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

Mental health during and after the COVID-19 pandemic - a longitudinal study over 42 months in five European countries

Background: The mental health impact of the COVID-19 pandemic is well documented. However, only a few studies investigated mental health in later phases of the pandemic and after its official end. Moreover, little is known about people's psychological burden related to the pandemic and other global crises post-pandemic.Objective: Study's first objective was to compare mental health outcomes in the general population over the course of the pandemic and ten months post-pandemic. The second objective was to explore people's psychological burden regarding the pandemic, in comparison to current wars, climate crises, inflation, and poor government management and/or corruption in the post-pandemic era.Method: Participants from the general population of Austria, Croatia, Germany, Greece, and Portugal (68.8% female, Mage = 41.55) were assessed online up to four times between June 2020 and March 2024 (baseline sample: N = 7913). Adjustment Disorder New Module - 8 (ADNM-8), Patient Health Questionnaire (PHQ-2), and World Health Organization-Five Well-Being Index (WHO-5) were used to measure adjustment disorder, depression, and well-being. Prevalence rates were calculated and repeated measures ANOVAs applied to assess mental health at four time points. One-way repeated measures ANOVA was run to explore how the different global crises were related to participants' burden.Results: Temporal variations in mental health were evident across four assessment waves, with highest levels of probable adjustment disorder and depression in winter 2020/2021 (T2). A slight improvement of mental health was found at later time points. Current wars and inflation were the greatest sources of psychological burden at the post-pandemic assessment, revealing some cross-country differences.Conclusion: Although mental health differences in the general population were not as pronounced as in the acute phase of the pandemic, psychosocial support is still needed post-pandemic. This is likely to be due to other global crises that take a toll on people's mental health.

An Imagination - Procrastination Link? The Role of Efficacy Beliefs, Visual Imagery, and Affect in Academic Procrastination

Previous studies have established that there is a relationship between efficacy beliefs and procrastination. Theory and research on motivation suggest that visual imagery (the capacity to create vivid mental images) may be implicated in this relationship and in the general tendency to procrastinate. This study's aim was to build on prior work by examining the role of visual imagery, as well as roles of other specific personal and affective factors, in predicting academic procrastination. Self-efficacy for self regulatory behavior was observed to be the strongest predictor, predicting lower rates of academic procrastination, though this effect was significantly greater for individuals who scored higher on a measure of visual imagery. Visual imagery predicted higher levels of academic procrastination when included in a regression model with other significant factors, though this relationship did not hold for individuals who scored higher on self regulatory self-efficacy, suggesting that this self-belief may shield individuals who would otherwise be disposed to procrastination behavior. Negative affect was observed to predict higher levels of academic procrastination, contrary to a previous finding. This result highlightsthe importance of considering social contextual issues that may influence emotional states, such as those surrounding the Covid-19 epidemic, in studies of procrastination.

Global, regional and national burdens of major depression disorders and its attributable risk factors in adolescents and young adults aged 10-24 years from 1990 to 2021

BACKGROUND

Major depressive disorder (MDD) is an important public health problem among adolescents and young adults, and its increasing prevalence underscores the need for region-specific and age-specific interventions. Despite its increasing burden, comprehensive data on regional and longitudinal trends in MDD among adolescents are scarce. This study analyzed global, regional, and national trends in MDD incidence, prevalence, and disability-adjusted life years (DALYs) among individuals aged 10-24 from 1990 to 2021, while examining differences by gender, age, socio-demographic factors, and emerging risk factors to guide targeted mental health strategies.

METHODS

With data from the 2021 Global Burden of Disease Study, we conducted an analysis of age-standardized incidence, prevalence, and DALYs due to MDD by sex, age group, and 21 geographic regions with a special focus on sociodemographic index (SDI) levels, which measures development on a scale from low to high. Key risk factors, such as bullying and intimate partner violence, were also assessed in order to understand their contribution to the burden of MDD.

RESULTS

Between 1990 and 2021, the global burden of MDD increased substantially. Prevalence rose by 56.36% globally, particularly among men and young adults aged 20-24 years, with the largest increases observed in Eastern Sub-Saharan Africa (184.26% increase). Incidence grew by 56.11%, with Eastern Sub-Saharan Africa experiencing the steepest rise compared to slower increases in other regions. DALYs also increased by 56.32%, with the greatest burden observed in Eastern Sub-Saharan Africa. Bullying and intimate partner violence were leading contributors to DALYs across all regions. Bullying and childhood sexual abuse increased MDD-related DALYs, with bullying peaking at ages 10-14, while childhood sexual abuse had a higher impact on females, rising sharply after 2006. Post- 2020, all metrics (prevalence, incidence, and DALYs) rose sharply, particularly in high-SDI regions, likely due to the specific impacts of the COVID- 19 pandemic, such as prolonged lockdowns, increased social isolation, and disruptions to mental health services.

CONCLUSIONS

This study highlights the need for culturally sensitive mental health policies focusing on prevention and early intervention, while also providing insights to improve resource allocation and support further research on adolescent mental health.

TRIAL REGISTRATION

Not applicable.

Development of a national Distress Brief Intervention: a multi-agency service to provide connected, compassionate support for people in distress

BACKGROUND

Mental health problems, self-harm and suicide are major public health concerns. Following national strategic commitments to improve the response and follow-up support for adults in Scotland presenting to frontline services in emotional distress, this study describes the development of the first national Distress Brief Intervention, a multi-agency service to provide connected, compassionate support for people in distress.

METHODS

The six step Intervention Mapping protocol was used to account for the complexity of the intervention and to guide development, testing and implementation. Data/information sources comprised: literature and evidence review; delivery partner and stakeholder consultations (n = 19); semi-structured interviews and/or focus-groups with frontline services staff experienced in responding to distress (n = 8); interviews and/or focus groups with adults with experience of distress (n = 9); feedback from test training for staff (n = 16); self-assessed confidence ratings provided by staff immediately before and following training (n = 388).

RESULTS

We developed a time-limited, two-level, complex intervention for adults experiencing emotional distress, provided by 'frontline' statutory services (primary and acute healthcare, police, ambulance) and third-sector community organisations in Scotland. Intervention components included competency-based training programmes for staff, information, protocols and guidance for providers, personalised distress management planning and behaviour change tools. During the development phase, 525 intervention providers (n = 472 frontline statutory service staff; n = 53 third-sector community organisation staff) completed training programmes in four pilot areas in Scotland. Training evaluations from 388 providers (74%) indicated significantly greater confidence following training on key competencies.

CONCLUSIONS

A multi-agency national Distress Brief Intervention was systematically developed and implemented in a range of non-specialist frontline and community settings in Scotland. Up-take of training and evaluations of training indicate it is highly acceptable to potential providers and improves key competencies. Following independent evaluation, the Distress Brief Intervention has been rolled out nationally across the whole of Scotland, and has significant potential as a model of care and prevention internationally, including countries with low statutory health resources.

Transitions in mental health care utilisation at GHU Paris between 2019 and 2024: A post-pandemic perspective

OBJECTIVE

This study aimed to analyse the long-term evolution of mental health services use following the COVID-19 pandemic.

DESIGN

This was a retrospective study, conducted from 2019 to 2024, using the Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences (GHU Paris) databases.

METHODS

We considered the number of patients consulting at GHU Paris clinics, number of patients presenting at the emergency department (ED), and number of hospital admissions per week, by sex and age group. We performed a piecewise linear regression, using a threshold approach to identify time patterns between 2019 and 2024: pre-pandemic period (T1), short-term (T2) and long-term post-pandemic period (T3). Temporal changes in mental healthcare service use were then analysed.

RESULTS

No significant overall changes were observed in the number of outpatients after the COVID-19 pandemic, except for a slight increase among patients aged 15-24 years. The number of hospital admissions remained lower in 2024 compared with 2019, with a decreasing trend in T3 for all subgroups. In contrast, the number of ED visits increased over time, with higher use of emergency services by women and young people in 2024 compared with 2019. The overall long-term trend (T3) continued to show an increasing pattern. Additionally, a reduction in schizophrenia presentations was observed, while there was an overall increase in patients with substance use or neurotic disorders.

CONCLUSIONS

Our results described transitions in mental health service use at GHU Paris between 2019 and 2024, highlighting reduced hospital admissions, increased psychiatric emergencies, and changes in the reasons for seeking care.

Flourishing During the COVID-19 Pandemic: A Longitudinal Study in South Africa

In this longitudinal study, we examine changes in psychological distress and multidimensional well-being from before to during the COVID-19 pandemic among South African adults. As a secondary purpose, we explore whether pre-pandemic flourishing is protective against subsequent psychological distress during the public health crisis. The analytic sample (n = 293; Mage = 44.27, SD = 14.28; female = 65.19%) completed measures of anxiety symptoms, depression symptoms, and well-being shortly before the stringent nationwide lockdown started in South Africa (T1). A follow-up assessment was completed approximately 6 months later (T2). Paired samples t-tests supported very small improvements in anxiety (d = -0.09) and depression symptoms (d = -0.13). For domains of well-being, small increases were found in close social relationships (d = 0.25) and financial and material stability (d = 0.19). Positive changes in the domains of character and virtue (d = 0.10) and meaning and purpose (d = 0.07) were very small. Changes in physical and mental health (d = -0.03) and life satisfaction and happiness (d = 0.02) were more negligible. Results from the generalized linear models indicated that continuous scores of secure flourishing assessed before the COVID-19 pandemic were associated with lower subsequent psychological distress (particularly depression symptoms) during the public health crisis. We discuss the implications of the findings for the development and delivery of interventions to promote and sustain human flourishing during public health crises, especially in contexts of social-structural vulnerability.

Psychological health of healthcare workers during Shanghai lockdown: Prevalence and associated factors

The 2022 Shanghai COVID-19 lockdown may lead to mental health issues among healthcare workers (HCWs). A cross-sectional study was conducted to investigate psychological health and its associated factors among HCWs. A total of 253 hCWs were recruited in Shanghai, China, through convenience sampling method. Demographic Questionnaire, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Insomnia Severity Index, and The Impact of Event Scale-Revised were used to assess demographic information, anxiety, depression, insomnia, and post-traumatic stress disorder (PTSD), respectively. The associated factors of psychological health were identified by binary logistic regression analysis. The prevalence of anxiety, depression, insomnia, and PTSD was 6.3%, 10.3%, 9.9% and 17.8%, respectively. Female HCWs were more likely to report anxiety (OR = 5.50, 95%CI = [1.45-20.82], p < 0.05) and PTSD (OR = 3.20, 95%CI= [1.23-8.28], p < 0.05). Besides, being a nurse was associated with a lower level of PTSD symptoms (OR = 0.23, 95%CI = [0.07-0.76], p < 0.05). Symptoms of psychological health were screened positive in HCWs during the 2022 Shanghai COVID-19 lockdown. Gender and occupation were associated with psychological health. The hospital authorities of Shanghai need to pay special attention to female HCWs.

Five-year changes in loneliness and mental health among adults 41-85 years: the Doetinchem Cohort Study

BACKGROUND

Both loneliness and mental health represent important public health themes with stable or even worsening population figures. The association between loneliness and mental health is cross-sectionally well-established, but longitudinal studies are scarce. The aim of this study is to explore the individual changes in loneliness and mental health and the relation between these changes.

METHODS

We used data from wave 5 (years: 2007-2012, n: 4016) and wave 6 (years: 2013-2017, n: 3437) of the Doetinchem Cohort Study, consisting of participants aged 41-86 years. Loneliness was measured using the De Jong-Gierveld 6-item Loneliness Scale and mental health was measured with the 5-item Mental Health Inventory. We assessed changes in loneliness and mental health over a 5-year period. Generalised estimating equations and linear regression were performed to determine the longitudinal association. Associations were adjusted for various sociodemographic, lifestyle and health factors.

RESULTS

Over a 5-year period, 23.4% experienced a change in loneliness and 9.7% in mental health.Higher levels of loneliness were significantly associated with poor mental health both cross-sectionally and over time (β:-3.56, 95% CI: -3.79 to -3.32). Increasing feelings of loneliness were associated with worsening mental health, and decreasing feelings of loneliness were associated with improving mental health (β:-2.35, 95% CI: -2.61 to -2.08).

CONCLUSION

The high rate of individual changes in loneliness, combined with the association between changes in loneliness and changes in mental health, shows a possible potential in improving poor mental health by designing public health interventions aimed at reducing feelings of loneliness.

Changes in tripartite dimensions of anxiety and depression in emerging adults before and during COVID-19

OBJECTIVE

Using the tripartite model of anxiety and depression, we examined general distress (common to anxiety/depression), anxious arousal (uniquely anxiety), and anhedonic depression (uniquely depressive) symptoms before and during the pandemic in emerging adults, who may experience higher levels of distress as a result of the COVID-19 pandemic relative to others.

PARTICIPANTS

Emerging adults (n = 89, 53% White) ages 18-24, participated in four data waves (Baseline: Fall 2017-Fall 2018; January 2020; July 2020; January 2021).

METHODS

We estimated covariance pattern models with various patterns of residual correlation, (selecting the best-fitting structure) and patterns of change (i.e., stable, linear, and quadratic).

RESULTS

Scores in all tripartite dimensions were elevated at baseline; anxious arousal remained elevated, while depression-specific symptoms decreased over time.

CONCLUSIONS

Findings contribute to a fine-grained approach to understanding emotional distress relating to the COVID-19 pandemic, proving potentially useful in conceptualizing the mental health of emerging adults in relation to disruptive life events.

Social distancing and mental health two years into a global pandemic: a sequential exploratory mixed-methods investigation in Hong Kong

INTRODUCTION

The COVID-19 pandemic has led to the implementation of social distancing measures on an unprecedented scale, but their impacts on the mental health of the general public, especially in places with strict and prolonged restrictions, are not well understood. This study explored the Hong Kong public's views on social distancing measures that were implemented approximately two years into the pandemic and examined how these perceptions influence their stay-at-home motivation and mental health based on Protection Motivation Theory (PMT).

DESIGN

A two-phase sequential exploratory mixed-methods study was conducted.

SETTING

Data were collected as part of a larger study of a universal online public health campaign in Hong Kong.

PARTICIPANTS

First, qualitative interviews with 26 participants from diverse backgrounds explored their views on COVID-19 and social distancing measures. Subsequently, a quantitative online survey of 1025 participants from the general population examined the relationship between PMT constructs, stay-at-home motivation, and mental health.

OUTCOME MEASURES

Mental health and PMT constructs, including protective motivation, perceived severity, perceived vulnerability, self-efficacy, response cost, and response efficacy.

RESULTS

The qualitative results identified three themes: 'the inescapable and unpredictable nature of COVID-19', 'stay-at-home impacts all facets of life', and 'the realities and challenges of social distancing during a pandemic'. Subsequently, quantitative findings showed that most PMT constructs, such as perceived severity (ß=0.21, 95% CI=0.15-0.27), perceived vulnerability (ß=0.24, 95% CI=0.18-0.30), self-efficacy (ß=0.27, 95% CI=0.20-0.34) and response efficacy (ß=0.09, 95% CI=0.02-0.15), were associated with stay-at-home motivation (all p<0.01), except for response cost. Higher perceived severity (ß=1.42-1.74), perceived vulnerability (ß=0.93-1.36), and response cost (ß=1.29-1.64) were associated with poorer mental health.

CONCLUSION

This study examined the public perceptions and experiences of strict and prolonged social distancing measures two years into a global pandemic. The findings highlighted the significance of using the PMT model to understand the factors influencing stay-at-home intentions and their mental health during the pandemic. The findings provide valuable insights to guide the development and implementation of future public health interventions.

Beyond Individual Differences in Affective Symptomatology: The Distinct Contributions of Emotional Competence and Rumination in a Nationally Representative Sample

Prior evidence suggests mental health, and affective symptomatology in particular, are influenced by emotion-related abilities. The strategies people use to identify, understand, and manage their emotions can serve as a protective or vulnerability factor for their psychological adjustment. Adaptive emotion regulation strategies, such as the ability to identify and understand emotions, can mitigate anxiety and depression symptoms, whereas maladaptive strategies, such as rumination, contribute to the vulnerability to suffering emotional symptomatology. To better understand the role of each strategy in affective outcomes, this study examines the role of adaptive emotion regulation strategies on anxiety, depression, and well-being, in comparison to rumination, among the general population. We hypothesize that the ability to accurately identify emotions and understand inner thoughts will act as protective factors against depression and anxiety, considering neuroticism. In comparison, rumination reactions, such as passively overthinking about inner experiences, will exacerbate the affective symptomatology. A sample of 1703 participants over the country, 50.43% female (18-75 years of age, mean = 45.48, SD = 14.73), closely aligned with the mean age of the target population in Spain, which is 44.1 years, were randomly selected to participate in this cross-sectional study. Participants completed self-report measures for emotional competence, rumination, anxiety and depression symptoms, well-being, and neuroticism. Structural equation modeling (SEM) was used to explore the relationships among the above-mentioned variables. Our results revealed neuroticism is related to higher levels of anxiety and depression and negatively related to wellbeing through the mediation effect of rumination and emotional competence, including all possible paths of the mediation model. This study has important implications for designing preventive and therapeutical interventions.

Development and validation of a digital community-based mental health protocol (RELATE-ME) in Malaysia

To bridge the gaps of mental health service in Malaysia, we developed a digital intervention protocol (RELATE-ME) aiming to restore social connectedness and well-being during the COVID-19 pandemic lockdown. Co-designed with a cross-disciplinary panel, we integrate principles of digital mental health, support group modality, psychoeducation elements, and community engagement into a 2-week online group program. To validate the protocol, we trained three community health workers (CHWs) to facilitate a briefer version of RELATE-ME with two groups of participants (six elders and six youths) in suburban Malaysia. After 4 days, they were interviewed regarding the feasibility and acceptability of this program. The interview transcripts were coded by the research assistant through an inductive-deductive method. Results showed that the majority of the participants reported the relationship with CHWs and peers as a motivator to sustain their engagement and it took time to build trust with each other. They appreciated the engaging group contents (e.g. relaxing and pleasant activities), sharing of their peers and skill-building lessons (e.g. learning of goal setting, stress management and relationship building). However, they faced the challenge of time constraints, family duties, low English literacy and digital literacy, especially among the elderly group. This finding suggested that RELATE-ME is a feasible protocol to increase social connectedness and well-being in the suburban area of a middle-income Asian country like Malaysia. Its effectiveness could be further enhanced through capacity building of CHWs, translating all contents into local languages and implementation in a physical setting.

Can a mobile application improve glucose-related and patient-reported outcome measures (PROMs) in people with type 1 diabetes mellitus? A randomized controlled trial using the mySugr® app

PURPOSE

Mobile applications (apps) have proven to be highly effective tools to empower patients with type 1 diabetes mellitus (T1DM) and enable them to achieve better self-care, quality of life (QOL), and glycemic control. The aim of the study is to examine whether mySugr®, an app for diabetes management, together with teleconsultations, can have a positive impact on these factors and, thereby, replace current clinical care.

METHODS

This study concerns an exploratory randomized clinical trial of 12 months' duration. People with T1DM using multiple daily injections were randomized to usual care (bolus calculator, five face-to-face visits) or intervention (mySugr® app, three face-to-face visits, and two teleconsultations). The main outcome was increase in empowerment assessed with the Diabetes Empowerment Scale Short Form questionnaire (DES-SF-S). Secondary outcomes were change in additional glucose-related (blood glucose monitoring, mean blood glucose, standard deviation, coefficient of variation (CV), and high and low blood glucose index) and patient-reported outcome measures (PROMs) (self-management, QOL, and distress).

RESULTS

A total of 25 out of 28 participants completed the study (52% men, age 44.52 years, diabetes duration 21.28 years). At 12 months, no significant differences were identified in the change of DES-SF-S and additional PROMs between arms. Similarly, no differences were observed in glucose-related outcomes except for the change in CV at 9 (control - 1.87 ± 4.98 vs. intervention 5.89 ± 11.33, p = 0.008) and 12 months (control - 2.33 ± 3.54 vs. intervention 5.12 ± 11.32, p = 0.018). Adherence to and satisfaction with the app were high.

CONCLUSION

Patients with diabetes using the mySugr® app and teleconsultation achieved similar results to those following usual care in empowerment, other PROMs, and most glucose-related outcomes, thus supporting its use in combination with face-to-face visits. The RCT was registered with ClinicalTrials.gov (NCT03819335, first registration 28/01/2019).

Prevalence and risk factors of post-traumatic stress disorder and psychological distress symptoms in populations affected by Ebola in DR Congo before and during the COVID-19 pandemic

BACKGROUND

Ebola virus disease (May 19-September 16, 2020) and COVID-19 simultaneously affected the province of Equateur in DR Congo (DRC). To date, no longitudinal studies have explored symptoms of post-traumatic stress disorder (PTSD) and psychological distress (PD) related to COVID-19 or Ebola in DRC.

METHODS

A representative sample of 1669 participants aged ≥18 was recruited in March-April 2019 (Time 1) and August-September 2020 (Time 2). Questionnaires assessed PTSD (PCL-5) and PD (K-10) symptoms, social support, Ebola and COVID-19 exposure and related stigmatization.

RESULTS

Prevalence of PTSD (58.24 % in T1 to 43.74% at T2, x2(1) = 5.83, p < .001) and PD symptoms (49.44 % in T1 to 28.94 % at T2, x2 (1) = 5.83, p < .001) decreased from the Ebola outbreak to the COVID-19 pandemic. Populations living in rural areas consistently reported higher prevalence of PTSD and PD symptoms. Generalized estimating equation (GEE) models showed that stigmatization related to Ebola is the most important predictor of both PTSD (B = 0.90, p < .0001) and PD (B = 1.22, p < .001) symptoms, followed by exposure to Ebola (B = 0.41, p < .001 and B = 0.56, p < .001). COVID-19 related stigmatization only predicted PTSD symptoms (B = 0.21, p = .009). GEE models also confirmed that PTSD (B = -0.78, p < .001) and PD (B = -1.25, p < .001) decreased from Ebola outbreak to the COVID-19 pandemic. A significant interaction was found between Ebola stigmatization and time (B = -0.40, p = .021) for PTSD, and between exposure to Ebola and time (B = -0.36, p = .026) for PD.

CONCLUSIONS

This study confirms that Ebola related stigmatization is the most important predictor of mental health problems. Community-based strategies can address, reduce, and eliminate this issue.

Stressors and suicidal ideation in low-income adults in Malaysia: A serial mediation analysis of social support and mental health symptoms

BACKGROUND

Studies have documented a heightened risk of suicidal ideation in response to stressors, especially among people from socioeconomically disadvantaged backgrounds. However, the mechanisms of this association remain elusive.

AIMS

Drawing on the social deterioration and counteractive models, this study aims to elucidate the pathways linking stressors to suicidal ideation through serial mediation of social support and mental health symptoms in Malaysia.

METHOD

Data were collected from 404 low-income adults (33.2% male and 66.8% female) receiving monthly financial assistance from Malaysia's social welfare department. We employed stressor measures (i.e. financial, family and work), the Oslo Social Support Scale, the Patient Health Questionnaire and the Suicidal Behaviour Questionnaire-Revised.

RESULTS

A total of 46.8% of participants reported mild-to-severe anxiety and depressive symptoms, with 11.1% classified as high risk for suicide. Direct and indirect effects were found. After controlling for age and gender, social support and mental health symptoms mediated the link between stressors and suicidal ideation. The serial mediation analysis indicates that stressors are connected to heightened suicidal ideation through a sequence involving insufficient social support, followed by elevated levels of mental health symptoms.

CONCLUSION

Understanding the multifaceted relationships among stressors, social support, mental health symptoms and suicide ideation expands the potential for developing targeted interventions and preventive strategies tailored for vulnerable populations. Clinical work with low-income individuals may include implementing early systematic efforts to develop accessible mental health and integrated care services.

Digital mental health service engagement changes during Covid-19 in children and young people across the UK: Presenting concerns, service activity, and access by gender, ethnicity, and deprivation

The adoption of digital health technologies accelerated during Covid-19, with concerns over the equity of access due to digital exclusion. The aim of this study was to assess whether service access and presenting concerns differed before and during the pandemic. Sociodemographic characteristics (gender, ethnicity, and deprivation level) were examined to identify disparities in service use. To do this we utilised routinely collected service data from a text-based online mental health service for children and young people. A total of 61221 service users consented to sharing their data which represented half of the service population. We used interrupted time-series models to assess whether there was a change in the level and rate of service use during the Covid-19 pandemic (April 2020-April 2021) compared to pre-pandemic trends (June 2019-March 2020) and whether this varied by sociodemographic characteristics. The majority of users identified as female (74%) and White (80%), with an age range between 13 and 20 years of age. There was evidence of a sudden increase (13%) in service access at the start of the pandemic (RR 1.13 95% CI 1.02, 1.25), followed by a reduced rate (from 25% to 21%) of engagement during the pandemic compared to pre-pandemic trends (RR 0.97 95% CI 0.95,0.98). There was a sudden increase in almost all presenting issues apart from physical complaints. There was evidence of a step increase in the number of contacts for Black/African/Caribbean/Black British (38% increase; 95% CI: 1%-90%) and White ethnic groups (14% increase; 95% CI: 2%-27%), sudden increase in service use at the start of the pandemic for the most (58% increase; 95% CI: 1%-247%) and least (47% increase; 95% CI: 6%-204%) deprived areas. During the pandemic, contact rates decreased, and referral sources changed at the start. Findings on access and service activity align with other studies observing reduced service utilization. The lack of differences in deprivation levels and ethnicity at lockdown suggests exploring equity of access to the anonymous service. The study provides unique insights into changes in digital mental health use during Covid-19 in the UK.

Incidence of Deliberate Self-Harm in Hong Kong Before and During the COVID-19 Pandemic: Population-Wide Retrospective Cohort Study

Background

COVID-19 ended on May 5, 2023, and since then Hong Kong reported increased mental distress, which was speculated to be from the policies implemented during the pandemic. Despite this, longitudinal surveillance of deliberate self-harm (DSH) incidences throughout the pandemic in Hong Kong remained insufficient.

Objective

The objective of this study was to outline the changes in DSH incidences before and during the COVID-19 pandemic in Hong Kong, with respect to sex, age, and co-occurring mental health issues.

Methods

A quasi-experiment was conducted using an interrupted time series design to estimate the impact of the pandemic on DSH-related emergency department (ED) visits. This design enabled the estimation of DSH-related ED visits based on prepandemic data from 2016 to 2019, assuming the pandemic had not occurred, and allowed for a comparison with observed DSH-related ED visits during the pandemic. The descriptive results were reported as the observed monthly DSH-related ED visits and observed incidence ratios during the pandemic. Afterwards, a negative binomial model was fitted to the prepandemic data (2016-2019) and adjusted for temporal trends, seasonality, and population variation to estimate the expected monthly DSH-related ED visits and adjusted incidence ratios (aIRs).

Results

Between January 2016 and December 2022, a total of 31,893 DSH episodes were identified. Initial descriptive analysis showed a significant difference in demographic characteristics (sex) and clinical characteristics (death within 28 d, diagnoses of co-occurring mental health issues, public assistance pay code, and triage level). Subsequent interrupted time-series analysis demonstrated significantly increasing trends in comparison with the prepandemic period. As reported in the aIRs among young adult males (aIR in 2020=1.34, P=.002; 2021: aIR=1.94, P<.001; and 2022: aIR=2.53, P<.001), adult males (aIR in 2020=1.58, P<.001; 2021: aIR=2.64, P<.001; and 2022: aIR=3.13, P<.001), adult females (aIR in 2020=1.13, P=.01; 2021: aIR=1.52, P<.001; and 2022: aIR=1.64, P<.001), and older male adults (aIR in 2020=1.53, P<.001; 2021: aIR=2.37, P<.001; and 2022: aIR=3.01, P<.001).

Conclusions

The average annual DSH-related ED visits increased during the pandemic period. Therefore, there is a need to raise awareness for such vulnerable groups in Hong Kong to prepare for postpandemic spillover.

An evaluation of lived experience email peer support for young people with eating disorders

Peer support is where individuals with the same shared experience provide mutual support. Using a non-controlled repeated measure design, this study evaluates initial efficacy of one-to-one email peer support. Young people with an eating disorder were matched with a recovered volunteer befriender, for up to one year, providing 1-3 email contacts a week. All participants completed measures (self-esteem, self-efficacy, wellbeing) at start of service, two and four-month intervals for recipients (n = 92) and peer befrienders (n = 86) respectively, and at end of service. Recipients also completed measures of social connectedness, impact of eating disorder, and goal-based outcomes. Multilevel mixed-effects linear regression models indicated significant improvements across all outcomes for recipients by 4 months, apart from self-esteem, and improvements self-efficacy, eating disorder impact and goal-based outcomes maintained at end of service. Peer befrienders did not show changes in self-esteem or self-efficacy, but there was a small significant reduction in wellbeing. The study provides evidence for email peer support for young people with eating disorders and highlights the need for robust support for befriending roles.

Genetic predisposition for negative affect predicts mental health burden during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic was accompanied by an increase in mental health challenges including depression, stress, loneliness, and anxiety. Common genetic variants can contribute to the risk for psychiatric disorders and may present a risk factor in times of crises. However, it is unclear to what extent polygenic risk played a role in the mental health response to the COVID-19 pandemic. In this study, we investigate whether polygenic scores (PGSs) for mental health-related traits can distinguish between four resilience-vulnerability trajectories identified during the COVID-19 pandemic and associated lockdowns in 2020/21. We used multinomial regression in a genotyped subsample (n = 1316) of the CovSocial project. The most resilient trajectory characterized by the lowest mental health burden and the highest recovery rates served as the reference group. Compared to this most resilient trajectory, a higher value on the PGS for the well-being spectrum decreased the odds for individuals to be in one of the more vulnerable trajectories (adjusted R-square = 0.3%). Conversely, a higher value on the PGS for neuroticism increased the odds for individuals to be in one of the more vulnerable trajectories (adjusted R-square = 0.2%). Latent change in mental health burden extracted from the resilience-vulnerability trajectories was not associated with any PGS. Although our findings support an influence of PGS on mental health during COVID-19, the small added explained variance suggests limited utility of such genetic markers for the identification of vulnerable individuals in the general population.

Bibliometric and visual analysis of suicide in aged people over the past 20 years

Background

The rapid aging of the global population presents pressing public health challenges, notably an increase in suicide rates among older adults. Despite this critical issue, there is a scarcity of comprehensive assessments regarding the existing literature on suicide within this demographic. This study seeks to employ bibliometric analysis and knowledge mapping to elucidate prevailing research trends and the overall status of this field.

Methods

We performed a comprehensive computer-based search of the Web of Science Core Collection to identify relevant articles and reviews concerning suicide in the elderly. A bibliometric analysis was conducted, examining various aspects including countries or regions, institutions, authors, journals, keywords, and references. This analysis utilized tools such as CiteSpace, VOSViewer, Pajek, and Excel 365 to facilitate a thorough assessment.

Results

The analysis covered 1,116 publications from 2005 to 2024. The annual number of publications showed a fluctuating upward trend, with notable decreases in 2007, 2012, 2015, 2017, and 2022, and increases in 2009, 2013, 2016, and 2019, peaking at 121 in 2021, with citations reaching 4,741 in 2022, but declining since then. The United States stands out as the most productive and influential country in the field, boasting the highest number of publications and citations. The country is home to institutions leading in both publication and citation metrics. Prominent authors contributing significantly to this domain include Conwell Yeates, Van Orden Kimberly A., and Waern Margda. Key journals disseminating crucial research are the Journal of Affective Disorders, American Journal of Geriatric Psychiatry, and Lancet. Frequent keywords in this field encompass depression, suicidal ideation, suicide, older-adults, risk, risk factors, prevalence, older adults, ideation, behavior, health, mental health, life, age, people, prevention, symptoms, scale, population, and elderly. The contemporary research emphasis is primarily on identifying, treating, and preventing the suicide risk associated with depression in older adults.

Conclusions

This study highlights the growing research focus on suicide in older adults, particularly related to depression and the identification, treatment, and prevention of suicide risk. The findings underscore the need for targeted prevention strategies and further investigation in this critical public health area.

Reasons for living and depressive symptomatology in young adults with and without suicide attempts: a moderated mediation approach

Introduction

Suicide is a public health problem worldwide, being the fourth leading cause of death in young adult population (15-29 years). Therefore, it is important to identify its risk and protective factors, and how they interact to develop more effective interventions. The present study aims to analyze the relation between depressive symptoms, hopelessness (risk factors) with reasons for living (protective factors) and suicidal ideation in young adults with and without previous suicide attempts.

Methods

A sample of 845 Portuguese young adults answered an online form which assessed suicidal ideation, hopelessness, depressive symptoms, and reasons for living. Mean comparisons, correlations, and moderated mediation analysis were computed.

Results

Individuals with a history of suicide attempt showed higher mean levels in risk factors, compared to individuals without suicide attempt. When no history of suicide attempt was present, ideation was positively and significantly correlated to depression and hopelessness, and negatively correlated to the reasons for living. Higher levels of depressive symptomatology predict lower levels of reasons for living. Mediation and moderation relations were assessed in a model and the history of suicide attempts showed a relevant role.

Conclusions

The evidence found in this study reinforce that reasons for living may play a preponderant role in suicidal ideation, that is as a negative mediator and therefore it can act as a protective factor.

Job satisfaction and animal welfare at slaughter: A survey of Official Veterinarians in the United Kingdom and Republic of Ireland

In the UK and the Republic of Ireland, Official Veterinarians (OVs) are employed by the Food Standards Agency and the Food Safety Authority, respectively, as legal authorities for both animal welfare and food safety. However, little is known about job satisfaction in this profession which has the potential to impact professionals' well-being and performance. Moreover, despite animal welfare issues being a reality that OVs witness, we do not yet understand how OVs perceive these issues at slaughter or whether this impacts job satisfaction. We assessed OVs' perceptions on job satisfaction and views on welfare at slaughter across the UK and ROI, through an online questionnaire with 113 participants, which included socio-demographic information of participants and questions or statements about different aspects of job satisfaction and animal welfare issues at slaughter. While most OVs committed to their work they reported issues that may compromise job satisfaction, such as often experiencing loneliness at work, threatening situations and sleep disorders. Moreover, job satisfaction was often impacted by animal welfare incidents, and conflicts with food business operators were considered one of the greatest barriers to improving welfare at slaughter. There is also the likelihood of professionals' individual ethical values being challenged since OVs are virtually certain to witness religious slaughter yet disagree with this practice to the extent that they consider it should be banned. We reveal significant challenges associated with the role of OV that justify creation of a support network to assist and safeguard this profession, as well as animal welfare at slaughter.

Non-fatal acute barium carbonate poisoning following suicidal ingestion: A case report

Acute barium poisoning is a rare but life-threatening method of suicide attempt, and it is a challenging disease in the emergency department. We report a case of barium carbonate poisoning in a 21-year-old man who ingested a large dose to attempt suicide and presented with gastrointestinal symptoms, gradual muscular weakness, and severe hypokalemia (K+1.63 mmol/L). He was promptly managed with gastric lavage, respiratory support, and large doses of oral and intravenous potassium supplementation. In addition, intravenous sodium thiosulfate and continuous venovenous hemodiafiltration were administered to reduce the serum concentration of barium ions. Following comprehensive treatment, the patient recovered within 5 days and discharged home for 12 days. Clinicians should be vigilant when a patient presents gastrointestinal symptoms and limb weakness, associated with severe hypokalemia and cardiac arrhythmia over a short disease course as these may indicate potential barium poisoning. Furthermore, we advocate for paying more attention to the management of toxic substances and the mental health education of young adults.

The unequal impacts of the COVID-19 pandemic on young adults' mental health. Predictors of vulnerability and resilience using longitudinal birth cohort data in the UK

INTRODUCTION

Previous studies have demonstrated deteriorations in young adult mental health during the COVID-19 pandemic, but evidence suggests heterogeneity in the mental health impacts of the pandemic. We sought to identify factors which may predict changes in psychological distress and wellbeing during the COVID-19 pandemic in UK young adults.

METHODS

A total of 2607 young adults from the Millennium Cohort Study were included. Psychological distress and mental wellbeing were measured using the Kessler-6 and Short Warwick-Edinburgh Mental Wellbeing Scale, respectively. Assessment occurred at three timepoints between the ages of 17-19: 2018/19 (pre-COVID Baseline), May 2020 (COVID Wave 1) and September/October 2020 (COVID Wave 2). Latent change score models were used to study change in distress and wellbeing across the study period, as well as the impact of sex, relative family poverty, parental education, preexisting mental health difficulties and perceived social support on these changes.

RESULTS

The latent change score models suggested both distress and wellbeing tended to increase across the study period. Being female and in relative poverty predicted greater increases in distress and/or poorer wellbeing. Higher levels of parental education and greater perceived social support were protective against increased distress and associated with improved wellbeing.

CONCLUSIONS

The impact of the COVID-19 pandemic on UK young adult mental health is complex. We provide further evidence for a distinction between symptoms of poor mental health and wellbeing. Research is urgently needed to assess the long-term impacts of the COVID-19 pandemic on the mental health and wellbeing of young people, particularly in more vulnerable groups.

Facing stress and inflammation: From the cell to the planet

As identified in 1936 by Hans Selye, stress is shaping diseases through the induction of inflammation. But inflammation display some yin yang properties. On one hand inflammation is merging with the innate immune response aimed to fight infectious or sterile insults, on the other hand inflammation favors chronic physical or psychological disorders. Nature has equipped the cells, the organs, and the individuals with mediators and mechanisms that allow them to deal with stress, and even a good stress (eustress) has been associated with homeostasis. Likewise, societies and the planet are exposed to stressful settings, but wars and global warming suggest that the regulatory mechanisms are poorly efficient. In this review we list some inducers of the physiological stress, psychologic stress, societal stress, and planetary stress, and mention some of the great number of parameters which affect and modulate the response to stress and render it different from an individual to another, from the cellular level to the societal one. The cell, the organ, the individual, the society, and the planet share many stressors of which the consequences are extremely interconnected ending in the domino effect and the butterfly effect.

Exploring the gender gap in young adult mental health during COVID-19: Evidence from the UK

AIMS

To explore the prevalence of a mental health gender gap within a young adult sample during the COVID-19 pandemic, and to identify the impact of loneliness and domestic time use on young people's, and particularly young women's mental health.

METHOD

Using data from the UK Longitudinal Household Survey (UKHLS), this research examines mental health prior to the pandemic (2019) and during the pandemic (April 2020 until September 2021). A random-effects regression analysis was conducted to examine the effects of loneliness, and domestic factors across age and gender to ascertain their contribution to the mental health gender gap in a young adult population.

RESULTS

Average mental health decline was consistently higher for women compared to men, and young people (ages 16-24) saw a reduction in mental health twice as much as those in the oldest age category (over 65). Loneliness accounted for a share of the mental health gender gap, and a more decrease in mental health was recorded for young women experiencing loneliness, compared to older age groups. Domestic and familial factors did not have a significant impact on young people's mental health.

CONCLUSIONS

Although across all ages and genders, mental health had returned to near pre-pandemic levels by September 2021, young people and especially women continue to have worse mental health compared to other age groups, which is consistent with pre-COVID age and gender inequalities. Loneliness is a key driver in gendered mental health inequalities during the pandemic in a young adult population.

COVID-19 impacted the suicidal ideation among health care workers and medical students: An interrupted time-series analysis of data from 30 countries

AIM

To investigate the impact of public health emergencies on the prevalence of suicidal ideation among healthcare workers (HCWs) and medical students.

METHODS

The prevalence of suicidal ideation among HCWs and medical students was searched for analysis. The platforms included PubMed, medRVix, bioRvix, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. Interrupted time-series analysis was employed to determine whether the COVID-19 pandemic influenced the prevalence and trends of suicidal ideation. To account for autocorrelation and heteroskedasticity, Newey-West standard errors were utilized with a lag of order one.

RESULTS

Seventy studies with 145,641 HCWs and medical students from 30 countries were included in the final analysis, with 30 studies before COVID-19 and 40 studies during the pandemic. Before the pandemic outbreak (April 2020), the monthly increasing rate was 0.063 % (95 % CI: -0.009 %, 0.135 %, z = 1.73, P = 0.084). The tendency of suicidal ideation prevalence increased by 1.116 % (95%CI: 0.888 %, 1.344 %, z = 9.60, P < 0.001). In other words, the calculated monthly growth rate of suicidal ideation after the pandemic outbreak is 1.179 % (95%CI: 0.968 %, 1.391 %, z = 10.93, P < 0.001) per month. The overall growing trend of prevalence of suicidal ideation during the pandemic is 1.896 % per month in America; 1.590 % in Europe; 0.443 % (95%CI: 0.213 %, 0.673 %, z = 3.77, P < 0.001) in Asia; 1.055 % in HCWs; and 0.645 % in medical students.

CONCLUSION

This study highlights that the COVID-19 pandemic can significantly impact the prevalence of suicidal ideation among HCWs and medical students, and the prevalence showed an upward trend.

A Questionnaire-Based Analysis of the Impact of the COVID-19 Pandemic on the Psychological Health of Key Stakeholders Within an Elite Sports Organization

OBJECTIVE

To examine the impact of the COVID-19 pandemic on the psychological health of key stakeholders within an elite UK sports organization.

DESIGN

The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) was sent electronically to 500 employees, and 8 face-to-face interviews were conducted at an elite-level professional football club.

SETTING

English Premier League (EPL) Football Club.

PARTICIPANTS

Office/stadium staff, coaching/backroom staff, players from the male U23, women's and men's senior teams.

INDEPENDENT VARIABLES

Stakeholder groups that were invited to participate in the study: office/stadium staff, coaching/backroom staff, players from the U23, women's and men's senior teams, and variables of age and gender.

MAIN OUTCOME MEASURE

WEMWBS scores across the office/stadium staff, coaching/backroom staff, and player cohort.

RESULTS

Of 122 responses (24% response rate) and 8 face-face interviews, the average WEMWBS score was 51.2 (SD ±8.4) and 14% of the cohort presented with scores suggestive of a higher risk of depression. The main findings were moderate effect size differences in WEMWBS scores with the players scoring higher than both the office/stadium staff (P = 0.01) and the coaching/backroom staff (P = 0.01).

CONCLUSIONS

Office/stadium staff experienced greater compromising mental health effects from the COVID-19 pandemic, as compared with the coaching/backroom staff and players, respectively, suggesting that elite sports organizations should also consider providing mental health education and signposting strategies for this area of the workforce.

Augmented Depression Therapy for young adults: A mixed methods randomised multiple baseline case series evaluation

Augmented Depression Therapy (ADepT) is an individual psychotherapy for depression, which has been shown to be effective in the general adult population. A randomised multiple baseline case series evaluated the feasibility, acceptability, and effectiveness of ADepT in young adults (aged 20-24). Eleven depressed young adults were recruited from a UK university wellbeing service to receive ADepT during the COVID-19 pandemic, with outcomes evaluated relative to pre-specified continuation targets. All participants received a minimum adequate treatment dose (>60% target); 89% judged ADepT as acceptable and satisfactory and would recommend it to others (>60% target); only 9% showed reliable deterioration for depression or wellbeing (meeting <30% target); and there were no trial- or treatment-related serious adverse events. Qualitative interviews revealed most participants were satisfied with and experienced benefits from ADepT. At post-treatment, reliable improvement was shown by 33% of participants for depression and 67% of participants for wellbeing (not meeting target of both >60%), with medium effect size improvements for depression (g = 0.78) and large effect size improvement for wellbeing (g = 0.93; not meeting target of both >0.80). ADepT is feasible, acceptable, and safe in young adults but may require modification to maximise effectiveness. Further research outside of the COVID-19 pandemic is warranted.

Lifestyles of Palestinians during the COVID-19 pandemic: A cross-sectional study

Background: Although the COVID-19 epidemic was linked to movement limitations and a sense of risk among the general public, changes in lifestyle and mental health were not examined among Palestinians. The study aimed to investigate changes in a group of Palestinians' lifestyles and mental health. Methodology: A translated questionnaire about demographics, mental health difficulties, and lifestyle choices was created using Google Forms and distributed over social media and academic platforms. SPSS 21 was used to analyze the data. Results: The participants' mean age was 25 9 years, 67% were women, and 47% were city dwellers. About 82% had a bachelor's degree. Infection with COVID-19 was present in 13% of study group, COVID-19 infection caused the death of a relative in 13% of study group, and commitment to limits was present in 14% of study group. Negative emotions like despair, hopelessness, and worry were extremely common. Despite eating a few fruits and vegetables and drinking a lot of soft beverages, study participants were generally active. Conclusion: The COVID-19 pandemic is associated with a negative impact on lifestyle and mental well-being.

Adaptive and maladaptive pathways of COVID-19 worry on well-being: A cross-national study

OBJECTIVE

In a preregistered study, we examined whether worries about COVID-19 are simultaneously linked with enhanced well-being through social interaction and with reduced well-being through depression symptoms.

METHOD

In August 2020, census-matched participants from high- and low-prevalence regions in the United States and Italy (N = 857) completed assessments of COVID-19 worry, social interaction, depression symptoms, and well-being.

RESULTS

Worries about COVID-19 predicted both more social interaction and more depression (ps < 0.001). In multiple mediational analyses, an adaptive pathway of COVID-19 worry through social interaction was associated with higher well-being, whereas a maladaptive pathway through depression symptoms was associated with lower well-being. Further, a comparison of high and low COVID-19 prevalence regions replicated the mediational findings for social interaction, providing evidence against reverse causation and common method variance.

CONCLUSION

Findings suggest that normative worries about acute stressors may both benefit and undermine well-being, depending on their impact on social behavior or depression symptoms.

The trajectory of anxiety and depressive symptoms and the impact of self-injury: A longitudinal 12-month cohort study of individuals with psychiatric symptoms

BACKGROUND

Individuals reporting self-injury are at greater risk of several adverse outcomes, including suicide. There is reason to be concerned how these individuals cope when stressful life events increase. This study aimed to investigate the trajectories of anxiety and depressive symptoms and the predictive value of self-injury history in individuals with psychiatric symptoms during the unique and stressful conditions of the COVID-19 pandemic.

METHODS

In a longitudinal population cohort study (N = 1810) ranging from 2020 to 2022, anxiety (measured by Generalized Anxiety Disorder, GAD-7) and depressive symptoms (measured by Patient Health Questionnaire, PHQ-9) were self-reported monthly during 12 months. Latent growth curve models with and without self-reported self-injury history as predictors were conducted.

RESULTS

Overall, anxiety and depressive symptoms decreased from baseline, but remained at moderate severity at follow-up. Individuals reporting suicidal or nonsuicidal self-injury reported significantly higher symptom severity at baseline. In addition, individuals reporting suicidal self-injury demonstrated a slower rate of decline in the symptom load over the course of 12 months.

CONCLUSIONS

Over the course of 12 months, anxiety and depressive symptoms decreased in individuals with psychiatric symptoms, but still indicate a psychiatric burden. Individuals with a history of self-injury could be more vulnerable in face of stressful conditions such as those experienced during the COVID-19 pandemic.

Childhood trauma and suicide risk: Investigating the role of adult attachment

BACKGROUND

Suicide is a leading cause of death globally and a serious public health concern. Childhood trauma has been found to be associated with adult suicide vulnerability. Recent research has turned attention to investigating the role of attachment in the context of the childhood trauma-adult suicide relationship. The current study investigated for the first time whether attachment influences and moderates the childhood trauma-suicidality relationship, using a daily diary design, in the general population.

METHODS

481 participants completed questionnaires assessing experiences of childhood trauma, attachment patterns, and history of suicidality. 243 participants continued to a daily diary phase where measures of daily stress, defeat and entrapment were completed for 7 consecutive days.

RESULTS

Higher levels of childhood trauma were associated with a history of suicide ideation and attempt and also higher levels of daily defeat, entrapment and stress during the 7 day study. Similarly, higher levels of attachment anxiety and avoidance were associated with a history of suicide ideation and attempt together with higher levels of daily defeat, entrapment and stress. However, the effects of childhood trauma on suicide history and on daily suicide vulnerability factors were not moderated by attachment anxiety or avoidance.

LIMITATIONS

The measure of childhood trauma was a retrospective self-report tool that may be influenced by memory biases.

CONCLUSIONS

Childhood trauma and insecure attachment are implicated in adult suicide risk. Interventions aimed at mitigating the negative effects of childhood trauma and insecure attachment should also incorporate components that target modifiable risk factors such as defeat, entrapment and stress.

Beneficial Impact of Vaccination Against SARS-CoV-2 on the Mental Health of IPF Patients

Background: Depression and anxiety represent significant comorbidities in idiopathic pulmonary fibrosis (IPF) patients, affecting their quality of life. The COVID-19 pandemic has had an uneven impact on global mental health. The Hospital Anxiety and Depression Scale (HADS) constitutes a validated tool to identify anxiety disorders and depression. The aim of this multicentre study was to evaluate the effect of COVID-19 vaccination on depression and anxiety in IPF patients. Methods: Consecutive IPF patients (median 73.5 years) who are regularly followed-up with were included in the study. Demographics, functional, and clinical were recorded. The HADS score was calculated before and one month after vaccination against COVID-19 in all participants. A Wilcoxon signed ranks test was conducted. Results: A total of 180 IPF patients (median 73.5 years) were included in the study. Among them, 145 patients (81%) received antifibrotic treatment. A significant reduction in HADS, both in anxiety and depression scales, was observed one month after vaccination against SARS-COV-2), independent of age, smoking, lung function impairment, and prior history of depression (p < 0.01). Conclusions: A higher Hospital Anxiety and Depression Scale score was detected before vaccination against COVID-19. It seems that vaccination also offered a beneficial effect on depression and anxiety in IPF patients, independent of age, smoking, lung function impairment, and prior history of depression.

Trends in medically serious suicide attempts before and after COVID-19: a four-year retrospective analysis (2018-2022)

BACKGROUND

Suicide has become a first-order public health concern after the negative impact of COVID-19 on the general population's mental health. Several studies have analyzed the trends in suicide attempts (SA) before and after the onset of the pandemic, but few studies focus on the impact of the pandemic on medically serious suicide attempts (MSSA).

METHODS

Participants were 385 hospitalized individuals ≥ 16 years old who made MSSA identified retrospectively through a review of e-medical records between 2018 and 2022 ("pre-COVID-19" and "COVID" periods). The two groups were compared on sociodemographic and clinical variables using Chi-square or Exact Fisher's tests for categorical variables and a Mann-Whitney test for continuous variables. To study the variation in MSSA over time, MSSA were aggregated monthly. Joinpoint regression analyses were used to assess time trends.

RESULTS

A sample of 161 MSSA patients, 80 women and 81 men, were selected from 385 admissions after a suicide attempt (SA) in the four years (n = 160 pre-COVID period vs. n = 225 COVID period) (OR = 1.41; CI 95% = 1.0003-1.7223, p < 0.001). Sixty-eight patients with MSSA were admitted during the first period, and 93 during the COVID period (OR = 1.4 ; CI 95% = 1-1.9 ; p < 0.05). MSSA patients were more likely to be admitted to an intensive care unit during the COVID period than during the pre-COVID period (OR = 3.5; CI 95% = 1.7-6.9; p < 0.001).

CONCLUSIONS

This study highlights the need for research on suicide risk during and after crisis periods, such as the COVID-19 pandemic. It provides valuable knowledge on the incidence of SA needing hospitalization, MSSA, and highly severe MSSA for four years before and after the pandemic onset.

The longitudinal patterns of depression subtypes and stressors in depression severity in the Canadian longitudinal study on aging (CLSA)

AIM

The current study aims to characterize the longitudinal patterns of depression subtypes and investigate the associations among the stability of depression subtypes, COVID-19-related stressors, and depression severity.

METHODS

The study utilized data from the Canadian Longitudinal Study on Aging, which is a national, long-term study of Canadian adults aged 45 and older (n = 12,957). Latent profile analysis was used to identify latent depression subtypes. Latent transition analysis was then applied to assess the stability of these subtypes over time. Hierarchical multivariate linear regression was used to explore the relationships among these identified depression subtypes, COVID-19-related stressors, and depression severity among males and females, respectively.

RESULTS

Distinct depression subtypes were identified. Except for atypical depression, other depression subtypes showed greater stability over time. We also found that melancholic depression (B = 9.432) and typical depression (B = 6.677) were strongly associated with depression severity during the pandemic. Health-related stressors (B = 0.840), conflict (B = 3.639), difficulties accessing resources (B = 0.927), separation from family (B = 0.840), and caregiving experience (B = 0.764), were significantly associated with increased depression severity. Sex-specific analyses also revealed differences in the associations between stressors and depression severity between males and females.

CONCLUSIONS

This study contributes valuable insights into the latent clustering of depression subtypes and their stability. Stressors were associated with increased depression severity, with distinct associations observed among males and females. These findings have implications for targeted early interventions and integrated clinical management strategies by providing the evidence base for tailored mental health care during and after the pandemic.

Impact of pandemics on primary care: changes in general practitioner antidepressant prescriptions and mental health referrals during lockdowns in England, UK

OBJECTIVES

In recent times, the world has witnessed unprecedented challenges, with the COVID-19 pandemic being a major disruptor to various aspects of daily life. This article delves into the profound impact of pandemics on primary care, specifically focussing on changes in antidepressant prescriptions and mental health referrals before, during, and after lockdowns in England, UK.

METHODS

In this retrospective study, we used anonymised individual-level electronic health record data from general practitioner (GP) practices in the North of England, UK. We applied a negative binomial-logit hurdle model and a multinominal logit regression model to assess the impact on antidepressant prescriptions and GP referral types, respectively.

RESULTS

The initiation of antidepressant prescriptions showed a notable decrease during and post lockdowns, with a minor uptick in ongoing antidepressant prescriptions during the lockdown periods. Over the course of lockdowns and beyond, there was a growing trend of patients being referred to social prescribing interventions. Notably, individuals from ethnic minorities were more inclined to receive fewer medical treatments and more social prescribing interventions.

CONCLUSION

The increase in antidepressant prescriptions during the pandemic-related lockdowns was expected due to these challenging circumstances. Reduced referrals to secondary mental health services occurred as online counselling services were deemed inappropriate by some doctors, and patients were hesitant to seek face-to-face help. Notably, there was a rise in social prescribing referrals, emerging as a valuable resource for psychological support amid heightened mental health strain. Additionally, ethnic minority patients were less likely to receive medical treatments but more likely to be referred to social prescribing services. Despite the inevitable negative impacts of the COVID-19 pandemic, these findings highlight the active role of non-clinical support in a social model of health, addressing unmet needs and reducing barriers to mental health care for certain groups.

COVID-19 Pandemic, Mental Health Status and Suicide Ideation of Iranian University Students

Background

The COVID-19 pandemic has had far-reaching effects on societies globally, including significant psychological impacts. This study aims to address the research gap by examining the impact of the COVID-19 pandemic on mental health and suicidality among Iranian university students, comparing prepandemic and pandemic data.

Methods

The data collection for this cross-national study involved 2 sections: prepandemic data from 11,515 records of new incoming students in 2019 and postpandemic data from 27,743 records of students studying in 2020. The data were merged, resulting in a total of 10,240 students for analysis. The instrument used was the "Iranian Mental Health Scale for Students (IMHS). The variables were compared before and during the pandemic using the McNemar and paired t tests. Multiple linear regression models assessed determinants of mental health, while logistic regression examined predictors of suicidal ideation during COVID-19. Risk factors and protective factors on students' mental health and suicidal thoughts during the pandemic were investigated.

Results

The mean mental health score of students during the COVID-19 pandemic was slightly higher than before the pandemic (P = 0.001). The number of suicide attempts among students decreased from 23 before the pandemic to 0 during the pandemic. However, the rate of suicidal ideation increased from 10.2% before the pandemic to 16% during the pandemic.

Conclusion

Evaluating the mental health of university students is crucial to identifying potential issues early and providing appropriate interventions. Understanding the effects of the pandemic on this vulnerable population can inform strategies for supporting their well-being during these challenging times.

The supervisory relationship as a predictor of mental health outcomes in doctoral students in the United Kingdom

Introduction

The process of a doctorate degree has been implicated in the onset and exacerbation of mental health problems among doctoral students. Previous studies have suggested that the student-supervisor relationship may predict emotional wellbeing and mental health outcomes in doctoral students in the UK. However, these studies were conducted before the COVID-19 pandemic and often used unstandardized measures to investigate supervisory styles.

Methods

The present study was part of the Better Together project, a wellbeing initiative for doctoral students in the UK. It explored the predictive ability of aspects of the student-supervisor relationship with regards to doctoral students' mental health outcomes. The sample consisted of 141 students doing a research-based doctorate degree in the UK. The survey included demographic questions and questionnaires assessing supervisory styles, the discrepancy between actual and preferred supervisory relationship, depression, anxiety, and stress.

Results

A large proportion of participants fell in the severe and extremely severe categories in the depression, anxiety, and stress sub-scales. Multiple regression analyses indicated that both supervisory styles and discrepancy significantly predicted students' mental health outcomes. More specifically, higher scores in the uncertain supervisory style, which is characterized by indecisiveness and ambiguity, were linked with higher scores in depression, anxiety, and stress.

Discussion

The findings provided new insights concerning the aspects of the student-supervisor relationship that are related to the mental health issues of doctoral students in the UK. They have important implications for future research and supervision practice.

Information as a resource: Can perceived information process quality in the workplace contribute to more optimism in times of crisis?

Against the background of Job Demands-Resources and Conservation of Resources theory and research on organizational communication, this prospective study among n = 312 employees explores the significant role of perceived information process quality (PIPQ) in enhancing employees' optimism during the COVID-19 pandemic. It thereby contributes to a deeper understanding of the factors influencing employee optimism in challenging contexts. In this study, PIPQ is defined by the availability of timely information, clarity, and consistency in the information provided. Results from latent change score modelling revealed that employees who experienced high PIPQ, particularly consistent information, reported feeling more optimistic about work-related aspects and also experienced spillover effects into their private lives. Notably, both consistency in information prior to the pandemic and increases in consistent information during the pandemic demonstrated this beneficial effect. Moreover, timely available information also positively influenced optimism, especially regarding work-related aspects. However, the study did not find evidence that clarity in information significantly affected optimism. In summary, the findings underscore the importance of accessible and consistent information as a vital resource for employees' ability to navigate crises.

Post-COVID pandemic: The new normal and aftermath

Background

The COVID-19 pandemic has brought about unparalleled worldwide transformations, impacting all facets of human existence, including health systems, economies, societal norms, and individual behaviors.

Aim

The goal is to comprehend the enduring alterations in public health strategies, economic recuperation processes, changes in work and education paradigms, and the psychological consequences for populations globally.

Methods and Materials

This analysis uses a multidisciplinary approach by incorporating data from healthcare studies, economic reports, educational research, and psychological assessments. It aims to offer a comprehensive perspective on the world after the pandemic.

Results

The findings suggest that the "New Normal" encompasses a wide range of changes, such as a greater dependence on digital technology, a transition toward remote work and learning, substantial modifications in global supply chains, and a revised outlook on health and wellness. The potential long-term consequences of these changes indicate that some may provide opportunities for innovation and expansion, whereas others present challenges that necessitate strategic planning and policy interventions.

Conclusion

The aftermath of the COVID-19 pandemic presents a critical moment for global leaders, policymakers, and individuals to navigate the complexities of a transformed world, emphasizing the need for resilience, adaptability, and a renewed commitment to collective well-being.

Longitudinal change in symptoms of depression, anxiety and post-traumatic stress disorder during the COVID-19 pandemic among Mexican college students

Longitudinal studies suggest the psychological difficulties precipitated by the COVID-19 pandemic have gradually declined, but our understanding of the factors that predict change in mental health is limited. We evaluated the mental health of Mexican college students during the early stage of the pandemic and 4 months later, as well as predictors of change in students' mental health. Participants were 648 students (71% women, Mage = 21.46) from a private University in Northern Mexico who completed online surveys from May 2020 to September 2020. Students' self-reported levels of mental health symptoms (depression, anxiety and post-traumatic stress disorder) significantly decreased from May to September. Poor physical health, more COVID-related worry and higher initial levels of peer social support predicted less change in psychological symptoms. On the other hand, more hours of sleep per night and a pre-existing mental health diagnosis predicted steeper decreases in symptoms. Findings suggest reductions in mental health difficulties that are consistent with theoretical frameworks of resilience among Mexican college students. In addition, results underscore the interplay between physical, psychological and social functioning, and the need for continued monitoring of mental health and intervention efforts that address physical health, sleep and pandemic-related worry in University settings.

Patterns of Hospital Presenting Suicide-Related Ideation in Older Adults before and during COVID-19: Findings from a National Clinical Service in Ireland 2018-2021

OBJECTIVE

To examine changes in trends of hospital-presenting suicide-related ideation in older adults living in Ireland, during the first 24 months of the COVID-19 pandemic and 2018-2019.

METHODS

Data on presentations of patients aged 60 and older from participating hospitals of the National Clinical Programme for Self-Harm and Suicide-related Ideation were used to compare trends during the first two years of the COVID-19 pandemic (2020-2021) with the preceding period (2018-2019). Poisson regression models were used to estimate trends in the pre-pandemic and pandemic periods.

RESULTS

There were 1531 presentations for suicide-related ideation to hospital emergency departments in older adults between January 1, 2018-December 31, 2021, with most presentations involving males (57.2%, n = 876). There was a 27% increase in suicide-related ideation presentations during the pandemic years (2020-2021) when compared to 2018-2019 (RR: 1.27, p = .001, 95%CI: 1.14-1.40), with females showing a 29% increase (RR: 1.29, p = .001, 95%CI: 1.11-1.51) and males a 23% increase (RR: 1.23, p = .002, 95%CI: 1.08-1.40). When examining these trends by years, there were only significant increases in 2021, and no significant increases were observed in 2020.

CONCLUSIONS

The study findings show that in the second year following the start of the pandemic, significant increases were observed in suicide-related ideation hospital-presentations in older adults. While immediate changes in trends were not observed in the first year of the pandemic, it is important to consider the pandemic's medium and long-term impact on older adults' mental health, to provide adequate support and reduce suicide risk among those presenting with suicide-related ideation.

Barriers and risk factors associated with non-treatment-seeking for suicidality onset during the COVID-19 pandemic among young adults

INTRODUCTION

Researchers predict long-term increases in suicide deaths following the COVID-19 pandemic. Little is known about risk factors for suicidal ideation (SI) and suicidal attempts (SA) or treatment barriers and promoters during the pandemic. We examine these factors in a young adult sample.

METHODS

Analyses used a 2022 cross-sectional survey dataset (N = 1,956). Logistic regression identified factors associated with pandemic suicidality (i.e., SI, SA). Non-treatment seekers reported barriers to seeking treatment. Logistic regression identified promotive factors associated with treatment-seeking.

RESULTS

28.6 % of our sample developed suicidality during the pandemic, of whom 49.6 % did not seek treatment. Asian race and sexual minority status were strongly associated with increased odds of pandemic suicidality. Among SI non-treatment-seekers, barriers were primarily attitudinal (e.g., "symptoms are not serious enough for treatment"); among non-treatment-seekers with SA, barriers were mostly structural (e.g., insufficient funds). Previous depression treatment was strongly associated with increased odds of treatment-seeking.

CONCLUSION

Asian American individuals were at increased risk for pandemic suicidality, which may reflect interpersonal risks related to COVID-19-related anti-Asian racism. Our findings point to a "foot-in-the-door" effect: past treatment-seeking was positively associated with future treatment-seeking. To promote this effect and decrease barriers, we suggest integrated mental health screening and referrals in primary care.

Psychosocial Identity, Intimacy and Suicidality in Young Adults

OBJECTIVE

Suicidality in young adults is a serious and growing clinical and social problem. The theory of psychosocial ego development assumes that identity and intimacy are two key factors for adaptation and vulnerability in early adulthood. The aim of the present study was to test whether psychosocial identity and intimacy are related to suicidality in young adults, even when controlling for confounding variables (depressive symptoms, sex, age, health and economic assessment, religious commitment, and pandemic-related distress).

METHOD

Respondents aged 18-25 (n = 607) completed the Identity-Confusion and Intimacy-Isolation subscales from the Modified Erikson Psychosocial Stage Inventory, as well as the Patient Health Questionnaire-9, the Suicidal Behaviors Questionnaire-Revised and answered questions about the pandemic-related distress and various sociodemographic factors.

RESULTS

At the level of bivariate analyses, both identity and intimacy were negatively associated with suicidal risk in the overall sample and with the frequency of suicidal ideation in the suicide risk subsample (n = 242). Weaker identity, but not intimacy, was associated with belonging to a suicide risk group in multivariable logistic regression. Moreover, ordinal regression showed that, in the subgroup with suicide risk, identity was negatively associated with the frequency of suicidal thoughts.

CONCLUSIONS

Identity is a negative correlate of suicidality in young adults. Identity-focused therapy may be a promising target for intervention in suicidal young adults.

Psychological impact of COVID-19 on the Ecuadorian population: a comparative analysis 1 year after quarantine measures

Introduction

Social isolation during and after the COVID-19 pandemic has sparked interest in its psychological and neurobiological consequences. The pandemic has been associated with an increase in anxiety, depression, and stress, according to some cross-sectional studies. This study aims to analyze changes in the levels of anxiety, depression and stress by comparing the confinement phase to the post-confinement period in the Ecuadorian population.

Methods

A longitudinal, comparative, prospective study was conducted using an online survey comprising two sections. The first section gathered demographic information, whereas the second section included the DASS-21 questionnaire. Ecuadorian participants who completed the survey during the initial data-collection period were included.

Results

In total, 162 participants were included in the final analysis. The average age of the participants was 29.6 ± 11.7 years, and the majority were women (63.3%). In 2020, the median depression, anxiety, and stress scores were 6 (IQR 2-12), 6 (IQR 2-10), and 10 (IQR 6-16) respectively. In 2021, the median depression score was 8 (IQR 4-14), the median anxiety score was 8 (IQR 4-14.5), and the median stress and its interquartile range were 10 (IQR 6-18). The levels of depression, anxiety, and stress were significantly inversely correlated with age, number of children, self-reported general health, and self-reported mental health in both 2020 and 2021.

Conclusion

Exercise, being a student, sex and having had COVID-19 examination may be predictors for the changes in the levels of psychological disorders. Implementing psychological strategies, such as cognitive behavioral therapy, and physiological interventions, like regular physical activity, early in the post-lockdown period could help mitigate the negative mental health impacts observed in the aftermath of the pandemic. These interventions can provide necessary support and coping mechanisms for those at higher risk, thereby improving overall mental health outcomes.

COVID-19 and collective trauma: Implementing a trauma-informed model of care for post-COVID patients

AIM

To describe the implementation of a trauma-informed model of care in the Post COVID Respiratory Clinic of a large tertiary referral centre in NSW.

DESIGN

Discussion paper.

DATA SOURCES

Evidence gathered from a literature search (2008-2022) was used to develop a framework for management of patients presenting to this Post COVID Respiratory Clinic. This paper outlines the personal reflections of the clinic staff as they developed and implemented this framework. Ethical approval was obtained to report the data collected from patient reviews.

DISCUSSION

The literature highlights the high prevalence of trauma in patients following COVID-19 infection, as well as the larger population both during and after the pandemic. This experience of trauma was observed in patients seen within the clinic, indicating a need for specialized care. In response, a trauma-informed model of care was implemented.

CONCLUSION

Reconceptualizing COVID-19 as a 'collective trauma' can help healthcare workers understand the needs of post-COVID patients and enable them to respond empathetically. A trauma-informed model is complementary to this cohort as it specifically addresses vulnerable populations, many of whom have been further marginalized by the pandemic.

IMPLICATIONS FOR NURSING AND PATIENT CARE

Frontline healthcare workers, particularly nurses, are well positioned to implement trauma-informed care due to their high-level of patient contact. Adequate allocation of resources and investment in staff is essential to ensure such care can be provided.

IMPACT

The COVID-19 pandemic has led to adverse physical and mental health outcomes for many. Trauma-informed care is a way to promote reengagement with the healthcare system in this group. Post COVID patients globally may benefit from this approach, as it aims to build trust and independence.

PATIENT OR PUBLIC CONTRIBUTION

Feedback was sought from a patient representative to ensure this paper adequately reflected the experience of the post-COVID patient.

Tailored Physical Activity Interventions for Long COVID: Current Approaches and Benefits-A Narrative Review

This narrative review explores the essential role of physical activity in managing long COVID, which is characterized by persistent symptoms such as fatigue, breathlessness, and cognitive impairments following SARS-CoV-2 infection. In this context, "physical activity" includes various exercises, such as aerobic and resistance training, as well as flexibility and balance exercises, thereby encompassing the subset known as "exercise". The methodology involved a comprehensive literature search across PubMed, EBSCO (EDS), and Google Scholar, selecting peer-reviewed articles from December 2019 to June 2024 focusing on long COVID physical activity interventions. The review highlights that tailored exercise programs, adjusted to individual health status and abilities, significantly alleviate symptoms and enhance psychological well-being. Key findings emphasize the importance of personalized exercise prescriptions due to the variability in patient responses and the need for a multidisciplinary approach in developing and monitoring interventions. Despite promising outcomes, the review identifies research gaps, including the need for long-term studies, randomized controlled trials, and deeper mechanistic insights. It suggests that standardized reporting, templates like the Consensus on Exercise Reporting Template (CERT), and integrating digital health tools are essential for optimizing interventions. Overall, the review advocates including personalized physical activity or exercise programs in standard care for long COVID to improve patient outcomes and quality of life.

The moderating effect of perceived hope in the relationship between anxiety and posttraumatic growth during the Russian-Ukrainian war

Introduction

This study examines the relationships between perceived hope, posttraumatic growth, well-being, anxiety, and perceived threat of the Russian-Ukrainian War (RUW) in the Czech adult population. Drawing on the evidence of posttraumatic growth (PTG) amidst crisis, we hypothesized that perceived hope moderates the effects of perceived threat of war and anxiety on PTG.

Methods

Data were obtained from 1,000 Czech respondents via an online questionnaire ten months post-invasion. The form included measures of posttraumatic growth, perceived hope, well-being, anxiety and depression, and perceived threat of war.

Results

Our findings reveal that perceived hope acted as a moderator enhancing the positive effects of perceived threat and anxiety on PTG. However, perceived hope did not significantly moderate the direct effects of perceived threats and anxiety on well-being.

Discussion

This study highlights the significant role of hope amidst adversity and underscores its potential as a target for interventions aiming to foster PTG in populations who navigate traumatic experiences. Furthermore, it advocates for continued exploration of the factors interacting to enhance well-being and facilitate PTG in affected communities.

The Coronavirus Pandemic and Mental Health Presentations of Young Children

Children under the age of four are emotionally vulnerable to global disasters, such as the COVID-19 pandemic given the lack of socialization opportunities and coping mechanisms, and susceptibility to heightened caregiver stress. Currently, the extent to which the pandemic impacted the mental health of clinically referred young children is unknown. To evaluate how children's mental health outcomes were impacted during the pandemic, interRAI Early Years assessments (N = 1343) were obtained from 11 agencies across the Province of Ontario, during pre-pandemic and pandemic timepoints. Findings demonstrated that the number of completed assessments declined during the pandemic. Further, children's emotional concerns differed before and during the pandemic, whereby children exhibited greater emotional dysregulation during the pandemic. However, there were no significant differences when examining caregiver distress, parenting strengths, child distractibility/inattention or behavioural issues. Implications for young children and their families, clinicians, and policy makers are discussed.