Mental health consequences of COVID-19: the next global pandemic

Natural language processing analysis of the psychosocial stressors of mental health disorders during the pandemic

Over the past few years, the COVID-19 pandemic has exerted various impacts on the world, notably concerning mental health. Nevertheless, the precise influence of psychosocial stressors on this mental health crisis remains largely unexplored. In this study, we employ natural language processing to examine chat text from a mental health helpline. The data was obtained from a chat helpline called Safe Hour from the "It Gets Better" project in Chile. This dataset encompass 10,986 conversations between trained professional volunteers from the foundation and platform users from 2018 to 2020. Our analysis shows a significant increase in conversations covering issues of self-image and interpersonal relations, as well as a decrease in performance themes. Also, we observe that conversations involving themes like self-image and emotional crisis played a role in explaining both suicidal behavior and depressive symptoms. However, anxious symptoms can only be explained by emotional crisis themes. These findings shed light on the intricate connections between psychosocial stressors and various mental health aspects in the context of the COVID-19 pandemic.

Impact assessment of COVID-19 global pandemic on water, environment, and humans

One of the most significant threats to global health since the Second World War is the COVID-19 pandemic. Due to COVID-19 widespread social, environmental, economic, and health concerns. Other unfavourable factors also emerged, including increased trash brought on by high consumption of packaged foods, takeout meals, packaging from online shopping, and the one-time use of plastic products. Due to labour shortages and residents staying at home during mandatory lockdowns, city municipal administrations' collection and recycling capacities have decreased, frequently damaging the environment (air, water, and soil) and ecological and human systems. The COVID-19 challenges are more pronounced in unofficial settlements of developing nations, particularly for developing nations of the world, as their fundamental necessities, such as air quality, water quality, trash collection, sanitation, and home security, are either non-existent or difficult to obtain. According to reports, during the pandemic's peak days (20 August 2021 (741 K cases), 8 million tonnes of plastic garbage were created globally, and 25 thousand tonnes of this waste found its way into the ocean. This thorough analysis attempts to assess the indirect effects of COVID-19 on the environment, human systems, and water quality that pose dangers to people and potential remedies. Strong national initiatives could facilitate international efforts to attain environmental sustainability goals. Significant policies should be formulated like good quality air, pollution reduction, waste management, better sanitation system, and personal hygiene. This review paper also elaborated that further investigations are needed to investigate the magnitude of impact and other related factors for enhancement of human understanding of ecosystem to manage the water, environment and human encounter problems during epidemics/pandemics in near future.

Prevalence and risk factors of psychiatric symptoms and diagnoses before and during the COVID-19 pandemic: findings from the ELSA-Brasil COVID-19 mental health cohort

BACKGROUND

There is mixed evidence on increasing rates of psychiatric disorders and symptoms during the coronavirus disease 2019 (COVID-19) pandemic in 2020. We evaluated pandemic-related psychopathology and psychiatry diagnoses and their determinants in the Brazilian Longitudinal Study of Health (ELSA-Brasil) São Paulo Research Center.

METHODS

Between pre-pandemic ELSA-Brasil assessments in 2008-2010 (wave-1), 2012-2014 (wave-2), 2016-2018 (wave-3) and three pandemic assessments in 2020 (COVID-19 waves in May-July, July-September, and October-December), rates of common psychiatric symptoms, and depressive, anxiety, and common mental disorders (CMDs) were compared using the Clinical Interview Scheduled-Revised (CIS-R) and the Depression Anxiety Stress Scale-21 (DASS-21). Multivariable generalized linear models, adjusted by age, gender, educational level, and ethnicity identified variables associated with an elevated risk for mental disorders.

RESULTS

In 2117 participants (mean age 62.3 years, 58.2% females), rates of CMDs and depressive disorders did not significantly change over time, oscillating from 23.5% to 21.1%, and 3.3% to 2.8%, respectively; whereas rate of anxiety disorders significantly decreased (2008-2010: 13.8%; 2016-2018: 9.8%; 2020: 8%). There was a decrease along three wave-COVID assessments for depression [β = -0.37, 99.5% confidence interval (CI) -0.50 to -0.23], anxiety (β = -0.37, 99.5% CI -0.48 to -0.26), and stress (β = -0.48, 99.5% CI -0.64 to -0.33) symptoms (all ps < 0.001). Younger age, female sex, lower educational level, non-white ethnicity, and previous psychiatric disorders were associated with increased odds for psychiatric disorders, whereas self-evaluated good health and good quality of relationships with decreased risk.

CONCLUSION

No consistent evidence of pandemic-related worsening psychopathology in our cohort was found. Indeed, psychiatric symptoms slightly decreased along 2020. Risk factors representing socioeconomic disadvantages were associated with increased odds of psychiatric disorders.

Telemonitoring as a Telehealth strategy to contain the COVID-19 pandemic in a Brazilian capital

Objective

This study aimed to describe and analyze the process of creating and implementing telemonitoring services for COVID-19 cases, focusing on strengths and weaknesses.

Methods

A single case study incorporating qualitative and quantitative data using descriptive and exploratory approach was performed from 24 March 2020 to 24 March 2021 in a Brazilian capital city. Data collection took place through interviews, document analysis, and direct observation. Thematic content analysis was performed, and the results were presented in categories.

Results

The project included 512 health professionals, and 102,000 patients were monitored. The service was designed to break the chain of transmission, reinforce biosecurity measures, and provide comprehensive care to patients. Initially, two levels of monitoring were created. The first was a multidisciplinary health team that made calls to patients in the database. If the patients showed warning signs or aggravation, they were referred to the physician's monitoring referral service. Subsequently, a third level was created and staffed by psychologists. The main challenges were the number of patients notified, needing to update the contact forms as COVID-19 knowledge increased, and inconsistent telephone numbers recorded in the notifications.

Conclusions

Telemonitoring allowed signs of worsening COVID-19 to be identified, monitored thousands of people, and stopped infected patients from circulating. Adapting the existing telehealth structure was a viable, agile, and powerful strategy to reach a large number of people.

Suicide Attempts Assisted By Firefighters According to Traumatic Brain Injury

Studies worldwide have reported increasing trends in suicides and attempts during the pandemic. The literature shows that improving surveillance and monitoring of suicide and attempts requires broad multisectoral prevention strategies. In Brazil, the São Paulo State Fire Department (CBPMESP) makes up the emergency response team for suicide and suicide attempted calls and public emergencies. Given this context, this paper sought to describe the characteristics of suicide attempts assisted by the CBPMESP according to traumatic brain injury (TBI), between 2018 and 2020, measured by the Glasgow Coma Scale (GCS). For this purpose, a descriptive study of 6,582 suicide attempts attended by CBPMESP was carried out. The factors associated with trauma brain injury according to the Glasgow Coma Scale (dependent variable) were analyzed by a multinomial regression model. Results show a significant increase of 8.0% (p = 0.039) in the number of calls responded by CBPMESP between 2018 and 2020. Men presented a higher prevalence of more violent methods for suicide attempts, namely firearms and hanging, followed by severe TBI; in women, severe TBI occurred mostly by hanging. Despite the increase in fatal suicide attempts during the pandemic, time to attend to victim acted as a protective factor for preventing severe TBI in men and women.

Time series analysis of the suicide attempts assisted by firefighters from 2017 to 2021 in São Paulo, Brazil

OBJECTIVE

This study aimed to analyze the time trends of suicide attempts assisted by the Fire Department of the Military Police of the State of São Paulo (Corpo de Bombeiros da Polícia Militar do Estado de São Paulo - CBPMESP) from 2017 to 2021, between sexes.

METHODS

This is an ecological study of 11,435 suicide attempts assisted by CBPMESP calls from January 2017 to December 2021. Three seasonal auto-regressive integrated moving average with exogenous (SARIMAX) models were adjusted considering total population, only men, and only women.

RESULTS

The total occurrences of suicide attempts were stationary in the prepandemic period but had an increased growth pattern after the pandemic began. This trend was higher among men, due to (1) lower assistance of suicide attempts during early pandemic than in the prepandemic period and (2) significant increased assistance after the beginning of vaccination against COVID-19, followed by a decrease, but with a tendency to increase, in the long-term pandemic.

CONCLUSION

Our results indicate a growth in the long-term suicide attempts during COVID-19. The beginning of vaccination was not considered significant in the reduction of CBPMESP attendances. These results corroborate the need for a multisectoral national suicide prevention strategy to mitigate the effects of the pandemic on mental health in the State of São Paulo.

Mental health nurses' constructions of compassion: A discourse analysis

Compassion is an important element of contemporary nursing work. Compassion has been recognized as necessary for improving health outcomes. However, very little is known about how compassion is understood in the mental health practice setting. We conducted interviews with seven mental health nurses to explore their perspectives on compassion and views on compassion policy. Analysis of the data revealed that compassion was identified and discussed as Compassion as part of the person (and the profession); Compassion: Fundamental to the nursing role; Barriers to compassion; Perspectives on compassion policy. In addition, findings demonstrated ethical constraints on compassion in the mental health context, as well as the administrative burden on nurses more broadly, which was also a reported barrier to compassion. Mental health nurses identified compassion as fundamental to their clinical practice, yet compassion was impeded owing to practical and emotional constraints upon nurses. System-wide action must be taken to increase and support the mental health nursing workforce to strengthen the practice of compassion. This will be fundamental to improving health outcomes that are claimed to be enhanced by compassion. This study is reported according to the COREQ guidelines.

Alcohol Use and Anxiety in Primary Health Care Patients During the COVID-19 Pandemic: a Phone-Based Study

In March 2020, physical distancing and quarantine measures were implemented in Brazil, which may have affected the physical and mental health of the population. This cross-sectional study used a convenience sample and telephone-based interviews to identify anxiety symptoms and alcohol use patterns among 1,264 Brazilian primary health care (PHC) patients during the COVID-19 pandemic. The State-Trait Anxiety Inventory-State 6 and Alcohol Use Disorders Identification Test (AUDIT-C) questionnaires were used to assess anxiety symptoms and alcohol use patterns, respectively. According to the AUDIT-C results, the prevalence of harmful drinking was 38.5%. Those who reported that their alcohol consumption decreased during the pandemic had high scores on the AUDIT-C, indicating a moderate/severe risk of drinking. Moderate or severe anxiety was observed in 60.1% of participants. These results highlight the needs to assess the pandemic's consequences on the mental health of the population and to encourage the implementation of preventive approaches in PHC settings to address anxiety and harmful alcohol consumption.

Cancer as a risk factor for distress and its interactions with sociodemographic variables in the context of the first wave of the COVID-19 pandemic in Germany

The COVID-19 pandemic poses a psychological challenge, especially for individuals with chronic illnesses. The aim of this study was to investigate associations of cancer with distress, including its interplay with further risk and protective factors. We conducted a representative survey of the German population (N = 2503, including N = 144 with a cancer diagnosis) during the first wave of the pandemic. In multiple linear and logistic regression analyses, we tested associations of cancer with depression and anxiety symptoms and suicidal ideation. We also investigated moderating effects of age, gender, income, living situation, marital status, and loneliness. Individuals with cancer were more likely to report anxiety symptoms (φ = .061), suicidal ideation (φ = .050), and loneliness (φ = .044) than other participants. In regression analyses that controlled for sociodemographic differences, cancer was still associated with anxiety symptoms. We also observed interaction effects, indicating that this relation was especially strong in men with cancer and that cancer survivors with a low income were particularly likely to report anxiety symptoms. The findings demonstrate that cancer survivors are a vulnerable group and that factors of different life domains interact in shaping well-being in the population, necessitating comprehensive risk assessment and support offers during the pandemic and beyond.

Fear and Attitude towards SARS-CoV-2 (COVID-19) Infection in Spanish Population during the Period of Confinement

In January 2020, the WHO classified SARS-CoV-2 infection as a public health emergency and it was declared a pandemic on 11 March 2020. The media warned about the danger of infection, fuelling the population’s fear of the new situation and increasing the perception of risk. This fear can cause behaviour that will determine the course of the pandemic and, therefore, the purpose of this study was to analyse the fear of infection from COVID-19 among the Spanish population during the state of emergency. A cross-sectional, descriptive observational study was conducted with 16,372 participants. Data on sociodemographic factors, health factors, risk perception and fear were collected through an online survey. Level of fear is associated with older age, a lower level of education, having a person infected with SARS-CoV-2 in the immediate surroundings and living with and belonging to the most socioeconomically vulnerable group of people. Risk perception is associated with increased preventive behaviour. This paper provides relevant information for the public health sector since it contributes first-hand knowledge of population data that is highly useful in terms of prevention. Understanding the experiences of people in this pandemic helps to create more effective future intervention strategies in terms of planning and management for crisis situations.

Trajectories of common mental disorders symptoms before and during the COVID-19 pandemic: findings from the ELSA-Brasil COVID-19 Mental Health Cohort

AIM

Evidence indicates most people were resilient to the impact of the COVID-19 pandemic on mental health. However, evidence also suggests the pandemic effect on mental health may be heterogeneous. Therefore, we aimed to identify groups of trajectories of common mental disorders' (CMD) symptoms assessed before (2017-19) and during the COVID-19 pandemic (2020-2021), and to investigate predictors of trajectories.

METHODS

We assessed 2,705 participants of the ELSA-Brasil COVID-19 Mental Health Cohort study who reported Clinical Interview Scheduled-Revised (CIS-R) data in 2017-19 and Depression Anxiety Stress Scale-21 (DASS-21) data in May-July 2020, July-September 2020, October-December 2020, and April-June 2021. We used an equi-percentile approach to link the CIS-R total score in 2017-19 with the DASS-21 total score. Group-based trajectory modeling was used to identify CMD trajectories and adjusted multinomial logistic regression was used to investigate predictors of trajectories.

RESULTS

Six groups of CMD symptoms trajectories were identified: low symptoms (17.6%), low-decreasing symptoms (13.7%), low-increasing symptoms (23.9%), moderate-decreasing symptoms (16.8%), low-increasing symptoms (23.3%), severe-decreasing symptoms (4.7%). The severe-decreasing trajectory was characterized by age < 60 years, female sex, low family income, sedentary behavior, previous mental disorders, and the experience of adverse events in life.

LIMITATIONS

Pre-pandemic characteristics were associated with lack of response to assessments. Our occupational cohort sample is not representative.

CONCLUSION

More than half of the sample presented low levels of CMD symptoms. Predictors of trajectories could be used to detect individuals at-risk for presenting CMD symptoms in the context of global adverse events.

Psychological Distress in Men during the COVID-19 Pandemic in Brazil: The Role of the Sociodemographic Variables, Uncertainty, and Social Support

Objective: To analyze the relationships between sociodemographic variables, intolerance to uncertainty (INT), social support, and psychological distress (i.e., indicators of Common Mental Disorders (CMDs) and perceived stress (PS)) in Brazilian men during the COVID-19 pandemic. Methods: A cross-sectional study with national coverage, of the web survey type, and conducted with 1006 Brazilian men during the period of social circulation restriction imposed by the health authorities in Brazil for suppression of the coronavirus and control of the pandemic. Structural equation modeling analysis was performed. Results: Statistically significant direct effects of race/skin color (λ = 0.268; p-value < 0.001), socioeconomic status (SES) (λ = 0.306; p-value < 0.001), household composition (λ = 0.281; p-value < 0.001), PS (λ = 0.513; p-value < 0.001), and INT (λ = 0.421; p-value < 0.001) were evidenced in the occurrence of CMDs. Black-skinned men with higher SES, living alone, and with higher PS and INT levels presented higher prevalence values of CMDs. Conclusions: High levels of PS and INT were the factors that presented the strongest associations with the occurrence of CMDs among the men. It is necessary to implement actions to reduce the stress-generating sources as well as to promote an increase in resilience and the development of intrinsic reinforcements to deal with uncertain threats.

A longitudinal model for psychological distress in the COVID-19 crisis among brazilian graduate students

As most evidence for mental health impacts of the COVID-19 crisis is cross-sectional, the present study aimed to analyze the longitudinal development of psychological suffering among 619 Brazilian adults by assessing mental health outcomes and individual factors in two periods: a year before and a month after the break of the pandemic. As major findings, pandemic psychological suffering was directly explained by previous-year suffering, conscientiousness, and pandemic perceived stress, and correlated with pandemic suicidal ideation. Pandemic perceived stress correlated with pandemic psychological distress, and was explained by previous-year suffering, neuroticism, and conscientiousness, as well as by pandemic life satisfaction and perceived pandemic impact. Finally, pandemic suicidal ideation variance was explained by prior ideation and pandemic life satisfaction. These findings are in line with current models of mental health and highlight the importance of integrating both more stable individual factors and more transient variables towards and explanation for mental health outcomes.

Home Confinement in Previously Active Older Adults: A Cross-Sectional Analysis of Physical Fitness and Physical Activity Behavior and Their Relationship With Depressive Symptoms

AIM

The aim of our study was to analyze physical activity levels, sitting time, physical fitness, and their relationship with depressive symptoms after home confinement in previously active older adults.

METHODS

This cross-sectional study sample comprised 68 older adults (74.24 ± 5.67 years) from a community-based exercise program conducted in Porto, Portugal. After home confinement, participants were assessed in person for lower-body strength (30-s chair stand test), cardiorespiratory fitness (6-min walking test), agility/dynamic balance (8-ft up-and-go test), handgrip strength, and anthropometry. Telephone interviews were performed to evaluate depressive symptoms with the Geriatric Depression Scale - 15 items (GDS-15) and physical activity levels through the International Physical Activity Questionnaire (IPAQ-SV). Individuals were also asked to self-report changes in their physical activity levels and time spent sitting.

RESULTS

Ninety percent of older adults self-reported a decrease in overall physical activity levels, and nearly 65% increased daily sitting time during the home confinement. However, previously active older adults still presented high levels of physical fitness (scores above 50th compared with Portuguese normative values) after 11 weeks of home confinement. Overall, 52.9% of participants scored 5 or more points on GDS-15, which is suggestive of depression. Higher levels of moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness were found in the non-depressed group compared with the depressed group. Finally, results from multiple regression analysis revealed that MVPA was negatively associated with depression. This model explained 16.4% of the variability seen in depression score, controlled for age, gender, and education.

CONCLUSION

Even reporting a decline in physical activity, older adults who previously participated in a formal exercise program, still presented high levels of physical fitness after 11 weeks of home confinement. However, MVPA, but not physical fitness, seems to be an associated depression score in previously active older adults. These results reinforce the importance of older adults to remain physically active, since higher levels of MVPA may have a protective effect on depressive symptoms and, therefore, mitigate the negative impact of home confinement on mental health. Future longitudinal research studies are needed to ascertain these results.

Effect of a mobile-based intervention on mental health in frontline healthcare workers against COVID-19: Protocol for a randomized controlled trial

Aim

To evaluate the impact of a psychoeducational, mobile health intervention based on cognitive behavioural therapy and mindfulness‐based approaches on the mental health of healthcare workers at the frontline against COVID‐19 in Spain.

Design

We will carry out a two‐week, individually randomized, parallel group, controlled trial. Participants will be individually randomized to receive the PsyCovidApp intervention or control App intervention.

Methods

The PsyCovidApp intervention will include five modules: emotional skills, lifestyle behaviour, work stress and burnout, social support, and practical tools. Healthcare workers having attended patients with COVID‐19 will be randomized to receive the PsyCovidApp intervention (intervention group) or a control App intervention (control group). A total of 440 healthcare workers will be necessary to assure statistical power. Measures will be collected telephonically by a team of psychologists at baseline and immediately after the 2 weeks intervention period. Measures will include stress, depression and anxiety (DASS‐21 questionnaire—primary endpoint), insomnia (ISI), burnout (MBI‐HSS), post‐traumatic stress disorder (DTS), and self‐efficacy (GSE). The study was funded in May 2020, and was ethically approved in June 2020. Trial participants, outcome assessors and data analysts will be blinded to group allocation.

Discussion

Despite the increasing use of mobile health interventions to deliver mental health care, this area of research is still on its infancy. This study will help increase the scientific evidence about the effectiveness of this type of intervention on this specific population and context.

Impact

Despite the lack of solid evidence about their effectiveness, mobile‐based health interventions are already being widely implemented because of their low cost and high scalability. The findings from this study will help health services and organizations to make informed decisions in relation to the development and implementation of this type of interventions, allowing them pondering not only their attractive implementability features, but also empirical data about its benefits.

Clinical trial registration

NCT04393818 (ClinicalTrials.gov identifier).

Approved funding

May 2020.

Translating science into policy: mental health challenges during the COVID-19 pandemic

Several stressors associated with the coronavirus disease 2019 (COVID-19) are expected to affect the mental health of global populations: the effects of physical distancing, quarantine, and social isolation; the emotional suffering of health and other frontline workers; neuropsychiatric sequelae in those affected by the virus; the impact to families of lives lost to the disease; differential effects for those with severe mental disorders; and the consequences of social and economic deterioration.

In this context, we sought: to form a panel of Brazilian experts on child and adolescent health, neurodevelopment, health services, and adult and elderly mental health; and to compile evidence-based interventions to support suggested policy changes in Brazil to mitigate the expected increase in mental health disorders during the pandemic and its mental health consequences. The following actions are recommended: 1) invest in prevention programs for the safe return of students to schools; 2) adopt evidence-based psychosocial interventions to maintain an adequate environment for child and adolescent development; 3) target socially vulnerable populations and those experiencing discrimination; 4) train primary care teams to solve common mental health problems, provide needs-based assessments, and manage long-term, at-home care for older patients; 5) invest in technological advancements (e.g., telemedicine, e-Health, and web-based algorithms) to promote coordinated care; 6) increase access to and literacy in the use of computers and mobile phones, especially among older adults; 7) expand protocols for remote, brief psychotherapy interventions and psychoeducation to manage common mental health problems.