Anxiety and Depression Symptoms Among Young U.S. Essential Workers During the COVID-19 Pandemic.

OBJECTIVE: Emerging cross-sectional data indicate that essential workers in the COVID-19 era face increased mental health risks. This study longitudinally examined clinical symptoms of generalized anxiety disorder, depression, and posttraumatic stress disorder (PTSD) among U.S. essential workers, including health care workers and workers in indispensable occupations such as manufacturing, food industry, construction, transportation, hospitality, and emergency services, during the COVID-19 pandemic. The authors anticipated high symptom levels and greater symptom severity among women versus men and among younger adults compared with older adults. Analyses also explored the association between COVID-19 vaccination status and clinical symptoms. METHODS: This four-wave online survey study assessed clinical symptoms in a convenience sample of 4,136 essential workers at baseline and 14, 30, and 90 days between August and December 2021. Symptoms of anxiety, depression, and PTSD were measured with the Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Primary Care PTSD Screen instruments, respectively. RESULTS: At every time point, 74%-78% of respondents reported symptoms of anxiety and depression, which were highest among younger adults (ages 18-22 years), females, and transgender respondents. Vaccinated participants had slightly higher symptom levels than unvaccinated respondents. Rates of clinical symptoms did not change significantly over time. CONCLUSIONS: Essential workers consistently reported symptoms of generalized anxiety, depression, or PTSD, especially younger adult, female, and transgender participants. The overwhelming and unprecedented nature of the COVID-19 pandemic underscores the need to offer mental health care to essential workers, especially those in these subgroups. Employers and administrators should support and proactively encourage employees to access care when needed.

Brief Video Intervention to Increase Treatment-Seeking Intention Among U.S. Health Care Workers: A Randomized Controlled Trial.

OBJECTIVE: Many health care workers avoid seeking mental health care, despite COVID-19-related increases in risk of psychopathology. This study assessed the effects of two versions (distinguished by the race of the protagonist) of a brief social contact-based video on treatment-seeking intention and stigma toward mental health services among U.S. health care workers. METHODS: Participants (N=1,402) were randomly assigned to view a 3-minute video in which a Black or White female nurse described struggles with COVID-19-related anxiety and depression, barriers to care, and how therapy helped, or to view a control video unrelated to mental health. Half of the participants receiving the intervention watched the same video (i.e., booster) again 14 days later. Treatment-seeking intention and treatment-related stigma were assessed at baseline, postintervention, and 14- and 30-day follow-ups. RESULTS: Both intervention videos elicited an immediate increase in treatment-seeking intention in the intervention groups (p<0.001, effect size [ES]=21%), with similar effects among those who watched the booster video (p=0.016, ES=13%) and larger effects among those who had never sought treatment (p<0.001, ES=34%). The increased effects were not sustained 14 days after the initial video or at 30-day follow-up. The results showed an immediate reduction in stigma, but with no booster effect. The race of the protagonist did not influence outcomes. CONCLUSIONS: This easily administered intervention could increase the likelihood of care seeking by proactively encouraging health care workers with mental health challenges to pursue treatment. Future studies should examine whether the inclusion of linkable referrals to mental health services helps to increase treatment-seeking behavior.

Destigmatising mental health treatment and increasing openness to seeking treatment: randomised controlled trial of brief video interventions.

BACKGROUND: Despite an elevated risk of psychopathology stemming from COVID-19-related stress, many essential workers stigmatise and avoid psychiatric care. This randomised controlled trial was designed to compare five versions of a social-contact-based brief video intervention for essential workers, differing by protagonist gender and race/ethnicity. AIMS: We examined intervention efficacy on treatment-related stigma ('stigma') and openness to seeking treatment ('openness'), especially among workers who had not received prior mental healthcare. We assessed effectiveness and whether viewer/protagonist demographic concordance heightened effectiveness. METHOD: Essential workers (N = 2734) randomly viewed a control video or brief video of an actor portraying an essential worker describing hardships, COVID-related anxiety and depression, and psychotherapy benefits. Five video versions (Black/Latinx/White and male/female) followed an identical 3 min script. Half the intervention group participants rewatched their video 14 days later. Stigma and openness were assessed at baseline, post-intervention, and at 14- and 30-day follow-ups. Trial registration: NCT04964570. RESULTS: All video intervention groups reported immediately decreased stigma (P < 0.0001; Cohen's d = 0.10) and increased openness (P < 0.0001; d = 0.23). The initial increase in openness was largely maintained in the repeated-video group at day 14 (P < 0.0001; d = 0.18), particularly among viewers without history of psychiatric treatment (P < 0.0001; d = 0.32). Increases were not sustained at follow-up. Female participants viewing a female protagonist and Black participants viewing a Black protagonist demonstrated greater openness than other demographic pairings. CONCLUSIONS: Brief video-based interventions improved immediate stigma and openness. Greater effects among female and Black individuals viewing demographically matched protagonists emphasise the value of tailored interventions, especially for socially oppressed groups. This easily disseminated intervention may proactively increase care-seeking, encouraging treatment among workers in need. Future studies should examine intervention mechanisms and whether linking referrals to psychiatric services generates treatment-seeking.

The Impacts of COVID-19 on a Statewide Population With Mental Illness.

OBJECTIVE: This survey examined the experiences of individuals receiving treatment in a large public mental health system during the early months of the COVID-19 pandemic. METHODS: The survey, conducted between May and June 2020, assessed four domains: impacts on mental health, experiences with telehealth, access to care and resources, and sources and adequacy of support. Descriptive analyses were conducted. RESULTS: Of 4,046 respondents, 70% reported increases in their anxiety and stress because of the pandemic. A majority (55%) reported experiencing challenges related to the social determinants of health and functional needs. Most respondents reported that their care went undisrupted, with 92% using telehealth and 90% reporting feeling adequately supported. CONCLUSIONS: The pandemic substantially affected individuals with mental illness, particularly with regard to mental health related to the social determinants of health and functional needs. However, respondents felt that their mental health care was maintained and that they were adequately supported.

Justice for George Floyd and a reckoning for global mental health.

In the wake of George Floyd's killing by police in Minneapolis and the global response inspired by Black Lives Matter, it is time for the field of global mental health to reexamine how we have acknowledged and addressed racism in our institutions, our research, and our mental health services. In solidarity with street level responses, this is an important opportunity to understand and collaboratively respond to public demand for systemic change. To respond effectively, it is vital to (1) be aware of the colonial history that influences today's practices, and move forward with anti-colonial and anti-racist actions; (2) identify where and why diversity and representation are lacking in the global mental health workforce, then follow steps to combat these disparities; and (3) work with communities and institutions to end both police violence and structural violence.