSWs.MethodsThis study used a mixed-methods design. From June to December 2020, we conducted a survey of 634 PSWs to understand their working conditions during the COVID-19 pandemic. Semi-structured interviews with 31 survey respondents were conducted from February to May 2021 to understand in greater depth how working conditions were impacting the well-being of PSWs.ResultsWe found PSWs faced a range of challenges related to COVID-19, including anxiety about contracting COVID-19, reduced work hours, taking leaves of absences, concerns about job security, and losing childcare. While the COVID-19 pandemic highlighted the PSW workforce and their importance to the healthcare system (especially in the long-term care system), pre-existing poor work conditions of insecure jobs with no paid sick days and benefits exacerbated COVID-19–related challenges. Despite these hardships, PSWs were able to rely on their mental resilience and passion for their profession to cope with challenges.ConclusionSignificant changes need to be made to improve PSW working conditions. Better compensation, increased job security, decreased workload burden, and mental health supports are needed.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-022-00643-7.     

Examine the associations between perceived neighborhood conditions,physical activity,and mental health during the COVID-19 pandemic

This study examined how neighborhood conditions changed and how neighborhood conditions were associated with physical activity and mental health during the COVID-19 pandemic among Americans. The major outcomes were stratified by the neighborhood's poverty and regression models were used to assess the associations between neighborhood conditions and their change during the pandemic and the outcomes of physical activity and mental health. The results show that low-poverty neighborhoods had more health-promoting neighborhood conditions before the outbreak and more positive changes during the outbreak. Health-promoting neighborhood conditions were associated with higher physical activity and moderate physical activity and lack of negative neighborhood conditions such as crime/violence and traffic were associated with a lower risk of mental health problems including loneliness, depression, and anxiety. Mental health problems were also significantly associated with the COVID-19 infection and death and household income level. Our findings suggest that it is plausible that the disparities of physical activity and mental health by neighborhood exacerbate due to the pandemic and people who living in socioeconomically disadvantaged neighborhoods bear increasingly disproportionate burden.     

Changes in physical activity and basic psychological needs related to mental health among people with physical disability during the COVID-19 pandemic in Norway

BackgroundPeople with a physical disability are more inactive than the general population. Due to the positive effects of physical activity (PA) on physical and mental health, maintaining a physically active lifestyle is important especially during challenging periods of life.ObjectiveExplore whether people with a physical disability experienced changes in PA, health status, and psychological need satisfaction (autonomy, competence and relatedness) during the first wave of the COVID-19 pandemic in Norway. Further, explore whether changes in psychological need satisfaction were associated with changes in PA level and mental health.MethodsCross-sectional retrospective study using an online self-reported questionnaire after the first wave during the COVID-19 pandemic.ResultsOf the 298 participants with physical disabilities (Age_M = 49yr; 62% females; 66% using mobility aids), 66% reported decreased PA compared to the same period in the previous year, 45% reported declined health status due to increased pain and reduced physical functioning. Regarding psychological need satisfaction, it was primarily the change in need for autonomy and competence for PA that were associated with change in PA and mental health.ConclusionsMost of the participants indicated decreased PA and about half decreased Health status during the COVID-19 pandemic. Further, the results indicated that it is important to nurture the basic psychological needs of autonomy and competence for PA when aiming to maintain or increase PA levels and mental health for this population living under restrictions of a pandemic.     

COVID-19 clinical outcomes by patient disability status: A retrospective cohort study

BackgroundPeople with disabilities might experience worse clinical outcomes of SARS-CoV-2 infection, but evidence is limited.ObjectiveTo investigate if people with disabilities requiring assistance are more likely to experience severe COVID-19 or death.MethodsData from the Johns Hopkins COVID-19 Precision Medicine Analytics Platform Registry (JH-CROWN) included 6494 adult patients diagnosed with COVID-19 and admitted between March 4, 2020–October 29, 2021. Severe COVID-19 and death were defined using the occurrence and timing of clinical events. Assistive needs due to disabilities were reported by patients or their proxies upon admission. Multivariable-adjusted Cox proportional hazards models were used to examine the associations between disability status and severe COVID-19 or death. Primary models adjusted for demographics and secondary models additionally adjusted for clinical covariates.ResultsIn this clinical cohort (47–73 years, 49% female, 39% Black), patients with disabilities requiring assistance had 1.35 times (95% confidence interval [CI]:1.01, 1.81) the hazard of severe COVID-19 among patients <65 years, but not among those ≥65 years, equating to an additional 17.5 severe COVID-19 cases (95% CI:7.7, 28.2) per 100 patients. A lower risk of mortality was found among patients <65 years, but this finding was not robust due to the small number of deaths.ConclusionsPeople with disabilities requiring assistance aged <65 years are more likely to develop severe COVID-19. Although our study is limited by using a medical model of disability, these analyses intend to further our understanding of COVID-19 outcomes among people with disabilities. Also, standardized disability data collection within electronic health records is needed.