The association between sociodemographic inequalities, COVID-related impacts and mental health

Investigating inequalities in patient outcomes for first-episode psychosis

BACKGROUND

Understanding inequalities in outcomes between demographic groups is a necessary step in addressing them in clinical care. Inequalities in treatment uptake between demographic groups may explain disparities in outcomes in people with first-episode psychosis (FEP).

AIMS

To investigate disparities between broad demographic groups in symptomatic improvement in patients with FEP and their relationship to treatment uptake.

METHOD

We used data from 6813 patients from the 2021-2022 National Clinical Audit of Psychosis data-set. Data were grouped by category type to obtain mean outcomes before adjustment to see whether disparities in outcomes remained after differences in treatment uptake had been accounted for. After matching, the average effect of each demographic variable in terms of outcome change was calculated. Moderator effects on specific treatments were investigated using interaction terms in a regression model.

RESULTS

Observational results showed that patients aged 18-24 years were less likely to improve in outcome, unless adjusted for intervention uptake. Patients classified as Black and Black British were less likely to improve in outcome (moderation effect 0.04, 95% CI 0-0.07) after adjusting for treatment take-up and demographic factors. Regression analysis showed the general positive effect of supported employment interventions in improving outcomes (coefficient -0.13, 95% CI -0.07 to -0.18, P < 0.001), and moderator analysis suggested targeting particular groups for interventions.

CONCLUSIONS

Inequalities in treatment uptake and psychotic symptom outcome of FEP by social and demographic factors require monitoring over time. Our analysis provides a framework for monitoring health inequalities across national clinical audits in the UK.

Anxiety symptoms and risk factors in patients with SARS-CoV-2 Omicron variant in Shanghai, China

OBJECTIVES

The psychological effects of the COVID-19 pandemic have been shown to include anxiety. However, the association between demographic and physiological factors in COVID-19-associated anxiety symptoms is poorly understood. Therefore, the present cross-sectional study was conducted to examine anxiety symptoms and associated factors among patients with the SARS-CoV-2 Omicron variant during the quarantine period in Shanghai.

METHODS

The study was conducted between April 16, 2022, and May 21, 2022, at Fangcang Shelter Hospital in Shanghai, China. Data were collected using an anonymous online questionnaire. Demographic characteristics, respiratory symptoms, vaccine dose, comorbidities (such as hypertension and diabetes), type of work, and mental health symptoms were evaluated. Logistic regression was used to examine the relationship between anxiety symptoms and risk factors. Stratified analyses were performed to investigate potential interactions.

RESULTS

A total of 2132 patients with confirmed Omicron variant SARS-CoV-2 infection were enrolled. The results demonstrated that female gender (OR = 1.47, 95% CI = 1.11-1.94), nonmanual labor (OR = 1.62, 95% CI = 1.25-2.09), respiratory symptoms (OR = 3.19, 95% CI = 2.30-4.43), and having other comorbidities (OR = 1.65, 95% = 1.09-2.50) were positively associated with anxiety symptoms. A significant interaction was found between gender and (a) nonmanual labor (OR = 1.54, 95% = 1.29-1.85), (b) respiratory symptoms (OR = 2.06, 95% = 1.72- 2.48), and (c) comorbidities (OR = 1.57, 95% = 1.16-2.12), such that the relationship with anxiety symptoms was stronger in women compared to men. There were also significant interactions between age group and (a) nonmanual labor (stronger in those ages >46) and (b) respiratory symptoms (stronger in those ages 36-45) regarding the association with anxiety symptoms.

CONCLUSIONS

Alleviation of respiratory symptoms, addressing comorbidities, and implementation of both psychological and psychopharmacological treatments may help reduce anxiety symptoms following infection with the SARS-CoV-2 Omicron variant in mainland China.

Fluctuations in Mediterranean Diet Adherence Pre- and Post-Pandemic: A Study of Portuguese Cohorts 2019-2024

BACKGROUND/OBJECTIVES

The Mediterranean Diet (MD) is a lifestyle offering numerous health benefits. Nevertheless, the adherence to the MD is moderate even in Mediterranean countries. While sociodemographic factors influence MD adherence, additional impacts occurred due to the COVID-19 pandemic. This cross-sectional longitudinal study with three cohorts of Portuguese adults analyzes MD adherence before, during, and after the COVID-19 pandemic, and explores the effect of sociodemographic variables.

METHODS

Sociodemographic factors, lifestyle habits, and MD adherence were assessed in the years 2019, 2021, and 2024 with an online self-filled questionnaire. MD adherence was measured with the Mediterranean Diet Adherence Screener (MEDAS).

RESULTS

MEDAS score increased significantly (p < 0.05) from 2019 to 2021 (6.2 ± 0.7 to 7.7 ± 0.1), followed by a significant (p < 0.05) decrease in 2024 (7.2 ± 0.1) relative to 2019, which was more pronounced in participants with higher income. Accordingly, a trend in healthier food choices was observed followed by a decline in 2024. Of note is the significant increase in red meat consumption (p < 0.05) in 2024 relative to 2021. Respondents who consumed more red meat were mostly men, employed, or in a stable relationship. Most respondents practiced sport "Never or occasionally" in 2019 and 2021 (59.4 and 55.2%, respectively); in 2024, this category was significantly (p < 0.05) reduced (40.9%); men or higher-income participants were more likely to meet the recommended activity levels.

CONCLUSIONS

This study reveals that the improvements in MD lifestyle during the pandemic were not sustained in 2024, as healthier habits formed during confinement were not fully integrated into long-term behavior. These findings strengthen the need for targeted public health interventions to promote the MD.

The online world as a means of connection and disconnection during the COVID-19 pandemic: A test of the interpersonal-connections-behaviour framework

BACKGROUND

The interpersonal-connections-behaviour framework proposes that social media is helpful/unhelpful to the individual to the extent that it facilitates/hinders satisfaction of core needs for acceptance and belonging (connecting and disconnecting pathways). However, little research has, to date, explicitly tested this framework.

METHODS

Both pathways were explored in a cross-sectional sample of UK adults at the start of the pandemic (N = 632) and in longitudinal (cross-lagged) analyses (N = 227-240). Participants completed measures of online and offline socialising with friends and family (connecting pathway), and online and offline social comparisons (disconnecting pathway), anxiety, depression and loneliness.

RESULTS

In cross-sectional analyses higher levels of online comparisons were associated with poorer mental health, an effect that survived after controlling for offline comparisons, and was partially mediated by loneliness. Counter to our predictions, online socialising was also associated with poorer mental health. Longitudinal analyses did not support predicted directions of causality.

LIMITATIONS

Limitations include a lack of testing of individual-level moderators, the use of single item questions to probe some constructs, and an inability to test for effects potentially operating at different time-scales.

CONCLUSIONS

The findings reported partially support the interpersonal-connections-behaviour framework in highlighting a disconnecting (but not connecting) pathway between online engagement and mental health. From a clinical perspective they highlight the importance of including people's online lives when considering mental health risk and resilience, particularly (one might argue) during periods of social isolation.