Article

Trajectories of Mental Distress among U.S. Adults during the COVID-19 Pandemic

February 2021
Annals of Behavioral Medicine 55(5)

DOI:10.1093/abm/kaaa126

Authors:

Calliope Holingue

Johns Hopkins Bloomberg School of Public Health

Emily Smail

University of Florida

Arie Kapteyn

University of Southern California

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Background Cross-sectional studies have found that the coronavirus disease 2019 (COVID-19) pandemic has negatively affected population-level mental health. Longitudinal studies are necessary to examine trajectories of change in mental health over time and identify sociodemographic groups at risk for persistent distress. Purpose To examine the trajectories of mental distress between March 10 and August 4, 2020, a key period during the COVID-19 pandemic. Methods Participants included 6,901 adults from the nationally representative Understanding America Study, surveyed at baseline between March 10 and 31, 2020, with nine follow-up assessments between April 1 and August 4, 2020. Mixed-effects logistic regression was used to examine the association between date and self-reported mental distress (measured with the four-item Patient Health Questionnaire) among U.S. adults overall and among sociodemographic subgroups defined by sex, age, race/ethnicity, household structure, federal poverty line, and census region. Results Compared to March 11, the odds of mental distress among U.S. adults overall were 1.84 (95% confidence interval [CI] = 1.65–2.07) times higher on April 1 and 1.92 (95% CI = 1.62–2.28) times higher on May 1; by August 1, the odds of mental distress had returned to levels comparable to March 11 (odds ratio [OR] = 0.80, 95% CI = 0.66–0.96). Females experienced a sharper increase in mental distress between March and May compared to males (females: OR = 2.29, 95% CI = 1.85–2.82; males: OR = 1.53, 95% CI = 1.15–2.02). Conclusions These findings highlight the trajectory of mental health symptoms during an unprecedented pandemic, including the identification of populations at risk for sustained mental distress.

Temporal dynamics of socioeconomic inequalities in depressive and anxiety symptoms during the COVID-19 pandemic: a scoping review

Article

Full-text available

Jul 2024

Background The existence of socioeconomic inequalities in the prevalence of symptoms of depression and anxiety is widely acknowledged, and individuals from lower socioeconomic backgrounds tend to exhibit higher rates of symptoms. However, the direction in which the COVID-19 pandemic has influenced these disparities remains uncertain. We therefore aimed to systematically outline the available evidence on the temporal dynamics of socioeconomic inequalities in symptoms related to depression and anxiety during the COVID-19 pandemic across high-income countries. Methods A scoping review was conducted by searching the databases Embase, Scopus and PsycINFO. According to pre-defined eligibility criteria, two reviewers independently screened titles and abstracts as well as full texts of the compiled records. Data from the included studies were extracted using a standardised data-extraction form and analysed numerically and narratively. The scoping review followed the PRISMA-ScR guidelines. Results A total of 49 studies comprising 149 analyses of socioeconomic indicators in relation to symptoms of depression and anxiety were included. Despite heterogeneous study designs and results, there was a tendency of increasing (40.9%; n = 61) or persistent (38.2%; n = 57) inequality trends to the detriment of those in socially more disadvantaged positions. Increasing inequalities were most pronounced when income was used as a socioeconomic indicator. Groups with lower socioeconomic status appeared most vulnerable in the initial phase of the COVID-19 pandemic. Throughout the pandemic, dynamics were diverse, with persistent trends most frequently reported. Conclusion Overall, to the detriment of those with lower socioeconomic status, mental-health inequalities persisted or increased in most analyses. Continually monitoring socioeconomic inequalities over time is crucial, since this makes it possible to adapt prevention and intervention strategies to specific pandemic phases. Interventions targeting job security, income security and educational attainment could reduce mental-health inequalities. The results can contribute to preparedness plans for future pandemics and crises.

Assets and depression in U.S. adults during the COVID-19 pandemic: a systematic review

Article

Full-text available

Oct 2023
SOC PSYCH PSYCH EPID

Mental health is shaped by social and economic contexts, which were altered during the COVID-19 pandemic. No study has systematically reviewed the literature on the relation between different assets and depression during the COVID-19 pandemic. We conducted a systematic review of the literature on financial (e.g. income/savings), physical (e.g., home ownership), and social (e.g., marital status, educational attainment) assets and depression in U.S. adults. For each asset type, we created binary comparisons to report on the direction of the relationship and described if each study reported insignificant, positive, negative, or mixed associations. Among the 41 articles identified, we found that income was the most studied asset (n=34), followed by education (n=25), marital status (n=18), home ownership (n=5), and savings (n=4). 88%, 100%, and 100% of articles reported a significant association of higher income, home ownership, and higher savings, respectively, with less depression. The association between marital status and education with depression was more nuanced: 72% (13 of 18) studies showed that unmarried persons had greater risk of depression than married or cohabitating persons and 52% (13 of 25) of studies reported no significant difference in depression across educational groups. This work adds to the literature a deeper understanding of how different assets relate to depression. In the context of largescale traumatic events, policies that maintain and protect access to social, physical, and financial assets may help to protect mental health.

Trajectories of Psychological Distress during the COVID‐19 Pandemic among Community‐Dwelling Older Adults in Quebec: A Longitudinal Study

Article

Full-text available

Jan 2023

Objective: The COVID-19 pandemic and its associated public health measures may increase the risk for psychological distress among vulnerable older adults. This longitudinal study aimed to identify predictors of psychological distress trajectories among community-dwelling older adults in Quebec, Canada. Methods: The study spanned four time points across 13 months and three waves of the COVID-19 pandemic. The sample included 645 community-dwelling older adults ages 60 years and older in Quebec. Participants completed telephone-based interviews that included the Kessler 6-item Psychological Distress Scale (K6) to assess psychological distress at each time point as well as information on socioeconomic, medical, psychological and COVID-19 related factors. Group-based trajectory modelling was used to identify distinct trajectories of psychological distress across time. Results: Three group-based trajectories of psychological distress were identified: the resilient (50.5%), reactive (34.9%), and elevated distress groups (14.6%). Individuals with mobility issues, insomnia symptoms, COVID-19 related acute stress, general health anxiety, increased loneliness symptoms, and those unable to use technology to see others were more likely to be in the reactive and elevated groups than the resilient group. Those with past mental health problems had uniquely increased odds of being in the reactive group compared to the resilient group. Individuals living in poverty and those who reported taking psychotropic medication had increased odds of being in the elevated distress group compared to the resilient group. Conclusion: These findings characterized distinct trajectories of psychological distress in older adults and identified risk factors for elevated distress levels.

Are Cisgender Women and Transgender and Nonbinary People Drinking More During the COVID-19 Pandemic? It Depends

Article

Full-text available

Dec 2023

Cindy Veldhuis

PURPOSE This narrative review of research conducted during the first 2 years of the COVID-19 pandemic examines whether alcohol use among cisgender women and transgender and nonbinary people increased during the pandemic. The overarching goal of the review is to inform intervention and prevention efforts to halt the narrowing of gender-related differences in alcohol use. SEARCH METHODS Eight databases (PubMed, APA PsycInfo, CINAHL, Embase, Scopus, Gender Studies Database, GenderWatch, and Web of Science) were searched for peer-reviewed literature, published between March 2020 and July 2022, that reported gender differences or findings specific to women, transgender or nonbinary people, and alcohol use during the pandemic. The search focused on studies conducted in the United States and excluded qualitative research. SEARCH RESULTS A total 4,132 records were identified, including 400 duplicates. Of the remaining 3,732 unique records for consideration in the review, 51 were ultimately included. Overall, most studies found increases in alcohol use as well as gender differences in alcohol use, with cisgender women experiencing the most serious consequences. The findings for transgender and nonbinary people were equivocal due to the dearth of research and because many studies aggregated across gender. DISCUSSION AND CONCLUSIONS Alcohol use by cisgender women seems to have increased during the pandemic; however, sizable limitations need to be considered, particularly the low number of studies on alcohol use during the pandemic that analyzed gender differences. This is of concern as gender differences in alcohol use had been narrowing before the pandemic; and this review suggests the gap has narrowed even further. Cisgender women and transgender and nonbinary people have experienced sizable stressors during the pandemic; thus, understanding the health and health behavior impacts of these stressors is critical to preventing the worsening of problematic alcohol use.

Mental health during the COVID-19 outbreak in Uruguay: the impact of healthy lifestyle behaviors and sociodemographic factors

Article

Jun 2023
Minerva Psichiatr

Heterogeneous Mental Health Responses to the COVID-19 Pandemic in Germany: An Examination of Long-Term Trajectories, Risk Factors, and Vulnerable Groups

Article

Full-text available

May 2023

Abundant studies have examined mental health in the early periods of the COVID-19 pandemic. However, empirical work examining the mental health impact of the pandemic’s subsequent phases remains limited. In the present study, we investigated how mental vulnerability and resilience evolved over the various phases of the pandemic in 2020 and 2021 in Germany. Data were collected (n = 3522) across seven measurement occasions using validated and self-generated measures of vulnerability and resilience. We found evidence for an immediate increase in vulnerability during the first lockdown in Germany, a trend towards recovery when lockdown measures were eased, and an increase in vulnerability with each passing month of the second lockdown. Four different latent trajectories of resilience–vulnerability emerged, with the majority of participants displaying a rather resilient trajectory, but nearly 30% of the sample fell into the more vulnerable groups. Females, younger individuals, those with a history of psychiatric disorders, lower income groups, and those with high trait vulnerability and low trait social belonging were more likely to exhibit trajectories associated with poorer mental well-being. Our findings indicate that resilience–vulnerability responses in Germany during the COVID-19 pandemic may have been more complex than previously thought, identifying risk groups that could benefit from greater support.

Essays in empirical economics

Thesis

Jan 2023

Valentin Klotzbücher

Temporal association of pre-pandemic perceived social support with psychological resilience and mental well-being during the COVID-19 pandemic among people with a history of injection drug use

Article

Feb 2023
DRUG ALCOHOL DEPEN

Background: There are limited data on whether modifiable social factors foster psychological resilience and mental well-being among people who use drugs following Big Events. We examined the temporal association of pre-pandemic perceived social support with psychological resilience and negative mental health symptoms during the COVID-19 pandemic among people with a history of injection drug use. Methods: Between June and September 2020, we conducted a telephone survey among 545 participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study: a community-based cohort of adults with a history of injection drug use. Leveraging data from study visits in 2018-early 2020, associations of pre-pandemic perceived social support with psychological resilience scores (range=1-5) and the probability of negative mental health symptoms during the pandemic were assessed using multivariable linear and modified Poisson regression models, respectively. Results: Participants' median age was 58 years, 38.2% were female, 83.3% identified as Black, and 30.3% were living with HIV. During the pandemic, 14.5% had low (<3) resilience scores, 36.1% experienced anxiety, and 35.8% reported increased loneliness. Compared to participants in the lowest tertile of pre-pandemic social support, participants in the highest tertile had higher mean resilience scores (β = 0.27 [95% CI = 0.12, 0.43]), a lower probability of anxiety (prevalence ratio [PR] = 0.71 [95% CI = 0.52, 0.96]), and a lower probability of increased loneliness (PR = 0.62 [95% CI = 0.45, 0.84]). Conclusions: Pre-pandemic perceived social support was associated with greater psychological resilience and generally better mental well-being during the pandemic. Interventions that improve social support may foster psychological resilience and protect the mental well-being of people who use drugs, especially during periods of social disruption.

Stressful Events, Psychological Distress and Well-Being during the Second Wave of COVID-19 Pandemic in Spain: A Gender Analysis

Article

Full-text available

Dec 2022

The present study investigates gender differences in stressful events, psychological distress and well-being during the second wave of COVID-19 in Spain, analyzing women’s and men’s risk and resilience factors for psychological distress and for well-being. Participants were 1758 individuals from the general population, 50.8% women, aged between 18 and 79 years. Women and men did not differ in age, number of children, educational level, occupation or marital status. The participants were assessed by seven self-report questionnaires and scales. The results revealed that women experienced more psychological distress, more negative feelings, more stressful events related to the COVID-19 pandemic, more social support, and lower thriving and self-esteem than men. Multiple regression analyses showed that, in the case of women and men as well, self-esteem was the most important predictor of higher well-being and lower psychological distress and negative feelings while more COVID-19 pandemic-related stressful events were associated with higher psychological distress and lower well-being. Another important predictor of greater well-being for either gender was social support while unemployment was associated with lower well-being. In women and men, a higher educational level was associated with greater psychological distress and negative feelings; the male sample revealed that psychological distress was also connected to younger age while in women it was associated with lower instrumental social support. The results suggest that gender plays an important role in the mental health effects of the COVID-19 pandemic, with the risk being higher for women than for men.

The mental health impact of repeated COVID-19 enforced lockdowns in England: evidence from the UK Household Longitudinal Study

Article

Full-text available

Jan 2025

Background Research shows initial COVID-19 lockdowns increased population mental distress. Yet, the mental health impact of repeated lockdowns in England remains unknown. AimsTo: (a) explore changes in population mental health symptoms over the COVID-19 pandemic period (March 2020 to March 2021) in England, comparing this with trends from a decade before (2009–2019) as well as after (2021–2023); (b) compare the mental health impact of each of the three lockdowns in England with periods of eased restrictions, determining who was most affected; (c) examine the impact of demographics and distinct time periods on the prevalence of mental health symptoms. MethodA secondary analysis of a national longitudinal cohort study, utilising data from Waves 1–13 of the UK Household Longitudinal Study and from Waves 1–9 of the COVID-19 Survey. Mental health was assessed using the 12-item General Health Questionnaire. Student t-tests and logistical regressions were conducted. ResultsThere was a significant increase in the prevalence of self-reported symptoms of mental health during England's pandemic period, encompassing three lockdowns, compared with the average of rates from 10 years before. Rates of reported mental health symptoms were not significantly different across each lockdown, but were significantly higher than pre-pandemic rates, declining with eased restrictions. Rates from the end of lockdown to May 2023 revealed elevated mental health symptoms compared with pre-pandemic. Elevated symptoms were observed for women, people homeworking, those with health conditions, individuals aged 30–45 years and those experiencing loneliness. Conclusion Repeated lockdowns in England had a substantial impact on mental health, indicating requirements for ongoing mental health support.

Depressive Symptom Change Patterns during the COVID-19 Pandemic and Their Impact on Psychiatric Treatment Seeking: A 24-Month Observational Study of the Adult Population

Article

Full-text available

Aug 2024
DEPRESS ANXIETY

Despite the presence of individual differences in the depressive symptom change in adults during the COVID-19 pandemic, most studies have investigated population-level changes in depression during the first year of the pandemic. This longitudinal repeated-measurement study obtained 39,259 observations from 4,361 adults assessed nine times over a 24-month period in Norway (March 2020 to March 2022). Using a Latent Change Score Mixture Model to investigate differential change patterns in depressive symptoms, five profiles were identified. Most adults revealed a consistently resilient (42.52%) or predominantly resilient pattern differentiated by an initial shock in symptomatology (13.17%). Another group exhibited consistently high depressive adversities (8.5%). One group showed mild deterioration with small increases in depressive symptomatology compared to onset levels (29.04%), and a second strong deterioration group exhibited clinically severe levels of gained symptoms over time (6.77%). Both deteriorating depressive symptom change patterns predicted the presence of a psychiatric diagnosis and treatment seeking at the end of the study period. Together, the absence of a preexisting psychiatric diagnosis at the onset of the pandemic and severe symptom increases during, combined with reports of psychiatric treatment seeking and diagnosis at the end of the study period, indicated that the strongly deteriorating subgroup represents an additional and newly emerged group of adults struggling with depressive problems. Factors related to general adverse change (lower education levels, lone residence), initial shocks prior to recovery (frequent information seeking, financial and occupational concerns), and resilience and recovery (older age, being in a relationship, physical activity) were identified. Binge drinking and belonging to an ethnic minority were influential predictors of the strongly deteriorating group. All major change patterns in depressive symptoms occurred during the first 3 months of the pandemic, suggesting this period represents a window of sensitivity for the development of long-lasting depressive states versus patterns of recovery and resilience. These findings call for increased vigilance of psychiatric symptoms during the initial phases of infectious disease outbreaks and highlight a specific target period for the implementation of preventive measures.

Pre-pandemic individual and household predictors of caregiver and child COVID-19-related stress in a high-risk sample

Article

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Aug 2024

Associations Between Driving Cessation and Mental Health Among Rural and Urban Older Adults

Article

Full-text available

Jul 2024

Driving cessation is robustly associated with poor mental health outcomes among older adults; however, the magnitude of this relationship may differ by rurality. This study examined cross-sectional and longitudinal associations between driving cessation and life satisfaction and depressive symptoms and assessed whether these relationships were moderated by rurality. Data is from participants in the 2014 and 2016 Health and Retirement Study (Mage = 73; 58% female) with information on either depressive symptoms (n = 5,650) or life satisfaction (n = 1,931). Multivariate linear regression models were built to test whether rurality moderated the relationship between driving status and two mental health outcomes (life satisfaction and depressive symptoms). Models tested (1) unadjusted associations and (2) associations adjusted for age, gender, race/ethnicity, years of education, partnership status, current employment, and number of chronic conditions. We found that limited driving and inability to drive were significantly associated (p < .05) with worse cross-sectional life satisfaction; however, there were no significant longitudinal associations for this relationship. Driving status was significantly associated (p < .05) with heightened cross-sectional and longitudinal depressive symptoms. No moderation by rurality was observed in both unadjusted and adjusted models (p > .05). Findings support the importance of policy and programming to support the mental health of older adults across the rural–urban continuum as they experience limitations in their driving ability.

Gendered Racism in Pregnancy and Stress Among Women in the United States During the COVID-19 Pandemic

Article

Full-text available

Jan 2024

High stress experienced during pregnancy increases risk for adverse birth outcomes such as low birthweight and preterm birth that occur disproportionately among women of color in the United States. Prior research has identified a distinct form of discrimination, gendered racism in pregnancy (GRiP), that likely elevates stress and is suspected to contribute to racial disparities in birth outcomes among American women. We investigated associations of GRiP experiences and distress with two types of stress, pregnancy related and pandemic related, among 2,995 pregnant women in the United States at the height of the COVID-19 pandemic, a time when health care restrictions, social contact limitations, and concerns about COVID-19 infection created added stress for pregnant women. Using data collected online during the second US pandemic surge (December 2020), we found that pregnant self-identified Hispanic/Latina (n = 233), Non-Hispanic/Latina Black/African American (n = 182), and Multiracial/Other (n = 201) women experienced greater GRiP and greater stress of both types than Non-Hispanic/Latina White women. Structural equation modeling indicated a strong association of racial/ethnic identity with prenatal stress that was mediated by GRiP, independent of other contributors to prenatal stress. Focusing on the harmful impact of gendered racism coupled with culturally informed individual interventions and change at multiple societal levels and institutions may help reduce the poorer reproductive outcomes that are disproportionately common among communities of color in the United States. Addressing and alleviating discrimination can improve reproductive justice for all who choose to give birth throughout the world, regardless of their race, ethnicity, nationality, or other identities.

Depression and assets during the COVID-19 pandemic: A longitudinal study of mental health across income and savings groups

Article

Full-text available

Jun 2024
PLOS ONE

The prevalence of depression in U.S. adults during the COVID-19 pandemic has been high overall and particularly high among persons with fewer assets. Building on previous work on assets and mental health, we document the burden of depression in groups based on income and savings during the first two years of the COVID-19 pandemic. Using a nationally representative, longitudinal panel study of U.S. adults (N = 1,271) collected in April-May 2020 (T1), April-May 2021 (T2), and April-May 2022 (T3), we estimated the adjusted odds of reporting probable depression at any time during the COVID-19 pandemic with generalized estimating equations (GEE). We explored probable depression—defined as a score of ≥10 on the Patient Health Questionnaire-9 (PHQ-9)—by four asset groups, defined by median income (≥

65,000) and savings (≥

20,000) categories. The prevalence of probable depression was consistently high in Spring 2020, Spring 2021, and Spring 2022 with 27.9% of U.S. adults reporting probable depression in Spring 2022. We found that there were four distinct asset groups that experienced different depression trajectories over the COVID-19 pandemic. Low income-low savings asset groups had the highest level of probable depression across time, reporting 3.7 times the odds (95% CI: 2.6, 5.3) of probable depression at any time relative to high income-high savings asset groups. While probable depression stayed relatively stable across time for most groups, the low income-low savings group reported significantly higher levels of probable depression at T2, compared to T1, and the high income-low savings group reported significantly higher levels of probable depression at T3 than T1. The weighted average of probable depression across time was 42.9% for low income-low savings groups, 24.3% for high income-low savings groups, 19.4% for low income-high savings groups, and 14.0% for high income-high savings groups. Efforts to ameliorate both savings and income may be necessary to mitigate the mental health consequences of pandemics.

Gender, psychological distress, and subjective well-being two years after the onset of the COVID-19 pandemic in Spain

Article

Full-text available

Mar 2024

This study aimed to examine gender differences in distress and well-being two years after the onset of the COVID-19 pandemic, analyzing risk and protective factors for psychological distress and subjective well-being. It is a repeated cross-sectional study with a sample of 1,588 women (50%) and men (50%) from the general Spanish population aged 18-74 years who were assessed online by seven questionnaires and scales. Descriptive, variance, and hierarchical multiple regression analyses were performed. From February to April 2022, 57.4% of women and 38.7% of men had psychological distress, percentages that totaled 50.5% and 41.5%, respectively, from October 2022 to February 2023. Women also had greater perceived vulnerability to diseases, more negative feelings, and lower affect balance, resilience, and self-esteem than men. The most important predictors of greater psychological distress refer to lower self-esteem, resilience, and social support and higher perceived vulnerability to diseases. Other statistically significant predictors included lower educational level in women and neither being married nor living with a partner in men. Lower self-esteem also best predicted lower subjective well-being, with lower social support and lower resilience also constituting significant predictors. Moreover, lower educational level and higher perceived vulnerability to diseases statistically and significantly predicted lower subjective well-being in women, as did not being a student in men. We conclude that psychological distress remains greatly prevalent in Spain two years after the beginning of the COVID-19 pandemic, especially in women.

Coping with Mental Health When Teaching Online during the COVID-19 Pandemic

Article

Jan 2023

Adriaan Cornet

The COVID-19 pandemic keeps taking hold of our daily lives in 2021. This study aims to analyze the effect of the pandemic on teachers from CamEd Business School. A literature review examined how levels of psychological distress are elevated during the pandemic. Teachers were highlighted as an at-risk group through various factors, and the paper discusses the effect of coping styles and resilience on psychological distress. The study measured psychological distress and deployed coping strategies of 17 respondents using the Perceived Stress Scale and Brief COPE, respectively. Statistical analysis showed similar levels of psychological distress in this sample as the pre-pandemic norm group of the PSS (M=14.23). Positive and Emotional Coping were used most often in this population and pre-pandemic norm groups (M=2.40, M=2.05). A significant positive correlation was found between Problem Solving and Psychological Distress, r(13) = .76, p = 0.01. There was no higher use of Avoidant coping styles than the pre-pandemic norm group (M=1.45). The study suggests that this population found resilience over time, helping to manage psychological distress during the COVID-19 pandemic. Keywords: COVID-19; Psychological distress; Coping; Teachers; Online teaching

Depression and Anxiety Symptoms Among Cisgender Gay and Bisexual Men During the Onset of the COVID-19 Pandemic: Time Series Analysis of a US National Cohort Study

Article

Jan 2024

Background The onset of the COVID-19 pandemic in the United States in March 2020 caused a dramatic change in the way many people lived. Few aspects of daily life were left undisrupted by the pandemic’s onset as well as the accompanying policies to control the spread of the disease. Previous research has found that the pandemic may have significantly impacted the mental health of lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals—potentially more so than other individuals. However, the pandemic did not affect all areas of the United States at the same time, and there may be regional variation in the impact of the onset of the pandemic on depressive symptoms among LGBTQ individuals. Objective To assess regional variation of the impact of the pandemic, we conducted a time series analysis stratified by US geographic region to examine symptoms of depression and anxiety among a sample of primarily cisgender gay and bisexual men before and after the onset of the COVID-19 pandemic in the United States. Methods In total, 5007 participants completed assessments as part of the Together 5000 study, an ongoing prospective cohort study. Depressive and anxiety symptoms were measured using the Patient Health Questionnaire-4. Patient Health Questionnaire-4 scores were graphed as a function of days from March 15, 2020. Locally estimated scatterplot smoothing trend lines were applied. A sieve-bootstrap Mann-Kendall test for monotonic trend was conducted to assess the presence and direction of trends in the scatterplots. We then compared the observed trends to those observed for 1 year prior (2018-2019) to the pandemic onset using data collected from the same sample. Results Significant positive trends were detected for the Northeast (P=.03) and Midwest (P=.01) regions of the United States in the 2020 assessment, indicating that symptoms of anxiety and depression were increasing in the sample in these regions immediately prior to and during the onset of the pandemic. In contrast, these trends were not present in data from the 2018 to 2019 assessment window. Conclusions Symptoms of anxiety and depression increased among the study population in the Northeast and Midwest during the beginning months of the COVID-19 pandemic, but similar increase was not observed in the South and West regions. These trends were also not found for any region in the 2018 to 2019 assessment window. This may indicate region-specific trends in anxiety and depression, potentially driven by the burden of the pandemic and policies that varied from region to region. Future studies should consider geographic variation in COVID-19 spread and policies as well as explore potential mechanisms by which this could influence the mental health of LGBTQ individuals.

Relationship between Vaccine Hesitancy and Psychological Distress in Elderly Population of South Punjab

Article

Full-text available

Dec 2023

Vaccines have eliminated and prevented several deadly diseases, yet they face skepticism from the public. This research aimed to find the moderating role of optimism in elderly people on the relationship between vaccine skepticism of COVID-19 booster dose and the psychological distress because of it. The purpose of this research was to find out hesitant attitude of elders towards COVID-19 booster dose, explore level of psychological distress among elderly people who were already vaccinated and find out life optimism among elderly people (age range of 45-65 years, M=55.75, SD=6.51). Correlational research design and systematic random sampling technique were used to collect data from elders (n=427, M= 264, F=161). The data was collected from different cities of Punjab province namely Muzaffargarh, Lodhran, Multan, and Bahawalpur. Vaccine skepticism, psychological distress and optimism were checked using "Oxford COVID-19 Scale of Vaccine Hesitancy, Kessler Psychological Distress Scale (K-10) and Revised Life Orientation Test (LOT-R). Data was analysed using Correlation, t test, and ANOVA. The results found a positive relationship between psychological distress and life orientation. On the other hand, vaccine hesitancy was found to be negatively correlated with psychological distress and life orientation. The males were found high on vaccine hesitancy and psychological distress. People above age 60 years had lowest psychological distress.

Factors associated with perceived stress and depressive symptoms among college students during the COVID-19 pandemic

Article

Full-text available

Nov 2023
J AM COLL HEALTH

The COVID-19 pandemic had detrimental effects on college students' psychosocial well-being due to campus closures starting in Spring 2020. This study examined changes in perceived stress and depressive symptoms before and during the pandemic using longitudinal data collected from students over the 2019-2020 academic year. We also compared data from this sample in Fall 2019 (N = 282) to data collected from another sample in Fall 2020 (N = 240). Latent change modeling showed increases in stress during Spring 2020. Additionally, the Fall 2020 sample had higher levels of stress than the Fall 2019 sample. Differences in stress and depressive symptoms did not depend on underrepresented minority (URM) status, income, gender, or membership in Greek life or other organizations. However, third- and fourth-year students and student-athletes experienced more stress during the pandemic. Findings suggest an adverse and differential impact of the pandemic on students' psychosocial well-being.

Racial and ethnic disparities in psychological distress during the COVID-19 pandemic in the United States: The role of experienced and perceived racial bias

Article

Full-text available

May 2023
BMC PUBLIC HEALTH

Background: Research on mental health disparities by race-ethnicity in the United States (US) during COVID-19 is limited and has generated mixed results. Few studies have included Asian Americans as a whole or by subgroups in the analysis. Methods: Data came from the 2020 Health, Ethnicity, and Pandemic Study, based on a nationally representative sample of 2,709 community-dwelling adults in the US with minorities oversampled. The outcome was psychological distress. The exposure variable was race-ethnicity, including four major racial-ethnic groups and several Asian ethnic subgroups in the US. The mediators included experienced discrimination and perceived racial bias toward one’s racial-ethnic group. Weighted linear regressions and mediation analyses were performed. Results: Among the four major racial-ethnic groups, Hispanics (22%) had the highest prevalence of severe distress, followed by Asians (18%) and Blacks (16%), with Whites (14%) having the lowest prevalence. Hispanics’ poorer mental health was largely due to their socioeconomic disadvantages. Within Asians, Southeast Asians (29%), Koreans (27%), and South Asians (22%) exhibited the highest prevalence of severe distress. Their worse mental health was mainly mediated by experienced discrimination and perceived racial bias. Conclusions: Purposefully tackling racial prejudice and discrimination is necessary to alleviate the disproportionate psychological distress burden in racial-ethnic minority groups.

Population mental health in Burma after 2021 military coup: online non-probability survey

Article

Full-text available

Aug 2023

Background: Humanitarian crises and armed conflicts lead to a greater prevalence of poor population mental health. Following the 1 February 2021 military coup in Burma, the country's civilians have faced humanitarian crises that have probably caused rising rates of mental disorders. However, a dearth of data has prevented researchers from assessing the extent of the problem empirically. Aims: To better understand prevalence of depressive and anxiety disorders among the Burmese adult population after the February 2021 military coup. Method: We fielded an online non-probability survey of 7720 Burmese adults aged 18 and older during October 2021 and asked mental health and demographic questions. We used the Patient Health Questionnaire-4 to measure probable depression and anxiety in respondents. We also estimated logistic regressions to assess variations in probable depression and anxiety across demographic subgroups and by level of trust in various media sources, including those operated by the Burmese military establishment. Results: We found consistently high rates of probable anxiety and depression combined (60.71%), probable depression (61%) and probable anxiety (58%) in the sample overall, as well as across demographic subgroups. Respondents who 'mostly' or 'completely' trusted military-affiliated media sources (about 3% of the sample) were significantly less likely than respondents who did not trust these sources to report symptoms of anxiety and depression (AOR = 0.574; 95% CI 0.370-0.889), depression (AOR = 0.590; 95% CI 0.383-0.908) or anxiety (AOR = 0.609; 95% CI 0.390-0.951). Conclusions: The widespread symptoms of anxiety and depression we observed demonstrate the need for both continuous surveillance of the current situation and humanitarian interventions to address mental health needs in Burma.

Young people’s mental and social distress in times of international crisis: evidence from helpline calls, 2019–2022

Article

Full-text available

Jul 2023

We document mental and social distress of children, adolescents and adults, using data on 3 million calls to German helplines between January 2019 and May 2022. High-frequency data from crisis helpline logs offer rich information on the evolution of “revealed distress” among the most vulnerable, unaffected by researchers’ study design and framing. Distress of adults, measured by the volume of calls, rose significantly after both the outbreak of the pandemic and the Russian invasion of Ukraine. In contrast, the overall revealed distress of children and adolescents did not increase during those crises. The nature of young people’s concerns, however, changed more strongly than for adults after the COVID-19 outbreak. Consistent with the effects of social distancing, call topics of young people shifted from problems with school and peers to problems with family and mental health. We find the share of severe mental health problems among young people to have increased with a delay, in the second and third year of the pandemic.

Identifying Psychological Distress Patterns during the COVID-19 Pandemic using an Intersectional Lens

Article

Full-text available

Jul 2023

_OBJECTIVE_. We inform an intersectional understanding of differences in psychological distress across the U.S. population during the early months of the COVID-19 pandemic by examining the unique and interactive influences of multiple social variables on levels of psychological distress. _METHODS_. The March and April 2020 waves of the American Trends Panel (N = 4,560) were analyzed using conditional inference trees and random forests to examine how complex interactions among social status variables influence psychological distress levels. _RESULTS_. Age, gender, socioeconomic status, and community attachment most influenced distress in March 2020, while race and ethnicity emerged as influential in April 2020, especially among older men. _CONCLUSIONS._ The results provide insights into how multiple social statuses interact to shape psychological distress levels. By analyzing distress as a result of multiple pathways, we address theoretical mandates to consider the intersecting influence of social statuses on mental health. Targeted interventions by mental health specialists are discussed. _CONTRIBUTION._ This study builds upon the extensive and ever-growing literature on the effects that the COVID-19 pandemic has had on health, while specifically approaching the analysis with an intersectional lens and using tree-based statistical modeling to better visualize the differential impact the early months of the pandemic had on mental health.

Day to Day and Environmental Risk Factors for Psychological Distress Among Healthcare Workers: A Mixed Methods Analysis

Article

Jun 2023
J OCCUP ENVIRON MED

Objective: Despite a growing literature on mental health among clinical staff during COVID-19, factors shaping distress for non-clinical staff are understudied and may be driven by inequalities at work. We aimed to discuss the role of workplace factors in shaping psychological distress for a diverse group of clinical, non-clinical, and other health and hospital workers (HHWs). Methods: This convergent parallel mixed-methods study with HHWs in a U.S. hospital system included an online survey (n = 1,127) and interviews (n = 73) collected from August 2020 to January 2021. We thematically analyzed interviews; findings informed log binomial regression estimating risk factors for severe psychological distress (PHQ-4 scores of 9 or greater). Results: Qualitatively, day-to-day stressors fostered fear and anxiety, and concerns about work environments manifest as betrayal and frustration with leadership. Distress was associated with burnout, financial concerns, and feeling betrayed or unsupported by the institution and leadership. Staff in service vs clinical roles had higher risk for severe distress (aPR 2.04, 95% CI 1.13-2.66); HHWs receiving workplace mental health support had lower risk (aPR 0.52, 95% CI 0.29-0.92. Conclusions: Our mixed-methods study underscores how the pandemic brought inequalities to the surface to increase distress for vulnerable HHWs. Workplace mental health activities can support HHWs now and during future crises.

Racial-ethnic disparities in psychological distress during the COVID-19 pandemic in the United States: the role of experienced discrimination and perceived racial bias

Article

Full-text available

May 2023
BMC PUBLIC HEALTH

Background Research on mental health disparities by race-ethnicity in the United States (US) during COVID-19 is limited and has generated mixed results. Few studies have included Asian Americans as a whole or by subgroups in the analysis. Methods Data came from the 2020 Health, Ethnicity, and Pandemic Study, based on a nationally representative sample of 2,709 community-dwelling adults in the US with minorities oversampled. The outcome was psychological distress. The exposure variable was race-ethnicity, including four major racial-ethnic groups and several Asian ethnic subgroups in the US. The mediators included experienced discrimination and perceived racial bias toward one’s racial-ethnic group. Weighted linear regressions and mediation analyses were performed. Results Among the four major racial-ethnic groups, Hispanics (22%) had the highest prevalence of severe distress, followed by Asians (18%) and Blacks (16%), with Whites (14%) having the lowest prevalence. Hispanics’ poorer mental health was largely due to their socioeconomic disadvantages. Within Asians, Southeast Asians (29%), Koreans (27%), and South Asians (22%) exhibited the highest prevalence of severe distress. Their worse mental health was mainly mediated by experienced discrimination and perceived racial bias. Conclusions Purposefully tackling racial prejudice and discrimination is necessary to alleviate the disproportionate psychological distress burden in racial-ethnic minority groups.

Change in mental health during the COVID-19 pandemic: a longitudinal study of residents of Indian metropolitan cities

Article

Full-text available

Mar 2023
J Ment Health

Background: Initial studies have reported an increase in the incidence of mental health problems during the early months of COVID-19. Longitudinal studies of changes in mental health undertaken in Low and Middle Income countries during the pandemic remains an under-researched area. Aims: The current study examines changes in mental health among adult residents of metropolitan cities of India, a middle-income country reporting the second-highest COVID cases and third-highest fatalities, during the pandemic. Method: Data was collected, based on a telephonic survey using the internationally accepted abridged Depression Anxiety Stress schedule (DASS-21), in August and September 2020 and July-August 2021. The sample size is 994. The data was analysed using an ordered logit model. Results: At the onset of the pandemic, high levels of anxiety, stress and depression prevailed; their levels reduced after one year. Respondents who have experienced a decline in economic fortunes, have family members with pre-existing co-morbidity or had COVID in the family are significantly less likely to report improvement in mental health; less-educated respondents are also vulnerable. Conclusions: Specific sub-groups, identified as at risk, need monitoring and continued provisioning of tailor-made mental health services addressing their specific needs. Relief measures targeting economically affected households are also required.

Gender and Racial/Ethnic Disparities in Undergraduate and Graduate Students’ Mental Health and Treatment Use Amid the COVID-19 Pandemic

Article

Full-text available

Feb 2023
ADM POLICY MENT HLTH

The COVID-19 pandemic has negatively impacted numerous people?s mental health and created new barriers to services. To address the unknown effects of the pandemic on accessibility and equality issues in mental health care, this study aimed to investigate gender and racial/ethnic disparities in mental health and treatment use in undergraduate and graduate students amid the COVID-19 pandemic. The study was conducted based on a largescale online survey (N = 1,415) administered during the weeks following a pandemic-related university-wide campus closure in March 2020. We focused on the gender and racial disparities in current internalizing symptomatology and treatment use. Our results showed that in the initial period of the pandemic, students identified as cis women (p < .001), non-binary/genderqueer (p < .001), or Hispanic/Latinx (p = .002) reported higher internalizing problem severity (aggregated from depression, generalized anxiety, intolerance of uncertainty, and COVID-19-related stress symptoms) compared to their privileged counterparts. Additionally, Asian (p < .001) and multiracial students (p = .002) reported less treatment use than White students while controlling for internalizing problem severity. Further, internalizing problem severity was associated with increased treatment use only in cisgender, non-Hispanic/Latinx White students (pcis man = 0.040, pcis woman < 0.001). However, this relationship was negative in cis-gender Asian students (pcis man = 0.025, pcis woman = 0.016) and nonsignificant in other marginalized demographic groups. The findings revealed unique mental health challenges faced by different demographic groups and served as a call that specific actions to enhance mental health equity, such as continued mental health support for students with marginalized gender identities, additional COVID-related mental and practical support for Hispanic/Latinx students and promotion of mental health awareness, access, and trust in non-White, especially Asian, students are desperately needed.

Perceived discrimination based on the symptoms of covid-19, mental health, and emotional responses–the international online COVISTRESS survey

Article

Full-text available

Jan 2023
PLOS ONE

Background Despite the potential detrimental consequences for individuals’ health and discrimination from covid-19 symptoms, the outcomes have received little attention. This study examines the relationships between having personally experienced discrimination based on the symptoms of covid-19 (during the first wave of the pandemic), mental health, and emotional responses (anger and sadness). It was predicted that covid-19 discrimination would be positively related to poor mental health and that this relationship would be mediated by the emotions of anger and sadness. Methods The study was conducted using an online questionnaire from January to June 2020 (the Covistress network; including 44 countries). Participants were extracted from the COVISTRESS database (Ntotal = 280) with about a half declaring having been discriminated due to covid-19 symptoms (N = 135). Discriminated participants were compared to non-discriminated participants using ANOVA. A mediation analysis was conducted to examine the indirect effect of emotional responses and the relationships between perceived discrimination and self-reported mental health. Results The results indicated that individuals who experienced discrimination based on the symptoms of covid-19 had poorer mental health and experienced more anger and sadness. The relationship between covid-19 personal discrimination and mental health disappeared when the emotions of anger and sadness were statistically controlled for. The indirect effects for both anger and sadness were statistically significant. Discussion This study suggests that the covid-19 pandemic may have generated discriminatory behaviors toward those suspected of having symptoms and that this is related to poorer mental health via anger and sadness.

The association between social determinants of health and psychological distress during the COVID-19 pandemic: a secondary analysis among four racial/ethnic groups

Article

Full-text available

Nov 2022
BMC PUBLIC HEALTH

Background Racial disparities in psychological distress associated with COVID-19 remain unclear in the U.S. This study aims to investigate the associations between social determinants of health and COVID-19-related psychological distress across different racial/ethnic groups in the US (i.e., non-Hispanic Whites, Hispanic, non-Hispanic Asians, and non-Hispanic African Americans). Methods This study used cross-sectional data from the 2020 California Health Interview Survey Adult Data Files ( N = 21,280). Adjusting for covariates—including age, gender, COVID-19 pandemic challenges, and risk of severe illness from COVID-19—four sets of weighted binary logistic regressions were conducted. Results The rates of moderate/severe psychological distress significantly varied across four racial/ethnic groups ( p < 0.001), with the highest rate found in the Hispanic group. Across the five domains of social determinants of health, we found that unemployment, food insecurity, housing instability, high educational attainment, usual source of health care, delayed medical care, and low neighborhood social cohesion and safety were associated with high levels of psychological distress in at least one racial/ethnic group ( p < 0.05). Conclusion Our study suggests that Hispanic adults face more adverse social determinants of health and are disproportionately impacted by the pandemic. Public health practice and policy should highlight social determinants of heath that are associated with different racial/ethnic groups and develop tailored programs to reduce psychological distress.

Economic precarity, loneliness, and suicidal ideation during the COVID-19 pandemic

Article

Full-text available

Nov 2022
PLOS ONE

The US population faced stressors associated with suicide brought on by the COVID-19 pandemic. Understanding the relationship between stressors and suicidal ideation in the context of the pandemic may inform policies and programs to prevent suicidality and suicide. We compared suicidal ideation between two cross-sectional, nationally representative surveys of adults in the United States: the 2017–2018 National Health and Nutrition Examination Survey (NHANES) and the 2020 COVID-19 and Life Stressors Impact on Mental Health and Well-being (CLIMB) study (conducted March 31 to April 13). We estimated the association between stressors and suicidal ideation in bivariable and multivariable Poisson regression models with robust variance to generate unadjusted and adjusted prevalence ratios (PR and aPR). Suicidal ideation increased from 3.4% in the 2017–2018 NHANES to 16.3% in the 2020 CLIMB survey, and from 5.8% to 26.4% among participants in low-income households. In the multivariable model, difficulty paying rent (aPR: 1.5, 95% CI: 1.2–2.1) and feeling alone (aPR: 1.9, 95% CI: 1.5–2.4) were associated with suicidal ideation but job loss was not (aPR: 0.9, 95% CI: 0.6 to 1.2). Suicidal ideation increased by 12.9 percentage points and was almost 4.8 times higher during the COVID-19 pandemic. Suicidal ideation was more prevalent among people facing difficulty paying rent (31.5%), job loss (24.1%), and loneliness (25.1%), with each stressor associated with suicidal ideation in bivariable models. Difficulty paying rent and loneliness were most associated with suicidal ideation. Policies and programs to support people experiencing economic precarity and loneliness may contribute to suicide prevention.

A HOPE Online Community Peer Support Intervention for Help Seeking: A Randomized Controlled Trial

Article

Nov 2022

Objective: A 6-week study was conducted to test the effectiveness of the Harnessing Online Peer Education (HOPE) intervention on anxiety, help seeking (requests for electronic resources [e-resources] on anxiety reduction), and online engagement. Methods: Three hundred participants with moderate to severe anxiety (i.e., seven-item Generalized Anxiety Disorder scale [GAD-7] scores ≥10) were randomly assigned to social media (i.e., Facebook) groups with or without peer leaders. The study was conducted from April 5 to May 17, 2020. GAD-7 scores, e-resource requests, and online engagement were measured at baseline and at weeks 2, 4, and 6. Results: GAD-7 scores improved in both intervention and control groups, with no difference between conditions. Participants in the intervention group were more likely than those in the control group to request e-resources (OR=10.27, 95% CI=4.52-23.35) and engage online (OR=2.84, 95% CI=1.70-4.76). Conclusions: The HOPE intervention effectively promoted mental health help-seeking behavior and online engagement.

The risks of attrition bias in longitudinal surveys of the impact of COVID-19

Article

Nov 2022

As the COVID-19 pandemic continues, interest in mental health impacts is shifting from short-term to long-term outcomes. As part of a longitudinal online survey study examining mental health impacts of the pandemic, we assessed the risk of attrition bias related to a history of depression—a condition research shows can increase challenges of recruitment and retention. Among 5023 participants who completed the baseline survey, significantly more reporting a history of depression were lost to follow-up: baseline to 3 months: 497/760 (65.4%) vs 2228/4263 (52.3%), P < 0.001; 3 to 6 months: 179/263 (68.1%) vs 1183/2035 (58.1%), P = 0.002. Participants reporting a history of depression also had greater adjusted odds of a Patient Health Questionnaire-8 score ≥10 (odds ratio [OR] = 3.97, 95% confidence interval [CI] 3.27, 4.84), Generalized Anxiety Disorder-7 score ≥10 (OR = 3.77, 95% CI 3.07, 4.62), and Posttraumatic Diagnostic Scale for DSM V score ≥ 28 (OR = 7.17, 95% CI 4.67, 11.00) at baseline, indicating a need to account for attrition bias when examining these outcomes. Similar considerations likely apply to other longitudinal survey studies and are important to address to ensure accurate evidence is available to support policy decisions regarding resource allocation and funding.

Impact of the COVID-19 vaccinations on economic outcomes and mental health services in the U.S

Article

Full-text available

May 2024

Kolawole Ogundari

Gender-Specific Non-Disclosure of Mental Distress: A Cross-Sectional Survey on Reasons and Associated Factors

Article

Full-text available

Apr 2024

Research suggests that non-disclosure of mental distress is associated with poorer mental health. While men are more reluctant to communicate about personal issues with informal and professional social contacts, little is known about the reasons for and factors associated with non-disclosure among men and women. Based on the Disclosure Decision-Making Model and the Communication Privacy Management Theory, we conducted a cross-sectional online survey with a quota sample of 2,471 participants in Germany. In the study, we (a) examined gender differences regarding non-disclosure of distress, (b) aimed to identify individual and relational factors associated with non-disclosure for both genders, and (c) studied men’s and women’s reasoning for non-disclosure of mental distress. Findings demonstrate that (a) non-disclosure was not higher in the male subsample but men had less trusted contacts; (b) individual level factors, particularly the conformity to traditional gender norms, were associated with non-disclosure among both genders; (c) men stipulated the superficiality of the relationship as more relevant reasons, while women indicated privacy and feelings of shame/self-blame as more important. The study findings might inform gender-sensitive mental health campaigns in the sense that questioning traditional gender norms could contribute to disclosure of mental distress among both men and women.

Benefits and Process of Providing Peer Support for Pediatric Burn Survivors and Caregivers during Inpatient and Outpatient Phases of Recovery

Article

Apr 2024

The World Health Organization reveals that pediatric burns represent a large portion of burns globally (61). Increases in survival rates have guided clinical and research focus on physical, psychological, and social outcomes. Research on other childhood illnesses has shown the efficacy of social support throughout recovery. In the pediatric burn literature, studies have shown the efficacy of burn camps for promoting positive interactions among survivors, learning coping skills, and facilitating socialization and reintegration. However, few studies have focused on the benefits of peer support for pediatric burn survivors and their caregivers in the inpatient and outpatient phases of recovery. This descriptive paper identifies options for building resilience for pediatric burn survivors through peer support in the inpatient and outpatient phases of recovery. The authors discuss options for providing peer support during the coronavirus disease 2019 pandemic on the pediatric intensive care unit, general pediatric floor, and outpatient setting.

Sức khỏe tâm thần của giảng viên đại học Thành phố Hồ Chí Minh trong giai đoạn dịch COVID và mối tương quan với tình trạng kiệt sức nghề nghiệp

Article

Full-text available

Jan 2023

Nghiên cứu này được thực hiện nhằm phác họa sức khỏe tâm thần của giảng viên đại học trong đại dịch COVID-19 và mối liên quan đến tình trạng kiệt sức nghề nghiệp. Khảo sát được thực hiện trên 188 giảng viên thuộc 3 khối ngành đào tạo ở Thành phố Hồ Chí Minh bằng các thang đo Cảm nhận hạnh phúc WHO-5, thang đo Sức khỏe tổng quát, thang đo Stress nhận thức được và Bảng kê kiệt sức nghề nghiệp. Kết quả chỉ ra tỷ lệ giảng viên đại học có các khó khăn về sức khỏe tâm thần và stress mức độ cao lần lượt là 16% và 11,2%. Tỷ lệ giảng viên đại học bị kiệt sức nghề nghiệp là 53,7%, trong đó 4,8% ở mức độ cao. Kết quả nghiên cứu ghi nhận tương quan thuận giữa vấn đề sức khỏe tâm thần tổng quát và stress với kiệt sức nghề nghiệp ở giảng viên đại học (r = 0,609 và r = 0,533; p < 0,001), tương quan nghịch giữa mức độ hạnh phúc và kiệt sức nghề nghiệp (r = -0,556; p < 0,001). Kết quả góp phần chỉ ra mối liên quan giữa sức khỏe tâm thần và tình trạng kiệt sức nghề nghiệp của giảng viên đại học và gợi ý cho công tác chăm sóc sức khỏe tâm thần cho giảng viên đại học ở Thành phố Hồ Chí Minh.

Variation in symptoms of common mental disorders in the general population during the COVID-19 pandemic: longitudinal cohort study

Article

Full-text available

Feb 2024

Background A significant rise in mental health disorders was expected during the COVID-19 pandemic. However, referrals to mental health services dropped for several months before rising to pre-pandemic levels. Aims To identify trajectories of incidence and risk factors for common mental disorders among the general population during 14 months of the COVID-19 pandemic, to inform potential mental health service needs. Method A cohort of 33 703 adults in England in the University College London COVID-19 Social Study provided data from March 2020 to May 2021. Growth mixture modelling was used to identify trajectories based on the probability of participants reporting symptoms of depression (Patient Health Questionnaire-9) or anxiety (Generalised Anxiety Disorder-7) in the clinical range, for each month. Sociodemographic and personality-related characteristics associated with each trajectory class were explored. Results Five trajectory classes were identified for depression and anxiety. Participants in the largest class (62%) were very unlikely to report clinically significant symptom levels. Other trajectories represented participants with a high likelihood of clinically significant symptoms throughout, early clinically significant symptoms that reduced over time, clinically significant symptoms that emerged as the pandemic unfolded and a moderate likelihood of clinically significant symptoms throughout. Females, younger adults, carers, those with existing mental health diagnoses, those that socialised frequently pre-pandemic and those with higher neuroticism scores were more likely to experience depression or anxiety. Conclusions Nearly 40% of participants followed trajectories indicating risk of clinically significant symptoms of depression or anxiety. The identified risk factors could inform public health interventions to target individuals at risk in future health emergencies.

Stability and shifts in the combined positive and negative mental health of clergy: A longitudinal latent class and latent transition analysis study of united methodist pastors before and after the onset of COVID-19

Article

Feb 2024
SOC SCI MED

Real men don't talk? Relationships among depressiveness, loneliness, conformity to masculine norms, and male non-disclosure of mental distress

Article

Jun 2024

COVID-19 Concerns, Information Needs, and Adverse Mental Health Outcomes among U.S. Soldiers

Article

Sep 2023
Mil Med

Introduction: The coronavirus disease 2019 (COVID-19) pandemic disrupted U.S. Military operations and potentially compounded the risk for adverse mental health outcomes by layering unique occupational stress on top of general restrictions, fears, and concerns. The objective of the current study was to characterize the prevalence of COVID-19 concerns and information needs, demographic disparities in these outcomes, and the degree to which COVID-19 concerns and information needs were associated with heightened risk for adverse mental health outcomes among U.S. Army soldiers. Materials and methods: Command-directed anonymous surveys were administered electronically to U.S. soldiers assigned to one of three regional commands in the Northwest United States, Europe, and Asia-Pacific Region. Surveys were administered in May to June 2020 to complete (time 1: n = 21,294) and again in December 2020 to January 2021 (time 2: n = 10,861). Only active duty or active reservists/national guard were eligible to participate. Members from other branches of service were also not eligible. Results: Highly prevalent COVID-19 concerns included the inability to spend time with friends/family, social activities, and changing rules, regulations, and guidance related to COVID-19. Some information needs were endorsed by one quarter or more soldiers at both time points, including stress management/coping, travel, how to protect oneself, and maintaining mission readiness. COVID-19 concerns and information needs were most prevalent among non-White soldiers. Concerns and information needs did not decline overall between the assessments. Finally, COVID-19 concerns were associated with greater risk of multiple adverse mental health outcomes at both time points. Conclusions: COVID-19 concerns and information needs were prevalent and showed little evidence of decrement over the course of the first 6 months of the pandemic. COVID-19 concerns were consistently associated with adverse mental health outcomes. These data highlight two targets and potential demographic subgroups such that local leadership and Army medicine and public health enterprises can be better prepared to monitor and address to maintain force health and readiness in the face of possible future biomedical threats.

Extended Impact of the COVID-19 Pandemic: Trajectories of Mental Health and Substance Use among U.S. Adults, September 2020 – August 2021

Article

Full-text available

Aug 2023

Background: Americans reported significant increases in mental health and substance use problems after the COVID-19 pandemic outbreak. This can be a product of the pandemic disruptions in everyday life, with some populations being more impacted than others. Objectives: To assess the ongoing impact of the COVID-19 pandemic on mental health and substance use in U.S. adults from September 2020 to August 2021. Methods: Participants included 1056 adults (68.5% women) who participated in a national longitudinal online survey assessing the perceived impact of COVID-19 on daily life, stress, depression and anxiety symptoms, and alcohol and cannabis use at 3-time points from September 2020 to August 2021. Results: Individuals with lower self-reported social status reported the highest perceived impact. Participants' perceived impact of the COVID-19 pandemic on daily life, stress, anxiety, and alcohol use risk significantly decreased over time but remained high. However, there was no change in depressive symptoms and cannabis use. Higher levels of perceived impact of the pandemic significantly predicted both more baseline mental health concerns and lower decreases over time. Lower self-report social status predicted more baseline mental health concerns and smaller decreases in those concerns. Black adults reported significantly higher cannabis use rates than non-Hispanic White adults. Conclusion: The impact of COVID-19 on daily life continued to be a risk factor for mental health during the second wave of the pandemic. In addition to infection prevention, public health policies should focus on pandemic-related social factors such as economic concerns and caretaking that continue to affect mental health.

Prevalence of Depression, Anxiety, Stress, and Fear of COVID-19 Among the Students of the University of Bojnord in Iran

Article

Aug 2022

Khadije Alavi

Background and Objectives: A significant increase in mental problems among students have been reported during the coronavirus disease 2019 (COVID-19) pandemic. The present study aims to investigate the prevalence of depression, anxiety, stress, and fear of COVID-19 and the relationships between them among college students, approximately two years after the onset of the pandemic in Iran. Methods: In this descriptive study, 148 students were recruited from the University of Bojnord using a convenience sampling method. The depression, anxiety stress scale (DASS) and the Fear of COVID-19 Scale were used to collect data. Descriptive statistics, t-test, and Pearson correlation test were used to analyze the data. Results: The results show that 15.5% of students had depression, 12.8% had anxiety, and 14.2% had stress and fear of COVID-19 symptoms. The mean score of DASS in this study was not significantly different from the scores reported in the beginning of pandemic. The fear of COVID-19 had no significant relationship with depression, anxiety, and stress. Conclusion: The levels of depression, anxiety and stress two years after the COVID-19 pandemic do not differ from their levels at the beginning of the pandemic among college students, but the fear of COVID-19 level is significantly lower. Acceleration of the vaccination and the increase of awareness about the disease might be reasons for improvement in the psychological status of students.

Use of substances to cope during the COVID-19 pandemic among transgender and gender diverse adults

Article

Feb 2023
AM J DRUG ALCOHOL AB

Background: Studies have found changes in substance use during the COVID-19 pandemic in specific populations. Transgender and gender diverse (TGD) individuals have experienced greater distress compared to cisgender individuals during the pandemic; however, there is little research on substance use among TGD individuals during this sensitive time period. Objectives: The objective of this study is to examine distress from COVID-19 and coping via substance use including alcohol, cannabis, tobacco, and non-medical use of prescription drugs (NMUPD) among TGD adults. Method: An online survey assessing substance use, general psychiatric symptoms, and COVID-19 anxiety was completed by 342 TGD individuals (16.4% transfeminine, 19.6% transmasculine, 64.0% Gender Diverse) in June/July 2020. Chi-square and structural equation modeling (SEM) analyses examined the connections between distress, coping, and substance use. Results: Seventy-one percent of participants reported no changes in substance use since the start of the pandemic and 22% reported an increase in substance use. Increased substance use was associated with alcohol (p < .001), cannabis (p < .001), and combustible tobacco (p < .001) use in the prior three months. SEM showed significant direct effects between distress and substance use coping, substance use coping and recent drug use, and an indirect effect of distress on recent drug use through substance use coping (β = .31, p = .001). Conclusion: Results highlight the risk of substance use to cope with COVID-19-related stress in a large sample of a minoritized population with mental health disparities. Transmasculine and gender diverse participants were especially likely to report using substances to cope.

Association of Recent SARS-CoV-2 Infection With New-Onset Alcohol Use Disorder, January 2020 Through January 2022

Article

Full-text available

Feb 2023

Importance: The COVID-19 pandemic affects many diseases, including alcohol use disorders (AUDs). As the pandemic evolves, understanding the association of a new diagnosis of AUD with COVID-19 over time is required to mitigate negative consequences. Objective: To examine the association of COVID-19 infection with new diagnosis of AUD over time from January 2020 through January 2022. Design, setting, and participants: In this retrospective cohort study of electronic health records of US patients 12 years of age or older, new diagnoses of AUD were compared between patients with COVID-19 and patients with other respiratory infections who had never had COVID-19 by 3-month intervals from January 20, 2020, through January 27, 2022. Exposures: SARS-CoV-2 infection or non-SARS-CoV-2 respiratory infection. Main outcomes and measures: New diagnoses of AUD were compared in COVID-19 and propensity score-matched control cohorts by hazard ratios (HRs) and 95% CIs from either 14 days to 3 months or 3 to 6 months after the index event. Results: This study comprised 1 201 082 patients with COVID-19 (56.9% female patients; 65.7% White; mean [SD] age at index, 46.2 [18.9] years) and 1 620 100 patients with other respiratory infections who had never had COVID-19 (60.4% female patients; 71.1% White; mean [SD] age at index, 44.5 [20.6] years). There was a significantly increased risk of a new diagnosis of AUD in the 3 months after COVID-19 was contracted during the first 3 months of the pandemic (block 1) compared with control cohorts (HR, 2.53 [95% CI, 1.82-3.51]), but the risk decreased to nonsignificance in the next 3 time blocks (April 2020 to January 2021). The risk for AUD diagnosis increased after infection in January to April 2021 (HR, 1.30 [95% CI, 1.08-1.56]) and April to July 2021 (HR, 1.80 [95% CI, 1.47-2.21]). The result became nonsignificant again in blocks 7 and 8 (COVID-19 diagnosis between July 2021 and January 2022). A similar temporal pattern was seen for new diagnosis of AUD 3 to 6 months after infection with COVID-19 vs control index events. Conclusions and relevance: Elevated risk for AUD after COVID-19 infection compared with non-COVID-19 respiratory infections during some time frames may suggest an association of SARS-CoV-2 infection with the pandemic-associated increase in AUD. However, the lack of excess hazard in most time blocks makes it likely that the circumstances surrounding the pandemic and the fear and anxiety they created also were important factors associated with new diagnoses of AUD.

PESQUISA, SAÚDE E GRADUAÇÃO: MONOGRAFIAS QUE ENTRELAÇAM E CONTRIBUEM PARA O SER-PROFISSIONAL

Book

Jan 2021

Prisca Dara Lunieres Pêgas Coêlho

Anxiety trajectories among cancer survivors during the COVID-19 pandemic

Article

Jan 2023
J PSYCHOSOC ONCOL

Purpose: To describe trajectories of general and bodily vigilance anxiety among cancer survivors during COVID-19 and examine associated factors. Design: Longitudinal survey study (May-December 2020). Sample: Colorado-based cancer survivors (N = 147). Methods: Latent class growth analyses were used to examine trajectories for two types of anxiety (general and body vigilance), and to evaluate associations with fear of cancer recurrence (FCR), loneliness, and emotional approach coping. Findings: Anxiety levels remained stable over time. Most participants were best characterized by the mild general anxiety and moderate bodily vigilance anxiety classes. FCR predicted both general and bodily vigilance anxiety class, and loneliness distinguished between mild and moderate bodily vigilance anxiety classes. Conclusions: Current cancer survivors experienced mild general anxiety and moderate body vigilance anxiety during the early pandemic with no detectable improvement over time, and FCR consistently predicted anxiety outcomes. Implications for psychosocial providers: These findings provide insight into the anxiety profiles of cancer survivors during COVID-19 and possible therapeutic targets.

Depression trajectories during the COVID-19 pandemic in the high quality health care setting of Switzerland: the COVCO-Basel Cohort

Article

Full-text available

Jan 2023
PUBLIC HEALTH

Objectives During the pandemic, Switzerland avoided stringent lockdowns and provided funds to stabilize the economy. To assess whether and in what subgroups the pandemic impacted on depressive symptoms in this specific Swiss context, we derived depression trajectories over an extended pandemic period in a Swiss cohort and related them to individuals’ socio-demographic characteristics. Study design This was a population-based cohort study. Methods The population-based COVCO-Basel cohort in North-Western Switzerland invited 112’848 adult residents of whom 12’724 participated at baseline. Between July 2020 and December 2021 6’396 participants answered to additional 18 monthly online questionnaires. Depression symptoms were repeatedly measured by the DASS-21 scale. Group-based Trajectory Models methods were applied to identify clusters of similar depression trajectories. Trajectory clusters were characterized descriptively and with a Multinomial response model. Results Three distinct trajectories were identified. The “Highly affected” trajectory (13%) had a larger presence of younger and female participants with lower average income, higher levels of past depression, and living alone. A majority of individuals in the “Unaffected” trajectory (52%) were of medium or high average income, older average age, without previous depression symptoms, and not living alone. The “Moderately affected” trajectory (35%) had a composition intermediate between the two opposite “extreme” trajectories. Conclusions This study is among few studies investigating depression trajectories up to the time when COVID-19 vaccination was readily available to the entire population. During these 18 months of the pandemic depressive symptoms increased in a substantial percentage of participants. Economic support, high quality health care system, and moderate containment measures did not sufficiently protect all population subgroups from adverse, potentially long-term psychological pandemic impacts.

The prevalence, incidence, and risk factors of mental health problems and mental health service use before and 9 months after the COVID-19 outbreak among the general Dutch population. A 3-wave prospective study

Article

Full-text available

Nov 2022
PLOS ONE

Objectives Gain insight into the effects of the COVID-19 pandemic on the prevalence, incidence, and risk factors of mental health problems among the Dutch general population and different age groups in November-December 2020, compared with the prevalence, incidence, and risk factors in the same period in 2018 and 2019. More specifically, the prevalence, incidence, and risk factors of anxiety and depression symptoms, sleep problems, fatigue, impaired functioning due to health problems, and use of medicines for sleep problems, medicines for anxiety and depression, and mental health service. Methods We extracted data from the Longitudinal Internet studies for the Social Sciences (LISS) panel that is based on a probability sample of the Dutch population of 16 years and older by Statistics Netherlands. We focused on three waves of the longitudinal Health module in November-December 2018 (T1), November-December 2019 (T2), and November-December 2020 (T3), and selected respondents who were 18 years and older at T1. In total, 4,064 respondents participated in all three surveys. Data were weighted using 16 demographics profiles of the Dutch adult population. The course of mental health problems was examined using generalized estimating equations (GEE) for longitudinal ordinal data and differences in incidence with logistic regression analyses. In both types of analyses, we controlled for sex, age, marital status, employment status, education level, and physical disease. Results Among the total study sample, no significant increase in the prevalence of anxiety and depression symptoms, sleep problems, fatigue, impaired functioning due to health problems, use of medicines for sleep problems, of medicines for anxiety and depression, and of mental health service in November-December 2020 was observed, compared with the prevalence in November-December 2018 and 2019 (T3 did not differ from T1 and T2). Among the four different age categories (18–34, 35–49, 50–64, and 65 years old and older respondents), 50–64 years respondents had a significantly lower prevalence of anxiety and depression symptoms at T3 than at T1 and T2, while the prevalence at T1 and T2 did not differ. A similar pattern among 65+ respondents was found for mental health service use. We found no indications that the incidence of examined health problems at T2 (no problems at T1, problems at T2) and T3 (no problems at T2, problems at T3) differed. Risk factors for mental health problems at T2 were mostly similar to risk factors at T3; sex and age were less/not a risk factor for sleep problems at T3 compared with at T2. Conclusions The prevalence, incidence, and risk factors of the examined mental health problems examined nine months after the COVID-19 outbreak appear to be very stable across the end of 2018, 2019, and 2020 among the Dutch adult population and different age categories, suggesting that the Dutch adult population in general is rather resilient given all disruptions due to this pandemic.

Food insecurity associated with self-reported mental health outcomes in Peruvian households during the COVID-19 pandemic

Article

Full-text available

Nov 2022

Background The global pandemic of COVID-19 and the social distancing efforts implemented worldwide to limit its spread have disrupted the economy, increased food insecurity, and mental health problems. Objectives The aim of this study was to determine the association between food insecurity and mental health outcomes (stress, depression, and anxiety) in Peruvian households during the COVID-19 pandemic. Materials and methods A cross-sectional investigation was conducted with 525 participants of both sexes (68% women), over 18 years of age and from the three geographic regions of Peru: Coast (54.9%), Highlands (28.4%), and Jungle (16.8%). The data were collected during the year 2021, between July 6 and September 22 through a self-administered online survey designed to assess socio-demographic, socioeconomic, food insecurity, and mental health outcomes (depression, anxiety, and stress). Results The majority of households (71.4%) experienced some degree of food insecurity. Mild food insecurity was the most frequent, affecting 49.1%, followed by moderate 15.4%, and severe 6.9%. Regarding mental health outcomes, 24.8% manifested depression, 26.7% anxiety, and 15.3% stress. With respect to the association between the level of food insecurity and anxiety, this was highly significant (p < 0.01). Households with mild, moderate and severe food insecurity are 2.04, 4.5, and 10.44 times, respectively, more likely to have moderate-severe anxiety. On the other hand, the mild food insecurity was not associated with moderate-severe depression. In contrast, households with moderate and severe food insecurity are 2.8 and 5.7 times, respectively, more likely to have moderate-severe depression. Finally, households with moderate food insecurity are 5.9 times more likely to have moderate-severe stress, and households with severe food insecurity are 8.5 times more likely to have moderate-severe stress, both having a highly significant association (p < 0.01). Conclusion In conclusion, during the second wave of the COVID-19 pandemic in Peru, household food insecurity was independently associated with worse mental health outcomes. Monitoring of both food insecurity and mental health will be important as the COVID-19 pandemic continues.

The unfolding COVID-19 pandemic: A probability-based, nationally representative study of mental health in the U.S

Article

Full-text available

Sep 2020

The COVID-19 pandemic is a collective stressor unfolding over time, yet rigorous published empirical studies addressing mental health consequences of COVID-19 among large probability-based national samples are rare. Between 3/18-4/18/20, during an escalating period of illness and death in the United States, we assessed acute stress, depressive symptoms and direct, community, and media-based exposures to COVID-19 in three consecutive representative samples across three 10-day periods (total N=6,514) from the U.S. probability-based nationally representative NORC AmeriSpeak panel. Acute stress and depressive symptoms increased significantly over time as COVID-19 deaths increased across the U.S. Pre-existing mental and physical health diagnoses, daily hours of COVID-19-related media exposure, exposure to conflicting COVID-19 information in media, and secondary stressors were all associated with acute stress and depressive symptoms. Results have implications for targeting of public health interventions and risk communication efforts to promote community resilience as the pandemic waxes and wanes over time.

Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic

Article

Full-text available

Sep 2020

Importance: The coronavirus disease 2019 (COVID-19) pandemic and the policies to contain it have been a near ubiquitous exposure in the US with unknown effects on depression symptoms. Objective: To estimate the prevalence of and risk factors associated with depression symptoms among US adults during vs before the COVID-19 pandemic. Design, setting, and participants: This nationally representative survey study used 2 population-based surveys of US adults aged 18 or older. During COVID-19, estimates were derived from the COVID-19 and Life Stressors Impact on Mental Health and Well-being study, conducted from March 31, 2020, to April 13, 2020. Before COVID-19 estimates were derived from the National Health and Nutrition Examination Survey, conducted from 2017 to 2018. Data were analyzed from April 15 to 20, 2020. Exposures: The COVID-19 pandemic and outcomes associated with the measures to mitigate it. Main outcomes and measures: Depression symptoms, defined using the Patient Health Questionnaire-9 cutoff of 10 or higher. Categories of depression symptoms were defined as none (score, 0-4), mild (score, 5-9), moderate (score, 10-14), moderately severe (score, 15-19), and severe (score, ≥20). Results: A total of 1470 participants completed the COVID-19 and Life Stressors Impact on Mental Health and Well-being survey (completion rate, 64.3%), and after removing those with missing data, the final during-COVID-19 sample included 1441 participants (619 participants [43.0%] aged 18-39 years; 723 [50.2%] men; 933 [64.7%] non-Hispanic White). The pre-COVID-19 sample included 5065 participants (1704 participants [37.8%] aged 18-39 years; 2588 [51.4%] women; 1790 [62.9%] non-Hispanic White). Depression symptom prevalence was higher in every category during COVID-19 compared with before (mild: 24.6% [95% CI, 21.8%-27.7%] vs 16.2% [95% CI, 15.1%-17.4%]; moderate: 14.8% [95% CI, 12.6%-17.4%] vs 5.7% [95% CI, 4.8%-6.9%]; moderately severe: 7.9% [95% CI, 6.3%-9.8%] vs 2.1% [95% CI, 1.6%-2.8%]; severe: 5.1% [95% CI, 3.8%-6.9%] vs 0.7% [95% CI, 0.5%-0.9%]). Higher risk of depression symptoms during COVID-19 was associated with having lower income (odds ratio, 2.37 [95% CI, 1.26-4.43]), having less than $5000 in savings (odds ratio, 1.52 [95% CI, 1.02-2.26]), and exposure to more stressors (odds ratio, 3.05 [95% CI, 1.95-4.77]). Conclusions and relevance: These findings suggest that prevalence of depression symptoms in the US was more than 3-fold higher during COVID-19 compared with before the COVID-19 pandemic. Individuals with lower social resources, lower economic resources, and greater exposure to stressors (eg, job loss) reported a greater burden of depression symptoms. Post-COVID-19 plans should account for the probable increase in mental illness to come, particularly among at-risk populations.

Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic - United States, June 24-30, 2020

Article

Full-text available

Aug 2020

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.

Mental health and psychosocial well-being during the COVID-19 pandemic: The invisible elephant in the room

Article

Full-text available

May 2020

The novel SARS-CoV-2 coronavirus pandemic has emerged as a truly formidable threat to humankind’s existence. In the wake of the massively volatile global situation created by COVID-19, it is vital to recognize that the trauma it causes can affect people in different ways, at the individual and collective levels, resulting in mental health challenges for many. Although mental health problems account for about one-third of the world’s disability among adults, these issues tend to be under-addressed and overlooked in society and are closely associated with deadly disease outbreaks. In large scale outbreaks, the mental health problems experienced are not limited to infected persons but also extend to involve frontline health workers and community members alike. While it is crucial to limit the spread of infections during an outbreak, previous experience suggests that mental and behavioural health interventions should be fully included in public health response strategies.

Early Health System Experiences with Collaborative Care (CoCM) Billing Codes: a Qualitative Study of Leadership and Support Staff

Article

Full-text available

Jul 2019

Background Although collaborative care (CoCM) is an evidence-based and widely adopted model, reimbursement challenges have limited implementation efforts nationwide. In recent years, Medicare and other payers have activated CoCM-specific codes with the primary aim of facilitating financial sustainability. Objective To investigate and describe the experiences of early adopters and explorers of Medicare’s CoCM codes. Design and Participants Fifteen interviews were conducted between October 2017 and May 2018 with 25 respondents representing 12 health care organizations and 2 payers. Respondents included dually boarded medicine/psychiatry physicians, psychiatrists, primary care physicians (PCPs), psychologists, a registered nurse, administrative staff, and billing staff. Approach A semi-structured interview guide was used to address health care organization characteristics, CoCM services, patient consent, CoCM operational components, and CoCM billing processes. All interviews were recorded, transcribed, coded, and analyzed using a content analysis approach conducted jointly by the research team. Key Results Successful billing required buy-in from key, interdisciplinary stakeholders. In planning for CoCM billing implementation, several organizations hired licensed clinical social workers (LICSWs) as behavioral health care managers to maximize billing flexibility. Respondents reported a number of consent-related difficulties, but these were not primary barriers. Workflow changes required for billing the CoCM codes (e.g., tracking cumulative treatment minutes, once-monthly code entry) were described as arduous, but also stimulated creative solutions. Since CoCM codes incorporate the work of the psychiatric consultant into one payment to primary care, organizations employed strategies such as inter-departmental ledger transfers. When challenges arose from variations in the local payer mix, some organizations billed CoCM codes exclusively, while others elected to use a mixture of CoCM and traditional fee-for-service (FFS) codes. For most organizations, it was important to demonstrate financial sustainability from the CoCM codes. Conclusions With deliberate planning, persistence, and widespread organizational buy-in, successful utilization of newly available FFS CoCM billing codes is achievable.

An Ultra-Brief Screening Scale for Anxiety and Depression: The PHQ–4

Article

Full-text available

Nov 2009

The most common mental disorders in both outpatient settings and the general population are depression and anxiety, which frequently coexist. Both of these disorders are associated with considerable disability. When the disorders co-occur, the disability is even greater. Authors sought to test an ultra-brief screening tool for both. Validated two-item ultra-brief screeners for depression and anxiety were combined to constitute the Patient Health Questionnaire for Depression and Anxiety (the PHQ-4). Data were analyzed from 2,149 patients drawn from 15 primary-care clinics in the United States. Factor analysis confirmed two discrete factors (Depression and Anxiety) that explained 84% of the total variance. Increasing PHQ-4 scores were strongly associated with functional impairment, disability days, and healthcare use. Anxiety had a substantial effect on functional status that was independent of depression. The PHQ-4 is a valid ultra-brief tool for detecting both anxiety and depressive disorders.

Lifetime Risk and Persistence of Psychiatric Disorders across Ethnic Groups in the United States

Article

Full-text available

Apr 2005

Recent research in the United States has demonstrated striking health disparities across ethnic groups. Despite a longstanding interest in ethnic disadvantage in psychiatric epidemiology, patterns of psychiatric morbidity across ethnic groups have never been examined in a nationally representative sample. Ethnic differences in psychiatric morbidity are analyzed using data from the National Comorbidity Survey (NCS). The three largest ethnic groups in the United States--Hispanics, Non-Hispanic Blacks and Non-Hispanic Whites were compared with respect to lifetime risk and persistence of three categories of psychiatric disorder: mood disorder, anxiety disorder, and substance use disorder. Where differences across ethnic groups were found in lifetime risk, socially disadvantaged groups had lower risk. Relative to Non-Hispanic Whites, Hispanics had lower lifetime risk of substance use disorder and Non-Hispanic Blacks had lower lifetime risk of mood, anxiety and substance use disorders. Where differences were found in persistence of disorders, disadvantaged groups had higher risk. Hispanics with mood disorders were more likely to be persistently ill as were Non-Hispanic Blacks with respect to both mood disorders and anxiety disorders. Closer examination found these differences to be generally consistent across population subgroups. Members of disadvantaged ethnic groups in the United States do not have an increased risk for psychiatric disorders. Members of these groups, however, do tend to have more persistent disorders. Future research should focus on explanations for these findings, including the possibility that these comparisons are biased, and on potential means of reducing the disparity in persistence of disorders across ethnic groups.

Distinguishing distress from disorder as psychological outcomes of stressful social arrangments

Article

Full-text available

Aug 2007
HEALTH

Allan Horwitz

Some studies in the sociology of stress conceptualize their outcome variables as distress, while others treat the same outcomes as mental disorder. This article focuses on the importance of distinguishing between the two. It argues that there are fundamental differences between distress that arises in non-disordered persons and genuine mental disorder but that studies of stress typically fail to distinguish between these conditions. The article outlines the historical developments that led the field to conflate distress and disorder. Finally, it indicates some advantages for research, treatment and policy that can accrue when distress that is initiated and maintained by social conditions is distinguished from mental disorders that are dysfunctions of internal psychological mechanisms.

Mental Distress in the United States at the Beginning of the COVID-19 Pandemic

Article

Sep 2020
AM J PUBLIC HEALTH

Objectives. To assess the impact of the COVID-19 pandemic on mental distress in US adults. Methods. Participants were 5065 adults from the Understanding America Study, a probability-based Internet panel representative of the US adult population. The main exposure was survey completion date (March 10–16, 2020). The outcome was mental distress measured via the 4-item version of the Patient Health Questionnaire. Results. Among states with 50 or more COVID-19 cases as of March 10, each additional day was significantly associated with an 11% increase in the odds of moving up a category of distress (odds ratio = 1.11; 95% confidence interval = 1.01, 1.21; P = .02). Perceptions about the likelihood of getting infected, death from the virus, and steps taken to avoid infecting others were associated with increased mental distress in the model that included all states. Individuals with higher consumption of alcohol or cannabis or with history of depressive symptoms were at significantly higher risk for mental distress. Conclusions. These data suggest that as the COVID-19 pandemic continues, mental distress may continue to increase and should be regularly monitored. Specific populations are at high risk for mental distress, particularly those with preexisting depressive symptoms.

A Call to Protect the Health Care Workers Fighting COVID-19 in the United States

Article

Jul 2020

Structural Racism, Social Risk Factors, and Covid-19 — A Dangerous Convergence for Black Americans

Article

Jul 2020

COVID‐19 and the gender gap in work hours

Article

Jul 2020
GENDER WORK ORGAN

School and daycare closures due to the COVID‐19 pandemic have increased caregiving responsibilities for working parents. As a result, many have changed their work hours to meet these growing demands. In this study, we use panel data from the U.S. Current Population Survey to examine changes in mothers’ and fathers’ work hours from February through April, 2020, the period of time prior to the widespread COVID‐19 outbreak in the U.S. and through its first peak. Using person‐level fixed effects models, we find that mothers with young children have reduced their work hours four to five times more than fathers. Consequently, the gender gap in work hours has grown by 20 to 50 percent. These findings indicate yet another negative consequence of the COVID‐19 pandemic, highlighting the challenges it poses to women's work hours and employment.

Psychological Distress and Loneliness Reported by US Adults in 2018 and April 2020

Article

Jun 2020

Integrating Mental Health and Addiction Treatment Into General Medical Care: The Role of Policy

Article

Jun 2020

Interventions that integrate care for mental illness or substance use disorders into general medical care settings have been shown to improve patient outcomes in clinical trials, but efficacious models are complex and difficult to scale up in real-world practice settings. Existing payment policies have proven inadequate to facilitate adoption of effective integrated care models. This article provides an overview of evidence-based models of integrated care, discusses the key elements of such models, considers how existing policies have fallen short, and outlines future policy strategies. Priorities include payment policies that adequately support structural elements of integrated care and incentivize multidisciplinary team formation and accountability for patient outcomes, as well as policies to expand the specialty mental health and addiction treatment workforce and address the social determinants of health that disproportionately influence health and well-being among people with mental illness or substance use disorders.

COVID-19 and Racial/Ethnic Disparities

Article

May 2020

Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science

Article

Apr 2020

The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.

Mental Health and the Covid-19 Pandemic

Article

Apr 2020
NEW ENGL J MED

The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention

Article

Apr 2020

The psychological impact of quarantine and how to reduce it: rapid review of the evidence

Article

Feb 2020

The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.

An interactive web-based dashboard to track COVID-19 in real time

Article

Feb 2020
LANCET INFECT DIS

Use of Medicare’s Behavioral Health Integration Service Codes in the First Two Years: an Observational Study

Article

Dec 2019

Cubic splines to model relationships between continuous variables and outcomes: a guide for clinicians

Article

Oct 2019
BONE MARROW TRANSPL

We are pleased to add this typescript to the Bone Marrow Transplantation Statistics Series. We realize the term cubic splines may be a bit off-putting to some readers, but stay with us and don’t get lost in polynomial equations. What the authors describe is important conceptually and in practice. Have you ever tried to buy a new pair of hiking boots? Getting the correct fit is critical; shoes that are too small or too large will get you in big trouble! Now imagine if hiking shoes came in only 2 sizes, small and large, and your foot size was somewhere in between. You are in trouble. Sailing perhaps? Transplant physicians are often interested in the association between two variables, say pre-transplant measurable residual disease (MRD) test state and an outcome, say cumulative incidence of relapse (CIR). We typically reduce the results of an MRD test to a binary, negative or positive, often defined by an arbitrary cut-point. However, MRD state is a continuous biological variable, and reducing it to a binary discards what may be important, useful data when we try to correlate it with CIR. Put otherwise, we may miss the trees from the forest. Another way to look at splines is a technique to make smooth curves out of irregular data points. Consider, for example, trying to describe the surface of an egg. You could do it with a series of straight lines connecting points on the egg surface but a much better representation would be combining groups of points into curves and then combining the curves. To prove this try drawing an egg using the draw feature in Microsoft Powerpoint; you are making splines. Gauthier and co-workers show us how to use cubic splines to get the maximum information from data points, which may, unkindly, not lend themselves to dichotomization or a best fit line. Please read on. We hope readers will find their typescript interesting and exciting, and that it will give them a new way to think about how to analyse data. And no, a spline is not a bunch of cactus spines. Robert Peter Gale, Imperial College London, and Mei-Jie Zhang, Medical College of Wisconsin and CIBMTR.

Regression Modeling Strategies: With Applications to Linear Models, Logistic and Ordinal Regression, and Survival Analysis

Book

Jan 2015

Frank E. Harrell

Mental Health Recovery in the Patient-Centered Medical Home

Article

Jul 2015
AM J PUBLIC HEALTH

We examined the impact of transitioning clients from a mental health clinic to a patient-centered medical home (PCMH) on mental health recovery. We drew data from a large US County Behavioral Health Services administrative data set. We used propensity score analysis and multilevel modeling to assess the impact of the PCMH on mental health recovery by comparing PCMH participants (n = 215) to clients receiving service as usual (SAU; n = 22 394) from 2011 to 2013 in San Diego County, California. We repeatedly assessed mental health recovery over time (days since baseline assessment range = 0-1639; mean = 186) with the Illness Management and Recovery (IMR) scale and Recovery Markers Questionnaire. For total IMR (log-likelihood ratio χ(2)[1] = 4696.97; P < .001) and IMR Factor 2 Management scores (log-likelihood ratio χ(2)[1] = 7.9; P = .005), increases in mental health recovery over time were greater for PCMH than SAU participants. Increases on all other measures over time were similar for PCMH and SAU participants. Greater increases in mental health recovery over time can be expected when patients with severe mental illness are provided treatment through the PCMH. Evaluative efforts should be taken to inform more widespread adoption of the PCMH. (Am J Public Health. Published online ahead of print July 16, 2015: e1-e9. doi:10.2105/AJPH.2015.302683).

Serving Persons With Severe Mental Illness in Primary Care–Based Medical Homes

Article

Feb 2015
PSYCHIAT SERV

Objective: Primary care-based medical homes are rapidly disseminating through populations with chronic illnesses. Little is known about how these models affect the patterns of care for persons with severe mental illness who typically receive much of their care from mental health specialists. This study examined whether enrollment in a primary care medical home alters the patterns of care for Medicaid enrollees with severe mental illness. Methods: The authors conducted a retrospective secondary data analysis of medication adherence, outpatient and emergency department visits, and screening services used by adult Medicaid enrollees with diagnoses of schizophrenia (N=7,228), bipolar disorder (N=13,406), or major depression (N=45,000) as recorded in North Carolina Medicaid claims from 2004-2007. Participants not enrolled in a medical home (control group) were matched by propensity score to medical home participants on the basis of demographic characteristics and comorbidities. Those dually enrolled in Medicare were excluded. Results: Results indicate that medical home enrollees had greater use of both primary and specialty mental health care, better medication adherence, and reduced use of the emergency department. Better rates of preventive lipid and cancer screening were found only for persons with major depression. Conclusions: Enrollment in a medical home was associated with substantial changes in patterns of care among persons with severe mental illness. These changes were associated with only a modest set of incentives, suggesting that medical homes can have large multiplier effects in primary care of persons with severe mental illness.

A 4-item measure of depression and anxiety: Validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population

Article

Jan 2010

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.

Prevalence and incidence of depressive disorder: The Baltimore ECA follow-up, 1981-2004

Article

Oct 2007

To describe trends in prevalence and incidence of depressive disorder in a cohort from Eastern Baltimore. Twenty-three-year-old longitudinal cohort, the Baltimore Epidemiologic Catchment Area Follow-up. Participants were selected probabilistically from the household population in 1981, and interviewed in 1981, 1993, and 2004. Diagnoses were made via the Diagnostic Interview Schedule according to successive editions of the American Psychiatric Association Diagnostic and Statistical Manual. Older age, lower education, non-White race, and cognitive impairment are independent predictors of attrition due to death and loss of contact, but depressive disorder is not related to attrition. Prevalence rates rise for females between 1981, 1993, and 2004. Incidence rates in the period 1993-2004 are lower than the period 1981-1993, suggesting the rise in prevalence is due to increasing chronicity. There has been a rise in the prevalence of depression in the prior quarter century among middle-aged females.

How the coronavirus pandemic unfolded: A timeline. NY Times

Jun 2020

D B Taylor

Taylor DB. How the coronavirus pandemic unfolded: A timeline. NY Times. 2020. Available at https://www.nytimes.com/ article/coronavirus-timeline.html. Accessibility verified June 30, 2020.

See which states and cities have told residents to stay at home. NY Times

Jun 2020

S Mervosh
D Lu
V Swales

Mervosh S, Lu D, Swales V. See which states and cities have told residents to stay at home. NY Times. 2020. Available at https://www.nytimes.com/interactive/2020/us/coronavirusstay-at-home-order.html. Accessibility verified June 30, 2020.

Training Manual for Mental Health and Human Service Workers in Major Disasters

D J Dewolfe

DeWolfe DJ. Training Manual for Mental Health and Human Service Workers in Major Disasters. 2nd ed. HHS Publication No. ADM 90-538. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

The COVID-19 pandemic is straining families' abilities to afford basic needs

Jun 2020

M Karpman
S Zuckerman
D Gonzalez

Karpman M, Zuckerman S, Gonzalez D, et al. The COVID-19 pandemic is straining families' abilities to afford basic needs. Available at https://www.urban.org/sites/default/files/publication/102124/the-covid-19-pandemic-is-straining-families-abilitiesto-afford-basic-needs_2.pdf. Accessibility verified June 30, 2020.

Hispanic women, immigrants, young adults, those with less education hit hardest by COVID-19 job losses

Jun 2020

R Kochhar

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Jan 2019

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