Living through the pandemic together: Exploring the associations among couples' communal orientation, self-disclosure, and thriving

The present study tested several pathways detailed in the theory of resilience and relational load (TRRL) in the context of urban couples living together during the COVID-19 pandemic. Fifty cohabitating couples completed a baseline assessment and 7 days of daily diaries. Results indicated that, the more an individual or their partner reported being communally oriented within their relationship at baseline, the greater that individual's relational thriving each day. Results also revealed that, the more an individual reported being communally oriented, the more they viewed their partner as engaging in self-disclosure each day. Two indirect effects emerged, such that one's own communal orientation positively predicted their perceptions of their partner's self-disclosure, which in turn predicted greater individual and relational thriving. These findings and their implications for the TRRL, couples' communication, and coping with pandemic-related stress are discussed.

Impact of early telemedicine follow-up on 30-Day hospital readmissions.

INTRODUCTION: Telemedicine is increasing in popularity but the impact of this shift on patient outcomes has not been well described. Prior data has shown that early post-discharge office visits can reduce readmissions. However, it is unknown if routine use of telemedicine visits for this purpose is similarly beneficial. MATERIALS AND METHODS: We conducted a retrospective observational study using electronic health records data to assess if the rate of 30-day hospital readmissions differed between modality of visit for primary care or cardiology post-discharge follow-up visits. RESULTS: Compared to discharges with completed in-person follow-up visits, the adjusted odds of readmission for those with telemedicine follow-up visits was not significantly different (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.61 to 1.51, P = 0.86). CONCLUSIONS: Our study showed that 30-day readmission rate did not differ significantly according to the modality of visit. These results provide reassurance that telemedicine visits are a safe and viable alternative for primary care or cardiology post-hospitalization follow-up.

The associations of COVID-19 percent positivity rate, relationship quality, and season with daily anxiety and depression in couples living in NYC.

Background: The COVID-19 pandemic changed nearly every aspect of daily life and had detrimental effects on mental health. Yet, impacts have been heterogeneous. We tested whether fluctuations in local COVID-19 percent positivity rates were associated with daily anxiety and depression in couples living in NYC, as well as whether these associations varied by relationship quality or season. We expected that adverse impacts of COVID-19 may be attenuated by high-quality relationships and during warmer months, or that people may habituate over time. Methods: Data on seven-day rolling average COVID-19 percent positive rate each day in NYC were merged with a 14-day dyadic diary study of cohabiting couples living in NYC between August 2020 through April 2021 (232 individuals from 116 couples; mean age 28.42 years, 52.59% female, 53.02% White). Dyadic multilevel models estimated the association COVID-19 positivity rate, season (sine and cosine of the calendar date), baseline relationship quality, and all two-and three-way interactions of these variables with daily anxiety and depression. Covariates included weekend and COVID-positive case within the couple. Results: Anxiety and depression mirrored COVID-19 positivity rates, and there was some evidence for habituation over time. Significant two-and three-way interactions suggested that being in a high-quality relationship buffered the association of COVID-19 positivity rate with both anxiety and depression during months when cases were low. Anxiety was elevated for individuals in high- (v. low-) quality relationships during the December-January surge. Conclusion: Seven-day rolling average COVID-19 percent positivity rate was associated with daily anxiety and depression among couples living in NYC. There was some evidence that individuals habituated to this stressor over time and that high-quality relationships were protective for mental well-being; however, there was some suggestion that couples in high-quality relationships may have engaged in processes such as co-rumination during surges, worsening their daily anxiety.

Critical Care Clinicians' Experiences of Patient Safety During the COVID-19 Pandemic.

OBJECTIVE: It is unknown how hospital- and systems-level factors have impacted patient safety in the intensive care unit (ICU) during the COVID-19 pandemic. We sought to understand how the pandemic has exacerbated preexisting patient safety issues and created novel patient safety challenges in ICUs in the United States. METHODS: We performed a national, multi-institutional, mixed-methods survey of critical care clinicians to elicit experiences related to patient safety during the pandemic. The survey was disseminated via email through the Society of Critical Care Medicine listserv. Data were reported as valid percentages, compared by COVID caseload and peak of the pandemic; free-text responses were analyzed and coded for themes. RESULTS: We received 335 survey responses. On general patient safety, 61% felt that conditions were more hazardous when compared with the prepandemic period. Those who took care of mostly COVID-19 patients were more likely to perceive that care was more hazardous (odds ratio, 4.89; 95% CI, 2.49-9.59) compared with those who took care of mostly non-COVID-19 or no COVID-19 patients. In free-text responses, providers identified patient safety risks related to pandemic adaptations, such as ventilator-related lung injury, medication and diagnostic errors, oversedation, oxygen device removal, and falls. CONCLUSIONS: Increased COVID-19 case burden was significantly associated with perceptions of a less safe patient care environment by frontline ICU clinicians. Results of the qualitative analysis identified specific patient safety hazards in ICUs across the United States as downstream consequences of hospital and provider strain during periods of the COVID-19 pandemic.

COVID-19 distress and interdependence of daily emotional intimacy, physical intimacy, and loneliness in cohabiting couples

Introduction: COVID-19 has had a profound impact on relationship functioning, though effects have been heterogeneous. Reasons for divergent effects on relationship functioning remain unclear. Theoretical models suggest that it is not just stress exposure that leads to adverse relationships outcomes, but also subjective response to these stressors. Using data from a 14-day intensive longitudinal study of romantic dyads, we hypothesized that COVID-19-related distress would adversely impact one’s own and one’s partner’s report of relationship functioning, on average. Interdependence at the trait level (random effects between couples) and day level (residuals within couples) was also examined. Methods: Participants were 104 female-male romantic couples cohabiting the New York metropolitan area (Mage = 28.86, SDage = 7.69) between August 2020 – April 2021. Couples reported COVID-19 distress during a baseline interview and daily relationship functioning for 14 days. Multilevel models were specified for six outcomes simultaneously: female and male partner daily physical intimacy, emotional intimacy, and loneliness. Interrelationships of the intercepts of the six outcomes were specified, reflecting trait-level associations of each partner’s stable outcome tendencies. Interrelationships of the daily residuals of the six outcomes were also specified, reflecting within-couple associations at the daily level. Results: Female partner COVID-19 distress was inversely associated with her own emotional and physical intimacy and positively associated with her own and her partner’s loneliness. Male COVID-19 distress was associated with his own loneliness only. There was significant interdependence at both levels, such that greater loneliness in either partner was associated with less intimacy in each member of the couple. Discussion: Only one partner effect for COVID-19 distress emerged, such that female partner distress was associated with male partner loneliness;however, trait- and day-level interdependence suggested that distress may adversely impact relational well-being over time. Future studies should examine reciprocal relationships between COVID-19-related distress and relationship functioning.

The association between sleep and psychological distress among New York City healthcare workers during the COVID-19 pandemic.

BACKGROUND: Healthcare workers (HCWs) treating patients with COVID-19 report psychological distress. We examined whether disturbed sleep was associated with psychological distress in New York City (NYC) HCWs during the initial peak of the COVID-19 pandemic (April-May 2020). METHODS: HCWs completed a survey screening for acute stress (4-item Primary Care PTSD screen), depressive (Patient Health Questionaire-2), and anxiety (2-item Generalized Anxiety Disorder scale) symptoms. Insomnia symptoms (modified item from the Insomnia Severity Index) and short sleep (SS, sleep duration <6 h/day) were assessed. Poisson regression analyses predicting psychological distress from SS and insomnia symptoms, adjusting for demographics, clinical role/setting, redeployment status, shifts worked, and multiple comparisons were performed. RESULTS: Among 813 HCWs (80.6% female, 59.0% white) mean sleep duration was 5.8 ± 1.2 h/night. Prevalence of SS, insomnia, acute stress, depressive, and anxiety symptoms were 38.8%, 72.8%, 57.9%, 33.8%, and 48.2%, respectively. Insomnia symptoms was associated with acute stress (adjusted prevalence ratio [PR]: 1.51, 95% CI: 1.35, 1.69), depressive (PR: 2.04, 95% CI: 1.78, 2.33), and anxiety (PR: 1.74, 95% CI: 1.55, 1.94) symptoms. SS was also associated with acute stress (PR: 1.17, 95% CI: 1.07, 1.29), depressive (PR: 1.36, 95% CI: 1.233, 1.51), and anxiety (PR: 1.38, 95% CI: 1.26, 1.50) symptoms. LIMITATIONS: Our cross-sectional analysis may preclude the identification of temporal associations and limit causal claims. CONCLUSIONS: In our study, SS and insomnia were associated with psychological distress symptoms in NYC HCWs during the COVID-19 pandemic. Sleep may be a target for interventions to decrease psychological distress among HCWs.

The Association between Sleep and Psychological Distress among New York City Healthcare Workers during the COVID-19 Pandemic

Background Healthcare workers (HCWs) treating patients with COVID-19 report psychological distress. We examined whether disturbed sleep was associated with psychological distress in New York City (NYC) HCWs during the initial peak of the COVID-19 pandemic (April-May 2020). Methods HCWs completed a survey screening for acute stress (4-item Primary Care PTSD screen), depressive (Patient Health Questionaire-2), and anxiety (2-item Generalized Anxiety Disorder scale) symptoms. Insomnia symptoms (modified item from the Insomnia Severity Index) and short sleep (SS, sleep duration <6 hours/day) were assessed. Poisson regression analyses predicting psychological distress from SS and insomnia symptoms, adjusting for demographics, clinical role/setting, redeployment status, shifts worked, and multiple comparisons were performed. Results Among 813 HCWs (80.6% female, 59.0% white) mean sleep duration was 5.8±1.2 hours/night. Prevalence of SS, insomnia, acute stress, depressive, and anxiety symptoms were 38.8%, 72.8%, 57.9%, 33.8%, and 48.2%, respectively. Insomnia symptoms was associated with acute stress (adjusted prevalence ratio [PR]: 1.51, 95% CI: 1.35, 1.69), depressive (PR: 2.04, 95% CI: 1.78, 2.33), and anxiety (PR: 1.74, 95% CI: 1.55, 1.94) symptoms. SS was also associated with acute stress (PR: 1.17, 95% CI: 1.07, 1.29), depressive (PR: 1.36, 95% CI: 1.233, 1.51), and anxiety (PR: 1.38, 95% CI: 1.26, 1.50) symptoms. Limitations Our cross-sectional analysis may preclude the identification of temporal associations and limit causal claims. Conclusions In our study, SS and insomnia were associated with psychological distress symptoms in NYC HCWs during the COVID-19 pandemic. Sleep may be a target for interventions to decrease psychological distress among HCWs.

Relationship quality and objectively measured physical activity before and after implementation of COVID-19 stay-home orders.

In a sample of 28 individuals cohabiting with a partner in NYC, Boston, or Chicago, this study tested whether implementation of stay-home orders to combat the spread of COVID-19 disrupted physical activity and whether high-quality romantic relationships buffered adverse effects. Participants provided FitBit data between February and October, 2020. Stay-home orders were associated with a reduction in daily step counts, B = -1595.72, p = 0.018, increased sedentary minutes, B = 33.75, p = 0.002, and reduced daily minutes of light and moderate physical activity, B = -25.01, p = 0.011; B = -0.72, p = 0.021. No moderation effects emerged.

Association of Hispanic ethnicity and linguistic acculturation with cardiovascular medication adherence in patients with suspected acute coronary syndrome.

Despite a higher prevalence of cardiovascular disease (CVD) risk factors, Hispanic-Americans have lower rates of CVD-related and all-cause mortality, as well as higher life expectancy than non-Hispanic whites - a phenomenon known as the Hispanic health paradox. However, this survival benefit attenuates with increased acculturation to Western lifestyles, potentially due to adoption of unhealthy behaviors. Accordingly, we assessed whether Hispanic ethnicity and linguistic acculturation, as measured by English proficiency, were associated with nonadherence to cardiovascular medications. We enrolled patients presenting to an academic medical center emergency department with suspected acute coronary syndrome between May 2014 and November 2017. Ethnicity, native language, and English proficiency were self-reported. Cardiovascular medication adherence was assessed using an electronic pill bottle that recorded the date and time of each bottle opening. Generalized linear models with a logit link were used to examine the association of Hispanic ethnicity and English proficiency with daily cardiovascular medication adherence, adjusting for demographics, comorbidities, and dosing frequency of the electronically-monitored medication. Among 332 included patients, mean age was 61.68 ± 12.05 years, 43.07% were women, and 62.95% were Hispanic, of whom 80.38% were native Spanish-speakers. Overall, Hispanics had higher odds of medication adherence than non-Hispanics (adjusted OR 1.31, 95% CI 1.16-1.49, p < 0.001). However, among native Spanish-speaking Hispanics, greater English proficiency was associated with lower odds of medication adherence (adjusted OR 0.80 per 1-point increase in English proficiency, 95% CI 0.75-0.86, p < 0.001). Although Hispanics had better medication adherence than non-Hispanics overall, increased linguistic acculturation among native Spanish-speakers was associated with worse adherence behaviors.

The association of transmission concerns and social distance from loved ones with distress in medical professionals providing care during the COVID-19 pandemic in New York City.

BACKGROUND: Health care workers (HCWs) during the COVID-19 pandemic report high levels of psychological distress. We examined whether concerns regarding transmission of COVID-19 to loved ones and social distancing from loved ones were associated with HCWs' distress. We tested whether living with others modified these associations. METHOD: HCWs at a New York City academic medical center (N = 767; 80.7% female, 58.5% White) enrolled in the COVID-19 Health Care Provider Study and completed a web-based survey between April 9, 2020 and May 11, 2020. RESULTS: Controlling for demographics, distress regarding potential transmission to loved ones and social distancing from loved ones were each significantly associated with higher odds of a positive screen for acute stress, depression, and anxiety (ORs = 1.29-1.59, all ps < .01). Living with others was associated with lower odds of a positive screen for depression and anxiety, though the protective effect for anxiety was evident only for HCWs with no distress regarding transmission concerns. CONCLUSIONS: Transmission concerns and social distancing from loved ones were associated with greater odds of psychological distress, whereas living with others was associated with lower odds of distress. Interventions should consider ways to facilitate the ability of HCWs to receive social support from loved ones, while simultaneously protecting their family's health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic.

OBJECTIVE: The mental health toll of COVID-19 on healthcare workers (HCW) is not yet fully described. We characterized distress, coping, and preferences for support among NYC HCWs during the COVID-19 pandemic. METHODS: This was a cross-sectional web survey of physicians, advanced practice providers, residents/fellows, and nurses, conducted during a peak of inpatient admissions for COVID-19 in NYC (April 9th-April 24th 2020) at a large medical center in NYC (n = 657). RESULTS: Positive screens for psychological symptoms were common; 57% for acute stress, 48% for depressive, and 33% for anxiety symptoms. For each, a higher percent of nurses/advanced practice providers screened positive vs. attending physicians, though housestaff's rates for acute stress and depression did not differ from either. Sixty-one percent of participants reported increased sense of meaning/purpose since the COVID-19 outbreak. Physical activity/exercise was the most common coping behavior (59%), and access to an individual therapist with online self-guided counseling (33%) garnered the most interest. CONCLUSIONS: NYC HCWs, especially nurses and advanced practice providers, are experiencing COVID-19-related psychological distress. Participants reported using empirically-supported coping behaviors, and endorsed indicators of resilience, but they also reported interest in additional wellness resources. Programs developed to mitigate stress among HCWs during the COVID-19 pandemic should integrate HCW preferences.