Association between the Onset of the COVID-19 Pandemic and Mental Health Outcomes among Patients Enrolled in a Supported Digital Health Intervention (preprint)

Objective: This study compared mental health outcomes among people enrolled in an evidence-based digital mental health intervention before and during the onset of the COVID-19 pandemic. Methods: Growth curve modeling was used to evaluate changes in biweekly depression and anxiety scores from 131 adults who participated pre- (2019; n=51) versus during- (2020; n=80) pandemic onset. Results: Individuals who completed the intervention during the pandemic (2020) had less steep declines in depression symptoms than those who participated pre-pandemic (2019). Despite an initial relative increase in anxiety and depression scores at the onset of the pandemic, differences in overall change in outcomes between the two cohorts were not evident by program completion. Conclusions: Participation in an evidence-based, digital mental health intervention during the onset of the COVID-19 pandemic was associated with similar magnitudes of symptom improvement as participation before the pandemic.

HIV and SARS-CoV-2 infection in postpartum Kenyan women and their infants (preprint)

ABSTRACT Background HIV may increase SARS-CoV-2 infection risk and COVID-19 severity generally, but data are limited about its impact on postpartum women and their infants. As such, we characterized SARS-CoV-2 infection among mother-infant pairs in Nairobi, Kenya. Methods We conducted a nested study of 53 HIV-uninfected and 51 healthy women living with HIV, as well as their HIV-exposed uninfected (N=41) and HIV-unexposed (N=48) infants, participating in a prospective cohort. SARS-CoV-2 serology was performed on plasma collected between 1 May-31 December 2020 to determine the incidence, risk factors, and symptoms of infection. SARS-CoV-2 RNA PCR and sequencing was also performed on stool samples from seropositive participants. Results SARS-CoV-2 seropositivity was found in 38% of the 104 mothers and in 17% of the 89 infants. There was no significant association between SARS-CoV-2 infection and maternal HIV (Hazard Ratio [HR]=1.51, 95% CI: 0.780-2.94) or infant HIV exposure (HR=1.48, 95% CI: 0.537-4.09). Maternal SARS-CoV-2 was associated with a >10-fold increased risk of infant infection (HR=10.3, 95% CI: 2.89-36.8). Twenty percent of participants had symptoms, but no participant experienced severe COVID-19 or death. Seroreversion occurred in ∼30% of mothers and infants. SARS-CoV-2 sequences obtained from stool were related to contemporaneously circulating variants. Conclusions These data indicate that postpartum Kenyan women and their infants were at high risk for SARS-CoV-2 infection in 2020, and that antibody responses waned rapidly. However, most cases were asymptomatic and healthy women living with HIV did not have a substantially increased risk of infection or severe COVID-19.

Rapid Assessment of Psychological and Epidemiological Correlates of COVID-19 Concern, Financial Strain, and Health-Related Behavior Change in a Large Online Sample (preprint)

COVID-19 emerged in November 2019 leading to a global pandemic that has not only resulted in widespread medical complications and loss of life, but has also impacted global economies and transformed daily life. The current rapid response study in a convenience online sample quickly recruited 2,065 participants across the United States, Canada, and Europe in late March and early April 2020. Cross-sectional findings indicated elevated anxiety and depressive symptoms compared to historical norms, which were associated with COVID-19 concern more strongly than epidemiological data signifying objective risk. Employment loss was associated with greater depressive symptoms and COVID-19 concern, and depressive symptoms and COVID-19 concern were significantly associated with more stringent self-quarantine behavior. The rapid collection of data during the early phase of this pandemic is limited by under-representation of non-Caucasians and middle age and older adults. Nevertheless, these findings have implications for interventions to slow the spread of COVID-19 inflection.