“Don't Just Study our Distress,Do Something”: Implementing and Evaluating a Modified Stepped-Care Model for Health Care Worker Mental Health During the COVID-19 Pandemic

ObjectiveThroughout the COVID-19 pandemic, there have been concerns about the mental health of health care workers (HCW). Although numerous studies have investigated the level of distress among HCW, few studies have explored programs to improve their mental well-being. In this paper, we describe the implementation and evaluation of a program to support the mental health of HCW at University Health Network (UHN), Canada''s largest healthcare network.MethodsUsing a quality improvement approach, we conducted a needs assessment and then created and evaluated a modified stepped-care model to address HCW mental health during the pandemic. This included: online resources focused on psychoeducation and self-management, access to online support and psychotherapeutic groups, and self-referral for individual care from a psychologist or psychiatrist. We used ongoing mixed-methods evaluation, combining quantitative and qualitative analysis, to improve program quality.ResultsThe program is ongoing, running continuously throughout the pandemic. We present data up to November 30, 2021. There were over 12,000 hits to the UHN''s COVID mental health intranet web page, which included self-management resources and information on group support. One hundred and sixty-six people self-referred for individual psychological or psychiatric care. The mean wait time from referral to initial appointment was 5.4 days, with an average of seven appointments for each service user. The majority had moderate to severe symptoms of depression and anxiety at referral, with over 20% expressing thoughts of self-harm or suicide. Post-care user feedback, collected through self-report surveys and semistructured interviews, indicated that the program is effective and valued.ConclusionsDevelopment of a high-quality internal mental health support for HCW program is feasible, effective, and highly valued. By using early and frequent feedback from multiple perspectives and stakeholders to address demand and implement changes responsively, the program was adjusted to meet HCW mental health needs as the pandemic evolved.     

College Students’ Academic Stressors on Mental Health during the COVID-19 Pandemic: A Comparison between Graduating Students and Non-Graduating Students

The study aimed to investigate the influence of academic stressors on mental health and the mediating effect of social support and self-identity among college students and further studied the difference between the graduating students and non-graduating students during the COVID-19 Pandemic. Recruiting 900 college students as subjects, used the college students’ academic stressors questionnaire, social support questionnaire, self-identity scale and depression anxiety stress scales (DASS-21). The results showed that: (1) The college students’ academic stressor positively predicted mental health; (2) Social support and self-identity mediated the relationship; (3) The model also held when academic stressors was replaced by work stressor, but there were differences between the graduating and non-graduating students; (4) The direct effect work stressor on mental health in the graduating group was not significant; (5) The non-graduating students’ work stressor could not predict mental health through social support.     

Child and Maternal Mental Health Before and During the COVID-19 Pandemic: Longitudinal Social Inequalities in a Brazilian Birth Cohort

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Biopsychosocial exposure to the COVID-19 pandemic and the relative risk of schizophrenia: Interrupted time-series analysis of a nationally representative sample

BackgroundStudies of COVID-19 pandemic biopsychosocial exposure and schizophrenia risk showed contradictory results, were undertaken early in the pandemic, and did not consider lockdowns or COVID-19 infection. Hence, we examined the association between COVID-19 biopsychosocial exposure and incident schizophrenia.MethodsAn interrupted time-series study design was implemented based on Israeli electronic health records from 2013 to 2021 with national coverage. The period coinciding with the COVID-19 pandemic biopsychosocial exposures from March 2020 to February 2021 was classified as exposed, otherwise unexposed. The effect of the COVID-19 pandemic on incident schizophrenia was quantified by fitting a Poisson regression and modeling the relative risk (RR) and corresponding 95% confidence intervals (CI). Three scenarios were projected from the third lockdown to 10 months to forecast incident schizophrenia rates and their associated 95% prediction intervals (PI).ResultsThe total population (N = 736,356) yielded 4,310 cases of incident schizophrenia over time. The primary analysis showed that the period exposed to the COVID-19 pandemic was associated with a reduced RR (RR = 0.81, 95% CI = 0.73, 0.91, p < 0.001). This conclusion was supported in 12 sensitivity analyses, including scrutinizing lockdowns and COVID-19 infection status. Two of three forecast scenarios projected an incident increase (6.74, 95% PI = 5.80, 7.84; 7.40, 95% PI = 6.36, 8.60).ConclusionsThe reduced risk of schizophrenia during the pandemic suggests no immediate triggering of new onsets either by the virus or the pandemic-induced psychosocial adversities. Once restrictions are lifted, the increased projected presentations have implications for clinicians and healthcare policy.     

“One Degree of Separation”: A Mixed-Methods Evaluation of Canadian Mental Health Care User and Provider Experiences With Remote Care During COVID-19

ObjectivesThe COVID-19 pandemic has contributed to a shift from in-person to remote mental health care. While remote care methods have long existed, their widespread use is unprecedented. There is little research about mental health care user and provider experiences with this transition, and no published studies to date have compared satisfaction between these groups.MethodsCanadian mental health care users (n = 332) and providers (n = 107) completed an online self-report survey from October 2020 to February 2021 hosted by the Canadian Biomarker Integration Network in Depression. Using a mixed-methods approach, participants were asked about their use of remote care, including satisfaction, barriers to use, helpful and unhelpful factors, and suggestions for improvement.ResultsOverall, 59% to 63% of health care users and 59% of health care providers were satisfied with remote care. Users reported the greatest satisfaction with the convenience of remote care, while providers were most satisfied with the speed of provision of care; all groups were least satisfied with therapeutic rapport. Health care providers were less satisfied with the user-friendliness of remote care (P < 0.001) than users, while health care users were less satisfied than providers with continuity of care (P < 0.001). The use of a video-based platform was associated with remote care satisfaction among health care users (P < 0.02), and qualitative responses support the importance of visual cues in maintaining therapeutic rapport remotely. The majority of users (55%) and providers (87%) reported a likelihood of using remote care after the pandemic.ConclusionsRemote mental health care is generally accepted by both users and providers, and the majority would consider using remote care following the pandemic. Suggestions for improvement include greater use of video, increased attention to body language and eye contact, consistency with in-person care, as well as increased provider training and administrative support.     

SARS-CoV-2 consequences for mental health: Neuroinflammatory pathways linking COVID-19 to anxiety and depression

The coronavirus disease 2019 (COVID-19) pandemic has been linked to an increased prevalence of mental health disorders, particularly anxiety and depression. Moreover, the COVID-19 pandemic has caused stress in people worldwide due to several factors, including fear of infection; social isolation; difficulty in adapting to new routines; lack of coping methods; high exposure to social media, misinformation, and fake reports; economic impact of the measures implemented to slow the contagion and concerns regarding the disease pathogenesis. COVID-19 patients have elevated levels of pro-inflammatory cytokines, such as interleukin (IL)-1β, IL-6, and tumor necrosis factor-α, and other inflammation-related factors. Furthermore, invasion of the central nervous system by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may potentially contribute to neuroinflammatory alterations in infected individuals. Neuroinflammation, a consequence of psychological stress due to the COVID-19 pandemic, may also play a role in the development of anxiety and depressive symptoms in the general population. Considering that neuroinflammation plays a significant role in the pathophysiology of depression and anxiety, this study investigated the effects of SARS-CoV-2 on mental health and focused on the impact of the COVID-19 pandemic on the neuroinflammatory pathways.     

Protective Factors for Loneliness among Adolescents during COVID-19: Role of the Interpersonal Relationships and Sibling Status

This study examined the moderating effects of parent-child, same-sex, opposite-sex and teacher-student relationships between sibling status and loneliness during COVID-19. A total of 1,591 adolescents in China completed thestudy questionnaires which assessed the aforementioned variables. The results showed that same-sex and teacherstudent relationships moderated the association between sibling status and loneliness. The results indicated thatamong participants with good same-sex relationships during COVID-19, compared to non-only-children participants, the only-children participants were more likely to experience a lower level of loneliness. However, participants with poor same-sex relationships experienced similar level of loneliness regardless of whether they hadsiblings. These findings would be helpful for parents, teachers, and other stakeholders to take effective measuresto reduce loneliness feelings among Chinese adolescents.     

Circadian rhythm abnormalities during the COVID-19 outbreak related to mental health in China: a nationwide university-based survey

Objective/backgroundSchool closure and home quarantine has been implemented worldwide during the coronavirus disease 2019 (COVID-19) outbreak. The study aims to assess the associations of circadian rhythm abnormalities (CRA) during the COVID-19 outbreak with mental health in Chinese undergraduates.MethodsA nationwide cross-sectional university-based survey was conducted from 4th February to 12th, 2020. Based on different geographical locations and purposive sampling approach, 19 universities from 16 provinces or municipalities in the mainland of China were selected. A total of 14,789 participants were recruited by using multistage stratified random sampling. The data of CRA were collected by self-reported questionnaires consist of four items involved rest–activity cycle, diet rhythm, wake up rhythm and sleep rhythm. The Patient Health Questionnaire and the Generalized Anxiety Disorder were applied to evaluate the symptoms of depression and anxiety. Chi-square test and ordinal logistic regression models were used to describe the distributions and associations of CRA and mental health.ResultsA total of 11,787 students [female: 6731(57.1%)] aged 15–26 years old (M = 20.45, SD = 1.76) were analyzed (response rate: 79.7%). The results showed the percentage of CRA were 17.5–28.7%. The prevalence of depression and anxiety were significantly higher in students with single CRA. Students who reported the coexistence of four CRA were more likely to be with the symptoms of depression (OR: 4.43, 95% CI: 3.91–5.03) and anxiety (OR: 3.11, 95% CI: 2.70–3.60). Dose–response relationships were found between multiple CRA and mental problems.ConclusionCircadian rhythm abnormalities are positively associated with mental health among university studies. Mental health care is needed for college students during the COVID-19 epidemic period.     

The Effect of Online Wellness Coaching for Nursing Students during the COVID-19 Lockdown on Well-Being: A Qualitative Study

Aim: The aim of this study was to explore and describe the lived experience of 3rd-year nursing students who participated in an online wellness coaching program during the COVID-19 pandemic lockdown. Methods: This qualitative research study on an online wellness coaching program included 30 female students, aged 21 to 30 years, who were confined to their home during the COVID-19 outbreak for two months. The students were asked to describe their feelings and responses during the COVID-19 lockdown. Results: Four thematic clusters emerged in the data analysis: what the students felt during the quarantine period, what the wellness coaching practice added to the students’ lives, what changes resulted from the application and whether the students would like the application to continue and recommend the application. The study showed that students had a high level of stress, fear and anxiety at home during the COVİD-19 outbreak. With the online wellness coaching application, they experienced a decrease in social isolation, an improved ability to cope with stress, and improved positivity and well-being. Conclusion: Findings from this study demonstrate that online wellness coaching during the COVID-19 quarantine has a positive effect on students’ well-being.     

A Longitudinal Cohort Study of Youth Mental Health and Substance use Before and During the COVID-19 Pandemic in Ontario,Canada: An Exploratory Analysis

BackgroundYouth mental health appears to have been negatively impacted by the COVID-19 pandemic. The impact on substance use is less clear, as is the impact on subgroups of youth, including those with pre-existing mental health or substance use challenges.ObjectiveThis hypothesis-generating study examines the longitudinal evolution of youth mental health and substance use from before the COVID-19 pandemic to over one year into the pandemic among youth with pre-existing mental health or substance use challenges.MethodA total of 168 youth aged 14–24 participated. Participants provided sociodemographic data, as well as internalizing disorder, externalizing disorder, and substance use data prior to the pandemic’s onset, then every two months between April 2020–2021. Linear mixed models and Generalized Estimating Equations were used to analyze the effect of time on mental health and substance use. Exploratory analyses were conducted to examine interactions with sociodemographic and clinical characteristics.ResultsThere was no change in internalizing or externalizing disorder scores from prior to the pandemic to any point throughout the first year of the pandemic. Substance use scores during the pandemic declined compared to pre-pandemic scores. Exploratory analyses suggest that students appear to have experienced more mental health repercussions than non-students; other sociodemographic and clinical characteristics did not appear to be associated with mental health or substance use trajectories.ConclusionsWhile mental health remained stable and substance use declined from before the COVID-19 pandemic to during the pandemic among youth with pre-existing mental health challenges, some youth experienced greater challenges than others. Longitudinal monitoring among various population subgroups is crucial to identifying higher risk populations. This information is needed to provide empirical evidence to inform future research directions.     

The Impact of the COVID-19 Pandemic on the Mental Health of First-Year Undergraduate Students Studying at a Major Canadian University: A Successive Cohort Study

ObjectiveTo examine the impact of the COVID-19 pandemic on first year undergraduate student mental health.MethodsAs part of the Queen’s University U-Flourish Student Well-Being and Academic Success study, three successive cohorts of students entering undergraduate studies in 2018 (pre-pandemic), 2019 (transitional), and 2020 (during pandemic) completed electronic surveys at entry and completion of first year. Validated self-report measures were used to assess mental health status including symptom levels of anxiety, depression, and insomnia, self-harm and frequency of substance use. Propensity matching and multivariable log-binomial regression were used in comparisons of mental health indicators across the cohorts.ResultsClinically significant symptoms of depression, anxiety, insomnia, and self-harm were reported more frequently in the 2020–2021 cohort, coincident with remote learning and pandemic restrictions. In female students, screen positive rates for anxiety and depression, and suicidal ideation increased from about one-third to just under one-half in association with the pandemic (χ², p < .01), while increases in mental health concerns were less pronounced among males. Among females, increases in clinically significant symptoms over first year appeared greatest during the pandemic year, while striking decreases in alcohol consumption in both females and males were reported in that same year. Studying under pandemic conditions had a negative impact on student well-being, social relationships and school connectedness, quality of learning experience, leisure activities, and optimism about future prospects.ConclusionsMental health concerns including anxiety, depression and sleep problems increased in first year students during the pandemic, especially among females, while alcohol use declined. These findings highlight the negative mental health impact associated with studying under pandemic restrictions involving remote learning and social distancing.