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Martínez-Alés G, Keyes K. Invited Commentary: Modern Epidemiology Confronts COVID-19-Reflections From Psychiatric Epidemiology. Am J Epidemiol 2023; 192:856-860. [PMID: 36843016 DOI: 10.1093/aje/kwad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/07/2023] [Accepted: 02/22/2023] [Indexed: 02/28/2023] Open
Abstract
Dimitris et al. (Am J Epidemiol. 2022;191(6):980-986) outline how the coronavirus disease 2019 (COVID-19) pandemic has, with mixed results, put epidemiology under the spotlight. While epidemiologic theory and methods have been critical in many successes, the ongoing global death toll from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the sometimes chaotic public messaging underscore that epidemiology as a field has room for improvement. Here, we use examples from psychiatric epidemiologic studies conducted during the COVID-19 era to reflect on errors driven by overlooking specific major methodological advances of modern epidemiology. We focus on: 1) use of nonrepresentative sampling in online surveys, which limits the potential knowledge to be gained from descriptive studies and amplifies collider stratification bias in causal studies; and 2) failure to acknowledge multiple versions of exposures (e.g., lockdown, school closure) and differences in prevalence of effect measure modifiers across contexts, which causes violations of the consistency assumption and lack of effect transportability. We finish by highlighting: 1) the heterogeneity of psychiatric epidemiologic results during the pandemic across place and sociodemographic groups and over time; 2) the importance of following the foundational advancements of modern epidemiology even in emergency settings; and 3) the need to limit the role of political agendas in cherry-picking and reporting epidemiologic evidence.
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Martínez-Alés G, López-Cuadrado T, Morrison C, Keyes K, Susser E. The impact of the COVID-19 pandemic on suicide mortality in Spain: Differences by sex and age. J Affect Disord 2023; 329:315-323. [PMID: 36863466 PMCID: PMC9974212 DOI: 10.1016/j.jad.2023.02.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Variations in suicide following the initial COVID-19 pandemic outbreak were heterogeneous across space, over time, and across population subgroup. Whether suicide has increased during the pandemic in Spain, a major initial COVID-19 hotspot, remains unclear, and no study has examined differences by sociodemographic group. METHODS We used 2016-2020 data on monthly suicide deaths from Spain's National Institute of Statistics. We implemented Seasonal Autoregressive Integrated Moving Average (SARIMA) models to control seasonality, non-stationarity, and autocorrelation. Using January 2016-March 2020 data, we predicted monthly suicide counts (95 % prediction intervals) between April and December 2020, and then compared observed and predicted monthly suicide counts. All calculations were conducted for the overall study population and by sex and age group. RESULTS Between April and December 2020, the number of suicides in Spain was 11 % higher-than-predicted. Monthly suicide counts were lower-than-expected in April 2020 and peaked in August 2020 with 396 observed suicides. Excess suicide counts were particularly salient during the summer of 2020 - largely driven by over 50 % higher-than-expected suicide counts among males aged 65 years and older in June, July, and August 2020. DISCUSSION The number of suicides increased in Spain during the months following the initial COVID-19 pandemic outbreak in Spain, largely driven by increases in suicides among older adults. Potential explanations underlying this phenomenon remain elusive. Important factors to understand these findings may include fear of contagion, isolation, and loss and bereavement - in the context of the particularly high mortality rates of older adults during the initial phases of the pandemic in Spain.
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Affiliation(s)
- Gonzalo Martínez-Alés
- CAUSALab, Harvard TH Chan School of Public Health, Boston, MA, USA; La Paz Research Institute (IdiPAZ), Madrid, Spain; Network Center for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.
| | | | | | - Katherine Keyes
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ezra Susser
- Columbia University Mailman School of Public Health, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
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Pérez-Gómez B, Pastor-Barriuso R, Fernández-de-Larrea N, Hernán MA, Pérez-Olmeda M, Oteo-Iglesias J, Fernández-Navarro P, Fernández-García A, Martín M, Cruz I, Sanmartín JL, León-Paniagua J, Muñoz-Montalvo JF, Blanco F, Yotti R, Pollán M. SARS-CoV-2 Infection During the First and Second Pandemic Waves in Spain: the ENE-COVID Study. Am J Public Health 2023; 113:533-544. [PMID: 36893370 PMCID: PMC10088950 DOI: 10.2105/ajph.2023.307233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 03/11/2023]
Abstract
Objectives. To describe participant characteristics associated with severe acute respiratory syndrome coronavirus 2 infection in Spain's first 2 COVID-19 waves per the Spanish National Seroepidemiological Survey of SARS-CoV-2 Infection (ENE-COVID). Methods. A representative cohort of the noninstitutionalized Spanish population, selected through stratified 2-stage sampling, answered a questionnaire and received point-of-care testing April to June 2020 (first wave: n = 68 287); previously seronegative participants repeated the questionnaire and test November 2020 (second wave: n = 44 451). We estimated seropositivity by wave and participant characteristics, accounting for sampling weights, nonresponse, and design effects. Results. We found that 6.0% (95% confidence interval [CI] = 5.7%, 6.4%) of Spain's population was infected by June and 3.8% (95% CI = 3.5%, 4.1%) more by November 2020. Both genders were equally affected. Seroprevalence decreased with age in adults 20 years and older in the second wave; socioeconomic differences increased. Health care workers were affected at 11.1% (95% CI = 9.0%, 13.6%) and 6.1% (95% CI = 4.4%, 8.5%) in the first and second waves, respectively. Living with an infected person increased infection risk to 22.1% (95% CI = 18.9%, 25.6%) in the first and 35.0% (95% CI = 30.8%, 39.4%) in the second wave. Conclusions. ENE-COVID characterized the first 2 pandemic waves, when information from surveillance systems was incomplete. (Am J Public Health. 2023;113(5):533-544. https://doi.org/10.2105/AJPH.2023.307233).
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Affiliation(s)
- Beatriz Pérez-Gómez
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Roberto Pastor-Barriuso
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Nerea Fernández-de-Larrea
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Miguel A Hernán
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Mayte Pérez-Olmeda
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Jesús Oteo-Iglesias
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Pablo Fernández-Navarro
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Aurora Fernández-García
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Mariano Martín
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Israel Cruz
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - José L Sanmartín
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - José León-Paniagua
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Juan F Muñoz-Montalvo
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Faustino Blanco
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Raquel Yotti
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Marina Pollán
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
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Mediavilla R, Martínez-Alés G, Andreo-Jover J, Louzao-Rojas I, Cebolla-Lorenzo S, Muñoz-San-José A, Fernández-Jiménez E, Aguirre P, Luis Ayuso-Mateos J, Bravo-Ortiz MF, Bayón-Pérez C. Mental health service requirements after COVID-19 hospitalization: A 1-year follow-up cohort study using electronic health records. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022; 16:S1888-9891(22)00108-2. [PMID: 36249883 PMCID: PMC9540701 DOI: 10.1016/j.rpsm.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Gonzalo Martínez-Alés
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- CAUSALab, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jorge Andreo-Jover
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Iker Louzao-Rojas
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | - Susana Cebolla-Lorenzo
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | - Ainoa Muñoz-San-José
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | - Eduardo Fernández-Jiménez
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | - Pablo Aguirre
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - María Fe Bravo-Ortiz
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | - Carmen Bayón-Pérez
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
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5
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Mediavilla R, Monistrol-Mula A, McGreevy KR, Felez-Nobrega M, Delaire A, Nicaise P, Palomo-Conti S, Bayón C, Bravo-Ortiz MF, Rodríguez-Vega B, Witteveen A, Sijbrandij M, Turrini G, Purgato M, Vuillermoz C, Melchior M, Petri-Romão P, Stoffers-Winterling J, Bryant RA, McDaid D, Park AL, Ayuso-Mateos JL. Mental health problems and needs of frontline healthcare workers during the COVID-19 pandemic in Spain: A qualitative analysis. Front Public Health 2022; 10:956403. [PMID: 35968478 PMCID: PMC9363705 DOI: 10.3389/fpubh.2022.956403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Healthcare workers (HCWs) from COVID-19 hotspots worldwide have reported poor mental health outcomes since the pandemic's beginning. The virulence of the initial COVID-19 surge in Spain and the urgency for rapid evidence constrained early studies in their capacity to inform mental health programs accurately. Here, we used a qualitative research design to describe relevant mental health problems among frontline HCWs and explore their association with determinants and consequences and their implications for the design and implementation of mental health programs. Materials and methods Following the Programme Design, Implementation, Monitoring, and Evaluation (DIME) protocol, we used a two-step qualitative research design to interview frontline HCWs, mental health experts, administrators, and service planners in Spain. We used Free List (FL) interviews to identify problems experienced by frontline HCWs and Key informant (KI) interviews to describe them and explore their determinants and consequences, as well as the strategies considered useful to overcome these problems. We used a thematic analysis approach to analyze the interview outputs and framed our results into a five-level social-ecological model (intrapersonal, interpersonal, organizational, community, and public health). Results We recruited 75 FL and 22 KI interviewees, roughly balanced in age and gender. We detected 56 themes during the FL interviews and explored the following themes in the KI interviews: fear of infection, psychological distress, stress, moral distress, and interpersonal conflicts among coworkers. We found that interviewees reported perceived causes and consequences across problems at all levels (intrapersonal to public health). Although several mental health strategies were implemented (especially at an intrapersonal and interpersonal level), most mental health needs remained unmet, especially at the organizational, community, and public policy levels. Conclusions In keeping with available quantitative evidence, our findings show that mental health problems are still relevant for frontline HCWs 1 year after the COVID-19 pandemic and that many reported causes of these problems are modifiable. Based on this, we offer specific recommendations to design and implement mental health strategies and recommend using transdiagnostic, low-intensity, scalable psychological interventions contextually adapted and tailored for HCWs.
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Affiliation(s)
- Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Anna Monistrol-Mula
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Kerry R. McGreevy
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Mireia Felez-Nobrega
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Audrey Delaire
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - Pablo Nicaise
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | | | - Carmen Bayón
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Psychiatry, Hospital Universitario La Paz, Madrid, Spain
| | - María-Fe Bravo-Ortiz
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Psychiatry, Hospital Universitario La Paz, Madrid, Spain
| | - Beatriz Rodríguez-Vega
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Psychiatry, Hospital Universitario La Paz, Madrid, Spain
| | - Anke Witteveen
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Giulia Turrini
- Department of Neurosciences, Biomedicine and Movement Sciences, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Cécile Vuillermoz
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Research Team on Social Epidemiology, Paris, France
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Research Team on Social Epidemiology, Paris, France
| | | | | | - Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Psychiatry, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
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6
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Martínez-Alés G, Fernández-Jiménez E, Mediavilla R, Quintana-Díaz M, Louzao I, Cebolla S, Muñoz-Sanjosé A, Bayón C, Susser ES, Bravo-Ortiz MF. Role of medical comorbidity in the association between psychiatric disorders and mortality among patients with COVID-19. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1727-1730. [PMID: 35322285 PMCID: PMC8942759 DOI: 10.1007/s00127-022-02271-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/08/2022] [Indexed: 11/30/2022]
Abstract
We examined whether excess chronic medical comorbidity mediated excess COVID-19 inpatient mortality among people with mental disorders in the early phase of the pandemic, a question with important implications for public health and clinical decision-making. Using records of 2599 COVID-19 hospitalized patients, we conducted a formal causal mediation analysis to estimate the extent to which chronic comorbidity mediates the association between mental disorders and COVID-19 mortality. The Odds Ratio (95% CI) for Natural Indirect Effect and Controlled Direct Effect were 1.07(1.02, 1.14) and 1.40 (1.00, 1.95), respectively, suggesting that a large proportion of excess COVID-19 mortality among people with mental disorders may be explained by factors other than comorbidity.
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Affiliation(s)
- Gonzalo Martínez-Alés
- Harvard University T.H. Chan School of Public Health, Boston, MA, USA. .,Columbia University Mailman School of Public Health, New York, NY, USA. .,Mental Health Network Biomedical Research Center (CIBERSAM), Madrid, Spain. .,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain. .,CAUSALab, Harvard University T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Eduardo Fernández-Jiménez
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain ,La Paz University Hospital, Madrid, Spain
| | - Roberto Mediavilla
- Mental Health Network Biomedical Research Center (CIBERSAM), Madrid, Spain ,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain ,La Paz University Hospital, Madrid, Spain ,Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | | | | | | | - Ainoa Muñoz-Sanjosé
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain ,La Paz University Hospital, Madrid, Spain
| | - Carmen Bayón
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain ,La Paz University Hospital, Madrid, Spain ,Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Ezra S. Susser
- Columbia University Mailman School of Public Health, New York, NY USA ,New York Psychiatric Institute, New York, NY USA
| | - María Fe Bravo-Ortiz
- Mental Health Network Biomedical Research Center (CIBERSAM), Madrid, Spain ,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain ,La Paz University Hospital, Madrid, Spain ,Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
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7
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Fernández-Jiménez E, Muñoz-Sanjose A, Mediavilla R, Martínez-Alés G, Louzao II, Andreo J, Cebolla S, Bravo-Ortiz MF, Bayón C. Prospective Analysis Between Neutrophil-to-Lymphocyte Ratio on Admission and Development of Delirium Among Older Hospitalized Patients With COVID-19. Front Aging Neurosci 2021; 13:764334. [PMID: 34887744 PMCID: PMC8650500 DOI: 10.3389/fnagi.2021.764334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/01/2021] [Indexed: 12/23/2022] Open
Abstract
Objective: To examine any prospective association between neutrophil-to-lymphocyte ratio (NLR) at hospital admission and subsequent delirium in older COVID-19 hospitalized patients comparing by sex and age groups. Methods: The sample consisted of 1,785 COVID-19 adult inpatients (minimum sample size required of 635 participants) admitted to a public general hospital in Madrid (Spain) between March 16th and April 15th, 2020. Variables were obtained from electronic health records. Binary logistic regression models were performed between baseline NLR and delirium adjusting for age, sex, medical comorbidity, current illness severity, serious mental illness history and use of chloroquine and dexamethasone. An NLR cut-off was identified, and stratified analyses were performed by age and sex. Also, another biomarker was tested as an exposure (the systemic immune-inflammation index -SII). Results: 55.3% of the patients were men, with a mean age of 66.8 years. Roughly 13% of the patients had delirium during hospitalization. NLR on admission predicted subsequent delirium development (adjusted OR = 1.02, 95 percent CI: 1.00-1.04, p = 0.024). Patients between 69 and 80 years with NLR values > 6.3 presented a twofold increased risk for delirium (p = 0.004). There were no sex differences in the association between baseline NLR and delirium (p > 0.05) nor SII predicted delirium development (p = 0.341). Conclusion: NLR is a good predictor of delirium during hospitalization, especially among older adults, independently of medical comorbidity, illness severity, and other covariates. Routine blood tests on admission might provide valuable information to guide the decision-making process to be followed with these especially vulnerable patients.
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Affiliation(s)
- Eduardo Fernández-Jiménez
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Ainoa Muñoz-Sanjose
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Centro de Investigación Biomédica en Red (CIBERSAM), Madrid, Spain
| | - Gonzalo Martínez-Alés
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain.,Centro de Investigación Biomédica en Red (CIBERSAM), Madrid, Spain.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Iker I Louzao
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | - Jorge Andreo
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Susana Cebolla
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - María-Fe Bravo-Ortiz
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Centro de Investigación Biomédica en Red (CIBERSAM), Madrid, Spain
| | - Carmen Bayón
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
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