Factors associated with stress about returning to pre-pandemic routines among Canadians.

The COVID-19 pandemic continues to be a public health concern, with important impacts on individuals' mental health. Many people have experienced significant changes to their daily routines due to the pandemic and for some, returning to pre-pandemic routines could create elevated stress. The present study explored factors associated with stress about returning to pre-pandemic routines (SRPR). A web-based, cross-sectional survey of 1,001 Canadian adults aged 18 years and older was conducted on July 9-13, 2021. SRPR was assessed by asking the respondents how much stress they have been feeling about returning to their pre-pandemic routines. Sociodemographic variables, anxiety, depression, loneliness, and COVID-19-related worry were examined in relation to SRPR. Overall, 28.8% of respondents reported moderate to extreme SRPR. After adjusting for covariates, factors associated with elevated SRPR included: younger age (AOR = 2.29, 95%CI 1.30-4.03), higher education (AOR = 2.08, 95%CI 1.14-3.79), being very worried about getting COVID-19 (AOR = 4.14, 95%CI 2.46-6.95), switching to working from home (AOR = 2.43, 95%CI 1.44-4.11), having anxiety (AOR = 5.02, 95%CI 3.19-7.89), feeling depressed (AOR = 1.93, 95%CI 1.14-3.25), and feeling lonely (AOR = 1.74, 95%CI 1.07-2.83). The findings of this study suggest that individuals experiencing mental health concerns (anxiety, feeling depressed, feeling lonely) may be especially likely to feel elevated SRPR and may therefore need additional support in making the transition back to prior routines.

Determinants of social distancing adherence.

Introduction: Governments and public health authorities across many jurisdictions implemented social (physical) distancing measures to contain the spread of the 2019 novel coronavirus disease (COVID-19). Adherence to these measures is variable and likely influenced by various factors. This study aimed to 1) identify the individual sociodemographic, COVID-19 and social distancing related, and psychological determinants of social distancing adherence, and 2) explore regional differences in social distancing adherence in the United States (U.S.) and English-speaking Canada based on each region's discrepant response to social distancing restrictions. Methods: A web-based repeated cross-sectional survey was conducted in 4,942 English-speaking participants from the four most populous U.S. states, specifically New York, California, Texas, and Florida, and Canada (www.covid19-database.com). The study was conducted at two timepoints, from May 1 to 5, 2020 (n = 1,019, Canadian participants only) and from July 6 to 10, 2020 (n = 3,923). Separate univariate models were computed for individual sociodemographic, COVID-19 and social distancing related, and psychological determinants of social distancing adherence. To determine the total variance explained, a univariate analysis including all of the determinants was performed. Regional differences in social distancing were compared between the four U.S. states and Canada, and between the U.S. as a whole and Canada. Results: Adherence to social distancing was higher in May (mean = 4.4/5.0±0.7) compared to July (mean = 4.3/5.0±0.7) [t (4940) = 6.96, p < 0.001], likely a reflection of relaxing restrictions. There were no regional differences in adherence. Sociodemographic, COVID-19 and social distancing related, and psychological determinants explained 10, 36, and 23% of the variance of social distancing adherence, respectively. Higher perceived seriousness of COVID-19 [ß (SE) = 0.39 (0.01), p < 0.001, partial η2 = 0.22], lower risk propensity [ß (SE) = -0.15 (0.01), p < 0.001, partial η2 = 0.06], germ aversion [ß (SE) = 0.12 (0.01), p < 0.001, partial η2 = 0.03], age [ß (SE) = 0.01 (0.00), p < 0.001, partial η2 = 0.02], and greater social support [ß (SE) = 0.03 (0.00), p < 0.001, partial η2 = 0.02] had the largest effects on social distancing adherence. Conclusion: Public service initiatives to emphasize the serious consequences of infection and targeted interventions toward certain sociodemographic groups, such as younger adults and vulnerable individuals in greater need of social support, may help enhance the public's adherence to social distancing measures during subsequent waves of COVID-19 and future pandemics.

Determinants of social distancing adherence

Introduction Governments and public health authorities across many jurisdictions implemented social (physical) distancing measures to contain the spread of the 2019 novel coronavirus disease (COVID-19). Adherence to these measures is variable and likely influenced by various factors. This study aimed to 1) identify the individual sociodemographic, COVID-19 and social distancing related, and psychological determinants of social distancing adherence, and 2) explore regional differences in social distancing adherence in the United States (U.S.) and English-speaking Canada based on each region's discrepant response to social distancing restrictions. Methods A web-based repeated cross-sectional survey was conducted in 4,942 English-speaking participants from the four most populous U.S. states, specifically New York, California, Texas, and Florida, and Canada (www.covid19-database.com). The study was conducted at two timepoints, from May 1 to 5, 2020 (n = 1,019, Canadian participants only) and from July 6 to 10, 2020 (n = 3,923). Separate univariate models were computed for individual sociodemographic, COVID-19 and social distancing related, and psychological determinants of social distancing adherence. To determine the total variance explained, a univariate analysis including all of the determinants was performed. Regional differences in social distancing were compared between the four U.S. states and Canada, and between the U.S. as a whole and Canada. Results Adherence to social distancing was higher in May (mean = 4.4/5.0±0.7) compared to July (mean = 4.3/5.0±0.7) [t(4940) = 6.96, p < 0.001], likely a reflection of relaxing restrictions. There were no regional differences in adherence. Sociodemographic, COVID-19 and social distancing related, and psychological determinants explained 10, 36, and 23% of the variance of social distancing adherence, respectively. Higher perceived seriousness of COVID-19 [β (SE) = 0.39 (0.01), p < 0.001, partial η2 = 0.22], lower risk propensity [β (SE) = −0.15 (0.01), p < 0.001, partial η2 = 0.06], germ aversion [β (SE) = 0.12 (0.01), p < 0.001, partial η2 = 0.03], age [β (SE) = 0.01 (0.00), p < 0.001, partial η2 = 0.02], and greater social support [β (SE) = 0.03 (0.00), p < 0.001, partial η2 = 0.02] had the largest effects on social distancing adherence. Conclusion Public service initiatives to emphasize the serious consequences of infection and targeted interventions toward certain sociodemographic groups, such as younger adults and vulnerable individuals in greater need of social support, may help enhance the public's adherence to social distancing measures during subsequent waves of COVID-19 and future pandemics.

COVID-19 behavior determinants dataset.

The COVID-19 Behavior Determinants Database (http://covid19-database.com) is a research project that examined the sociodemographic and psychological determinants of COVID-19 related attitudes and behaviors. It is a comprehensive web-based survey that was administered to adults ages 18 or older (total n=8070) from the United States of America (n = 5326), including the four most populous states, specifically New York, California, Florida, and Texas, and Canada (n = 2744), including all provinces, except Quebec. The survey was collected at three timepoints, May 2020 (n=1019), July 2020 (n=4027), and March 2021 (n=3024). Participants provided detailed sociodemographic information and completed a battery of psychological assessments. Participants also provided information about prior testing for COVID-19 and perceived seriousness of COVID-19 and the need for current physical (social) distancing restrictions. The database is helpful to researchers and public health policy decision-makers who are interested in investigating and identifying the determinants of COVID-19 related attitudes and behaviors in North America.

Household composition and anxiety symptoms during the COVID-19 pandemic: A population-based study.

INTRODUCTION: Household composition may be an important factor associated with anxiety during the COVID-19 pandemic as people spend more time at home due to physical distancing and lockdown restrictions. Adults living with children-especially women-may be particularly vulnerable to anxiety as they balance additional childcare responsibilities and homeschooling with work. The objective of this study was to examine the association between household composition and anxiety symptoms during the COVID-19 pandemic and explore gender as an effect modifier. METHODS: Data were derived from seven waves of a national online survey of Canadian adults aged 18+ years from May 2020 to March 2021, which used quota sampling by age, gender, and region proportional to the English-speaking Canadian population (n = 7,021). Multivariable logistic and modified least-squares regression models were used. RESULTS: Compared to those living alone, significantly greater odds of anxiety symptoms were observed among single parents/guardians (aOR = 2.00; 95%CI: 1.41-2.84), those living with adult(s) and child(ren) (aOR = 1.39; 95%CI: 1.10-1.76), and those living with adult(s) only (aOR = 1.22; 95%CI: 1.00-1.49). Gender was a significant effect modifier on the additive scale (p = 0.0487) such that the association between living with child(ren) and anxiety symptoms was stronger among men than women. CONCLUSION: Additional tailored supports are needed to address anxiety among adults living with children-especially men-during the COVID-19 pandemic and future infectious disease events.

Self-reported mental health during the COVID-19 pandemic and its association with alcohol and cannabis use: a latent class analysis.

BACKGROUND: Mental health problems and substance use co-morbidities during and after the COVID-19 pandemic are a public health priority. Identifying individuals at high-risk of developing mental health problems and potential sequela can inform mitigating strategies. We aimed to identify distinct groups of individuals (i.e., latent classes) based on patterns of self-reported mental health symptoms and investigate their associations with alcohol and cannabis use. METHODS: We used data from six successive waves of a web-based cross-sectional survey of adults aged 18 years and older living in Canada (6,021 participants). We applied latent class analysis to three domains of self-reported mental health most likely linked to effects of the pandemic: anxiety, depression, and loneliness. Logistic regression was used to characterize latent class membership, estimate the association of class membership with alcohol and cannabis use, and perform sex-based analyses. RESULTS: We identified two distinct classes: (1) individuals with low scores on all three mental health indicators (no/low-symptoms) and (2) those reporting high scores across the three measures (high-symptoms). Between 73.9 and 77.1% of participants were in the no/low-symptoms class and 22.9-26.1% of participants were in the high-symptom class. We consistently found across all six waves that individuals at greater risk of being in the high-symptom class were more likely to report worrying about getting COVID-19 with adjusted odds ratios (aORs) between 1.72 (95%CI:1.17-2.51) and 3.51 (95%CI:2.20-5.60). Those aged 60 + were less likely to be in this group with aORs (95%CI) between 0.26 (0.15-0.44) and 0.48 (0.29-0.77) across waves. We also found some factors associated with class membership varied at different time points. Individuals in the high-symptom class were more likely to use cannabis at least once a week (aOR = 2.28, 95%CI:1.92-2.70), drink alcohol heavily (aOR = 1.71, 95%CI:1.49-1.96); and increase the use of cannabis (aOR = 3.50, 95%CI:2.80-4.37) and alcohol (aOR = 2.37, 95%CI:2.06-2.74) during the pandemic. Women in the high-symptom class had lower odds of drinking more alcohol during the pandemic than men. CONCLUSIONS: We identified the determinants of experiencing high anxiety, depression, and loneliness symptoms and found a significant association with alcohol and cannabis consumption. This suggests that initiatives and supports are needed to address mental health and substance use multi-morbidities.

Deployment of Health Equity Strike Teams to Address COVID-19 Vaccine Disparities in Arkansas, 2021.

Minority populations have been disproportionately affected by the COVID-19 pandemic, and disparities have been noted in vaccine uptake. In the state of Arkansas, health equity strike teams (HESTs) were deployed to address vaccine disparities. A total of 13 470 vaccinations were administered by HESTs to 10 047 eligible people at 45 events. Among these individuals, 5645 (56.2%) were African American, 2547 (25.3%) were White, and 1068 (10.6%) were Hispanic. Vaccination efforts must specifically target populations that have been disproportionately affected by the pandemic. (Am J Public Health. 2022;112(1):29-33. https://doi.org/10.2105/AJPH.2021.306564).

Changes in alcohol use during the COVID-19 pandemic and previous pandemics: A systematic review.

The objective of this study is to summarize the research on the relationships between exposure to the COVID-19 pandemic or previous pandemics and changes in alcohol use. A systematic search of Medline and Embase was performed to identify cohort and cross-sectional population studies that examined changes in alcohol use during or following a pandemic compared to before a pandemic occurred. Outcomes examined included differences in the volume and frequency of alcohol consumption and the frequencies of heavy episodic drinking (HED) and alcohol-related problems during a pandemic compared to before a pandemic. Quality assessment was performed using the Cochrane Risk of Bias Tool for Nonrandomized Studies. This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search yielded 672 articles; 27 were included in the narrative review, of which 6 were cohort studies (all from high-income countries). A total of 259,188 participants were included. All cohort studies examined the impact of COVID-19 and associated pandemic-related policies, including social distancing and alcohol-specific policies, on alcohol use. Cohort studies demonstrated a consistent significant decrease in total alcohol consumption (Australia) and a significant increase in the frequency of alcohol use (United States). A significant decrease in the frequency of HED was observed in Australia and Spain but not in the United States. A significant increase in the proportion of people with problematic alcohol use was observed in the United Kingdom. Initial insights into changes in alcohol use indicate substantial heterogeneity. Alcohol use may have decreased in some countries, while HED and the proportion of people with problematic alcohol use may have increased. The lack of high-quality studies from low- and middle-income countries reflects a dearth of information from countries inhabited by most of the world's population.

Alcohol and cannabis use during the COVID-19 pandemic among transgender, gender-diverse, and cisgender adults in Canada.

BACKGROUND: This study examined whether heavy episodic drinking (HED), cannabis use, and subjective changes in alcohol and cannabis use during the COVID-19 pandemic differ between transgender and gender-diverse (TGD) and cisgender adults. METHODS: Successive waves of web-based cross-sectional surveys. SETTING: Canada, May 2020 to March 2021. PARTICIPANTS: 6,016 adults (39 TGD, 2,980 cisgender men, 2,984 cisgender women, and 13 preferred not to answer), aged ≥18 years. MEASUREMENTS: Measures included self-reported HED (≥5 drinks on one or more occasions in the previous week for TGD and cisgender men and ≥4 for cisgender women) and any cannabis use in the previous week. Subjective changes in alcohol and cannabis use in the past week compared to before the pandemic were measured on a five-point Likert scale (1: much less to 5: much more). Binary and ordinal logistic regressions quantified differences between TGD and cisgender participants in alcohol and cannabis use, controlling for age, ethnoracial background, marital status, education, geographic location, and living arrangement. RESULTS: Compared to cisgender participants, TGD participants were more likely to use cannabis (adjusted odds ratio (aOR)=3.78, 95%CI: 1.89, 7.53) and to have reported subjective increases in alcohol (adjusted proportional odds ratios (aPOR)= 2.00, 95%CI: 1.01, 3.95) and cannabis use (aPOR=4.56, 95%CI: 2.13, 9.78) relative to before the pandemic. Compared to cisgender women, TGD participants were more likely to use cannabis (aOR=4.43, 95%CI: 2.21, 8.87) and increase their consumption of alcohol (aPOR=2.05, 95%CI: 1.03, 4.05) and cannabis (aPOR=4.71, 95%CI: 2.18, 10.13). Compared to cisgender men, TGD participants were more likely to use cannabis (aOR=3.20, 95%CI: 1.60, 6.41) and increase their use of cannabis (aPOR=4.40, 95%CI: 2.04, 9.49). There were no significant differences in HED between TGD and cisgender participants and in subjective change in alcohol between TGD and cisgender men; however, the odds ratios were greater than one as expected. CONCLUSIONS: Increased alcohol and cannabis use among TGD populations compared to before the pandemic may lead to increased health disparities. Accordingly, programs targeting the specific needs of TGD individuals should be prioritized.

Daily cannabis use during the novel coronavirus disease (COVID-19) pandemic in Canada: a repeated cross-sectional study from May 2020 to December 2020.

BACKGROUND: Daily cannabis use is most strongly implicated in the cannabis-attributable burden of disease. In the context of the novel coronavirus disease (COVID-19) pandemic in Canada, we characterized trends in daily cannabis use in the overall sample and various population subgroups, and examined risk characteristics associated with daily cannabis use. METHODS: A cross-sectional design was operationalized using data from six waves of a national, online survey of adults residing in Canada who spoke English (N = 6,021; May-08 2020 to December-01 2020). Trends were characterized using the Cochran-Armitage test and risk characteristics were identified using chi-square test and logistic regression analysis. RESULTS: Daily cannabis use in the overall sample remained stable (5.34% - 6.10%; p = 0.30). This pattern of findings extended to various population subgroups as well. The odds of daily cannabis use were higher for those who: were males (Odds Ratio; 95% Confidence Interval: 1.46; 1.15 - 1.85), were between 18 - 29 years (2.36; 1.56 - 3.57), 30 - 39 years (2.65; 1.93 - 3.64) or 40-49 years (1.74; 1.19 - 2.54), self-identified as white (1.97; 1.47 - 2.64), had less than college or university completion (1.78; 1.39 - 2.28), engaged in heavy episodic drinking (2.05; 1.62 - 2.61), had a job that increased the risk of contracting COVID-19 (1.38; 1.01 - 1.88), experienced loneliness 5-7 days in the past week (1.86; 1.26 - 2.73) and felt very worried (2.08; 1.21 - 3.58) or somewhat worried (1.83; 1.11 - 3.01) about the pandemic's impact on their financial situation. CONCLUSIONS: Daily cannabis use did not change in the overall sample or various population subgroups during the pandemic. Pandemic-related risks and impacts were associated with daily cannabis use.

Age differences in the association between loneliness and anxiety symptoms during the COVID-19 pandemic.

Loneliness and associated mental health problems are of particular concern during the COVID-19 pandemic due to physical distancing and lockdown restrictions. Loneliness is most common among young adults and women during the pandemic, but it is unclear if the association between loneliness and mental health problems, notably anxiety, is strongest in these groups. The objective of this study was to examine whether the association between loneliness and anxiety differed by age and/or gender during the pandemic. We analyzed data from a multi-wave national online survey of Canadians aged 18+ years from May 2020 to March 2021 (n = 7,021). Multivariable modified least-squares regression was used to examine whether the association between loneliness and moderate to severe anxiety symptoms (GAD-7 10+) differed by age and/or gender on the additive scale, controlling for socio-demographic factors, depression, hopefulness, and survey wave. Age significantly moderated the association between loneliness and anxiety symptoms while gender did not. Loneliness was associated with anxiety symptoms for all age groups, but the association was not as strong among those aged 70+ years compared to other age groups. Evidence-based loneliness interventions that target younger adults are needed to mitigate the mental health effects of infectious disease events such as COVID-19.

Vaccine Hesitancy Is a Barrier to Achieving Equitable Herd Immunity Among Racial Minorities

Introduction: Racial minority groups have been disproportionately affected by the 2019 novel coronavirus disease (COVID-19). Vaccine hesitancy may be a major barrier to achieving equitable herd immunity and must be addressed to reduce the excess morbidity and mortality of COVID-19 in disproportionately affected communities. This study aimed to determine if COVID-19 vaccine hesitancy, and its factors vaccine complacency and confidence, are more prominent among disproportionately affected racial minority groups. Methods:We collected data from participants aged 18 years or older from the four most populous U.S. states, including New York, California, Florida, and Texas, and Canada. Data were collected using a web-based survey platform. Data are available at http://www.covid19-database.com. Results:Data from 4,434 participants were included [mean (SD) age = 48.7 (17.2) and 50.4% women]. Vaccine hesitancy was higher in Black, Indigenous (Native American and Indigenous People of Canada, including First Nations, Inuit and Métis), and Latinx compared to White participants, while no difference was found between East Asian and White participants. The group differences in vaccine hesitancy for Indigenous and Black compared to White participants remained after controlling for sociodemographic factors. Determinants of vaccine complacency were equivalent between disproportionately affected racial groups and white participants. Vaccine confidence (i.e., trust in vaccine benefit) was generally lower in all racial groups compared to White participants. Differences in vaccine mistrust comparing Black and East Asian to White participants remained after controlling for sociodemographic factors. Discussion:Disproportionately affected racial minorities may have higher vaccine hesitancy and lower confidence in COVID-19 vaccines. Public health and other relevant government services should address vaccine hesitancy among racial minorities using a culturally sensitive, community-centered approach to attain equitable herd immunity.

Machine Learning-Based Predictive Modeling of Anxiety and Depressive Symptoms During 8 Months of the COVID-19 Global Pandemic: Repeated Cross-sectional Survey Study.

BACKGROUND: The COVID-19 global pandemic has increased the burden of mental illness on Canadian adults. However, the complex combination of demographic, economic, and lifestyle factors and perceived health risks contributing to patterns of anxiety and depression has not been explored. OBJECTIVE: The aim of this study is to harness flexible machine learning methods to identify constellations of factors related to symptoms of mental illness and to understand their changes over time during the COVID-19 pandemic. METHODS: Cross-sectional samples of Canadian adults (aged ≥18 years) completed web-based surveys in 6 waves from May to December 2020 (N=6021), and quota sampling strategies were used to match the English-speaking Canadian population in age, gender, and region. The surveys measured anxiety and depression symptoms, sociodemographic characteristics, substance use, and perceived COVID-19 risks and worries. First, principal component analysis was used to condense highly comorbid anxiety and depression symptoms into a single data-driven measure of emotional distress. Second, eXtreme Gradient Boosting (XGBoost), a machine learning algorithm that can model nonlinear and interactive relationships, was used to regress this measure on all included explanatory variables. Variable importance and effects across time were explored using SHapley Additive exPlanations (SHAP). RESULTS: Principal component analysis of responses to 9 anxiety and depression questions on an ordinal scale revealed a primary latent factor, termed "emotional distress," that explained 76% of the variation in all 9 measures. Our XGBoost model explained a substantial proportion of variance in emotional distress (r2=0.39). The 3 most important items predicting elevated emotional distress were increased worries about finances (SHAP=0.17), worries about getting COVID-19 (SHAP=0.17), and younger age (SHAP=0.13). Hopefulness was associated with emotional distress and moderated the impacts of several other factors. Predicted emotional distress exhibited a nonlinear pattern over time, with the highest predicted symptoms in May and November and the lowest in June. CONCLUSIONS: Our results highlight factors that may exacerbate emotional distress during the current pandemic and possible future pandemics, including a role of hopefulness in moderating distressing effects of other factors. The pandemic disproportionately affected emotional distress among younger adults and those economically impacted.

Individual determinants of COVID-19 vaccine hesitancy.

BACKGROUND: Novel coronavirus disease 2019 (COVID-19) vaccine hesitancy is a barrier to achieving herd immunity, and thus, a prominent public health concern. This study aimed to identify the determinants of COVID-19 vaccine hesitancy based on the World Health Organization's '3Cs' model (i.e., confidence, complacency, and convenience) in the United States (U.S.) and Canada. METHODS: Data from 7678 adults ages 18 or older were collected from the four most populous U.S. States, specifically New York, California, Florida, and Texas, and from English-speaking Canada at three timepoints, in May and July 2020, and March 2021 using a web-based survey (www.covid19-database.com). Sociodemographic information was collected, and comprehensive psychological assessments were administered. Univariate analyses were performed to identify the individual determinants of vaccine hesitancy, which were categorized as: 1) vaccine confidence, 2) vaccine complacency, 3) sociodemographic, and 4) other psychological factors. A series of models were computed using these categorizations. RESULTS: Mistrust of vaccine benefit (ß(SE) = 0.67(0.01), p<0.001, partial η2 = 0.26) and lower perceived seriousness of COVID-19 (ß(SE) = 0.68(0.02), p<0.001, partial η2 = 0.12) were the principal determinants of vaccine hesitancy. Right-wing political affiliation (ß(SE) = 0.32(0.02), p<0.001, partial η2 = 0.03), higher risk propensity (ß(SE) = 0.24(0.02), p<0.001, partial η2 = 0.03), and less negative mental health effects of the COVID-19 pandemic (ß(SE) = 0.20(0.01), p<0.001, partial η2 = 0.03) were the main sociodemographic and psychological determinants. Other sociodemographic determinants included younger age, women, race, and employment status. Lack of vaccine confidence and complacency explained 38% and 21% of the variance in vaccine hesitancy, respectively; whereas, sociodemographic and psychological determinants explained 13% and 11% of the variance in vaccine hesitancy, respectively. DISCUSSION: Targeted and tailored public health interventions that enhance the public's confidence in vaccines and emphasize the risk and seriousness of COVID-19 may address COVID-19 vaccine hesitancy. Efforts directed toward specific marginalized and underserved groups may be required to promote vaccine confidence.

Changes in Alcohol Consumption in Canada During the COVID-19 Pandemic: Associations With Anxiety and Self-Perception of Depression and Loneliness.

AIM: To examine whether changes in alcohol consumption in Canada since the start of the novel coronavirus disease (COVID-19) pandemic are associated with feelings of anxiety, depression, loneliness and/or with changes in employment due to COVID-19. METHODS: Data collection occurred between 29 May 2020 and 23 March 2021 via a web panel, AskingCanadians, which sampled 5892 adults (≥18 years of age). Data were collected on changes in alcohol consumption compared to before the pandemic (ordinal variable ranging from 1='much less alcohol' to 5='much more alcohol'), anxiety (General Anxiety Disorder-7), self-perceived depression (Center for Epidemiologic Studies Depression Scale), self-perceived loneliness, changes in employment status due to COVID-19 and socio-demographic variables (age, gender, living situation, household income and urban vs rural residence). Multivariate associations were assessed using ordinal logistic regression. Effect modification by gender was tested using likelihood-ratio tests. RESULTS: Changes in alcohol consumption were positively associated with anxiety, feeling depressed and loneliness. In particular, people with mild to moderate (ordered Odds Ratio (OR):1.23, 95% Confidence Interval (CI):1.07, 1.62) or severe anxiety (ordered OR:1.49, 95% CI:1.15, 1.93) had a greater odds of increased drinking than did people with no to low levels of anxiety. Gender, age, household income, living situation and survey wave were also associated with changes in drinking. No effect modifications by gender were observed. CONCLUSION: Given the health harms caused by alcohol use, public health practitioners and primary care physicians should focus health messaging to identify and support individuals at risk of increased alcohol consumption, especially people experiencing depression, loneliness or anxiety.

The association between COVID-19 diagnosis or having symptoms and anxiety among Canadians: A repeated cross-sectional study.

BACKGROUND: The mental health effects of being diagnosed with COVID-19 are unknown. The present study examined whether individuals or those with someone close to them with a COVID-19 diagnosis differentially experienced anxiety during the pandemic. METHODS: Four web-based repeated cross-sectional surveys were conducted among Canadians aged 18 and older (n = 4015) regarding the impact of COVID-19 on mental health between May 8th and July 14th, 2020. Data on sociodemographic, COVID-19 symptoms/diagnoses for self or someone close, and anxiety were collected. Multiple logistic regression analyses were performed controlling for potential confounders. RESULTS: Anxiety among individuals affected by the pandemic remained stable over time. Individuals or those with someone close diagnosed with COVID-19 had greater odds of having anxiety (OR = 1.55; 95%CI 1.12, 2.14) compared to those who had not been diagnosed (self or close other) with COVID-19. Individuals or those with someone close to them who had symptoms of COVID-19 had greater odds of having anxiety (OR = 2.08; 95%CI 1.51, 2.87) compared to those who did not report symptoms (self or close other). CONCLUSIONS: This evidence highlights the importance of targeted psychosocial interventions for those directly impacted by the COVID-19 virus.

Household- and employment-related risk factors for depressive symptoms during the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic has generated multiple psychological stressors, which may increase the prevalence of depressive symptoms. Utilizing Canadian survey data, this study assessed household- and employment-related risk factors for depressive symptoms during the pandemic. METHODS: A sample of 1005 English-speaking Canadian adults aged 18+ years completed a web-based survey after physical distancing measures were implemented across Canada. Hierarchical binary logistic regression analyses were conducted to examine the associations of depressive symptoms with household- (household size, presence of children, residence locale) and employment-related (job with high risk of COVID-19 exposure, working from home, laid off/not working, financial worry) risk factors, controlling for demographic factors (gender, age, education, income). RESULTS: About 20.4% of the sample reported depressive symptoms at least 3 days per week. The odds of experiencing depressive symptoms 3+ days in the past week were higher among women (AOR = 1.67, p = 0.002) and younger adults (18-29 years AOR = 2.62, p < 0.001). After adjusting for demographic variables, the odds of experiencing depressive symptoms were higher in households with 4+ persons (AOR = 1.88, p = 0.01), in households with children aged 6 to 12 years (AOR = 1.98, p = 0.02), among those with a job at high risk for exposure to COVID-19 (AOR = 1.82, p = 0.01), and those experiencing financial worry due to COVID-19 ('very worried' AOR = 8.00, p < 0.001). CONCLUSION: Pandemic responses must include resources for mental health interventions. Additionally, further research is needed to track mental health trajectories and inform the development, targeting, and implementation of appropriate mental health prevention and treatment interventions.

RéSUMé: OBJECTIF: La pandémie de COVID-19 a engendré de multiples facteurs de stress psychologique qui peuvent faire augmenter la prévalence des symptômes de dépression. Cette étude se fonde sur les résultats de sondages auprès de Canadien.ne.s pour évaluer les facteurs de risque liés à l'emploi et dans les ménages qui prédisposent aux symptômes de dépression pendant la pandémie. MéTHODE: Un échantillon de 1 005 Canadien.ne.s anglophones âgé.e.s de 18 ans ou plus ont rempli un sondage en ligne après l'imposition des mesures de distanciation physique partout au Canada. Une analyse de régression logistique binaire de type hiérarchique a permis d'établir les liens entre les symptômes de dépression et certains facteurs de risque dans les ménages (nombre de membres, présence d'enfants, localité de la résidence) ainsi que des facteurs de risque liés à l'emploi (emploi comportant un risque élevé d'exposition à la COVID-19, télétravail, mise à pied ou chômage, soucis financiers), après un contrôle des facteurs démographiques (sexe, âge, niveau d'éducation, revenu). RéSULTATS: Environ 20,4 % des répondant.e.s ont dit avoir eu des symptômes de dépression au moins trois jours par semaine. La probabilité d'avoir des symptômes de dépression trois jours ou plus au cours de la semaine écoulée est plus élevée pour les femmes (rapport de cotes ajusté, ou RCA = 1,67, p = 0,002) et les jeunes adultes (18 à 29 ans, RCA = 2,62, p < 0,001). Après réajustement des variables démographiques, cette probabilité est plus élevée pour les ménages de quatre personnes ou plus (RCA = 1,88, p = 0,01) et ceux ayant des enfants de 6 à 12 ans (RCA = 1,98, p = 0,02), ainsi que pour les personnes dont l'emploi comporte un risque élevé d'exposition à la COVID-19 (RCA = 1,82, p = 0,01), et celles éprouvant des soucis financiers à cause de la COVID-19 (« très inquiet ¼, RCA = 8,00, p < 0,001). CONCLUSION: Les ressources d'intervention en santé mentale doivent faire partie des mesures de lutte contre la pandémie. De plus, des recherches approfondies s'imposent afin de suivre l'évolution de la santé mentale des Canadien.ne.s et de guider l'élaboration, le ciblage et la mise en œuvre de mesures appropriées de prévention et de traitement des problèmes de santé mentale.

Loneliness in the COVID-19 pandemic: Associations with age, gender and their interaction.

Loneliness is associated with mental health and thus is of particular concern in the COVID-19 pandemic, due to physical distancing restrictions and shelter-in-place orders. The current study assessed the associations of age, gender and their interaction with loneliness during the COVID-19 pandemic, controlling for other sociodemographic variables. A pooled sample of 3,012 English-speaking Canadian adults aged 18+ years completed a web-based survey in one of three waves between May 8 and June 23, 2020. Multivariable logistic regression was used to examine the associations of loneliness with age and gender controlling for marital status, household income, education, living alone, employment situation, and survey wave. A likelihood ratio test assessed the model with interaction between age and gender included. Approximately 8.4% of the sample reported feeling lonely 5+ days in the past week. The regression model with main effects found greater odds of loneliness among women than men (AOR = 1.76, 95%CI = 1.32, 2.34) and among all age groups younger than 60 years compared to those aged 60+ years (p = 0.002). In the final regression model, a significant interaction effect between age and gender on loneliness was found. The interaction showed that women had greater odds of loneliness than men among those aged 18-29 years (AOR = 3.53, 95%CI = 1.69, 7.37) and 60+ years (AOR = 2.62, 95%CI = 1.33, 5.17). Special consideration of loneliness among younger and older adult women is needed in service planning. Given inconsistencies with pre-pandemic studies, detailed data collected during the current crisis is essential to inform proactive resource allocation to prevent and treat mental health consequences of the pandemic.

Cannabis Use During the COVID-19 Pandemic in Canada: A Repeated Cross-sectional Study.

OBJECTIVES: In the context of the ongoing coronavirus disease pandemic in Canada, we aimed to (1) characterize trends in cannabis use in the overall population; and (2) characterize patterns of and identify risk characteristics associated with an increase in cannabis use among those who used cannabis. METHODS: Data were obtained from three waves of an online, repeated cross-sectional survey of adults residing in Canada (May 08-June 23, 2020; N = 3012). Trends were assessed using Cochran-Armitage and chi-square tests, and risk characteristics were identified using logistic regression analyses. RESULTS: Cannabis use in the overall population remained stable during the months of May and June. Among those who used cannabis, about half increased their cannabis use compared to before the start of the pandemic. This proportion of an increase in cannabis use among those who used cannabis remained consistent across the survey waves. Risk characteristics associated with higher odds of an increase in cannabis use included residence in the central region (Odds ratio, 95% confidence intervals: 1.93, 1.03-3.62), being 18 to 29 years old (2.61, 1.32-5.17) or 30 to 49 years old (1.85, 1.07-3.19), having less than college or university education (1.86, 1.13-3.06) and being somewhat worried about the pandemic's impact on personal finances (1.73, 1.00-3.00). CONCLUSIONS: A large proportion of those who used cannabis have increased cannabis use during the pandemic, suggesting a need for interventions to limit increased cannabis use, policy measures to address cannabis-attributable harms, and continued monitoring of cannabis use during and after the pandemic.

SARS-CoV-2 Seroprevalence among a Southern U.S. Population Indicates Limited Asymptomatic Spread under Physical Distancing Measures.

Characterizing the asymptomatic spread of SARS-CoV-2 is important for understanding the COVID-19 pandemic. This study was aimed at determining asymptomatic spread of SARS-CoV-2 in a suburban, Southern U.S. population during a period of state restrictions and physical distancing mandates. This is one of the first published seroprevalence studies from North Carolina and included multicenter, primary care, and emergency care facilities serving a low-density, suburban and rural population since description of the North Carolina state index case introducing the SARS-CoV-2 respiratory pathogen to this population. To estimate point seroprevalence of SARS-CoV-2 among asymptomatic individuals over time, two cohort studies were examined. The first cohort study, named ScreenNC, was comprised of outpatient clinics, and the second cohort study, named ScreenNC2, was comprised of inpatients unrelated to COVID-19. Asymptomatic infection by SARS-CoV-2 (with no clinical symptoms) was examined using an Emergency Use Authorization (EUA)-approved antibody test (Abbott) for the presence of SARS-CoV-2 IgG. This assay as performed under CLIA had a reported specificity/sensitivity of 100%/99.6%. ScreenNC identified 24 out of 2,973 (0.8%) positive individuals among asymptomatic participants accessing health care during 28 April to 19 June 2020, which was increasing over time. A separate cohort, ScreenNC2, sampled from 3 March to 4 June 2020, identified 10 out of 1,449 (0.7%) positive participants.IMPORTANCE This study suggests limited but accelerating asymptomatic spread of SARS-CoV-2. Asymptomatic infections, like symptomatic infections, disproportionately affected vulnerable communities in this population, and seroprevalence was higher in African American participants than in White participants. The low, overall prevalence may reflect the success of shelter-in-place mandates at the time this study was performed and of maintaining effective physical distancing practices among suburban populations. Under these public health measures and aggressive case finding, outbreak clusters did not spread into the general population.