ABSTRACT
Background: The 2019 coronavirus disease (COVID-19) poses great demands on medical care and resulted in delayed prescribing. Objective: To evaluate the number of newly dispensed antidepressant and anxiolytic drugs among the Dutch population, before and during COVID-19. Methods: Pharmacy dispensing data was obtained from Stichting Farmaceutische Kentallen on newly dispended antidepressants and anxiolytics, covering 96% of the Dutch population. The number and week of first-time dispensed drugs were determined for the period January – June 2019 and 2020, and age and sex of patients was recorded. Using independent t-tests, data was compared between men and women, age groups, and between 2019 and 2020. Age groups considered were children (0-9 years old), adolescents (10-19 years old), adults (20-64 years old), and elderly (65 year and older). Three time periods were considered: week 1-11 (in 2020 corresponding to the pre-COVID-19 lockdown period), week 12-19 (in 2020 corresponding to the COVID-19 lockdown), and week 20-26 (in 2020 corresponding to the post-COVID-19 lockdown). Results: An overall reduction was observed in 2020 for the number of newly dispensed antidepressants (139.186 in 2019 and 126.487 in 2020, respectively) and anxiolytics (200.661 in 2019 and 189.559 in 2020, respectively). In both 2019 and 2020, the drugs were significantly more often dispensed to women than men, and most were prescribed to adults followed by the elderly. For antidepressants, in both male and female adolescents, adults and elderly, for week 1-11 no significant differences were found between 2019 and 2020. Compared to 2019, a significant reduction in the number of dispensed antidepressants was seen in during 2020 COVID-19 lockdown in these groups (p<0.05). In adolescents, but not for the other age groups, a significant reduction in dispensing was also found post COVID-19 lockdown (p<0.001). For children, a general reduction in the number of dispensed antidepressant drugs was seen in 2020 before and during COVID-19 lockdown (p<0.001). In male children there was a significant reduction in dispensing during COVID-19 lockdown (p=0.04), which was not significant among female children. For anxiolytics, in both male and female children and adolescents, a general reduction of dispensing was seen throughout 2020 (p<0.05). In male adults, in 2020 a significant reduction in dispensing was found during COVID-19 lockdown (p=0.01), and for both male and female adults post-COVID-19 lockdown (p<0.05). For elderly, no significant differences in dispending were found between 2019 and 2020. Conclusions: Across all age groups a significant reduction was seen for the number of newly dispensed antidepressant drugs. For all age groups except the elderly a significant reduction in dispensed anxiolytic drugs was seen during COVID-19 lockdown. This data corresponds with reports of delayed care. However, in elderly no reduction was found for dispensed anxiolytics during COVID-19 lockdown. Future research should determine if the continued dispensing of anxiolytics among elderly during lockdown may reflect the fact that fear of COVID-19 may be greater among this age group, as they are over-represented in COVID-19 related hospital admissions and have the highest mortality rates. No conflict of interest
ABSTRACT
Background: To address the rapid spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) around the world, in the absence of a vaccine or adequate treatment for the 2019 coronavirus disease (COVID-19), many governments around the world enforced lockdown periods. While lockdowns are beneficial in reducing the spread of the virus, literature shows that lockdowns may also have a significant negative impact on mood, wellbeing, and health. In this context, we hypothesized that negative mood changes increase overall stress levels, which in turn has a negative effect on perceived immune fitness, expressed in a greater presence and severity of COVID-19 symptoms [1]. Objective: The aim of this study was to investigate the impact of mood and stress during COVID-19 lockdown on perceived immune fitness and reported COVID-19 symptoms. Methods: An online retrospective survey was held among Dutch adults, to evaluate the first lockdown in The Netherlands [1]. Questions were answered for the period before the lockdown (15 January–14 March 2020) as well as for the lockdown period (15 March–11 May 2020). Mood was assessed via 1-item scales including “stress”, “anxiety”, “depression”, “fatigue”, “hostile”, “lonely” and “happy” [2]. Perceived immune fitness was assessed on a scale ranging from 0 (very poor) to 10 (excellent) [3]. The COVID-19 Symptoms Scale comprised the items sneezing, running nose, sore throat, cough, and malaise/feeling sick, high temperature (up to 38 Celsius), fever (38 Celsius and higher), shortness of breath, and chest pain [1]. The severity of each of the nine items could be rated as none (0), mild (1), moderate (2), or severe (3). The sum score of items served as COVID-19 symptom severity score, with a possible range from 0 (no complaints) to 27 (severe complaints). In addition, the presence of COVID-19 symptoms was calculated by counting the number of symptoms with a score > 0. Assessments before and during COVID19 lockdown were compared using the Related Samples Wilcoxon Signed Rank Test. For each variable, difference scores (Δ, lockdown – before lockdown) were calculated. Pearson's correlations were calculated between difference scores. Results: Data of 1415 Dutch adults (64% women, age range: 18 to 94 years old) were analyzed. During lockdown, all mood ratings, stress, and perceived immune fitness were significantly poorer compared to the period before lockdown (p<0.0001). The COVID-19 symptom severity score as significantly higher during the lockdown period (p=0.018), but no difference was found for the number of reported COVID-19 symptoms (p=0.256). Significant correlations were found between mood changes and Δ stress (r ranged from 0.334 to 0.557, all p<0.0001). The correlation between Δ stress and Δ perceived immune fitness was also significant (r=-0.310, p<0.0001). Finally, Δ perceived immune fitness correlated significantly with difference scores for the presence (r=-0.223, p<0.0001) and severity (r=-0.245, p<0.0001) of COVID-19 related symptoms. Conclusions: The findings support the hypothesis that lockdown has a negative effect on mood and increases stress. This is reflected in poorer perceived immune fitness, which in turn is associated with a greater presence and severity of COVID-19 symptoms. No conflict of interest
ABSTRACT
Background: The 2019 coronavirus disease (COVID-19) poses great demands on hospitals and resulted in delayed care. It can be hypothesized that this delayed professional health care is reflected in a reduction of pharmacy dispensed analgesics. Objective: The purpose of this study was to investigate the possible impact of COVID-19 lockdown on the dispensing rates of analgesics drugs by Dutch pharmacies. Methods: Pharmacy dispensing data was obtained from Stichting Farmaceutische Kentallen on newly dispended analgesics (ATC2 N02), covering 1890 pharmacies and 96% of the Dutch population. Over-the-counter (OTC) painkillers were not considered. Age and sex of the patient were recorded, as well as the week of first-time dispensed drugs. Data were collected for the first half year of 2019 and the first half year of 2020. Patients were allocated to one of the following age groups: children (0-9 years old), adolescents (10-19 years old), adults (20-64 years old), and elderly (65 year and older). Further, data was combined into three time periods: week 1-11 (for 2020 corresponding to the pre-COVID-19 lockdown period), week 12-19 (for 2020 corresponding to the COVID-19 lockdown), and week 20-26 (for 2020 corresponding to the post-COVID-19 lockdown). Using independent t-tests, dispensing data was compared between males and females, age groups, and between 2019 and 2020. Results: An overall reduction was observed in the first half of 2020 for the number of newly dispensed analgesics (379.657 in 2019 and 360.094 in 2020, respectively). In both years, analgesics were significantly more often dispensed to females than to males, and most were prescribed to adults followed by the elderly. In addition, significantly more analgesics were dispensed in week 1-11 compared to the other time periods. In male children, compared to 2019 the reduction was only significant during the COVID-19 lockdown in 2020. For female children, no significant differences were found. For adolescents of both sexes, compared to 2019, a significantly reduced number of dispensed analgesics was found for all three time periods (p<0.001). In adults of both sexes, the reduction in dispensed analgesics in 2020 was only significant during the COVID-19 lockdown. In elderly, a reduction in dispensed analgesics in 2020 was found for pre- and during the COVID-19 lockdown (p<0.001), but not post-COVID-19 lockdown. In elderly males, a significant reduction in 2020 was found for pre-COVID lockdown, but not thereafter. For elderly females, the reduction in 2020 was significant for both week pre- (p<0.001) and during COVID-19 lockdown (p=0.02), but not thereafter. Conclusions: These findings show that the number of dispensed analgesics was significantly lower in 2020 compared to 2019. The reduction in dispensed analgesics was most consistently seen for the 2020 COVID-19 lockdown period, reflecting delayed professional health care across all age groups. Future research should investigate whether, due to delayed care, a substantial number of patients may have suffered from untreated pain complaints during the 2020 COVID-19 lockdown, or whether they have established pain relief via non-prescription painkillers. No conflict of interest
ABSTRACT
Background: The alcohol hangover is defined as the combination of negative mental and physical symptoms which can be experienced after a single episode of alcohol consumption, starting when blood alcohol concentration (BAC) approaches zero [1]. While performance impairment during hangover has been consistently demonstrated [2], research on the impact on work performance, absenteeism, and presenteeism is scarce. A recent investigation estimated the combined annual costs of being hungover or under the influence of alcohol at work for the UK economy at 1.61 billion euro [3]. In 2013, the National Institute of Public Health and the Environment of the Netherlands (RIVM) estimated the annual costs of alcohol-related absenteeism and presenteeism for The Netherlands at 1.3 billion euro (hangover and under the influence of alcohol at work combined), including and 0.22 absenteeism days, and 2.5 presenteeism days with a 27% reduction of performance on presenteeism days[4]. Objective: The purpose of this study was to investigate hangover-related absenteeism and presenteeism, and estimate the annual costs for the Dutch economy. Methods: An online survey was conducted among Dutch adults [5]. Participants indicated whether in 2019 (i.e., pre-COVID-19) they consumed alcohol and were employed. Absenteeism and presenteeism due to alcohol hangover were assessed, using questions adapted from Bhattacharya [3], including the number of days that participants (a) did not work because they experienced a hangover and (b) worked while having a hangover. Performance on presenteeism days was rated on a scale ranging from 0% (compared to a regular day I achieved nothing/did not work) to 100% (my work was absolutely not influenced by experiencing reduced immune fitness). Statistics Netherlands provided information on the average Dutch income. Using the method by Bhattacharya [3], the economic costs of absenteeism and presenteeism due to reduced immune fitness were calculated. Results: Data of N=351 participants (63.5% female) with a mean (SD) age of 34.6 (14.5) years old was evaluated. About one third (33.6%) of all employees had been hungover at work at least once in 2019, and 8.3% reported absenteeism due to hangover. The mean (SD) number of absenteeism and presenteeism days were 0.2 (0.9) and 2.4 (7.0) days, respectively. On average, employees reported a 26% reduction in performance when being at work while having a hangover. The estimated economic cost of the alcohol hangover due to absenteeism (€306 million euro) and presenteeism (€986 million euro) sum up to a total of €1.29 billion euro. Presenteeism and absenteeism were most commonly reported by younger, male, and higher educated individuals. Conclusions: These findings suggest that alcohol hangover has a significant impact on the Dutch economy. The 2019 data are comparable to those obtained in 2013, although for the current analysis only hangover was considered and not being under the influence of alcohol at work. However, it should be noted the data were obtained from a relatively small convenience sample. To obtain a more accurate estimate of the costs of hangover-related absenteeism and presenteeism, the study should be replicated in a larger and national representative sample. No conflict of interest
ABSTRACT
Background: Research has shown that individuals have applied a variety of measures to cope with the negative effects of self-isolation during the 2019 coronavirus (COVID-19) lockdowns. These coping strategies are not always beneficial and can have adverse effects on psychological wellbeing and health. To cope with the negative effects of the lockdown, individuals may engage in unhealthy behaviors, including increased use of tobacco, alcohol and other drugs, either as a result of loneliness and despair, or in the hope that this will help them handle lockdown-related stress and mood changes. Objective: The purpose of this literature review was to evaluate the impact of COVID-19 lockdowns on alcohol consumption, and to identify possible moderating factors. Methods: A literature search was conducted (April 15, 2021) to identify studies that investigated the impact of COVID-19 lockdowns on alcohol consumption. PubMed was searched using the search terms ‘alcohol’ and ‘COVID-19’, and cross-References were checked. Articles were included if they were written in the English language and provided data on alcohol consumption (quantity and/or frequency) during COVID-19 lockdowns. Results: A total of 31 studies were included in the review, including a total of 94.630 participants. Most studies were retrospective surveys investigating convenience samples, and originated from Europe (11), the USA (14), Australia (3), China (1), or mixed countries (2). Mixed results were presented by studies that examined their sample as a whole. That is, some studies reported an increase in alcohol consumption, whereas others found a decrease, or unchanged drinking behavior. More detailed analysis revealed subgroups within studied populations. These subgroups reported either increased alcohol consumption (about 25%), decreased alcohol consumption (about 25%), or did not change their alcohol consumption during COVID-19 lockdown (about 50%). Factors influencing the direction of change in alcohol consumption included various demographic characteristics such as sex, age, race, educational level, living situation, and employment status. Important moderating factors are negative mood changes experienced during lockdown, such as stress, loneliness, and depression. The amount of associated stress and (in-)capability of successfully coping with stress showed to be an important determinant of alcohol intake. Greater mood changes were associated with an increased likelihood of drinkers changing their drinking behavior. This could be either a reduction in alcohol intake in order to maintain an adequate health status, or an increase in alcohol consumption as a mechanism to cope with stress and loneliness. The latter is associated with subsequent poorer health and an increased susceptibility to experiencing COVID-19 symptoms. Conclusions: These findings show that the COVID-19 lockdown has varying effects on alcohol consumption. About half of the individuals do not change or reduce their alcohol intake during the lockdown. However, a substantial number of individuals (about 1 in 4 drinkers) reported increased alcohol consumption during lockdown, which was associated with negative mood, increased stress, poorer health, and increased susceptibility to experiencing COVID-19 symptoms. No conflict of interest
ABSTRACT
Background: The 2019 coronavirus (COVID-19) lockdowns have been associated with significant increases in negative mood and stress, reduced (perceived) health and poorer quality of life [1]. These effects were particularly seen among people who live alone and lack daily social support of family or housemates. Objective: To compare mood and stress of those that lived alone or together with others during the COVID-19 lockdown, and to investigate the impact on perceived immune fitness and presence and severity of COVID-19 related symptoms. Methods: An online survey among Dutch adults compared the period before the lockdown (15 January–14 March 2020) with the lockdown period (15 March–11 May 2020) [2]. Participants indicated whether they ‘lived alone’ or ‘together with others’ during the lockdown. Mood (“anxiety”, “depression”, “fatigue”, “hostility”, “loneliness” and “happiness) and “stress” was assessed via 1-item scales [3]. Perceived immune fitness and quality of life was measured using a scale ranging from 0 (very poor) to 10 (excellent) [3,4]. The severity of COVID-19 symptoms was assessed using the COVID-19 Symptoms Scale [2]. Items could be rated as none (0), mild (1), moderate (2), or severe (3). The sum score served as severity score, and the number of items with a score > 0 as COVID-19 symptom presence score. Differences between outcomes of the groups that lived alone or lived together during lockdown were compared with Independent-Samples Mann-Whitney U tests. For each variable, difference scores (Δ, lockdown – before lockdown) were calculated and compared between the groups with analysis of variance. Pearson's correlations were calculated between difference scores. Results: Data of N=505 participants were analyzed. The mean (SD) age was 38.2 (15.8), and 65.5% of the sample were female. During the lockdown period, 115 (22.8%) lived alone and 390 (77.2%) lived together with others. The mean (SD) number of household members was 2.8 (1.6), with a range of 1 to 12. During the lockdown, individuals that lived alone reported significantly higher ratings (p<0.05) of loneliness, anxiety, depression, and significantly lower scores on happiness and quality of life compared to the group that lived together with others. Comparing difference scores (during lockdown – before lockdown) of both groups revealed that the group that lived alone reported a significant greater increase in loneliness (p=0.002), which was accompanied by a significant increase in reported COVID-19 symptoms (presence: p=0.019, severity: p=0.041), whereas a small decrease in symptom presence and severity was seen among the ‘lived together’ group. The Δ loneliness scores correlated significantly with Δ perceived immune fitness (r = -0.239, p<0.0001) and Δ presence (r = 0.144, p=0.001) and Δ severity (r = 0.160, p<0.0001) of COVID-19 symptoms. Conclusions: Living alone and associated feelings of loneliness have a negative impact on mood, perceived immune fitness, and the presence and severity of COVID-19 symptoms. Loneliness is an important determinant of mental health, though often underestimated. Future research should investigate how the impact of increased social support, for example with the aid of mobile technology, can counteract loneliness and thereby improve health and quality of life. No conflict of interest