A hidden pandemic? An umbrella review of global evidence on mental health in the time of COVID-19.

Background: The mental health impacts of the COVID-19 pandemic remain a public health concern. High quality synthesis of extensive global literature is needed to quantify this impact and identify factors associated with adverse outcomes. Methods: We conducted a rigorous umbrella review with meta-review and present (a) pooled prevalence of probable depression, anxiety, stress, psychological distress, and post-traumatic stress, (b) standardised mean difference in probable depression and anxiety pre-versus-during the pandemic period, and (c) comprehensive narrative synthesis of factors associated with poorer outcomes. Databases searched included Scopus, Embase, PsycINFO, and MEDLINE dated to March 2022. Eligibility criteria included systematic reviews and/or meta-analyses, published post-November 2019, reporting data in English on mental health outcomes during the COVID-19 pandemic. Findings: Three hundred and thirty-eight systematic reviews were included, 158 of which incorporated meta-analyses. Meta-review prevalence of anxiety symptoms ranged from 24.4% (95%CI: 18-31%, I 2: 99.98%) for general populations to 41.1% (95%CI: 23-61%, I 2: 99.65%) in vulnerable populations. Prevalence of depressive symptoms ranged from 22.9% (95%CI: 17-30%, I 2: 99.99%) for general populations to 32.5% (95%CI: 17-52%, I 2: 99.35) in vulnerable populations. Prevalence of stress, psychological distress and PTSD/PTSS symptoms were 39.1% (95%CI: 34-44%; I 2: 99.91%), 44.2% (95%CI: 32-58%; I 2: 99.95%), and 18.8% (95%CI: 15-23%; I 2: 99.87%), respectively. Meta-review comparing pre-COVID-19 to during COVID-19 prevalence of probable depression and probable anxiety revealed standard mean differences of 0.20 (95%CI = 0.07-0.33) and 0.29 (95%CI = 0.12-0.45), respectively. Conclusion: This is the first meta-review to synthesise the longitudinal mental health impacts of the pandemic. Findings show that probable depression and anxiety were significantly higher than pre-COVID-19, and provide some evidence that that adolescents, pregnant and postpartum people, and those hospitalised with COVID-19 experienced heightened adverse mental health. Policymakers can modify future pandemic responses accordingly to mitigate the impact of such measures on public mental health.

Feasibility of telehealth counselling pilot for people experiencing homelessness and/or complex needs: During COVID-19 and beyond.

ISSUES ADDRESSED: People experiencing homelessness and/or complex needs often require targeted health services to address unique vulnerabilities. COVID-19 restrictions acted as a barrier for this group accessing health and alcohol and other drug (AOD) treatment services. The Haymarket Foundation, an accommodation and health facility in Australia, transitioned from in-person AOD-counselling services to online consultations. Clients accessing these services were tracked, from March 2019 to November 2020, to assess the impact of the switch to telehealth on client retention. METHODS: Qualitative analysis of Haymarket clients' service experience surveys and quantitative descriptives of "no-show" (nonattended sessions) rates and survival analysis of client treatment separations were completed to assess the impact of transitioning to telehealth on client retention. RESULTS: Although the initial transition to telehealth in March 2020 minimally impacted client no-show rates, reinstated government restrictions in June/July 2020 coincided with increasing no-shows and a substantial increase in treatment exits without notice, especially amongst males. Qualitative analysis showed clients had mixed feelings towards telehealth: some attributed their dissatisfaction to the inability to build rapport with their counsellor online, or with COVID-19 in general. Others appreciated the availability and genuine care of their counsellors through either setting. CONCLUSIONS: Telehealth may be a feasible replacement for face-to-face AOD counselling for people experiencing homelessness, however further investigation needs to be conducted to understand factors associated with improved client retention. SO WHAT?: This pilot demonstrates telehealth may be a feasible ongoing feature of health promotion for vulnerable high-needs populations, including people experiencing homelessness who use substances.

In their own words: An Australian community sample's priority concerns regarding mental health in the context of COVID-19.

The COVID-19 pandemic has resulted in significant and unprecedented mental health impacts in Australia. However, there is a paucity of research directly asking Australian community members about their mental health experiences, and what they perceive to be the most important mental health issues in the context of the pandemic. This study utilises qualitative data from Alone Together, a longitudinal mixed-methods study investigating the effects of COVID-19 on mental health in an Australian community sample (N = 2,056). A total of 1,037 participants, ranging in sex (69.9% female), age (M = 40-49 years), state/territory of residence, and socioeconomic status, shared responses to two open-ended questions in the first follow up survey regarding their mental health experiences and priorities during COVID-19. Responses were analysed using thematic analysis. Participants described COVID-19 as primarily impacting their mental health through the disruption it posed to their social world and financial stability. A key concern for participants who reported having poor mental health was the existence of multiple competing barriers to accessing high quality mental health care. According to participant responses, the pandemic placed additional pressures on an already over-burdened mental health service system, leaving many without timely, appropriate support. Absent or stigmatising rhetoric around mental health, at both a political and community level, also prevented participants from seeking help. Insights gained from the present research provide opportunities for policymakers and health practitioners to draw on the expertise of Australians' lived experience and address priority issues through targeted policy planning. This could ultimately support a more responsive, integrated, and effective mental health system, during and beyond the COVID-19 pandemic.

Beware the "loneliness gap"? Examining emerging inequalities and long-term risks of loneliness and isolation emerging from COVID-19.

Emerging evidence suggests COVID lockdowns have not only increased the social problem of loneliness but widened the 'loneliness gap' between the most and least lonely people. Qualitative investigation can reveal why this gap might have increased, for whom, and whether the loneliness gap will remain long term. Using multi-wave qualitative survey data conducted during Australia's 2020 lockdown period and beyond, we examine personal experiences of interaction transitioning out of lockdown. We find substantial and uneven impacts of COVID lasting well beyond lockdown. Participants reported heightened loneliness attributable to: physical isolation, health anxieties, ceased activities, reduced connection quality, and poor motivation. COVID also created new interactive difficulties for singles, those with physical and mental disabilities, their carers, and those with low social capital. There was also reported 'pruning' of social networks (i.e. reduced bridging, increased bonding social capital), and evidence that increased digital interaction did not substitute for lost physical contact. Younger people also experienced isolating COVID-induced life disruptions (e.g. travel, university attendance etc). Findings suggest COVID has increased potential long-term inequalities in loneliness, highlight the post COVID risks faced by vulnerable groups, and suggest caution in advocating digital solutions as a panacea for diminished physical interaction in the post-pandemic world.