AGE AND COMORBIDITIES PREDICT COVID-19 OUTCOME REGARDLESS OF SEVERITY OF INNATE IMMUNE RESPONSE

B Methods: b A prospective cohort study of severely ill COVID-19 patients requiring ICU level care was performed to assess the contributions of age, comorbidities, and innate immune response on mortality. B Introduction/Hypothesis: b Although, SARS-CoV-2-induced hyperinflammation is one of the mechanisms underlying this severe mortality, the association between age and innate immune response in COVID-19 mortality remains unclear. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Meta-Analytic Evidence of Depression and Anxiety in Eastern Europe during the COVID-19 Pandemic (preprint)

Objective: To perform a systematic and meta-analysis on the prevalence rates of mental health symptoms including anxiety and depression during the COVID-19 pandemic in the general population in Eastern Europe, as well as three select sub-populations: students, general healthcare workers, and frontline healthcare workers. Data sources: Studies in PubMed, Embase, Web of Science, Psycinfo, and medRxiv up to February 6, 2021. Eligibility criteria and data analysis: Prevalence rates of mental health symptoms in the general population and key sub-populations during the COVID-19 pandemic in Eastern Europe. Data were pooled using a random-effects meta-analysis to estimate the prevalence rates of anxiety and depression. Results: The meta-analysis identifies and includes 21 studies and 26 independent samples in Eastern Europe. Poland (n=4), Serbia (n=4), Russia (n=3), and Croatia (n=3) had the greatest number of studies. To our knowledge, no studies have been conducted in eleven Eastern European countries including Hungary, Slovakia, and Slovenia. The pooled prevalence of anxiety in 18 studies with 22 samples was 30% (95% CI: 24%-37%) and pooled prevalence of depression in 18 studies with 23 samples was 27% (95% CI: 21%-34%). Implications: The cumulative evidence from the meta-analysis reveals high prevalence rates of clinically significant symptoms during the COVID-19 pandemic in Eastern Europe. The findings suggest evidence of a potential mental health crisis in Eastern Europe during the ongoing COVID-19 pandemic. Our synthesis also reveals a relative lack of studies in certain Eastern European countries as well as high heterogeneities among the existing studies, calling for more effort to achieve evidence-based mental healthcare in Eastern Europe. Keywords: COVID-19; Epidemic; General Population; Healthcare Workers; Frontline Healthcare Workers; Psychiatry Highlights: The pooled prevalence of anxiety and depression were 30% and 27% in Eastern Europe, respectively.

A Systematic Review and Meta-Analysis of the Mental Health Symptoms during the Covid-19 Pandemic in Southeast Asia (preprint)

ABSTRACT Aims The Covid-19 pandemic has had a substantial impact on the mental health of the general public and high-risk groups worldwide. Due to its proximity and close links to China, Southeast Asia was one of the first regions to be affected by the outbreak. The aim of this systematic review was to evaluate the prevalence of anxiety, depression and insomnia in the general adult population and healthcare workers (HCWs) in Southeast Asia during the course of the first year of the pandemic. Methods Several literature databases were systemically searched for articles published up to February 2021 and two reviewers independently evaluated all relevant studies using pre-determined criteria. The prevalence rates of mental health symptoms were calculated using a random-effect meta-analysis model. Results In total, 32 samples from 25 studies with 20,352 participants were included. Anxiety was assessed in all 25 studies and depression in 15 studies with pooled prevalence rates of 22% and 16% respectively. Only two studies assessed insomnia, which was estimated at 19%. The prevalence of anxiety and depression was similar amongst frontline HCWs (18%), general HCWs (17%), and students (20%) whilst being noticeably higher in the general population (27%). Conclusions This is the first systematic review to investigate the mental health impact of the Covid-19 pandemic in Southeast Asia. A considerable proportion of the general population and HCWs reported mild to moderate symptoms of anxiety and depression; the pooled prevalence rater, however, remain significantly lower than those reported in other areas such as China and Europe.

Meta-Analytical Evidence on Mental Disorder Symptoms During the COVID-19 Pandemic in Latin America (preprint)

Background: There is a considerable increase in psychological morbidities during COVID-19 pandemic among several demographic groups, including healthcare workers, the general population, and students. Regional disparities across the globe do exist, but evidence on the prevalence of mental disorder symptoms as well as their heterogeneities in Latin America during the COVID-19 pandemic is lacking. The current study aims to provide meta-analytical evidence on mental disorder symptoms during COVID-19 among frontline healthcare workers, general healthcare workers, the general population, and university students in Latin America. Methods: Bibliographical databases, such as PubMed, Embase, Web of Sciences, PsycINFO, and medRxiv, were systematically searched to identify pertinent studies up to February 6, 2021. Two coders performed the screening using predefined eligibility criteria. Studies were assigned quality scores using the Mixed Methods Appraisal Tool. The double data extraction method was used to minimize data entry errors. The pooled prevalence of anxiety, depression, distress, and insomnia was calculated using a random-effects model. Doi plot and the Luis Furuya–Kanamori (LFK) index were used to quantify publication bias. Findings: A total of 33 studies with 101,772 participants in Latin America were identified. The pooled prevalence of anxiety, depression, distress, and insomnia was 32%, 27%, 32%, and 35%, respectively. There was a higher prevalence of mental health symptoms in South America compared to Central America (33% vs. 27%, p <0.001). The pooled prevalence of mental health symptoms in the general population, general healthcare workers, frontline healthcare workers, and students in Latin America was 33%, 31%, 37%, and 36%, respectively. Interpretation: The high yet heterogenous level of prevalence of mental disorder symptoms emphasizes the need for appropriate identification of and interventions for mental health needs in Latin America. The findings also highlight the heterogeneity of mental disorder symptoms during COVID-19 across population subgroups. The evidence suggests timely implementation of psychological interventions to address mental health.Registration Details: Registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020224458).Funding Information: Oregon State University College of Business provides research support.Declaration of Interests: All authors have completed the Unified Competing Interest form and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

A Systematic Review and Meta-Analysis on Mental Illness Symptoms in Spain in the COVID-19 Crisis (preprint)

Objective This paper systematically reviews and assesses the prevalence of anxiety, depression, and insomnia symptoms in the general population, frontline healthcare workers (HCWs), and adult students in Spain during the COVID-19 crisis. Data sources Articles in PubMed, Embase, Web of Science, PsycINFO, and medRxiv from March 2020 to February 6, 2021. Results The pooled prevalence of anxiety symptoms in 23 studies comprising a total sample of 85,560 was 20% (95% CI: 15% - 25%, I2 = 99.9%), that of depression symptoms in 23 articles with a total sample comprising of 86,469 individuals was 23% (95% CI: 18% - 28%, I2 = 99.8%), and that of insomnia symptoms in 4 articles with a total sample of 915 were 52% (95% CI: 42-64%, I2 = 88.9%). The overall prevalence of mental illness symptoms in frontline HCWs, general population, and students in Spain are 42%, 19%, and 50%, respectively. Discussion The accumulative evidence from the meta-analysis reveals that adults in Spain suffered higher prevalence rates of mental illness symptoms during the COVID-19 crisis with a significantly higher rate relative to other countries such as China. Our synthesis reveals high heterogeneity, varying prevalence rates and a relative lack of studies in frontline and general HCWs in Spain, calling future research and interventions to pay attention to those gaps to help inform evidence-based mental health policymaking and practice in Spain during the continuing COVID-19 crisis. The high prevalence rates call for preventative and prioritization measures of the mental illness symptoms during the Covid-19 pandemic.

One Year of Evidence on Mental Health in the COVID-19 Crisis - A Systematic Review and Meta-Analysis (preprint)

ABSTRACT Objective: This paper provides a systematic review and meta-analysis on the prevalence rate of mental health issues of the major population, including general population, general healthcare workers (HCWs), and frontline healthcare workers (HCWs), in China over one year of the COVID-19 crisis. Design: A systematic review and meta-analysis. Data sources: articles in PubMed, Embase, Web of Science, and medRxiv up to November 16, 2020, one year after the first publicly known confirmed COVID-19 case. Eligibility criteria and data analysis: any COVID-19 and mental disorders relevant English studies with frontline/general healthcare workers, general adult population sample, using validated scales. We pooled data using random-effects meta-analyses to estimate the prevalence rates of anxiety, depression, distress, general psychological symptoms (GPS), insomnia, and PTSD and ran meta-regression to tease out the heterogeneity. Results: The meta-analysis includes 131 studies and 171 independent samples. The overall prevalence of anxiety, depression, distress, GPS, insomnia, and PTSD are 11%, 13%, 20%, 13%, 19%, and 20%, respectively. The meta-regression results uncovered several predictors of the prevalence rates, including severity (e.g., above severe vs. above moderate, p<0.01; above moderate vs. above mild, p<0.01) and type of mental issues (e.g., depression vs. anxiety, p=0.04; insomnia vs. anxiety p=0.04), population (frontline HCWs vs. general HCWs, p<0.01), sampling location (Wuhan vs. non-Wuhan, p=0.04), and study quality (p=0.04). Limitations: First, we only focus on China population, which may limit the generalizability of the results. Second, 96.2% studies included in this meta-analysis were cross-sectional. Last, since we only included studies published in English, we expect to have a language bias. Conclusion: Our pooled prevalence rates are significantly different from, yet largely between, the findings of previous meta-analyses, suggesting the results of our larger study are consistent with, yet fine-tune, the findings of the smaller, previous meta-analyses. Hence, this meta-analysis not only provides a significant update on the mental health prevalence rates in COVID-19 but also suggests the need to update meta-analyses continuously to provide more accurate estimates of the prevalence of mental illness during this ongoing health crisis. While prior meta-analyses focused on the prevalence rates of mental health disorders based on one level of severity (i.e., above mild), our findings also suggest a need to examine the prevalence rates at varying levels of severity. The one-year cumulative evidence on sampling locations (Wuhan vs. non-Wuhan) corroborates the typhoon eye effect theory. Our finding that the prevalence rates of distress and insomnia and those of frontline healthcare workers are higher suggest future research and interventions should pay more attention to those mental outcomes and populations. Keywords: systematic review; meta-analysis; COVID-19; mental health; epidemic; general population; healthcare workers; frontline healthcare workers

Typhoon Eye Effect Vs. Ripple Effect: the Role of Family Size on the Mental Health Under the COVID-19 Pandemic in Pakistan (preprint)

Background: The recent outbreak of COVID-19 impacts the mental health of people worldwide. The mental conditions and the associated predictors of adults in Pakistan, the fifth most populous country in the world, during the COVID-19 remains understudied. We aim to investigate distress, anxiety, and overall mental health and their associated predictors among Pakistani adults in this pandemic. We specifically examine the mental health issues based on the distance to the epicenter, a predictor that has revealed opposing evidence in other countries based on the theories of typhoon eye effect and ripple effect. The samples consist of 601 adults who were surveyed online about 2.5 months into the outbreak across Pakistan with varying distance to the epicenter of COVID-19 of Karachi in Pakistan. Results: The results showed that 9.2% and 19.0% of the participants surpassed the cut-off of distress and anxiety disorders, respectively. Overall, the distance to the epicenter positively predicted the mental health of adults in Pakistan, and family size negatively moderated this effect. The distance to the epicenter negatively predicted distress and anxiety disorders for adults in large families, which are quite common in Pakistan. Conclusion: The evidence of the study interestingly finds the prediction of the mental health of people by their distance to the epicenter depends on the family. The evidence of this study can help to provide the initial indicator for mental health care providers to screen vulnerable groups in Pakistan, a populous country that continues struggling to cope with the COVID-19 pandemic.

Typhoon Eye Effect vs. Ripple Effect: The Role of Family Size on the Mental Health under the COVID-19 Pandemic in Pakistan (preprint)

BackgroundThe recent outbreak of COVID-19 impacts the mental health of people worldwide. The mental conditions and the associated predictors of adults in Pakistan, the fifth most populous country in the world, during the COVID-19 remains understudied. We aim to investigate distress, anxiety and overall mental health and their associated predictors among Pakistani adults in this pandemic. We specifically examine the mental health issues based on the distance to the epicenter, a predictor that has revealed opposing evidence in other countries based on the theories of typhoon eye effect and ripple effect. The samples consist of 601 adults who were surveyed online about 2.5 months into the outbreak across Pakistan with varying distance to the epicenter of COVID-19 of Karachi in Pakistan. ResultsThe results showed that 9.2% and 19.0% of the participants surpassed the cut-off of distress and anxiety disorders, respectively. Overall, the distance to the epicenter positively predicted the mental health of adults in Pakistan, and family size negatively moderated this effect. The distance to the epicenter negatively predicted distress and anxiety disorders for adults in large families, which are quite common in Pakistan. ConclusionThe evidence of the study interestingly finds the prediction of the mental health of people by their distance to the epicenter depends on the family. The evidence of this study can help to provide the initial indicator for mental health care providers to screen vulnerable groups in Pakistan, a populous country that continues to struggle to cope with the COVID-19 pandemic.

Typhoon Eye Effect Vs. Ripple Effect: The Role of Family Size on the Mental Health Under the Covid-19 Pandemic in Pakistan (preprint)

Background: The recent outbreak of COVID-19 impacts the mental health of people worldwide. The mental conditions and the associated predictors of adults in Pakistan, the fifth most populous country in the world, during the COVID-19 remains understudied. We aim to investigate distress, anxiety and overall mental health and their associated predictors among Pakistani adults in this pandemic. We specifically examine the mental health issues based on the distance to the epicenter, a predictor that has revealed opposing evidence in other countries based on the theories of typhoon eye effect and ripple effect. The samples consist of 601 adults who were surveyed online about 2.5 months into the outbreak across Pakistan with varying distance to the epicenter of COVID-19 of Karachi in Pakistan. Results: The results showed that 9.2% and 19.0% of the participants surpassed the cut-off of distress and anxiety disorders, respectively. Overall, the distance to the epicenter positively predicted the mental health of adults in Pakistan, and family size negatively moderated this effect. The distance to the epicenter negatively predicted distress and anxiety disorders for adults in large families, which are quite common in Pakistan. Conclusion: The evidence of the study interestingly finds the prediction of the mental health of people by their distance to the epicenter depends on the family. The evidence of this study can help to provide the initial indicator for mental health care providers to screen vulnerable groups in Pakistan, a populous country that continues to struggle to cope with the COVID-19 pandemic.