Distress in the time of COVID-19: Understanding the distinction between COVID-19 specific mental distress and depression among United States adults.

BACKGROUND: During the COVID-19 pandemic, many Americans have experienced mental distress, which may be partially characterized by a rise in mental illnesses. However, COVID-19 specific psychological distress may also be separate from diagnosable conditions, a distinction that has not been well established in the context of the pandemic. METHODS: Data came from an online survey of US adults collected in March 2020. We used factor analysis to assess the relationship between COVID-19 related mental distress and depressive symptoms. Using four questions on psychological distress modified for COVID-19 and eight depressive symptoms, we conducted an exploratory factor analysis (EFA) to identify the factor structure and then estimated a confirmatory factor analysis (CFA). RESULTS: The EFA model indicated a two-factor solution, where the COVID-19 distress items loaded onto the first factor and depression items loaded onto the second. Only two items cross-loaded between factors: feeling fearful and being bothered by things that do not usually bother the participant. The CFA indicated that this factor structure fit the data adequately (RMSEA=0.106, SRMR=0.046, CFI=0.915, TLI=0.890). LIMITATIONS: It is possible that there are additional important symptoms of COVID-19 distress that were not included. Depression symptoms were measured via the CES-D-10, which while validated is not equivalent to a clinician diagnosis. CONCLUSIONS: As COVID-19 related mental distress appears to be distinct from, though related to, depression, public health responses must consider what aspects of depression treatment may apply to this phenomenon. For COVID-related distress, it may be more appropriate to treat symptomatically and with supportive psychotherapy.

Political partisanship and stigma against people who use drugs in opinions about allocating COVID-19 prevention resources to vulnerable populations.

BACKGROUND: The distribution of resources during the COVID-19 pandemic has been politicized and contentious in the United States. Vulnerable populations, such as those living in poverty, experiencing homelessness, or who use drugs, are particularly susceptible to becoming infected with COVID-19 and often have limited access to protective supplies, such as masks and hand sanitizer. Our aim was to understand public opinion on increasing the allocation of COVID-19 prevention resources to vulnerable populations. METHODS: Data were from an online survey of 680 United States adults. Participants' opinions on the allocation of COVID-19 prevention resources to people with low income, experiencing homelessness, or who use drugs were assessed using a five-item Likert scale. We examined the prevalence of these opinions and their relationship to sociodemographic characteristics, COVID-19 beliefs, and drug-related experiences. RESULTS: Most participants supported increasing resources for individuals with low incomes (79.6%) and experiencing homelessness (74.6%), while a minority supported increasing resources for people who use drugs (33.5%). Politically conservative participants were less likely to support increasing resources for all three populations than those who were politically liberal. Skepticism about the severity of COVID-19 was also associated with less support for increasing resources across groups. DISCUSSION: Our results demonstrate that people who use drugs continue to be stigmatized in the context of the COVID-19 pandemic, resulting in popular opinion not supporting people who use drugs with potentially lifesaving resources. Overcoming this stigma is essential to prevent COVID-19 among people who use drugs, a population which experiences elevated risk of COVID-19 infection.