Bidirectional Associations Between Depressive and Anxiety Symptoms and Loneliness During the COVID-19 Pandemic: Dynamic Panel Models With Fixed Effects.

Background: Understanding the direction and magnitude of mental health-loneliness associations across time is important to understand how best to prevent and treat mental health and loneliness. This study used weekly data collected over 8 weeks throughout the COVID-19 pandemic to expand previous findings and using dynamic panel models with fixed effects which account for all time-invariant confounding and reverse causation. Methods: Prospective data on a convenience and snowball sample from all 50 US states and the District of Colombia (n = 2,361 with ≥2 responses, 63.8% female; 76% retention rate) were collected weekly via online survey at nine consecutive timepoints (April 3-June 3, 2020). Anxiety and depressive symptoms and loneliness were assessed at each timepoint and participants reported the COVID-19 containment strategies they were following. Dynamic panel models with fixed effects examined bidirectional associations between anxiety and depressive symptoms and loneliness, and associations of COVID-19 containment strategies with these outcomes. Results: Depressive symptoms were associated with small increases in both anxiety symptoms (ß = 0.065, 95% CI = 0.022-0.109; p = 0.004) and loneliness (ß = 0.019, 0.008-0.030; p = 0.001) at the subsequent timepoint. Anxiety symptoms were associated with a small subsequent increase in loneliness (ß = 0.014, 0.003-0.025; p = 0.015) but not depressive symptoms (ß = 0.025, -0.020-0.070; p = 0.281). Loneliness was strongly associated with subsequent increases in both depressive (ß = 0.309, 0.159-0.459; p < 0.001) and anxiety (ß = 0.301, 0.165-0.436; p < 0.001) symptoms. Compared to social distancing, adhering to stay-at-home orders or quarantining were not associated with anxiety and depressive symptoms or loneliness (both p ≥ 0.095). Conclusions: High loneliness may be a key risk factor for the development of future anxiety or depressive symptoms, underscoring the need to combat or prevent loneliness both throughout and beyond the COVID-19 pandemic. COVID-19 containment strategies were not associated with mental health, indicating that other factors may explain previous reports of mental health deterioration throughout the pandemic.

High Sitting Time Is a Behavioral Risk Factor for Blunted Improvement in Depression Across 8 Weeks of the COVID-19 Pandemic in April-May 2020.

The COVID-19 pandemic has elicited increased sedentary behaviors, decreased moderate-to-vigorous physical activity (MVPA), and worsened mental health, yet the longitudinal impact of these changes and their inter-relations remains unknown. Our purpose was to examine associations between changes in self-reported activity behaviors and mental health over an 8-week period following the COVID-19 outbreak. Participants from all 50 states and the District of Colombia were recruited through convenience and snowball sampling at baseline April 3-10, 2020. Prospective data from 2,327 US adults with ≥2 responses (63.8% female; 74.3% response rate) were collected weekly via online survey for eight consecutive weeks (April 3-June 3, 2020). Primary exposures were self-reported time spent sitting, viewing screens and in MVPA, with primary outcomes being depressive symptoms, anxiety symptoms, and positive mental health (PMH). A significant sitting-by-time interaction (p < 0.05) showed slightly higher marginal effects for depressive symptoms for the 90th-percentile of sitting time than the 10th-percentile at baseline (5.8 [95% confidence interval = 5.5-6.2] vs. 5.7 [5.4-6.1]), with the difference magnifying over time (week 8: 3.5 [3.2-3.9] vs. 2.7 [2.4-2.9]). No other interactions over time were significant. Screen time was negatively associated with PMH and positively associated with depressive and anxiety symptoms (p < 0.05). Sitting time was negatively associated with PMH (p < 0.05). Rapid changes in sitting patterns (e.g., due to a pandemic) may have lasting effects on depressive symptoms. Strategies targeting those most affected (i.e., young adults, females) and/or focused on reducing sitting time may be critical for preventing long-term mental health effects resulting from COVID-19 or other large-scale behavior changes in the general population.

Associations Between Employment Changes and Mental Health: US Data From During the COVID-19 Pandemic.

Objectives: To examine associations of changing employment conditions, specifically switching to working from home (WFH) or job loss, with mental health, using data collected during the COVID-19 pandemic. Methods: Data from 2,301 US adults in employment prior to COVID-19 were collected April 3rd-7th, 2020. Participants reported whether their employment remained unchanged, they were WFH when they had not been before, or they had lost their job due to the pandemic. Outcomes were symptoms of depression, anxiety, stress, loneliness, and positive mental health (PMH) assessed using validated questionnaires. Linear regression quantified associations of employment changes with mental health outcomes, controlling for age, sex, race, BMI, smoking status, screen time, physical activity, marital status, chronic conditions, and current COVID-19 containment strategies being followed. Results: Compared to participants whose employment remained unchanged, those who switched to WFH did not differ in any measures of mental health (all p ≥ 0.200). Participants who had lost their job reported higher symptoms of depression (g = -0.200, 95%CI = -0.333 to -0.067; p = 0.003), anxiety (g = -0.212, -0.363 to -0.061; p = 0.008), and stress (g = -0.348, -0.482 to -0.214; p < 0.001), and lower PMH (g = -0.212, -0.347 to -0.078; p = 0.002). Loneliness did not differ between groups (p = 0.087). Conclusion: This study demonstrates (1) that concerns around potential adverse mental health effects, particularly increases in loneliness, should not preclude WFH in the general population, while considering each individual's personal circumstances, and (2) the acute adverse association of job loss with mental health. Tailored and sensitive interventions may be required to prevent deteriorations in mental health associated with job loss during periods of societal stress.

Associations Between Change in Outside Time Pre- and Post-COVID-19 Public Health Restrictions and Mental Health: Brief Research Report.

The novel coronavirus disease 2019 (COVID-19) and associated pandemic has resulted in systemic changes to much of life, affecting both physical and mental health. Time spent outside is associated with positive mental health; however, opportunities to be outside were likely affected by the COVID-19 public health restrictions that encouraged people not to leave their homes unless it was required. This study investigated the impact of acute COVID-19 public health restrictions on outside time in April 2020, and quantified the association between outside time and both stress and positive mental health, using secondary analyses of cross-sectional data from the COVID and Well-being Study. Participants (n = 3,291) reported demographics, health behaviors, amount of time they spent outside pre/post COVID-19 public health restrictions (categorized as increased, maintained, or decreased), current stress (Perceived Stress Scale-4), and positive mental health (Short Warwick-Edinburgh Mental Well-being Scale). Outside time was lower following COVID-19 restrictions (p < 0.001; Cohen's d = -0.19). Participants who increased or maintained outside time following COVID-19 restrictions reported lower stress (p < 0.001, 5.93 [5.74-6.12], Hedges' g = -0.18; p < 0.001, mean = 5.85 [5.67-6.02], Hedges' g = -0.21; respectively) and higher positive mental health (p < 0.001, 24.49 [24.20-24.77], Hedges' g = 0.21; p < 0.001, 24.78 [24.52-25.03], Hedges' g = 0.28) compared to those who decreased outside time. These findings indicate that there are likely to be negative stress and mental health implications if strategies are not implemented to encourage and maintain safe time outside during large-scale workplace and societal changes (e.g., during a pandemic).

Working From Home and Job Loss Due to the COVID-19 Pandemic Are Associated With Greater Time in Sedentary Behaviors.

Objectives: Due to the COVID-19 pandemic, major changes to how, or even whether, we work have occurred. This study examines associations of changing COVID-19-related employment conditions with physical activity and sedentary behavior. Methods: Data from 2,303 US adults in employment prior to COVID-19 were collected April 3rd-7th, 2020. Participants reported whether their employment remained unchanged, they were working from home (WFH) when they had not been before, or they lost their job due to the pandemic. Validated questionnaires assessed physical activity, sitting time, and screen time. Linear regression quantified associations of COVID-19-related employment changes with physical activity, sitting time, and screen time, controlling for age, sex, race, BMI, smoking status, marital status, chronic conditions, household location, public health restrictions, and recalled physical activity, sitting time, and screen time prior to the COVID-19 pandemic. Results: Compared to those whose employment remained unchanged, participants whose employment changed (either WFH or lost their job) due to COVID-19 reported higher sitting time (WFH: g = 0.153, 95% CI = 0.095-0.210; lost job: g = 0.212, 0.113-0.311) and screen time (WFH: g = 0.158, 0.104-0.212; lost job: g = 0.193, 0.102-0.285). There were no significant group differences for physical activity (WFH: g = -0.030, -0.101 to 0.042; lost job: g=-0.070, -0.178 to 0.037). Conclusion: COVID-19 related employment changes were associated with greater sitting and screen time. As sedentary time is consistently negatively associated with current and future health and wellbeing, increased sedentary time due to employment changes is a public health concern.