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1.
EuropePMC;
Preprint in English | EuropePMC | ID: ppcovidwho-328949

ABSTRACT

Aim. The Covid-19 pandemic may be associated with an increase in mental disorders and mental distress. However, there are no representative studies testing the impact of stressors directly related to Covid-19. We aimed to determine whether Covid-19 related stressors were associated with mental disorders and mental distress in the second year of the pandemic.Method. This cross-sectional observational epidemiological survey was conducted from June to October 2021. We interviewed a representative sample of the adult population in Serbia (18-65 years) in the second year of the pandemic, at a time when large parts of the population had been affected by the pandemic in different ways. Multistage probabilistic household sampling of the adult population in 60 municipalities was used. Mental disorders were assessed by in-person interviews using the Mini International Neuropsychiatric Interview and depression and anxiety symptoms were self-rated on the PHQ-9 and GAD-7. Covid-19 related stressors i.e., infection, self-isolation, infection of a close relative, and lack of protective equipment at work, as well as stressors during the pandemic that were not directly Covid-19 related were measured. Associations of potential predictor variables with mental disorders and mental distress were explored through univariable and multivariable regression analyses.Results. In total, 1023 individuals (mean age 43.7±13.6 years, 48.7% male) were interviewed. Most respondents (67.8%) of the sample had already experienced Covid-19 related stressors (20.1% had Covid-19 infection;43.2% had a close relative member who had Covid-19;28.1% had to work without appropriate protection;27.5% had been in quarantine themselves) and about 50% had already been vaccinated. The prevalence of any mental disorder was 15.2% (95% CI 13.2–17.2): mood disorders 4.6%, anxiety disorders 4.3% and substance use disorders 8.0%. Mean levels of distress were: PHQ-9=3.2±3.8;GAD-7=2.1±3.1. A lack of protective equipment was associated with higher levels of any disorder, anxiety disorders, and anxiety symptoms. No other Covid-19 related stressor predicted mental disorders or mental distress.Conclusions. In this study, lack of personal protective equipment for Covid-19 when it would have been appropriate was associated with higher levels of anxiety and a greater frequency of anxiety disorders. Provision of the appropriate equipment at workplaces is likely to prevent lasting increased levels of anxiety. There is no evidence that the prevalence of mental disorders in the second year was elevated.

2.
BMJ Open ; 11(10): e053268, 2021 10 29.
Article in English | MEDLINE | ID: covidwho-1495473

ABSTRACT

OBJECTIVE: To test the feasibility and acceptability of a short-term reminder and incentives intervention in adolescents with low adherence to asthma medications. METHODS: Mixed-methods feasibility study in a tertiary care clinic. Adolescents recruited to a 24-week programme with three 8-weekly visits, receiving electronic reminders to prompt inhaled corticosteroid (ICS) inhalation through a mobile app coupled with electronic monitoring devices (EMD). From the second visit, monetary incentives based on adherence of ICS inhalation: £1 per dose, maximum £2 /day, up to £112/study, collected as gift cards at the third visit. End of study interviews and questionnaires assessing perceptions of asthma and ICS, analysed using the Perceptions and Practicalities Framework. PARTICIPANTS: Adolescents (11-18 years) with documented low ICS adherence (<80% by EMD), and poor asthma control at the first clinic visit. RESULTS: 10 out of 12 adolescents approached were recruited (7 males, 3 females, 12-16 years). Eight participants provided adherence measures up to the fourth visits and received rewards. Mean study duration was 281 days, with 7/10 participants unable to attend their fourth visit due to COVID-19 lockdown. Only 3/10 participants managed to pair the app/EMD up to the fourth visit, which was associated with improved ICS adherence (from 0.51, SD 0.07 to 0.86, SD 0.05). Adherence did not change in adolescents unable to pair the app/EMD. The intervention was acceptable to participants and parents/guardians. Exit interviews showed that participants welcomed reminders and incentives, though expressed frustration with app/EMD technological difficulties. Participants stated the intervention helped through reminding ICS doses, promoting self-monitoring and increasing motivation to take inhalers. CONCLUSIONS: An intervention using electronic reminders and incentives through an app coupled with an EMD was feasible and acceptable to adolescents with asthma. A pilot randomised controlled trial is warranted to better estimate the effect size on adherence, with improved technical support for the EMD.


Subject(s)
Asthma , COVID-19 , Adolescent , Asthma/drug therapy , Communicable Disease Control , Electronics , Feasibility Studies , Female , Humans , Male , Medication Adherence , Reward , SARS-CoV-2 , Tertiary Healthcare
3.
BMJ Open ; 11(9): e052339, 2021 09 13.
Article in English | MEDLINE | ID: covidwho-1406662

ABSTRACT

INTRODUCTION: Improving the mental health of young people is a global public health priority. In Latin America, young people living in deprived urban areas face various risk factors for mental distress. However, most either do not develop mental distress in the form of depression and anxiety, or recover within a year without treatment from mental health services. This research programme seeks to identify the personal and social resources that help young people to prevent and recover from mental distress. METHODS AND ANALYSIS: A cross-sectional study will compare personal and social resources used by 1020 young people (aged 15-16 and 20-24 years) with symptoms of depression and/or anxiety and 1020 without. A longitudinal cohort study will follow-up young people with mental distress after 6 months and 1 year and compare resource use in those who do and do not recover. An experience sampling method study will intensively assess activities, experiences and mental distress in subgroups over short time periods. Finally, we will develop case studies highlighting existing initiatives that effectively support young people to prevent and recover from mental distress. The analysis will assess differences between young people with and without distress at baseline using t-tests and χ2 tests. Within the groups with mental distress, multivariate logistic regression analyses using a random effects model will assess the relationship between predictor variables and recovery. ETHICS AND DISSEMINATION: Ethics approvals are received from Ethics Committee in Biomedical Research, Faculty of Medicine, University of Buenos Aires; Faculty of Medicine-Research and Ethics Committee of the Pontificia Universidad Javeriana, Bogotá; Institutional Ethics Committee of Research of the Universidad Peruana Cayetano Heredia and Queen Mary Ethics of Research Committee. Dissemination will include arts-based methods and target different audiences such as national stakeholders, researchers from different disciplines and the general public. TRIAL REGISTRATION NUMBER: ISRCTN72241383.


Subject(s)
Longitudinal Studies , Adolescent , Cohort Studies , Cross-Sectional Studies , Humans , Latin America , Prospective Studies
4.
BMJ Open ; 11(8): e051173, 2021 08 09.
Article in English | MEDLINE | ID: covidwho-1350026

ABSTRACT

OBJECTIVES: The arts therapies include music therapy, dance movement therapy, art therapy and dramatherapy. Preferences for art forms may play an important role in engagement with treatment. This survey was an initial exploration of who is interested in group arts therapies, what they would choose and why. DESIGN: An online cross-sectional survey of demographics, interest in and preferences for the arts therapies was designed in collaboration with patients. The survey took 10 min to complete, including informed consent and 14 main questions. Summary statistics, multinomial logistic regression and thematic analysis were used to analyse the data. SETTING: Thirteen National Health Service mental health trusts in the UK asked mental health patients and members of the general population to participate. PARTICIPANTS: A total of 1541 participants completed the survey; 685 mental health patients and 856 members of the general population. All participants were over 18 years old, had capacity to give informed consent and sufficient understanding of English. Mental health patients had to be using secondary mental health services. RESULTS: Approximately 60% of participants would be interested in taking part in group arts therapies. Music therapy was the most frequent choice among mental health patients (41%) and art therapy was the most frequent choice in the general population (43%). Past experience of arts therapies was the most important predictor of preference for that same modality. Expectations of enjoyment, helpfulness, feeling capable, impact on mood and social interaction were most often reported as reasons for preferring one form of arts therapy. CONCLUSIONS: Large proportions of the participants expressed an interest in group arts therapies. This may justify the wide provision of arts therapies and the offer of more than one modality to interested patients. It also highlights key considerations for assessment of preferences in the arts therapies as part of shared decision-making.


Subject(s)
Art Therapy , Music Therapy , Adolescent , Cross-Sectional Studies , Humans , Mental Health , State Medicine
5.
BMJ Glob Health ; 6(3)2021 03.
Article in English | MEDLINE | ID: covidwho-1311147

ABSTRACT

BACKGROUND: Mental health disorders are viewed as a global concern requiring globally led approaches to address them. Since the publication of the 2007 Lancet series on global mental health (GMH), the term has become widespread. Over the last two decades, GMH has become increasingly affiliated with policy reform, academic courses, funding bodies and research. However, it is not always obvious how those working in the field of GMH are using the term, resulting in a lack of clarity. Therefore, work is needed to synthesise the current understanding(s) of GMH to help characterise its meaning. AIM: To synthesise the literature and identify the different ways GMH is understood. METHOD: A conceptual review, using a systematic search and a content analysis, was conducted to develop a conceptual framework of the different conceptual understandings of GMH. RESULTS: We developed a conceptual framework of four understandings of GMH. These understandings of GMH are as follows: an area of research generating findings to establish a GMH evidence-base; implementation of research into practice; improving the mental health environment; learning from and supporting low-and-middle-income countries (LMICs). CONCLUSION: Our review proposes a simple framework, clarifying the key characteristics of the GMH landscape. The findings highlight the diversity of usage of the term in the literature, as well as present the wide scope that comprises the field of GMH. Referring to this framework may help those engaged with GMH to be more specific with which aspect of the field they are concerned with.


Subject(s)
Global Health , Mental Health , Humans , Poverty
7.
BMJ Open ; 11(3): e042335, 2021 03 18.
Article in English | MEDLINE | ID: covidwho-1143042

ABSTRACT

BACKGROUND: The imperative for physical distancing (mostly referred to as social distancing) during COVID-19 pandemic may deteriorate physical and mental health. We aimed at summarising the strength of evidence in the published literature on the association of physical and mental health with social connection via social isolation, living alone and loneliness. METHODS: We conducted a systematic search in April 2020 to identify meta-analyses using the Medline, PsycINFO and Web of Science databases. The search strategy included terms of social isolation, loneliness, living alone and meta-analysis. Eligible meta-analyses needed to report any sort of association between an indicator of social connection and any physical or mental health outcome. The findings were summarised in a narrative synthesis. RESULTS: Twenty-five meta-analyses met our criteria, of which 10 focused on physical health and 15 on mental health outcomes. The results suggest that lack of social connection is associated with chronic physical symptoms, frailty, coronary heart disease, malnutrition, hospital readmission, reduced vaccine uptake, early mortality, depression, social anxiety, psychosis, cognitive impairment in later life and suicidal ideation. CONCLUSIONS: The existing evidence clearly indicates that social connection is associated with a range of poor physical and mental health outcomes. A potential negative impact on these outcomes needs to be considered in future decisions on physical distancing measures.


Subject(s)
COVID-19/psychology , Mental Health , Physical Distancing , COVID-19/prevention & control , Humans , Pandemics
8.
Front Psychol ; 11: 587282, 2020.
Article in English | MEDLINE | ID: covidwho-948050

ABSTRACT

OBJECTIVE: Due to the wide impact of the COVID-19 pandemic on mental health, the need for scalable interventions that can effectively reduce psychological distress has been recognized. Expressive writing (EW) can be beneficial for different conditions, including depression, suicidal ideation, and coping with trauma. Therefore, we aim to assess the applicability and effectiveness of an online format of EW in the reduction of psychological distress in context of the COVID-19 pandemic. METHODS: In this parallel-group, randomized controlled trial, participants (n = 120) were randomly allocated to (1) the intervention group-who completed five EW sessions over the 2 week period-or (2) the control group-who received treatment as usual (TAU). Participants were assessed for primary and secondary outcome measures at baseline, post-treatment, and follow-up-1-month after the treatment. The primary outcome was severity of psychological distress assessed at post-treatment, operationalized as Depression Anxiety Stress Scale (DASS) summary score. Secondary outcomes were severity of depression, anxiety, and stress (DASS subscale scores), well-being (WHO-5), subjective perception of quality of life (SQOL), and subjective evaluation of difficulties coping with pandemic, which were also assessed at post-treatment. Per protocol, analysis was conducted with available cases only. RESULTS: A less favorable outcome was found in the intervention group on psychological distress, and symptoms of stress, after controlling for baseline scores. Increased stress was recorded in the treatment group, with no effect in the control group. There was no significant difference between the groups on depression, anxiety, well-being, and subjective quality of life. No group effect for any of the outcomes measures was recorded at follow-up. Additional analysis revealed moderation effects of age and gender with older and male participants scoring higher on distress measures. CONCLUSION: Engaging in EW during the pandemic was found to elevate stress; thus, when applied in the context of the COVID-19 pandemic, it may be harmful. Hence, EW or similar self-guided interventions should not be applied without prior evidence on their effects in the context of a pandemic and similar stressful and unpredictable circumstances. CLINICAL TRIAL REGISTRATION: This study is approved by the Institutional Ethics Committee (Protocol number #2020-20), and a trial has been registered at ISRCTN registry https://www.isrctn.com/ISRCTN17898730.

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