COVID-19 Concerns, Perceived Stress, and Increased Alcohol Use Among Adult Women in the United States.

The objective of this study was to assess the direct and indirect (via perceived stress) effects of different types of pandemic-related concerns and increased alcohol use among adult women in the United States (US). We conducted a secondary analysis of cross-sectional survey data from April 2020 for adult females in the US who use alcohol (n = 1,089). The indirect effect model accounted for 19% of the variance in perceived stress and 8% of the variance in reporting increased alcohol use compared to no change or decreased use. Path analysis results indicated that concerns about isolation (odds ratio [OR] = 1.027, 95% confidence interval [CI] = 1.013-1.046), job/finances (OR = 1.025, 95% CI = 1.007-1.065), basic needs (OR = 1.021, 95% CI = 1.008-1.047), and concerns about government (OR = 1.038, 95% CI = 1.014-1.179]) were significantly related to reporting increased alcohol use through perceived stress. These findings can inform timely public health interventions to minimize alcohol-related harm among women.

Major Depression in Postpartum Women during the COVID-19 Pandemic: Can Social Support Buffer Psychosocial Risks and Substance Use?

Rates of mood disorders and substance use increased during the COVID-19 pandemic for postpartum women. The present study's aims were to: (1) examine the prevalence of major depressive disorder (MDD) in postpartum women during the COVID-19 pandemic, and (2) evaluate whether social support can buffer the associations between MDD, psychosocial factors (perceived stress, generalized anxiety, and intimate partner violence) and substance use (alcohol and drug use). A nationwide survey included 593 postpartum mothers (within 12 months from birth). Participants were assessed for a provisional diagnosis of MDD, and provided responses on validated instruments measuring stress, intimate partner violence, suicidal ideation, generalized anxiety, social support, and substance use. A hierarchical logistic regression model assessed the association of psychosocial factors and substance use with MDD. The final model shows that social support attenuates the association of MDD with perceived stress, alcohol use, and drug use, but does not buffer the relationship of MDD with anxiety or intimate partner violence. Social support was shown to significantly attenuate the effects of stress, alcohol use, and drug use on MDD, suggesting that the presence of a strong, supportive social network should be an area of increased focus for public health and healthcare professionals when caring for postpartum women.

Increased Self-Reported Mental Health Problems Among Asian-Americans During the COVID-19 Pandemic in the United States: Evidence from a Nationally Representative Database.

BACKGROUND: To investigate changes in mental health outcomes among racial groups between 2019 and 2020. METHODS: A retrospective cohort study was conducted using the third through fourth quarters of 2019-2020 longitudinal data from the National Health Interview Survey. Self-reports of diagnosed depression and anxiety disorder were key outcomes. We calculated the percentage of depression and anxiety disorder across baseline sample characteristics. Discrete-time hazard models stratified by race/ethnicity were conducted, with hazard ratios (HRs), 95% confidence intervals (CIs), and p-values reported. RESULTS: Of a total 10,415 individuals, 16.3 and 14.1% reported that they were diagnosed with depression and anxiety disorder in 2019, respectively. In the multivariable model, only Asian-Americans experienced a significant increase in the probability of receiving a diagnosis of depression by 104% between 2019 and 2020 (HR 2.04, 95%CI 1.19-3.52; p = 0.010). Also, Asian-Americans had a 97% (HR 1.97, 95%CI 1.23-3.15; p = 0.005) greater probability of being diagnosed with anxiety disorder in 2020 than in the previous year, while Hispanics and Whites had a relatively moderate increase of 40% (HR 1.40, 95%CI 1.01-1.76; p = 0.040) and 11% (HR 1.11, 95%CI 1.03-1.20; p = 0.007), respectively. CONCLUSIONS: Asian-Americans experienced a disproportionate increase in mental health conditions during the COVID-19 pandemic. Discriminatory behaviors against Asian-Americans may be important contributors. The study findings suggest the need for serious actions to address this issue.

A Multicenter Evaluation of the Seraph 100 Microbind Affinity Blood Filter for the Treatment of Severe COVID-19.

The Seraph100 Microbind Affinity Blood Filter (Seraph 100) (ExThera Medical, Martinez, CA) is an extracorporeal therapy that can remove pathogens from blood, including severe acute respiratory syndrome coronavirus 2. The aim of this study was to evaluate safety and efficacy of Seraph 100 treatment for COVID-19. DESIGN: Retrospective cohort study. SETTING: Nine participating ICUs. PATIENTS: COVID-19 patients treated with Seraph 100 (n = 53) and control patients matched by study site (n = 53). INTERVENTION: Treatment with Seraph 100. MEASUREMENTS AND MAIN RESULTS: At baseline, there were no differences between the groups in terms of sex, race/ethnicity, body mass index, and need for mechanical ventilation. However, patients in the Seraph 100 group were younger (median age, 54 yr; interquartile range [IQR], 41-65) compared with controls (median age, 64 yr; IQR, 56-69; p = 0.009). Charlson comorbidity index scores were lower in the Seraph 100 group (2; IQR, 0-3) compared with the control group (3; IQR, 2-4; p = 0.006). Acute Physiology and Chronic Health Evaluation II scores were also lower in Seraph 100 subjects (12; IQR, 9-17) compared with controls (16; IQR, 12-21; p = 0.011). The Seraph 100 group had higher vasopressor-free days with an incidence rate ratio of 1.30 on univariate analysis. This difference was not significant after adjustment. Seraph 100-treated subjects were less likely to die compared with controls (32.1% vs 64.2%; p = 0.001), a difference that remained significant after adjustment. However, no difference in mortality was observed in a post hoc analysis utilizing an external control group. In the full cohort of 86 treated patients, there were 177 total treatments, in which only three serious adverse events were recorded. CONCLUSIONS: Although this study did not demonstrate consistently significant clinical benefit across all endpoints and comparisons, the findings suggest that broad spectrum, pathogen agnostic, blood purification can be safely deployed to meet new pathogen threats while awaiting targeted therapies and vaccines.

A Retrospective Review of Emergency Department Visits That May Be Appropriate for Management in Non-Emergency Settings.

BACKGROUND: Emergency departments (EDs) continue to struggle with overcrowding, increasing wait times, and a surge in patients with non-urgent conditions. Patients frequently choose the ED for non-emergent medical issues or injuries that could readily be handled in a primary care setting. We analyzed encounters in the ED at the Brooke Army Medical Center-the largest hospital in the Department of Defense-to determine the percentage of visits that could potentially be managed in a lower cost, appointment-based setting. MATERIALS AND METHODS: We conducted a retrospective chart review of patients within our electronic medical record system from September 2019 to August 2020, which represented equidistance from the start of the COVID-19 pandemic, resulting in a shift in ED used based on previously published data. Our study also compared the number of ED visits pre-covid vs. post-covid. We defined visits to be primary care eligible if they were discharged home and received no computed tomography imaging, ultrasound, magnetic resonance imaging, intravenous medications, or intramuscular-controlled substances. RESULTS: During the 12 month period, we queried data on 75,205 patient charts. We categorized 56.7% (n = 42,647) of visits as primary care eligible within our chart review. Most primary-care-eligible visits were ESI level 4 (59.2%). The largest proportion of primary-care-eligible patients (28.3%) was seen in our fast-track area followed by our pediatric pod (21.9%). The total number of ED visits decreased from 7,477 pre-covid to 5,057 post-covid visits. However, the proportion of patient visits that qualified as primary care eligible was generally consistent. CONCLUSIONS: Over half of all ED visits in our dataset could be primary care eligible. Our findings suggest that our patient population may benefit from other on-demand and appointment-based healthcare delivery to decompress the ED.

Pandemic-related work status is associated with self-reported increases in substance use

Abrupt changes in employment status associated with the COVID-19 pandemic can exacerbate maladaptive coping strategies—including substance use behavior. This online study assessed self-reported increases in substance use (alcohol, cigarettes, marijuana, and opioid pain medication) during the initial COVID-19 period, identifying how current employment status was associated with increases in substance use behavior. Individuals working from home and outside of home, and those unemployed due to the pandemic reported increases in alcohol, cigarette, and marijuana use. Identifying work-status-related increases in substance use during the COVID-19 pandemic is necessary as it relates to uncertain economic impact and mitigating virus risk. [ABSTRACT FROM AUTHOR] Copyright of Journal of Workplace Behavioral Health is the property of Taylor & Francis Ltd 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 abstract 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 abstract. (Copyright applies to all Abstracts.)

Pandemic-Specific Factors Related to Generalized Anxiety Disorder during the Initial COVID-19 Protocols in the United States.

Little is known about the psychological stress and secondary impacts emerging among the general U.S. population as a result of the ongoing COVID-19 pandemic. The purpose for the current study is to assess the prevalence rates of Generalized Anxiety Disorder (GAD) and to establish psychosocial correlates, pandemic-themed concerns, and other comorbidities for those with GAD at the initial onset of the COVID-19 pandemic. This online study included 2,101 U.S. adults between April 14-22, 2020, during the initial stay-at-home protocols and assessed GAD, psychosocial factors, and pandemic-related factors including concerns, changes in health behaviors, and adherence to protocols. The results demonstrated a high prevalence rate (17.9%) for GAD during the initial COVID-19 outbreak compared with the prior 1.8% 12-month estimate before the pandemic. Individuals with GAD reported significantly higher levels of stress, loneliness, fatigue, and empathic concern, along with reductions in levels of quality of life. Likewise, those with GAD reported significantly higher pandemic-related concerns, poorer changes in general health behaviors, and less confidence in the government's response to the pandemic. For clinical purposes, these findings provide insight into the various types of pandemic-themed worries that individuals meeting clinical criteria for GAD will have the most difficulties controlling.