A longitudinal study of predictors of serious psychological distress during COVID-19 pandemic.

BACKGROUND: The prevalence of serious psychological distress (SPD) was elevated during the COVID-19 pandemic in the USA, but the relationships of SPD during the pandemic with pre-pandemic SPD, pre-pandemic socioeconomic status, and pandemic-related social stressors remain unexamined. METHODS: A probability-based sample (N = 1751) of the US population age 20 and over was followed prospectively from February 2019 (T1), with subsequent interviews in May 2020 (T2) and August 2020 (T3). Multinomial logistic regression was used to assess prospective relationships between T1 SPD with experiences of disruption of employment, health care, and childcare at T2. Binary logistic regression was then used to assess relationships of T1 SPD, and socioeconomic status and T2 pandemic-related stressors with T3 SPD. RESULTS: At T1, SPD was associated with age, race/ethnicity, and household income. SPD at T1 predicted disruption of employment (OR 4.5, 95% CI 1.4-3.8) and health care (OR 3.2, 95% CI 1.4-7.1) at T2. SPD at T1 (OR 10.2, 95% CI 4.5-23.3), low household income at T1 (OR 2.6, 95% CI 1.1-6.4), disruption of employment at T2 (OR 3.2, 95% CI 1.4-7.6), and disruption of healthcare at T2 (OR 3.3, 95% CI 1.5-7.2) were all significantly associated with elevated risk for SPD at T3. CONCLUSIONS: Elevated risk for SPD during the COVID-19 pandemic is related to multiple psychological and social pathways that are likely to interact over the life course. Policies and interventions that target individuals with pre-existing mental health conditions as well as those experiencing persistent unemployment should be high priorities in the mental health response to the pandemic.

Nature, nurture, (Neo-)nostalgia? Back-casting for a more socially and environmentally sustainable post-COVID future

Commentaries on lived experiences of COVID-19-induced ‘lockdown' have simultaneously directed public imaginations backwards to draw inspiration and fortitude from historical periods of national and global challenge, and forwards into futures characterised by greater environmental sensitivity and community resilience. In this article, we argue that individuals' and households' practical coping strategies from different phases of lockdown within the UK offer clues as to how adaptive embodiments of close connection – to nature and community – both inform contemporary practices of everyday resilience and signpost towards enablers of a more socially compassionate and environmentally sustainable future. Our novel approach to conceptualising post-COVID recovery draws on ‘back-casting' – an approach which envisages pathways towards alternative, ‘better' futures – to work back from the notion of sustainable lifestyles, through participants' narratives of coping in/with lockdown, to the forms of adaptation that provided solace and encouragement. We highlight how these embodied and emotional adaptations constitute a form of nascent ‘neo-nostalgia' capable of reaching beyond the enabling of coping mechanisms in the present to inform long-lasting capacity for individual and community resilience in the face of future socio-environmental crises.

The Experiences of Post-ICU COVID-19 Survivors: An Existential Perspective using Interpretative Phenomenological Analysis.

COVID-19 has highlighted the vulnerability of intensive care unit (ICU) patients and the negative sequelae associated with ICU treatment. While the potentially traumatic impact of ICU is well documented, less is known about the ICU survivor's subjective experience and how it influences life post-discharge. Existential psychology addresses the universal concerns of existence, including death, isolation, and meaninglessness, and offers a holistic view of human experience beyond diagnostic categories. An existential psychological understanding of ICU COVID-19 survivorship may therefore provide a rich account of what it means to be among the worst affected by a global existential crisis. This study employed interpretive phenomenological analysis of qualitative interviews with 10 post-ICU COVID-19 survivors (aged 18-78). Interviews were structured on existential psychology's 'Four Worlds' model that explores the physical, social, personal, and spiritual dimensions of human experience. The essential meaning of ICU COVID-19 survival was conceptualised as 'Trying to Reconnect with a Changed Reality' and consisted of four themes. The first, Between Shifting Realities in ICU, described the liminal nature of ICU and the need to ground oneself. The second, What it Means to Care and Be Cared For, captured the emotive nature of personal interdependence and reciprocity. The third, The Self is Different, described survivors' struggle to reconcile old and new selves. The fourth, A New Relationship with Life, outlined how survivors' experiences shaped their new worldviews. Findings evidence the value of holistic, existentially informed psychological support for ICU survivors.

Nature, nurture, (Neo-)nostalgia? Back-casting for a more socially and environmentally sustainable post-COVID future

Commentaries on lived experiences of COVID-19-induced ‘lockdown’ have simultaneously directed public imaginations backwards to draw inspiration and fortitude from historical periods of national and global challenge, and forwards into futures characterised by greater environmental sensitivity and community resilience. In this article, we argue that individuals’ and households’ practical coping strategies from different phases of lockdown within the UK offer clues as to how adaptive embodiments of close connection – to nature and community – both inform contemporary practices of everyday resilience and signpost towards enablers of a more socially compassionate and environmentally sustainable future. Our novel approach to conceptualising post-COVID recovery draws on ‘back-casting’ – an approach which envisages pathways towards alternative, ‘better’ futures – to work back from the notion of sustainable lifestyles, through participants’ narratives of coping in/with lockdown, to the forms of adaptation that provided solace and encouragement. We highlight how these embodied and emotional adaptations constitute a form of nascent ‘neo-nostalgia’ capable of reaching beyond the enabling of coping mechanisms in the present to inform long-lasting capacity for individual and community resilience in the face of future socio-environmental crises. (English) [ FROM AUTHOR] Resumen Los comentarios sobre las experiencias vividas en los ‘cierres’ inducidos por el COVID-19 han dirigido simultáneamente la imaginación del público hacia atrás para inspirarse y fortalecerse en los períodos históricos de desafío nacional y global, y hacia futuros caracterizados por una mayor sensibilidad ambiental y resiliencia comunitaria. En este artículo, argumentamos que las estrategias prácticas de los individuos para hacer frente a las diferentes fases del confinamiento dentro del Reino Unido ofrecen pistas sobre cómo las encarnaciones adaptativas de conexión cercana, con la naturaleza y la comunidad, informan las prácticas contemporáneas de resiliencia cotidiana y señalan hacia los facilitadores de un futuro más socialmente compasivo y ambientalmente sostenible. Nuestro enfoque novedoso para conceptualizar la recuperación post-COVID se basa en el ‘backcasting’, un enfoque que prevé caminos hacia futuros alternativos y ‘mejores’, para trabajar desde la noción de estilos de vida sostenibles, a través de las narrativas de los participantes sobre cómo hacer frente a los cierres, a las formas de adaptación que proporcionaban consuelo y aliento. Destacamos cómo estas adaptaciones corporales y emocionales constituyen una forma de ‘neo-nostalgia’ naciente, capaz de ir más allá de la habilitación de mecanismos para hacer frente a los problemas en el presente para informar la capacidad duradera de resiliencia individual y comunitaria frente a futuras crisis socioambientales. (Spanish) [ FROM AUTHOR] Résumé Les commentaires sur les expériences vécues pendant les « confinements » de la pandémie de COVID ont simultanément dirigé l’imaginaire du grand public vers le passé à la recherche d’inspiration et de courage dans les périodes historiques difficiles aux niveaux national et international, et vers des avenirs définis par plus de sensibilité écologique et de résilience collective. Dans cet article, nous soutenons que les stratégies d’adaptation pratiques des personnes et des foyers au cours des différentes phases de confinement au Royaume-Uni offrent des indices sur la manière dont les incarnations adaptatives des liens étroits (avec la nature et la communauté) façonnent à la fois les pratiques contemporaines de résilience quotidienne et ouvrent la voie à des catalyseurs pour un avenir avec une société plus humaine et un environnement plus durable. Notre approche originale pour conceptualiser la reprise après la pandémie de COVID s’appuie sur la « rétroprévision » (une approche qui envisage les directions vers un éventail d’avenirs « meilleurs ») pour commencer par la notion de mode de vie durable, puis les récits des participants sur leur adaptation au confinement pendant celui-ci, et enfin les formes d’adaptation qui ont apporté du réconfort et des encouragements.Nous soulignons la manière dont ces adaptations incarnées et émotionnelles constituent une forme de « néo-nostalgie » naissante, capable d’aller par-delà l’activation de mécanismes d’adaptation dans le présent pour façonner les capacités à long terme de la résilience des personnes et des communautés face aux crises socio-environnementales du futur. (French) [ FROM AUTHOR] Copyright of Social & Cultural Geography is the property of Routledge 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.)

The road to ‘local green recovery’: signposts from COVID-19 lockdown life in the UK

Responding to the conspicuous absence of reference to the local scale in national and global discourses of ?green recovery? from COVID-19, this paper articulates a series of interlinked research agendas united by a focus on what a ?green recovery? might involve at a local scale within the context of the United Kingdom. We argue that geography as a discipline is particularly well placed to contribute to theoretical and practical framings of ?green recovery? as manifested at and through a range of scales, including the micro (individual), meso (household) and what we term ?meso+? (neighbourhood). Specifically, we signpost what might be considered ?green shoots? worthy of urgent empirical investigation ? shifts in everyday life and practice catalysed by COVID-19 and with the potential to underpin longer-lasting transformations towards socially, economically and environmentally sustainable localities.

Hofbauer Cells and COVID-19 in Pregnancy.

CONTEXT.­: SARS-CoV-2 can undergo maternal-fetal transmission, heightening interest in the placental pathology findings from this infection. Transplacental SARS-CoV-2 transmission is typically accompanied by chronic histiocytic intervillositis together with necrosis and positivity of syncytiotrophoblast for SARS-CoV-2. Hofbauer cells are placental macrophages that have been involved in viral diseases, including HIV and Zika virus, but their involvement in SARS-CoV-2 is unknown. OBJECTIVE.­: To determine whether SARS-CoV-2 can extend beyond the syncytiotrophoblast to enter Hofbauer cells, endothelium, and other villous stromal cells in infected placentas of liveborn and stillborn infants. DESIGN.­: Case-based retrospective analysis by 29 perinatal and molecular pathology specialists of placental findings from a preselected cohort of 22 SARS-CoV-2-infected placentas delivered to pregnant women testing positive for SARS-CoV-2 from 7 countries. Molecular pathology methods were used to investigate viral involvement of Hofbauer cells, villous capillary endothelium, syncytiotrophoblast, and other fetal-derived cells. RESULTS.­: Chronic histiocytic intervillositis and trophoblast necrosis were present in all 22 placentas (100%). SARS-CoV-2 was identified in Hofbauer cells from 4 of 22 placentas (18.2%). Villous capillary endothelial staining was positive in 2 of 22 cases (9.1%), both of which also had viral positivity in Hofbauer cells. Syncytiotrophoblast staining occurred in 21 of 22 placentas (95.5%). Hofbauer cell hyperplasia was present in 3 of 22 placentas (13.6%). In the 7 cases having documented transplacental infection of the fetus, 2 (28.6%) occurred in placentas with Hofbauer cell staining positive for SARS-CoV-2. CONCLUSIONS.­: SARS-CoV-2 can extend beyond the trophoblast into the villous stroma, involving Hofbauer cells and capillary endothelial cells, in a small number of infected placentas. Most cases of SARS-CoV-2 transplacental fetal infection occur without Hofbauer cell involvement.

Do social isolation and neighborhood walkability influence relationships between COVID-19 experiences and wellbeing in predominantly Black urban areas?

Black Americans have been disproportionately affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) pandemic. Since the pandemic's start, we have observed compounded health, social, and economic impacts for communities of color, fueled in part by profound residential segregation in the United States that, for centuries prior to the pandemic, created differences in access to opportunity and resources. Based on a longitudinal cohort of Black residents living in two racially isolated Pittsburgh neighborhoods, we sought to: 1) describe the experiences of behavioral responses to COVID-19 conditions (e.g., closures of businesses, schools, government offices) and illness experiences reported by residents within these disinvested, urban areas and 2) determine if these experiences were associated with perceptions of risk, negative mental health outcomes, and food insecurity; and 3) examine whether any of the associations were explained by social isolation or modified by neighborhood walkability. We found direct associations between residents' experience with COVID-19-related closures and with the illness, with perceived risk, and change in psychological distress, sleep quality, and food insecurity from pre-COVID-19 levels. Social isolation was a statistically significant mediator of all of these associations, most strongly mediating the pathway to psychological distress. We found neighborhood walkability to be a significant moderator of the association between closure experiences and sleep quality. The results suggest that experiences of COVID-19 closures and illness were associated with serious threats to public health in Black, disinvested, urban neighborhoods, beyond those caused directly by the virus. Outcomes of the pandemic appear very much dependent on the extent to which social and physical resources are available to meet the demands of stress.

Perceived Need for Mental Health Treatment and the Mental Health Response to the COVID-19 Pandemic in the United States.

Objective: Population-based information on the extent of perceived need for mental health treatment and clinically significant psychological distress can help inform strategies for responding to the mental health impact of the COVID-19 pandemic.Methods: A representative sample of U.S. adults, age 20 and over (N = 1,957), completed surveys in May and June 2020. Potential target populations were distinguished based on perceived need for mental health treatment and psychological distress, assessed by the Kessler-6, among those without perceived need. Populations were characterized with respect to demographic characteristics and prior mental health treatment history using logistic regression models.Results: The prevalence of perceived need for mental health treatment was 21%. Perceived need was strongly associated with pre-pandemic treatment history; compared to those with no treatment history, perceived need was dramatically higher among those in treatment when the pandemic began (OR = 53.8 95% CI 28.2-102.8) and those with pre-pandemic treatment history (OR = 9.3, 95% CI 5.1-16.8). Among the 79% who did not perceive need, moderate or greater distress was reported by 19% and was associated with younger age and Hispanic ethnicity (OR = 2.1, 95% CI 1.2-3.6).Conclusions: In the U.S., where mental health treatment is relatively common, mental health treatment response during the pandemic, and perhaps other crises, should target people with a history of mental health treatment. Outreach to people less likely to seek care on their own despite clinically significant distress should target Hispanic populations.

Food Insecurity in a Low-Income, Predominantly African American Cohort Following the COVID-19 Pandemic.

Objectives. To examine the impact of COVID-19 shutdowns on food insecurity among a predominantly African American cohort residing in low-income racially isolated neighborhoods.Methods. Residents of 2 low-income African American food desert neighborhoods in Pittsburgh, Pennsylvania, were surveyed from March 23 to May 22, 2020, drawing on a longitudinal cohort (n = 605) previously followed from 2011 to 2018. We examined longitudinal trends in food insecurity from 2011 to 2020 and compared them with national trends. We also assessed use of food assistance in our sample in 2018 versus 2020.Results. From 2018 to 2020, food insecurity increased from 20.7% to 36.9% (t = 7.63; P < .001) after steady declines since 2011. As a result of COVID-19, the United States has experienced a 60% increase in food insecurity, whereas this sample showed a nearly 80% increase, widening a preexisting disparity. Participation in the Supplemental Nutrition Assistance Program (52.2%) and food bank use (35.9%) did not change significantly during the early weeks of the pandemic.Conclusions. Longitudinal data highlight profound inequities that have been exacerbated by COVID-19. Existing policies appear inadequate to address the widening gap.

Chronic Histiocytic Intervillositis With Trophoblast Necrosis Is a Risk Factor Associated With Placental Infection From Coronavirus Disease 2019 (COVID-19) and Intrauterine Maternal-Fetal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Transmission in Live-Born and Stillborn Infants.

CONTEXT.­: The number of neonates with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is increasing, and in a few there are reports of intrauterine infection. OBJECTIVE.­: To characterize the placental pathology findings in a preselected cohort of neonates infected by transplacental transmission arising from maternal infection with SARS-CoV-2, and to identify pathology risk factors for placental and fetal infection. DESIGN.­: Case-based retrospective analysis by a multinational group of 19 perinatal specialists of the placental pathology findings from 2 cohorts of infants delivered to mothers testing positive for SARS-CoV-2: live-born neonates infected via transplacental transmission who tested positive for SARS-CoV-2 after delivery and had SARS-CoV-2 identified in cells of the placental fetal compartment by molecular pathology, and stillborn infants with syncytiotrophoblast positive for SARS-CoV-2. RESULTS.­: In placentas from all 6 live-born neonates acquiring SARS-CoV-2 via transplacental transmission, the syncytiotrophoblast was positive for coronavirus using immunohistochemistry, RNA in situ hybridization, or both. All 6 placentas had chronic histiocytic intervillositis and necrosis of the syncytiotrophoblast. The 5 stillborn/terminated infants had placental pathology findings that were similar, including SARS-CoV-2 infection of the syncytiotrophoblast, chronic histiocytic intervillositis, and syncytiotrophoblast necrosis. CONCLUSIONS.­: Chronic histiocytic intervillositis together with syncytiotrophoblast necrosis accompanies SARS-CoV-2 infection of syncytiotrophoblast in live-born and stillborn infants. The coexistence of these 2 findings in all placentas from live-born infants acquiring their infection prior to delivery indicates that they constitute a pathology risk factor for transplacental fetal infection. Potential mechanisms of infection of the placenta and fetus with SARS-CoV-2, and potential future studies, are discussed.

A longitudinal study of psychological distress in the United States before and during the COVID-19 pandemic.

The COVID-19 pandemic has caused financial stress and disrupted daily life more quickly than any prior economic downturn and on a scale beyond any prior natural disaster. This study aimed to assess the impact of the pandemic on psychological distress and identify vulnerable groups using longitudinal data to account for pre-pandemic mental health status. Clinically significant psychological distress was assessed with the Kessler-6 in a national probability sample of adults in the United States at two time points, February 2019 (T1) and May 2020 (T2). To identify increases in distress, psychological distress during the worst month of the past year at T1 was compared with psychological distress over the past 30-days at T2. Survey adjusted logistic regression was used to estimate associations of demographic characteristics at T1 (gender, age, race, and income) and census region at T2 with within-person increases in psychological distress. The past-month prevalence of serious psychological distress at T2 was as high as the past-year prevalence at T1 (10.9% vs. 10.2%). Psychological distress was strongly associated across assessments (X2(4) = 174.6, p < .0001). Increase in psychological distress above T1 was associated with gender, age, household income, and census region. Equal numbers of people experienced serious psychological distress in 30-days during the pandemic as did over an entire year prior to the pandemic. Mental health services and research efforts should be targeted to those with a history of mental health conditions and groups identified as at high risk for increases in distress above pre-pandemic levels.

Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection.

Importance: Published data suggest that there are increased hospitalizations, placental abnormalities, and rare neonatal transmission among pregnant women with coronavirus disease 2019 (COVID-19). Objectives: To evaluate adverse outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy and to describe clinical management, disease progression, hospital admission, placental abnormalities, and neonatal outcomes. Design, Setting, and Participants: This observational cohort study of maternal and neonatal outcomes among delivered women with and without SARS-CoV-2 during pregnancy was conducted from March 18 through August 22, 2020, at Parkland Health and Hospital System (Dallas, Texas), a high-volume prenatal clinic system and public maternity hospital with widespread access to SARS-CoV-2 testing in outpatient, emergency department, and inpatient settings. Women were included if they were tested for SARS-CoV-2 during pregnancy and delivered. For placental analysis, the pathologist was blinded to illness severity. Exposures: SARS-CoV-2 infection during pregnancy. Main Outcomes and Measures: The primary outcome was a composite of preterm birth, preeclampsia with severe features, or cesarean delivery for abnormal fetal heart rate among women delivered after 20 weeks of gestation. Maternal illness severity, neonatal infection, and placental abnormalities were described. Results: From March 18 through August 22, 2020, 3374 pregnant women (mean [SD] age, 27.6 [6] years) tested for SARS-CoV-2 were delivered, including 252 who tested positive for SARS-CoV-2 and 3122 who tested negative. The cohort included 2520 Hispanic (75%), 619 Black (18%), and 125 White (4%) women. There were no differences in age, parity, body mass index, or diabetes among women with or without SARS-CoV-2. SARS-CoV-2 positivity was more common among Hispanic women (230 [91%] positive vs 2290 [73%] negative; difference, 17.9%; 95% CI, 12.3%-23.5%; P < .001). There was no difference in the composite primary outcome (52 women [21%] vs 684 women [23%]; relative risk, 0.94; 95% CI, 0.73-1.21; P = .64). Early neonatal SARS-CoV-2 infection occurred in 6 of 188 tested infants (3%), primarily born to asymptomatic or mildly symptomatic women. There were no placental pathologic differences by illness severity. Maternal illness at initial presentation was asymptomatic or mild in 239 women (95%), and 6 of those women (3%) developed severe or critical illness. Fourteen women (6%) were hospitalized for the indication of COVID-19. Conclusions and Relevance: In a large, single-institution cohort study, SARS-CoV-2 infection during pregnancy was not associated with adverse pregnancy outcomes. Neonatal infection may be as high as 3% and may occur predominantly among asymptomatic or mildly symptomatic women. Placental abnormalities were not associated with disease severity, and hospitalization frequency was similar to rates among nonpregnant women.

Intrauterine Transmission of SARS-COV-2 Infection in a Preterm Infant.

We present a preterm infant who developed a fever and mild respiratory disease on the second day of life. Infant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nasopharyngeal testing was positive at 24 and 48 hours of life. Placenta histopathology revealed SARS-CoV-2 infection by electron microscopy and immunohistochemistry. Further understanding of the risk factors that lead to in utero transmission of SARS-CoV-2 infection is needed.