Effectiveness of a mental health stepped-care programme for healthcare workers with psychological distress in crisis settings: a multicentre randomised controlled trial.

BACKGROUND: Evidence-based mental health interventions to support healthcare workers (HCWs) in crisis settings are scarce. OBJECTIVE: To evaluate the capacity of a mental health intervention in reducing anxiety and depression symptoms in HCWs, relative to enhanced care as usual (eCAU), amidst the COVID-19 pandemic. METHODS: We conducted an analyst-blind, parallel, multicentre, randomised controlled trial. We recruited HCWs with psychological distress from Madrid and Catalonia (Spain). The intervention arm received a stepped-care programme consisting of two WHO-developed interventions adapted for HCWs: Doing What Matters in Times of Stress (DWM) and Problem Management Plus (PM+). Each intervention lasted 5 weeks and was delivered remotely by non-specialist mental health providers. HCWs reporting psychological distress after DWM completion were invited to continue to PM+. The primary endpoint was self-reported anxiety/depression symptoms (Patient Health Questionnaire-Anxiety and Depression Scale) at week 21. FINDINGS: Between 3 November 2021 and 31 March 2022, 115 participants were randomised to stepped care and 117 to eCAU (86% women, mean age 37.5). The intervention showed a greater decrease in anxiety/depression symptoms compared with eCAU at the primary endpoint (baseline-adjusted difference 4.4, 95% CI 2.1 to 6.7; standardised effect size 0.8, 95% CI 0.4 to 1.2). No serious adverse events occurred. CONCLUSIONS: Brief stepped-care psychological interventions reduce anxiety and depression during a period of stress among HCWs. CLINICAL IMPLICATIONS: Our results can inform policies and actions to protect the mental health of HCWs during major health crises and are potentially rapidly replicable in other settings where workers are affected by global emergencies. TRIAL REGISTRATION NUMBER: NCT04980326.

Service use preceding and following first referral for psychiatric emergency care at a short-stay crisis unit: A cohort study across three cities and one rural area in England.

BACKGROUND: Internationally, hospital-based short-stay crisis units have been introduced to provide a safe space for stabilisation and further assessment for those in psychiatric crisis. The units typically aim to reduce inpatient admissions and psychiatric presentations to emergency departments. AIMS: To assess changes to service use following a service user's first visit to a unit, characterise the population accessing these units and examine equality of access to the units. METHODS: A prospective cohort study design (ISCTRN registered; 53431343) compared service use for the 9 months preceding and following a first visit to a short-stay crisis unit at three cities and one rural area in England. Included individuals first visited a unit in the 6 months between 01/September/2020 and 28/February/2021. RESULTS: The prospective cohort included 1189 individuals aged 36 years on average, significantly younger (by 5-13 years) than the population of local service users (<.001). Seventy percent were White British and most were without a psychiatric diagnosis (55%-82% across sites). The emergency department provided the largest single source of referrals to the unit (42%), followed by the Crisis and Home Treatment Team (20%). The use of most mental health services, including all types of admission and community mental health services was increased post discharge. Social-distancing measures due to the COVID-19 pandemic were in place for slightly over 50% of the follow-up period. Comparison to a pre-COVID cohort of 934 individuals suggested that the pandemic had no effect on the majority of service use variables. CONCLUSIONS: Short-stay crisis units are typically accessed by a young population, including those who previously were unknown to mental health services, who proceed to access a broader range of mental health services following discharge.

Views and experiences of migrants and stakeholders involved in social and health care for migrants in Italy during the COVID-19 pandemic: a qualitative study.

BACKGROUND: The COVID-19 pandemic has had major and potentially long-lasting effects on mental health and wellbeing across populations worldwide. However, these impacts were not felt equally, leading to an exacerbation of health inequalities, especially affecting vulnerable populations such as migrants, refugees and asylum seekers. Aiming to inform the adaptation and implementation of psychological intervention programmes, the present study investigated priority mental health needs in this population group. METHODS: Participants were adult asylum seekers, refugees and migrants (ARMs) and stakeholders with experience in the field of migration living in Verona, Italy, and fluent in Italian and English. A two-stage process was carried out to examine their needs using qualitative methods including free listing interviews and focus group discussions, according to Module One of the DIME (Design, Implementation, Monitoring, and Evaluation) manual. Data were analyzed using an inductive thematic analyses approach. RESULTS: A total of 19 participants (12 stakeholders, 7 ARMs) completed the free listing interviews and 20 participants (12 stakeholders and 8 ARMs) attended focus group discussions. Salient problems and functions that emerged during free listing interviews were discussed during the focus group discussions. During the COVID-19 pandemic, ARMs struggled with many everyday living difficulties in their resettlement country due to social and economic issues, revealing a strong influence of contextual factors in determining mental health. Both ARMs and stakeholders highlighted a mismatch between needs, expectations and interventions as factors that may hamper proper implementation of health and social programmes. CONCLUSIONS: The present findings could help in the adaptation and implementation of psychological interventions targeting the needs of asylum seekers, refugees and migrants aiming to find a match between needs, expectations, and the corresponding interventions. TRIAL REGISTRATION: Registration number 2021-UNVRCLE-0106707, February 11 2021.

Excess resource use and costs of physical comorbidities in individuals with mental health disorders: A systematic literature review and meta-analysis.

Individuals with mental health disorders (MHDs) have worse physical health than the general population, utilise healthcare resources more frequently and intensively, incurring higher costs. We provide a first comprehensive overview and quantitative synthesis of literature on the magnitude of excess resource use and costs for those with MHDs and comorbid physical health conditions (PHCs). This systematic review (PROSPERO CRD42017075319) searched studies comparing resource use or costs of individuals with MHDs and comorbid PHCs versus individuals without comorbid conditions published between 2007 and 2021. We conducted narrative and quantitative syntheses, using random-effects meta-analyses to explore ranges of excess resource use and costs across care segments, comparing to MHD only, PHC only, or general population controls (GPC). Of 20,075 records, 228 and 100 were eligible for narrative and quantitative syntheses, respectively. Most studies were from the US, covered depression or schizophrenia, reporting endocrine/metabolic or circulatory comorbidities. Frequently investigated healthcare segments were inpatient, outpatient, emergency care and medications. Evidence on lost productivity, long-term and informal care was rare. Substantial differences exist between MHDs, with depressive disorder tending towards lower average excess resource use and cost estimates, while excess resource use ranges between +6% to +320% and excess costs between +14% to +614%. PHCs are major drivers of resource use and costs for individuals with MHDs, affecting care segments differently. Significant physical health gains and cost savings are potentially achievable through prevention, earlier identification, management and treatment, using more integrated care approaches. Current international evidence, however, is heterogeneous with limited geographical representativeness and comparability.

Potential mechanisms by which cash transfer programmes could improve the mental health and life chances of young people: A conceptual framework and lines of enquiry for research and policy

Mental health is inextricably linked to both poverty and future life chances such as education, skills, labour market attachment and social function. Poverty can lead to poorer mental health, which reduces opportunities and increases the risk of lifetime poverty. Cash transfer programmes are one of the most common strategies to reduce poverty and now reach substantial proportions of populations living in low- and middle-income countries. Because of their rapid expansion in response to the COVID-19 pandemic, they have recently gained even more importance. Recently, there have been suggestions that these cash transfers might improve youth mental health, disrupting the cycle of disadvantage at a critical period of life. Here, we present a conceptual framework describing potential mechanisms by which cash transfer programmes could improve the mental health and life chances of young people. Furthermore, we explore how theories from behavioural economics and cognitive psychology could be used to more specifically target these mechanisms and optimise the impact of cash transfers on youth mental health and life chances. Based on this, we identify several lines of enquiry and action for future research and policy.Copyright © The Author(s), 2023. Published by Cambridge University Press.

Effectiveness of a stepped-care programme of WHO psychological interventions in migrant populations resettled in Italy: Study protocol for the RESPOND randomized controlled trial.

Introduction: Migrant populations, including workers, undocumented migrants, asylum seekers, refugees, internationally displaced persons, and other populations on the move, are exposed to a variety of stressors and potentially traumatic events before, during, and after the migration process. In recent years, the COVID-19 pandemic has represented an additional stressor, especially for migrants on the move. As a consequence, migration may increase vulnerability of individuals toward a worsening of subjective wellbeing, quality of life, and mental health, which, in turn, may increase the risk of developing mental health conditions. Against this background, we designed a stepped-care programme consisting of two scalable psychological interventions developed by the World Health Organization and locally adapted for migrant populations. The effectiveness and cost-effectiveness of this stepped-care programme will be assessed in terms of mental health outcomes, resilience, wellbeing, and costs to healthcare systems. Methods and analysis: We present the study protocol for a pragmatic randomized study with a parallel-group design that will enroll participants with a migrant background and elevated level of psychological distress. Participants will be randomized to care as usual only or to care a usual plus a guided self-help stress management guide (Doing What Matters in Times of Stress, DWM) and a five-session cognitive behavioral intervention (Problem Management Plus, PM+). Participants will self-report all measures at baseline before random allocation, 2 weeks after DWM delivery, 1 week after PM+ delivery and 2 months after PM+ delivery. All participants will receive a single-session of a support intervention, namely Psychological First Aid. We will include 212 participants. An intention-to-treat analysis using linear mixed models will be conducted to explore the programme's effect on anxiety and depression symptoms, as measured by the Patient Health Questionnaire-Anxiety and Depression Scale summary score 2 months after PM+ delivery. Secondary outcomes include post-traumatic stress disorder symptoms, resilience, quality of life, resource utilization, cost, and cost-effectiveness. Discussion: This study is the first randomized controlled trial that combines two World Health Organization psychological interventions tailored for migrant populations with an elevated level of psychological distress. The present study will make available DWM/PM+ packages adapted for remote delivery following a task-shifting approach, and will generate evidence to inform policy responses based on a more efficient use of resources for improving resilience, wellbeing and mental health. Clinical trial registration: ClinicalTrials.gov, identifier: NCT04993534.

Effectiveness of a stepped-care programme of WHO psychological interventions in migrant populations resettled in Italy: Study protocol for the RESPOND randomized controlled trial

Introduction Migrant populations, including workers, undocumented migrants, asylum seekers, refugees, internationally displaced persons, and other populations on the move, are exposed to a variety of stressors and potentially traumatic events before, during, and after the migration process. In recent years, the COVID-19 pandemic has represented an additional stressor, especially for migrants on the move. As a consequence, migration may increase vulnerability of individuals toward a worsening of subjective wellbeing, quality of life, and mental health, which, in turn, may increase the risk of developing mental health conditions. Against this background, we designed a stepped-care programme consisting of two scalable psychological interventions developed by the World Health Organization and locally adapted for migrant populations. The effectiveness and cost-effectiveness of this stepped-care programme will be assessed in terms of mental health outcomes, resilience, wellbeing, and costs to healthcare systems. Methods and analysis We present the study protocol for a pragmatic randomized study with a parallel-group design that will enroll participants with a migrant background and elevated level of psychological distress. Participants will be randomized to care as usual only or to care a usual plus a guided self-help stress management guide (Doing What Matters in Times of Stress, DWM) and a five-session cognitive behavioral intervention (Problem Management Plus, PM+). Participants will self-report all measures at baseline before random allocation, 2 weeks after DWM delivery, 1 week after PM+ delivery and 2 months after PM+ delivery. All participants will receive a single-session of a support intervention, namely Psychological First Aid. We will include 212 participants. An intention-to-treat analysis using linear mixed models will be conducted to explore the programme's effect on anxiety and depression symptoms, as measured by the Patient Health Questionnaire—Anxiety and Depression Scale summary score 2 months after PM+ delivery. Secondary outcomes include post-traumatic stress disorder symptoms, resilience, quality of life, resource utilization, cost, and cost-effectiveness. Discussion This study is the first randomized controlled trial that combines two World Health Organization psychological interventions tailored for migrant populations with an elevated level of psychological distress. The present study will make available DWM/PM+ packages adapted for remote delivery following a task-shifting approach, and will generate evidence to inform policy responses based on a more efficient use of resources for improving resilience, wellbeing and mental health. Clinical trial registration ClinicalTrials.gov, identifier: NCT04993534.

Correlation between Ptt and Thromboelastography in Adult Icu Patients Requiring Bivalirudin for Ecmo

INTRODUCTION: Bivalirudin remains a viable strategy during extracorporeal membrane oxygenation (ECMO). The accuracy of activated partial thromboplastin time (aPTT) for bivalirudin intensity in ECMO may be imperfect resulting in suboptimal dosing, which may increase the risk of bleeding or thrombotic complications. The purpose of this study was to evaluate the correlation between PTT and thromboelastography (TEG) reaction (R) time in adult ECMO patients anticoagulated with bivalirudin. METHOD(S): This was a multicenter, retrospective study conducted over a 22-month period (January 2020 to October 2021. Adult ICU patients requiring ECMO and bivalirudin therapy with >=1 corresponding TEG and aPTT samples drawn <=4 hours of each other were included. The primary endpoint was to determine the correlation coefficient between the TEG R time and bivalirudin aPTT serum concentrations. Pearson's correlation coefficient was used to evaluate the correlation using a kappa measure of agreement between TEG results and bivalirudin aPTT serum concentrations. RESULT(S): A total of 104 patients consisting of 848 concurrent laboratory assessments of R time and aPTT were included. COVID-19 positive tests were confirmed in 48.1% (n=50) of included patients. A moderate correlation between TEG R time and aPTT was demonstrated in the study population (r=0.41;p< 0.001). A similar relationship between TEG R time and aPTT was observed in both COVID-19 positive (r=0.44;p< 0.0001) and negative (r=0.45;p< 0.0001). Overall, 59.2% of all concurrent TEG R time and aPTT values showed agreement on the study institution's therapeutic category (sub-, supra-, and therapeutic) of bivalirudin. 78.3% (n=277) of aPTT values were categorized as therapeutic among all discordant assessment (n=346) between TEG R time and aPTT. The discordant TEG R times with a therapeutic PTT were almost equally distributed between subtherapeutic and supratherapeutic categories. CONCLUSION(S): Moderate correlation was found between TEG R time and aPTT associated with bivalirudin during ECMO in critically ill adults. Further research is warranted to address the optimal test to guide clinical decision-making for anticoagulation dosing in ECMO patients with discordant results.

Impact of work arrangements during the COVID-19 pandemic on mental health in France.

•Symptoms of anxiety/depression were found in 28.8% of the participants at least once.•Unemployment and financial difficulties were associated with anxiety/depression.•Targeted mental health support could lessen mental health impact.

Effectiveness of a stepped-care programme of internet-based psychological interventions for healthcare workers with psychological distress: Study protocol for the RESPOND healthcare workers randomised controlled trial.

Background and aims: The coronavirus disease 2019 pandemic has challenged health services worldwide, with a worsening of healthcare workers' mental health within initial pandemic hotspots. In early 2022, the Omicron variant is spreading rapidly around the world. This study explores the effectiveness and cost-effectiveness of a stepped-care programme of scalable, internet-based psychological interventions for distressed health workers on self-reported anxiety and depression symptoms. Methods: We present the study protocol for a multicentre (two sites), parallel-group (1:1 allocation ratio), analyst-blinded, superiority, randomised controlled trial. Healthcare workers with psychological distress will be allocated either to care as usual only or to care as usual plus a stepped-care programme that includes two scalable psychological interventions developed by the World Health Organization: A guided self-help stress management guide (Doing What Matters in Times of Stress) and a five-session cognitive behavioural intervention (Problem Management Plus). All participants will receive a single-session emotional support intervention, namely psychological first aid. We will include 212 participants. An intention-to-treat analysis using linear mixed models will be conducted to explore the programme's effect on anxiety and depression symptoms, as measured by the Patient Health Questionnaire - Anxiety and Depression Scale summary score at 21 weeks from baseline. Secondary outcomes include post-traumatic stress disorder symptoms, resilience, quality of life, cost impact and cost-effectiveness. Conclusions: This study is the first randomised trial that combines two World Health Organization psychological interventions tailored for health workers into one stepped-care programme. Results will inform occupational and mental health prevention, treatment, and recovery strategies. Registration details: ClinicalTrials.gov Identifier: NCT04980326.

SARS-COV-2 INFECTION AND HEMOFILTRATION-TARGETING VIREMIA

SESSION TITLE: COVID-19 Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: The SARS-CoV-2 pandemic spawned the use and study of novel therapeutics, re-purposed drugs, and interventions– all with limited success. Seraph® 100 Microbind Affinity Blood Filter® [Seraph®] is an investigational device that was given Emergency Use Authorization (EUA) by the Food and Drug Administration in 2019 to treat severe coronavirus disease. Higher viremia is correlated with higher mortality. Seraph® uses extracorporeal filtration to aid the innate immune system by reducing viral load and mitigating downstream effects of inflammation. CASE PRESENTATION: A forty-eight year old gentleman presented to the emergency room with coughs and fever of 101° F. He tested positive via polymerase chain reaction [PCR] testing for SARS-CoV-19 pneumonia. A computed-tomography angiogram [CTA] of the chest was negative for pulmonary embolism, but demonstrated significant bilateral ground-glass opacities consistent with viral pneumonia. Vitals were notable for an oxygen saturation of 69% on room air that improved to 96% on 6 liters/minute [L/min] of supplemental oxygen via nasal cannula. He was initiated on both dexamethasone and remdesivir. Within hours, the patient's oxygen requirements escalated to 15 L/min via non-rebreather to high flow humidified nasal cannula with a flow rate of 40 L/min and 60% FiO2. On day three, he was transferred to the ICU for treatment with Seraph®. After one treatment, the patient was weaned from high flow humidified nasal cannula to room air. On day five, after a second treatment, he transferred to the floor. He was discharged on day six, on room air, having completed his course of remdesivir, with an additional 5 days of oral steroids. DISCUSSION: Preliminary data regarding Seraph® remain limited with only select eligible patients undergoing therapy. Cases like our patient demonstrate dramatic improvements with even one or two treatments which correlate well with data that show up to 99% reduction in the bloodstream of targeted pathogens per pass. While database collection data have revealed trends towards improved outcomes, further investigation into populations most likely to benefit from treatment is needed. Timing, immunocompromised status and other comorbidities that raise or lower the chances of successful hemofiltration need to be considered. CONCLUSIONS: Studies in the SARS-CoV-2 pandemic augment ongoing research as filtration devices are used to target bacterial infections, cytokines and inflammatory markers. Since the invention of antibiotics, multi-drug resistant organisms have increased in prevalence. Novel interventions such as Seraph® warrant investigation to prevent infectious diseases from becoming unmanageable threats. Reference #1: Kielstein JT, Borchina DN, Fühner T, Hwang S, Mattoon D, Ball AJ. Hemofiltration with the Seraph® 100 Microbind® Affinity filter decreases SARS-CoV-2 nucleocapsid protein in critically ill COVID-19 patients. Crit Care. 2021;25(1):190. Published 2021 Jun 1. doi:10.1186/s13054-021-03597-3 Reference #2: Pape A, Kielstein JT, Krüger T, Fühner T, Brunkhorst R. Treatment of a Critically Ill COVID-19 Patient with the Seraph 100 Microbind Affinity Filter. TH Open. 2021;5(2):e134-e138. Published 2021 Apr 14. doi:10.1055/s-0041-1727121 Reference #3: Schmidt JJ, Borchina DN, van T Klooster M, et al. Interim-analysis of the COSA (COVID-19 patients treated with the Seraph® 100 Microbind® Affinity filter) registry [published online ahead of print, 2021 Dec 7]. Nephrol Dial Transplant. 2021;gfab347. doi:10.1093/ndt/gfab347 DISCLOSURES: No relevant relationships by Aneesa Afroze No relevant relationships by Lydia Meece No relevant relationships by Angela Park

IMPACT OF INCREASED TELEMEDICINE USAGE ON RESIDENT EDUCATION

BACKGROUND: The COVID-19 pandemic has led to an unprecedented and rapid increase in telemedicine visits. It is unclear how this has affected resident training. This study explores Internal Medicine residents' perceptions of the impact of the transition to telemedicine on their learning experience. METHODS: Three focus groups were held over Zoom with post-graduate year 1 - 3 residents at the New York University Grossman School of Medicine who have their Primary Care continuity experiences at the Manhattan Veterans Affairs Medical Center. Issues explored include relationships with patients, decision-making around clinical issues, use of preceptors, and general impressions of tele-visits. Recordings of the focus groups were transcribed and thematically analyzed. RESULTS: Common themes across the focus groups were categorized into five domains: 1) building patient relationships, 2) using the remote setting, 3) judging appearance and physical examination, 4) confidence with decision making, and 5) interactions with supervisors. Participants felt that they were able to maintain relationships with pre-existing patients, particularly those with chronic conditions for whom tele-visits were an appropriate and even preferable alternative to routine in-person encounters. Participants reported difficulty connecting and building rapport with new patients but suggested the remote setting was helpful for providing additional context (e.g. input from a family member), allowing them to better understand patients' concerns or circumstances. However, some participants expressed hesitancy about asking personal questions because patients were not in private settings. The inability to conduct comprehensive physical exams made it difficult to evaluate physical concerns, and participants were frequently unable to rely on skills that were emphasized in their training, such as assessing overall appearance and frailty. As a result, they had a higher level of uncertainty about diagnosis and management and a lower threshold for making referrals and ordering diagnostic testing. Residents did not ask preceptors for help during a tele-visit - in contrast to in-person clinical visits - which precluded real-time support when participants encountered uncertainty. Due to the awkwardness of asynchronous communication, participants had a higher threshold for asking their preceptors questions and making changes in management plans after televisits were concluded. CONCLUSIONS: In light of the staying power of telemedicine and the overall trend towards virtual care, our findings substantiate the need to identify and address new clinical training competencies. In particular, trainees may need guidance for negotiating clinical decision-making and management when caring for patients remotely;structured preceptor protocols can help to support trainee education and quality patient care.

Mental health problems and needs of frontline healthcare workers during the COVID-19 pandemic in Spain: A qualitative analysis

Background Healthcare workers (HCWs) from COVID-19 hotspots worldwide have reported poor mental health outcomes since the pandemic's beginning. The virulence of the initial COVID-19 surge in Spain and the urgency for rapid evidence constrained early studies in their capacity to inform mental health programs accurately. Here, we used a qualitative research design to describe relevant mental health problems among frontline HCWs and explore their association with determinants and consequences and their implications for the design and implementation of mental health programs. Materials and methods Following the Programme Design, Implementation, Monitoring, and Evaluation (DIME) protocol, we used a two-step qualitative research design to interview frontline HCWs, mental health experts, administrators, and service planners in Spain. We used Free List (FL) interviews to identify problems experienced by frontline HCWs and Key informant (KI) interviews to describe them and explore their determinants and consequences, as well as the strategies considered useful to overcome these problems. We used a thematic analysis approach to analyze the interview outputs and framed our results into a five-level social-ecological model (intrapersonal, interpersonal, organizational, community, and public health). Results We recruited 75 FL and 22 KI interviewees, roughly balanced in age and gender. We detected 56 themes during the FL interviews and explored the following themes in the KI interviews: fear of infection, psychological distress, stress, moral distress, and interpersonal conflicts among coworkers. We found that interviewees reported perceived causes and consequences across problems at all levels (intrapersonal to public health). Although several mental health strategies were implemented (especially at an intrapersonal and interpersonal level), most mental health needs remained unmet, especially at the organizational, community, and public policy levels. Conclusions In keeping with available quantitative evidence, our findings show that mental health problems are still relevant for frontline HCWs 1 year after the COVID-19 pandemic and that many reported causes of these problems are modifiable. Based on this, we offer specific recommendations to design and implement mental health strategies and recommend using transdiagnostic, low-intensity, scalable psychological interventions contextually adapted and tailored for HCWs.

Relationship Between Economic Loss and Anxiety During the Coronavirus Disease 2019 Pandemic: Moderating Effects of Knowledge, Gratitude, and Perceived Stress.

Objectives: The prolonged coronavirus disease 2019 (COVID-19) pandemic has caused individuals to suffer economic losses, in particular due to the implementation of intensive quarantine policies. Economic loss can cause anxiety and has a negative psychological impact on individuals, worsening their mental health and satisfaction with life. We examined the protective and risk factors that can influence the relationship between economic loss and anxiety during the COVID-19 pandemic. Methods: Panel data from 911 participants were collected in April and May 2020 and again 6 months later. We analyzed the relationship between economic loss and anxiety and investigated the moderating effects of knowledge about COVID-19, gratitude, and perceived stress. Moreover, we investigated whether there were any changes in moderating effects over time or in different demographic groups. Results: In the early stages of the spread of COVID-19, gratitude (B = -0.0211, F = 4.8130, p < 0.05) and perceived stress (B = 0.0278, F = 9.3139, p < 0.01) had moderating effects on the relationship between economic loss and anxiety. However, after 6 months, only perceived stress had a significant moderating effect (B = 0.0265, F = 7.8734, p < 0.01). Conclusion: In the early stages of COVID-19, lower levels of gratitude and higher perceived stress led to greater anxiety. In later stages of the prolonged pandemic, only perceived stress had a continued moderating effect on the relationship between economic loss and anxiety. This study suggests that psychological interventions to reduce perceived stress are needed to treat the possible adverse effects of the spread of infectious diseases on mental health.

Short-stay crisis units for mental health patients on crisis care pathways: systematic review and meta-analysis.

BACKGROUND: Internationally, an increasing proportion of emergency department visits are mental health related. Concurrently, psychiatric wards are often occupied above capacity. Healthcare providers have introduced short-stay, hospital-based crisis units offering a therapeutic space for stabilisation, assessment and appropriate referral. Research lags behind roll-out, and a review of the evidence is urgently needed to inform policy and further introduction of similar units. AIMS: This systematic review aims to evaluate the effectiveness of short-stay, hospital-based mental health crisis units. METHOD: We searched EMBASE, Medline, CINAHL and PsycINFO up to March 2021. All designs incorporating a control or comparison group were eligible for inclusion, and all effect estimates with a comparison group were extracted and combined meta-analytically where appropriate. We assessed study risk of bias with Risk of Bias in Non-Randomized Studies - of Interventions and Risk of Bias in Randomized Trials. RESULTS: Data from twelve studies across six countries (Australia, Belgium, Canada, The Netherlands, UK and USA) and 67 505 participants were included. Data indicated that units delivered benefits on many outcomes. Units could reduce psychiatric holds (42% after intervention compared with 49.8% before intervention; difference = 7.8%; P < 0.0001) and increase out-patient follow-up care (χ2 = 37.42, d.f. = 1; P < 0.001). Meta-analysis indicated a significant reduction in length of emergency department stay (by 164.24 min; 95% CI -261.24 to -67.23 min; P < 0.001) and number of in-patient admissions (odds ratio 0.55, 95% CI 0.43-0.68; P < 0.001). CONCLUSIONS: Short-stay mental health crisis units are effective for reducing emergency department wait times and in-patient admissions. Further research should investigate the impact of units on patient experience, and clinical and social outcomes.

ASSOCIATIONS OF LONELINESS AND SLEEP WITH SOLITARY DRINKING AND DRINKING CONSEQUENCES

Purpose: Loneliness and sleep problems have been independently associated both with each other and with drinking-related impairment. However, much research investigating loneliness and sleep has not considered the social context of drinking. Of particular relevance, individuals may engage in solitary drinking as a means of managing both loneliness and sleep problems. This cross-sectional study tested (a) associations of loneliness and sleep quality with solitary drinking, and (b) associations of loneliness, sleep quality, and solitary drinking with drinking consequences. Methods & Data: Online survey data were drawn from 184 past-year college drinkers (Mage = 18.73 [SD = 1.07];55% female;68% White) reporting on affect and substance use behavior six months into the COVID-19 pandemic. Logistic regression was used to detect differences in odds of past-year solitary drinking by loneliness and subjective sleep quality, and zero-inflated negative binomial regression was used to detect differences in drinking consequences by loneliness, subjective sleep quality, and past-year solitary drinking. All analyses controlled for sex, age, White race, depressive symptoms, and overall drinking frequency. Results: Loneliness, but subjective sleep quality, was positively associated with odds of past-year solitary drinking (OR = 1.11 [95% CI = 1.02, 1.21], p = .02). The relationship of loneliness with solitary drinking was attenuated to non-significance (p = .06) when the interaction between loneliness and sleep on solitary drinking was considered. Solitary drinking was associated with greater drinking consequences (RR = 1.28 [95% CI = 1.01, 1.59], p = .03), although neither loneliness nor sleep were associated with drinking consequences. Conclusions: College students may engage in solitary drinking to cope with loneliness, which may be particularly heightened in the context of pandemic-related social isolation;however, they do not appear to drink alone to manage sleep. Consistent with prior literature, findings highlight solitary drinking as a risk for greater drinking consequences, though null associations with loneliness and sleep suggest that additional risk factors for solitary drinking and associated consequences be explored.

Relationship Between Economic Loss and Anxiety During the Coronavirus Disease 2019 Pandemic: Moderating Effects of Knowledge, Gratitude, and Perceived Stress

Objectives The prolonged coronavirus disease 2019 (COVID-19) pandemic has caused individuals to suffer economic losses, in particular due to the implementation of intensive quarantine policies. Economic loss can cause anxiety and has a negative psychological impact on individuals, worsening their mental health and satisfaction with life. We examined the protective and risk factors that can influence the relationship between economic loss and anxiety during the COVID-19 pandemic. Methods Panel data from 911 participants were collected in April and May 2020 and again 6 months later. We analyzed the relationship between economic loss and anxiety and investigated the moderating effects of knowledge about COVID-19, gratitude, and perceived stress. Moreover, we investigated whether there were any changes in moderating effects over time or in different demographic groups. Results In the early stages of the spread of COVID-19, gratitude (B = –0.0211, F = 4.8130, p < 0.05) and perceived stress (B = 0.0278, F = 9.3139, p < 0.01) had moderating effects on the relationship between economic loss and anxiety. However, after 6 months, only perceived stress had a significant moderating effect (B = 0.0265, F = 7.8734, p < 0.01). Conclusion In the early stages of COVID-19, lower levels of gratitude and higher perceived stress led to greater anxiety. In later stages of the prolonged pandemic, only perceived stress had a continued moderating effect on the relationship between economic loss and anxiety. This study suggests that psychological interventions to reduce perceived stress are needed to treat the possible adverse effects of the spread of infectious diseases on mental health.