A longitudinal study of predictors of serious psychological distress during COVID-19 pandemic

BACKGROUND

The prevalence of serious psychological distress (SPD) was elevated during the COVID-19 pandemic in the USA, but the relationships of SPD during the pandemic with pre-pandemic SPD, pre-pandemic socioeconomic status, and pandemic-related social stressors remain unexamined.

METHODS

A probability-based sample (N = 1751) of the US population age 20 and over was followed prospectively from February 2019 (T1), with subsequent interviews in May 2020 (T2) and August 2020 (T3). Multinomial logistic regression was used to assess prospective relationships between T1 SPD with experiences of disruption of employment, health care, and childcare at T2. Binary logistic regression was then used to assess relationships of T1 SPD, and socioeconomic status and T2 pandemic-related stressors with T3 SPD.

RESULTS

At T1, SPD was associated with age, race/ethnicity, and household income. SPD at T1 predicted disruption of employment (OR 4.5, 95% CI 1.4-3.8) and health care (OR 3.2, 95% CI 1.4-7.1) at T2. SPD at T1 (OR 10.2, 95% CI 4.5-23.3), low household income at T1 (OR 2.6, 95% CI 1.1-6.4), disruption of employment at T2 (OR 3.2, 95% CI 1.4-7.6), and disruption of healthcare at T2 (OR 3.3, 95% CI 1.5-7.2) were all significantly associated with elevated risk for SPD at T3.

CONCLUSIONS

Elevated risk for SPD during the COVID-19 pandemic is related to multiple psychological and social pathways that are likely to interact over the life course. Policies and interventions that target individuals with pre-existing mental health conditions as well as those experiencing persistent unemployment should be high priorities in the mental health response to the pandemic.

Age declines in numeracy: An analysis of longitudinal data

Numeracy, the ability to understand and use basic probability and numerical concepts, is associated with diverse positive outcomes across the lifespan. Prior cross-sectional research on numeracy has generally found a negative association with age, but positive correlations with male gender, education attainment, and measures of fluid and crystallized intelligence have been more robust. Age effects on cognitive functioning are well established, but little is known about longitudinal trends of numeracy into older age. The present study investigates longitudinal age effects on numeracy using a sample of 524 adults (2008 Age_range = 20-78) from the RAND American Life Panel. Participants completed a numeracy measure in both 2008 and 2019, a span of 11 years. Using a linear mixed-effect model to predict numeracy scores, a significant interaction between the year of testing and the quadric age term shows a decline in numeracy scores beginning in later middle age, a trend that falls in between those previously found for crystallized and fluid cognitive abilities. Numeracy declines are somewhat mitigated for males and those with higher education, but the interaction of the two variables did not return a clear pattern of results. Prior research has shown that numeracy is positively related to the quality of health and financial decisions and, ultimately, more positive health and economic outcomes. The implications of age declines in numeracy are discussed in relation to health and financial decision-making, tasks that remain relevant into old age. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Nationally Representative Sample Shows an Increase in Domestic Conflict Early in the COVID-19 Pandemic

OBJECTIVE

The coronavirus disease (COVID-19) pandemic and associated social distancing increased stressors related to risk for domestic conflict, but increases in domestic conflict early in the pandemic have yet to be studied in community samples.

METHODS

Increase in domestic conflict (verbal or physical fights) since the beginning of the pandemic was assessed in 1196 partnered and cohabitating respondents, drawn from a nationally representative sample, in May 2020. Chi-square tests and logistic regression analyses were used to estimate associations of demographic characteristics and financial worry with domestic conflict.

RESULTS

An increase in domestic conflict was reported by 10.6% (95% CI: 7.7-13.4) of the sample. Domestic conflict increase was significantly associated with younger age, lower education, and financial worry.

CONCLUSION

Increases in domestic conflict were seen in certain vulnerable groups and in those who report financial worry. Policies ensuring financial stability, particularly early in the disaster conditions, could reduce domestic conflict during continued COVID-19 conditions or other disasters.

Measuring Subjective Probabilities: The Effect of Response Mode on the Use of Focal Responses, Validity, and Respondents' Evaluations

Subjective probabilities are central to risk assessment, decision making, and risk communication efforts. Surveys measuring probability judgments have traditionally used open-ended response modes, asking participants to generate a response between 0% and 100%. A typical finding is the seemingly excessive use of 50%, perhaps as an expression of "I don't know." In an online survey with a nationally representative sample of the Dutch population, we examined the effect of response modes on the use of 50% and other focal responses, predictive validity, and respondents' survey evaluations. Respondents assessed the probability of dying, getting the flu, and experiencing other health-related events. They were randomly assigned to a traditional open-ended response mode, a visual linear scale ranging from 0% to 100%, or a version of that visual linear scale on which a magnifier emerged after clicking on it. We found that, compared to the open-ended response mode, the visual linear and magnifier scale each reduced the use of 50%, 0%, and 100% responses, especially among respondents with low numeracy. Responses given with each response mode were valid, in terms of significant correlations with health behavior and outcomes. Where differences emerged, the visual scales seemed to have slightly better validity than the open-ended response mode. Both high-numerate and low-numerate respondents' evaluations of the surveys were highest for the visual linear scale. Our results have implications for subjective probability elicitation and survey design.

Strengthening Integration Of Health Services And Systems

New care delivery models that hold providers more accountable for coordinated, high-quality care and the overall health of their patients have appeared in the US health care system, spurred by recent legislation such as the Affordable Care Act. These models support the integration of health care systems, but maximizing health and well-being for all individuals will require a broader conceptualization of health and more explicit connections between diverse partners. Integration of health services and systems constitutes the fourth Action Area in the Robert Wood Johnson Foundation's Culture of Health Action Framework, which is the subject of this article. This Action Area conceives of a strengthened health care system as one in which medical care, public health, and social services interact to produce a more effective, equitable, higher-value whole that maximizes the production of health and well-being for all individuals. Three critical drivers help define and advance this Action Area and identify gaps and needs that must be addressed to move forward. These drivers are access, balance and integration, and consumer experience and quality. This article discusses each driver and summarizes practice gaps that, if addressed, will help move the nation toward a stronger and more integrated health system.

You can be too thin (but not too tall): Social desirability bias in self-reports of weight and height

Previous studies of survey data from the U.S. and other countries find that women tend to understate their body weight on average, while both men and women overstate their height on average. Social norms have been posited as one potential explanation for misreporting of weight and height, but lack of awareness of body weight has been suggested as an alternative explanation, and the evidence presented to date is inconclusive. This paper is the first to offer a theoretical model of self-reporting behavior for weight and height, in which individuals face a tradeoff between reporting an accurate weight (or height) and reporting a socially desirable weight (or height). The model generates testable implications that help us to determine whether self-reporting errors arise because of social desirability bias or instead reflect lack of awareness of body weight and/or other factors. Using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010, we find that self-reports of weight offer robust evidence of social desirability bias. However, lack of awareness of weight may also contribute to self-reporting biases, and this factor appears to be more important within some demographic groups than others. Among both women and men, self-reports of height exhibit significant social desirability bias only among those of below-average height, and very few individuals underreport their height. Implied self-reports of BMI exhibit gender-specific patterns similar to those observed for self-reporting of weight, and the inferred social norms for BMI (20.8 for women and 24.8 for men) are within the "normal" range established by public health institutions. Determining why individuals misreport their weight has important implications for survey design as well as for clinical practice. For example, our findings suggest that health care providers might take additional steps to increase self-awareness of body weight. The framework also helps to explain previous findings that the degree of self-reporting bias in weight is stronger in telephone surveys than it is in in-person surveys.

Knowledge as a Predictor of Insurance Coverage Under the Affordable Care Act

BACKGROUND

The Affordable Care Act established policy mechanisms to increase health insurance coverage in the United States. While insurance coverage has increased, 10%-15% of the US population remains uninsured.

OBJECTIVES

To assess whether health insurance literacy and financial literacy predict being uninsured, covered by Medicaid, or covered by Marketplace insurance, holding demographic characteristics, attitudes toward risk, and political affiliation constant.

RESEARCH DESIGN

Analysis of longitudinal data from fall 2013 and spring 2015 including financial and health insurance literacy and key covariates collected in 2013.

SUBJECTS

A total of 2742 US residents ages 18-64, 525 uninsured in fall 2013, participating in the RAND American Life Panel, a nationally representative internet panel.

MEASURES

Self-reported health insurance status and type as of spring 2015.

RESULTS

Among the uninsured in 2013, higher financial and health insurance literacy were associated with greater probability of being insured in 2015. For a typical uninsured individual in 2013, the probability of being insured in 2015 was 8.3 percentage points higher with high compared with low financial literacy, and 9.2 percentage points higher with high compared with low health insurance literacy. For the general population, those with high financial and health insurance literacy were more likely to obtain insurance through Medicaid or the Marketplaces compared with being uninsured. The magnitude of coefficients for these predictors was similar to that of commonly used demographic covariates.

CONCLUSIONS

A lack of understanding about health insurance concepts and financial illiteracy predict who remains uninsured. Outreach and consumer-education programs should consider these characteristics.

Does Financial Literacy Contribute to Food Security?

Food insecurity, not having consistent access to adequate food for active, healthy lives for all household members, is most common among low income households. However, income alone is not sufficient to explain who experiences food insecurity. This study investigates the relationship between financial literacy and food security. We find that low income households who exhibit financial literacy are less likely to experience food insecurity.

Measuring risk perceptions: what does the excessive use of 50% mean?

OBJECTIVES

Risk perceptions are central to good health decisions. People can judge valid probabilities but use 50% disproportionately. The authors hypothesized that 50% is more likely than other responses to reflect not knowing the probability, especially among individuals with low education and numeracy, and evaluated the usefulness of eliciting "don't know" explanations.

METHODS

Respondents (n = 1020) judged probabilities for living or dying in the next 10 years, indicating whether they gave a good estimate or did not know the chances. They completed demographics, medical history, and numeracy questions.

RESULTS

Overall, 50% was more likely than other probabilities to be explained as "don't know" (v. "a good estimate"). Correlations of using 50% with low education and numeracy were mediated by expressing "don't know." Judged probabilities for survival and mortality explained as "don't know" had lower correlations with age, diseases, and specialist visits.

CONCLUSIONS

When judging risks, 50% may reflect not knowing the probability, especially among individuals with low numeracy and education. Probabilities expressed as "don't know" are less valid. Eliciting uncertainty could benefit theoretical models and educational efforts.