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Years of life lost due to the psychosocial consequences of COVID19 mitigation strategies based on Swiss data

  • Child and Adolescent Psychiatry CHUV


Background: The pandemic caused by COVID-19 has forced governments to implement strict social mitigation strategies to reduce the morbidity and mortality from acute infections. These strategies however carry a significant risk for mental health which can lead to increased short-term and long-term mortality and is currently not included in modelling the impact of the pandemic. Methods: We used years of life lost (YLL) as the main outcome measure as applied to Switzerland as an exemplar. We focused on suicide, depression, alcohol use disorder, childhood trauma due to domestic violence, changes in marital status and social isolation as these are known to increase YLL in the context of imposed restriction in social contact and freedom of movement. We stipulated a minimum duration of mitigation of 3 months based on current public health plans. Results: The study projects that the average person would suffer 0.205 YLL due to psychosocial consequence of COVID-19 mitigation measures. However, this loss would be entirely borne by 2.1% of the population, who will suffer an average 9.79 YLL. Conclusions: The results presented here are likely to underestimate the true impact of the mitigation strategies on YLL. However, they highlight the need for public health models to expand their scope in order to provide better estimates of the risks and benefits of mitigation.
Years of life lost due to the psychosocial consequences of COVID19 mitigation strategies based on
Swiss data
Dominik A. Moser1,2, Jennifer Glaus2, Sophia Frangou3,4, Daniel S. Schechter2,5,6
1 University of Bern, Institute of Psychology, Bern, Switzerland
2 Lausanne University Hosptital, Child and Adolescent Psychiatry Service, Department of Psychiatry,
Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
3 Djavad Mowafaghian Centre for Brain Health, Department of Psychiatry, University of British
Columbia, Vancouver, Canada
4 Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
5 Université de Genève Faculté de médecine, Department of Psychiatry, Geneva, Switzerland
6 New York University Grossman School of Medicine, Department of Child and Adolescent
Psychiatry, New York, NY USA
Corresponding Author: Dominik A. Moser email:
Short Title: COVID19: psychosocial stress and mortality
Background: The pandemic caused by COVID-19 has forced governments to implement strict social
mitigation strategies to reduce the morbidity and mortality from acute infections. These strategies
however carry a significant risk for mental health which can lead to increased short-term and long-
term mortality and is currently not included in modelling the impact of the pandemic.
Methods: We used years of life lost (YLL) as the main outcome measure as applied to Switzerland as
an exemplar. We focused on suicide, depression, alcohol use disorder, childhood trauma due to
domestic violence, changes in marital status and social isolation as these are known to increase YLL
in the context of imposed restriction in social contact and freedom of movement. We stipulated a
minimum duration of mitigation of 3 months based on current public health plans.
Results: The study projects that the average person would suffer 0.205 YLL due to psychosocial
consequence of COVID-19 mitigation measures. However, this loss would be entirely borne by 2.1%
of the population, who will suffer an average 9.79 YLL.
Conclusions: The results presented here are likely to underestimate the true impact of the mitigation
strategies on YLL. However, they highlight the need for public health models to expand their scope in
order to provide better estimates of the risks and benefits of mitigation.
Coronavirus disease 2019 (COVID-19) has led to the first truly global pandemic. At the time of writing
this paper, there were over two million reported cases worldwide and more than 130,000 deaths
attributed to COVID19 acute infection (1). Based on models of its spread, and potential for morbidity
and mortality, most governments worldwide have adopted mitigation strategies that essentially limit
social contacts (2, 3). The goal of these measures is to “flatten the curve” of acute presentations so
as to prevent widespread morbidity and the break-down of health care systems. Variants of these
social mitigation strategies range from “social distancing”, at-home-confinement- referred to as
“self-isolation”, to selective “quarantine”, and to population “lockdown” that includes restriction of
movement outdoors and closure of schools and all non-essential services and businesses.
None of the existing models have factored the possible adverse mental health effects of mitigation
at a population level. These adverse effects can be intuitively anticipated but have never been
rigorously modelled (4). Negative mental health outcomes can be attributed to the emotional and
physiological effects of the risk posed by the virus and by reduced physical activity, social interaction
and human physical contact (5-7). Studies on prior pandemics, such as the Severe Acute Respiratory
Syndrome (SARS)found that the length of quarantine was an important predictor of post-traumatic
stress disorder (PTSD), depression and anxiety with a cumulative prevalence exceeding 30% of the
population (8, 9). Psychosocial stressors within families and loneliness for those living alone are also
likely to spike in confinement and have adverse effects on mental and physical health (10-13).
Available data suggest that stress associated with population-wide disasters increases the level of
violence, including domestic violence and child abuse (14, 15). These are recognised risk factors for
mental health and substance abuse problems (16) as well as suicide (17).
The anticipated impact of the COVID19 pandemic on mental health is expected to be significant but
has not been considered in formulation current public policies. To address this gap, the present
study makes a rapid model-projection concerning the years of life lost (YLL) if restrictive social
mitigation measures are implemented for a period of 3 months. This duration was chosen as it aligns
with the expected duration of social mitigation in many countries. We use data from Switzerland as
an example. The model focuses on what we consider to be the major contributors to YLL affecting
the majority of the population, namely: suicide, emergence or increase in psychopathology,
childhood physical abuse and continued restriction of movement and at home confinement.
To be clear, this model focuses on changes to psychosocial risk factors. The COVID-19 crisis may also
have other adverse consequences that may impact on longevity such as economic adversity, changes
to activities of daily living such as eating, sleeping, smoking and ordinary alcohol consumption or
decrease in medical provision to those who have health problems unrelated to COVID-19. Such
additional factors are however beyond the scope of the present study. A more precise estimation of
the mental health impact of the pandemic will be possible as relevant data become available.
Model: We conducted a literature review focusing on studies reporting on YLL in connection to
situations conceptually similar to the current pandemic. These included data from studies on
confinement in different contexts and from previous disasters including pandemics. We focused on
studies from developed countries, primarily Switzerland, and when not available, from Europe
followed by the United States, based on the United Nations Development Programme- Country
Classification System. Switzerland has a population of 8.57 million (18) and introduced an
“extraordinary situation” on March 16 2020. All boarders were closed to travel, all schools, markets,
restaurants, non-essential shops, bars and entertainment and leisure facilities were closed, and all
public and private events and gatherings were prohibited (19). Several regions had already taken a
number of these measures in the preceding days and weeks. The Federal Council called on members
of the public to avoid all unnecessary contact, maintain physical distance from others and stay
whenever possible at home. According to government announcements these measures are expected
to continue until at least April 27 2020 while a number of measures aimed at “social distancing”,
including prohibition of gatherings, are expected to last until at least June 8 (20) .
The following risk factors were considered based on their importance and data availability:
Suicidality, depression, alcohol use disorder, childhood trauma due to domestic violence, changes in
marital status, and social isolation. The projection of YLL for each of these factors is further
described below. Data concerning the incidence of the risk factors as well as their impact on YLL
were then applied to a model that assumes population-wide severe social mitigation policies (stay-
at-home and restriction of outdoors movement) for a duration of 3 months. As a general rule, the
present model erred on the conservative side when choosing YLL. For purposes of illustration only,
we also present projected YLL for countries other than Switzerland based on their population size
(21) assuming similar prevalence of risk factors.
The model involved a six step process.
For each factor:
1. Estimation of baseline risk of outcome i (BRi) based on the literature
2. Estimation of YLL per incident of outcome i (YLLi) from the literature
3. Estimation of increased risk factor during the pandemic for outome i (PRi), where possible
based on literature
4. Estimation of the increased incident cases relating to the pandemic outcome i (PICi)
Where PRi is the estimate of the increased risk of outcome i relating to the pandemic, D is the
duration of the social mitigation measures, which is fixed 0.25 years (3 months)i
5. Estimation of YLL for incidencei due to the pandemic (PYYLi)
6. Calculation of summary statistics
PICs is the sum of all PICi; PYLLs is the sum of all PYLLi
Average YLL per impacted Person: PICs / PYLLs
Percentage of Persons impacted: PICs/100* Population of Switzerland (8.57 million)
Average PYLL per person of the general population: PYLLs/ Population of Switzerland (8.57
To align with current models that focus on acute mortality, we focus on the 3-month period which
represents an underestimate of the overall impact of the pandemic.
A summary of the results is provided in Table 1 and details of the estimation of the increased YLL
linked to the pandemic are presented below.
BRi: In 2017, Switzerland counted 1043 suicides excluding assisted suicide or euthanasia. Non
euthanasia-related suicide was the cause of death in 16 out of 1000 deaths (22).
YLLi: US data from 2016, showed 1.542 million years were lost due to suicide (23) across 44965
suicides (24) leading to 34.3 YLL per death (1.542 million/44965).
PRi: We extrapolated on the relationship between confinement and suicidality from data from the
penitentiary system. Community cell-confined prisoners already have an increased suicide rate by
factors between 3.5 and 21 compared to the general population (25, 26). However, the risk of
suicide for prisoners in single cells is further increased approximately 9 to 15 times (27).
Extrapolating from these data, we assume that confinement in the household increases their
likelihood of suicide by a factor of 3 in multi-person households and a factor of 27 in single-person
households (3*9). We assume this increase is stable for the entire 3-month duration. In Switzerland,
16% of the population live in single-households (28). These calculations result in a population-wide
PRi of 6.84 (0.16*27 + 0.84*3).
PICi: 5.84* 1043*0.25= 1523 additional suicides.
PYLLi: = 1523*34.3 = 52239.
General: As mood and anxiety disorders are comorbid, we used data on depression in our model as
it is likely to capture much of the distress related psychopathology; additionally, depression has the
most convincing link to YLL which is our outcome of interest (29).
BRi: We used population prevalence data for depression as they capture both incident and pre-
existing conditions(30, 31). Accordingly, we estimated that the pre-pandemic risk of depression for
the Swiss population in a 3-month period is 3.45% (i.e. 8.57 million*0.0345= 295’665) with 64.7% of
affected individuals being women. Because BRi is already adjusted for the 3-month period, no
further correction for PICi was undertaken.
YLLi: Using data from a prior study on depression (32), we assumed loss of 7.91 years of life for men
and 6.22 for women. Given the male-female ratio for depression (64.7% women) this results in YLLi =
PRi: Three years after the SARS epidemic, the proportion of persons with symptoms related to higher
stress was still increased by a factor of 3.47 among those who had been in quarantine, thus
demonstrating the long-term implications of the phenomenon (33). A study of an Australian
population quarantined due to equine flu suggested a similar 3-fold increase in depression (34). We
used the latter estimate as it was the most conservative. We also factored in that -given therapy-
84% of individuals with depression are likely to remit within 3 years (31). To be conservative and to
capture cases most likely associated with mortality, we adjusted the model accordingly leading to a
PRi of 1.32.
PICi: 295665*0.32=94613.
PYLLi: 94613*6.82= 645’2260 YLL.
Alcohol use disorder:
General: Distress under any circumstances is a known risk factor for alcohol abuse disorder (AUD).
There is abundant evidence of increased alcohol consumption during the current pandemic (35).
Although the use of other substances seems to be increased as well, our model focuses on AUD as it
is the most prevalent substance abuse disorder and the major contributor to mortality worldwide
(36). Substance use disorders are significantly associated with increased mortality due to increased
accidents, impulse-dyscontrol leading to violence and suicide, as well as increased physical morbidity
(i.e. cardiovascular, gastro-intestinal, hepatic, and other somatic conditions) (37-39).
BRi: In Switzerland, 16.1 of men and 3.2% of women were estimated to suffer from AUD, meaning
that 83.5% of cases are men and 16.5% are women (36).
YLLi: A cross-national Scandinavian study indicated that life expectancy among inpatients with AUD
was reduced by 24-28 years compared to the general population (39). When only deaths from
natural causes are considered, then life expectancy is reduced by 18.1 years in men and 16.5 years in
women (38). To be conservative, and to account for the preponderance of men with AUD we
assumed a reduction of life expectancy by 18 years in men (83.5% of cases) and 16 years in women
(16.5% of cases) resulting in a total YLLi of 17.67 years.
PRi: We assume a population-level increase in AUD of 0.15% per month, with the first month leading
to a higher incidence (0.3%). Therefore, countermeasures lasting 3 months would increase incidence
by approximately 0.6%.
PICi: 0.6% of the population (8.57 million) = 51’000.
PYLLi: 51000*17.67 = 901’170.
Marital Status:
General: Recent media reports indicate that divorce rates have increased since the instigation of
COVID-19 mitigation policies (11, 40) In individual cases, divorces and separations can be beneficial
to individual health and stress levels (for example in situations of abuse). Overall, however, even
after taking into account risk factors that contribute to divorce and separation (i.e. financial
stressors, mental and physical illness and substance abuse), divorce and separation given the
experience of relational and economic stress, loss, and greater likelihood for social isolation, have
been shown to have a negative impact on longevity (10). Causes for this may also include
detrimental habits that individuals may adopt to cope with the stress, loss, and isolation (such as
increased smoking (41)). Additionally having parents who divorce during childhood has been
estimated to increase mortality by 44% and reduce life expectancy by an average of 4 years (42).
BRi: In 2018, there were 16542 divorces in Switzerland leading to a BRi=33084. Additionally 12212
minors were affected by the breakdown of marital relationships (43).
YLLi: A German study estimated that YLL atteibutable to divorce range between 3-8 years for
women and 4-9 years for men (44). For this projection, 3.5 YLLi were modeled per couple (4 years
for men, 3 years for women) and 4 years for each affected minor (42).
PRi: We based our calculation on the increase in divorce rate for the year following the Hurricane
Hugo disaster (45) (wherefore factor D is omitted in the calculation of PICi). PRi was modelled as
PICi: for adults: 33084 *0.63 = 20842; for affected minors: 12212*0.63 = 7694.
PYLLi: for adults: 20842*3.5= 72947; for affected minors: 7694*4=30776.
Childhood trauma due to domestic violence:
General: Although family violence is commonly targeted towards both women and children, we
focus specifically on the effects on children as specific impact on women was hard to quantify.
BRi: Even when not directly being the victim themselves, children being witnesses to violence can be
an adverse childhood event.
In 2013, 9381 victims of domestic violence registered by the Swiss police. However, a survey
indicated that that this latter number of victims would only represent 22% of the actual number,
which would increase the number to 42641 victims per year (9381/22*100). 64.5% of domestic
violence referred to violent interactions between either parents and their children or current
romantic partners (46) (42641*0.645=27’503). Of Swiss multi-person-households 46% include
children (28) and on average there are 1.76 children living in each of these households (47). BRi is
therefore assumed to be 22’266 (27503*0.46*1.76).
YLLi: Experiencing 3 or more adverse childhood events (ACEs) is associated with 9.5 years of reduced
expected quality longevity (48). Among adults, 25% report having experienced multiple averse
childhood events (49). Because of this we conservatively project that only about every fourth of
these events will lead to the full loss of 9.5 years; we therefore adjusted the YLLi to 2.37 years.
PRi: According to the World Health Organization (WHO), there has been a threefold increase in
family violence since the start of the pandemic (50). However, additional events are not likely to be
normally distributed across victims (46) and the measures to which these numbers refer may have
been stricter than the one in Switzerland; accordingly we adopted a conservative PRi = 2.
PICi: 22266*1*0.25=5567.
PYLLi: 5567*2.37=13194.
Social isolation and reduced social connectedness:
General: No studies were found that indicated the cost of social isolation or reduced social
connectivity in YLL in a way directly adaptable to the present study. Moreover, the entire population
is somewhere on a spectrum from socially hyperconnected to socially isolated. However, studies
concerning risk ratios do exist.
BRi: The entire Swiss population of 8.57 million is on a spectrum from socially connected to socially
isolated, depending on their personal circumstances.
YLLi: Based on the most recent data, Switzerland counted 67008 deaths in 2018 that were
distributed across age groups as follows: category 1 (ages: 0-19): 0.8%; cat 2 (20-39): 1.2%; cat3 (40-
64): 11.1%; cat 4 (65-79): 25.0%; cat5 (80+): 61.9% (22). There are no data informing on the baseline
number of deaths that can be attributed to social disconnection or loneliness. In response, we
averaged the life-expectancy of men and women and calculated YLLi according to the following
steps: 1) life expectancy by category was taken from the Federal Statistics office of Switzerland
which gives remaining life expectancy at birth, 30, 50, 65 and 80 years of age. (51). 2) We then
conservatively adjusted YLL for each age category as a very rough approximation. This approximation
is -if anything- aimed at underestimating the remaining life expectancy (cat 1: 73.45, cat 2: 54.2, cat
3: 34.8, cat 4: 15.5, cat 5: 4.95). 3) Overall, remaining life expectancy was then multiplied with the
percentage of deaths in each age group, leading to a cumulative YLLi =12.03 for each additional
PRi: Having more social connections has been associated with lower death rate with an odds ratio of
1.5 (52). Conversely, a comprehensive meta-analysis indicated that social isolation is associated with
an increase of all-cause mortality by a factor of 1.29 (53). Similarly, a large-scale study estimated that
social isolation increased the hazard risk by a factor of 1.26 after adjusting for multiple potential
confounders including anxiety, depression and lower socio-economic status (54). In our model, we
use the most conservative estimate of 1.26. In a phase of confinement, we assume that a majority of
75% of the population experiences either reduced social connectedness and/or increased social
isolation. This would lead to a PRi of 1.208.
PICi: Based on the 2018 data on the number of deaths in Switzerland (n=67008) (22), PICi was
estimated as 67008*0.208*0.25=3484.
PYLLi: 3484*12.03=41’912.
Summary Statistics:
The findings presented above are summarized in Table 1. The contribution of the different risk
factors to PYLL in descending order was: Alcohol use disorder: 901’170, Depression: 645’260,
Divorce: 103’723, Suicide: 52’239, Reduction of Social contact: 41’912, Averse childhood events due
to domestic violence: 13’194.
The sum of all PYLLi was 1757’498, this represents 0.205 PYLL per person in Switzerland
(1757498/8.57 million) (Table 1). In other words, we project a loss of 10 weeks and 5 days due to
COVID-19 related mitigation strategies if YLL is equally distributed in the entire Swiss population. The
sum of all PICi was 179520 which represents 2.1% of the Swiss population (179520/8.57 million).
Assuming that this subpopulation will be most impacted, the average PYLL was estimated to be 9.79
The current study focused on years of life lost due to the social mitigation strategies implemented in
response to the COVID19 pandemic, with a primary focus on the consequences of at home
confinement and restriction to freedom of movement.
The literature suggests that increased duration of confinement is associated with worse outcomes
for psychological health of those confined (4). While some of the stress related problems ensuing
from confinement may remit, an important portion of this damage may prove to be hard or
impossible to reverse and the affected individuals may experience on going suffering. Our projection
suggests that the Swiss population will incur a substantial increase in mortality as a consequence of
confinement related psychosocial stress, which should be considered in forming public health
responses to the pandemic. It is important that policy makers factor mental health when conduction
cost-benefit analyses of mitigation strategies.
The present study hopes to have achieved two aims: 1) to provide information that helps authorities
to consider whether and, if so, how to enact these countermeasures and what resources to employ
for mitigation of their adverse consequences: 2) to make the case for more comprehensive
modelling of the effect of pandemic-responses beyond the immediate risk attributed to acute
Limitations: As we demonstrate here, the evidence base for building such comprehensive models is
limited and accordingly we had to make several assumptions. In this sense, our model projection is
obviously constrained by the limitations of the available literature which, itself, involves a number of
unknowns. Given the time constraints, the uncertainty in those assumptions is increased; the
authors however judge the urgency of such projections to be very high at the moment. Moreover, in
this respect our model is not dissimilar to current projections of the spread and consequences of
COVID19 which are being continually revised as more. Additionally, the present projection is not all-
encompassing concerning potential effects of confinement: such as (prolonged) grief, elder abuse,
increase of sedentary lifestyle or change of diet. The pandemic is also likely to have multiple
additional consequences including distress due to job losses and financial hardship. The projection
also does not model potentially positive changes in behaviour, for example reductions in car
accidents and air pollution. Due to frequent co-occurrence of certain phenomena it is possible that a
single individual may be affected by more than one of the factors presented. When possible, data
were adjusted for age, sex and socioeconomics. However, for several factors, possibilities to do so
were impeded by virtue of limitations of the current literature.
Competing interests: The authors received no financial support for the submitted work; the authors
report no financial relationships with any organizations that might have an interest in the submitted
work in the previous three years; the authors report no other relationships or activities that could
appear to have influenced the submitted work.
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Table 1: Projection of lost years of life for the population of Switzerland due to demographics and
mental health changes related to a mass confinement of 3 months.
Estimated Persons
Affected with reduced
longevity (% of the
overall population)
Years of
Life Lost
per Person
Years of life lost per
person across the
entire population
(8.57 million)
1'523 (0.02%)
20842 (0.24%)
(affected minors)
7694 (0.09%)
Family Violence
(affected minors)
5’567 (0.06%)
94’613 (1.10%)
Alcohol use
51’000 (0.60%)
Social contacts
3484 (0.04%)
179’520 (2.09%)
Table 2 indicates how many Years of life lost selected other countries would be projected to have,
were their disorder and social representation were the same as Switzerland’s (it is simply a
multiplication of the years of life lost by the size of the population). Population numbers for
countries other than Switzerland were sourced from Wikipedia (21).
Population in millions
Years of Life Lost for an isolation
3 months period in millions
United Kingdom
United States
... The COVID-19 pandemic's various reactive measures taken by the world's governments included the methods having an assortment of direct and indirect effects on stakeholders, institutions, and the environment. Some of the effects included mental health, substance abuse, divorce, violence, theft, loss of jobs, loss of self-esteem, loss of businesses, physical health issues, depression, anger, changes in technology, change in business, change in institutions, change in governments, growth of governments, et cetera (Amis & Janz, 2020;Godinic et al., 2020;Knipe et al., 2020;Moser et al., 2020;Woolliscroft, 2020;Wu et al., 2020). ...
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This study has applied stakeholder theory as a lens to focus on mitigating future health crises by learning from COVID-19, working collectively, using proven business and scientific strategies to create a cohesive pandemic mitigation plan for local and global entities. Utilizing publicly available data on the COVID-19 pandemic, a quantitative analysis was performed using Pearson's r correlation coefficient that tested for relationships between the strictness of pandemic control measures and the reported anxiety, depression, and the number of COVID-19-related deaths. The analysis results revealed that the degree of strictness of pandemic control measures suggested no relationship with the growing mental health crisis and the number of COVID-19 deaths. Therefore, it has been recommended that stakeholders of the world collectively work to proactively prepare for the future to mitigate the effects of health crises and pandemics and thereby secure a chance at long-term survival.
... Very few studies have analysed the health consequences of social isolation measures and most of them have focused on the impact on mental illness [5,6]. Two studies have examined the effect on the control of diabetes mellitus, although the results are inconsistent [7,8], and a few short articles suggest that these measures have reduced screening [9] and childhood vaccination [10]. ...
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Background: To analyse the impact of the COVID-19 epidemic and the lockdown measures on the follow-up and control of chronic diseases in primary care. Methods: Retrospective study in 288 primary care practices (PCP) of the Catalan Institute of Health. We analysed the results of 34 indicators of the Healthcare quality standard (EQA), comprising different types: treatment (4), follow-up (5), control (10), screening (7), vaccinations (4) and quaternary prevention (4). For each PCP, we calculated each indicator's percentage of change in February, March and April 2020 respective to the results of the previous month; and used the T-Student test for paired data to compare them with the percentage of change in the same month of the previous year. We defined indicators with a negative effect those with a greater negative change or a lesser positive change in 2020 in comparison to 2019; and indicators with a positive effect those with a greater positive change or a lesser negative change. Results: We observed a negative effect on 85% of the EQA indicators in March and 68% in April. 90% of the control indicators had a negative effect, highlighting the control of LDL cholesterol with a reduction of - 2.69% (95%CI - 3.17% to - 2.23%) in March and - 3.41% (95%CI - 3.82% to - 3.01%) in April; and the control of blood pressure with a reduction of - 2.13% (95%CI - 2.34% to - 1.9%) and - 2.59% (95%CI - 2.8% to - 2.37%). The indicators with the greatest negative effect were those of screening, such as the indicator of diabetic foot screening with a negative effect of - 2.86% (95%CI - 3.33% to - 2.39%) and - 4.13% (95%CI - 4.55% to - 3.71%) in March and April, respectively. Only one vaccination indicator, adult Measles-Mumps-Rubella vaccine, had a negative effect in both months. Finally, among the indicators of quaternary prevention, we observed negative effects in March and April although in that case a lower inadequacy that means better clinical outcome. Conclusions: The COVID-19 epidemic and the lockdown measures have significantly reduced the results of the follow-up, control, screening and vaccination indicators for patients in primary care. On the other hand, the indicators for quaternary prevention have been strengthened and their results have improved.
... Таким образом, основополагающие противоэпидемические меры -самоизоляция и социальное дистанцирование -которые в сложившейся ситуации пандемии являются необходимыми, в исследованной выборке были самостоятельным стрессовым фактором. Это вполне согласуется с данными литературы, демонстрирующими, что даже не столкнувшиеся лично с инфекцией люди могут переживать критические последствия социальных ограничений [15] вплоть до уменьшения продолжительности жизни на 9 лет среди 2% населения [19]. Здесь важно отметить, что субъективность восприятия населением рекомендуемых противо-эпидемических мер может определять как конструктивный характер их реагирования (социальное дистанцирование), так и деструктивный (избегание социальных контактов), что связывают с вариантами развития адаптивной тревоги человека по поводу здоровья [5]. ...
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One of the many negative consequences of the COVID-19 pandemic is the “secondary epidemic” of negative psychological effects The aim of the study was to identify socio-psychological factors associated with adaptive behavior in the population. Materials and methods: an on-line survey of 1957 Russian-speaking respondents over 18 years old was performed from 30.03.2020 to 05.04.2020. The level of anxiety distress was verified with the psychological stress scale (PSM-25). Dispersion analyses were used (p<0.05). The size of the effects (SE) was evaluated according to Cohen’s d and Cramer’s V criteria. Results: Increased levels of psychological stress were associated with self-isolation (SE=0.13), social distanc- ing (SE=0.14) and antiseptic usage (SE=0.11). The scores of psychological stress were higher in individuals who search the media for coronavirus news more than once or twice a day (SE=0.11). At the same time, the fre- quency of requests for information about COVID-19 was not linearly associated to the individuals fears for their own lives. The concerns about the availability of protective equipment were specifically associated to compliance with self-isolation measures (SE=0.1). The combination of concerns about the contagiousness of the virus and the unavailability of medication for daily intake were associated with the principles of social distance (SE=0.12 and SE=0.11 respectively). Moreover, concerns about the lack of specific treatment for COVID-19, the danger to one’s own life, the contagiousness of the virus and the lack of protective equipment were associated with the protective behaviours related to hand hygiene (SE=0.12, SE=0.12, SE=0.11, SE=0.11 respectively). Wearing a mask was characterized by the same anxiety patterns as hand hygiene, but their association was inverse (respectively SE=0.13, SE=0.12, SE=0.14, SE=0.15). The most common type of anxious experience—fear for the health of relatives—was not specifically associated with certain types of behavior and accompanied each of its variants. Conclusion: Psychological reactions of the population to the COVID-19 pandemic are specifically associated with adaptive behavior in the dynamics of anti-epidemic measures.
... Entire populations may witness decreased quality of life and mental health. 19 Gun sales in the US have increased sharply since the lockdown began, with unpredictable consequences. ...
... Depending on the psychosocial results caused by COVID-19, an average of 0.2 years of total life-year loss per person is envisaged. Moreover, it has been estimated that this loss will reach 9.8 years for 2% of the population (79). ...
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Büyük salgınların toplumun sosyal yapısı ve döngüsünde çeşitli değişimlere yol açtığı bilinmektedir. Başta gelen değişimlerden biri de suç oranlarında ve türlerinde görülen değişimdir. Gerçekte, toplam suç sayılarında belirgin bir düşme görülmesine karşın, bazı suç türlerinin sıklığı azalırken bazılarınınki artmaktadır. Artış gösteren suç tiplerinden biri de ev içi şiddet olgularıdır. Yeterli sayıda sistematik çalışmalar bulunmasa da, Türkiye'de COVID-19 salgını süresince kadına yönelik şiddet olgularının arttığını gösteren veriler vardır. Bir önceki yıla kıyasla 2020 yılı Mart ayında fiziksel şiddet %80, psikolojik şiddet %93, sığınma evi talebi %78 oranında artmıştır. Anket niteliğindeki bir başka çalışma ise pandemi sürecinde kadına yönelik şiddet olaylarında %27.8 oranında artış olduğunu bildirmiştir. Ancak, bu dönemde çocuk istismarı olgularının sayısının azaldığı görülmüştür. Bu durumun sosyal kısıtlamalar nedeniyle olguların saptanmasının zorlaşmasından kaynaklandığı bildirilmektedir. Bu sosyal kısıtlamalar ile pandemini oluşturduğu korku ortamının yaşlı istismarı ve ihmali riskini de arttırabileceği belirtilmiştir. COVID-19 salgınına karşı alınan önlemlerden başta geleni olan karantina uygulamasında evde uzun zaman kısıtlı kalmanın olumsuz etkilerinin azaltılabilmesi için gerekli önlemlerin alınması önemlidir. Bu zorlu süreçte, toplumun her bireyi, birey ve toplum sağlığının korunmasındaki rolünün farkında olarak üzerine düşen sorumluluğu yerine getirmelidir. Bu derlemede, mevdut veriyi de sunarak, COVID-19 salgını süresince ev içi şiddetin kadınlara, çocuklara, LGBTİ ve yaşlı bireylere yönelik olarak artışını irdeledik. Türkiye'deki ve dünyadaki durumu özetledikten sonra, artışın nedenlerini, sorunun çözümünde uluslararası ve ulusal kuruluşların yaptıkları önerileri ortaya koymayı amaçladık.
BACKGROUND. The relevance is due to the negative consequences caused by the COVID-19 pandemic for individuals and for society as a whole, covering almost all aspects of life at the macro and individual levels, and the lack of detailed studies of the psychological state of the population. AIM. Study of the specifics and dynamics of psychological adaptation in subjects during the COVID-19 pandemic. MATERIAL AND METHODS. Method of studying personality accentuations of K. Leonhard (modified by S. Shmishek); diagnostics of the state of aggression (Bass-Darkey questionnaire), multilevel personality questionnaire Adaptiveness by A.G. Maklakov and S.V. Chermyanin, test-questionnaire Health, activity, mood, clinical questionnaire for the detection and evaluation of neurotic conditions (Yakhin K.K., Mendelevich D.M.). Statistical analysis of the data was performed using Spearmans rank correlation coefficient, Students t-test for independent samples, and Students t-test for dependent samples. The study involved 51 people 16% are men and 84% are women, who were selected by a random continuous method, whose average age is 21.31.87 years. The study was carried out in 2 stages. The first stage: the end of April 2020 21 days after the start of voluntary self-isolation; second stage: end of September beginning of November 2020. RESULTS. The subjects were found to have such character accentuations as exaltation 94%, hyperthymism 88%, emotivity 86%, low level of personal adaptive potential (2.11.43), neurotic depression prevailed 43%, obsessive-phobic disorders 33%, conversion disorders 27%. The expression of aggression was carried out mainly through verbal aggression (6.352.43), guilt (5.591.72) and irritation (5.371.92). CONCLUSION. The subjects have a low level of personal adaptive potential, which increased with the end of self-isolation, accompanied by a gradual acceptance of what is happening, stabilization of the growth in the number of sick and dead, news about the development of measures to combat the spread of the virus, methods of treatment and prevention.
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Objective: The primary objective of this scoping review was to examine and map the range of neurophysiological impacts of human touch and eye gaze, and consider their potential relevance to the therapeutic relationship and to healing. Introduction: Clinicians, and many patients and their relatives, have no doubt as to the efficacy of a positive therapeutic relationship; however, much evidence is based on self-reporting by the patient or observation by the researcher. There has been little formal exploration into what is happening in the body to elicit efficacious reactions in patients. There is, however, a growing body of work on the neurophysiological impact of human interaction. Physical touch and face-to-face interaction are two central elements of this interaction that produce neurophysiological effects on the body. Inclusion criteria: This scoping review considered studies that included cognitively intact human subjects in any setting. This review investigated the neurophysiology of human interaction including touch and eye gaze. It considered studies that have examined, in a variety of settings, the neurophysiological impacts of touch and eye gaze. Quantitative studies were included as the aim was to examine objective measures of neurophysiological changes as a result of human touch and gaze. Methods: An extensive search of multiple databases was undertaken to identify published research in the English language with no date restriction. Data extraction was undertaken using an extraction tool developed specifically for the scoping review objectives. Results: The results of the review are presented in narrative form supported by tables and concept maps. Sixty-four studies were included and the majority were related to touch with various types of massage predominating. Only seven studies investigated gaze with three of these utilizing both touch and gaze. Interventions were delivered by a variety of providers including nurses, significant others and masseuses. The main neurophysiological measures were cortisol, oxytocin and noradrenaline. Conclusions: The aim of this review was to map the neurophysiological impact of human touch and gaze. Although our interest was in studies that might have implications for the therapeutic relationship, we accepted studies that explored phenomena outside of the context of a nurse-patient relationship. This allowed exploration of the boundary of what might be relevant in any therapeutic relationship. Indeed, only a small number of studies included in the review involved clinicians (all nurses) and patients. There was sufficient consistency in trends evident across many studies in regard to the beneficial impact of touch and eye gaze to warrant further investigation in the clinical setting. There is a balance between tightly controlled studies conducted in an artificial (laboratory) setting and/or using artificial stimuli and those of a more pragmatic nature that are contextually closer to the reality of providing nursing care. The latter should be encouraged.
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Importance Early adversity is associated with leading causes of adult morbidity and mortality and effects on life opportunities. Objective To provide an updated prevalence estimate of adverse childhood experiences (ACEs) in the United States using a large, diverse, and representative sample of adults in 23 states. Design, Setting, and Participants Data were collected through the Behavioral Risk Factor Surveillance System (BRFSS), an annual, nationally representative telephone survey on health-related behaviors, health conditions, and use of preventive services, from January 1, 2011, through December 31, 2014. Twenty-three states included the ACE assessment in their BRFSS. Respondents included 248 934 noninstitutionalized adults older than 18 years. Data were analyzed from March 15 to April 25, 2017. Main Outcomes and Measures The ACE module consists of 11 questions collapsed into the following 8 categories: physical abuse, emotional abuse, sexual abuse, household mental illness, household substance use, household domestic violence, incarcerated household member, and parental separation or divorce. Lifetime ACE prevalence estimates within each subdomain were calculated (range, 1.00-8.00, with higher scores indicating greater exposure) and stratified by sex, age group, race/ethnicity, annual household income, educational attainment, employment status, sexual orientation, and geographic region. Results Of the 214 157 respondents included in the sample (51.51% female), 61.55% had at least 1 and 24.64% reported 3 or more ACEs. Significantly higher ACE exposures were reported by participants who identified as black (mean score, 1.69; 95% CI, 1.62-1.76), Hispanic (mean score, 1.80; 95% CI, 1.70-1.91), or multiracial (mean score, 2.52; 95% CI, 2.36-2.67), those with less than a high school education (mean score, 1.97; 95% CI, 1.88-2.05), those with income of less than $15 000 per year (mean score, 2.16; 95% CI, 2.09-2.23), those who were unemployed (mean score, 2.30; 95% CI, 2.21-2.38) or unable to work (mean score, 2.33; 95% CI, 2.25-2.42), and those identifying as gay/lesbian (mean score 2.19; 95% CI, 1.95-2.43) or bisexual (mean score, 3.14; 95% CI, 2.82-3.46) compared with those identifying as white, those completing high school or more education, those in all other income brackets, those who were employed, and those identifying as straight, respectively. Emotional abuse was the most prevalent ACE (34.42%; 95% CI, 33.81%-35.03%), followed by parental separation or divorce (27.63%; 95% CI, 27.02%-28.24%) and household substance abuse (27.56%; 95% CI, 27.00%-28.14%). Conclusions and Relevance This report demonstrates the burden of ACEs among the US adult population using the largest and most diverse sample to date. These findings highlight that childhood adversity is common across sociodemographic characteristics, but some individuals are at higher risk of experiencing ACEs than others. Although identifying and treating ACE exposure is important, prioritizing primary prevention of ACEs is critical to improve health and life outcomes throughout the lifespan and across generations.
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The infant's psycho-physiological regulatory system begins to develop prenatally and continues to mature during the postnatal period. Temperament is a construct comprising tonic individual differences in dispositional physiological and behavioural reactions as well as an evolving ability to regulate to environmental conditions. Theoretical models and research have shown that neurohormonal and -physiological factors contribute to individual development and impact infant behaviours as well as the developing regulatory system. Moreover, prenatal maternal risks such as stress and depression are thought to programme fetal regulatory tendencies and that influences neural and behavioural functioning in infancy. The purpose of this review is to examine the theories and research that link infant temperament to neurohormonal and -physiological development in typically developing infants and in those exposed to environmental risk. Research has demonstrated associations between individual variation in physiological stress responses and regulation (measured with cortisol). Moreover, studies have noted an association with physiological regulation and socio-emotional interaction (as measured by the touch–oxytocin link) that may buffer emotional dysregulation. The interaction between individual differences in temperamental tendencies, neurohormonal and -physiological patterns will be discussed by presenting data from studies that have shown that infant neurohormonal and -physiological functioning sets an important trajectory for the development of the individual. This article is part of the theme issue ‘Diverse perspectives on diversity: multi-disciplinary approaches to taxonomies of individual differences’.
The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.
Background: Adverse childhood experiences (ACEs) adversely impact morbidity and mortality. Objective: To quantify burden of disease associated with ACEs among U.S. adults by estimating quality-adjusted life expectancy (QALE) according to number of ACEs reported. Participants and setting: Data from respondents' adverse experiences occurring before age 18 were collected in nine states through the 2011 and 2012 Behavioral Risk Factor Surveillance System (BRFSS). Methods: We estimated health-related quality of life (HRQOL) scores from BRFSS data. We constructed life tables from the Compressed Mortality Files to calculate QALE, a generalization of life expectancy that weights expected years of life lived with the HRQOL score, according to number of ACEs. Results: The QALE for an 18-year-old person reporting 0, 1-2, and 3+ ACEs was 55.1, 53.4, and 45.6 years, respectively. Reporting 3+ ACEs was associated with a 9.5-year decrease (17%) in QALE. The adverse impact of ACEs are present according to age, gender, and race/ethnicity subgroups. The impact of 3+ ACEs on QALE was nearly 3-fold greater for women than men (13.2 vs. 4.7-year decrease). By contrast, an 18-year-old reporting 1-2 ACEs experienced a small decrease in QALE (1.7 years). Conclusions: Reporting 3+ ACEs led to a significant burden of disease, as assessed by QALE loss, to a similar degree as many other well-established behavioral risk factors and chronic conditions. Providers and policymakers should focus on efforts to prevent ACEs, initiate early detection of and interventions to minimize the impact of an ACE, and reduce the likelihood of engaging in maladaptive risky behaviors.
Background: Systematic reviews have consistently shown that individuals with mental disorders have an increased risk of premature mortality. Traditionally, this evidence has been based on relative risks or crude estimates of reduced life expectancy. The aim of this study was to compile a comprehensive analysis of mortality-related health metrics associated with mental disorders, including sex-specific and age-specific mortality rate ratios (MRRs) and life-years lost (LYLs), a measure that takes into account age of onset of the disorder. Methods: In this population-based cohort study, we included all people younger than 95 years of age who lived in Denmark at some point between Jan 1, 1995, and Dec 31, 2015. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and the date and cause of death was obtained from the Danish Register of Causes of Death. We classified mental disorders into ten groups and causes of death into 11 groups, which were further categorised into natural causes (deaths from diseases and medical conditions) and external causes (suicide, homicide, and accidents). For each specific mental disorder, we estimated MRRs using Poisson regression models, adjusting for sex, age, and calendar time, and excess LYLs (ie, difference in LYLs between people with a mental disorder and the general population) for all-cause mortality and for each specific cause of death. Findings: 7 369 926 people were included in our analysis. We found that mortality rates were higher for people with a diagnosis of a mental disorder than for the general Danish population (28·70 deaths [95% CI 28·57-28·82] vs 12·95 deaths [12·93-12·98] per 1000 person-years). Additionally, all types of disorders were associated with higher mortality rates, with MRRs ranging from 1·92 (95% CI 1·91-1·94) for mood disorders to 3·91 (3·87-3·94) for substance use disorders. All types of mental disorders were associated with shorter life expectancies, with excess LYLs ranging from 5·42 years (95% CI 5·36-5·48) for organic disorders in females to 14·84 years (14·70-14·99) for substance use disorders in males. When we examined specific causes of death, we found that males with any type of mental disorder lost fewer years due to neoplasm-related deaths compared with the general population, although their cancer mortality rates were higher. Interpretation: Mental disorders are associated with premature mortality. We provide a comprehensive analysis of mortality by different types of disorders, presenting both MRRs and premature mortality based on LYLs, displayed by age, sex, and cause of death. By providing accurate estimates of premature mortality, we reveal previously underappreciated features related to competing risks and specific causes of death. Funding: Danish National Research Foundation.
Background Marital separation and divorce are associated with an increased risk of early mortality, but the specific biobehavioral pathways that explain this association remain largely unknown. Purpose This study sought to identify the putative psychological, behavioral, and biomarker variables that can help explain the association of being separated or divorced and increased risk for early mortality. Methods Using data from the English Longitudinal Study of Ageing, a representative community sample of aging adults (N = 5,786), we examined the association of marital status and life satisfaction, health behaviors measured 2 years later, biomarkers measured 4 years later, and mortality outcomes from the subsequent 4 years. Results Consistent with prior literature, older adults who were separated/divorced evidenced greater risk of mortality relative to those in intact marriages over the study period, OR = 1.46, 95% CI [1.15, 1.86]. Marital status was associated with lower levels of life satisfaction, β = −0.22 [−0.25, −0.19] and greater likelihood of smoking 2 years later β = 0.17 [0.13, 0.21]. Lower life satisfaction predicted less frequent physical activity 2 years later, β = 0.07 [0.03, 0.10]. Smoking, but not physical activity, predicted poorer lung functioning 2 years later, β = −0.43 [−0.51, −0.35], and poorer lung function predicted increased likelihood of mortality over the following 4 years, β = −0.15 [−0.27, −0.03]. There was a significant total indirect effect of marital status on mortality through these psychological, behavioral, and biomarker variables, β = 0.03 [0.01, 0.05], which fully explained this mortality risk. Conclusions For separated/divorced adults, differences in life satisfaction predict health behaviors associated with poorer long-term lung function, and these intermediate variables help explain the association between marital dissolution and increased risk of earlier mortality.