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Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic - United States, June 24-30, 2020
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been associated with mental health challenges related to the morbidity and mortality caused by the disease and to mitigation activities, including the impact of physical distancing and stay-at-home orders.* Symptoms of anxiety disorder and depressive disorder increased considerably in the United States during April-June of 2020, compared with the same period in 2019 (1,2). To assess mental health, substance use, and suicidal ideation during the pandemic, representative panel surveys were conducted among adults aged ≥18 years across the United States during June 24-30, 2020. Overall, 40.9% of respondents reported at least one adverse mental or behavioral health condition, including symptoms of anxiety disorder or depressive disorder (30.9%), symptoms of a trauma- and stressor-related disorder (TSRD) related to the pandemic† (26.3%), and having started or increased substance use to cope with stress or emotions related to COVID-19 (13.3%). The percentage of respondents who reported having seriously considered suicide in the 30 days before completing the survey (10.7%) was significantly higher among respondents aged 18-24 years (25.5%), minority racial/ethnic groups (Hispanic respondents [18.6%], non-Hispanic black [black] respondents [15.1%]), self-reported unpaid caregivers for adults§ (30.7%), and essential workers¶ (21.7%). Community-level intervention and prevention efforts, including health communication strategies, designed to reach these groups could help address various mental health conditions associated with the COVID-19 pandemic.
... Research is already showing that the coronavirus pandemic exacerbates mental health risks, including suicide and IPV. For example, in a weeklong period of the pandemic, adults in the US experienced elevated mental health morbidity (Czeisler et al., 2020). Moreover, suicidal thoughts within the last 30 days were significantly higher among the ages of 18 to 24 years in June of 2020 than in other age categories (Czeisler et al., 2020). ...
... For example, in a weeklong period of the pandemic, adults in the US experienced elevated mental health morbidity (Czeisler et al., 2020). Moreover, suicidal thoughts within the last 30 days were significantly higher among the ages of 18 to 24 years in June of 2020 than in other age categories (Czeisler et al., 2020). In addition, Hispanic and Black respondents reported a higher prevalence of anxiety and depression disorder symptoms, increased substance abuse, and increased consideration of suicidal ideation than non-Hispanic white respondents at that same time (Czeisler et al., 2020). ...
... Moreover, suicidal thoughts within the last 30 days were significantly higher among the ages of 18 to 24 years in June of 2020 than in other age categories (Czeisler et al., 2020). In addition, Hispanic and Black respondents reported a higher prevalence of anxiety and depression disorder symptoms, increased substance abuse, and increased consideration of suicidal ideation than non-Hispanic white respondents at that same time (Czeisler et al., 2020). These demographics also coincide with those at higher risk for IPV (Smith et al., 2017), making the intersection between COVID-19, IPV, and mental health burdens a current and dangerous combination for many in the United States. ...
Purpose
Suicide risk is higher among violence-involved individuals. Intimate Partner Violence hotline workers are a critical source of support and can potentially be suicide prevention champions. Our primary goal was to examine the effectiveness of disseminating a free, online IPV—Suicide Prevention curriculum, via a randomized control trial, to hotline workers in ten states with the highest suicide and IPV homicide rates.
Method
We divided the country into five regions and, based on criterion, chose two states in each region to randomize into the two arms of the study. We examined training participation and engagement between the two approaches: (1) ‘dissemination as usual’ (control) using a National Domestic Violence Hotline email and a postcard to state/county IPV directors, versus (2) ‘enhanced dissemination’ (intervention) using a four-point touch method (postcard, phone call, email, and letter) to ‘drive’ participation.
Results
Participation increased in the intervention arm as approaches became more personal (i.e., email and phone calls vs. letters). Results indicate that traditional dissemination strategies such as email announcements and invitations are not as effective as varied and multiple touchpoints for IPV hotline staff.
Conclusion
Successful dissemination strategies to promote digital training should consider the value added by personalized connection. Future research is needed to understand how to offer effective and efficient web-based training to those providing IPV and child abuse services.
... The COVID-19 pandemic has had far-reaching impacts on mental health [1,2]. Within the general population, the pandemic has been found to be associated with symptoms of anxiety, depression, stress, sleep problems, substance use, and suicidal ideation [3][4][5][6][7]. However, fewer studies have examined mental health outcomes among adults diagnosed with COVID-19. ...
... We found that mental health outcomes differed across sociodemographic groups and were generally consistent with patterns of mental health outcomes observed in the broader population, including patterns observed during the COVID-19 pandemic [6,39]. For example, a survey of the U.S. population in an early phase of the pandemic (June 2020) found that younger adults (ages [18][19][20][21][22][23][24] were more likely to report worse mental health outcomes compared to older adults [6]. ...
... We found that mental health outcomes differed across sociodemographic groups and were generally consistent with patterns of mental health outcomes observed in the broader population, including patterns observed during the COVID-19 pandemic [6,39]. For example, a survey of the U.S. population in an early phase of the pandemic (June 2020) found that younger adults (ages [18][19][20][21][22][23][24] were more likely to report worse mental health outcomes compared to older adults [6]. Likewise, Hispanic respondents had a higher prevalence of anxiety and depressive symptoms, compared to respondents in other racial/ethnic groups [6]. ...
Purpose
The COVID-19 pandemic has had wide-ranging impacts on mental health, however, less is known about predictors of mental health outcomes among adults who have experienced a COVID-19 diagnosis. We examined the intersection of demographic, economic, and illness-related predictors of depressive and anxiety symptoms within a population-based sample of adults diagnosed with COVID-19 in the U.S. state of Michigan early in the pandemic.
Methods
Data were from a population-based survey of Michigan adults who experienced a COVID-19 diagnosis prior to August 1, 2020 (N = 1087). We used weighted prevalence estimates and multinomial logistic regression to examine associations between mental health outcomes (depressive symptoms, anxiety symptoms, and comorbid depressive/anxiety symptoms) and demographic characteristics, pandemic-associated changes in accessing basic needs (accessing food/clean water and paying important bills), self-reported COVID-19 symptom severity, and symptom duration.
Results
Relative risks for experiencing poor mental health outcomes varied by sex, age, race/ethnicity, and income. In adjusted models, experiencing a change in accessing basic needs associated with the pandemic was associated with higher relative risks for anxiety and comorbid anxiety/depressive symptoms. Worse COVID-19 symptom severity was associated with a higher burden of comorbid depressive/anxiety symptoms. “Long COVID” (symptom duration greater than 60 days) was associated with all outcomes.
Conclusion
Adults diagnosed with COVID-19 may face overlapping risk factors for poor mental health outcomes, including pandemic-associated disruptions to household and economic wellbeing, as well as factors related to COVID-19 symptom severity and duration. An integrated approach to treating depressive/anxiety symptoms among COVID-19 survivors is warranted.
... The main risk factors for death and hospitalization from COVID-19 are advanced age (≥ 65 years), male sex, and chronic conditions, such as mental health disorders, chronic respiratory diseases, diabetes, cardiovascular diseases, and chronic kidney diseases Semenzato et al., 2021). In addition, people more affected by psychological impairment during confinement were youth, women, people affected by chronic disease, and people previously receiving mental health treatment (Czeisler, 2020;Findlay et al., 2020;Peretti-Watel et al., 2020;Qiu et al., 2020;Ran et al., 2020;. For youth and women, a lower fear of infection (at least for themselves) can be overcome by other mechanisms, such as a greater decrease in social interaction (Etheridge & Spantig, 2022;Samji et al., 2022). ...
... The lockdown that started in March 2020 led to a sharp decrease in GP activity (Tuppin et al., 2022), but mental health care demand increased for half of GPs, and the increase in consultations for stress, anxiety and depressive disorders was slightly more frequent in the most impacted areas (Monziols et al., 2020). Stress, anxiety, and depressive symptoms associated with COVID-19 have been related, among some people, to an increase in tobacco and alcohol consumption or new substance use (Czeisler, 2020;Guignard et al., 2021;Rodriguez et al., 2020). ...
Benzodiazepines are widely used psychotropic drugs in France. This high use is a concern regardingthe efficiency of treatment and thus questions its determinants and consequences. Chapters 1 and 2focus on the interrelation between benzodiazepine use and overuse and work accidents, by studyingthe two directions of causality. Chapter 3 explores the impact of the COVID-19 pandemic onbenzodiazepine use, at the municipality level. This dissertation relies on the French National HealthData System, matched with data on occupational accidents and diseases. It aims at improving theknowledge of benzodiazepine use and overuse, as well as work accident prevention. The subject isoriginal because of the literature on this topic and the data source.
... A growing body of evidence reports sleep and occupational factors associated with burnout among healthcare professionals during the COVID-19 pandemic; [22][23][24][25] however, comparatively little research has focused on burnout across occupational sectors. Furthermore, studies conducted during the COVID-19 pandemic have found unpaid caregivers for children and adults, young adults, women and essential workers have disproportionately experienced adverse mental health symptoms, [26][27][28][29][30] but our understanding of how these and other demographic factors relate to burnout during the pandemic is limited. ...
... Our findings of burnout among young persons and unpaid caregivers closely align with broader mental health research that has revealed that these populations have disproportionately experienced adverse mental health symptoms, including depression and anxiety symptoms. [26][27][28][29][30] Occupational burnout symptoms may be another area of concern for these populations. There is debate regarding the extent to which burnout symptoms may overlap with depression and anxiety symptoms, 5 yet recent findings show these conditions to be distinct, 41 and, to our knowledge, there is no evidence of this overlap using the Mini-Z burnout measure administered in the current study. ...
Objectives:
Studies have found associations between occupational burnout symptoms and reduced engagement with healthy behaviours. We sought to characterise demographic, employment and sleep characteristics associated with occupational burnout symptoms, and to evaluate their relationships with adherence to COVID-19 prevention behaviours (mask usage, hand hygiene, avoiding gatherings, physical distancing, obtaining COVID-19 tests if potentially infected).
Methods:
During December 2020, surveys were administered cross-sectionally to 5208 US adults (response rate=65.8%). Quota sampling and survey weighting were employed to improve sample representativeness of sex, age and race and ethnicity. Among 3026 employed respondents, logistic regression models examined associations between burnout symptoms and demographic, employment and sleep characteristics. Similar models were conducted to estimate associations between burnout and non-adherence with COVID-19 prevention behaviours.
Results:
Women, younger adults, unpaid caregivers, those working more on-site versus remotely and those with insufficient or impaired sleep had higher odds of occupational burnout symptoms. Burnout symptoms were associated with less frequent mask usage (adjusted odds ratio (aOR)=1.7, 95% CI 1.3-2.1), hand hygiene (aOR=2.1, 95% CI 1.7-2.7), physical distancing (aOR=1.3, 95% CI 1.1-1.6), avoiding gatherings (aOR=1.4, 95% CI 1.1-1.7) and obtaining COVID-19 tests (aOR=1.4, 95% CI 1.1-1.8).
Conclusions:
Disparities in occupational burnout symptoms exist by gender, age, caregiving, employment and sleep health. Employees experiencing occupational burnout symptoms might exhibit reduced adherence with COVID-19 prevention behaviours. Employers can support employee health by addressing the psychological syndrome of occupational burnout.
... From the earliest articles documenting mortality from the virus, data on COVID-19 have found that men have been dying from the virus at higher rates than women Morgan et al., 2021;Smith et al., 2020a). In June 2020, men reported slightly lower rates of anxiety than women, but had higher rates of depressive symptoms (Czeisler et al., 2020) and suicidal ideation (Czeisler et al., 2020). Symptoms of depression in men tend to include aggression, engaging in high-risk activities, and utilisation of alcohol or drugs (Martin et al., 2013;National Institute of Mental Health, 2017). ...
... From the earliest articles documenting mortality from the virus, data on COVID-19 have found that men have been dying from the virus at higher rates than women Morgan et al., 2021;Smith et al., 2020a). In June 2020, men reported slightly lower rates of anxiety than women, but had higher rates of depressive symptoms (Czeisler et al., 2020) and suicidal ideation (Czeisler et al., 2020). Symptoms of depression in men tend to include aggression, engaging in high-risk activities, and utilisation of alcohol or drugs (Martin et al., 2013;National Institute of Mental Health, 2017). ...
The COVID-19 pandemic piled stress and strain onto a history of structural racism that has impeded opportunities for Black men to be mentally healthy, happy, and well. Yet, interventions to promote the mental health and wellbeing of young Black men are few and are often limited in their ability to reach a large portion of this population. There is a need to mobilize the resources ubiquitous in young Black men’s lives to promote their mental health and wellbeing. Becoming was designed to help fill this gap, and to promote the mental health, wellbeing, and self-care of 18-to-25-year-old Black men in the United States. While there are many aspects of Becoming, this chapter focuses on the rationale for and aspects of mental health, wellbeing, and self-care that underlie this program. Using a biopsychosocial approach, we discuss key considerations for promoting wellbeing as a foundation for increasing participants’ capacity to protect and promote their mental health by engaging in intentional self-care practices. We highlight how anti-Black gendered structural racism shapes but does not determine Black men’s opportunities to be healthy and thrive, and we use the Information-Motivation-Behavioural Skills (IMB) model of health behaviour change to outline and justify the conceptual targets of the program.
... Cross-sectional evidence indicates that some young adults retrospectively report using substances more than they previously did in order to cope with their emotions during the COVID-19 pandemic (Czeisler et al., 2020). Another crosssectional study found that college students' alcohol consumption was higher after their university closed than drinking prior to school closure (Lechner et al., 2020). ...
... A priori covariates were selected based on their associations with pandemic-related stressors and alcohol use (Czeisler et al., 2020;Lechner et al., 2021). Sociodemographic characteristics included baseline gender identity, sexual orientation, and race/ethnicity as well as education, living situation, financial situation, and age at baseline and follow-up (see Table 1 for response categories). ...
Objective
To estimate the extent to which drinking to cope with the COVID-19 pandemic and experiencing pandemic-related life stressors are associated with alcohol use escalation among young adults.
Methods
Respondents in Los Angeles, CA, USA (N = 2,130) completed prospective cohort study surveys before (baseline; October 2018–November 2019; mean age: 19.7[SD = 0.4]) and during (follow-up; May–August 2020) the COVID-19 outbreak. Past 30-day drinking days and number of drinks per drinking day were assessed from baseline to follow-up. At follow-up, participants reported drinking to cope with social isolation and pandemic-related stressors.
Results
Pandemic-related stressor prevalence ranged from 5.5% (evicted/lost home) to 72.6% (worried about education) and 27.1% drank to cope with social isolation during the pandemic. Respondents who did (vs. did not) report pandemic-related coping drinking were more likely to increase past 30-day drinking days and drinks per drinking day from baseline to follow-up after adjustment for possible confounders. Employment loss/reduction, financial problems, and perceived likelihood of contracting COVID-19 or handling the pandemic poorly were each associated with increases in drinking days or drinks per drinking day.
Conclusions
Experiencing certain life stressors and drinking to cope with social isolation may be associated with drinking escalation among young adults during the COVID-19 pandemic.
... According to some studies, early intervention in psychiatric disorders is associated with better outcomes; hence, detecting psychiatric symptoms in the early stages for high-risk patients could provide appropriate early interventions. Psychiatric disorders are both risk factors and the consequences of infection with COVID-19 (37,38); hence, the patients suffering from such disorders should be considered, with other patients prioritized for vaccination (39). ...
Background: The large proportion of coronavirus disease 2019 (COVID-19) patients has been associated with a large number of neuropsychiatric manifestations. Despite the high prevalence of COVID-19, few studies have examined such manifestations, especially in children and adolescents. Objectives: This study investigated neuropsychiatric manifestations in hospitalized children and adolescents admitted for COVID-19 infection in Iran. Methods: This prospective observational study included admitted children and adolescents (4 - 18 years old) diagnosed with COVID-19 infection, pediatric neurologists, child and adolescent psychiatrists, and infectious disease specialists, and assessed 375 infected patients during August and December 2021. Results: Of the 375 patients, 176 (47%) were female, with a mean age of 9.0 ± 3.39 years. Psychiatric and neurological manifestations were reported in 58 (15.5%) and 58 (15.5%) patients, respectively. The most prevalent psychiatric disorders were separation anxiety disorder (SAD) (5.1%), major depressive disorder (MDD) (3.5%), generalized anxiety disorder (GAD) (2.7%), insomnia (2.4%), and oppositional defiant disorder (ODD) (2.4%). Regarding neurological complications, seizures were the most prevalent (13.1%), followed by encephalitis (1.9%), transverse myelitis (0.3%), acute ischemic stroke (0.3%), and Guillain-Barre syndrome (0.3%). There was no significant relationship between the duration of COVID-19 infection (P = 0.54) and ICU admission (P = 0.44) with the emergence of psychiatric symptoms. Conclusions: The most prevalent neurologic and psychiatric complications among children and adolescents with COVID-19 infection were seizures and the symptoms of anxiety/mood disorders, respectively.
... 9,10 A Centers for Disease Control and Prevention (CDC) survey in June 2020 found that more than 4 in 10 adults had at least 1 mental or behavioral health concern, with 31% reporting symptoms of anxiety or depression. 11 These concerns occurred more often among young adults, racial/ethnic minorities, and those with preexisting mental health concerns. 12,13 Additional research is needed to understand the consequences of the pandemic on Hispanic/Latino families to guide targeted prevention and intervention programs and predict future physical and mental health consequences of COVID-19 and future pandemics. ...
... Recent studies showed a positive association between DHL and wellbeing. 37,42 The DHL was reported to serve as a protective factor from COVID-19-related psychological issues, such as alleviating stress and anxiety, 23 mitigating negative effects on perceived stress, depressive symptoms, and impulsivity, 43 and lowering fear of COVID-19. 20 In addition, it was proved that dimension information searching and evaluating reliability were associated with better information satisfaction. ...
Background Digital health literacy (DHL) enables healthy decisions, improves protective behaviors and adherence to COVID-19 measures, especially during the era of the “infodemic”, and enhances psychological well-being. Objective We aimed to explore the mediating roles of fear of COVID-19, information satisfaction, and the importance of online information searching on the association between DHL and well-being. Methods A cross-sectional web-based survey was conducted among 1631 Taiwanese university students, aged 18 years and above, from June 2021 to March 2022. The collected data include sociodemographic characteristics (sex, age, social status, and financial satisfaction), the importance of online information searching, information satisfaction, fear of COVID-19, DHL, and well-being. A linear regression model was utilized to investigate factors associated with well-being, followed by a pathway analysis to assess the direct and indirect relationship between DHL and well-being. Results The scores of DHL and overall well-being were 3.1 ± 0.4 and 74.4 ± 19.7, respectively. Social status (B = 2.40, 95% confidence interval (CI) 1.73–3.07, p
... For example, loneliness was associated with major depressive disorder and anxiety, especially in men, during the COVID-19 pandemic [115]. Specifically, men reported higher rates of depressive symptoms and suicidal ideation than women during the COVID-19 pandemic [116]. Symptoms of depression in males may be different from those observed in females. ...
Loneliness and social isolation are detrimental to mental health and may lead to cognitive impairment and neurodegeneration. Although several molecular signatures of loneliness have been identified, the molecular mechanisms by which loneliness impacts the brain remain elusive. Here, we performed a bioinformatics approach to untangle the molecular underpinnings associated with loneliness. Co-expression network analysis identified molecular ‘switches’ responsible for dramatic transcriptional changes in the nucleus accumbens of individuals with known loneliness. Loneliness-related switch genes were enriched in cell cycle, cancer, TGF-β, FOXO, and PI3K-AKT signaling pathways. Analysis stratified by sex identified switch genes in males with chronic loneliness. Male-specific switch genes were enriched in infection, innate immunity, and cancer-related pathways. Correlation analysis revealed that loneliness-related switch genes significantly overlapped with 82% and 68% of human studies on Alzheimer’s (AD) and Parkinson’s diseases (PD), respectively, in gene expression databases. Loneliness-related switch genes, BCAM, NECTIN2, NPAS3, RBM38, PELI1, DPP10, and ASGR2, have been identified as genetic risk factors for AD. Likewise, switch genes HLA-DRB5, ALDOA, and GPNMB are known genetic loci in PD. Similarly, loneliness-related switch genes overlapped in 70% and 64% of human studies on major depressive disorder and schizophrenia, respectively. Nine switch genes, HLA-DRB5, ARHGAP15, COL4A1, RBM38, DMD, LGALS3BP, WSCD2, CYTH4, and CNTRL, overlapped with known genetic variants in depression. Seven switch genes, NPAS3, ARHGAP15, LGALS3BP, DPP10, SMYD3, CPXCR1, and HLA-DRB5 were associated with known risk factors for schizophrenia. Collectively, we identified molecular determinants of loneliness and dysregulated pathways in the brain of non-demented adults. The association of switch genes with known risk factors for neuropsychiatric and neurodegenerative diseases provides a molecular explanation for the observed prevalence of these diseases among lonely individuals.
... There were no significant differences in symptoms before and during the pandemic for DASS Stress and DASS Depression. As there were initial concerns reported of dramatic increases in symptoms of anxiety and depression during the pandemic (Czeisler et al., 2020;Twenge & Joiner, 2020), we explored whether the lack of symptom change observed between the initial assessment (pre-pandemic) and the COVID survey in our study was due to participants who were treated with cognitive behavioral therapy at CARD in that timeframe. A mixed ANOVA analysis was completed with pre-and post-COVID-19 DASS scores as the withinsubjects factor and treatment as the between-subjects factor. ...
Purpose
The present study examined the prospective direct and interactive effects of personality (neuroticism, extraversion) and experiencing changes in friendships during the pandemic on symptoms of stress, anxiety, and depression.
Methods
A sample of patients (N = 77) at an outpatient treatment clinic who had received a diagnostic assessment in the 6 months prior to the COVID-19 lockdown was re-contacted during the pandemic (May–June 2020) and completed a survey assessing stressors and symptoms of internalizing psychopathology.
Results
Neuroticism had main effects on anxiety, whereas experiencing changes in friendships had main effects on stress and depression. Extraversion did not have main effects on stress, depression, or anxiety. The relationship between experiencing changes in friendships and stress and anxiety was moderated by extraversion, such that the strength of the relationship between changes in friendships and stress and anxiety waned as the level of extraversion increased. Neuroticism was not a moderator of the association between changes in friendships and emotional disorder symptoms.
Conclusion
These results suggest that higher levels of extraversion may protect against symptoms of stress reactivity and anxiety that are associated with COVID-related changes in friendships, while neuroticism may have limited prospective associations with symptoms during the pandemic.
... The COVID-19 pandemic and the associated public health measures introduced to mitigate the spread of the virus have had significant impacts on mental health and substance use. One survey of adults living in the United States (US) found a 3-fold increase in the prevalence of anxiety symptoms, a 4-fold increase in the prevalence of depressive symptoms and a 2-fold increase in suicidal ideation after the onset of the pandemic [1]. In the same survey, 13% of adults reported starting or increasing substance use to cope with stress or emotions related to People with HIV (PWH) may be particularly vulnerable to the psychological impacts of COVID-19 as they were disproportionately impacted by stigma, discrimination, and isolation before the onset of the pandemic and inevitably experienced further social isolation as a result of the measures put in place to minimize the spread of the virus [2]. ...
People with HIV (PWH) may be particularly vulnerable to the psychological impacts of COVID-19. To assess this, participants were recruited from two established cohorts of PWH and HIV− adults with the available pre-pandemic baseline data and completed the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Alcohol Use Identification Test (AUDIT), National Institute on Drug Abuse Quick Screen (NIDA-QS), and Pittsburgh Sleep Quality Index (PSQI) at two distinct intra-pandemic time periods. All outcomes were evaluated using generalized linear mixed models. In total, 87 participants completed all the questionnaires; 45 were PWH and 42 were HIV−. The pre-pandemic mean BDI-II, BAI, AUDIT and PSQI scores were higher in the PWH cohort. After the onset of the pandemic, the mean BDI-II, AUDIT and PSQI scores increased within the sample as a whole (p < 0.001, p = 0.029 and p = 0.046, respectively). The intra-pandemic mean BDI-II scores fell slightly for both groups and the AUDIT scores increased slightly for the PWH group and fell slightly for the HIV− group, but not significantly. The intra-pandemic PSQI scores increased sharply for both groups. The percentage of PWH and HIV− participants who moved into a more severe category of depression was identical (18%), but more PWH met the criteria for clinical evaluation. The BAI and NIDA-QS scores did not increase significantly. In conclusion, the measures of mental health symptoms and alcohol use increased in both groups after the onset of the pandemic. Although there were no significant differences in the changes between the groups, the PWH had higher baseline scores and the changes in this group had more clinical impacts.
... The findings are also consistent with a previous study, which reported 14% increase in alcohol consumption during COVID-19 "Lockdown" in Poland (Chodkiewicz et al., 2020). Likewise, Czeisler et al. (2020) reported that 13.3% of the participants experienced increased substance use during COVID-19 lockdown. However, only 18.9% of the participants in our study reported no changes in their behavior. ...
... and trauma-and stress-related disorder symptoms (26%). 13 Studies from Australia, Canada and the US have shown increased alcohol consumption among people experiencing elevated stress, anxiety and depression. [14][15][16][17][18][19] In Canada, where cannabis has been legal and regulated since 2018, the prevalence of current (past-week) nonmedical cannabis use in the overall population does not appear to have shifted noticeably during the COVID-19 pandemic; 20 however, between 30% and 50% of people who used nonmedical cannabis pre-pandemic increased their frequency of use during the pandemic; 3,20-22 this estimate is even higher among those with depression, anxiety and/or suicidality. ...
Introduction
The COVID-19 pandemic has had widespread secondary negative health impacts including loss of material security and exacerbation of mental illness in at-risk populations. While increases in the nonmedical use of certain substances, including cannabis, have been observed in samples of the Canadian population, no research has documented COVID-concurrent shifts in medical cannabis use in Canada.
Methods
Data were derived from the 2021 Canadian Cannabis Patient Survey, an online survey administered in May 2021 to people authorized to use medical cannabis recruited from one of two Canadian licensed medical cannabis producers. McNemar tests assessed for changes in past 3-month medical cannabis frequency from before to during the pandemic. We explored correlates of increasing frequency of cannabis use since before the pandemic in bivariable and multivariable logistic models.
Results
In total, 2697 respondents (49.1% women) completed the survey. Daily medical cannabis use increased slightly but significantly from before the pandemic (83.2%) to during the pandemic (90.3% at time of survey; p < 0.001). Factors significantly associated with increasing frequency of medical cannabis use included female gender, younger age, pandemic-related job loss, primary cannabis use to manage mental health, prescription drug use and nonmedical cannabis use (p < 0.05).
Conclusion
There were slight shifts towards higher frequency of medical cannabis use after the onset of the COVID-19 pandemic. While short- and long-term impacts of cannabis use on pandemic-related mental distress are unknown, clinicians working with patients who use medical cannabis should be aware of possible changes in use patterns during the pandemic.
... School closures due to the pandemic impacted about 55 million students in the USA (Kuhfeld et al., 2020). Recent research suggests that the impact of stressors related to COVID-19 (e.g., family financial distress, social isolation) has had a dramatic impact on children and adolescents' psychological, emotional, and physical well-being as there has been a significant increase in mental health issues and rise in suicide rates among adolescents since the pandemic (Czeisler et al., 2020;Isumi et al., 2020;Sher, 2020;Tanaka & Okamoto, 2021). Though the shift from in-person to online ensured everyone's safety at school, rules around social distancing and sudden school closings disrupted students' daily routines and limited their interaction with their peers and educators due to the transition to an online mode of instruction (Wyse et al., 2020). ...
The current study investigated the associations among student perceptions of COVID-19 stress, internalizing problems, and school social support (teacher and classmate support) and how these relations differed across elementary/middle and high school students. Based on data from 526 4th- through 12th-grade students from a school district in the Northeast, we found that COVID-19-related stress was significantly related to internalizing problems for all students, regardless of grade level. We also found that teacher social support, but not classmate social support, buffered the positive relation between COVID-19 stress and internalizing problems. The results of the current study have implications for school psychologists, counselors, social workers, and other educators in alleviating COVID-19-related stress in students and associated symptoms of internalizing problems in students. As the pandemic unwinds, future research should examine the long-term impacts of the COVID-19 pandemic, especially for students with marginalized identities, and how teacher and/or peer support may play a role in buffering these stressors for students.
... This led in turn to an increase in emotional and behavior problems of up to 43% [1 -3]. Research indicates that the stressors brought about by COVID-19 selectively impacted adolescents more than toddlers or latency-aged children [4,5] and further selectively impacted underresourced populations of youth, especially those with prior exposure to adversity [3,6]. At the present time, over half of adolescents need mental health care, and symptoms of depression and anxiety among youth are at an all-time high [7][8][9][10]. ...
Background:
The pandemic was followed by a severe mental health crisis in youth with both an increase in the prevalence of mental health problems and a decrease in requests for and access to care.
Methods:
data were extracted from the school-based health center records in three large public high schools that include under-resourced and immigrant communities. Data from 2018/2019 (pre-pandemic), 2020 during the pandemic, and then in 2021 after the return to in-person school were compared regarding the impact of in-person, telehealth, and hybrid care.
Results:
Despite the increase in mental health needs globally, there was a dramatic decrease in referrals, evaluations, and the total number of students seen for behavioral health care. The time course of this decrease in care was specifically associated with the transition to telehealth, although treatment did not return to pre-pandemic levels, even after in-person care became available.
Conclusions:
Despite ease of access and increased need, these data suggest that telehealth has unique limitations when delivered in school-based health centers.
... Over the last two decades, the proportion of pregnant women reporting non-prescription opioid use has quadrupled and the proportion reporting methamphetamine use has doubled [3,4]. Further, overall SUD rates have risen in the U.S. since the onset of the COVID-19 pandemic [5]. ...
Background
Individuals with substance use disorders (SUD) have disproportionately high rates of unintended pregnancy. Reducing harm associated with this risk and its biopsychosocial consequences requires evidence-based, non-coercive interventions that ensure access to contraception for individuals who choose to prevent pregnancy. We examined feasibility and impact of SexHealth Mobile, a mobile unit-based intervention that aimed to increase access to patient-centered contraceptive care for individuals in SUD recovery programs.
Methods
We conducted a quasi-experimental study (enhanced usual care [EUC] followed by intervention) at three recovery centers with participants (n = 98) at risk for unintended pregnancy. EUC participants were offered printed information on community locations where they could access contraception care. SexHealth Mobile participants were offered same-day, onsite clinical consultation on a medical mobile unit and contraception if desired. The primary outcome was use of contraception (hormonal or intrauterine device) at one-month post-enrollment. Secondary outcomes were at two-weeks and three-months. Confidence in preventing unintended pregnancy, reasons for non-use of contraception at follow-up, and intervention feasibility were also assessed.
Results
Participants (median age = 31, range 19–40) enrolled in the intervention period were almost 10 times more likely to be using contraception at one-month (51.5%) versus the those enrolled in the EUC period (5.4%) (unadjusted relative risk [URR] = 9.3 [95%CI: 2.3–37.1]; adjusted relative risk [ARR] = 9.8 [95%CI: 2.4–39.2]). Intervention participants were also more likely to be using contraception at 2-weeks (38.7% vs. 2.6%; URR = 14.3 [95%CI: 2.0–104.1]) and three-months (40.9% vs. 13.9%; URR = 2.9 [95% CI: 1.1–7.4]). EUC participants reported more barriers (cost, time) and less confidence in preventing unintended pregnancies. Mixed-methods feasibility data indicated high acceptability and feasible integration into recovery settings.
Conclusions
Mobile contraceptive care based on principles of reproductive justice and harm reduction reduces access barriers, is feasible to implement in SUD recovery settings, and increases contraception use. Expanding interventions like SexHealth Mobile may help reduce harm from unintended pregnancies among individuals in SUD recovery.
Trial Registration NCT04227145.
... Kathirvel [3] of the World Bank predicts that the COVID-19 pandemic will cause a decades-long global economic recession that may largely affect mental health, including correlations with distress, anxiety, depression, and substance abuse disorders. The Centers for Disease Control and Prevention (CDC) has reported that at least one adverse mental or behavioral health condition has been developed by 40.9% of US adult respondents, with 10.7% of respondents seriously considering suicide in the last 30 days [4]. Other researchers have also found a similar trend globally that children and adolescents are suffering from more serious depression and anxiety effects, with a 30-50% report rate during the COVID-19 pandemic [5]. ...
The purpose of this perspective article is to identify problematic behaviors during the COVID-19 pandemic and recommend a school-based intervention (e.g., self-reflection, motivational interview, and workbook) to address post-COVID social anxiety among children and adolescents. The recommendations involve comparing students’ social interaction behaviors pre-pandemic, during the pandemic, and post-pandemic, and evaluating any behavioral changes in social relationships six months later. We also discuss the evaluation criteria and surveys used to assess the impact of the intervention on behavioral changes. Our evaluation criteria are based on students’ beliefs and abilities and aim to demonstrate that the intervention improves in-person social interactions and helps students adapt to the transition back to school. The proposed perspectives and strategies of the intervention can be modified to meet the needs of the researchers and professionals. By working together, global policymakers from the fields of education and public health can create school-based interventions that enhance students’ physical, mental, and spiritual well-being. This program aims to mitigate the negative effects of school closures and social isolation and to broaden the role of schools in supporting students in the challenging post-pandemic world by addressing their holistic needs.
... The finding that suicide counts were overall lower than expected in April 2020, immediately following the initial pandemic outbreak in Spain, is in keeping with reports from countries and regions across the globe Pirkis et al., 2021;Tanaka and Okamoto, 2021). Interpreting these temporary decreases in suicide mortality is challenging, as suicide decreases were not expected (Reger et al., 2020;Sher, 2020) based on the socioeconomic stressors brought about by the pandemic and on increases in population-level prevalence of mental health symptoms (Prati and Mancini, 2021;Robinson et al., 2022) and suicidal thoughts (Czeisler, 2020). On the one hand, suicide mortality can decrease in the early aftermath of certain major adverse societal eventsincluding some natural disasters (Matsubayashi et al., 2013), wars (Thomas and Gunnell, 2010), genocides (Lester, n.d.), terrorist attacks (Claassen et al., 2010), or pandemics (Bastiampillai et al., 2021;Gaddy, 2021). ...
Background:
Variations in suicide following the initial COVID-19 pandemic outbreak were heterogeneous across space, over time, and across population subgroup. Whether suicide has increased during the pandemic in Spain, a major initial COVID-19 hotspot, remains unclear, and no study has examined differences by sociodemographic group.
Methods:
We used 2016-2020 data on monthly suicide deaths from Spain's National Institute of Statistics. We implemented Seasonal Autoregressive Integrated Moving Average (SARIMA) models to control seasonality, non-stationarity, and autocorrelation. Using January 2016-March 2020 data, we predicted monthly suicide counts (95 % prediction intervals) between April and December 2020, and then compared observed and predicted monthly suicide counts. All calculations were conducted for the overall study population and by sex and age group.
Results:
Between April and December 2020, the number of suicides in Spain was 11 % higher-than-predicted. Monthly suicide counts were lower-than-expected in April 2020 and peaked in August 2020 with 396 observed suicides. Excess suicide counts were particularly salient during the summer of 2020 - largely driven by over 50 % higher-than-expected suicide counts among males aged 65 years and older in June, July, and August 2020.
Discussion:
The number of suicides increased in Spain during the months following the initial COVID-19 pandemic outbreak in Spain, largely driven by increases in suicides among older adults. Potential explanations underlying this phenomenon remain elusive. Important factors to understand these findings may include fear of contagion, isolation, and loss and bereavement - in the context of the particularly high mortality rates of older adults during the initial phases of the pandemic in Spain.
... This result is similar to other findings in this area Vahia, Jeste, & Reynolds, 2020). The Centers for Disease Control and Prevention (CDC) showed that during June 24-30, 2020, 6.2% of individuals aged 65 years or older reported anxiety symptoms compared with 49.1% of individuals aged 18 through 24 years (Czeisler et al., 2020). ...
COVID-19 continues to take a large toll on the mental health of the not working population, particularly of those who were unable to work. This study, using the Household Pulse Survey, estimated the association between reasons for not working and major depression and anxiety symptoms (MDAS). The lowest MDAS was reported by retirees. Individuals who were unable to work because of transportation problems, layoffs, COVID-19 concerns, and sickness or disability reported the highest MDAS. Mediation analysis showed that the direct and indirect effects of reasons for not working were much higher for those individuals who were unable to work than for individuals who were working or decided not to work.
... In this study, two older people died by suicide due to care burden problems, two older people died by suicide due to personal health reasons, and another one due to multiple reasons. Previous studies reported that older people living in rural areas with two or more chronic physical conditions have a significantly higher risk of suicidal ideation (Czeisler et al., 2020;Jing et al., 2021). In this study, three of the older people who have died by suicide had more than three chronic diseases. ...
Aim:
The aim of the study is to provide insight and facilitate a deeper understanding of family members who have experienced their older family member's suicide.
Design:
Interpretative phenomenological analysis (IPA) study.
Methods:
Semi-structured individual interviews with five family members of older people who died by suicide recruited from a rural area of Shanxi Province, China. Smith's (2009) six steps of IPA was used for data analysis.
Results:
Three main themes emerged from the study: (a) Initial psychological reactions; (b) Long-term life effects; (c) Social attitudes. The study shows how the family members of older people who died by suicide have experienced stigmatization and felt largely ignored. A suicide event poses a challenge to the future living quality of the family members. The study also highlights that it is necessary to pay attention to families of older people who died by suicide and providing support is required to improve the quality of life of these family members in rural China.
Conclusion:
The study adds to the understanding of the lived experience of family members of older people who died by suicide in less economically developed rural areas.
Patient or public contribution:
Patients and the public were not involved in the design, conduct or reporting of this study. Participants of this study helped with recruitment via snowball sampling.
... Second, considering that our data was collected during the outbreak of the COVID-19 pandemic when people experienced drastic changes in their daily lives, it is probable that levels of depression, anxiety, and suicidality were reported relatively higher than they would have been without the pandemic extant throughout the study. 77 Third, due to the cross-sectional nature of the data, the current study was unable to examine the predictive validity of the SCI-2. Thus, further study with a longitudinal study design would advance current findings. ...
Objective:
Because of the exceptionally high suicide rates in South Korea, new assessment methods are needed to improve suicide prevention. The current study aims to validate the revised Suicide Crisis Inventory-2 (SCI-2), a self-report measure that assesses a cognitiveaffective pre-suicidal state in a Korean sample.
Methods:
With data from 1,061 community adults in South Korea, confirmatory factor analyses were first conducted to test the proposed one-factor and five-factor structures of the SCI-2. Also, an exploratory factor analysis (EFA) was performed to examine possible alternative factor structure of the inventory.
Results:
The one-factor model of the SCI-2 resulted in good model fit and similarly, the five-factor model also exhibited strong fit. Comparing the two models, the five-factor was evaluated as the superior model fit. An alternative 4-factor model derived from EFA exhibited a comparable model fit. The Korean version of the SCI-2 had high internal consistency and strong concurrent validity in relation to symptoms of suicidal ideation, depression, and anxiety.
Conclusion:
The SCI-2 is an appropriate and a valid tool for measuring one's proximity to imminent suicide risk. However, the exact factor structure of the SCI-2 may be culture-sensitive and warrants further study.
Throughout history, people have united to demand change and accountability in the face of injustice. Although freedom of speech and assembly rights have been essential in uplifting and empowering marginalized communities throughout history, it is important to name the existence of speech that seeks to expand rights and speech which aims to restrict rights. Hate speech occurrences have increased dramatically since 2016 and many scholars cite college campuses as a specialized place for hate and social movements. Despite this increase in incidents and scholarly attention focused on on-campus hate speech, there is a gap in knowledge regarding those staff members who oversee hate speech incidents as people of color, especially those who work in community colleges. Utilizing a Critical Race Study lens, this study explored how student affairs professionals of color in California community college settings experience and navigate hate speech and White supremacy. Through eight collective counter-narratives, educators provided insight into White supremacy incidents on campus and the biased federal policy that affects their day-to-day work with students. Their collective stories re-imagine the post-pandemic community college what it means to be safe in community colleges through the twin pandemics and how the community college campus as a whole can come together to challenge White supremacy and support highly vulnerable and marginalized community college students. Their exploration of experiences also paints a picture of coalitions that must be built and sustained within the community. And finally, this study provides insight into the navigation and radical re-imagining of hate speech education and healing together as community colleges reopen during the COVID-19 pandemic and escalation of racial injustice.
Background:
Medications for alcohol use disorder (MAUD) are highly effective in achieving and maintaining abstinence in patients with alcohol use disorder (AUD). Our aim was to evaluate the effect of MAUD on all-cause mortality in patients with alcohol-associated cirrhosis and active alcohol use.
Methods:
This was a retrospective cohort study of patients with alcohol-associated cirrhosis and high-risk alcohol use disorder in the Veterans Outcomes and Costs Associated with Liver Disease (VOCAL) database. Propensity score matching for exposure to MAUD (acamprosate or naltrexone) within a year after cirrhosis diagnosis was performed to account for potential confounders, and the association between MAUD and all-cause mortality was subsequently evaluated using Cox regression analysis.
Results:
A total of 9131 patients were included, of whom 886 (9.7%) were exposed to MAUD (naltrexone: 520, acamprosate: 307, both medications: 59). The duration of MAUD exposure was >3 months in 345 patients (39%). The strongest positive predictor of MAUD prescription was an inpatient diagnosis code for AUD, followed by a concurrent diagnosis of depression; the strongest negative predictor was a history of cirrhosis decompensation. After propensity score matching (866 patients in each group) with excellent covariate balance (absolute standardized mean differences <0.1), MAUD exposure was associated with improved survival, with an HR of 0.80 relative to no MAUD exposure (95% CI: 0.67-0.97, p = 0.024).
Conclusion:
MAUD are underutilized in patients with alcohol-associated cirrhosis with high-risk alcohol use behavior but are associated with improved survival after adjustment for confounders such as the severity of liver disease, age, and engagement in the healthcare system.
Without proper treatment, people with co-occurring mental health and substance use problems are at great risk for poor outcomes and high treatment costs in multiple domains. Intermediary organizations can provide support to programs implementing integrated treatment and other evidence-based practices; this includes developing practical tools for programs built to encourage fidelity to a particular practice. In this paper, we describe a group curriculum workbook designed to help practitioners provide integrated treatment with fidelity and a pilot learning collaborative to evaluate whether this workbook is a helpful tool for programs to support people with serious mental health conditions and substance use in identifying and achieving personal goals. Results of the pilot found that nearly all participants demonstrated progress with respect to their identified goals, and group facilitators reported that the workbook was easy to use, that participants enjoyed the material, and that they intended to continue offering the group as part of their regular programming.
Adolescent resettled refugees across the United States have been significantly impacted by the COVID-19 pandemic, through socio-economic stressors in households, disproportionate morbidity and mortality in immigrant communities, and social isolation and loss of learning due to school closures and the shift to online learning. The Study of Adolescent Lives after Migration to America [SALaMA] investigates the mental health and wellbeing of adolescents who come from-or who have parents who came from-the Middle East and North Africa [MENA] region and settled in the U.S. There is a gap in understanding of the experiences during the pandemic of MENA-background adolescents in the U.S. The objective of this study was to describe the perspective of educators and other school-affiliated service providers on the impact of the COVID-19 pandemic on mental health and wellbeing of adolescent resettled refugees and access to and quality of education and support services for adolescent resettled refugees. The researchers collected data using in-depth interviews with key informants in Chicago, Illinois; Harrisonburg, Virginia; and Detroit Metropolitan Area [DMA], Michigan, Key informants were school administrators, managers of English language learning services and programs, teachers, therapists, staff of non-governmental organizations and/ or community-based organizations, and case workers. Data analysis was conducted utilizing directed content analysis to develop an initial codebook and identify key themes in the data. Findings revealed a number of pathways through which the pandemic impacted adolescent refugees and immigrants' mental health and wellbeing, with online programming impacting students' engagement, motivation and social isolation in terms of peer and provider relationships. Specific dynamics in refugee adolescents' households increased stressors and reduced engagement through online learning, and access to space and resources needed to support learning during school closures were limited. Service providers emphasized multiple and overlapping impacts on service quality and access, resulting in reduced social supports and mental health prevention and response approaches. Due to the long-term impacts of school closures in the first two years of the pandemic, and ongoing disruption, these data both provide a snapshot of the impacts of the pandemic at a specific moment, as well as insights into ways forward in terms of adapting services and engaging students within restrictions and limitations due to the pandemic. These findings emphasize the need for educators and mental health service providers to rebuild and strengthen relationships with students and families. These findings indicate the need to consider, support and expand social support and mental health services, specifically for refugee adolescent students, in the context of learning and well-being during the COVID-19 pandemic.
Coronavirus (COVID-19) lockdowns provided a unique opportunity to examine how changes in the social environment impact mental health and wellbeing. We addressed this issue by assessing how perceived social support across COVID-19 restrictions alters alcohol and cannabis use in emerging adults, a population vulnerable to adverse outcomes of substance use. Four hundred sixty-three young adults in Canada and the United States completed online questionnaires for three retrospective timepoints: Pre-Covid, Lockdown and Eased Restrictions. Sociodemographic factors, perceived social support, and substance use were assessed. Overall, alcohol use decreased while cannabis use increased during Lockdown. Interestingly, social support negatively predicted alcohol use and positively predicted cannabis use during Lockdown. These findings suggest a difference in motives underlying alcohol and cannabis use in emerging adults. Importantly, these changes were not sustained when restrictions eased, suggesting that emerging adults exhibit resiliency to the impacts of COVID-19 restrictions on substance use.
Background:
Caring Contacts can effectively reduce suicide ideation, attempts, and death. In published clinical trials, Caring Contacts were sent by someone who knew the recipient. At scale, Caring Contacts programs rarely introduce the recipient and sender. It is not known whether receiving Caring Contacts from someone unknown is as effective as messages from someone the recipient has met.
Methods:
Pragmatic randomized controlled trial comparing Caring Contacts with (CC+) versus without an introductory phone call (CC). Recruitment occurred January-July 2021, with outcomes assessed at 6 months. Participants were primary care patients or healthcare providers/staff reporting adverse mental health outcomes on a qualifying survey. Participants were sent 11 standardized caring text messages over 6 months; when participants replied, they received personalized unscripted responses. CC+ calls were semi-structured. The primary outcome was loneliness (NIH Toolkit).
Results:
Participants included 331 patients (mean [SD] age: 45.5 [16.4], 78.9 % female) and 335 healthcare providers/staff (mean [SD] age: 40.9 [11.8], 86.6 % female). There were no significant differences in loneliness at 6 months by treatment arm in either stratum. In patients, mean (SD) loneliness was 61.9 (10.7) in CC, and 60.8 (10.3) in CC+, adjusted mean difference of -1.0 (95 % CI: -3.0, 1.0); p-value = 0.31. In providers/staff, mean (SD) loneliness was 61.2 (11) in CC, and 61.3 (11.1) in CC+, adjusted mean difference of 0.2 (95 % CI: -1.8, 2.2); p-value = 0.83.
Limitations:
Study population was 93 % white which may limit generalizability.
Conclusions:
Including an initial phone call added operational complexity without significantly improving the effectiveness of a Caring Contacts program.
Objective:
This study aimed to: (1) explore changes in the volume of calls to poison control centers (PCs) for intentional exposures (IEs) in Dallas County, Texas, overall and by gender and age, and (2) examine the association between 2 different public health emergencies (PHEs) and changes in IE call volume.
Methods:
PCs categorize calls they receive by intentionality of the exposure, based on information from the caller. We analyzed data on PC calls categorized as intentional in Dallas County, Texas, from March 2019 - April 2021. This period includes the COVID-19 pandemic declaration (March 2020), a surge in COVID-19 cases (July 2020), and Winter Storm Uri (February 2021). Changes in IE call volume (overall and by age and gender), were explored, and interrupted time series analysis was used to examine call volume changes after PHE onset.
Results:
The summer surge in COVID-19 cases was associated with 1.9 additional IE calls/day (95% CI 0.7 to 3.1), in the context of a baseline unadjusted mean of 6.2 calls per day (unadjusted) before November 3, 2020. Neither the pandemic declaration nor Winter Storm Uri was significantly associated with changes in call volume. Women, on average, made 1.2 more calls per day compared to men during the study period. IE calls for youth increased after the pandemic declaration, closing the longstanding gap between adults and youth by early 2021.
Conclusions:
Changes in IE call volume in Dallas County varied by gender and age. Calls increased during the local COVID-19 surge. Population-level behavioral health may be associated with local crisis severity.
Our cross-sectional study seeks to understand how COVID-19 stigma, race/ethnicity [Asian, Black, Hispanic/Latinx, white] and residency [New York City (NYC) resident vs. non-NYC resident] associated with depression. Our sample includes 568 participants: 260 (45.77%) were NYC residents and 308 (54.3%) were non-NYC residents. A series of multiple linear regression were run to examine the relationship between race/ethnicity, COVID-19 stigma, and depressive symptoms. Irrespective of residency, older age and ever being diagnosed with COVID-19 were negatively associated with depressive symptoms. Stigma and thinking less of oneself significantly associates with depressive symptoms across residency. Our study expects to benefit mental health care providers and public health professionals in designing best practices to mitigate stigma in ongoing or future pandemics.
Social workers support clients’ psychosocial and resource needs across care settings. Social workers are typically not, however, trained to engage in emergency response practices such as the ones that may be necessary to support needs brought on by the COVID-19 pandemic. This article reports findings from a cross-sectional survey of social work students and recent graduates entering the field of social work during COVID-19, exploring their preparation, perceived readiness, and training needs.
The study sample ( N = 94) included 70 students and 24 recent graduates. The sample was 52% White, 22% Hispanic, and 21% Black/African American. Respondents reported training needs in the areas of trauma-informed care (70%), behavioral health (57%), culturally competent practice (49%), telehealth (48%), loss and grief (44%), and emergency management (43%). No significant differences emerged in self-efficacy ratings of students and recent graduates; both groups reported low self-efficacy in their ability to apply advanced practice skills. After controlling for demographics, receiving training specific to the COVID-19 pandemic (β = .271, p < .05), perceived readiness (β = .779, p < .001), and satisfaction with training/preparation (β = .4450, p < .001) significantly contribute to levels of perceived self-efficacy among SW students and recent graduates.
Social work curricular developments, and continuing education, are needed to prepare and support emerging social workers for practice in the context of COVID-19 and its long-term implications. This includes enhancing social workers’ readiness to engage in telehealth, trauma-informed practice, emergency management, policy interpretation, self-care, and grief support.
The Wellness-Inspired Resident Education (WIRE) curriculum is a resident-driven educational program consisting of six formal panels or lectures that are fully incorporated into the yearly resident didactic schedule, in addition to informal events and a resident wellness retreat. The curriculum promotes personal and professional wellness, enhances resident and department camaraderie, and provides opportunities to network with leaders in the field of plastic surgery. This paper provides the context which inspired the development of this curriculum, as well as key steps for successful implementation of wellness educational programming at any institution.
There is considerable interest in exploring effects of coronavirus disease 2019 (COVID-19) pandemic on mental health. Suicide is one of the leading causes of mortality worldwide and changes in daily life brought by the pandemic may be additional risk factors in people with pre-existing mental disorders. This rapid PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) scoping review aims to identify and analyze current evidence about the relation between COVID-19 pandemic outbreak, along with COVID-19 disease and severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection, and suicide in individuals with previously diagnosed mental disorders. First, we conducted a comprehensive review of the literature, then proceeded to discuss findings in a narrative way. Tables were constructed and articles sorted according to the studies’ methodologies. 53 papers were eventually identified as eligible, among which 33 are cross-sectional studies, 9 are longitudinal studies, and 11 studies using other methodologies. Despite suffering from a mental disorder is a risk factor for suicidal behavior per se, the advent of COVID-19 pandemic may exacerbate this relation. Nevertheless, data addressing a clear correlation between suicidal behavior and the pandemic outbreak are still controversial. Longitudinal analysis using validated suicide scales and multicenter studies could provide deeper insight and knowledge about this topic.
Background: Individuals experienced increased social isolation resulting from the COVID-19 pandemic. Studies have found social isolation and loneliness to be strongly associated with anxiety and depression, which have been associated with increased smoking and vaping rates among young adults, including college students.
Objectives: To examine relationships between psychological distress and nicotine use within the context of the COVID-19 pandemic.
Methods: A cross-sectional online survey (n = 4634; 77.9% female) was used to collect nicotine use and psychological measures from students enrolled at a large Midwestern university. Timeline follow-back data were collected from students reporting current cigarette or electronic cigarette (e-cigarette) use in the week before and immediately following the closure of campus due to the pandemic. Generalized estimating equations were used to examine the interaction between nicotine use and psychological symptoms across the 2-week period.
Results: Both cigarette (Rate ratio (RR) = 1.115, 95% CI = 1.061, 1.171, p < .0001) and e-cigarette (β = 0.258, 95% CI = 0.166, 0.351, p < .0001) use increased significantly following campus closure. Students experiencing higher levels of depression reported greater increases in e-cigarette use frequency over time as compared to students reporting fewer symptoms of depression (β = 0.018, 95% CI = 0.006, 0.030, p = .004).
Conclusions: Increases in nicotine use were found immediately following the implementation of public health safety measures that closed most university campuses. Additional and/or increased stressors have potentially impacted young adults who are college students as a result of campus closures resulting from the pandemic, which may have contributed to further increases in nicotine use.
Needs assessments have been successful in helping communities and congregations focus their health ministry efforts; however, most have used leader perceptions of congregational health needs. The purpose of this study was to examine and compare the self-reported needs of both church leaders and members to be addressed by their congregation. Church leaders (n = 369) and members (n = 459) from 92 congregations completed the 2019 Mid-South Congregational Health Survey. Frequencies and generalized linear mixed models (GLMM) were performed to examine the top 10 self-reported needs and associations by church role, respectively. Of the top 10 congregational needs, anxiety or depression, high blood pressure, stress, and healthy foods were ranked identically regardless of church role. Church leaders perceived obesity and diabetes to be important congregational health needs, whereas members perceived affordable health care and heart disease to be important congregational health needs. GLMM, controlling for within-church clustering and covariates, revealed church leaders were more likely than members to report obesity (odds ratio [OR]: 1.93, 95% confidence interval [CI] = [1.39, 2.67], p < .0001) and diabetes (OR: 1.73, 95% CI = [1.24, 2.41], p = .001) as congregational needs. Findings display similarities and differences in needs reported by church role. Including many perspectives when conducting congregational health needs assessments will assist the development of effective faith-based health promotion programs.
Introduction
La pandémie de COVID-19 a eu des effets négatifs généralisés sur la santé, notamment une perte de sécurité matérielle et une exacerbation des maladies mentales chez les populations à risque. Bien que l’on ait observé une augmentation des cas d’usage non médical de certaines substances, dont le cannabis, dans des échantillons de la population canadienne, aucune étude n’a porté sur les changements dans la consommation de cannabis à des fins médicales au Canada pendant la pandémie de COVID.
Méthodologie
Les données ont été tirées de l’Enquête canadienne sur le cannabis de 2021, une enquête en ligne réalisée en mai 2021 auprès de personnes autorisées à utiliser du cannabis à des fins médicales et qui ont été recrutées par le biais de l’un des deux producteurs de cannabis à usage médical autorisés au Canada. Nous avons eu recours à des tests de McNemar pour comparer la fréquence de consommation de cannabis à des fins médicales au cours des trois mois ayant précédé la pandémie et la fréquence de consommation de cannabis à des fins médicales pendant la pandémie. Nous avons exploré les corrélats d’une augmentation de fréquence de consommation de cannabis depuis le début de la pandémie dans des modèles logistiques à deux variables et à variables multiples.
Résultats
Au total, 2 697 répondants (49,1 % de femmes) ont répondu à l’enquête. La consommation quotidienne de cannabis à des fins médicales a augmenté légèrement, mais de façon statistiquement significative, entre la période prépandémique (83,2 %) et la période pandémique (90,3 % au moment de l’enquête; p < 0,001). Les facteurs associés de manière statistiquement significative à l’augmentation de la fréquence de consommation de cannabis à des fins médicales sont notamment le genre féminin, un âge plus jeune, une perte d’emploi liée à la pandémie, la consommation de cannabis principalement pour la gestion de sa santé mentale, l’usage de médicaments sur ordonnance et la consommation de cannabis à des fins non médicales (p < 0,05).
Conclusion
Depuis le début de la pandémie de COVID-19, il y a eu une tendance légèrement à la hausse de la fréquence de consommation de cannabis à des fins médicales. Comme on ignore quels sont les effets à court et à long terme de la consommation de cannabis sur la détresse mentale en lien avec une pandémie, les cliniciens dont des patients utilisent du cannabis à des fins médicales devraient être à l’affût d’éventuels changements d’habitudes de consommation durant la pandémie.
Emerging research suggests suicidality may have increased during the COVID-19 pandemic. This cross-sectional study aimed to advance understanding of suicide risk during the pandemic through novel use of a large insurance database. Using logistic regression across time-points, we estimated the effect of exposure to SARS-CoV-2 infection on rates of suicidal ideation and suicide attempts in infected individuals versus uninfected controls during the pandemic (March 2020 - September 2021). In uninfected individuals, we estimated the effect of exposure to the pandemic period versus the pre-pandemic control period (January 2017 to February 2020) on suicidality rates. We also investigated within-pandemic temporal patterns of suicidality. All patients with data in the UnitedHealth Group claims during those intervals were included. ICD-10 codes defined suicidality measures. There were 525,312,717 (62.3% over age 45, 57.7% female) included encounters. From the pandemic subsample (32.8%), 1.7% were COVID+. Adjusted odds ratios showed that COVID+ patients were significantly more likely to have suicidal ideation and suicide attempts than COVID- patients. Among COVID- patients, adjusted odds of suicidality were significantly lower during versus prior to the pandemic. Results were unfortunately limited by the absence of data on deaths by suicide. Further research should examine how SARS-CoV-2 infection may influence suicidality.
Objetivos: verificar se a adesão à medida de distanciamento social e características sociodemográficas se associam com as alterações percebidas, durante a pandemia de COVID-19, na qualidade do sono e nas vivências afetivas de brasileiros residentes em Minas Gerais. Método: estudo transversal que analisou dados de questionário on-line aplicado a adultos e idosos residentes no estado de Minas Gerais. Foram estimadas prevalências e razões de prevalências, brutas e ajustadas, para as variáveis investigadas. Resultados: entre 35% e 55% dos respondentes referiram alterações nas vivências afetivas, como solidão, tristeza e ansiedade, e alterações do sono durante o período de isolamento social. Em geral, essas alterações foram mais frequentes entre aqueles que realizaram o isolamento de forma intensa ou total, indivíduos do sexo feminino e pessoas mais jovens. Conclusão: no presente estudo, foram observadas alterações importantes na qualidade de sono e nas vivências afetivas da população mineira, atingindo mais as pessoas do sexo feminino, pessoas mais jovens e que fizeram isolamento social intenso. É importante ofertar cuidados em saúde mental a fim de evitar os impactos negativos do distanciamento social em situações de pandemia.
Research indicates that diabetes and hypertension are linked to worsening periodontal disease and uncontrolled oral diseases can make it difficult to prevent or manage other chronic diseases, creating deleterious cycles that can undermine overall health. Colorado continues to test integration strategies to leverage clinical safety net and public health workforces to address the most pressing health care needs of underserved communities, with a focus on preventing and managing (pre)diabetes, (pre)hypertension and oral diseases.
As a relatively new field, there has been a recent explosion in evidence around the management of children in the emergency department (ED). This review highlights 10 articles published in the last year providing evidence that is germane to the care of children by emergency medicine (EM) physicians. There is a focus on high prevalence conditions, such as fever and trauma, as well as interventions that can improve mortality, such as cardiopulmonary resuscitation and massive transfusion.
Suicidal behaviors are common among patients with substance use disorders (SUD). However, the prevalence and clinical factors related to suicide behaviors among patients who have had substance-induced psychosis (SIP) is unknown. This study aims to explore the prevalence, clinical features, and factors related to lifetime suicidal ideation (SI) and suicide attempts (SA) in patients who have had SIP across their lifetime. A cross-sectional study was conducted in an outpatient center for addiction treatment between 01/01/2010 and 12/31/2021. 601 patients were evaluated with validated scales and questionnaires (79.03% males; M age 38.11±10.11 years). The prevalence of SI and SA was 55.4% and 33.6%, respectively. SI was independently related to any type of lifetime abuse, depressive spectrum disorders, benzodiazepine use disorder, borderline personality disorder, and the level of depressive symptoms. SA was independently associated with lifetime physical abuse, benzodiazepine use disorder, the number of psychotic symptoms, borderline personality disorder, and the level of depressive symptoms. The main factors related to SI and SA in those patients should be evaluated in daily clinical practice and considered in any approach to clinical practice as well as in health policies targeting suicide prevention.
In March 2020, the U.S. declared a state of emergency and stay-at-home orders were issued. This included school closures and limitation of dental practice to emergency treatment only. While public health measures were very much needed, it was not without unintended consequences. School closures only compound the economic, health and achievement inequities, disproportionately affecting disadvantaged children, which also includes access to dental care. As we emerged from the stay-at-home orders, dental practices have had to adapt and evolve.
Background:
Drug misuse is complex, and various treatment modalities are emerging. Providing supportive text messages to individuals with substance use disorder offers the prospect of managing and improving symptoms of drug misuse and associated comorbidities.
Objective:
This study evaluated the impact of the daily supportive text message program (Text4Hope-Addiction Support) in mitigating cravings and mental health symptoms in subscribers and quantify user satisfaction with the Text4Hope-Addiction Support program.
Methods:
Subscribers to the Text4Hope-Addiction Support program received daily supportive text messages for 3 months; the messages were crafted based on addiction counseling and cognitive behavioral therapy principles. Participants completed an anonymous web-based questionnaire to assess cravings, anxiety, and depressive symptoms using the Brief Substance Craving Scale (BSCS), Generalized Anxiety Disorder-7 (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9) scale at enrollment (baseline), after 6 weeks, and after 3 months. Likert scale satisfaction responses were used to assess various aspects of the Text4Hope-Addiction program.
Results:
In total, 408 people subscribed to the program, and 110 of 408 (26.9%) subscribers completed the surveys at least at one time point. There were significant differences between the mean baseline and 3-month BSCS scores P=.01 (-2.17, 95% CI -0.62 to 3.72), PHQ-9 scores, P=.004 (-5.08, 95% CI -1.65 to -8.51), and GAD-7 scores, P=.02 (-3.02, 95% CI -0.48 to -5.56). Participants who received the supportive text messages reported a reduced desire to use drugs and a longer time interval between substance use, which are reflected in 41.1% and 32.5% decrease, respectively, from baseline score. Approximately 89% (23/26) of the participants agreed that Text4Hope-Addiction program helped them cope with addiction-related stress, and 81% (21/25) of the participants reported that the messages assisted them in dealing with anxiety. Overall, 69% (18/26) of the participants agreed that it helped them cope with depression related to addiction; 85% (22/26) of the participants felt connected to a support system; 77% (20/26) of the participants were hopeful of their ability to manage addiction issues; and 73% (19/26) of the participants felt that their overall mental well-being was improved. Most of the participants agreed that the interventions were always positive and affirmative (19/26, 73%), and succinct (17/26, 65%). Furthermore, 88% (21/24) of the participants always read the messages; 83% (20/24) of the participants took positive or beneficial actions after reading; and no participant took a negative action after reading the messages. In addition, most participants agreed to recommend other diverse technology-based services as an adjunctive treatment for their mental and physical health disorders.
Conclusions:
Subscribers of Text4Hope-Addiction Support program experienced improved mental health and addiction symptoms. Addiction care practitioners and policy makers can implement supportive text-based strategies to complement conventional treatments for addiction, given that mobile devices are widely used.
In the context of the shutdowns related to the COVID-19 pandemic, we explored communication processes within families through both qualitative and quantitative means. A panel survey of 1,510 adults (1,059 parents) in the United States was administered during the summer of 2020 (June 18–July 22). Summary quantitative data are presented. Nearly half (N = 624) also chose to respond to five, open-ended, qualitative questions. From these data, diverse influences of COVID-19 on family communication were qualitatively reported, identified, coded, and analyzed. Four related themes are presented related to the influence of the COVID-19 pandemic on family communication: (1) negative influences, (2) neutral influences, (3) positive influences, and (4) dualistic (negative and positive) influences. About 50 verbatim excerpts from the qualitative data are shared, along with implications and applications.
The coronavirus disease 2019 (COVID-19) pandemic placed new strains on informal caregivers, who are already vulnerable to negative psychosocial effects due to demands of the caregiving role. The current study aimed to explore the early impact of COVID-19 on caregivers living with and apart from care recipients. Semi-structured qualitative interviews with seven cohabitating and 10 distanced caregivers of patients in a home-based primary care program were conducted from April to November 2020. A framework matrix was used to identify patterns in caregiver experiences. Cohabitating and distanced caregivers reported shared concerns about COVID-19 and unique concerns dependent on cohabitation status. Cohabitating caregivers reported financial worries, care recipients with dementia being unable to understand restrictions, and concerns about community business changes. Distanced caregivers reported communication challenges with cognitively impaired care recipients and challenges with visitation policies. During pandemics, caregivers' clinical and policy support needs may differ depending on their place of residence relative to care recipients. [Journal of Gerontological Nursing, 49(3), 19-26.].
During the COVID-19 pandemic, many potential risk groups have been identified, such as those with obesity, diabetes, preexisting organ injuries, and several other conditions. Smoking is the most reported substance use disorder linked to increased COVID-19 hospitalization rate and disease severity. In relation to smoking, we discuss the impairment of the innate and the adaptive immune systems as being among the main potential reasons for increased COVID-19 infection risk and severity. Chronic alcohol consumption and alcohol use disorder (AUD) also have a negative impact on the immune system, but when it comes to COVID-19 risk, they produce diverse outcomes. Some studies provide evidence that chronic alcohol consumption and AUD increase the risk of COVID-19 infection and severe disease progression, while others report reduced hospitalization and death rates. In this review, we summarize the current state of epidemiological and molecular data concerning alcohol consumption and AUD as risk factors for COVID-19 infection, hospitalization, and mortality.
Online Acceptance and Commitment Therapy (ACT) interventions use websites and smartphone apps to deliver ACT exercises and skills. The present meta-analysis provides a comprehensive review of online ACT self-help interventions, characterizing the programs that have been studied (e.g. platform, length, content) and analyzing their efficacy. A transdiagnostic approach was taken, including studies that addressed a range of targeted problems and populations. Multi-level meta-analyses were used to nest multiple measures of a single construct within their respective studies. A total of 53 randomized controlled trials were included (n = 10,730). Online ACT produced significantly greater outcomes than waitlist controls at post-treatment for anxiety, depression, quality of life, psychological flexibility, and all assessed outcomes (i.e. omnibus effect), which were generally maintained at follow-up. However, only psychological flexibility and all assessed outcomes at post-treatment were found to be significantly greater for online ACT when compared to active controls, with no significant follow-up effects. Overall, these results further clarify that ACT can be effectively delivered in an online format to target a wide range of mental health concerns, although it is less clear if and when online ACT is more efficacious than other online interventions.
The issue:
Coronavirus-19 (COVID-19) is transforming every aspect of our lives. Identified in late 2019, COVID-19 quickly became characterized as a global pandemic by March of 2020. Given the rapid acceleration of transmission, and the lack of preparedness to prevent and treat this virus, the negative impacts of COVID-19 are rippling through every facet of society. Although large numbers of people throughout the world will show resilience to the profound loss, stress, and fear associated with COVID-19, the virus will likely exacerbate existing mental health disorders and contribute to the onset of new stress-related disorders for many.
Recommendations:
The field of traumatic stress should address the serious needs that will emerge now and well into the future. However, we propose that these efforts may be limited, in part, by ongoing gaps that exist within our research and clinical care. In particular, we suggest that COVID-19 requires us to prioritize and mobilize as a research and clinical community around several key areas: (a) diagnostics, (b) prevention, (c) public outreach and communication, (d) working with medical staff and mainstreaming into nonmental health services, and (e) COVID-19-specific trauma research. As members of our community begin to rapidly develop and test interventions for COVID-19-related distress, we hope that those in positions of leadership in the field of traumatic stress consider limits of our current approaches, and invest the intellectual and financial resources urgently needed in order to innovate, forge partnerships, and develop the technologies to support those in greatest need. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Background:
Posttraumatic stress disorder (PTSD) symptoms are common in acute respiratory distress syndrome (ARDS) survivors. Brief screening instruments are needed for clinical and research purposes. We evaluated internal consistency, external construct, and criterion validity of the Impact of Event Scale-6 (IES-6; 6 items) compared to the original Impact of Event Scale-Revised (IES-R; 22 items) and to the Clinician Administered PTSD Scale (CAPS) reference standard evaluation in ARDS survivors.
Methods:
This study is a secondary analysis from two independent multi-site, prospective studies of ARDS survivors. Measures of internal consistency, and external construct and criterion validity were evaluated.
Results:
A total of 1001 ARDS survivors (51% female, 76% white, mean (SD) age 49 (14) years) were evaluated.
The IES-6 demonstrated internal consistency over multiple time points up to 5 years after ARDS (Cronbach’s
alpha = 0.86 to 0.91) and high correlation with the IES-R (0.96; 95% confidence interval (CI): 0.94 to 0.97).
The IES-6 demonstrated stronger correlations with related constructs (e.g., anxiety and depression; |r| = 0.32 to 0.52) and weaker correlations with unrelated constructs (e.g., physical function and healthcare utilization measures (|r| = 0.02 to 0.27). Criterion validity evaluation with the CAPS diagnosis of PTSD in a subsample of 60 participants yielded an area under receiver operating characteristic curve (95% CI) of 0.93 (0.86, 1.00), with an IES-6 cutoff score of 1.75 yielding 0.88 sensitivity and 0.85 specificity.
Conclusions:
The IES-6 is reliable and valid for screening for PTSD in ARDS survivors and may be useful in clinical and research settings.
SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is thought to be transmitted mainly by person-to-person contact (1). Implementation of nationwide public health orders to limit person-to-person interaction and of guidance on personal protective practices can slow transmission (2,3). Such strategies can include stay-at-home orders, business closures, prohibitions against mass gatherings, use of cloth face coverings, and maintenance of a physical distance between persons (2,3). To assess and understand public attitudes, behaviors, and beliefs related to this guidance and COVID-19, representative panel surveys were conducted among adults aged ≥18 years in New York City (NYC) and Los Angeles, and broadly across the United States during May 5-12, 2020. Most respondents in the three cohorts supported stay-at-home orders and nonessential business closures* (United States, 79.5%; New York City, 86.7%; and Los Angeles, 81.5%), reported always or often wearing cloth face coverings in public areas (United States, 74.1%, New York City, 89.6%; and Los Angeles 89.8%), and believed that their state's restrictions were the right balance or not restrictive enough (United States, 84.3%; New York City, 89.7%; and Los Angeles, 79.7%). Periodic assessments of public attitudes, behaviors, and beliefs can guide evidence-based public health decision-making and related prevention messaging about mitigation strategies needed as the COVID-19 pandemic evolves.
The 4-item Patient Health Questionnaire-4 (PHQ-4) is an ultra-brief self-report questionnaire that consists of a 2-item depression scale (PHQ-2) and a 2-item anxiety scale (GAD-2). Given that PHQ-4, PHQ-2, and GAD-2 have not been validated in the general population, this study aimed to investigate their reliability and validity in a large general population sample and to generate normative data.
A nationally representative face-to-face household survey was conducted in Germany in 2006. The survey questionnaire consisted of the PHQ-4, other self-report instruments, and demographic characteristics.
Of the 5030 participants (response rate=72.9%), 53.6% were female and mean (SD) age was 48.4 (18.0) years. The sociodemographic characteristics of the study sample closely match those of the total populations in Germany as well as those in the United States. Confirmatory factor analyses showed very good fit indices for a two-factor solution (RMSEA .027; 90% CI .023-.032). All models tested were structurally invariant between different age and gender groups. Construct validity of the PHQ-4, PHQ-2, and GAD-2 was supported by intercorrelations with other self-report scales and with demographic risk factors for depression and anxiety. PHQ-2 and GAD-2 scores of 3 corresponded to percentile ranks of 93.4% and 95.2%, respectively, whereas PHQ-2 and GAD-2 scores of 5 corresponded to percentile ranks of 99.0% and 99.2%, respectively.
A criterion standard diagnostic interview for depression and anxiety was not included.
Results from this study support the reliability and validity of the PHQ-4, PHQ-2, and GAD-2 as ultra-brief measures of depression and anxiety in the general population. The normative data provided in this study can be used to compare a subject's scale score with those determined from a general population reference group.
To review the evidence of benefit from use of telemental health (TMH) in studies that reported clinical or administrative outcomes.
Relevant publications were identified through computerized literature searches using several electronic databases. Included for review were scientifically valid articles that described controlled studies, comparing TMH with a non-TMH alternative, and uncontrolled studies that had no fewer than 20 participants. Quality of the evidence was assessed with an approach that considers both study performance and study design. Judgments were made on whether further data were needed to establish each TMH application as suitable for routine clinical use.
Included in the review were 72 papers that described 65 clinical studies; 32 (49%) studies were of high or good quality. Quality of evidence was higher for Internet- and telephone-based interventions than for video conferencing approaches. There was evidence of success with TMH in the areas of child psychiatry, depression, dementia, schizophrenia, suicide prevention, posttraumatic stress, panic disorders, substance abuse, eating disorders, and smoking prevention. Evidence of success for general TMH programs and in the management of obsessive-compulsive disorder were less convincing. Further study was judged to be necessary or desirable in 53 (82%) of the studies.
Evidence of benefit from TMH applications is encouraging, though still limited. There is a need for more good-quality studies on the use of TMH in routine care. The emerging use of Internet-based applications is an important development that deserves further evaluation.
US Department of Health and Human Services, CDC, National Center for Health Statistics
CDC, National Center for Health Statistics. Early release of selected mental
health estimates based on data from the January-June 2019 National Health
Interview Survey. Atlanta, GA: US Department of Health and Human
Services, CDC, National Center for Health Statistics; 2020. https://www.
cdc.gov/nchs/data/nhis/earlyrelease/ERmentalhealth-508.pdf