Psychological Impact of the COVID-19 Pandemic and Social Determinants on the Portuguese Population: Protocol for a Web-Based Cross-sectional Study

Urgent Attention Needed for Mental Health Challenges Arising from Prolonged Grief During and in the Aftermath of COVID-19

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Anxiety and Depression Symptoms During the COVID-19 Pandemic: A Cluster Analysis of Individuals Living in Portugal

INTRODUCTION

The COVID-19 pandemic is an illustration of how a physical illness can damage people's minds. In this regard, the goal of this study was to see how different sociodemographic and behavioral factors were linked to anxiety and depression symptoms in a group of individuals living in Portugal.

METHODS

Between November 2020 and February 2021, a cross-sectional, snowball online study was conducted. The study's target population was adults over the age of 18, residents of the country. For the statistical analysis, the clustering technique - K-means algorithm was applied. The chi-squared test was used to determine the relationships between clusters and sociodemographic and behavioral characteristics. Statistical analyses were conducted in R language, with a significance level of 0.05. A total of 453 participants were included.

RESULTS

The majority were female (69.8%), under the age of 40 (60.8%), with a higher education degree (75.3%), and not married (54.4%). Furthermore, the majority were from the country's north region (66%). Cluster 1 (n = 194) was characterized by low or nonexistent levels of anxiety and depression symptoms, which means normal; cluster 2 by severe symptoms (n = 82), meaning case; and cluster 3 by mild symptoms (n = 177), which means borderline. Younger participants (p-value 0.024), female (p-value 0.041), with drinking habits (p-value 0.002), food insecurity (p-value < 0.001), food affordability exacerbation (p-value < 0.001), comorbidity (p-value < 0.001), use of anxiolytics (p-value < 0.001), insufficient household income (p-value 0.017) and income change (p-value < 0.001) were significantly associated with the anxiety-depression clusters. From the three clusters, cluster 2 was mainly represented by younger participants, with more persons stating that their household income was insufficient and that their income has changed as a result of COVID-19 and that they had the highest probability of food insecurity.

CONCLUSION

The impacts of a crisis on mental health extend longer than the event itself. We were able to observe that younger women with insufficient household income who suffered a change in income due to COVID-19 and were classified as food insecure presented higher levels of anxiety and depression symptoms. These results highlight the presence of a social gradient where we saw that people who were less advantaged in terms of socioeconomic position presented worse mental health outcomes, stressing, in this sense, the need to bring the best public health responses for these specific groups of the population.

Psychotropic consumption before and during COVID-19 in Asturias, Spain

BACKGROUND

Spain as multiple other countries has been experiencing an increasing and sustained trend in the use of psychotropic medications since the mid 90s. Recent studies show public health measures implemented to control SARS-Cov2, such as mobility restrictions and the shutdown of nonessential activities increased mental suffering, even contributing to a higher number of anxiety, depression and insomnia disorders that could lead to an increase in the consumption of psychotropics. The aims were: 1) Evaluate the temporal trend in psychotropic consumption by pharmacological subgroup, sex, and age group 2) Estimate the effect of the COVID-19 pandemic in the use of psychotropic drugs.

METHODS

We conducted a retrospective observational study, retrieving all prescriptions of anxiolytics, hypnotics and sedatives, and antidepressants dispensed in pharmacies of Asturias (Northern Spain) for Primary Care patients for the period 2018-2021. We presented the data expressed in Daily Defined Doses (DDDs) for 1000 persons/day (DHD). To estimate changes in DHDs by year and age group we conducted two multiple linear regressions (one for males and one for females) for every pharmacological subgroup studied. Changes were considered statistically significant when the regression coefficient was p < 0.05. We used the Software R 4.1.0.

RESULTS

For the studied period, the highest DHDs are for antidepressants, although all of the subgroups experienced an increase in consumption rates. Women consumed more psychotropic drugs than men. In 2021, 372 out of every 1000 women were taking daily 1 DDD of these drugs versus 184 out of every 1000 men. Consumption rates for all psychotropic drugs progressively increases with age. Conversely, the biggest increases in consumption were among the youngest age groups (0-14 and 15-29 years) for women, while for men there is more variability. The regression models suggest an upward trend in psychotropic consumption during all the period, especially remarkable from 2020, for both genders and all age groups.

CONCLUSIONS

- The consumption of psychotropic drugs has gradually increased over the last 4 years, with a significant boost starting in 2020 for both sexes, matching the start of the SARS-COV2 pandemic and the implementation of strict Public Health measures to contain it. - The increase observed on children and adolescents is a matter of concern.

Perception and Knowledge of Portuguese Veterinarians about the Zoonotic Transmission of Helicobacter pylori and Helicobacter suis: The Need for One Health Intervention

Helicobacter species can colonize the gastrointestinal tract of both humans and animals, and are associated with gastrointestinal and extra-gastrointestinal diseases. Some studies indicate that animals, health professionals, and people in close contact with animals might be at higher risk for infection with gastric Helicobacter spp. Considering that veterinarians are professionals at risk for infection with zoonotic gastric Helicobacters and are also seen by many as health communicators concerning zoonoses, the aim of this study was to evaluate the Portuguese veterinarians' perception and knowledge of Helicobacter spp. infection and its zoonotic risk/potential. Therefore, a structured questionnaire composed of 34 dichotomic, multiple-choice, rating scale, matrix, drop-down, and open-ended questions was developed and given to Portuguese veterinarians via an online platform from May 2021 to July 2021, and statistical analysis was used to obtain results. There was a total of 149 respondents, most of them (73.8%) being females. Evidently, Portuguese veterinarians have a limited perception regarding Helicobacter spp. infections. Of the respondents that "have heard of Helicobacter", 17.6% do not know which animal species can be affected by it. Most of the companion animal veterinarians (76.2%) do not consider Helicobacter spp. infection a differential diagnosis when evaluating animals with gastritis. A significant percentage (37.2%) of the respondents that have "heard of H. suis" do not consider it a zoonotic bacterium. There is a need for education and sensitization of veterinarians regarding the potential zoonotic risk of Helicobacter spp. in order to elucidate these professionals to this One Health issue, as the number of reports of non-Helicobacter pylori Helicobacter in livestock, companion, and wild animals is increasing.

A qualitative study on the impact of death during COVID-19: Thoughts and feelings of Portuguese bereaved adults

As a global threat, the COVID-19 pandemic has been an important factor in increasing death rate worldwide. As the virus spreads across international borders, it causes severe illness, death, and disruptions in our daily lives. Death and dying rituals and customs aid bereaved people in overcoming their grief. In this sense, the purpose of this study was to access thoughts and feelings of Portuguese adults and the impact of the loss in daily life during COVID-19. A structured online questionnaire was applied (snowball sampling) and qualitative data on death and mourning namely the impact of the loss in daily life, was collected. One hundred and sixty-six individuals have lost someone since the beginning of the pandemic and were included. Analysis was inspired by Braun and Clark's content analysis. Most participants were female (66.9%), the median age was of 37.3 years, and 70.5% had a high education degree. Moreover, 30.7% of the participants present anxiety symptoms and 10.2% depression symptoms. The answers of studied participants gave insights on the extent of the loss in day-to-day life and four thematic themes were found: (1) The perceived inadequacy of the funeral rituality, (2) Sadness, fear and loneliness, (3) Changes in sleeping and concentration and increased levels of anxiety and (4) Concerns regarding the pandemic situation. We found a high prevalence of anxiety and depression symptoms in the study sample. Also, the changes in post mortem procedures, have shown to be of great importance in the mourning procedure of the participants.

Food Insecurity in Portugal during the COVID-19 Pandemic: Prevalence and Associated Sociodemographic Characteristics

Introduction

The current worldwide COVID-19 pandemic has been having a considerable impact not only on health but also on the economy of societies, emphasizing food insecurity as a significant public health concern.

Aim

The objective of this study was to characterize the scenario of food insecurity in Portugal during the COVID-19 pandemic and explore its related sociodemographic characteristics.

Methodology

This is a cross-sectional study, using data from an online survey, performed from November 2020 until February 2021, including 882 residents aged 18 years or older in Portugal. Data on sociodemographics and food security status were collected, the latter was evaluated using the United States Household Food Security Survey Module: Six-Item Short Form. Crude and adjusted logistic regression models were performed (covariates: education, household income perception, and the working status during the COVID-19 pandemic). The odds ratio (OR) and respective 95% confidence intervals (CI) were estimated.

Results

Most participants were women (71.3%), with a mean age of 36.8 years (SD 11.0). Food insecurity prevalence was 6.8%. Less-educated individuals (≤12 years of schooling; OR 2.966; 95% CI 1.250–7.042), and those who were and remained unemployed since the beginning of the pandemic (OR 2.602; 95% CI 1.004–6.742) had higher odds of belonging to a food-insecure household, regardless of education, working status during the COVID-19 pandemic, and household income perception. Moreover, lower odds of belonging to a food-insecure household were observed among those reporting a comfortable household income (OR 0.007; 95% CI 0.001–0.062) than those who perceived their household income as insufficient, independently of education and the working status during the COVID-19 pandemic.

Conclusions

These findings highlight the population groups that are at a greater risk of food insecurity during the current COVID-19 pandemic. Effective public health strategies should be developed aiming to address food insecurity during this crisis, especially among the higher risk groups.

The bad, the ugly and the monster behind the mirror - Food insecurity, mental health and socio-economic determinants

INTRODUCTION

Food insecurity is associated with poor mental health outcomes, including depression and anxiety and COVID-19 could increase these relations. In this sense, we aimed to explore the relationship between food insecurity and mental health features and behaviors in adults from Portugal.

METHODOLOGY

We conducted a cross-sectional online snowball study from November 2020 until February 2021. A total of 882 Portuguese residents 18 years of age or older with food security data were included. Data on socio-demographics, food security status, and anxiety and depression symptoms were collected. Crude and adjusted logistic regression models were performed. Odds ratio (OR) and respective 95% confidence intervals (CI) were estimated.

RESULTS

Most participants were women (71.3%), with a mean (SD) age of 36.8 (10.9) years, three-thirds had a university degree (76.7%), and 65.3% lived in the country's northern region. Regarding the characteristics associated with food insecurity, we observed that less-educated participants (OR = 7.84; 95% CI: 3.67-16.73), with depression symptoms (OR = 5.91; 95% CI: 3.12-11.19) and with anxiety symptoms (OR = 6.41; 95% CI: 3.02-13.59), had a higher odds of belonging to a food-insecure household. After adjustments less educated individuals (OR = 8.37; 95% CI: 3.81-18.35), those who faced a reduction in income (OR = 0.27; 95% CI: 0.13-0.53) and, presenting anxiety symptoms (OR = 7.32; 95% CI: 3.53-15.17) had a higher odds of belonging to a food-insecure household.

CONCLUSIONS

Approaching food insecurity without addressing mental health, and the opposite is making partial and reductive interventions. It is important to have an integrative approach.