The impact of COVID-19 lockdown on a cohort of adults with recurrent major depressive disorder from Catalonia: a decentralized longitudinal study using remote measurement technology (preprint)

The present study analyzes the effects on depression levels of each containment phase of the first wave of COVID-19 in a cohort of adults with a history of major depressive disorder (MDD). This analysis is part of the Remote Assessment of Disease and Relapse-MDD (RADAR-MDD) study. Depression was evaluated with the Patient Health Questionnaire-8 (PHQ-8) and anxiety with the Generalized Anxiety Disorder-7 (GAD-7). A total of 121 participants from Catalonia were registered from November 1, 2019, to October 16, 2020. Levels of depression were explored across the phases (pre-lockdown, lockdown, four post-lockdown phases) of the restrictions imposed by the Spanish/Catalan governments. Then, a mixed model was fitted to estimate how depression varied over the phases. A significant rise in the depressive severity was found during the lockdown and phase 0 (early post-lockdown), as compared with pre-lockdown phase in this sample with a history of MDD. Those with low pre-lockdown depression experienced a higher increase in depression levels during the new-normality. We observed a significant decrease in the depression levels during the new-normality in those with high pre-lockdown depression, compared to the pre-lockdown period. These findings suggest that COVID-19 restrictions impacted on the depression of individuals diagnosed with MDD, depending on their pre-lockdown depression levels.

Sociodemographic, mental health, and physical health factors associated with participation within re-contactable mental health cohorts: an investigation of the GLAD Study (preprint)

Background: The Genetic Links to Anxiety and Depression (GLAD) Study is a large cohort of individuals with lifetime anxiety and/or depression, designed to facilitate re-contact of participants for mental health research. At the start of the pandemic, participants from three cohorts, including the GLAD Study, were invited to join the COVID-19 Psychiatry and Neurological Genetics (COPING) study to monitor mental and neurological health. However, previous research suggests that participation in longitudinal studies follows a systematic, rather than random, process, which can ultimately bias results. Therefore, this study assessed participation biases following the re-contact of GLAD Study participants. Methods: In April 2020, all current GLAD Study participants (N = 36,770) were invited to the COPING study. Using logistic regression, we investigated whether sociodemographic, mental, and physical health characteristics were associated with participation in the COPING baseline survey. Subsequently, we used a zero-inflated negative binomial regression examined whether these factors were related to participation in the COPING follow-up surveys. Results: For aim one, older age, female gender identity, non-binary or prefer to self-define gender identity, having one or more physical health disorders, and providing a saliva kit for the GLAD Study were associated with an increased odds of completing the COPING baseline survey. In contrast, lower educational attainment, Asian or Asian British ethnic identity, Black or Black British ethnic identity, higher alcohol consumption at the GLAD sign-up survey and current or ex-smoking were associated with a reduced odds. For aim 2, older age, female gender, and saliva kit provision were associated with greater COPING follow-up survey completion. On the other hand, lower educational attainment, ex-smoking, higher alcohol consumption at the GLAD Study sign-up, and self-reported attention deficit hyperactivity disorder had negative relationships. Conclusions: Participation biases surrounding sociodemographic and physical health characteristics were particularly evident when re-contacting the GLAD Study volunteers. Future researchers re-contacting participants from existing cohorts/BioResources should be mindful of participation bias and how it may affect results obtained from analyses.

The Eating Disorders Genetics Initiative (EDGI) United Kingdom (preprint)

Objective The Eating Disorders Genetics Initiative United Kingdom (EDGI UK), part of the National Institute for Health and Care Research (NIHR) Mental Health BioResource, aims to deepen our understanding of the environmental and genetic aetiology of eating disorders. EDGI UK launched in February 2020 and is partnered with the UK eating disorders charity, Beat. There are multiple EDGI branches worldwide. Method EDGI UK recruits via media and clinical services. Anyone living in England, at least 16 years old, with a lifetime probable or clinical eating disorder is eligible to sign up online: edgiuk.org . Participants complete online questionnaires, donate a saliva sample for genetic analysis, and consent to medical record linkage and recontact for future studies. Results As of September 2022, EDGI UK has recruited 8,397 survey participants: 98% female, 93% white, 97.7% cisgender, 67% heterosexual, and 52% have a university degree. Half (51.7%) of participants have returned their saliva kit. The most common diagnoses are anorexia nervosa (42.7%), atypical anorexia nervosa (31.4%), bulimia nervosa (33.2%), binge-eating disorder (14.6%), and purging disorder (33.5%). Conclusion EDGI UK is the largest UK eating disorders study but needs to increase its diversity, and efforts are underway to do so. It also offers a unique opportunity to accelerate eating disorder research, and collaboration between researchers and participants with lived experience, with unparalleled sample size.

Risk and protective factors for new onset binge eating, low weight, and self-harm symptoms in over 25,000 individuals in the UK during the COVID-19 pandemic (preprint)

Objective: The disruption caused by the COVID-19 pandemic has been associated with poor mental health, including increases in eating disorder and self-harm symptoms. We investigated risk and protective factors for new onset of these symptoms during the pandemic. Method: Data were from the COVID-19 Psychiatry and Neurological Genetics study and the Repeated Assessment of Mental health in Pandemics Study (n = 45,058). Exposures were socio-demographic characteristics, lifetime psychiatric disorder, and COVID-related variables, including SARS-CoV-2 infection/illness with COVID-19. We identified four sub-samples of participants without pre-pandemic experience of our outcomes: binge eating (n = 18,172), low weight (n = 19,148), suicidal and/or self-harm ideation (n = 12,650), and self-harm (n = 20,266). Participants reported on our outcomes at frequent intervals (fortnightly to monthly). We fitted four logistic regression models to identify factors associated with new onset of our outcomes. Results: Within each subsample, new onset was reported by: 16.9% for binge eating, 8.9% for low weight, 26.6% for suicidal and/or self-harm ideation, and 3.3.% for self-harm. Shared risk factors included having a lifetime psychiatric disorder, not being in paid employment, and higher pandemic worry scores. Conversely, infection with SARS-CoV-2/illness with COVID-19 was linked to lower odds of all outcomes. Other factors were associated with one outcome, such as pandemic-related loneliness with suicidal and/or self-harm ideation. Discussion: Overall, we detected shared risk factors that may drive the comorbidity between eating disorders and self-harm. Subgroups of individuals with these risk factors may require more frequent monitoring during future pandemics.

Experiences of mental health and wellbeing support for NHS staff during the COVID-19 pandemic: a reflexive thematic analysis (preprint)

Staff in the National Health Service (NHS) have been placed under considerable strain during the COVID-19 pandemic; whilst NHS Trusts provide a variety of health and wellbeing support services, there has been little research investigating staff perceptions of these services. Moreover, the research that does exist typically includes only clinical staff, despite a large proportion of patient-facing NHS workers being in non-clinical roles. We interviewed forty-eight clinical and non-clinical healthcare workers from eighteen NHS Trusts in England about their experiences of workplace health and wellbeing support during the pandemic. Reflexive thematic analysis identified that perceived stigma around help-seeking, and staffing shortages due to wider socio-political contexts such as austerity, were barriers to using support services. Visible, caring leadership at all levels (CEO to line managers), peer support, easily accessible services, and clear communication about support offers were enablers. Our evidence suggests Trusts should have active strategies to improve help-seeking. This could involve providing all staff with regular reminders about support options, in a variety of formats (e.g. email, posters, mentioned in meetings), and easily remembered single points of access, delivered by a mix of in-house and externally-provided services, to cater for those more and less concerned about stigma and confidentiality. In addition, managers at all levels should be trained and supported to feel confident to speak about mental health with staff, with formal peer support facilitated by building in time for this during working hours. As others have pointed out, this will require long-term strategic planning to address workforce shortages.

It hurts your heart: frontline healthcare worker experiences of moral injury during the COVID-19 pandemic (preprint)

Background: Moral injury is defined as the strong emotional and cognitive reactions following events which clash with someones moral code, values or expectations. During the COVID-19 pandemic, increased exposure to potentially morally injurious events (PMIEs) has placed healthcare workers (HCWs) at risk of moral injury. Yet little is known about the lived experience of cumulative PMIE exposure and how NHS staff respond to this. Objective: We sought to rectify this knowledge gap by qualitatively exploring the lived experiences and perspectives of clinical frontline NHS staff who responded to COVID-19. Methods: We recruited a diverse sample of 30 clinical frontline HCWs from the NHS CHECK study cohort, for single time point qualitative interviews. All participants endorsed at least one item on the 9-item Moral Injury Events Scale (MIES) (Nash et al., 2013) at six month follow up. Interviews followed a semi-structured guide and were analysed using reflexive thematic analysis. Results: HCWs described being routinely exposed to ethical conflicts, created by exacerbations of pre-existing systemic issues including inadequate staffing and resourcing. We found that HCWs experienced a range of mental health symptoms primarily related to perceptions of institutional betrayal as well as feeling unable to fulfil their duty of care towards patients. Conclusion: These results suggest that a multi-facetted organisational strategy is warranted to prepare for PMIE exposure, promote opportunities for resolution of symptoms associated with moral injury and prevent organisational disengagement.

Mental health of healthcare workers in England during the COVID-19 pandemic: a longitudinal cohort study (preprint)

Objective To examine variations in impact of the COVID-19 pandemic on the mental health of all types of healthcare workers (HCWs) in England over the first 17 months of the pandemic. Method We undertook a prospective cohort study of 22,501 HCWs from 18 English acute and mental health NHS Trusts, collecting online survey data on common mental disorders (CMDs), depression, anxiety, alcohol use, and PTSD, from April 2020 to August 2021. We analysed these data cross-sectionally by time period (corresponding to periods the NHS was under most pressure), and longitudinally. Data were weighted to better represent Trust population demographics. Results The proportion of those with probable CMDs was greater during periods when the NHS was under most pressure (measured by average monthly deaths). For example, 55% (95%CI 53%, 58%) of participants reported symptoms of CMDs in April-June 2020 versus 47% (95%CI 46%, 48%) July-October 2020. Contrary to expectation, there were no major differences between professional groups (i.e. clinical and non-clinical staff). Younger, female, lower paid staff, who felt poorly supported by colleagues/managers, and who experienced potentially morally injurious events were most at risk of negative mental health outcomes. Conclusion Among HCWs, the prevalence of probable CMDs increased during periods of escalating pressure on the NHS, suggesting staff support should be increased at such points in the future, and staff should be better prepared for such situations via training. All staff, regardless of role, experienced poorer mental health during these periods, suggesting that support should be provided for all staff groups.

Capturing the experiences of UK healthcare workers during the COVID-19 pandemic: A structural topic modelling analysis of 7,412 free-text survey responses (preprint)

Background Healthcare workers (HCWs) have provided vital services during the COVID-19 pandemic, but existing research consists of quantitative surveys (lacking in depth or context) or qualitative interviews (with limited generalisability). Structural Topic Modelling (STM) of large-scale free-text survey data offers a way of capturing the perspectives of a wide range of HCWs in their own words about their experiences of the pandemic. Methods In an online survey distributed to all staff at 18 geographically dispersed NHS Trusts, we asked respondents, Is there anything else you think we should know about your experiences of the COVID-19 pandemic?. We used STM on 7,412 responses to identify topics, and thematic analysis on the resultant topics and text excerpts. Results We identified 33 topics, grouped into two domains, each containing four themes. Our findings emphasise: the deleterious effect of increased workloads, lack of PPE, inconsistent advice/guidance, and lack of autonomy; differing experiences of home working as negative/positive; and the benefits of supportive leadership and peers in ameliorating challenges. Themes varied by demographics and time: discussion of home working decreasing over time, while discussion of workplace challenges increased. Discussion of mental health was lowest between September-November 2020, between the first and second waves of COVID-19 in the UK. Discussion Our findings represent the most salient experiences of HCWs through the pandemic. STM enabled statistical examination of how the qualitative themes raised differed according to participant characteristics. This relatively underutilised methodology in healthcare research can provide more nuanced, yet generalisable, evidence than that available via surveys or small interview studies, and should be used in future research.

Moral injury and psychological wellbeing in UK healthcare staff (preprint)

Background Potentially morally injurious events (PMIEs) can negatively impact mental health. The COVID-19 pandemic may have placed healthcare staff at risk of moral injury. Aim To examine the impact of PMIE on healthcare staff wellbeing. Method 12,965 healthcare staff (clinical and non-clinical) were recruited from 18 NHS-England trusts into a survey of PMIE exposure and wellbeing. Results PMIEs were significantly associated with adverse mental health symptoms across healthcare staff. Specific work factors were significantly associated with experiences of moral injury, including being redeployed, lack of PPE, and having a colleague die of COVID-19. Nurses who reported symptoms of mental disorders were more likely to report all forms of PMIEs than those without symptoms (AOR 2.7; 95% CI 2.2, 3.3). Doctors who reported symptoms were only more likely to report betrayal events, such as breach of trust by colleagues (AOR 2.7, 95% CI 1.5, 4.9). Conclusions A considerable proportion of NHS healthcare staff in both clinical and non-clinical roles report exposure to PMIEs during the COVID-19 pandemic. Prospective research is needed to identify the direction of causation between moral injury and mental disorder as well as continuing to monitor the longer term outcomes of exposure to PMIEs.

Biopsychosocial response to the COVID-19 lockdown in people with major depressive disorder and multiple sclerosis. (preprint)

BackgroundChanges in lifestyle, finances and work status during COVID-19 lockdowns may have led to biopsychosocial changes in people with pre-existing vulnerabilities such as Major Depressive Disorders (MDD) and Multiple Sclerosis (MS). MethodsData were collected as a part of the RADAR-CNS (Remote Assessment of Disease and Relapse - Central Nervous System) programme. We analyzed the following data from long-term participants in a decentralized multinational study: symptoms of depression, heart rate (HR) during the day and night; social activity; sedentary state, steps and physical activity of varying intensity. Linear mixed-effects regression analyses with repeated measures were fitted to assess the changes among three time periods (pre, during and post-lockdown) across the groups, adjusting for depression severity before the pandemic and gender. ResultsParticipants with MDD (N=255) and MS (N=214) were included in the analyses. Overall, depressive symptoms remained stable across the three periods in both groups. Lower mean HR and HR variation were observed between pre and during lockdown during the day for MDD and during the night for MS. HR variation during rest periods also decreased between pre-and post-lockdown in both clinical conditions. We observed a reduction of physical activity for MDD and MS upon the introduction of lockdowns. The group with MDD exhibited a net increase in social interaction via social network apps over the three periods. ConclusionsBehavioral response to the lockdown measured by social activity, physical activity and HR may reflect changes in stress in people with MDD and MS.

Understanding the subjective experience of long-term remote measurement technology use for symptom tracking in people with depression: A multisite, longitudinal qualitative analysis (preprint)

Background: Remote Measurement Technologies (RMTs) have the potential to revolutionise major depressive disorder (MDD) disease management by offering the ability to assess, monitor and predict symptom changes. However, the promise of RMT data depends heavily on sustained user engagement over extended periods of time. Here we report a longitudinal qualitative study of the subjective experience of people with MDD engaging with RMTs, to provide insight into system usability and user experience and to provide the basis for future promotion of RMT use in research and clinical practice. Objective We aimed to understand the subjective experience of long-term engagement with RMTs, through qualitative data collected throughout a longitudinal study of RMTs in MDD. The objectives were (1) to explore key themes associated with long-term RMT use, and (2) to identify recommendations for future system engagement. Methods In this multisite, longitudinal qualitative research study, 124 semi-structured interviews were conducted with 99 participants across the United Kingdom, Spain, and The Netherlands at 3-month, 12-month, and 24-month timepoints during a study exploring RMT use (the Remote Assessment of Disease and Relapse- Major Depressive Disorder study). Data was analysed using thematic analysis; interviews were audio recorded, transcribed, and coded in the native language, with resulting quotes translated into English. Results There were five main themes regarding the subjective experience of long-term RMT use: 1) research-related factors, 2) utility of RMTs for self-management, 3) technology-related factors, 4) clinical-related factors, and 5) system amendments and additions. Conclusions The subjective experience of long-term RMT use can be considered from two main perspectives: a) experiential factors (how participants construct their experience of engaging with RMTs), and b) system factors (direct engagement with the technologies). A set of recommendations based on these strands is proposed, for both future research and the real-world implementation of RMTs into clinical practice. Future exploration of experiential engagement with RMTs will be key to successful use of RMTs in clinical care.

NHS CHECK: protocol for a cohort study investigating the psychosocial impact of the COVID-19 pandemic on healthcare workers (preprint)

Introduction The COVID-19 pandemic has had profound effects on the working lives of healthcare workers (HCWs), but the extent to which their well-being and mental health have been affected remains unclear. This longitudinal cohort study aims to recruit a cohort of NHS healthcare workers, conducting surveys at regular intervals to provide evidence about the prevalence of symptoms of mental disorders, investigate associated factors such as occupational contexts and support interventions available. Methods and Analysis All staff, students, and volunteers working in each of the 18 participating NHS Trusts in England will be sent emails inviting them to complete a survey at baseline, with email invitations for the follow up surveys being sent 6 and 12 months later. Opening in late April 2020, the baseline survey collects data on demographics, occupational and organisational factors, experiences of COVID-19, a number of validated measures of symptoms of poor mental health (e.g. depression, anxiety, post-traumatic stress disorder; PTSD), and measures of constructs such as resilience and moral injury. These regular surveys will be complemented by in-depth psychiatric interviews with a select sample of healthcare workers. Qualitative interviews will also be conducted, to gain deeper understanding of the support programmes used or desired by staff, and facilitators and barriers to accessing such programmes. Ethics and Dissemination Ethical approval for the study was granted by the Health Research Authority (reference: 20/HRA/210, IRAS: 282686) and local Trust Research and Development approval. Cohort data are being collected via Qualtrics online survey software, are pseudonymised and held on secure University servers. Participants are aware that they can withdraw from the study at any time, and there is signposting to support services for any participant who feels they need it. Only those consenting to be contacted about further research will be invited to participate in the psychiatric and qualitative interview components of the study. Findings will be rapidly shared with NHS Trusts to enable better support of staff during the pandemic, and via academic publications in due course. Strengths and limitations of this study The longitudinal cohort design addresses the lack of long-term data on this population, and the current predominance of cross-sectional evidence available. The availability of Trust HR data means we will be able to calculate response rates, and weight the data appropriately. The diagnostic interview component of the study will allow us to establish the true prevalence of mental disorders, which can be inflated by the measures used in most mental health and wellbeing cohort studies. The qualitative interviews will give deeper insight into the support programmes that HCWs find most helpful, and provide ideas for Trusts to improve their offer to staff. The three components of the study give breadth and depth lacking in much of the mental health and wellbeing research currently available, but there is a risk of over-burdening already stretched HCWs.

Depression, anxiety and PTSD symptoms before and during the COVID-19 pandemic in the UK (preprint)

Background: The COVID-19 pandemic is a novel population-level stressor. As such, it is important to examine pandemic-related changes in mental health and to identify which individuals are at greatest risk of worsening symptoms. Methods: Online questionnaires were administered to 34,465 individuals in the UK, recruited from existing cohorts or via social media. Around one third (n = 12,718) with prior diagnoses of depression or anxiety completed pre-pandemic mental health assessments, allowing prospective investigation of symptom change. We examined changes in depression, anxiety and PTSD symptoms using prospective, retrospective and global ratings of change assessments. We also examined the effect of key risk factors on changes in symptoms.Outcomes: Prospective analyses showed small decreases in depression (PHQ-9: - .43 points) and anxiety symptoms (GAD-7: -.33 points), and increases in PTSD symptoms (PCL-6: .22 points). Conversely, retrospective analyses demonstrated large significant increases in depression (2.40 points) and anxiety symptoms (1.97 points) and 55% reported worsening mental health since the beginning of the pandemic on a global change rating. Using both prospective and retrospective symptom measures, regression analyses demonstrated that worsening depression, anxiety and PTSD symptoms were associated with i) prior mental health diagnoses, ii) female gender; iii) young age, and iv) unemployed or student status.Interpretation: We highlight the effect of prior mental health diagnoses on worsening mental health during the pandemic and confirm previously-reported sociodemographic risk factors. Discrepancies between prospective and retrospective measures of changes in mental health may be related to recall bias underestimating prior symptom severity.

Fitbeat: COVID-19 Estimation based on Wristband Heart Rate (preprint)

This study investigates the potential of deep learning methods to identify individuals with suspected COVID-19 infection using remotely collected heart-rate data. The study utilises data from the ongoing EU IMI RADAR-CNS research project that is investigating the feasibility of wearable devices and smart phones to monitor individuals with multiple sclerosis (MS), depression or epilepsy. Aspart of the project protocol, heart-rate data was collected from participants using a Fitbit wristband. The presence of COVID-19 in the cohort in this work was either confirmed through a positive swab test, or inferred through the self-reporting of a combination of symptoms including fever, respiratory symptoms, loss of smell or taste, tiredness and gastrointestinal symptoms. Experimental results indicate that our proposed contrastive convolutional auto-encoder (contrastive CAE), i. e., a combined architecture of an auto-encoder and contrastive loss, outperforms a conventional convolutional neural network (CNN), as well as a convolutional auto-encoder (CAE) without using contrastive loss. Our final contrastive CAE achieves 95.3% unweighted average recall, 86.4% precision, anF1 measure of 88.2%, a sensitivity of 100% and a specificity of 90.6% on a testset of 19 participants with MS who reported symptoms of COVID-19. Each of these participants was paired with a participant with MS with no COVID-19 symptoms.

Different Mental Health Responses to the COVID-19 Pandemic: Latent Class Trajectory Analysis Using Longitudinal UK Data (preprint)

Background: The UK population’s mental health declined at the pandemic onset. Convenience sample surveys indicate recovery began soon after. Using a probability sample, we tracked average mental health during the pandemic, characterised distinct mental health trajectories and identified predictors of deterioration.Methods: Secondary analysis of five waves of UK Household Longitudinal Survey from late April-early October 2020 and pre-pandemic data, 2018-2019. Mental health was assessed in 19,763 adults (≥16 years) using 12-item General Health Questionnaire. Latent class growth models identified discrete mental health trajectories and fixed-effects regression identified predictors of change in mental health.Findings: Average population mental health deteriorated with onset of the pandemic and did not begin improving until July 2020. Latent class analysis identified six distinct mental health trajectories up to October 2020. Three-quarters had consistently good (46·2%) or very good (30·9%) mental health. Two ‘recovery’ groups (15·8%) initially experienced marked declines in mental health, improving to their pre-pandemic levels by October. For 4·8%, mental health steadily deteriorated and for 2·3% it was very poor throughout. These two groups were more likely to have pre-existing mental or physical ill-health, live in deprived neighbourhoods and be non-white. Infection with COVID-19, local lockdown and financial difficulties all predicted subsequent mental health deterioration.Interpretation: Between April-October 2020, the mental health of most UK adults remained resilient or returned to pre-pandemic levels. One-in-fourteen experienced deteriorating or consistently poor mental health. People living in areas affected by lockdown, struggling financially, with pre-existing conditions or COVID infection might benefit most from early intervention.Funding Statement: None.Declaration of Interests: None.Ethics Approval Statement: Ethics approval was granted by the University of Essex Ethics Committee for the COVID-19 web and telephone surveys (ETH1920-1271).

The King's College London Coronavirus Health and Experiences of Colleagues at King's Study: SARS-CoV-2 antibody response in a higher education sample (preprint)

Objective: To assess the feasibility of home antibody testing as part of large-scale study, the King's College London Coronavirus Health and Experiences of Colleagues at King's (KCL CHECK). Methods: Participants of the KCL CHECK study were sent a SureScreen Diagnostics COVID-19 IgG/IgM Rapid Test Cassette to complete at home in June 2020 (phase 1) and September 2020 (phase 2). Participants were asked to upload a test result image to a study website. Test result images and sociodemographic information were analysed by the research team. Results: A total of n=2716 participants enrolled in the KCL CHECK study, with n=2003 (73.7%) and n=1825 (69.3%) consenting and responding to phase 1 and 2. Of these, n=1882 (93.9%; phase 1) and n=1675 (91.8%; phase 2) returned a valid result. n=123 (6.5%; phase 1) and n=91 (5.4%; phase 2) tested positive for SARS-CoV-2 antibodies. A total of n=1488 participants provided a result in both phases, with n=57 (3.8%) testing positive for SARS-CoV-2 antibodies across both phases, suggesting a reduction in the number of positive antibody results over time. Initial comparisons showed variation by age group, gender and clinical role. Conclusions: Our study highlights the feasibility of rapid, repeated and low-cost SARS-CoV-2 serological testing without the need for face-to-face contact.

Prevalence of Mental Disorders, Suicidal Ideation and Suicides in the General Population Before and During the COVID-19 Pandemic in Norway. A Population-Based Repeated Cross-Sectional Analysis from the HUNT Study and the Norwegian Cause of Death Registry (preprint)

Background: Self-report data indicate a deterioration of population mental health in many countries during the COVID-19 pandemic. A Norwegian epidemiological diagnostic psychiatric interview survey was conducted from January to September 2020, allowing for comparison of current prevalence of mental disorders from before through different pandemic phases. Prevalence of suicide deaths were compared between 2020 and 2014-2018.Methods: Participants from the Trøndelag Health Study (HUNT) in Trondheim were recruited through repeated probability sampling. Using the Composite International Diagnostic Interview (CIDI 5.0) (n=2,154), current prevalence of mental disorders was examined in repeated cross-sectional analyses. Data on suicide was retrieved from the Norwegian Cause of Death Registry and compared for the first phase of the pandemic with the same months 2014-2018. Findings: Prevalence of mental disorders decreased significantly from the pre-pandemic phase (January 28th to March 11th 2020; 15·3% [95% CI 12·4-18·8]) to the first pandemic phase (March 12th – May 31st ; 8·7% [6·8-11·0]) and was fairly stable through the interim phase (June 1st July 31st ; 14·2% [11·4-17·5]) and the second phase (August 1st -September 18th ; 11·9% [9·0-15·6]). Suicidal ideation was non-significantly (n.s) increased during the pandemic. Suicide deaths were 15% lower (n.s) in March-May 2020 (n=140) compared with the same months pooled over 2014-2018 (n=165). Interpretation: We found no increase in mental disorders or suicides during the COVID-19 pandemic up through early autumn 2020. COVID-19 related mortality, transmission rates, intensity and implementation of measures and lockdowns have been less severe in Norway than many other countries and could account for these results.Funding: NoneDeclaration of Interests: Dr. Hotopf reports grants from European Commission IMI/EFPIA, grants from National Institute of Health Research, grants from Medical Research Council, and grants from Economic and Social Research Council outside the submitted work. In the past 3 years, Dr. Kessler was a consultant for Datastat, Inc., Sage Pharmaceuticals, and Takeda. The authors Dr. Knudsen, Dr. Gustavson, Dr. Krokstad, Dr. Skogen, Dr. Stene-Larsen, Dr. Øverland and Dr. Reneflot report no conflict of interest.Ethics Approval Statement: The survey was a collaboration between the Norwegian Institute of Public Health (NIPH) and the HUNT Research Centre and approved by the Regional Committee for Medical Research Ethics (2017/28/REK midt).

The psychosocial impact of the COVID-19 pandemic on 4,378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic. (preprint)

Objectives This study reports preliminary findings on the prevalence of, and factors associated with, mental health and wellbeing outcomes of healthcare workers during the early months (April-June) of the COVID-19 pandemic in the UK. Methods Preliminary cross-sectional data were analysed from a cohort study (n=4,378). Clinical and non-clinical staff of three London-based NHS Trusts (UK), including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire (GHQ-12). Secondary outcomes are probable anxiety (GAD-7), depression (PHQ-9), Post-Traumatic Stress Disorder (PTSD) (PCL-6), suicidal ideation (CIS-R), and alcohol use (AUDIT). Moral injury is measured using the Moray Injury Event Scale (MIES). Results Analyses showed substantial levels of CMDs (58.9%, 95%CI 58.1 to 60.8), and of PTSD (30.2%, 95%CI 28.1 to 32.5) with lower levels of depression (27.3%, 95%CI 25.3 to 29.4), anxiety (23.2%, 95%CI 21.3 to 25.3), and alcohol misuse (10.5%, 95%CI, 9.2 to 11.9). Women, younger staff, and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one's moral code) was strongly associated with increased levels of CMDs, anxiety, depression, PTSD symptoms, and alcohol misuse. Conclusions Our findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic.

Indicators of COVID-19 status in a cohort study of university staff and post-graduate research students, including results from home antibody testing (preprint)

BackgroundCohort studies of people with a history of COVID-19 infection and controls will be essential to understand the epidemiology of long-term effects. However, clinical diagnosis requires resources that are frequently restricted to the severely ill. Cohort studies may have to rely on surrogate indicators of COVID-19 illness. We describe the prevalence and overlap of five potential indicators: self-reported suspicion, self-reported core symptoms, symptom algorithm, self-reported routine test results, and home antibody testing. MethodsAn occupational cohort of staff and postgraduate students at a large London university who participated in surveys and antibody testing. Self-report items cover March to June 2020 and antibody test results from lateral flow IgG/IgM antibody test cassettes sent to participants in June 2020. ResultsValid antibody test results were returned for 1882 participants. Of the COVID-19 indicators, the highest prevalence was core symptoms (770 participants positive, 41%), followed by participant suspicion of infection (n=509, 27%), a symptom algorithm (n=297, 16%), study antibody positive test (n=124, 6.6%) and self-report of a positive external test (n=39, 2.1%). Study antibody positive result was rare in people who had no suspicion they had experienced COVID-19 (n=4, 0.7%) or did not experience core symptoms (n=10, 1.6%). When study antibody test results were compared with earlier external antibody results in those who had reported them, the study antibody results agreed in 88% cases (kappa= 0.636), with a lower proportion testing positive on this occasion (proportion with antibodies detected 15% in study test vs 24% in external testing). DiscussionOur results demonstrate that there is some agreement between different COVID indicators, but that they a more complete story when used together. Antibody testing may provide greater certainty and be one of the only ways to detect asymptomatic cases, but is likely to under-ascertain due to weak antibody responses to mild infection, which wane over time. Cohort studies will need to review how they deal with different and sometimes conflicting indicators of COVID-19 illness in order to study the long-term outcomes of COVID-19 infection and related impacts. What is already known on this subject?Research into the effects of COVID-19 in the community is needed to respond to the pandemic. Objective testing has not been widely available and accuracy may not be high when carried out in retrospect. Many cohort studies are considering how best to measure COVID-19 infection status. What this study adds?Antibody testing is feasible, but it is possible that sensitivity may be poor. Each indicator included added different aspects to the ascertainment of COVID-19 exposure. Using combinations of self-reported and objectively measured variables, it may be possible to tailor COVID-19 indicators to the situation.

Scientific publications and COVID-19 "research pivots" during the pandemic: An initial bibliometric analysis (preprint)

An examination is presented of scientific research publication trends during the global coronavirus (COVID-19) pandemic in 2020. After reviewing the timing of the emergence of the pandemic in 2020 and the growth of governmental responses, available secondary and sources are used to highlight impacts of COVID-19 on scientific research. A bibliometric analysis is then undertaken to analyze developments in COVID-19 related scientific publications through to October of 2020 by broad trends, fields, countries, and organizations. Two publication data sources are used: PubMed and the Web of Science. While there has been a massive absolute increase in PubMed and Web of Science papers directly focused on COVID-19 topics, especially in medical, biological science, and public health fields, this is still a relatively small proportion of publication outputs across all fields of science. Using Web of Science publication data, the paper examines the extent to which researchers across all fields of science have pivoted their research outputs to focus on topics related to COVID-19. A COVID-19 research pivot is defined as the extent to which the proportion of output in a particular research field has shifted to a focus on COVID-19 topics in 2020 (to date) compared with 2019. Significant variations are found by specific fields (identified by Web of Science Subject Categories). In a top quintile of fields, not only in medical specialties, biomedical sciences, and public health but also in subjects in social sciences and arts and humanities, there are relatively high to medium research pivots. In lower quintiles, including other subjects in science, social science, and arts and humanities, low to zero COVID-19 research pivoting is identified. Version NoteThis working paper is Version 1, completed on December 6, 2020. As further data becomes available, it may be updated.