Physical and mental health impact of COVID-19 on children, adolescents, and their families: The Collaborative Outcomes study on Health and Functioning during Infection Times - Children and Adolescents (COH-FIT-C&A)

BACKGROUND

The COVID-19 pandemic has altered daily routines and family functioning, led to closing schools, and dramatically limited social interactions worldwide. Measuring its impact on mental health of vulnerable children and adolescents is crucial.

METHODS

The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT - www.coh-fit.com) is an on-line anonymous survey, available in 30 languages, involving >230 investigators from 49 countries supported by national/international professional associations. COH-FIT has thee waves (until the pandemic is declared over by the WHO, and 6-18 months plus 24-36 months after its end). In addition to adults, COH-FIT also includes adolescents (age 14-17 years), and children (age 6-13 years), recruited via non-probability/snowball and representative sampling and assessed via self-rating and parental rating. Non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to promote health and prevent mental and physical illness in children and adolescents will be generated by COH-FIT. Co-primary outcomes are changes in well-being (WHO-5) and a composite psychopathology P-Score. Multiple behavioral, family, coping strategy and service utilization factors are also assessed, including functioning and quality of life.

RESULTS

Up to June 2021, over 13,000 children and adolescents from 59 countries have participated in the COH-FIT project, with representative samples from eleven countries.

LIMITATIONS

Cross-sectional and anonymous design.

CONCLUSIONS

Evidence generated by COH-FIT will provide an international estimate of the COVID-19 effect on children's, adolescents' and families', mental and physical health, well-being, functioning and quality of life, informing the formulation of present and future evidence-based interventions and policies to minimize adverse effects of the present and future pandemics on youth.

The collaborative outcomes study on health and functioning during infection times in adults (COH-FIT-Adults): Design and methods of an international online survey targeting physical and mental health effects of the COVID-19 pandemic

BACKGROUND

. High-quality comprehensive data on short-/long-term physical/mental health effects of the COVID-19 pandemic are needed.

METHODS

. The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT) is an international, multi-language (n=30) project involving >230 investigators from 49 countries/territories/regions, endorsed by national/international professional associations. COH-FIT is a multi-wave, on-line anonymous, cross-sectional survey [wave 1: 04/2020 until the end of the pandemic, 12 months waves 2/3 starting 6/24 months threreafter] for adults, adolescents (14-17), and children (6-13), utilizing non-probability/snowball and representative sampling. COH-FIT aims to identify non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to improve social/health outcomes in the general population/vulnerable subgrous during/after COVID-19. In adults, co-primary outcomes are change from pre-COVID-19 to intra-COVID-19 in well-being (WHO-5) and a composite psychopathology P-Score. Key secondary outcomes are a P-extended score, global mental and physical health. Secondary outcomes include health-service utilization/functioning, treatment adherence, functioning, symptoms/behaviors/emotions, substance use, violence, among others.

RESULTS

. Starting 04/26/2020, up to 14/07/2021 >151,000 people from 155 countries/territories/regions and six continents have participated. Representative samples of ≥1,000 adults have been collected in 15 countries. Overall, 43.0% had prior physical disorders, 16.3% had prior mental disorders, 26.5% were health care workers, 8.2% were aged ≥65 years, 19.3% were exposed to someone infected with COVID-19, 76.1% had been in quarantine, and 2.1% had been COVID 19-positive.

LIMITATIONS

. Cross-sectional survey, preponderance of non-representative participants.

CONCLUSIONS

. Results from COH-FIT will comprehensively quantify the impact of COVID-19, seeking to identify high-risk groups in need for acute and long-term intervention, and inform evidence-based health policies/strategies during this/future pandemics.

Attitudes towards people with depression and schizophrenia among social service workers in Denmark

BACKGROUND

Mental health-related stigma is a major public health issue, and is an obstacle to the possibility for successful treatment, recovery, and reintegration.

AIM

To examine attitudes towards mental illness among employees in the social services.

METHODS

The study design was part of a large randomized trial, and data presented in this study are baseline data from this trial. Respondents completed a baseline questionnaire to assess the respondents' attitudes.

RESULTS

A significant difference was found between employees' personal attitudes towards depression and schizophrenia. The same significant difference was found in the employees' perceived attitudes. Furthermore, a significant difference was found between the employees' personal and perceived attitudes. A significant difference was found between the respondents wish for social distance towards depression and schizophrenia in all cases, except regarding the willingness to provide a job at one's own workplace.

CONCLUSION

Employees in the social services are comparable to the general public concerning attitudes towards mental illness.

IMPLICATIONS

The results indicate that the employees in social services could have great use of gaining more knowledge about mental illness and ways in which to recognize a mental illness, in order to be able to offer the right kind of help and reduce the treatment gap concerning people suffering from mental illness.

Staff attitudes towards patients with schizophrenia

INTRODUCTION

Stigmatizing attitudes have been reported in international studies among staff in psychiatry. The authors wanted to investigate if this was the case in Denmark.

MATERIAL AND METHODS

A survey of attitudes among staff at two psychiatric units in Copenhagen was performed using the Mental Illness: Clinicians' Attitudes scales. The scales have 16 questions to which another four questions were added by the authors.

RESULTS

A total of 548 staff members answered the questions (61 doctors and 487 other professionals). The majority of the respondents believed in the possibility of recovery for patients and only a minority associated a high degree of dangerousness with schizophrenia. The cause of the illness was mainly regarded as being biological, but all agreed to a bio-psycho-social aetiological approach. The majority of the respondents believed that the illness was chronic and agreed on the need for staff to also be aware of patients' somatic illness. The doctors did not question their role as "real doctors" or the scientific basis for psychiatry. The majority would not mind working with a colleague with schizophrenia, but about half would hesitate to disclose if they themselves were diagnosed with the illness. Being a woman working in community psychiatry with long experience and participation in a recovery educational programme was associated with less stigmatizing attitudes.

CONCLUSION

The survey showed a relatively low level of stigmatizing attitudes. This runs counter to the results from international investigation. This trend could be interpreted both as a result of a shift towards a more recovery-oriented approach to treatment as well as a reflection of political correctness.

[Stigmatizing of persons with a mental illness]

Persons with a mental illness and their relatives experience discrimination and expect to be discriminated. The public regards them as unpredictable and dangerous and do not wish to have any relation with them neither in private nor at work. This opinion is shared by people working in health care or social care. The myth of dangerousness is out of proportion and the media is to blame as they most often mention persons with mental illnesses as dangerous. Many countries make a great effort to reduce stigma and this is also under planning in Denmark.

[Assertive community treatment of psychoses]

Long-term institutionalization is no longer the preferred treatment for the severely mentally ill. Several models for outpatient treatment of the severely mentally ill have been developed, among them Assertive Community Treatment (ACT). The literature on this model is reviewed in a Cochrane review and in randomized trials comparing ACT with hospital admission. ACT is a clinically effective approach to managing the care of severely ill people in the community. ACT, if correctly targeted on high users of in-patient-care, can substantially reduce costs of hospital care whilst improving outcome and patient and relatives satisfaction. Setting up ACT teams should be supported by politicians, professionals and consumers.

Cerebrospinal fluid vasopressin--changes in depression

Cerebrospinal fluid (CSF), thyrotropin releasing hormone (TRH), CSF-vasopressin (AVP), plasma-AVP, CSF-osmolality, plasma-osmolality, CSF-adrenaline (A) and -noradrenaline (NA) were measured in psychiatric patients and controls. Psychiatric patients were classified according to ICD-9 and grouped into endogenous depression, non-endogenous depression, mania and schizophrenia. The depressive groups were classified according to the Newcastle Rating Scale for Depression 1965. Severity of disease was quantified by BRMES, BRMS and BPRS. No difference in CSF-TRH levels was seen among the different diagnostic groups and controls. A positive correlation between CSF-TRH and CSF-A was demonstrated. CSF-AVP concentrations were significantly lowered in both endogenous and non-endogenous depression; no correlation with CSF-A or -NA was seen. Neither did any difference between plasma levels of AVP, plasma-osmolality or CSF-osmolality appear among the groups investigated.

Vasoactive intestinal polypeptide decreased in cerebrospinal fluid (CSF) in atypical depression. Vasoactive intestinal polypeptide, cholecystokinin and gastrin in CSF in psychiatric disorders

Vasoactive intestinal polypeptide (VIP), cholecystokinin (CCK) and gastrin in the cerebrospinal fluid (CSF) were studied in patients with endogenous depression, non-endogenous depression, mania, schizophrenia and a control group. All patients were classified according to ICD-9 and the group of depressions was further classified according to the Newcastle Rating Scales for depression (Carney et al. 1965) (N-I). In the group of non-endogenously depressed patients, CSF-VIP levels (median 16 pmol/l) were found to be significantly lower than those of controls (median = 32 pmol/l) and endogenous depressives (36 pmol/l). In the non-endogenous group, it appeared that the low CSF-VIP was due to a group of patients who, during a past or present depressive episode, had been diagnosed as suffering from endogenous depression. Moreover, this group was clinically characterized by 'dysphoric/hysterical features', 'reversed diurnal variation' (i.e. worse in the evening), and 'lack of clearly circumscribed episodes'. In many aspects this group seems similar to the atypical depressives described as monoamine oxidase inhibitor responders. Concerning CSF-CCK and CSF-gastrin, no significant differences between the examined groups were demonstrated.

Chlormezanone in the treatment of migraine attacks: a double blind comparison with diazepam and placebo

One hundred and fifty patients treated for an acute migraine attack all received a standard regimen consisting of metoclopramide 10 mg i.m. and--20 min later--paracetamol 1 g orally. Simultaneous trial medication was given. This consisted of placebo, diazepam 5 mg as tablets, or chlormezanone 400 mg as capsules given in a double dummy fashion. A successful treatment result was defined as a decrease of two or three steps on a four-point verbal pain report scale, and no need for further treatment. Patients with severe pain (all three treatment groups together) showed significantly better treatment results (p less than 0.001) than patients with pain of medium severity. In the group with severe pain there was no significant difference between diazepam, chlormezanone or placebo. In the group with pain of medium severity there was a significant (p less than 0.01) effect of chlormezanone, but no significant effect of diazepam. Chlormezanone may possibly be a valuable addition to antiemetic and analgesic therapy of migraine attacks.

Intravenous glucose tolerance in lithium treated rats

A method for performing intravenous glucose tolerance tests in anaesthetized rats was developed, and factors influencing basal glucose tolerance was investigated. Glucose tolerance increased with increasing weight and body temperature, but decreased with fasting. Lithium administration increased glucose tolerance. The increase varied with the dose and the time interval between administration and glucose tolerance test. There was an immediate increase in glucose tolerance after lithium administration, which lasted under special conditions up to 24 hours. The duration was depending on the dose given and the fasting state of the animal.

Lithium treatment of meniere's disease. Results of a double-blind cross-over trial

21 patients with Meniere's disease participated in a double-blind, cross-over trial, with 6 months' lithium treatment and 6 months' placebo treatment. Even if the results were not completely unequivocal, no difference was found between lithium and placebo treatment. The results might imply that both other medical as well as surgical treatment of Meniere's disease exert a pure placebo effect; so far no controlled investigation has been published, establishing the value of surgical treatment of Meniere's disease.