Mental health and well-being during the COVID-19 pandemic: longitudinal analyses of adults in the UK COVID-19 Mental Health & Wellbeing study

Crohn's and Colitis Canada's 2021 Impact of COVID-19 and Inflammatory Bowel Disease in Canada: Mental Health and Quality of Life

There has been a dramatic rise in mental health difficulties during the coronavirus disease 2019 (COVID-19) pandemic. While young adults have the lowest risk of hospitalization and mortality due to COVID-19, they have been identified as being at highest risk of detrimental mental health outcomes during the pandemic, along with women, those with lower socioeconomic status and those with pre-existing mental health conditions. Somewhat of a crisis in mental health has emerged across the general population through the evolution of the pandemic. A national Canadian survey identified a quadrupling of those experiencing pervasive elevated anxiety symptoms early in the pandemic compared to pre-pandemic levels, and a doubling of those with pervasive elevated depressive symptoms. Independent of the pandemic, persons with inflammatory bowel disease (IBD) can face multiple challenges related to their disease, which can result in a significant psychosocial burden and psychologic distress. Anxiety and depression have been found to be more prevalent in persons with IBD. Many potential factors contribute to the increased psychologic distress and negative impacts on mental health of the COVID-19 pandemic on persons with IBD. These include the fears of contracting COVID-19 or infecting other people. Many believe that IBD or its treatments predispose them to an increased risk of COVID-19 or a worse outcome if acquired. Concerns about access to health care add to mental distress. People with IBD generally report lower quality of life (QOL) compared to community controls. Psychologic interventions, in addition to adequate disease control, have been shown to improve health-related QOL. Uncertainty is another factor associated with reduced health-related QOL. Most studies suggest that persons with IBD have suffered QOL impairment during the pandemic in comparison to the pre-pandemic period. Uncertainties brought on by the pandemic are important contributors for some of the reduction in QOL.

The association between COVID-19, personal wellbeing, depression, and suicide risk factors in Australian autistic adults

The COVID-19 pandemic has had a significant impact on the mental health and wellbeing of the world's population, with particularly negative effects on vulnerable populations, including autistic people. Although some consensus regarding specific impact on aspects of wellbeing and mental health in autism is starting to emerge, it is unclear whether the pandemic has increased suicide risk. The goals of this study were to examine (a) potential associations between COVID-19 impact and depression, personal wellbeing, and suicide risk factors in Australian autistic adults and (b) age and gender effects. The COVID-19 Impact Scale (CIS), Personal Wellbeing Index, Patient Health Questionnaire, and the Suicide Behavior Questionnaire, Revised (SBQ-R), were administered to 111 autistic adults aged 20 to 71 years during the second wave of the COVID-19 pandemic in Australia. COVID-19 impact showed small associations with poorer personal wellbeing (r = -0.224, p = 0.023, [-0.409, -0.016]) and higher depressive symptoms (r = 0.268, p = 0.006, [0.056, 0.445]) and was not associated with the SBQ-R suicide risk score (r = 0.081, p = 0.418, [-0.118, 0.264). No significant effects were identified for age. Although model results were similar for women and men, the strength of the associations between personal wellbeing and depression (z = -2.16, p = 0.015), and depression and SBQ-R suicide risk (z = 1.961, p = 0.025), were stronger in women than in men. Qualitative analysis of an open response question from the CIS suggested that the pandemic had both positive and negative impacts on participants. The COVID-19 pandemic has had a large impact on the mental health and wellbeing of the world's population, particularly vulnerable populations such as autistic people. It is not known if these impacts on mental health and wellbeing have increased suicide risk. Our findings suggest that the impact of the COVID-19 pandemic may be associated with poorer wellbeing and higher depression, but is not associated with suicide risk. Overall, autistic people reported both positive and negative impacts of the pandemic on their lives.

The impact of the first wave of the Covid-19 pandemic on parents of children with externalising difficulties in ireland: A longitudinal cohort study

BACKGROUND

This longitudinal cohort study aimed to examine the impact of the first wave of the COVID-19 pandemic in Ireland on parents of children with externalising difficulties, in comparison to parents of children without such difficulties.

METHOD

Parents of 159 children completed online self-report measures at three time points during the first wave of the COVID-19 pandemic; (a) Delay and Mitigation Phase (March 2020 to May 2020), (b) Reopening of Society Phase (June 2020 to July 2020) and (c) Wave 2 Case Acceleration Phase (September 2020 to October 2020). Participants were allocated to the clinical group if they met the clinical cut off point on the Conduct or Hyperactivity/Inattention subscales of the Strengths and Difficulties Questionnaire at Time 1.

RESULTS

Parents of children with externalising difficulties experienced significantly higher levels of stress, lower levels of wellbeing and engaged in higher levels of avoidant-focused coping strategies longitudinally. There was a significant difference between outcomes at the different phases of the COVID-19 pandemic, for stress related to parenting, personal/family stress related to the impact of the COVID-19 and type of coping strategies employed. Children with externalising difficulties, in comparison to children without externalising difficulties, showed significantly greater adjustment over time for behavioural and emotional difficulties, as reported by their parents.

CONCLUSIONS

Results provide important information regarding the trajectory of psychological outcomes in parents of children with externalising difficulties over the first wave of the COVID-19 pandemic, highlighting the need for increased parental supports during, and after, the COVID-19 pandemic.

Anxiety and depression symptoms after COVID-19 infection: results from the COVID Symptom Study app

BACKGROUND

Mental health issues have been reported after SARS-CoV-2 infection. However, comparison to prevalence in uninfected individuals and contribution from common risk factors (eg, obesity and comorbidities) have not been examined. We identified how COVID-19 relates to mental health in the large community-based COVID Symptom Study.

METHODS

We assessed anxiety and depression symptoms using two validated questionnaires in 413148 individuals between February and April 2021; 26998 had tested positive for SARS-CoV-2. We adjusted for physical and mental prepandemic comorbidities, body mass index (BMI), age and sex.

FINDINGS

Overall, 26.4% of participants met screening criteria for general anxiety and depression. Anxiety and depression were slightly more prevalent in previously SARS-CoV-2-positive (30.4%) vs SARS-CoV-2-negative (26.1%) individuals. This association was small compared with the effect of an unhealthy BMI and the presence of other comorbidities, and not evident in younger participants (≤40 years). Findings were robust to multiple sensitivity analyses. Association between SARS-CoV-2 infection and anxiety and depression was stronger in individuals with recent (<30 days) versus more distant (>120 days) infection, suggesting a short-term effect.

INTERPRETATION

A small association was identified between SARS-CoV-2 infection and anxiety and depression symptoms. The proportion meeting criteria for self-reported anxiety and depression disorders is only slightly higher than prepandemic.

Trajectories of depression and anxiety during COVID-19 associations with religion, income, and economic difficulties

OBJECTIVE

The current study examined trajectories of anxiety and depression symptoms at three-time points during the COVID-19 pandemic and examined correlates of those trajectories.

DESIGN

Data were collected at three time points during the COVID-19 pandemic.

PARTICIPANTS

The sample in the current study consisted of 804 respondents who had completed the online questionnaire at all three time points designed for the study.

RESULTS

Using Latent Growth Mixture Modeling (LGMM) we identified four trajectories: (a) A resilient group reported consistently low levels of symptoms (62% anxiety and 72% depression), (b) a chronic group reported consistently high levels of symptoms (12% anxiety and 14% depression), (c) an emerging group reported low initial symptoms that increased steadily across time (20% anxiety and 13% depression), and (d) an improving group reported high initial symptoms that decreased across time (6% anxiety and 3% depression).

CONCLUSIONS

The salient conclusion that emerged from these results is that even in a severe and prolonged crisis, such as the COVID-19 pandemic, the most common outcome in the population is that of resilience. Moreover, examining predictors of these trajectories, we found that the resilience trajectory was associated with fewer economic difficulties due to the COVID-19, greater income, and self-identification as religious.

Correlates of suicidal ideation related to the COVID-19 Pandemic: Repeated cross-sectional nationally representative Canadian data

OBJECTIVE

With significant levels of mental distress reported by populations, globally, the magnitude of suicidal ideation during and beyond the COVID-19 pandemic is a central concern. The goal of this study was to quantify the extent of pandemic-related suicidal ideation in the Canadian population during the first ten months of the pandemic and identify sociodemographic and pandemic-related stressors associated with increased risk of ideation.

METHOD

Data were derived from three rounds of a mental health monitoring survey, nationally representative by age, gender, household income, and region, delivered online in May 2020, September 2020, and January 2021. Bivariate analyses were used to quantify the proportion of respondents in Canada reporting suicidal ideation by sociodemographic factors and pandemic-related stressors. Unadjusted and adjusted multivariable logistic regression was used to study the association between suicidal ideation and correlates within four pandemic-related stressor categories (financial, relationship, substance use, COVID-19 exposure).

RESULTS

Of the 7002 respondents, 6.2% (n = 433) reported experiencing suicidal thoughts or feelings as a result of the pandemic within the two weeks prior to taking the survey. In terms of sociodemographic factors, suicidal ideation was more commonly reported among those who were not cisgender, <65 years-old, single, Indigenous, LGBT2Q+, and who experience a pre-existing mental health condition. After adjusting for sociodemographic factors, indicators across all four pandemic-related stressor categories were associated with two or more times the odds of suicidal ideation.

CONCLUSION

Disparities in COVID-19 related suicidal ideation have persisted throughout the first year of the pandemic for specific sociodemographic sub-groups and those who have faced stressors related to finances, relationships, increased substance use, and COVID-19 virus exposure. To best address these disparities and to prevent a transition from suicidal ideation to action, appropriate planning, resources, and policies are needed to ensure health and well-being for everyone.

Pilot study of a well-being app to support New Zealand young people during the COVID-19 pandemic

BACKGROUND

Well-being apps represent a promising and scalable approach for improving mental health outcomes in youth, especially during a global pandemic when access to face-to-face interventions may be limited. Whitu (meaning 7 in the New Zealand Māori language Te Reo) is a newly developed well-being app with 7 modules that support young people to learn and practice evidence-based coping skills, including relaxation, mindfulness, self-compassion, and goal-setting.

OBJECTIVE

During this pilot, we explored the acceptability, usability, and preliminary efficacy of Whitu before refining the app for a randomized controlled trial (RCT).

METHODS

We recruited 20 New Zealand young people aged 16-25 years via social media to trial the first prototype of the Whitu app over 6 weeks. Within-group differences from baseline to 2- and 6-weeks post intervention in self-reported well-being, depression, anxiety, stress, self-compassion, optimism and sleep quality were evaluated using repeated-measures ANOVA. A further 21 participants aged 16-30 years were recruited to participate in 4 focus groups to give feedback on the app's usability and cultural acceptability. Feedback was analysed using directed content analysis.

RESULTS

Statistically significant improvements in anxiety (p = 0.024) and stress (p = 0.017) were observed from baseline to 2-weeks post intervention. Improvements in well-being (p = 0.021), depression (p = 0.031), anxiety (p = 0.005), and stress (p = 0.004) were also observed from baseline to 6-weeks. No statistically significant changes were seen in self-compassion, optimism, or sleep quality. Effect sizes (partial η2s) ranged from 0.25 (depression) to 0.42 (stress). Qualitative feedback comprised of five key themes, namely: factors affecting engagement, issues with functionality, preferences regarding aesthetics, effectiveness and adverse effects, and cultural acceptability.

CONCLUSIONS

Our preliminary results suggest that Whitu may be an effective app for improving multiple dimensions of young people's well-being. Modifications to the look and feel, cultural content, and onboarding have been undertaken based on the qualitative feedback, and an RCT is currently underway.

See or Be? Contact with nature and well-being during COVID-19 lockdown

This study investigated how contact with nature benefitted well-being during a strict lockdown. The study took place in Israel during the last week of the first COVID-19 lockdown, when citizens were restricted to remain within 100 m of home. A survey company distributed questionnaires among 776 individuals. The questionnaires included demographic variables (gender, ethnic and cultural groups, age, income loss due to the pandemic), contact with nature variables (Nature near home, Nature viewed from home windows, and being in nature on the preceding day), and well-being measures (positive affect, negative affect, vitality, happiness, and stress). Before completing the well-being questionnaire, participants took part in an experiment that tested the effect of viewing nature images or urban images on well-being measures. The results showed that nature near home and nature viewed from the windows contributed to higher levels of well-being, and that being in nature on the preceding day was associated with higher levels of positive affect. These benefits emerged even among those who had been economically harmed by the pandemic. Viewing nature images was also associated with level of well-being, mainly to reduced level of stress and negative affect. The current findings extend the understanding of the benefits of access to nature during stressful times, particularly during emergencies when accessing remote nature is impossible. Furthermore, the findings highlight the dual effect of contact with nature on well-being: enhancement of positive affect together with reduction of negative affect and stress. The findings indicate that exposure to nature is much more valuable for women than for men. These findings are highly important in view of gender differences in pandemic's impact on people's well-being.

Exhausted due to the pandemic: Validation of Coronavirus Stress Measure and COVID-19 Burnout Scale in a Polish sample

This study validated Polish versions of the Coronavirus Stress Measure (CSM) and the COVID-19 Burnout Scale (COVID-19-BS) to measure stress and burnout associated with COVID-19. Participants were 431 Polish young adults (72.6% female; Meanage = 26.61 ± 12.63). Confirmatory factor analysis verified a one-factor solution for both the CSM and the COVID-19-BS. Both scales had high internal consistency reliability. Coronavirus stress and COVID-19 burnout were positively related to depression, anxiety, and stress and negatively related to resilience. The coronavirus stress and COVID-19 burnout were correlated with elevated levels of depression, anxiety, and stress over and beyond resilience, age, and gender. Findings suggest that the Polish versions of the CSM and the COVID-19-BS are valid scales to measure stress and burnout related to COVID-19. Findings also demonstrated that the coronavirus stress and COVID-19 burnout experienced during the later stages of the pandemic might be a permanent risk factor for mental health problems.

Changes in young adults' mental well-being before and during the early stage of the COVID-19 pandemic: disparities between ethnic groups in Germany

BACKGROUND

The COVID-19 pandemic resulted in substantial disruptions to the daily lives of young people. Yet knowledge is lacking about changes in mental well-being among young adults, whether those from ethnic minorities were more adversely impacted by the pandemic than the ethnic majority, and the extent to which pandemic-related stressors contributed to any declines in mental well-being.

METHODS

We draw on nationally representative German CILS4COVID data, collected early in the pandemic (N = 3517, Mage = 25). Respondents provided information on mental well-being (psychosomatic complaints, anxiety, depression, life satisfaction) and exposure to pandemic-related stressors (financial worries, health worries, discrimination, contact with COVID-19). Responses on mental well-being were matched to responses from two pre-pandemic waves. Individual fixed effects regressions examined ethnic group differences in changes in mental well-being prior to, and at the early stage of, the pandemic. Path analysis tested the role of pandemic-related stressors in declines in mental well-being.

RESULTS

Overall, young adults' mental well-being had improved at the pandemic assessment compared to pre-pandemic assessments, and few ethnic group differences in changes were found. However, greater pandemic-related stressors were associated with worsened mental well-being at the pandemic assessment. Among Asian minorities, indirect effects were found on anxiety via health worries, and on depression via health worries and discrimination. For Turkish, Middle Eastern and African minorities, indirect effects on anxiety and depression were found via health worries.

CONCLUSIONS

We did not find widespread declines in mental well-being among young adults at the early stage of the pandemic, and changes in mental well-being prior to and at the early stage of the pandemic were mostly similar across ethnic German and minority groups. Nevertheless, pandemic-related stressors posed risks for young adults' mental well-being, particularly increased discrimination and health worries among Asian minorities, and health worries among Turkish, Middle Eastern and African minorities.

Mental Well-Being during COVID-19: A Cross-Sectional Study of Fly-In Fly-Out Workers in the Mining Industry in Australia

Coronavirus disease 2019 (COVID-19) has devastated the world, and its mental health impact has been recognized in the general population. However, little is known about the mental health impact of COVID-19 on fly-in fly-out (FIFO) workers, who are flown to temporarily stay and work in remote areas, during this pandemic. This study examined the mental well-being of FIFO workers in the mining industry during COVID-19 restrictions in Western Australia. An online survey was conducted between May to November 2020 among (N = 842) FIFO workers who underwent COVID-19 screening at a large mining company in Western Australia. The mental well-being score among workers was higher than population norms. One-way ANOVA with Bonferroni post-hoc tests showed significant differences in mental well-being by age, being placed under travel quarantine, undertaking self-isolation, impact of social distance guidelines, and experience of COVID-19 related symptoms. Multiple linear regression analysis showed workers who were younger, placed under travel quarantine and experienced two or more COVID-19 related symptoms were more likely to have worse mental well-being. Acknowledging the negative emotions and distress experiences among the vulnerable groups could help in providing suitable support to help lessen these negative experiences in FIFO workers.

Need for cognitive closure predicts stress and anxiety of college students during COVID-19 pandemic

The COVID-19 pandemic has taken a massive toll on mental well-being. The unprecedented level of uncertainty associated with the pandemic may be a contributing factor to stress and anxiety, especially among individuals with high intolerance to uncertainty (Rettie & Daniels, 2021). Individual differences in need for cognitive closure have also been linked to mental distress during unpredictable situations (Berenbaum et al., 2008). The present study tested the hypothesis that individuals with a high need for cognitive closure would experience relatively higher stress and anxiety during the COVID-19 pandemic. College students (N = 400) completed an abbreviated Need for Closure Scale (Roets & Van Hiel, 2011), the Generalized Anxiety Disorder Scale (Spitzer et al., 2006), and the short-version of the Perceived Stress Scale (Cohen & Williamson, 1988). Results supported the hypothesized relationship between high need for cognitive closure and higher levels of stress and anxiety. Findings have relevance to college students who are experiencing heightened psychological stress during the COVID-19 pandemic.

Relationships among the Internal Health Locus of Control, Mental Health Problems, and Subjective Well-Being of Adults in South Korea

The purpose of this study was to confirm the relationship between internal health locus of control, mental health problems, and subjective well-being in adults during the prolonged COVID-19 pandemic. In particular, the mediating effect of mental health problems on the relationship between internal health locus of control and subjective well-being was examined. A cross-sectional descriptive design was conducted via online survey. The participants were 600 adults over 20 years of age living in South Korea. The collected data were analyzed using hierarchical regression analysis and SPSS Process Macro (Model 4). As a result of the study, the internal health locus of control had a significant negative effect on mental health problems. In addition, in the process of the internal health locus of control affecting subjective well-being, the mediating effect of mental health problems was significantly shown. In the period of an infectious disease pandemic such as COVID-19, it is necessary to establish a strong internal health locus of control of individuals and to promote monitoring and treatment introduction for those with a low internal health locus of control. In addition, it was discussed that controlling mental health problems can improve subjective well-being, which is life satisfaction and happiness.

Six Month Trajectories of COVID-19 Experiences and Associated Stress, Anxiety, Depression, and Impairment in American Adults

Background

The COVID-19 pandemic has had a profound impact on health and well-being worldwide. There is increasing research seeking to better understand the psychological impact of COVID-19 experiences. However, this research has largely been limited in size and scope.

Methods

The present study examined longitudinal trajectories of COVID-19 experiences on COVID-19 related stress, anxiety, depression, and functional impairment in a convenience sample of 788 American adults recruited through MTURK. Data was collected across four waves between March and October 2020.

Results

COVID-19 experiences were consistently associated with higher odds of probable anxiety and depression diagnoses. COVID-19 related stress also predicted large proportions of variance in anxiety, depression, and functional impairment in latent variable analyses. Overtime, the results indicated that while anxiety and depression decreased, functional impairment remained stable.

Conclusions

These findings highlight the emotional toll of the COVID-19 pandemic over time. Decreases in COVID-19 related stress, anxiety, and depression over time may reflect resiliency among respondents. Importantly, these results underscore the continued need for mental health services as associations between COVID-19 and functional impairment remained consistent over time.

The COVID-19 disaster and mental health-assessing, responding and recovering

The coronavirus disease 19 (COVID-19) pandemic is a disaster that has impacted lives globally. The purpose of this paper is to understand the linkage between COVID-19 and its impact on mental health. To reach this aim, we reviewed the literature on COVID-19 and mental conditions. Based on the literature, we identified COVID-19 as an unexpected, large-scale event that disrupted communities and caused death, destruction and trauma which upended normal existence. For mental conditions, effects of the pandemic are likely to manifest in different ways: development of symptoms in previously healthy individuals, new episodes in those with predisposition to mental disorders and development of symptoms that do not meet diagnostic criteria. The level of mental health problems varies depending on the stage of the pandemic, country, population groups and types of conditions. This also applies to the level of suicide, although suicides do not seem to have increased during the pandemic. Yet, we identified a net of factors contributing to mental conditions, in general. These factors include demographic factors (e.g. female gender, younger and older age), social factors (e.g. economically disadvantaged), mental factors (e.g. pre-existing mental conditions) and relationship factors (e.g. stressful relationship, lack of relationships). Additionally, we identified COVID-19-specific factors such as threat to own life and threat to life of loved ones, containment measures and interruption of services and social life. We further explored potentially additional suicide-related risk factors. Regardless of differences, health care and psychosocial systems were in many countries not prepared to respond to a viral disaster. Viral disaster requires that responses not only include direct care but also responses to populations that may need support due to known determinants of mental health.

The longitudinal psychological, physical activity, and financial impact of a COVID-19 lockdown on older adults in Singapore: The PIONEER-COVID population-based study

BACKGROUND

Several countries have implemented 'lockdown' measures to curb the spread of the coronavirus disease 2019 (COVID-19).

AIMS

To examine the psychological, physical activity (PA), and financial impact of a 2-month COVID-19 lockdown on older adults aged ≥60 years in Singapore, and to identify factors associated with adverse lockdown-related outcomes.

METHOD

We interviewed 496 community-dwelling adults (mean age [standard deviation]: 73.8 [7.6] years; 54.8% female) during the lockdown who had previously participated in a population-based epidemiological study. Validated questionnaires were utilised to assess loneliness and depressive symptoms at both timepoints, while inhouse questionnaires were used to assess PA and financial difficulty during lockdown. Multivariable regression models determined the lockdown-related change in loneliness and depression scores, and the factors associated with adverse outcomes.

RESULTS

Loneliness increased significantly during the lockdown period (p < 0.001) while depressive symptoms decreased (p = 0.022). Decreased PA, greater financial problems, male gender, Indian ethnicity, living alone, having a greater body mass index and perceived susceptibility to COVID-19 were all associated with worsening loneliness scores. A total of 36.9% and 19.6% participants reported decreased PA and had financial problems during the lockdown, respectively. Unemployment was associated with decreased PA, while self-employed individuals, cleaners, retail workers and smokers had greater odds of experiencing financial difficulty.

CONCLUSION

Despite a decrease in depressive symptoms, our population of older Asians reported a significant increase in loneliness and decreased PA, with one-fifth experiencing financial problems during lockdown. Our data suggest that more targeted public health efforts are needed to reduce repercussions of future lockdowns.

Nursing home staff mental health during the Covid-19 pandemic in the Republic of Ireland

BACKGROUND

Nursing homes for older adults have been disproportionately affected by the Covid-19 pandemic with increased mortality of residents and staff distress.

OBJECTIVE

To quantify the mental health of nursing home staff during the Covid-19 pandemic in the Republic of Ireland.

DESIGN/METHODS

Cross-sectional anonymous study of Republic of Ireland nursing home staff (n = 390) during the third wave of the Covid-19 pandemic. Online survey collecting demographic information, Covid-19 exposure history and mental health measures.

RESULTS

There were significant differences between nurses, healthcare assistants (HCA) and non-clinical staff history in age, ethnicity, years' experience, history of Covid-19 infection and contact with Covid-19 positive acquaintances. Moderate-severe post-traumatic stress disorder symptoms were found in 45.1% (95% confidence interval [CI] 40.2%-50.1%) of all staff. A World Health Organisation-5 (WHO-5) wellbeing index score ≤32, indicating low mood, was reported by 38.7% (95% CI, 33.9%-43.5%) of staff; significantly more nurses reported low mood. Suicidal ideation and suicide planning were reported, respectively, by 13.8% (95% CI, 10.4%-17.3%) and 9.2% (95% CI, 6.4%-12.1%) of participants with no between-group differences. HCAs reported a significantly higher degree of moral injury than non-clinical staff. Nurses were more likely to use approach coping styles than non-clinical staff. Work ability was insufficient in 24.6% (95% CI 20.3%-28.9%) of staff.

CONCLUSION

Nursing home staff report high levels of post-traumatic stress, mood disturbance and moral injury during the Covid-19 pandemic. Differences in degree of moral injury, wellbeing and coping styles were found between staff groups, which need to be incorporated into planning supports for this neglected workforce.

Effects of COVID-19-related life changes on mental health in Syrian refugees in Turkey

BACKGROUND

Mental disorders are currently the greatest global health burden. The coronavirus diseases 2019 (COVID-19) pandemic is having an adverse impact on people's mental health, particularly in vulnerable populations, such as refugees.

AIMS

The present study was designed to examine the association between COVID-19 and changes in mental health in Syrian refugees in Turkey.

METHOD

We conducted a two-wave panel survey of a representative sample of 302 of the estimated 500 000 Syrian refugees (ages 18 and older) living under humanitarian support in Istanbul (first wave between 9 and 15 July 2020 and the follow-up between 11 and 14 September 2020). We administered seven items from the CoRonavIruS Health Impact Survey in addition to one-context specific item about life changes because of COVID-19, and measures of depression (10-item Center for Epidemiologic Study Depression Scale, CESD-10), anxiety (6-item State-Trait Anxiety Inventory, STAI-6) and perceived stress (Perceived Stress Scale, PSS-4).

RESULTS

A factor analysis yielded three COVID-19 factors, labelled 'social relationships', 'stress' and 'hope.' We conducted a series of cross-lag panel analyses to test associations between the COVID-19 factors and mental health. We found associations between all COVID-19 factors and CESD-10, between COVID-19 'stress' and STAI-6, and between COVID-19 'stress' and COVID-19 'hope' and PSS-4.

CONCLUSIONS

Our measures of life changes because of the COVID-19 pandemic are associated with changes in the mental health of Syrian refugees living in Istanbul. It is therefore important that they are provided with services to reduce what may be particularly debilitating consequences of COVID-19.

Effects of an eight-week, online mindfulness program on anxiety and depression in university students during COVID-19: A randomized controlled trial

The COVID-19 pandemic has had adverse mental health effects for many groups in British society, especially young adults and university students. The present study reports secondary outcomes (i.e., symptoms of anxiety and depression) from a randomized waitlist controlled trial, with a one-month post-intervention follow-up, on the effects of a guided, eight-week mindfulness program delivered online during the COVID-19 pandemic among students at the University of Oxford. Longitudinal multilevel models showed greater reductions in anxiety but not depression symptoms for participants in the mindfulness condition relative to participants in the waitlist control condition (time X group B=-0.36, p=.025).

Temporal trends in primary care-recorded self-harm during and beyond the first year of the COVID-19 pandemic: Time series analysis of electronic healthcare records for 2.8 million patients in the Greater Manchester Care Record

BACKGROUND

Surveillance of temporal trends in clinically treated self-harm is an important component of suicide prevention in the dynamic context of COVID-19. There is little evidence beyond the initial months following the onset of the pandemic, despite national and regional restrictions persisting to mid-2021.

METHODS

Descriptive time series analysis utilizing de-identified, primary care health records of 2.8 million patients from the Greater Manchester Care Record. Frequencies of self-harm episodes between 1st January 2019 and 31st May 2021 were examined, including stratification by sex, age group, ethnicity, and index of multiple deprivation quintile.

FINDINGS

There were 33,444 episodes of self-harm by 13,148 individuals recorded during the study period. Frequency ratios of incident and all episodes of self-harm were 0.59 (95% CI 0.51 to 0.69) and 0.69 (CI 0.63 to 0.75) respectively in April 2020 compared to February 2020. Between August 2020 and May 2021 frequency ratios were 0.92 (CI 0.88 to 0.96) for incident episodes and 0.86 (CI 0.84 to 0.88) for all episodes compared to the same months in 2019. Reductions were largest among men and people living in the most deprived neighbourhoods, while an increase in all-episode self-harm was observed for adolescents aged 10-17.

INTERPRETATION

Reductions in primary care-recorded self-harm persisted to May 2021, though they were less marked than in April 2020 during the first national lockdown. The observed reductions could represent longer term reluctance to seek help from health services. Our findings have implications for the ability for services to offer recommended care for patients who have harmed themselves.

Increased suicidal ideation in the COVID-19 pandemic: an employee cohort in Japan

OBJECTIVES

This study investigated the change in suicidal ideation and its risk factors among employees. A longitudinal cohort study was conducted, starting with the baseline online survey in March 2020 (T1), followed by May (T2), and August (T3). The change in suicidal ideation from T2 to T3 and relevant factors associated with suicidal ideation at T3 were examined. Suicidal ideation significantly increased between May and August 2020 among females, younger (under 39 years old), highly educated population, and those without pre-existing mental health conditions. Factors significantly associated with suicidal ideation were younger age, suicidal ideation at T2, and with pre-existing mental health conditions. Loneliness at T2 showed a significant association with suicidal ideation, if adjusting those without pre-existing mental health conditions. National and community support is needed to target people who are likely to be left behind, such as young people and those with pre-existing mental health conditions, in the pandemic.

METHOD

A longitudinal study was conducted with a cohort of full-time employees, starting with the baseline online survey in March 2020 (time point 1), followed by May (time point 2) and August (time point 3). The change in suicidal ideation from time point 2 to 3, and relevant factors associated with suicidal ideation at time point 3, were examined.

RESULTS

Suicidal ideation significantly increased between time points 2 and 3 among women, younger people (aged <39 years), those who were highly educated and those without pre-existing mental health conditions. Factors significantly associated with suicidal ideation were younger age, suicidal ideation at time point 2 and pre-existing mental health conditions. Loneliness at time point 2 showed a significant association with suicidal ideation when adjusting for those without pre-existing mental health conditions.

CONCLUSIONS

National and community support is needed to target people who are likely to be left behind, such as young people, those with pre-existing mental health conditions and those experiencing loneliness, in the COVID-19 pandemic.

Socio-economic and demographic patterns of mental health complaints among the employed adults in Estonia

Background

Mental health problems follow a distinct socio-economic gradient and contribute to the health inequalities. The study aims to analyse the socio-economic and demographic factors of self-reported mental health complaints (stress, depressiveness, overtiredness, suicidal thoughts) among employed adult population in Estonia.

Methods

Data on 4041 employed respondents (2064 men and 1977 women) aged 20–64 years from nationally representative health surveys from years 2016 and 2018 in Estonia were used for the study. Dependent variables included self-reported stress, depressiveness, overtiredness, and suicidal thoughts. Descriptive statistics and both log-binomial and Poisson regression analysis were used to describe the socio-economic and demographic variations in these mental health complaints.

Results

More than half of the respondents had either stress, depressiveness, overtiredness or suicidal thoughts with 25% reporting two or more of mental health complaints. Lower personal income was associated with higher rates of all mental health complaints (stress, depressiveness, overtiredness, and suicidal thoughts) among employed adults in Estonia. Additionally, lower education was associated with higher prevalence of depressiveness and lower job skills predicted higher prevalence of suicidal thoughts. Higher prevalence ratios for depressiveness and overtiredness were found for women compared to men whereas Estonians had higher prevalence ratios for stress and suicidal thoughts compared to non-Estonians. All mental health complaints were more frequently reported at younger ages (compared to 50-64-year olds) and by not married or cohabiting respondents.

Conclusion

High prevalence of mental health complaints and their socio-economic and demographic patterning refer to considerable inequalities in mental health among employed adults. Policy actions targeting especially younger adults and those with financial difficulties are needed to address these early manifestations of mental health problems.

Perfectionistic Cognitions Pre-Pandemic Predict Greater Anxiety Symptoms During the Pandemic Among Emerging Adults: A Two-Wave Cross-Lagged Study

This study employed a two-wave cross-lagged panel analysis to examine associations between perfectionistic cognitions, anxiety, and depression pre-pandemic to during the pandemic in a sample of 171 (57% female, n = 98) emerging adults. Results demonstrated that perfectionistic cognitions decreased, anxiety increased, and depressive symptoms did not change pre-pandemic to during the pandemic. Cross-lagged results indicated that pre-pandemic perfectionistic cognitions predicted higher levels of anxiety symptoms (but not depressive symptoms) during the pandemic after accounting for pre-pandemic levels of anxiety and depressive symptoms. These results held with the inclusion of covariates (i.e., sex, age, education, exposure to COVID-19, whether or not participants knew someone diagnosed with COVID-19, had lost income due to the pandemic, and how often they thought about COVID-19). Psychological distress (i.e., anxiety and depressive symptoms) pre-pandemic did not predict perfectionistic cognitions during the pandemic after accounting for pre-pandemic levels of perfectionistic cognitions. Results support assertions that individuals with heightened levels of perfectionism are at an increased risk for poorer mental health during the pandemic. Findings underscore the importance of assessing perfectionistic cognitions for the prevention and treatment of anxiety symptoms among emerging adults during and post-pandemic.

Characteristics of patients in platform C19, a COVID-19 research database combining primary care electronic health record and patient reported information

BACKGROUND

Data to better understand and manage the COVID-19 pandemic is urgently needed. However, there are gaps in information stored within even the best routinely-collected electronic health records (EHR) including test results, remote consultations for suspected COVID-19, shielding, physical activity, mental health, and undiagnosed or untested COVID-19 patients. Observational and Pragmatic Research Institute (OPRI) Singapore and Optimum Patient Care (OPC) UK established Platform C19, a research database combining EHR data and bespoke patient questionnaire. We describe the demographics, clinical characteristics, patient behavior, and impact of the COVID-19 pandemic using data within Platform C19.

METHODS

EHR data from Platform C19 were extracted from 14 practices across UK participating in the OPC COVID-19 Quality Improvement program on a continuous, monthly basis. Starting 7th August 2020, consenting patients aged 18-85 years were invited in waves to fill an online questionnaire. Descriptive statistics were summarized using all data available up to 22nd January 2021.

FINDINGS

From 129,978 invitees, 31,033 responded. Respondents were predominantly female (59.6%), white (93.5%), and current or ex-smokers (52.6%). Testing for COVID-19 was received by 23.8% of respondents, of which 7.9% received positive results. COVID-19 symptoms lasted ≥4 weeks in 19.5% of COVID-19 positive respondents. Up to 39% respondents reported a negative impact on questions regarding their mental health. Most (67%-76%) respondents with asthma, Chronic Obstructive Pulmonary Disease (COPD), diabetes, heart, or kidney disease reported no change in the condition of their diseases.

INTERPRETATION

Platform C19 will enable research on key questions relating to COVID-19 pandemic not possible using EHR data alone.

Features of Mental Health Service Provision During the COVID-19 Pandemic in Specialists Who Work with Suicide Prevention in Rural Areas

The COVID-19 pandemic can influence the situation of suicide rates and mental health in rural regions even more than in major cities. The aim of the current study was to explore the functioning of mental health service provision during the COVID-19 pandemic through interviews with mental health professionals and other specialists who work with suicide prevention in rural areas. Thirty specialists were interviewed using a semi-structured interview format. The following codes were identified during the thematic analysis: providing help during the pandemic (mental health professionals and institutions adapted to the conditions of the pandemic, remote counselling makes providing help more difficult, the help is less reachable); help-seeking during the pandemic (people seek less help because of the pandemic, seeking remote help is easier, the frequency of help seeking didn’t change); the effects and governing of the pandemic situation (the pandemic can have negative effects on mental health; after the pandemic mental health might get worse; the governing of the pandemic situation in Lithuania could be more fluent). The current study reveals positive aspects of mental health professionals’ adaptivity during the pandemic, as well as severe problems which are related to the access to the mental health services during the COVID-19 pandemic.

The Relationship between Sustainable Built Environment, Art Therapy and Therapeutic Design in Promoting Health and Well-Being

At present, a smart city from the perspective of the United Nations Sustainable Development Goals (SDGs) emphasizes the importance of providing citizens with promising health and well-being. However, with the continuous impact of coronavirus disease 2019 (COVID-19) and the increase of city population, the health of citizens is facing new challenges. Therefore, this paper aims to assess the relationship between building, environment, landscape design, art therapy (AT), and therapeutic design (TD) in promoting health within the context of sustainable development. It also summarizes the existing applied research areas and potential value of TD that informs future research. This paper adopts the macro-quantitative and micro-qualitative research methods of bibliometric analysis. The results show that: the built environment and AT are related to sustainable development, and closely associated with health and well-being; the application of TD in the environment, architecture, space, and landscape fields promotes the realization of SDGs and lays the foundation for integrating digital technologies such as Building Information Modeling (BIM) into the design process to potentially solve the challenges of TD; and the principle of TD can consider design elements and characteristics from based on people's health needs to better promote human health and well-being.

The Interplay between Housing Environmental Attributes and Design Exposures and Psychoneuroimmunology Profile-An Exploratory Review and Analysis Paper in the Cancer Survivors' Mental Health Morbidity Context

Adult cancer survivors have an increased prevalence of mental health comorbidities and other adverse late-effects interdependent with mental illness outcomes compared with the general population. Coronavirus Disease 2019 (COVID-19) heralds an era of renewed call for actions to identify sustainable modalities to facilitate the constructs of cancer survivorship care and health care delivery through physiological supportive domestic spaces. Building on the concept of therapeutic architecture, psychoneuroimmunology (PNI) indicators-with the central role in low-grade systemic inflammation-are associated with major psychiatric disorders and late effects of post-cancer treatment. Immune disturbances might mediate the effects of environmental determinants on behaviour and mental disorders. Whilst attention is paid to the non-objective measurements for examining the home environmental domains and mental health outcomes, little is gathered about the multidimensional effects on physiological responses. This exploratory review presents a first analysis of how addressing the PNI outcomes serves as a catalyst for therapeutic housing research. We argue the crucial component of housing in supporting the sustainable primary care and public health-based cancer survivorship care model, particularly in the psychopathology context. Ultimately, we illustrate a series of interventions aiming at how housing environmental attributes can trigger PNI profile changes and discuss the potential implications in the non-pharmacological treatment of cancer survivors and patients with mental morbidities.

Persistent depressive symptoms during COVID-19: a national, population-representative, longitudinal study of U.S. adults

BACKGROUND

The COVID-19 pandemic and its consequences have been associated with an increase in poor population mental health. We assessed how depressive symptoms changed among U.S. adults over the course of the COVID-19 pandemic and identified the key risk factors for these symptoms.

METHODS

Longitudinal panel study of a nationally representative group of U.S. adults ages 18 years and older surveyed in March-April 2020 (Time 1; N=1441) and March-April 2021 (Time 2; N=1161) in the COVID-19 and Life Stressors Impact on Mental Health and Well-being study (CLIMB). The Patient Health Questionnaire-9 (PHQ-9) was used to define elevated depressive symptoms (cut-off ≥10) and depressive symptoms score (0-27).

FINDINGS

The prevalence of elevated depressive symptoms persisted from 27.8% in 2020 (95% CI: 24.9, 30.9) to 32.8% in 2021 (95% CI: 29.1, 36.8). Over time, the central drivers of depressive symptoms were low household income, not being married, and experiencing multiple stressors during the COVID-19 pandemic. The odds ratio of elevated depressive symptoms for low income relative to high income persons increased from 2.3 (95% CI: 1.2, 4.2) in 2020 to 7.0 (95% CI: 3.7, 13.3) in 2021. Fewer people reported experiencing 4 or more COVID-19 stressors in 2021 than in 2020 (47.5% in 2020 vs 37.1% in 2021), but the odds ratio of elevated depressive symptoms associated with 4 or more stressors relative to 1 stressor or less increased from 1.9 (95% CI: 1.2, 3.1) in 2020 to 5.4 (95% CI: 3.2, 9.2) in 2021.

INTERPRETATION

The burden of depressive symptoms in the U.S. adult population increased over the course of the COVID-19 pandemic. Mental health gaps grew between populations with different assets and stressor experiences during the COVID-19 pandemic.

FUNDING

CLIMB Time 1 was sponsored by the Rockefeller Foundation-Boston University 3-D Commission. CLIMB Time 2 was sponsored by the de Beaumont Foundation.

Suicide ideation during the COVID-19 outbreak in German university students: Comparison with pre-COVID 19 rates

Introduction

An increase of suicidal thinking within the COVID-19 pandemic has been postulated. Yet, direct comparisons with pre-COVID-19 rates are missing.

Methods

The present study investigated whether levels and rates of suicidal ideation have changed between 2016 and 2020. Data of N = 664 university students (five cohorts: 2016: n = 105, 2017: n = 117, 2018: n = 108, 2019: n = 154, 2020: n = 180) were collected by online surveys.

Results

The rate of students suffering from suicidal ideation was twice as high in 2020 than in previous years. Furthermore, levels of suicidal thinking and of depression were higher in 2020 than in 2019 and 2016.

Limitations

The sample size of the current study was rather modest and suicide ideation was assessed with a single item only.

Conclusions

The rate of students suffering from suicidal ideation was twice as high in 2020 than in previous years. Help-lines and online counselling should be promoted to the public and the possibilities of telepsychotherapy for suicidal people should be used and expanded.

The impact of social isolation and changes in work patterns on ongoing thought during the first COVID-19 lockdown in the United Kingdom

The COVID-19 pandemic led to lockdowns in countries across the world, changing the lives of billions of people. The United Kingdom's first national lockdown, for example, restricted people's ability to socialize and work. The current study examined how changes to socializing and working during this lockdown impacted ongoing thought patterns in daily life. We compared the prevalence of thought patterns between two independent real-world, experience-sampling cohorts, collected before and during lockdown. In both samples, young (18 to 35 y) and older (55+ y) participants completed experience-sampling measures five times daily for 7 d. Dimension reduction was applied to these data to identify common "patterns of thought." Linear mixed modeling compared the prevalence of each thought pattern 1) before and during lockdown, 2) in different age groups, and 3) across different social and activity contexts. During lockdown, when people were alone, social thinking was reduced, but on the rare occasions when social interactions were possible, we observed a greater increase in social thinking than prelockdown. Furthermore, lockdown was associated with a reduction in future-directed problem solving, but this thought pattern was reinstated when individuals engaged in work. Therefore, our study suggests that the lockdown led to significant changes in ongoing thought patterns in daily life and that these changes were associated with changes to our daily routine that occurred during lockdown.

Longitudinal analysis of the UK COVID-19 Psychological Wellbeing Study: Trajectories of anxiety, depression and COVID-19-related stress symptomology

COVID-19 has had a negative impact on the mental health of individuals. The aim of the COVID-19 Psychological Wellbeing Study was to identify trajectories of anxiety, depression and COVID-19-related traumatic stress (CV19TS) symptomology during the first UK national lockdown. We also sought to explore risk and protective factors. The study was a longitudinal, three-wave survey of UK adults conducted online. Analysis used growth mixture modelling and logistic regressions. Data was collected from 1958 adults. A robust 4-class model for anxiety, depression, and CV19TS symptomology distinguished participants in relation to the severity and stability of symptomology. Classes described low and stable and high and stable symptomology, and symptomology that improved or declined across the study period. Several risk and protection factors were identified as predicting membership of classes (e.g., mental health factors, sociodemographic factors and COVID-19 worries). This study reports trajectories describing a differential impact of COVID-19 on the mental health of UK adults. Some adults experienced psychological distress throughout, some were more vulnerable in the early weeks, and for others vulnerability was delayed. These findings emphasise the need for appropriate mental health support interventions to promote improved outcomes in the COVID-19 recovery phase and future pandemics.

COVID-19 and UK family carers: policy implications

Informal (unpaid) carers are an integral part of all societies and the health and social care systems in the UK depend on them. Despite the valuable contributions and key worker status of informal carers, their lived experiences, wellbeing, and needs have been neglected during the COVID-19 pandemic. In this Health Policy, we bring together a broad range of clinicians, researchers, and people with lived experience as informal carers to share their thoughts on the impact of the COVID-19 pandemic on UK carers, many of whom have felt abandoned as services closed. We focus on the carers of children and young people and adults and older adults with mental health diagnoses, and carers of people with intellectual disability or neurodevelopmental conditions across different care settings over the lifespan. We provide policy recommendations with the aim of improving outcomes for all carers.

Behavioural activation to prevent depression and loneliness among socially isolated older people with long-term conditions: The BASIL COVID-19 pilot randomised controlled trial

BACKGROUND

Older adults, including those with long-term conditions (LTCs), are vulnerable to social isolation. They are likely to have become more socially isolated during the Coronavirus Disease 2019 (COVID-19) pandemic, often due to advice to "shield" to protect them from infection. This places them at particular risk of depression and loneliness. There is a need for brief scalable psychosocial interventions to mitigate the psychological impacts of social isolation. Behavioural activation (BA) is a credible candidate intervention, but a trial is needed.

METHODS AND FINDINGS

We undertook an external pilot parallel randomised trial (ISRCTN94091479) designed to test recruitment, retention and engagement with, and the acceptability and preliminary effects of the intervention. Participants aged ≥65 years with 2 or more LTCs were recruited in primary care and randomised by computer and with concealed allocation between June and October 2020. BA was offered to intervention participants (n = 47), and control participants received usual primary care (n = 49). Assessment of outcome was made blind to treatment allocation. The primary outcome was depression severity (measured using the Patient Health Questionnaire 9 (PHQ-9)). We also measured health-related quality of life (measured by the Short Form (SF)-12v2 mental component scale (MCS) and physical component scale (PCS)), anxiety (measured by the Generalised Anxiety Disorder 7 (GAD-7)), perceived social and emotional loneliness (measured by the De Jong Gierveld Scale: 11-item loneliness scale). Outcome was measured at 1 and 3 months. The mean age of participants was aged 74 years (standard deviation (SD) 5.5) and they were mostly White (n = 92, 95.8%), and approximately two-thirds of the sample were female (n = 59, 61.5%). Remote recruitment was possible, and 45/47 (95.7%) randomised to the intervention completed 1 or more sessions (median 6 sessions) out of 8. A total of 90 (93.8%) completed the 1-month follow-up, and 86 (89.6%) completed the 3-month follow-up, with similar rates for control (1 month: 45/49 and 3 months 44/49) and intervention (1 month: 45/47and 3 months: 42/47) follow-up. Between-group comparisons were made using a confidence interval (CI) approach, and by adjusting for the covariate of interest at baseline. At 1 month (the primary clinical outcome point), the median number of completed sessions for people receiving the BA intervention was 3, and almost all participants were still receiving the BA intervention. The between-group comparison for the primary clinical outcome at 1 month was an adjusted between-group mean difference of -0.50 PHQ-9 points (95% CI -2.01 to 1.01), but only a small number of participants had completed the intervention at this point. At 3 months, the PHQ-9 adjusted mean difference (AMD) was 0.19 (95% CI -1.36 to 1.75). When we examined loneliness, the adjusted between-group difference in the De Jong Gierveld Loneliness Scale at 1 month was 0.28 (95% CI -0.51 to 1.06) and at 3 months -0.87 (95% CI -1.56 to -0.18), suggesting evidence of benefit of the intervention at this time point. For anxiety, the GAD adjusted between-group difference at 1 month was 0.20 (-1.33, 1.73) and at 3 months 0.31 (-1.08, 1.70). For the SF-12 (physical component score), the adjusted between-group difference at 1 month was 0.34 (-4.17, 4.85) and at 3 months 0.11 (-4.46, 4.67). For the SF-12 (mental component score), the adjusted between-group difference at 1 month was 1.91 (-2.64, 5.15) and at 3 months 1.26 (-2.64, 5.15). Participants who withdrew had minimal depressive symptoms at entry. There were no adverse events. The Behavioural Activation in Social Isolation (BASIL) study had 2 main limitations. First, we found that the intervention was still being delivered at the prespecified primary outcome point, and this fed into the design of the main trial where a primary outcome of 3 months is now collected. Second, this was a pilot trial and was not designed to test between-group differences with high levels of statistical power. Type 2 errors are likely to have occurred, and a larger trial is now underway to test for robust effects and replicate signals of effectiveness in important secondary outcomes such as loneliness.

CONCLUSIONS

In this study, we observed that BA is a credible intervention to mitigate the psychological impacts of COVID-19 isolation for older adults. We demonstrated that it is feasible to undertake a trial of BA. The intervention can be delivered remotely and at scale, but should be reserved for older adults with evidence of depressive symptoms. The significant reduction in loneliness is unlikely to be a chance finding, and replication will be explored in a fully powered randomised controlled trial (RCT).

TRIAL REGISTRATION

ISRCTN94091479.

Subjective Well-being during the Pandemic: A Pilot Study in the Cuban Population

Background

The study of aspects related to positive mental health and well-being in the general population with a gender approach is a necessity in the current context imposed by COVID-19.

Objective

To explore gender as a predictor of subjective well-being during COVID-19 in a sample of the Cuban population.

Design

A cross-sectional web-based survey design was adopted. The sample consisted of 129 Cuban participants. The Subjective Well-being-Reduced Scale (SW-RS) was used to explore subjective well-being in the sample. Descriptive statistics were used to explore the participants' characteristics. A multinomial logistic regression analysis was conducted to identify variables independently associated with the participants' subjective well-being.

Results

The gender of participants significantly predicted subjective well-being levels. The probability of males having middle or high levels of subjective well-being, rather than low levels, was 4.16 times greater than in females. The probability of males having a high self-image instead of a low one was 4.35 times greater than in females. According to the self-satisfaction dimension, the odds of males having high rather than low self-satisfaction were five times more than in females. In this sample, gender did not predict whether participants had middle or high levels of the hedonic dimension.

Conclusion

Our results corroborated international studies that have indicated the coincidence of lower well-being and greater psychosocial risk in women during the COVID-19 pandemic. The results also indicated the need to dig deeper into the experiences of subjective well-being from a gender perspective, and to strengthen the sufficiency and effectiveness of the actions and guidance that are offered to the population from psychological care services, the media, and public policies.

Feelings of Entrapment during the COVID-19 Pandemic Based on ACE Star Model: A Concept Analysis

This study aimed to analyze the concept of the "feelings of entrapment" during the COVID-19 (coronavirus disease 2019) pandemic using a systematic review. We included literature based on content and outcomes related to feelings of entrapment, such as antecedents, attributes, and consequences. The exclusion criteria were studies that did not have inappropriate subject, content, conceptual definition, and degree thesis was excluded. Walker and Avant's process of concept analysis was used in this systematic literature review. The attributes of the concept of feelings of entrapment during the COVID-19 pandemic were found to be feelings of: (1) being out of control, (2) no escape, (3) being trapped, (4) being robbed, and (5) hopelessness. The causes for these were identified as (1) the COVID-19 pandemic, (2) lockdown system, (3) restricted situation, (4) uncertain future, (5) economic hardship, and (6) poor coping abilities. Consequences of the concept were: (1) increased suicide, (2) decreased mental health, and (3) decreased well-being. In situations such as COVID-19, it is important need to know what feelings of entrapment's antecedents and attributes are to prevent suicide and enhance mental health and well-being. Based on the results of this study, counseling services, policies, and systems for relieving feelings of entrapment in the COVID-19 situation are recommended.

Efficacy of the FIBROWALK Multicomponent Program Moved to a Virtual Setting for Patients with Fibromyalgia during the COVID-19 Pandemic: A Proof-of-Concept RCT Performed Alongside the State of Alarm in Spain

FIBROWALK is a multicomponent program including pain neuroscience education, therapeutic exercise, cognitive behavioral therapy and mindfulness training that has recently been found to be effective in patients with fibromyalgia (FM). This RCT started before the COVID-19 pandemic and was moved to a virtual format (i.e., online videos) when the lockdown was declared in Spain. This study is aimed to evaluate the efficacy of a virtual FIBROWALK compared to Treatment-As-Usual (TAU) in patients with FM during the first state of alarm in Spain. A total of 151 patients with FM were randomized into two study arms: FIBROWALK plus TAU vs. TAU alone. The primary outcome was functional impairment. Secondary outcomes were kinesiophobia, anxiety and depressive symptomatology, and physical functioning. Differences between groups at post-treatment assessment were analyzed using Intention-To-Treat (ITT) and completer approaches. Baseline differences between clinical responders and non-responders were also explored. Statistically significant improvements with small-to-moderate effect sizes were observed in FIBROWALK+TAU vs. TAU regarding functional impairment and most secondary outcomes. In our study, the NNT was 5, which was, albeit modestly, indicative of an efficacious intervention. The results of this proof-of-concept RCT preliminarily support the efficacy of virtual FIBROWALK in patients with FM during the Spanish COVID-19 lockdown.

Everyday Life Meaningfulness for the Community-Dwelling Oldest Old During the COVID-19 Pandemic

In many countries, the COVID-19 pandemic has led to strong restrictions and changed the everyday lives of older people. In Finland, people aged 70 and over were instructed to stay at home under quarantine-like conditions. Existing studies from other countries have reported increases in negative experiences and symptoms as a result of such restrictions, including psychosocial stress. However, little focus has been given to older people's experiences of meaningfulness during the pandemic. Using survey and interview data, we ask to what extent have community-dwelling oldest old (80+) experienced meaningfulness during the pandemic, what background factors are associated with meaningfulness and what factors have contributed to everyday life meaningfulness during the pandemic. The data was collected as part of the COVID-19 sub-study of the third follow-up of the Cardiovascular Risk Factors, Aging and Dementia (CAIDE85+) study, a Finnish population-based cohort study carried out in the eastern part of the country. In the quantitative analyses, meaningfulness was assessed as part of the Experiences of Social Inclusion Scale. The association of meaningfulness with different background factors (gender, age, living alone, self-chosen quarantine or physical isolation, self-rated health, physical functioning, and cognitive capacity) was explored with the Chi-square test. The quantitative findings indicate that the majority of the participants experienced meaningfulness during the pandemic. Participants who did not practice any physical isolation measures and participants with higher self-rated health experienced more meaningfulness. There was no evidence for difference in the prevalence of meaningfulness and other background factors. The qualitative data was analyzed using thematic analysis. The findings indicated that factors contributing to meaningfulness in everyday life were social contacts, daily chores and activities, familiar places and seasonal changes. The small sample size does not provide possibilities for generalizing the results into the wider population of older adults. However, the results provide new understanding of the oldest old's experiences of meaningfulness in everyday life during the global pandemic. The findings may help find ways to support older people's meaningfulness in challenging times.

Rebooting Mental Health Care Delivery for the COVID-19 Pandemic (and Beyond): Guiding Cautions as Telehealth Enters the Clinical Mainstream

Across the COVID-19 pandemic, we have witnessed perhaps the field’s largest and most abrupt transformation in scope of practice. In the context of surging mental health needs and historically limited feasibility of traditional office-based services during the pandemic, telehealth has launched into the clinical mainstream and has become a dominant mode of outpatient mental health care delivery. The articles in this terrific Special Issue outline some of the field’s most exciting innovations from the past 18 months. The present commentary discusses how these unprecedented times have prompted unprecedented resourcefulness and innovation in the field. Issues related to evolving and uncertain telehealth regulation and reimbursement policies are discussed, and cautions for the road ahead are offered as we prepare for post-pandemic practices. The commentary concludes with a call to redouble efforts to move beyond the use of telehealth to largely treat only those populations who already enjoyed access to traditional office-based services. Understanding and overcoming barriers to telehealth care and ensuring equitable access to telehealth options are critical steps for actualizing the great potential of telehealth strategies for increasing the reach of supported care to underserved populations.

Cultivating Resilience During the COVID-19 Pandemic: A Socioecological Perspective

The coronavirus disease 2019 (COVID-19) pandemic poses wide-ranging impacts on the physical and mental health of people around the world, increasing attention from both researchers and practitioners on the topic of resilience. In this article, we review previous research on resilience from the past several decades, focusing on how to cultivate resilience during emerging situations such as the COVID-19 pandemic at the individual, organizational, community, and national levels from a socioecological perspective. Although previous research has greatly enriched our understanding of the conceptualization, predicting factors, processes, and consequences of resilience from a variety of disciplines and levels, future research is needed to gain a deeper and comprehensive understanding of resilience, including developing an integrative and interdisciplinary framework for cultivating resilience, developing an understanding of resilience from a life span perspective, and developing scalable and cost-effective interventions for enhancing resilience and improving pandemic preparedness. Expected final online publication date for the Annual Review of Psychology, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Hospitalization for self-harm during the early months of the COVID-19 pandemic in France: A nationwide retrospective observational cohort study

Background

Little is known to date about the impact of COVID-19 pandemic on self-harm.

Methods

The number of hospitalizations for self-harm (ICD-10 codes X60-X84) in France from 1st January to 31st August 2020 (including a two-month confinement) was compared to the same periods in 2017-2019. Statistical methods comprised Poisson regression, Cox regression and Student's t-test, plus Spearman's correlation test relating to spatial analysis of hospitalizations.

Outcomes

There were 53,583 self-harm hospitalizations in France during January to August 2020. Compared to the same period in 2019, this represents an overall 8·5% decrease (Relative Risk [95% Confidence Interval] = 0·91 [0·90-0·93]).This decrease started in the first week of confinement and persisted until the end of August. Similarly, decrease was found in both women (RR=0·90 [0·88-0·92]) and men (RR=0·94 [0·91-0·95]), and in all age groups, except 65 years and older. Regarding self-harm hospitalizations by means category, increases were found for firearm (RR=1·20 [1·03-1·40]) and for jumping from heights (RR=1·10 [1·01-1·21]). There was a trend for more hospitalizations in intensive care (RR=1·03 [0·99-1·07]). The number of deaths at discharge from hospital also increased (Hazard Ratio = 1·19 [1·09-1·31]). Self-harm hospitalizations were weakly correlated with the rates of hospitalization for COVID-19 across administrative departments (Spearman's rho =-0·21; p = 0·03), but not with overall hospitalizations.

Interpretation

The COVID-19 pandemic had varied effects on self-harm hospitalizations during the early months in France. Active suicide prevention strategies should be maintained.

Funding

French National Research Agency.

Psychiatric emergency admissions during and after COVID-19 lockdown: short-term impact and long-term implications on mental health

BACKGROUND

The 'lockdown' measures, adopted to restrict population movements in order to help curb the novel coronavirus disease 2019 (COVID-19) pandemic, contributed to a global mental health crisis. Although several studies have extensively examined the impact of lockdown measures on the psychological well-being of the general population, little is known about long-term implications. This study aimed to identify changes in psychiatric emergency department (ED) admissions between two 8-week periods: during and immediately after lifting the lockdown.

METHODS

Socio-demographic and clinical information on 1477 psychiatric ED consultations at the University Hospital of Geneva (HUG) were retrospectively analyzed.

RESULTS

When grouped according to admission dates, contrary to what we expected, the post-lockdown group presented with more severe clinical conditions (as measured using an urgency degree index) compared to their lockdown counterparts. Notably, after the lockdown had been lifted we observed a statistically significant increase in suicidal behavior and psychomotor agitation and a decrease in behavior disorder diagnoses. Furthermore, more migrants arrived at the HUG ED after the lockdown measures had been lifted. Logistic regression analysis identified diagnoses of suicidal behavior, behavioral disorders, psychomotor agitation, migrant status, involuntary admission, and private resident discharge as predictors of post-lockdown admissions.

CONCLUSIONS

Collectively, these findings can have implications concerning the prioritization of mental health care facilities and access for patients at risk of psychopathological decompensation in time of confinement policies, but above all, provide a foundation for future studies focusing on the long-term impact of the pandemic and its associated sanitary measures on mental health.

TRIAL REGISTRATION

Research Ethics Committee of Geneva, Registration number 2020-01510, approval date: 29 June 2020.

Ontario adults' health behaviors, mental health, and overall well-being during the COVID-19 pandemic

BACKGROUND

Public health measures such as physical distancing and work-from-home initiatives have been implemented to slow the spread of COVID-19. These measures may also be associated with unhealthy lifestyle behaviors, which could be particularly problematic for those already at highest risk for losing years of healthy life due to chronic disease (i.e., 30-59-year-olds). The purpose of this paper is two-fold: (1) to provide an overview of Ontario adults' health behaviors (i.e., physical activity, sedentary behaviors, and dietary intake), mental health, and well-being during the first few months of the COVID-19 pandemic (April-July 2020); and (2) to explore the difference between physical activity and various health behaviors (i.e., well-being, mental health, and dietary intake).

METHODS

As a part of a larger, longitudinal study, participants completed an online survey that included demographic information, the Global Physical Activity Questionnaire, Starting the Conversation, the Mental Health Inventory, and the Personal Wellbeing Index-Adult. Data analyses involved computing measures of central tendency and dispersion for demographic characteristics and tools followed by descriptive statistics. Separate independent t-tests were conducted to investigate the difference between physical activity status and well-being, mental health, and dietary intake.

RESULTS

A total of 2157 Ontarians completed an online survey. Descriptive statistics indicated that respondents met physical activity and sedentary behavior guidelines, reported double the amount of recommended recreational screen time, practiced moderately healthy dietary behaviors, experienced mental health problems, and scored below "normal" in some well-being domains.

CONCLUSION

As the end of the COVID-19 pandemic is currently unknown, its associated restrictions and society changes may influence adults' behaviors in both the short- and longer-term. As such, our findings might provide immediate insight into the development of timely and evidence-informed health promotion and disease prevention strategies for Canadians, which could support adults' health behaviors, mental health, and well-being during the COVID-19 pandemic and other, future pandemics.

Impacts of COVID-19 Pandemic on the Mental Health of Working Adults in the Czech Republic: Analysis of Self-Report Psychological Data in a One Year Perspective

The article presents research evidence on psychological impacts of the COVID-19 pandemic on the economically active Czech population aged 18–64 (n = 1603; 365 men and 1238 women) within a one year perspective. The aim is to describe the differences in the reported mental health indicators (anxiety, depression, and distress) for women and men in the four age groups, two groups with different working statuses (continuation of work/interrupted working status), and between two phases of the epidemic (March to May 2020 and September 2020 to February 2021). The results point to elevated scores of negative mental health indicators (anxiety, depression, and distress) in different subgroups. More negative experiences in a pandemic situation were found, especially in groups of women, people under the age of 35, and among people with interrupted working status. The results also indicate a deterioration of symptoms over time during the epidemic.

Risk factors for depression during the COVID-19 pandemic: a longitudinal study in middle-aged and older adults

BACKGROUND

The COVID-19 pandemic and resultant social restrictions have had widespread psychological ramifications, including a rise in depression prevalence. However, longitudinal studies on sociodemographic risk factors are lacking.

AIMS

To quantify longitudinal changes in depression symptoms during the pandemic compared with a pre-pandemic baseline, in middle-aged and older adults, and identify the risk factors contributing to this.

METHOD

A total of 5331 participants aged ≥50 years were drawn from the English Longitudinal Study of Ageing. Self-reported depression symptoms in June/July 2020 were compared with baseline data from 2-3 years prior. Regression models investigated sociodemographic and lifestyle variables that could explain variance in change in depression.

RESULTS

Within-participant depression scores increased significantly from pre-pandemic levels: 14% met the criteria for clinical depression at baseline, compared with 26% during the pandemic. Younger age, female gender, higher depression scores at baseline, living alone and having a long-standing illness were significant risk factors. Gender-stratified regression models indicated that older age was protective for women only, whereas urban living increased risk among women only. Being an alcohol consumer was a protective factor among men only.

CONCLUSIONS

Depression in UK adults aged ≥50 years increased significantly during the pandemic. Being female, living alone and having a long-standing illness were prominent risk factors. Younger women living in urban areas were at particularly high risk, suggesting such individuals should be prioritised for support. Findings are also informative for future risk stratification and intervention strategies, particularly if social restrictions are reimposed as the COVID-19 crisis continues to unfold.

Mental well-being during the first months of Covid-19 in adults and children: behavioral evidence and neural precursors

Pandemics such as the Covid-19 pandemic have shown to impact our physical and mental well-being, with particular challenges for children and families. We describe data from 43 adults (31♀, ages = 22-51; 21 mothers) and 26 children (10♀, ages = 7-17 years) including pre-pandemic brain function and seven assessment points during the first months of the pandemic. We investigated (1) changes in child and adult well-being, (2) mother-child associations of mental well-being, and (3) associations between pre-pandemic brain activation during mentalizing and later fears or burden. In adults the prevalence of clinically significant anxiety-levels was 34.88% and subthreshold depression 32.56%. Caregiver burden in parents was moderately elevated. Overall, scores of depression, anxiety, and caregiver burden decreased across the 11 weeks after Covid-19-onset. Children's behavioral and emotional problems during Covid-19 did not significantly differ from pre-pandemic levels and decreased during restrictions. Mothers' subjective burden of care was associated with children's emotional and behavioral problems, while depression levels in mothers were related to children's mood. Furthermore, meeting friends was a significant predictor of children's mood during early restrictions. Pre-pandemic neural correlates of mentalizing in prefrontal regions preceded later development of fear of illnesses and viruses in all participants, while temporoparietal activation preceded higher subjective burden in mothers.

COVID-19 and Risk Factors of Anxiety and Depression in South Korea

OBJECTIVE

The aims of this study were to explore the prevalence of and identify predictors of anxiety and depression related to coronavirus disease of 2019 (COVID-19) in South Korea.

METHODS

The analysis is based on a quota survey design and a sampling frame that permitted recruitment of a national sample of 1,014 individuals between March 17-31, 2020. Several standardized measurements were used, including GAD-7, PHQ-9, COVID-19 related fear, restrictions in deaily life, as well as sociodemographic information and physical and psychosocial needs during the pandemic. Multiple logistic regression was conducted to analyze the influence of sociodemographic factors, fear, and physical/psychosocial needs on anxiety and depression.

RESULTS

Significant numbers of the respondents were identifiable anxiety (19.0%) and depression group (17.5%), respectively. This indicates that the depression and anxiety prevalence rate after the COVID-19 is substantially high compared to the depression rate of 2.6% in 2020 and 2.8% in 2018 both reported in the Korea Community Health Survey and the anxiety rate of 5.7% reported in 2016 Survey of Mental Disorders in Korea. Multiple logistic regression results showed age, COVID-19 related fear, and the level of restrictions in daily as significant factors in understanding and predicting the anxiety group. Likfewise, the COVID-19 related fear, restrictions in daily life, and need for economic support were important predictors in predicting the depression group.

CONCLUSION

Findings on predictors for greater vulnerability to anxiety and depression has important implications for public mental health in the context of the COVID-19 pandemic.

Impact of COVID-19 restrictions on alcohol consumption behaviours

BACKGROUND

We aimed to evaluate how coronavirus (COVID-19) restrictions had altered individual's drinking behaviours, including consumption, hangover experiences, and motivations to drink, and changing levels of depression and anxiety.

METHOD

We conducted an online cross-sectional self-report survey. Whole group analysis compared pre- versus post-COVID restrictions. A correlation coefficient matrix evaluated the associations between all outcome scores. Self-report data was compared with Alcohol Use Disorders Identification Test (AUDIT) scores from the 2014 Adult Psychiatric Morbidity Survey. Multiple linear modelling (MLM) was calculated to identify factors associated with increasing AUDIT scores and post-restriction AUDIT scores.

RESULTS

In total, 346 individuals completed the survey, of which 336 reported drinking and were therefore analysed. After COVID-19 restrictions 23.2% of respondents reported an increased AUDIT score, and 60.1% a decreased score. AUDIT score change was positively correlated with change in depression (P < 0.01, r = 0.15), anxiety (P < 0.01, r = 0.15) and drinking to cope scores (P < 0.0001, r = 0.35). MLM revealed that higher AUDIT scores were associated with age, mental illness, lack of a garden, self-employed or furloughed individuals, a confirmed COVID-19 diagnosis and smoking status.

CONCLUSIONS

COVID-19 restrictions decreased alcohol consumption for the majority of individuals in this study. However, a small proportion increased their consumption; this related to drinking to cope and increased depression and anxiety.