Pathways of association between disordered eating in adolescence and mental health outcomes in young adulthood during the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic has been associated with increased mental health problems. We investigated (1) associations between disordered eating in adolescence and mental health problems after one year of the pandemic and (2) the mechanisms explaining associations. METHOD: We analyzed data from a population-based birth cohort in Quebec, Canada (557 males and 759 females). High and low levels of disordered eating symptom trajectories were previously estimated (age 12, 15, 17, and 20 years). Anxiety, depression, non-suicidal self-injury, and suicidal ideation were assessed at 23 years (March-June 2021). Putative mediators included loneliness and social media use (age 22 years, July-August 2020). Analyses controlled for mental health and socio-economic status at age 10-12 years and were conducted for males and females separately. RESULTS: Females in the high-level disordered eating symptom trajectory were at increased risk for non-suicidal self-injury (OR 1.60; 95% CI 1.02-2.52) and suicidal ideation (2.16; 1.31-3.57), whereas males were at increased risk for severe anxiety (2.49; CI 1.11-5.58). Males and females in the high-level trajectory were more likely to report severe depression (2.26; 1.14-5.92 and 2.15, 1.36-3.38 respectively). Among females, associations were partially explained (17-35%) by loneliness during the first 4 months of the pandemic. CONCLUSION: Young adults who experienced disordered eating as adolescents were at increased risk of mental health problems during the pandemic. Loneliness partially mediated the effect, suggesting that pandemic mitigation resulting in increased social isolation may have exacerbated mental health problems among women with a history of disordered eating.

RéSUMé: OBJECTIFS: La pandémie de COVID-19 a été associée à une augmentation des problèmes de santé mentale. Nous avons investigué 1) les associations entre les problèmes de comportement alimentaire à l'adolescence et les problèmes de santé mentale après un an de pandémie et 2) les mécanismes expliquant les associations. MéTHODE: Nous avons analysé les données d'une cohorte de naissance basée sur la population au Québec, Canada (557 hommes et 759 femmes). Nous avons utilisé des trajectoires précédemment estimées indicatives d'un haut et bas niveau de problèmes alimentaires (à l'âge de 12, 15, 17 et 20 ans). L'anxiété, la dépression, l'automutilation et les idées suicidaires ont été évaluées à 23 ans (mars à juin 2021). Les médiateurs putatifs incluaient la solitude et l'utilisation des réseaux sociaux (à l'âge de 22 ans, juillet à août 2020). Les analyses contrôlaient la santé mentale et le statut socio-économique à l'âge de 10 à 12 ans et ont été menées séparément pour les hommes et les femmes. RéSULTATS: Les femmes dans la trajectoire des problèmes alimentaires élevés présentaient un risque accru d'automutilation non-suicidaire (OR 1,60; IC à 95 % 1,02-2,52) et d'idées suicidaires (2,16; 1,31-3,57), tandis que les hommes présentaient un risque accru d'anxiété sévère (2,49; IC 1,11-5,58). Les hommes et les femmes de la trajectoire élevée étaient plus susceptibles de déclarer une dépression grave (2,26; 1,14-5,92 et 2,15; 1,36-3,38, respectivement). Chez les femmes, les associations s'expliquaient en partie (17-35 %) par la solitude durant les 4 premiers mois de la pandémie. CONCLUSION: Les jeunes adultes ayant connu des problèmes de comportement alimentaire à l'adolescence couraient un risque accru de problèmes de santé mentale pendant la pandémie. La solitude a partiellement atténué l'effet, suggérant que l'isolation accrue entrainée par la pandémie peut avoir exacerbé les problèmes de santé mentale chez les femmes ayant des antécédents de problèmes de comportement alimentaire.

Suicidal ideation following self-reported COVID-19-like symptoms or serology-confirmed SARS-CoV-2 infection in France: A propensity score weighted analysis from a cohort study.

BACKGROUND: A higher risk of suicidal ideation associated with self-report of Coronavirus Disease 2019 (COVID-19)-like symptoms or COVID-19 infection has been observed in cross-sectional studies, but evidence from longitudinal studies remains limited. The aims of this study were 2-fold: (1) to explore if self-reported COVID-19-like symptoms in 2020 were associated with suicidal ideation in 2021; (2) to explore if the association also existed when using a biological marker of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in 2020. METHODS AND FINDINGS: A total of 52,050 participants from the French EpiCov cohort were included (median follow-up time = 13.7 months). In terms of demographics, 53.84% were women, 60.92% were over 45 years old, 82.01% were born in mainland France from parents born in mainland France, and 59.38% completed high school. COVID-19-like symptoms were defined as participant report of a sudden loss of taste/smell or fever alongside cough, shortness of breath, or chest oppression, between February and November 2020. Symptoms were self-reported at baseline in May 2020 and at the first follow-up in Autumn 2020. Serology-confirmed SARS-CoV-2 infection in 2020 was derived from Spike protein ELISA test screening in dried-blood-spot samples. Samples were collected from October 2020 to March 2021, with 94.4% collected in 2020. Suicidal ideation since December 2020 was self-reported at the second follow-up in Summer 2021. Associations of self-reported COVID-19-like symptoms and serology-confirmed SARS-CoV-2 infection in 2020 with suicidal ideation in 2021 were ascertained using modified Poisson regression models, weighted by inverse probability weights computed from propensity scores. Among the 52,050 participants, 1.68% [1.54% to 1.82%] reported suicidal ideation in 2021, 9.57% [9.24% to 9.90%] had a serology-confirmed SARS-CoV-2 infection in 2020, and 13.23% [12.86% to 13.61%] reported COVID-19-like symptoms in 2020. Self-reported COVID-19-like symptoms in 2020 were associated with higher risks of later suicidal ideation in 2021 (Relative Riskipw [95% CI] = 1.43 [1.20 to 1.69]), while serology-confirmed SARS-CoV-2 infection in 2020 was not (RRipw = 0.89 [0.70 to 1.13]). Limitations of this study include the use of a single question to assess suicidal ideation, the use of self-reported history of mental health disorders, and limited generalizability due to attrition bias. CONCLUSIONS: Self-reported COVID-19-like symptoms in 2020, but not serology-confirmed SARS-CoV-2 infection in 2020, were associated with a higher risk of subsequent suicidal ideation in 2021. The exact role of SARS-CoV-2 infection with respect to suicide risk has yet to be clarified. Including mental health resources in COVID-19-related settings could encourage symptomatic individuals to care for their mental health and limit suicidal ideation to emerge or worsen.

A comparative analysis of pediatric mental health-related emergency department utilization in Montréal, Canada, before and during the COVID-19 pandemic.

BACKGROUND: Reports on longitudinal trends in mental health-related (MHR) emergency department (ED) utilization spanning the pre- and post-pandemic periods are lacking, along with evidence comparing healthcare services utilization by sociodemographic subgroups. The aim of this study was to evaluate COVID-19-associated changes in MHR ED utilization among youth overall and by age, sex, and socio-economic status (SES). METHODS: This retrospective cross-sectional study analyzed MHR ED utilization before and during the COVID-19 pandemic at a large urban pediatric tertiary care hospital in Montréal, Canada. All ED visits for children (5-11 years) and adolescents (12-17 years) between April 1, 2016 and November 30, 2021 were included. The main outcome was the monthly count of MHR ED visits. Pre-pandemic and pandemic periods were compared using an interrupted time series design. The effect of seasonality (in months), age (in years), sex (male or female), and SES (low, average, high) were compared using a generalized additive model. RESULTS: There were a total of 437,147 ED visits (204,215 unique patients) during the 5-year study period of which 9748 (5.8%) were MHR visits (7,686 unique patients). We observed an increase of 69% (95% CI, + 53% to + 85%; p = 0.001) in the mean monthly count of MHR ED visits during the pandemic period, which remained significant after adjusting for seasonality (44% increase, 95% CI, + 38% to + 51%; p = 0.001). The chance of presenting for a MHR ED visit increased non-linearly with age. There were increased odds of presenting for a MHR ED visit among girls between the pre-pandemic and pandemic periods (OR 1.42, 95% CI 1.29-1.56). No difference by SES group during and before the COVID-19 pandemic was found [OR 1.01, 95% CI 0.89-1.15 (low); OR 1.09, 95% CI 0.96-1.25 (high)]. CONCLUSIONS: Our study shows important increases in MHR ED utilization among youth, and especially among girls, during the first 20 months of the COVID-19 pandemic, highlighting the need for sustained, targeted and scalable mental health resources to support youth mental health during the current and future crises.

Depression and anxiety symptoms in young adults before and during the COVID-19 pandemic: evidence from a Canadian population-based cohort.

BACKGROUND: Concerns have been raised that the COVID-19 pandemic could increase risk for adverse mental health outcomes, especially in young adults, a vulnerable age group. We investigated changes in depression and anxiety symptoms (overall and severe) from before to during the pandemic, as well as whether these changes are linked to COVID-19-related stressors and pre-existing vulnerabilities in young adults followed in the context of a population-based cohort. METHOD: Participants (n = 1039) from the Quebec Longitudinal Study of Child Development reported on their depression (Centre for Epidemiological Studies Depression Scale, short form) and anxiety (General Anxiety Disorder-7 Scale) symptoms and completed a COVID-19 questionnaire during the first wave of the COVID-19 pandemic in the summer of 2020 (age 22 years). Assessments at age 20 (2018) were used to estimate pre-pandemic depression and anxiety symptom severity. RESULTS: While mean levels of depression and anxiety symptoms did not change from before to during the first wave of the COVID-19 pandemic (e.g., the mean of depressive symptoms was 9.30 in 2018 and 9.59 in 2020), we observed a slight increase in rates of severe depression (scores ≥ 21) from before (6.1%) to during (8.2%) the pandemic. Most COVID-19-related variables (e.g., loss of education/occupation, frequent news-seeking) - except living alone - and most pre-existing vulnerabilities (e.g., low SES, low social support) were not associated with changes in depression or anxiety symptoms. However, results varied as a function of pre-pandemic levels of depression and anxiety: depression and anxiety symptoms increased among adults with the lowest levels of symptoms before the pandemic, while they decreased among those with the highest levels of symptoms, possibly reflecting a regression to the mean. CONCLUSIONS: Depression and anxiety symptoms in young adults from Québec in Summer 2020 were mostly comparable to symptoms reported in 2018. Most COVID-19-related stressors and pre-existing vulnerabilities were not associated with changes in symptoms, except living alone and pre-existing symptoms of depression and anxiety. However, the increased rate of severe depression warrants further investigation.

Psychological distress of mental health workers during the COVID-19 pandemic: A comparison with the general population in high- and low-incidence regions.

OBJECTIVE: Despite their essential role during this health crisis, little is known about the psychological distress of mental health workers (MHW). METHOD: A total of 616 MHW and 658 workers from the general population (GP) completed an online survey including depressive, anxiety, irritability, loneliness, and resilience measures. RESULTS: Overall, MHW had fewer cases with above cut-off clinically significant depression (19% MHW vs. 27%) or anxiety (16% MHW vs. 29%) than the GP. MHW in high-incidence regions of COVID-19 cases displayed the same levels of depressive and anxiety symptoms than the GP and higher levels compared to MHW from low-incidence regions. MHW in high-incidence regions presented higher levels of irritability and lower levels of resilience than the MHW in low-incidence regions. Moreover, MHW in high-incidence regions reported more feelings of loneliness than all other groups. CONCLUSION: Implications for social and organizational preventive strategies to minimize the distress of MHW in times of crisis are discussed.

"My Life during the Lockdown": Emotional Experiences of European Adolescents during the COVID-19 Crisis.

This study investigates, using an online self-report questionnaire, adolescents' emotional reactions during the lockdown in a sample of 2105 secondary school students (aged 14-19) in Italy, Romania, and Croatia. We used a self-reported online questionnaire (answers on a 5-point scale or binary), composed of 73 questions investigating the opinions, feelings, and emotions of teenagers, along with sociodemographic information and measures of the exposure to lockdown. The survey was conducted online through a web platform in Italy (between 27 April and 15 June 2020), Romania, and Croatia (3 June and 2 July 2020). Students aged >14 years, living in a small flat, and not spending time outside were more likely to report anger, sadness, boredom/emptiness, and anxiety. Boys were significantly less likely than girls to report all measured emotional reactions. Those who lost someone from COVID-19 were more than twice as likely to experience anger compared to those who did not. Our findings may help identifying adolescents more likely to report negative emotional reactions during the COVID-19 pandemic and inform public health strategies for improving mental health among adolescents during/after the COVID-19 crisis.