Changes in household debt due to COVID-19 and mental health concerns among adults in Ontario, Canada.

BACKGROUND: Canadian households experienced unexpected changes in their economic well-being during the COVID-19 pandemic. The extent of the impact of the pandemic on household debt and its effect on health and mental health remains unknown. AIM: The aim of the study was to examine the associations of change in household debt due to COVID-19 with serious psychological distress (SPD) and general health measures. METHODS: Data were from the 2020 Monitor study, a repeated cross-sectional survey of adults 18 years and older in Ontario, Canada. The 2020 cycle employed a web-based panel survey of 3,033 adults. The survey included measures of change in household debt due to the COVID-19 pandemic, mental and general health. Odds ratios (OR) were estimated from logistic regression models accounting for sociodemographic factors. RESULTS: Overall, 17.5% of respondents reported that their household debt increased due to the COVID-19 pandemic. Such an increase in household debt was significantly associated with SPD (OR = 2.92, 95% CI, 2.05-4.16), fair/poor mental health (OR = 2.02, 95% CI, 1.59-2.56), frequent mental distress days (OR = 1.80, 95% CI, 1.31-2.48), fair/poor general health (OR = 1.93, 95% CI, 1.47-2.52), and suicidal ideation (OR = 3.71, 95% CI, 2.41-5.70) after adjusting for potential confounders including education, income and employment. CONCLUSIONS: Household debt during the COVID-19 pandemic is an important determinant of health. Individuals who reported an increase in household debt due to COVID-19 were more likely to report serious mental health concerns including suicidal ideation. This suggests that debt-related interventions may be needed to alleviate the adverse effects of indebtedness on health.

Factors associated with stress about returning to pre-pandemic routines among Canadians.

The COVID-19 pandemic continues to be a public health concern, with important impacts on individuals' mental health. Many people have experienced significant changes to their daily routines due to the pandemic and for some, returning to pre-pandemic routines could create elevated stress. The present study explored factors associated with stress about returning to pre-pandemic routines (SRPR). A web-based, cross-sectional survey of 1,001 Canadian adults aged 18 years and older was conducted on July 9-13, 2021. SRPR was assessed by asking the respondents how much stress they have been feeling about returning to their pre-pandemic routines. Sociodemographic variables, anxiety, depression, loneliness, and COVID-19-related worry were examined in relation to SRPR. Overall, 28.8% of respondents reported moderate to extreme SRPR. After adjusting for covariates, factors associated with elevated SRPR included: younger age (AOR = 2.29, 95%CI 1.30-4.03), higher education (AOR = 2.08, 95%CI 1.14-3.79), being very worried about getting COVID-19 (AOR = 4.14, 95%CI 2.46-6.95), switching to working from home (AOR = 2.43, 95%CI 1.44-4.11), having anxiety (AOR = 5.02, 95%CI 3.19-7.89), feeling depressed (AOR = 1.93, 95%CI 1.14-3.25), and feeling lonely (AOR = 1.74, 95%CI 1.07-2.83). The findings of this study suggest that individuals experiencing mental health concerns (anxiety, feeling depressed, feeling lonely) may be especially likely to feel elevated SRPR and may therefore need additional support in making the transition back to prior routines.

The impact of the novel coronavirus disease (COVID-19) pandemic on drug overdose-related deaths in the United States and Canada: a systematic review of observational studies and analysis of public health surveillance data.

BACKGROUND: There are preliminary indications that the trajectory of drug overdose-related deaths in North America has been exacerbated due to the novel coronavirus disease pandemic (COVID-19). As such, the impact of COVID-19 on drug overdose-related deaths was examined through a systematic review of the literature and percentage change analyses of surveillance data. METHODS: Systematic searches in electronic databases were conducted, a topical issue brief and bibliography were reviewed, reference lists of included studies were searched and expert consultations were held to identify studies (Registration # CRD42021230223). Observational studies from the United States and Canada were eligible for inclusion if drug overdose-related deaths were assessed in quantitative or qualitative analyses onwards from at least March 2020. In addition, percentage changes comparing drug overdose-related deaths in the second annual quarter (Q2 2020 [April to June]) with the first annual quarter (Q1 2020 [January to March]) were generated using national and subnational data from public health surveillance systems and reports from jurisdictions in the United States and Canada. RESULTS: Nine studies were included in the systematic review, eight from the United States and one from Canada. The maximum outcome assessment period in the included studies extended until September 2020. Drug overdose-related deaths after the onset of COVID-19 were higher compared with the months leading up to the pandemic in 2020 and the comparative months in 2019. In additional percentage change analyses, drug overdose-related deaths increased by 2 to 60% in jurisdictions in the United States and by 58% in Canada when comparing Q2 2020 with Q1 2020. CONCLUSIONS: Drug overdose-related deaths increased after the onset of COVID-19. The current situation necessitates a multi-pronged approach, encompassing expanded access to substance use disorder treatment, undisrupted access to harm reduction services, emphasis on risk reduction strategies, provision of a safe drug supply and decriminalization of drug use.

Priority setting for Canadian Take-Home Naloxone best practice guideline development: an adapted online Delphi method.

BACKGROUND: Take-Home Naloxone (THN) is a core intervention aimed at addressing the toxic illicit opioid drug supply crisis. Although THN programs are available in all provinces and territories throughout Canada, there are currently no standardized guidelines for THN programs. The Delphi method is a tool for consensus building often used in policy development that allows for engagement of stakeholders. METHODS: We used an adapted anonymous online Delphi method to elicit priorities for a Canadian guideline on THN as a means of facilitating meaningful stakeholder engagement. A guideline development group generated a series of key questions that were then brought to a 15-member voting panel. The voting panel was comprised of people with lived and living experience of substance use, academics specializing in harm reduction, and clinicians and public health professionals from across Canada. Two rounds of voting were undertaken to score questions on importance for inclusion in the guideline. RESULTS: Nine questions that were identified as most important include what equipment should be in THN kits, whether there are important differences between intramuscular and intranasal naloxone administration, how stigma impacts access to distribution programs, how effective THN programs are at saving lives, what distribution models are most effective and equitable, storage considerations for naloxone in a community setting, the role of CPR and rescue breathing in overdose response, client preference of naloxone distribution program type, and what aftercare should be provided for people who respond to overdoses. CONCLUSIONS: The Delphi method is an equitable consensus building process that generated priorities to guide guideline development.

Household composition and anxiety symptoms during the COVID-19 pandemic: A population-based study.

INTRODUCTION: Household composition may be an important factor associated with anxiety during the COVID-19 pandemic as people spend more time at home due to physical distancing and lockdown restrictions. Adults living with children-especially women-may be particularly vulnerable to anxiety as they balance additional childcare responsibilities and homeschooling with work. The objective of this study was to examine the association between household composition and anxiety symptoms during the COVID-19 pandemic and explore gender as an effect modifier. METHODS: Data were derived from seven waves of a national online survey of Canadian adults aged 18+ years from May 2020 to March 2021, which used quota sampling by age, gender, and region proportional to the English-speaking Canadian population (n = 7,021). Multivariable logistic and modified least-squares regression models were used. RESULTS: Compared to those living alone, significantly greater odds of anxiety symptoms were observed among single parents/guardians (aOR = 2.00; 95%CI: 1.41-2.84), those living with adult(s) and child(ren) (aOR = 1.39; 95%CI: 1.10-1.76), and those living with adult(s) only (aOR = 1.22; 95%CI: 1.00-1.49). Gender was a significant effect modifier on the additive scale (p = 0.0487) such that the association between living with child(ren) and anxiety symptoms was stronger among men than women. CONCLUSION: Additional tailored supports are needed to address anxiety among adults living with children-especially men-during the COVID-19 pandemic and future infectious disease events.

Self-reported mental health during the COVID-19 pandemic and its association with alcohol and cannabis use: a latent class analysis.

BACKGROUND: Mental health problems and substance use co-morbidities during and after the COVID-19 pandemic are a public health priority. Identifying individuals at high-risk of developing mental health problems and potential sequela can inform mitigating strategies. We aimed to identify distinct groups of individuals (i.e., latent classes) based on patterns of self-reported mental health symptoms and investigate their associations with alcohol and cannabis use. METHODS: We used data from six successive waves of a web-based cross-sectional survey of adults aged 18 years and older living in Canada (6,021 participants). We applied latent class analysis to three domains of self-reported mental health most likely linked to effects of the pandemic: anxiety, depression, and loneliness. Logistic regression was used to characterize latent class membership, estimate the association of class membership with alcohol and cannabis use, and perform sex-based analyses. RESULTS: We identified two distinct classes: (1) individuals with low scores on all three mental health indicators (no/low-symptoms) and (2) those reporting high scores across the three measures (high-symptoms). Between 73.9 and 77.1% of participants were in the no/low-symptoms class and 22.9-26.1% of participants were in the high-symptom class. We consistently found across all six waves that individuals at greater risk of being in the high-symptom class were more likely to report worrying about getting COVID-19 with adjusted odds ratios (aORs) between 1.72 (95%CI:1.17-2.51) and 3.51 (95%CI:2.20-5.60). Those aged 60 + were less likely to be in this group with aORs (95%CI) between 0.26 (0.15-0.44) and 0.48 (0.29-0.77) across waves. We also found some factors associated with class membership varied at different time points. Individuals in the high-symptom class were more likely to use cannabis at least once a week (aOR = 2.28, 95%CI:1.92-2.70), drink alcohol heavily (aOR = 1.71, 95%CI:1.49-1.96); and increase the use of cannabis (aOR = 3.50, 95%CI:2.80-4.37) and alcohol (aOR = 2.37, 95%CI:2.06-2.74) during the pandemic. Women in the high-symptom class had lower odds of drinking more alcohol during the pandemic than men. CONCLUSIONS: We identified the determinants of experiencing high anxiety, depression, and loneliness symptoms and found a significant association with alcohol and cannabis consumption. This suggests that initiatives and supports are needed to address mental health and substance use multi-morbidities.

Alcohol and cannabis use during the COVID-19 pandemic among transgender, gender-diverse, and cisgender adults in Canada.

BACKGROUND: This study examined whether heavy episodic drinking (HED), cannabis use, and subjective changes in alcohol and cannabis use during the COVID-19 pandemic differ between transgender and gender-diverse (TGD) and cisgender adults. METHODS: Successive waves of web-based cross-sectional surveys. SETTING: Canada, May 2020 to March 2021. PARTICIPANTS: 6,016 adults (39 TGD, 2,980 cisgender men, 2,984 cisgender women, and 13 preferred not to answer), aged ≥18 years. MEASUREMENTS: Measures included self-reported HED (≥5 drinks on one or more occasions in the previous week for TGD and cisgender men and ≥4 for cisgender women) and any cannabis use in the previous week. Subjective changes in alcohol and cannabis use in the past week compared to before the pandemic were measured on a five-point Likert scale (1: much less to 5: much more). Binary and ordinal logistic regressions quantified differences between TGD and cisgender participants in alcohol and cannabis use, controlling for age, ethnoracial background, marital status, education, geographic location, and living arrangement. RESULTS: Compared to cisgender participants, TGD participants were more likely to use cannabis (adjusted odds ratio (aOR)=3.78, 95%CI: 1.89, 7.53) and to have reported subjective increases in alcohol (adjusted proportional odds ratios (aPOR)= 2.00, 95%CI: 1.01, 3.95) and cannabis use (aPOR=4.56, 95%CI: 2.13, 9.78) relative to before the pandemic. Compared to cisgender women, TGD participants were more likely to use cannabis (aOR=4.43, 95%CI: 2.21, 8.87) and increase their consumption of alcohol (aPOR=2.05, 95%CI: 1.03, 4.05) and cannabis (aPOR=4.71, 95%CI: 2.18, 10.13). Compared to cisgender men, TGD participants were more likely to use cannabis (aOR=3.20, 95%CI: 1.60, 6.41) and increase their use of cannabis (aPOR=4.40, 95%CI: 2.04, 9.49). There were no significant differences in HED between TGD and cisgender participants and in subjective change in alcohol between TGD and cisgender men; however, the odds ratios were greater than one as expected. CONCLUSIONS: Increased alcohol and cannabis use among TGD populations compared to before the pandemic may lead to increased health disparities. Accordingly, programs targeting the specific needs of TGD individuals should be prioritized.

Daily cannabis use during the novel coronavirus disease (COVID-19) pandemic in Canada: a repeated cross-sectional study from May 2020 to December 2020.

BACKGROUND: Daily cannabis use is most strongly implicated in the cannabis-attributable burden of disease. In the context of the novel coronavirus disease (COVID-19) pandemic in Canada, we characterized trends in daily cannabis use in the overall sample and various population subgroups, and examined risk characteristics associated with daily cannabis use. METHODS: A cross-sectional design was operationalized using data from six waves of a national, online survey of adults residing in Canada who spoke English (N = 6,021; May-08 2020 to December-01 2020). Trends were characterized using the Cochran-Armitage test and risk characteristics were identified using chi-square test and logistic regression analysis. RESULTS: Daily cannabis use in the overall sample remained stable (5.34% - 6.10%; p = 0.30). This pattern of findings extended to various population subgroups as well. The odds of daily cannabis use were higher for those who: were males (Odds Ratio; 95% Confidence Interval: 1.46; 1.15 - 1.85), were between 18 - 29 years (2.36; 1.56 - 3.57), 30 - 39 years (2.65; 1.93 - 3.64) or 40-49 years (1.74; 1.19 - 2.54), self-identified as white (1.97; 1.47 - 2.64), had less than college or university completion (1.78; 1.39 - 2.28), engaged in heavy episodic drinking (2.05; 1.62 - 2.61), had a job that increased the risk of contracting COVID-19 (1.38; 1.01 - 1.88), experienced loneliness 5-7 days in the past week (1.86; 1.26 - 2.73) and felt very worried (2.08; 1.21 - 3.58) or somewhat worried (1.83; 1.11 - 3.01) about the pandemic's impact on their financial situation. CONCLUSIONS: Daily cannabis use did not change in the overall sample or various population subgroups during the pandemic. Pandemic-related risks and impacts were associated with daily cannabis use.

Age differences in the association between loneliness and anxiety symptoms during the COVID-19 pandemic.

Loneliness and associated mental health problems are of particular concern during the COVID-19 pandemic due to physical distancing and lockdown restrictions. Loneliness is most common among young adults and women during the pandemic, but it is unclear if the association between loneliness and mental health problems, notably anxiety, is strongest in these groups. The objective of this study was to examine whether the association between loneliness and anxiety differed by age and/or gender during the pandemic. We analyzed data from a multi-wave national online survey of Canadians aged 18+ years from May 2020 to March 2021 (n = 7,021). Multivariable modified least-squares regression was used to examine whether the association between loneliness and moderate to severe anxiety symptoms (GAD-7 10+) differed by age and/or gender on the additive scale, controlling for socio-demographic factors, depression, hopefulness, and survey wave. Age significantly moderated the association between loneliness and anxiety symptoms while gender did not. Loneliness was associated with anxiety symptoms for all age groups, but the association was not as strong among those aged 70+ years compared to other age groups. Evidence-based loneliness interventions that target younger adults are needed to mitigate the mental health effects of infectious disease events such as COVID-19.

Machine Learning-Based Predictive Modeling of Anxiety and Depressive Symptoms During 8 Months of the COVID-19 Global Pandemic: Repeated Cross-sectional Survey Study.

BACKGROUND: The COVID-19 global pandemic has increased the burden of mental illness on Canadian adults. However, the complex combination of demographic, economic, and lifestyle factors and perceived health risks contributing to patterns of anxiety and depression has not been explored. OBJECTIVE: The aim of this study is to harness flexible machine learning methods to identify constellations of factors related to symptoms of mental illness and to understand their changes over time during the COVID-19 pandemic. METHODS: Cross-sectional samples of Canadian adults (aged ≥18 years) completed web-based surveys in 6 waves from May to December 2020 (N=6021), and quota sampling strategies were used to match the English-speaking Canadian population in age, gender, and region. The surveys measured anxiety and depression symptoms, sociodemographic characteristics, substance use, and perceived COVID-19 risks and worries. First, principal component analysis was used to condense highly comorbid anxiety and depression symptoms into a single data-driven measure of emotional distress. Second, eXtreme Gradient Boosting (XGBoost), a machine learning algorithm that can model nonlinear and interactive relationships, was used to regress this measure on all included explanatory variables. Variable importance and effects across time were explored using SHapley Additive exPlanations (SHAP). RESULTS: Principal component analysis of responses to 9 anxiety and depression questions on an ordinal scale revealed a primary latent factor, termed "emotional distress," that explained 76% of the variation in all 9 measures. Our XGBoost model explained a substantial proportion of variance in emotional distress (r2=0.39). The 3 most important items predicting elevated emotional distress were increased worries about finances (SHAP=0.17), worries about getting COVID-19 (SHAP=0.17), and younger age (SHAP=0.13). Hopefulness was associated with emotional distress and moderated the impacts of several other factors. Predicted emotional distress exhibited a nonlinear pattern over time, with the highest predicted symptoms in May and November and the lowest in June. CONCLUSIONS: Our results highlight factors that may exacerbate emotional distress during the current pandemic and possible future pandemics, including a role of hopefulness in moderating distressing effects of other factors. The pandemic disproportionately affected emotional distress among younger adults and those economically impacted.

Changes in Alcohol Consumption in Canada During the COVID-19 Pandemic: Associations With Anxiety and Self-Perception of Depression and Loneliness.

AIM: To examine whether changes in alcohol consumption in Canada since the start of the novel coronavirus disease (COVID-19) pandemic are associated with feelings of anxiety, depression, loneliness and/or with changes in employment due to COVID-19. METHODS: Data collection occurred between 29 May 2020 and 23 March 2021 via a web panel, AskingCanadians, which sampled 5892 adults (≥18 years of age). Data were collected on changes in alcohol consumption compared to before the pandemic (ordinal variable ranging from 1='much less alcohol' to 5='much more alcohol'), anxiety (General Anxiety Disorder-7), self-perceived depression (Center for Epidemiologic Studies Depression Scale), self-perceived loneliness, changes in employment status due to COVID-19 and socio-demographic variables (age, gender, living situation, household income and urban vs rural residence). Multivariate associations were assessed using ordinal logistic regression. Effect modification by gender was tested using likelihood-ratio tests. RESULTS: Changes in alcohol consumption were positively associated with anxiety, feeling depressed and loneliness. In particular, people with mild to moderate (ordered Odds Ratio (OR):1.23, 95% Confidence Interval (CI):1.07, 1.62) or severe anxiety (ordered OR:1.49, 95% CI:1.15, 1.93) had a greater odds of increased drinking than did people with no to low levels of anxiety. Gender, age, household income, living situation and survey wave were also associated with changes in drinking. No effect modifications by gender were observed. CONCLUSION: Given the health harms caused by alcohol use, public health practitioners and primary care physicians should focus health messaging to identify and support individuals at risk of increased alcohol consumption, especially people experiencing depression, loneliness or anxiety.

The association between COVID-19 diagnosis or having symptoms and anxiety among Canadians: A repeated cross-sectional study.

BACKGROUND: The mental health effects of being diagnosed with COVID-19 are unknown. The present study examined whether individuals or those with someone close to them with a COVID-19 diagnosis differentially experienced anxiety during the pandemic. METHODS: Four web-based repeated cross-sectional surveys were conducted among Canadians aged 18 and older (n = 4015) regarding the impact of COVID-19 on mental health between May 8th and July 14th, 2020. Data on sociodemographic, COVID-19 symptoms/diagnoses for self or someone close, and anxiety were collected. Multiple logistic regression analyses were performed controlling for potential confounders. RESULTS: Anxiety among individuals affected by the pandemic remained stable over time. Individuals or those with someone close diagnosed with COVID-19 had greater odds of having anxiety (OR = 1.55; 95%CI 1.12, 2.14) compared to those who had not been diagnosed (self or close other) with COVID-19. Individuals or those with someone close to them who had symptoms of COVID-19 had greater odds of having anxiety (OR = 2.08; 95%CI 1.51, 2.87) compared to those who did not report symptoms (self or close other). CONCLUSIONS: This evidence highlights the importance of targeted psychosocial interventions for those directly impacted by the COVID-19 virus.

Changes in substance supply and use characteristics among people who use drugs (PWUD) during the COVID-19 global pandemic: A national qualitative assessment in Canada.

BACKGROUND: People who use drugs (PWUD) may be at an increased risk of experiencing negative effects related to COVID-19. Border and non-essential service closures may have placed PWUD at an increased risk of experiencing unintended consequences regarding drug consumption and supply patterns, as well as related outcomes. However, the extent of these effects upon this population is unknown. The current study examined how COVID-19 has impacted substance use supply and use characteristics among a national cohort of PWUD in Canada. METHODS: We conducted semi-structured one-on-one telephone-based interviews with 200 adult PWUD across Canada who were currently using a licit or illicit psychoactive substance at least weekly, and/or currently receiving opioid agonist treatment (OAT). Thematic analyses were conducted using qualitative software. RESULTS: PWUD attributed adverse changes to their substance use frequency, supply, use patterns, and risk behaviors and outcomes to COVID-19. Many participants noted supply disruptions with the majority indicating a decrease in potency and availability, and an increase in the price of substances since COVID-19. Nearly half of participants specified that they had increased their substance use, with some experiencing relapses. In terms of changes to risk level, many participants perceived they were at a greater risk for experiencing an overdose. CONCLUSION: This study demonstrated the impacts of COVID-19 on PWUD, including a significant disruption substance supply. For many, these changes led to increased use and substitution for toxic and adulterated substances, which ultimately amplified PWUD's risk for experiencing related harms, including overdoses. These findings warrant the need for improved supports and services, as well as accessibility of safe supply programs, take home naloxone kits, and novel approaches to ensure PWUD have the tools necessary to mitigate risk when using substances.

Identifying the impacts of the COVID-19 pandemic on service access for people who use drugs (PWUD): A national qualitative study.

INTRODUCTION: Closures and reductions in capacity of select health and social services in response to the COVID-19 pandemic may have placed people who use drugs (PWUD) at a disproportionately increased risk for experiencing harms, and resulted in critical treatment disruptions. We conducted the current national study among a cohort of PWUD to understand how COVID-19 has affected service access, including any significant impacts PWUD may have experienced. Results will contribute to the evidence base for informing future pandemic and public health policy planning for vulnerable populations. METHODS: The project involved qualitative telephone-based interviews with 196 adult (aged 18+) PWUD from across Canada. Eligibility criteria included daily or weekly use of psychoactive substance(s), and/or current enrollment in opioid agonist treatment (OAT). Data collection took place between May and July 2020. Data underwent thematic analyses, and common themes informed the results. RESULTS: Most participants experienced detrimental service access issues and treatment disruptions during COVID-19, including reduced access to harm reduction services, OAT, withdrawal management and treatment services, medical professionals (e.g., addictions and mental health counseling), shelters/housing, and food banks. Positive impacts included greater access to OAT take-home 'carries' and prescription deliveries. Decreases in service capacity resulted in increased health issues and risky substance use behaviors among PWUD, such as unaccompanied substance use, sharing/re-use of supplies, and overdose events. CONCLUSIONS: Reductions in the accessibility of critical services PWUD rely on during COVID-19 has increased existent substance use and health issues among PWUD, while decreasing their ability to mitigate risks related to substance use. Thus, the expansion of the depth and breadth of support options is crucial. Services must remain open and flexible to the unique needs of PWUD during COVID-19, while novel and effective adaptations and interventions should remain available and accessible post-COVID-19.

Household- and employment-related risk factors for depressive symptoms during the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic has generated multiple psychological stressors, which may increase the prevalence of depressive symptoms. Utilizing Canadian survey data, this study assessed household- and employment-related risk factors for depressive symptoms during the pandemic. METHODS: A sample of 1005 English-speaking Canadian adults aged 18+ years completed a web-based survey after physical distancing measures were implemented across Canada. Hierarchical binary logistic regression analyses were conducted to examine the associations of depressive symptoms with household- (household size, presence of children, residence locale) and employment-related (job with high risk of COVID-19 exposure, working from home, laid off/not working, financial worry) risk factors, controlling for demographic factors (gender, age, education, income). RESULTS: About 20.4% of the sample reported depressive symptoms at least 3 days per week. The odds of experiencing depressive symptoms 3+ days in the past week were higher among women (AOR = 1.67, p = 0.002) and younger adults (18-29 years AOR = 2.62, p < 0.001). After adjusting for demographic variables, the odds of experiencing depressive symptoms were higher in households with 4+ persons (AOR = 1.88, p = 0.01), in households with children aged 6 to 12 years (AOR = 1.98, p = 0.02), among those with a job at high risk for exposure to COVID-19 (AOR = 1.82, p = 0.01), and those experiencing financial worry due to COVID-19 ('very worried' AOR = 8.00, p < 0.001). CONCLUSION: Pandemic responses must include resources for mental health interventions. Additionally, further research is needed to track mental health trajectories and inform the development, targeting, and implementation of appropriate mental health prevention and treatment interventions.

RéSUMé: OBJECTIF: La pandémie de COVID-19 a engendré de multiples facteurs de stress psychologique qui peuvent faire augmenter la prévalence des symptômes de dépression. Cette étude se fonde sur les résultats de sondages auprès de Canadien.ne.s pour évaluer les facteurs de risque liés à l'emploi et dans les ménages qui prédisposent aux symptômes de dépression pendant la pandémie. MéTHODE: Un échantillon de 1 005 Canadien.ne.s anglophones âgé.e.s de 18 ans ou plus ont rempli un sondage en ligne après l'imposition des mesures de distanciation physique partout au Canada. Une analyse de régression logistique binaire de type hiérarchique a permis d'établir les liens entre les symptômes de dépression et certains facteurs de risque dans les ménages (nombre de membres, présence d'enfants, localité de la résidence) ainsi que des facteurs de risque liés à l'emploi (emploi comportant un risque élevé d'exposition à la COVID-19, télétravail, mise à pied ou chômage, soucis financiers), après un contrôle des facteurs démographiques (sexe, âge, niveau d'éducation, revenu). RéSULTATS: Environ 20,4 % des répondant.e.s ont dit avoir eu des symptômes de dépression au moins trois jours par semaine. La probabilité d'avoir des symptômes de dépression trois jours ou plus au cours de la semaine écoulée est plus élevée pour les femmes (rapport de cotes ajusté, ou RCA = 1,67, p = 0,002) et les jeunes adultes (18 à 29 ans, RCA = 2,62, p < 0,001). Après réajustement des variables démographiques, cette probabilité est plus élevée pour les ménages de quatre personnes ou plus (RCA = 1,88, p = 0,01) et ceux ayant des enfants de 6 à 12 ans (RCA = 1,98, p = 0,02), ainsi que pour les personnes dont l'emploi comporte un risque élevé d'exposition à la COVID-19 (RCA = 1,82, p = 0,01), et celles éprouvant des soucis financiers à cause de la COVID-19 (« très inquiet ¼, RCA = 8,00, p < 0,001). CONCLUSION: Les ressources d'intervention en santé mentale doivent faire partie des mesures de lutte contre la pandémie. De plus, des recherches approfondies s'imposent afin de suivre l'évolution de la santé mentale des Canadien.ne.s et de guider l'élaboration, le ciblage et la mise en œuvre de mesures appropriées de prévention et de traitement des problèmes de santé mentale.

Loneliness in the COVID-19 pandemic: Associations with age, gender and their interaction.

Loneliness is associated with mental health and thus is of particular concern in the COVID-19 pandemic, due to physical distancing restrictions and shelter-in-place orders. The current study assessed the associations of age, gender and their interaction with loneliness during the COVID-19 pandemic, controlling for other sociodemographic variables. A pooled sample of 3,012 English-speaking Canadian adults aged 18+ years completed a web-based survey in one of three waves between May 8 and June 23, 2020. Multivariable logistic regression was used to examine the associations of loneliness with age and gender controlling for marital status, household income, education, living alone, employment situation, and survey wave. A likelihood ratio test assessed the model with interaction between age and gender included. Approximately 8.4% of the sample reported feeling lonely 5+ days in the past week. The regression model with main effects found greater odds of loneliness among women than men (AOR = 1.76, 95%CI = 1.32, 2.34) and among all age groups younger than 60 years compared to those aged 60+ years (p = 0.002). In the final regression model, a significant interaction effect between age and gender on loneliness was found. The interaction showed that women had greater odds of loneliness than men among those aged 18-29 years (AOR = 3.53, 95%CI = 1.69, 7.37) and 60+ years (AOR = 2.62, 95%CI = 1.33, 5.17). Special consideration of loneliness among younger and older adult women is needed in service planning. Given inconsistencies with pre-pandemic studies, detailed data collected during the current crisis is essential to inform proactive resource allocation to prevent and treat mental health consequences of the pandemic.

Cannabis Use During the COVID-19 Pandemic in Canada: A Repeated Cross-sectional Study.

OBJECTIVES: In the context of the ongoing coronavirus disease pandemic in Canada, we aimed to (1) characterize trends in cannabis use in the overall population; and (2) characterize patterns of and identify risk characteristics associated with an increase in cannabis use among those who used cannabis. METHODS: Data were obtained from three waves of an online, repeated cross-sectional survey of adults residing in Canada (May 08-June 23, 2020; N = 3012). Trends were assessed using Cochran-Armitage and chi-square tests, and risk characteristics were identified using logistic regression analyses. RESULTS: Cannabis use in the overall population remained stable during the months of May and June. Among those who used cannabis, about half increased their cannabis use compared to before the start of the pandemic. This proportion of an increase in cannabis use among those who used cannabis remained consistent across the survey waves. Risk characteristics associated with higher odds of an increase in cannabis use included residence in the central region (Odds ratio, 95% confidence intervals: 1.93, 1.03-3.62), being 18 to 29 years old (2.61, 1.32-5.17) or 30 to 49 years old (1.85, 1.07-3.19), having less than college or university education (1.86, 1.13-3.06) and being somewhat worried about the pandemic's impact on personal finances (1.73, 1.00-3.00). CONCLUSIONS: A large proportion of those who used cannabis have increased cannabis use during the pandemic, suggesting a need for interventions to limit increased cannabis use, policy measures to address cannabis-attributable harms, and continued monitoring of cannabis use during and after the pandemic.