COVID-19, Mental Health, and Chronic Illnesses: A Syndemic Perspective

'It's not discrete, it's not going to be easy': A qualitative analysis of the practical application of syndemic theory in healthcare

Over the past decade, multiple federal, state and local government mission statements have employed syndemic theory in proposed policies and practices. We interviewed 20 key informants from academia, non-governmental organisations and local government public health officials on range of topics relating to how syndemic theory is shaping healthcare policy and practice. Informants highlighted the role of syndemic theory in providing person-centred services. They also provided examples of HIV-related care services and organisational change that have been influenced or shaped by syndemic theory. However, informants also indicated that they are just beginning to understand how to employ syndemics and noted that there are many barriers to putting syndemic theory into practice. In particular, they described how governance structures and funding are siloed and therefore at odds with the holistic and integrated framework that is core to syndemic theory. Nevertheless, they felt the central messages of syndemic theory are well supported among colleagues and remained committed to finding ways to put syndemic theory in practice. We argue that that governmental and non-governmental institutions and departments will need to substantially invest in braided funding streams and associated healthcare administrative structures.

SARS-CoV-2 Infection and the Risk of New Chronic Conditions: Insights from a Longitudinal Population-Based Study

BACKGROUND

The post-acute impact of SARS-CoV-2 infections on chronic conditions remains poorly understood, particularly in general populations.

OBJECTIVES

Our primary aim was to assess the association between SARS-CoV-2 infections and new diagnoses of chronic conditions. Our two secondary aims were to explore geographic variations in this association and to assess the association between SARS-CoV-2 infections and the exacerbation of pre-existing conditions.

METHODS

This longitudinal study used data from 8086 participants of the Specchio-COVID-19 cohort in the canton of Geneva, Switzerland (2021-2023). Mixed-effects logistic regressions and geographically weighted regressions adjusted for sociodemographic, socioeconomic, and healthcare access covariates were used to analyze self-reported SARS-CoV-2 infections, new diagnoses of chronic conditions, and the exacerbation of pre-existing ones.

RESULTS

Participants reporting a SARS-CoV-2 infection were more likely to be diagnosed with a new chronic condition compared to those who did not report an infection (adjusted odds ratio [aOR] = 2.15, 95% CI 1.43-3.23, adjusted p-value = 0.002). Notable geographic variations were identified in the association between SARS-CoV-2 infections and new diagnoses. While a positive association was initially observed between SARS-CoV-2 infections and exacerbation of pre-existing chronic conditions, this association did not remain significant after adjusting p-values for multiple comparisons.

CONCLUSIONS

These findings contribute to understanding COVID-19's post-acute impact on chronic conditions, highlighting the need for targeted health management approaches and calling for tailored public health strategies to address the pandemic's long-term effects.

Illness Stigma and Shame in People With Chronic Illnesses vs. SARS-CoV-2 Survivors: Associations With Psychological Distress Through Psychological Flexibility and Self-Compassion

Individuals with chronic illnesses and those infected with SARS-CoV-2 often face stigma, shame, and psychological distress related to their conditions. Higher psychological flexibility and self-compassion are often associated with less stigma and shame. Examining and comparing these experiences between people with chronic illness and people who have recovered from SARS-CoV-2 can provide valuable insights into the shared and unique challenges they encounter. This study aimed to compare these two groups, and used structural equation modelling to investigate the links between stigma, shame, and psychological distress, with a focus on the mediating roles of psychological flexibility and self-compassion in these associations. The study included 270 Portuguese participants (chronic illness: n = 104; SARS-CoV-2: n = 166), with an average age of 36.73 years and 86.6% of the sample being women. Results showed that the chronic illness subgroup reported higher levels of illness stigma, anxiety, and depression, compared to the SARS-CoV-2 subgroup. Findings from the mediation analysis, revealed that the model fit exceptionally well, accounting for 48% of the variance in anxiety and 45% in depression symptoms across the entire sample. Most parameters were consistent between the two subgroups, except for the association between self-compassion and depression symptoms, which was only statistically significant in the chronic illness subgroup. In this group, both psychological flexibility and self-compassion mediated the association between stigma and shame with symptoms of anxiety and depression. In the SARS-CoV-2 subgroup, these processes mediated the association with anxiety, whereas psychological flexibility only mediated depression symptoms. The findings from this study provide directions for future research on the possible development or refinement of personalized psychological interventions targeting emotional distress in adults with chronic illnesses and viral disease recovery cohorts.

Posttraumatic Growth: The Role of Health and Financial Difficulties During a Pandemic

OBJECTIVE

Trauma can have a range of effects on individuals over time, including the potential for positive changes in favorable outcomes commonly referred to as posttraumatic growth. The posttraumatic growth literature has been criticized for various methodological limitations and has largely neglected the exploration of factors that may strengthen or weaken posttraumatic growth trajectories. The present study contributes to this literature by investigating trajectories of five dimensions of posttraumatic growth during the COVID-19 pandemic and the moderating effects of health and financial difficulties on these trajectories.

METHOD

Longitudinal data were collected monthly between July 2020 and December 2022 from a sample of employed adults in Germany, involving N = 1678 participants over 30 time points (Nobservations = 29,552).

RESULTS

Results suggest that certain dimensions of posttraumatic growth showed significant increases (i.e., relationships) or decreases (i.e., spirituality and possibilities) over time and that trajectories of three dimensions (i.e., relationships, appreciation, and strength) demonstrated distinctive patterns of interaction with health and financial difficulties.

CONCLUSIONS

Findings are discussed in the context of the pandemic as well as dynamic theories of personality and identity, with implications for advancing posttraumatic growth theory and research.

Evolution of Primary Research Studies in Digital Interventions for Mental Well-Being Promotion from 2004 to 2023: A Bibliometric Analysis of Studies on the Web of Science

Research into digital interventions for mental well-being promotion has grown in recent years, fuelled by the need to improve mental health prevention strategies and respond to challenges arising from the coronavirus (COVID-19) pandemic. This bibliometric analysis provides a structured overview of publication trends and themes in primary research studies reporting an array of digital interventions indexed at WoS from 2004 to 2023. Bibliometric data were collected on a sample of 1117 documents and analysed using the Biblioshiny package. Supplemental network visualisation analysis was conducted using VosViewer. The study, based on Web of Science and Scopus databases, indicates a marked increase in publications post-2020. There were seven groups of research themes clustered around "Mindfulness", "Anxiety", "COVID-19", "Acceptance and Commitment Therapy", "Depression", "Web-based", and "Positive Psychology". Further, results demonstrated the growth of specific themes (e.g., mindfulness, mhealth), the defining impact of COVID-19 studies, and the importance of both randomised controlled trials and formative research. Overall, research in the field is still early in its development and is expected to continue to grow. Findings highlight the field's dynamic response to societal and technological changes, suggesting a future trajectory that leans increasingly on digital platforms for mental health promotion and intervention. Finally, study limitations and implications for future studies are discussed.

The importance of teaching climate-health literacy in psychotherapeutic training and continuing education

Climate-health literacy is the ability to find, access, understand, interpret, evaluate, and communicate information about the impact of climate change on human health and to make decisions and act accordingly to that information. Climate change affects people's health in numerous ways, both directly and indirectly, e.g., by increasing the risks of cardiovascular disease, infections, depression, anxiety disorders, and trauma. It is important for health professionals to understand the complex interaction between climate change and health. A teaching concept is presented that incorporates the core elements of climate-health literacy. On a first level, physical and climatological basics are taught, direct and indirect impacts of climate change on human health, climate protective measures, the psychological background of climate-protective behavior, and professional ethics. Furthermore, via self-awareness and self-reflection, the impact of climate change on the student's mental health should be evaluated. In an advanced level, the direct and indirect impacts of climate change on mental health are taught, coping strategies, resilience, and vulnerability, as well as the role of health-care professionals in the climate crisis. In expert-level lectures, the knowledge can be deepened, and special content like activist burnout can be addressed.

Absence of short-term changes in knowledge and attitudes among household contacts of COVID-19 cases during the post-acute phase of the pandemic in Catalonia and Navarre, Spain

Objectives

To evaluate short-term changes in knowledge and attitude towards COVID-19 and preventive measures during the post-acute phase of the pandemic in Spain.

Methods

A survey was performed in Catalonia and Navarre between May-2022 and July-2023 in household contacts of COVID-19 cases. Knowledge and attitude were assessed at baseline and at three months, using a Likert scale. Responses were grouped according to correct or incorrect.

Results

At baseline, 172 subjects were contacted, 118 (69%) of which completed a follow-up interview three months later. Knowledge of correct hand-washing and mask protocols had maintained over time (-1.7%, p = 0.553 and - 2.5%, p = 0.473, respectively). Attitudes toward preventive measures was adequate in the first interview (86%), but attitudes regarding use of face masks decreased significantly (-9.1%, p = 0.048) over time in participants with higher risk of severe COVID-19. However, most short-term changes in knowledge and attitudes were not statistically significant.

Conclusion

Household contacts showed correct knowledge and attitude towards COVID-19 and its preventive measures, without significant changes in the short term despite a relaxation of government-mandated preventive measures. These results provide relevant information in case of a new health emergency due to respiratory viruses.

Conceptualizing COVID-19 syndemics: A scoping review

Background

COVID-19's heavy toll on human health, and its concentration within specific at-risk groups including the socially vulnerable and individuals with comorbidities, has made it the focus of much syndemic discourse. Syndemic theory recognizes that social factors create the conditions that support the clustering of diseases and that these diseases interact in a manner that worsens health outcomes. Syndemics theory has helped to facilitate systems-level approaches to disease as a biosocial phenomenon and guide prevention and treatment efforts. Despite its recognized value, reviews of syndemics literature have noted frequent misuse of the concept limiting its potential in guiding appropriate interventions.

Objective

To review how the term 'syndemic' is defined and applied within peer-reviewed literature in relation to COVID-19.

Design

A scoping review of definitions within COVID-19 literature published between January 1, 2020 to May 15, 2023 was conducted. Searches took place across six databases: Academic Search Premier, CINAHL, JSTOR, MEDLINE/Pubmed, PsycINFO and Scopus. PRISMA-ScR guidelines were followed.

Results

Content analysis revealed that COVID-19 has varied clustered configurations of communicable-non-communicable diseases and novel communicable disease interactions. Spatial analysis was presented as a new strategy to evidence syndemic arrangements. However, syndemics continue to be regarded as universal, with continued misunderstanding and misapplication of the concept.

Conclusion

This review found that current applications of syndemics remain problematic. Recommendations are made on the design of syndemic studies. A syndemic framework offers an opportunity for systems-level thinking that considers the full complexity of human-disease interactions and is useful to inform future pandemic preparations and responses.

Synergistic Epidemic or Syndemic: An Emerging Pattern of Human Diseases

Synergistic epidemics refer to the phenomenon where the occurrence and interaction of multiple diseases or health conditions exacerbate their individual impact, leading to complex health challenges and increased vulnerability in populations. Syndemics are a complex, multilevel phenomenon. In a population with biological interactions, a syndemic is the accumulation of two or more concurrent or sequential epidemics, which significantly worsens the situation. Disease concentration, disease interaction, and their underlying social forces, such as poverty and social inequality, are the fundamental concepts. Extensive political, economic, and cultural factors have contributed to cluster epidemics of several infectious diseases, particularly HIV and tuberculosis. Concerning the SAVA (substance abuse, violence, AIDS) syndemic, this narrative review article explores the complex interactions between substance abuse, violence, and HIV/AIDS. Further, it describes in-depth interactions between the COVID-19 syndemic's health conditions, societal factors, biological factors, and global dynamics. The review also emphasizes how infectious and non-communicable diseases interact, emphasizing how having one condition can make the severity and outcomes of another worse. It investigates the causes of synergistic epidemics and the impact of environmental factors. Syndemics acknowledge that the presence of one condition can worsen the severity and progression of others and take into account the intricate relationships between diseases. We can create more efficient plans to enhance health outcomes, lessen disparities, and promote healthier communities by understanding the connections between disorders and the underlying social determinants. This narrative review provides insights into the emerging patterns of human diseases within synergistic epidemics.

Depression and Generalized Anxiety as Long-Term Mental Health Consequences of COVID-19 in Iraqi Kurdistan

Coronavirus disease 2019 (COVID-19) has been associated with a variety of psychiatric symptoms. However, COVID-19's association with psychiatric symptoms after the acute illness phase is not fully understood. Thus, this study sought to examine symptoms of depression and generalized anxiety and associated factors in the period following COVID-19 infection. A cross-sectional study design was conducted in three governorates of the Iraqi Kurdistan region. Face-to-face interviews were held between the period of 15 September and 20 December 2021 with both those who had been infected with COVID-19 and those who had not. Depression symptomology was assessed using the 9-item Patient Health Questionnaire and levels of anxiety were measured using the 7-item Generalized Anxiety Disorder scale. A total of 727 participants were recruited. The bulk of the respondents (n = 454) reported having a past COVID-19 infection, of whom a considerable proportion (82%) had mild-moderate symptoms. More than half of the infected respondents (53.3%) stated they were treated at home. The mean score of generalized anxiety was higher among the infected group compared to the non-infected group t(725) = 2.538, p = 0.011. Factors such as older age, female gender, unemployment, previous psychological problems, and diabetes mellitus were strongly associated with symptoms of depression and anxiety post-COVID-19 infection. Additionally, anxiety was associated with a longer duration of post-COVID symptoms. The majority of the study population had mild to moderate levels of post-COVID-19 depression and anxiety. Psychological education and interventions are required to reduce the psychological burden of post-COVID-19 symptoms among the general population.

The acceptance and hesitancy of COVID-19 vaccination among chronic obstructive pulmonary disease (COPD) patients

Severe acute respiratory syndrome coronavirus 2, which is responsible for the coronavirus disease 2019 (COVID-19), causes severe clinical outcomes in old individuals and patients with underlying diseases, including chronic obstructive pulmonary disease (COPD). Considering vaccination is still the most effective method to prevent COVID-19-associated death, it is imperative to evaluate COPD patients' attitudes toward the COVID-19 vaccine. This cross-sectional design study was conducted to assess vaccine acceptance and hesitancy among 212 COPD patients who attended the outpatient department from January 1, 2021, to July 31, 2022. All of the patients were not vaccinated and had undertaken lung function test at the time of our survey. Of 212 participants, 164 (77.4%) were willing to be vaccinated immediately while 48 (22.6%) were hesitant to be vaccinated. Compared with the acceptance group, patients who did not accept the vaccination instantly tended to have more comorbidities, like hypertension, coronary heart disease, recent cancers, and higher Modified British Medical Research Council score, or more frequent acute exacerbation. For the patients willing to be vaccinated, the main factors motivating them were an authorities-endorsed vaccine, free vaccination, and no obvious adverse reactions. For the hesitant group, no recommendation from the treating physician was the biggest obstacle for them to accept vaccination. Our results provide useful guidance for making intervention measures to enhance COPD patients' acceptance of a new COVID-19 vaccine. For those patients with comorbidities, treating physicians promoting messages framing the safety of vaccination is necessary to increase immunization rates.

The Effects of COVID-19 Lockdown on Social Connectedness and Psychological Distress in U.S. Adults with Chronic Diseases

Lockdown measures enacted in 2020 to control the spread of COVID-19 led to increases in the prevalence of mental health problems. Due to their high-risk status, individuals with chronic diseases may be at increased risk and disproportionately adversely affected by the COVID-19 pandemic. The investigators examined associations between having a high-risk chronic condition, social connectedness, and general distress and COVID-19-specific distress among U.S. adults during the COVID-19 lockdown. Baseline measures of a longitudinal survey collected at the beginning of the pandemic (April to June 2020) were analyzed to identify factors associated with loss of social connectedness from pre- to post-lockdown. The associations between social connectedness and both general and COVID-19-specific psychological distress were adjusted for certain high-risk chronic illnesses and interaction effects. The sample available for analysis included 1354 subjects (262 high-risk chronic diseases and 1092 without chronic illness). Those reporting the loss of social connectedness were younger (median = 39 vs. 42) and more likely to be unemployed because of the pandemic (19.4% vs. 11.0%). Adjustment for interaction demonstrated a stronger negative association between social connectedness change and the psychosocial impact of COVID-19 for those with high-risk illness(es) (change in connectedness*chronic illness OR = 0.88, 95%CI: 0.79-0.98, p = 0.020). These findings inform our understanding of the distribution and intersection of responses to public health lockdown orders in the U.S. and build further evidence of the importance of social connectedness on psychological distress.