Acute and longer-term psychological distress associated with testing positive for COVID-19: longitudinal evidence from a population-based study of US adults.

BACKGROUND: The novel coronavirus (SARS-CoV-2) has produced a considerable public health burden but the impact that contracting the disease has on mental health is unclear. In this observational population-based cohort study, we examined longitudinal changes in psychological distress associated with testing positive for coronavirus disease 2019 (COVID-19). METHODS: Participants (N = 8002; observations = 139 035) were drawn from 23 waves of the Understanding America Study, a nationally representative probability-based online panel of American adults followed-up every 2 weeks from 1 April 2020 to 15 February 2021. Psychological distress was assessed using the standardized total score on the Patient Health Questionnaire-4. RESULTS: Over the course of the study, 576 participants reported testing positive for COVID-19. Using regression analysis including individual and time-fixed effects we found that psychological distress increased by 0.29 standard deviations (p < 0.001) during the 2-week period when participants first tested positive for COVID-19. Distress levels remained significantly elevated (d = 0.16, p < 0.01) for a further 2 weeks, before returning to baseline levels. Coronavirus symptom severity explained changes in distress attributable to COVID-19, whereby distress was more pronounced among those whose symptoms were more severe and were slower to subside. CONCLUSIONS: This study indicates that testing positive for COVID-19 is associated with an initial increase in psychological distress that diminishes quickly as symptoms subside. Although COVID-19 may not produce lasting psychological distress among the majority of the general population it remains possible that a minority may suffer longer-term mental health consequences.

Trends in eating disorder risk among U.S. college students, 2013-2021.

Despite concerns about rising rates of mental health problems among college students in recent years, little is known about trends in eating disorder (ED). This study examined data from the 2013-2020/2021 Healthy Minds Study (HMS), a large study of US college students (N = 267,599). Students completed the SCOFF scale, a validated measure of ED symptoms. From 2013 to 2020/2021 the prevalence of ED risk increased significantly from 15% to 28% (13% increase, 95% CI, 12.2-13.9) with young, female, and Hispanic students experiencing the largest increases. ED risk increased significantly by 3 percentage points (95% CI, 1.7-4.2) during the COVID-19 pandemic.

Worker Stress, Burnout, and Wellbeing Before and During the COVID-19 Restrictions in the United Kingdom.

COVID-19 created a transformational shift in the working environment for much of the labour force, yet its impact on workers is unclear. This study uses longitudinal data to examine the wellbeing of 621 full-time workers assessed before (November 2019-February 2020) and during (May-June 2020) the first lockdown in the United Kingdom. We employ fixed effects analyses to investigate the impact of the restrictions and mandatory homeworking on cognitive, emotional, and psychological wellbeing. Within the sample, the rate of full-time homeworking increased from 2 to 74% between waves. We identify significant changes in 9 of the 15 measures assessed, with a general pattern of improvements in wellbeing during lockdown. Overall levels of stress, self-rated mental health, positive emotions and life and job satisfaction are not adversely affected by the restrictions. There is a reduction in the burnout symptoms of disengagement (-0.13 sd) and exhaustion (-0.20 sd) and in the frequency with which negative emotions are experienced at work (-0.15 sd). Workers feel more autonomous (+0.09 sd), closer to their co-workers (+0.10 sd), and more attached to their organisations (+0.19 sd). However, homelife satisfaction declines (-0.11 sd). These findings highlight the possibility that the COVID-19 pandemic and large-scale transition to homeworking was associated with unchanged or improved worker wellbeing. This study has important implications for governments and employers regarding a global shift to homeworking.

Psychological distress associated with the second COVID-19 wave: Prospective evidence from the UK Household Longitudinal Study.

BACKGROUND: In late 2020 a second wave of COVID-19 infections occurred in many countries and resulted in a national lockdown in the UK including stay at home orders and school closures. This study aimed to compare the prevalence of psychological distress before and during the second COVID-19 wave in the UK. METHODS: This study drew on data from 10,657 participants from the nationally representative probability-based UK Household Longitudinal Study (UKHLS). The 12-item General Health Questionnaire (GHQ-12) assessment measure was used to detect the proportion of UK adults experiencing clinically significant psychological distress. Changes in distress levels associated with the second pandemic wave were examined between September 2020 and January 2021 using logistic regression and linear fixed-effects regression models. RESULTS: Longitudinal analyses showed that the prevalence of clinically significant distress rose by 5.8% (95% CI: 4.4-7.2) from 21.3% in September 2020 to 27.1% in January 2021, compared with a 2019 pre-pandemic estimate of 21% in this cohort. Fixed effects analyses confirmed that the second COVID-19 wave was associated with a significant within-person increase in distress (d = 0.15, p < .001). Increases were particularly pronounced among those with school-age children in the home. LIMITATIONS: A non-specific measure of mental health symptoms was utilized and it was not possible to separate the potential impact of the pandemic from other changes occurring in tandem within the study period. CONCLUSION: Clinically significant distress rose during the second wave of the COVID-19 pandemic and reached levels similar to those observed in the immediate aftermath of the first pandemic wave.

A systematic review and meta-analysis of longitudinal cohort studies comparing mental health before versus during the COVID-19 pandemic in 2020.

BACKGROUND: Increases in mental health problems have been observed during the COVID-19 pandemic. The objectives were to examine the extent to which mental health symptoms changed during the pandemic in 2020, whether changes were persistent or short lived, and if changes were symptom specific. METHODS: Systematic review and meta-analysis of longitudinal cohort studies examining changes in mental health among the same group of participants before vs. during the pandemic in 2020. RESULTS: Sixty-five studies were included. Compared to pre-pandemic outbreak, there was an overall increase in mental health symptoms observed during March-April 2020 (SMC = .102 [95% CI: .026 to .192]) that significantly declined over time and became non-significant (May-July SMC = .067 [95% CI: -.022 to .157]. Compared to measures of anxiety (SMC = 0.13, p = 0.02) and general mental health (SMC = -.03, p = 0.65), increases in depression and mood disorder symptoms tended to be larger and remained significantly elevated in May-July [0.20, 95% CI: .099 to .302]. In primary analyses increases were most pronounced among samples with physical health conditions and there was no evidence of any change in symptoms among samples with a pre-existing mental health condition. LIMITATIONS: There was a high degree of unexplained heterogeneity observed (I2s > 90%), indicating that change in mental health was highly variable across samples. CONCLUSIONS: There was a small increase in mental health symptoms soon after the outbreak of the COVID-19 pandemic that decreased and was comparable to pre-pandemic levels by mid-2020 among most population sub-groups and symptom types.

Trajectories of change in internalizing symptoms during the COVID-19 pandemic: A longitudinal population-based study.

BACKGROUND: Longitudinal data indicates that the mental health of the general population may not have been as badly affected by the COVID-19 pandemic as some had feared. Most studies examining change in mental health during the pandemic have assumed population homogeneity which may conceal evidence of worsening mental health for some. In this study, we applied a heterogeneous perspective to determine if there were distinct groups in the population characterised by different patterns of change in internalizing symptoms during the pandemic. METHODS: Self-report data were collected from a nationally representative sample of Irish adults (N = 1041) at four time-points between April and December 2020. RESULTS: In the entire sample, mean levels of internalizing symptoms significantly declined from March to December 2020. However, we identified four distinct groups with different patterns of change. The most common response was 'Resilience' (66.7%), followed by 'Improving' (17.9%), 'Worsening' (11.3%), and 'Sustained' (4.1%). Belonging to the 'Worsening' class was associated with younger age, city dwelling, current and past treatment for a mental health problem, higher levels of empathy, and higher levels of loneliness. LIMITATIONS: Sample attrition was relatively high and although this was managed using robust statistical methods, bias associated with non-responses cannot be entirely ruled out. CONCLUSION: The majority of adults experienced no change, or an improvement in internalizing symptoms during the pandemic, and a relatively small proportion of adults experienced a worsening of internalizing symptoms. Limited public mental health resources should be targeted toward helping these at-risk individuals.

Changes in PTSD, depression, and generalized anxiety before and during the COVID-19 pandemic in Ireland.

BACKGROUND: : In this study, we compared the prevalence of posttraumatic stress disorder (PTSD), depression, and generalized anxiety disorder (GAD) before and during the COVID-19 pandemic across nationally representative samples of Irish adults. METHODS: : Participants were sampled in February 2019 (N = 1,020), April 2020 (N = 1,041), May 2020 (N = 1,032), and December 2020 (N = 1,100) using the same self-report measures. RESULTS: : The prevalence of PTSD significantly increased from 12.5% in 2019 to 18.0% in April 2020, to 22.0% in May, and returning to 17.6% in December 2020. PTSD increases were most consistently observed in males, those aged 18-34 years, those without a university qualification, and those living in the Leinster region of Ireland, where the capital city of Dublin is located. There were no significant changes in the prevalence of depression or GAD. LIMITATIONS: : The 2020 samples were not completely independent of one another and while the analysis took this into account, this bias cannot be completely removed. CONCLUSIONS: : These findings show an increase in PTSD during the initial stages of the COVID-19 pandemic compared to the pre-pandemic period and suggest specificity in mental health responses to the COVID-19 pandemic.

Longitudinal changes in psychological distress in the UK from 2019 to September 2020 during the COVID-19 pandemic: Evidence from a large nationally representative study.

In a large (n=10918), national, longitudinal probability-based sample of UK adults the prevalence of clinically significant psychological distress rose from prepandemic levels of 20.8% in 2019 to 29.5% in April 2020 and then declined significantly to prepandemic levels by September (20.8%). Longitudinal analyses showed that all demographic groups examined (age, sex, race/ethnicity, income) experienced increases in distress after the onset of the pandemic followed by significant decreases. By September 2020 distress levels were indistinguishable from prepandemic levels for all groups. This recovery may reflect the influence of the easing of restrictions and psychological adaptation to the demands of the pandemic.

Anxiety reported by US adults in 2019 and during the 2020 COVID-19 pandemic: Population-based evidence from two nationally representative samples.

BACKGROUND: The impact of the coronavirus disease 2019 (COVID-19) on the mental health of the US population is unclear. This study drew on two nationally representative samples to compare the prevalence rate of anxiety in the U.S. before and during the 2020 COVID-19 pandemic. METHODS: The Generalized Anxiety Disorder-2 (GAD-2) screening tool was used to detect the proportion of US adults screening positive for high levels of anxiety symptoms. Anxiety symptoms was assessed in 2019 using the National Health Interview Survey (NHIS; N = 30,915) and during the pandemic using biweekly surveys collected as part of the Understanding America Study (UAS; N=8,022 Obs.=121,768) between March and December 2020. RESULTS: The proportion of participants with high levels of anxiety symptoms increased significantly from 8.1% (95% CI[7.7, 8.5]) in 2019 to 21.4% (95% CI[19.9, 22.9]) at the beginning of April, 2020. The prevalence then declined to 11.4% (95% CI[10.3, 12.5]) in May and remained 3% above 2019 levels until December 2020. This pattern of increasing anxiety between 2019 and April 2020 followed by a rapid decrease in anxiety was identified across all demographic characteristics examined. LIMITATIONS: The NHIS and UAS samples differ in their sampling and mode of administration which may bias comparisons between samples. CONCLUSIONS: Anxiety symptoms increased markedly during the onset of the COVID-19 pandemic and reduced quickly as stay-at-home orders were lifted. These findings highlight the importance of providing mental health supports during future lockdowns and suggest that resilience in mental health may have been a key population-level response to the demands of the pandemic.

Willingness to Vaccinate Against COVID-19 in the U.S.: Representative Longitudinal Evidence From April to October 2020.

INTRODUCTION: Vaccines against COVID-19 have been developed in unprecedented time. However, the effectiveness of any vaccine is dictated by the proportion of the population willing to be vaccinated. This observational population-based study examines intentions to be vaccinated against COVID-19 throughout the pandemic. METHODS: In November 2020, longitudinal data from a nationally representative sample of 7,547 U.S. adults enrolled in the Understanding America Study were analyzed using multinomial logistic regression. Participants reported being willing, undecided, and unwilling to get vaccinated against COVID-19 across 13 assessments conducted from April to October 2020. Public attitudes to vaccination against COVID-19 were also assessed on a 4-point Likert-type scale. RESULTS: Willingness to vaccinate declined from 71% in April to 53.6% in October. This was explained by an increase in the percentage of participants undecided about vaccinating (from 10.5% to 14.4%) and the proportion of the sample unwilling to vaccinate (from 18.5% to 32%). The population subgroups most likely to be undecided/unwilling to vaccinate were those without a degree (undecided: RR=2.47, 95% CI=2.04, 3.00; unwilling: RR=1.92, 95% CI=1.67, 2.20), Black participants (undecided: RR=2.18, 95% CI=1.73, 2.74; unwilling: RR=1.98, 95% CI=1.63, 2.42), and female participants (undecided: RR=1.41, 95% CI=1.20, 1.65; unwilling: RR=1.29, 95% CI=1.14, 1.46). Participants who were older or were on higher incomes were least likely to be undecided or unwilling to vaccinate. Concerns about potential side effects of a vaccine were common. CONCLUSIONS: Intentions to be vaccinated against COVID-19 have declined rapidly during the pandemic, and close to half of Americans are undecided or unwilling to be vaccinated.

International estimates of intended uptake and refusal of COVID-19 vaccines: A rapid systematic review and meta-analysis of large nationally representative samples.

BACKGROUND: Widespread uptake of COVID-19 vaccines will be essential to controlling the COVID-19 pandemic. Vaccines have been developed in unprecedented time and quantifying levels of hesitancy towards vaccination among the general population is of importance. METHODS: Systematic review and meta-analysis of studies using large nationally representative samples (n ≥ 1000) to examine the percentage of the population intending to vaccinate, unsure, or intending to refuse a COVID-19 vaccine when available. Generic inverse meta-analysis and meta-regression were used to pool estimates and examine time trends. PubMed, Scopus and pre-printer servers were searched from January-November 2020. Registered on PROSPERO (CRD42020223132). FINDINGS: Twenty-eight nationally representative samples (n = 58,656) from 13 countries indicate that as the pandemic has progressed, the percentage of people intending to vaccinate decreased and the percentage of people intending to refuse vaccination increased. Pooled data from surveys conducted during June-October suggest that 60% (95% CI: 49% to 69%) intend to vaccinate and 20% (95% CI: 13% to 29%) intend to refuse vaccination, although intentions vary substantially between samples and countries (I2 > 90%). Being female, younger, of lower income or education level and belonging to an ethnic minority group were consistently associated with being less likely to intend to vaccinate. Findings were consistent across higher vs. lower quality studies. INTERPRETATION: Intentions to be vaccinated when a COVID-19 vaccine becomes available have been declining across countries and there is an urgent need to address social inequalities in vaccine hesitancy and promote widespread uptake of vaccines as they become available. FUNDING: N/A.

Longitudinal changes in mental health and the COVID-19 pandemic: evidence from the UK Household Longitudinal Study.

BACKGROUND: The COVID-19 pandemic has had a range of negative social and economic effects that may contribute to a rise in mental health problems. In this observational population-based study, we examined longitudinal changes in the prevalence of mental health problems from before to during the COVID-19 crisis and identified subgroups that are psychologically vulnerable during the pandemic. METHODS: Participants (N = 14 393; observations = 48 486) were adults drawn from wave 9 (2017-2019) of the nationally representative United Kingdom Household Longitudinal Study (UKHLS) and followed-up across three waves of assessment in April, May, and June 2020. Mental health problems were assessed using the 12-item General Health Questionnaire (GHQ-12). RESULTS: The population prevalence of mental health problems (GHQ-12 score ⩾3) increased by 13.5 percentage points from 24.3% in 2017-2019 to 37.8% in April 2020 and remained elevated in May (34.7%) and June (31.9%) 2020. All sociodemographic groups examined showed statistically significant increases in mental health problems in April 2020. The increase was largest among those aged 18-34 years (18.6 percentage points, 95% CI 14.3-22.9%), followed by females and high-income and education groups. Levels of mental health problems subsequently declined between April and June 2020 but remained significantly above pre-COVID-19 levels. Additional analyses showed that the rise in mental health problems observed throughout the COVID-19 pandemic was unlikely to be due to seasonality or year-to-year variation. CONCLUSIONS: This study suggests that a pronounced and prolonged deterioration in mental health occurred as the COVID-19 pandemic emerged in the UK between April and June 2020.

Explaining the rise and fall of psychological distress during the COVID-19 crisis in the United States: Longitudinal evidence from the Understanding America Study.

OBJECTIVES: It has been shown that psychological distress rose rapidly as the COVID-19 pandemic emerged and then recovered to pre-crisis levels as social lockdown restrictions were eased in the United States. The aim of the current study was to investigate psychosocial and behavioural factors that may explain the rise and fall of distress during the initial months of the COVID-19 crisis. DESIGN: This study examined six waves of longitudinal nationally representative data from the Understanding America Study (UAS) collected between March and June 2020 (N = 7,138, observations = 34,125). METHODS: Mediation analysis was used to identify whether changes in distress (PHQ-4) during the COVID-19 pandemic were explained by the following factors: perceived infection risk and risk of death, perceived financial risks, lifestyle changes resulting from the virus, perceived discrimination related to the virus, and changes in substance use and employment status. RESULTS: All mediating factors played a role in explaining changes in distress and together accounted for 70% of the increase in distress between 10-18 March and 1-14 April and 46.4% of the decline in distress between 1-14 April and early June 2020. Changes in perceived health risks were most important in explaining changes in distress followed by changes in lifestyle and the perceived financial risks associated with COVID-19. CONCLUSIONS: This study provides longitudinal population-based evidence detailing the mediating factors explaining changes in distress during the COVID-19 crisis. Perceived health risks associated with the virus may play a key role in explaining rising and falling levels of psychological distress during the COVID-19 pandemic.

Willingness to vaccinate against COVID-19 in the US: Longitudinal evidence from a nationally representative sample of adults from April-October 2020.

INTRODUCTION: Vaccines against COVID-19 have been developed in unprecedented time. However, the effectiveness of any vaccine is dictated by the proportion of the population willing to be vaccinated. In this observational population-based study we examined intentions to be vaccinated against COVID-19 over the course of the pandemic. METHODS: We analyzed longitudinal data from a nationally representative sample of 7,547 US adults enrolled in the Understanding America Study (UAS). Participants reporting being willing, undecided and unwilling to get vaccinated against coronavirus across 13 assessments conducted from April-October, 2020. Public attitudes to vaccination against the coronavirus were also assessed. RESULTS: Willingness to vaccinate declined from 71% in April to 53.6% in October. This was explained by an increase in the percentage of participants undecided about vaccinating (from 10.5% to 14.4%) and the portion of the sample unwilling to vaccinate (from 18.5% to 32%). The population subgroups most likely to be undecided/unwilling to vaccinate were those without a degree (undecided: RRR=2.47, 95% CI: 2.04-3.00; unwilling: RRR=1.92, 95% CI: 1.67-2.20), Black participants (undecided: RRR=2.18, 95% CI: 1.73-2.74; unwilling: RRR=1.98, 95% CI: 1.63-2.42), and females (undecided: RRR=1.41, 95% CI: 1.20-1.65; unwilling: RRR=1.29, 95% CI: 1.14-1.46). Those aged 65+, those on high incomes, and other race/ethnicity participants were least likely to be undecided or unwilling to vaccinate. Concerns about potential side effects of a vaccine were common. CONCLUSIONS: Intentions to be vaccinated against coronavirus have declined rapidly during the pandemic and close to half of Americans are undecided or unwilling to be vaccinated.

High-Risk Drinking in Midlife Before Versus During the COVID-19 Crisis: Longitudinal Evidence From the United Kingdom.

INTRODUCTION: Emerging evidence suggests that the COVID-19 pandemic and associated lockdown restrictions may have influenced alcohol consumption. This study examines changes in high-risk alcohol consumption from before to during the COVID-19 crisis in an established cohort of middle-aged British adults. METHODS: Participants consisted of 3,358 middle-aged adults from the 1970 British Cohort Study who completed the Alcohol Use Disorders Identification Test for detecting hazardous drinkers in primary care settings in 2016-2018 (when aged 46-48 years) and May 2020 (aged 50 years). Multivariable logistic regression analysis was used to examine changes in high-risk drinking (scores of ≥5), and multinomial regression was used to compare responses with individual test items in 2016-2018 and May 2020. RESULTS: Among middle-aged British adults, high-risk drinking increased by 5.2 percentage points from 19.4% to 24.6% (p<0.001) between 2016-2018 and May 2020. The increase in high-risk drinking was not moderated by sex, marital status, educational attainment, the presence of a chronic illness, or the year the baseline survey was completed. The prevalence of drinking ≥4 times a week doubled from 12.5% to 26% from before to during the pandemic (p<0.001), and there was also evidence of an increase in the frequency of being unable to stop drinking. CONCLUSIONS: This study provides evidence linking the COVID-19 crisis and associated lockdown restrictions to an increase in high-risk drinking patterns and particularly frequent drinking in British adults. Potential long-term changes in drinking habits should be monitored following the emergence of the COVID-19 pandemic.

Psychological distress and adaptation to the COVID-19 crisis in the United States.

There is growing concern that the COVID-19 crisis may have long-standing mental health effects across society particularly amongst those with pre-existing mental health conditions. In this observational population-based study, we examined how psychological distress changed following the emergence of the COVID-19 crisis in the United States and tested whether certain population subgroups were vulnerable to persistent distress during the crisis. We analyzed longitudinal nationally representative data from eight waves of the Understanding America Study (UAS) collected between March 10th and July 20th, 2020 (N = 7319 Observations = 46,145). Differences in distress trends were examined by age, sex, race/ethnicity, and household income and by the presence of a pre-existing mental health diagnosis. Psychological distress was assessed using the standardized total score on the Patient Health Questionnaire-4 (PHQ-4). On average psychological distress increased significantly by 0.27 standard deviations (95% CI [0.23,0.31], p < .001) from March 10-18 to April 1-14, 2020 as the COVID-19 crisis emerged and lockdown restrictions began in the US. Distress levels subsequently declined to mid-March levels by June 2020 (d = -0.31, 95% CI [-0.34, -0.27], p < .001). Across the sociodemographic groups examined and those with pre-existing mental health conditions we observed a sharp rise in distress followed by a recovery to baseline distress levels. This study identified substantial increases in distress in the US during the emergence of the COVID-19 crisis that largely diminished in the weeks that followed and suggests that population level resilience in mental health may be occurring in response to the pandemic.

Depression reported by US adults in 2017-2018 and March and April 2020.

BACKGROUND: Coronavirus disease 2019 (COVID-19) and the associated social distancing and lockdown restrictions are expected to have substantial and enduring mental health effects. In this study, we aimed to assess depression levels before and during the COVID-19 pandemic in the United States. METHODS: We used the Patient Health Questionnaire-2 (PHQ-2) brief screening instrument to detect probable depression in two nationally representative surveys of US adults. Pre-pandemic levels of depression were assessed in a sample of 5,075 adults from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). Depression was assessed in March (N = 6,819) and April 2020 (N = 5,428) in the Understanding America Study, a representative sample of the US population. RESULTS: The percentage of US adults with depression increased significantly from 8.7% (95% CI[7.6%-9.8%]) in 2017-2018 to 10.6% (95% CI[9.6%-11.6%) in March 2020 and 14.4% (95% CI[13.1%-15.7%]) in April 2020. Statistically significant increases in depression levels were observed for all population subgroups examined with the exception of those aged 65+ years and Black participants. Young adults (aged 18-34) experienced a marked increase in depression of 13.4 percentage points (95% CI [9.5%-17.2%]) that was larger than any other age group. Additional analyses of depression trends in NHANES from 2007/2008-2017/2018 showed that the substantial increase in depression in April 2020 was unlikely to be due to typical year-to-year variation. CONCLUSIONS: Our findings suggest that depression levels have risen substantially during the COVID-19 pandemic and reinforce recent findings indicating that young adults may be particularly vulnerable to the mental health effects of the pandemic.