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Objective: Suicide is one of the leading causes of death in the world. The present research aimed to investigate the moderating role of thwarted belongingness, perceived burdensomeness, and suicidal capability in suicidal ideation, behavior, and attempts among the Iranian population. Method(s): The data were analyzed using cross-sectional regression models. The population of this study included 600 students of the University of Mohaghegh Ardabili. The tools used to collect the data in this study were the Patient Health Questionnaire-2, the Depressive Symptom Index-Suicidality Subscale (DSI-SS), the Suicide Attempt Questionnaire, the Interpersonal Needs Questionnaire (IPTS), the Suicide Capacity Scale-3, the Adverse Childhood Experiences, the Generalized Anxiety Disorder Questionnaire, and the Suicidal Behaviors Questionnaire-Revised. Result(s): The results of this study showed that there was an interaction between thwarted belongingness and perceived burdensomeness in suicidal behavior and DSI-SS. The results also showed that the acquired and practical capability subscales (suicidal capability) strengthen the relationship between suicidal behavior and the DSI-SS, on the one hand, and suicide attempt, on the other hand. Conclusion(s): The findings of the study showed that the interpersonal theory of suicide can pave the way to prevent suicidal ideation and behavior in Iranian society, and it is recommended that Iranian practitioners apply the theory in practice.Copyright © 2022 Yerkure Tanitim ve Yayincilik Hizmetleri A.S.. All rights reserved.
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Background: Rapid transmission of novel coronavirus (COVID-19) causing severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) occurred all across the world in few months causing a pandemic. Frontline medical staff as a result of heavy workload, insufficient protective equipment, a lack of information of the pathogen, and direct contact with patients faced the fear of getting infected themselves and their family. Anxiety, stress, and other negative emotions have led to a series of psychological crises in them. Aim(s): To compare the coping strategies, emotional reactions, burnout and resilience in doctors caring and not caring for COVID19 patients. Materials And Methods: Total 304 Doctors in tertiary care hospitals out of which 163 were caring and 141 were not caring for COVID19 patients participated in our study. Both groups were assessing and compared using The Fear of COVID-19 Scale, the coronavirus anxiety scale (CAS), Patient Health Questionnaire-2 (PHQ-2), Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), Brief COPE, Connor-Davidson Resilience Scale abbreviated, Abbreviated Maslach Burnout Inventory, Two-Item Conjoint Screen (TICS) Results: All participants those who did COVID duty and those who did not do it showed high level of resilience though on comparison no significant different was found between two groups. Those who did not do COVID duty were scored higher in emotion focused coping strategies whereas who did not do COVID duty scored higher in avoidant coping strategies. Abbreviated version of Maslach Burnout Inventory indicated a great personal accomplishment, less depersonalization and low emotional exhaustion in all the participants irrespective of their duty status. Conclusion(s): On comparing those who did COVID duties against those who haven't, it was found that those who did not do COVID duty used more emotion-focused ways to cope and those who were doing COVID duties were using harmful avoidant coping to manage their daily chores. All the doctors participating in study showed high resilience irrespective of whether they did COVID duty or not.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Background: Globally, the coronavirus disease-19 (COVID-19) pandemic has had a devastating psychological impact on people, especially the healthcare workers/students, in many different community settings. Limited research has been reported on the mental health issue of healthcare students in Vietnam. Objective(s): This study investigated and quantified depression, anxiety, and psychological distress levels among healthcare students, with an emphasis on comparing those studying pharmacy to students in other healthcare-related disciplines, in Vietnam during the COVID-19 pandemic. Method(s): A cross-sectional study recruited 2246 respondents between September 7 and October 7, 2021, in which 230 were pharmacy students with a mean age of 20.0 +/- 1.6 years and most of them had a low COVID-19 fear level. The standardized Patient Health Questionnaire-4 (PHQ-4) scale, consisting of two subscales of PHQ-2 and Generalized Anxiety Disorder-2 (GAD-2), was utilized for the screening of depression and anxiety levels. Result(s): Pharmacy students scored significantly higher on the PHQ-4 psychological distress measure than non-pharmacy students (mean 2.23 vs. 1.90, p = 0.039). Compared to non-pharmacy students, pharmacy students had higher rates of anxiety (10.4% vs. 6.5%, p = 0.028). Conclusion(s): The prevalence of anxiety was higher among pharmacy students in comparison to non-pharmacy students. These findings present a need to recognize and conduct early intervention measures for mental health problems in healthcare students, especially pharmacy students, during recovery from the COVID-19 pandemic.Copyright © 2022 Pharmacotherapy Publications, Inc.
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Background: The COVID-19 pandemic has had far-reaching implications in terms of physical and mental health ramifications, and minority communities have been disproportionately impacted;particularly, prevalence of depression increased. Throughout the pandemic, ESKD patients have continued thrice-weekly in-center hemodialysis sessions or home therapies. We explored whether there was an increase in depression prevalence after the start of the pandemic in our urban predominantly Black ESKD population. Method(s): We used data from social worker-administered PHQ-2 questionnaire depression screenings (required by Centers for Medicare & Medicaid Services) in eligible patients treated at four Emory University affiliated in-center dialysis units and three home dialysis units from 2018-2019 (pre-pandemic) to 2020-2021 (pandemic). Excluded from this study were patients with no assessments or incomplete assessments. Data were analyzed using chi-square tests comparing the prevalence of depression in pre-pandemic versus pandemic period. Result(s): In 2021, 91.5% of our patients were Black. There were 2433 in-center patient depression scores and 586 home dialysis patient depression scores. Excluded from the study were 1045 patients in the in-center and 214 patients in the home population. Of the 2433 patient scores analyzed in the in-center group, 1289 were pre-pandemic and 1144 were in the pandemic period. 155 (12%) in-center patient scores in the prepandemic period were classified as depressed while 128 (11.2%) in-center patient scores during the pandemic were classified as depressed (two-sided p-value 0.5272). Of the 586 home dialysis patient scores, 325 were pre-pandemic and 261 in the pandemic period. 71 (21.8%) patient scores in the pre-pandemic period had a positive depression screening while 29 (11.1%) patient scores during the pandemic period had depression (two-sided p-value 0.0006). Conclusion(s): We did not observe an increase in depression prevalence during the COVID-19 pandemic in in-center dialysis patients, and surprisingly observed a statistically significant decrease in depression among our home dialysis patients. The decrease in depression in our home dialysis patients during the pandemic may reflect being at home is a protective mechanism, and this observation should be further investigated.
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Background: Our frontline nurses and physicians seemed to have increased anxiety at the beginning of the COVID-19 pandemic and increased depression as the year progressed. Perceptions of anxiety and depression coincided with concern for one's own health, limited knowledge of how to care for patients during a pandemic, limited personal protective equipment (PPE), and/or financial constraints. To date, there are no studies looking at pediatric frontline healthcare providers and their rates of anxiety and depression over the course of a pandemic. Furthermore, nurses and physicians have distinct roles in the emergency setting that affect their perceptions of anxiety and depression. Currently, there are limited studies comparing nurse and physician anxiety and depression rates during a pandemic. The purpose of this study was to determine if there was a difference in perceptions of anxiety and depression among our Pediatric Emergency and Urgent Care frontline providers during the COVID-19 pandemic. Methods: This was a prospective cross-sectional study at a large quaternary level 1 trauma center including 3 emergency departments and 7 urgent care sites. We used the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-2 (PHQ-2), both standardized validated screening tools for identifying anxiety and depressive disorders, respectively. The GAD-7 scores range from 0-21 points, with 0-4 considered minimal anxiety, 5-9 mild anxiety, 10-14 moderate anxiety, and 15-21 severe anxiety. PHQ-2 scores range from 0-6 points with 3-6 considered likely major depressive disorder. We surveyed healthcare providers including physicians and nurses twice with the GAD-7, once at the beginning of the pandemic in Spring 2020 and again after vaccine implementation in Spring 2021. We surveyed healthcare providers once after vaccine implementation with the PHQ-2. Results: 396 surveys were distributed in Spring 2020 and 466 surveys were distributed in Spring 2021, with one-third physician and two-thirds nurse response each time. Table 1 shows the average GAD-7 and PHQ2 scores for healthcare providers by role. The average GAD-7 score decreased for both nurses and physicians from the beginning of the pandemic to after vaccine implementation. Nurses on average had higher anxiety scores with mild score range compared to minimal score range for physicians. Nurses on average had higher depression scores compared to physicians but both roles had scores in the low likelihood range. Conclusion: Many healthcare providers perceived higher anxiety and depression levels during the pandemic. The anxiety levels appeared to decrease after vaccine implementation although hospital-wide pandemic relief efforts may have played a role in improved perceptions. Even though nurses had higher anxiety scores, the difference in the score is unlikely to be clinically significant. Our data supports rigorous mental health infrastructure during pandemic preparedness to support the sudden feelings of anxiety and depression in frontline healthcare providers.
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BACKGROUND: Student health centers provide necessary care to university students, yet there is limited literature on efforts to standardize or improve quality of this care. When our urban student health center rapidly shifted to telemedicine-based care at the onset of COVID-19, we designed and deployed two unannounced standardized patient (USP) cases as part of a quality improvement project to assess, broadly, the impact of a new telemedicine workflow and common clinical activities. METHODS: In April and May of 2021, 12 primary care and 4 women's health clinicians conducted virtual visits with two distinct USP cases (N=32 visits, 2 per clinician). Cases included (1) a 21-year-old female requesting a birth control prescription with a positive PHQ-9 and (2) a 21-year-old gaymale who has questions regarding safe sex and vapes regularly. Clinicians were evaluated using two assessments: (1) a behaviorally anchored checklist completed by the USP covering the microsystem and the clinician's skills and (2) a systematic chart review of the electronic health record. RESULTS: Overall, 88% of USPs reported that they would recommend the clinic. Regarding the clinic workflow, 12 of 32 USPs reported receiving a previsit call (clinical protocol), 10 answered the calls and of those, 20% verified two patient identifiers. Between cases, there were significant differences in three domains (mean % well done). Information gathering was significantly higher for the depression case (84% vs. 48%;p=0.004), patient activation was higher for the sexual health case (53% vs 23%;p=0.027), and telemedicine skills were higher in the depression case (77% vs. 57%;p=0.015). Clinician performance was relatively low in case-specific education (depression: 28%, sexual health: 20%) and moderate in management/treatment plan (mean across cases: 66%), relationship development (64%), and education and counseling (65%). In a number of “gold standards of care” items identified by clinical leadership, less than half of clinicians met the target. In the depression case, 56% documented both PHQ-2 and PHQ-9 screenings, 0% screened for alcohol use and quantity, and 66% screened for relationship violence. In the sexual health case, 56% screened for vaping quantity and frequency. 63% counseled on PrEP. No providers completed any part of a physical exam besides commenting on appearance. CONCLUSIONS: Through USP visits and chart reviews, we identified variation in quality of communication skills and use of common screening protocols at this student health center during virtual visits. Health system standards previously integrated into in-person visits may have been lost in the transition to telemedicine care. Our results suggest opportunities exist for targeted improvement efforts that ensure quality virtual care for all students.
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BACKGROUND: COVID-19 Pandemic worsened food insecurity and mental health. However, little is known about risk factors for mental health (MH) symptoms and access during the pandemic. We aimed to examine the associations between food scarcity and mental health/access to mental health care and their population health factors. METHODS: We retrospectively analyzed a national cross-sectional survey, the week-39 data of Household Pulse Survey (HPS), collected between 09/29 and 10/11/2021 by US Census Bureau. Food scarcity is defined as those reporting “sometimes” or “often” not enough to eat in the last 7 days. Dependent (binary) variables included depression and anxiety defined as 3 points or above on PHQ-2 and GAD-2, respectively and lack of access to MH care defined as not being seen by MH providers in the last 4 weeks despite needing care. Multiple logistic regression models were adjusted for demographic and socio-economic factors and time-invariant unobserved factors between states were accounted for by including state fixed effects. RESULTS: We found an estimated total of 250,265,449 US adults. Male comprised 48.4%. Age between 25-39 and 40-54 was the most common (26.3% and 25.4%) followed by 65 and above (22.3%). White race was dominant (62.3%), followed by Hispanic (17.3%), Black (11.3%), or Other (9.1%). Descriptive analysis found that 30.6% of respondents who screened positive for depression had the lack of MH care access. On the multiple logistic regression model, the odds of depression, anxiety, and lack of mental health access were 2.84, 3.08, and 1.74, respectively (all p values < 0.001). We also found that female, young age between 18-24, lower income, unemployment in the last 4 weeks, and reduced mobility were significantly associated with depression, anxiety, and lack of MH access (Table). CONCLUSIONS: The prevalence of MH symptoms and lack of MH care access among US adults remained high in 2021. The most vulnerable population may be young low-income adults who also suffer from food insecurity, unemployment, or limited functional capacity.
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BACKGROUND: Only 30% of coronary heart disease (CHD) patients are screened and treated for depression, far below general population rates. Utilizing a theoretical framework based on the Behavior Change Wheel integrated with patient-centered design processes, we conducted a second round of postcoronavirus disease 2019 (COVID-19) beta-phase testing of a web-based, electronic shared decision-making (eSDM) tool for depression screening and follow-up in patients with CHD. METHODS: We recruited English-speaking patients who had internal medicine or cardiology clinic appointments from October 2020-January 2021. All participants were aged ≥21 years with CHD and a diagnosis of and/or positive screen for depression by the patient health questionnaire (PHQ)-2 and/or -8. Think aloud usability sessions with participants verbalizing their thoughts on the eSDM tool were conducted remotely. Sessions lasted approximately one hour. Pre-and post-session questionnaires assessed comfort, ease-of-use of the tool, and perceived barriers to success, and included the Decisional Conflict Scale (DCS) and System Usability Scale (SUS). Think aloud and survey feedback were analyzed for recurring themes. RESULTS: Four patients participated before we reached saturation (25% aged > 65;75% male;75% White). The average SUS score was 77.00 (C, or “Good” on the scale). Three of four participants found the tool easy to use and straightforward, and none expressed confusion/difficulty utilizing the tool. Only 25% felt the tool alone was sufficient to make informed treatment decisions (pre-post decisional conflict increased from 21.3 to 27.5). Postsession, we observed lower perceived barriers to treatment related to access/ coordination (75% vs. 50%), stigma/motivation/efficacy (100% vs. 75%) but not in cost of treatment (50% vs. 50%) or time/travel (50% vs 50%). Three of four participants found the tool's video depicting a patient's depression treatment journey after experiencing a heart attack helpful but two found it retraumatizing. Finally, all participants indicated they would spend time reading about cardiac wellness topics at the end of the tool. CONCLUSIONS: Using an innovative theory-based approach to usability testing, we found high acceptability and usability of our eSDM tool but highlighted several features that will need to be optimized to improve postCOVID-19 adoption rates (e.g., traumatization considerations and increased decisional support). Our study adds further evidence to concerns that selfadministered eSDM tools may be insufficient without provider and clinician level intervention components. Enhancing a tool's features may improve its usefulness to patients, ultimately improving patient and provider adoption.
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Background Time constraints during ambulatory visits in subspecialty clinics can lead to abbreviated histories and dissatisfaction among fellow trainees. Outpatient gastroenterology (GI) clinic visits can cover a wide range of digestive complaints, thus pre-visit questionnaires (PVQs) are sometimes used to gather information before the start of the visit. The aim of this quality improvement (QI) study was to determine if initiation of a PVQ in our fellows' clinic can increase trainee satisfaction and improve data capture for fellows. Methods The GI fellows at our urban, tertiary care, academic medical center were surveyed to assess their satisfaction with information available pre-visit as well as their habits in obtaining dietary assessment and counseling, query of drug and alcohol use, and screening for mood disorders. The feedback was used to develop a PVQ for patients to complete while waiting to start the visit. The PVQ (Figure 1) was deployed in GI Fellows' clinic between September and November 2021;fellows were resurveyed after 8 weeks. Patient PVQs with one section completed and fellow pre- and post-surveys were included in the analysis using a Fisher exact test and χ2 to determine QI success. Results All 12 fellows completed the preassessment, and 11 completed the post-assessment (one fellow was on leave) as summarized in Table 1. The number of fellows who were unsatisfied with available information before clinic decreased from 7 (58%) to 2 (18%) after the PVQ (p=0.09). Initially, all 12 fellows (100%) never or rarely screened for food insecurity and none knew where to direct food insecure patients, compared to 5 (45%) and 9 (82%) respectively after the intervention (p= 0.005 and p=<0.001). Utilizing food recall increased (58% to 81%). Assessment of mood disorders increased (42% to 91%;p=0.03), and assessment of tobacco, marijuana and alcohol also increased (50%, 42%, and 58% respectively to 91%, 73%, and 100%). A total of 239 patients were seen in fellows' clinic and 144 (60%) PVQs were reviewed. The average patient age was 52 years old and 41% identified as male. 89% filled out the English PVQ. Using the Hunger vital sign for food insecurity, 17 persons (12%) screened positive and could be referred for social services. 76% completed part of the 24-hour food recall section. Alcohol, tobacco, and marijuana use were noted among 32%, 30% and 17% of respondents, respectively. 78% of respondents were vaccinated for COVID-19. PHQ2 and GAD2 scores were on average 1.3 and 1.5, respectively. Conclusions A fellow created PVQ can increase fellow satisfaction as well as create actionable opportunities to improve patient care, specifically around food insecurity. As a fellow driven entity, the PVQ can be refined with fellow feedback. We plan to continue using the PVQ in fellows' clinic and offer it for faculty clinic as well. (Figure Presented)Figure 1: Two-sided pre-visit questionnaire with sides in English and in Spanish (Table Presented)
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Introduction: Sleep difficulties and fatigue are highly prevalent, pervasive symptoms reported in patients with Post-Acute Sequelae of COVID-19 (PASC). As little is known of the predictors and severity of PASC-related sleep disturbance and intersection with fatigue, we leverage systematic data collected from the Cleveland Clinic ReCOVer Clinic for further elucidation Methods: Analysis of data collected from Cleveland Clinic ReCOVer Clinic patients (February-November 2021) who completed the Patient-Reported Outcomes Measurement (PROMIS) Sleep Disturbance and PROMIS Fatigue questionnaires was performed. Data were extracted from the Cleveland Clinic COVID-19 registry and the electronic health record.PROMIS scores are standardized to the general U.S. adult population on a T-scale with mean 50±10. PROMIS sleep disturbance and fatigue T-scores ≥60 indicates at least moderate disturbance and ≥70 indicate severe disturbance. T-test and Chi-square tests were used to examine cross-group differences. Multivariable logistic regression adjusted for age, race, sex, and body mass index(kg/m2) was performed to investigate factors associated with sleep disturbance severity. Results: Out of 1321, 682 patients completed the PROMIS Sleep Disturbance questionnaire with age 49.8±13.6, 75.2% female and 12.3% black race. Average T-scores were 57.7±8.3, 281 (41.2%) patients reported at least moderate sleep disturbance and 50 (7.3%) reported severe sleep disturbances. Average PROMIS Fatigue T-score was 63.0±9.2;68.6% patients reported at least moderate fatigue, 22.6% reported severe fatigue. Patients with moderate-severe compared to normal-to-mild sleep disturbances respectively had higher BMI (32.3±8.7 vs 30.9±7.5, p=0.049), were more likely of black race (40.0±10.0 vs 41.0±15.7,p=0.010), had worse eneral Anxiety Disorder (GAD)-2 questionnaires scores (2.8±2.1 vs 1.6±1.7,p<0.001), Patient Health Questionnaire (PHQ)-2 scores (2.8±2.0 vs 1.6±1.7,p<0.001) and PROMIS fatigue scores (66.7±7.8 vs 60.4±9.1,p<0.001) with no difference in age, sex, or hospitalization due to COVID-19. In the adjusted model, black race was associated with moderate-severe sleep disturbance (OR=3.42, 95%CI:1.64-7.13). Conclusion: The prevalence of moderate to severe sleep disturbances reported by patients presenting for PASC was very high i.e.>40% and associated with obesity, black race and mood symptoms. Notably, after adjustment for demographics, black race conferred a 3-fold higher odds of moderate-severe sleep disturbance emphasizing the need to characterize race-specific determinants and disparities in COVID-19 survivors.
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Background: Owing to the spread of coronavirus disease 2019 (COVID-19), people have refrained from going out unnecessarily and have been maintaining social distance. These new lifestyle approaches have affected people physically, psychologically, and socially. Patients with heart failure (HF) are more likely to have social frailty, physical frailty, cognitive impairment, and depressive symptoms, and an overlap of these conditions leads to adverse events. Therefore, multi-domain assessment and understanding of the condition of patients with HF are important for disease management. The spread of COVID-19 is a predicted risk factor for these events, but its impact in patients with HF has not been investigated. Purpose: We investigated whether the spread of COVID-19 is associated with the development of the multi-domain of frailty in patients with HF. Methods: Patients who were independent in their daily activities before admission were included in the study. The presence of social frailty (Makizako's five items), physical frailty (Fried phenotype model), cognitive impairment (Mini-Cog), and depressive symptoms (the Patient Health Questionnaire-2) in patients with HF were assessed at hospital discharge. Logistic regression analyses were used to examine the impact of the spread of COVID-19 on the development of the multi-domain of frailty in patients with HF. Results: We included 482 patients in this study. Median patient age was 74 years, and 64.5% were male. In multivariate logistic regression analyses, the spread of COVID-19 was significantly associated with the development of social frailty (odds ratio [OR]: 1.15, 95% confidence interval [CI]: 1.02-1.30) and depressive symptoms (OR: 1.14, 95% CI: 1.02-1.27) but not with the development of physical frailty (OR: 1.24, 95% CI: 0.51-3.02) and cognitive impairment (OR: 1.72, 95% CI: 0.80-3.73). Conclusion: The spread of COVID-19 was associated with the development of social frailty and depressive symptoms in patients with HF. Evaluation of social frailty and depressive symptoms during hospitalization would support disease management and understand their social and psychological conditions specific to the spread of COVID-19. (Table Presented).
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Background: The current scarcity of research surrounding sexual minorities has yielded an incomplete picture of their health needs, especially during the COVID-19 pandemic. The Household Pulse Survey (HPS) was launched in April of 2020 to efficiently understand the impact of the coronavirus pandemic on households and was recently expanded to include questions related to sexual orientation and gender identity (SOGI). Aim: In this study, we examined the mental health of sexual minorities (gay/lesbian and bisexual) in the United States compared with heterosexual peers during the COVID-19 pandemic. Methods: This study used data from 357,939 heterosexual adults, 13,293 gay/lesbian adults, and 12,856 bisexual adults aged 18 years and older surveyed in waves 34-39 from the HPS. We compared anxiety and depression (calculated using the PHQ-2 and GAD-2), as well as access to and utilization of mental health treatment between sexual minority and heterosexual adults using multivariable logistic regression models controlling for sociodemographic characteristics. Results: After adjusting for sociodemographic characteristics, gay men had higher odds of experiencing both anxiety (OR=1.798, p<0.001) and depression (OR=1.603, p<0.001) than heterosexual men. Bisexual men experienced similar disparities of a greater magnitude for anxiety (OR=2.453, p<0.001) and depression (OR=2.309, p<0.001). Lesbian women also had higher odds of experiencing anxiety (OR=1.762, p<0.001) and depression (OR=1.740, p<0.001) than heterosexual women. Bisexual women experienced similar disparities of a greater magnitude for both anxiety (OR=2.084, p<0.001) and depression (OR=2.386, p<0.001). These disparities are not restricted to the prevalence of anxiety and depression but are instead also reflected in health access measures. Unmet mental health care needs displayed similar disparities: gay (OR=2.482, p<0.001) and bisexual (OR=2.644, p<0.001) men had higher odds of reporting this outcome than heterosexual men. Similarly, lesbian (OR=2.009, p<0.001) and bisexual (OR=2.092, p<0.001) women had higher odds of reporting unmet mental health care needs than heterosexual women. Discussion and Limitations: Although we used weighting to generate nationally representative estimate, important limitations include possible selection bias (owing to low survey response rate). Causal associations cannot be assumed given the repeated cross-section design and because sexual minority respondents may be different from heterosexual respondents in ways not accounted for. Implications for Health Care Provision and Use: Practitioners and public health leaders should be mindful of sexual minority vulnerabilities when developing targeted treatment plans, public health campaigns, and interventions to combat the mental health effects of the COVID-19 pandemic. Implications for Health Policies: These results establish that sexual minorities are extremely vulnerable in the area of mental health during the COVID-19 pandemic and that they are experiencing disproportionate gaps in access to care. Policymakers must consider the access gaps faced by this population when designing policies to combat the mental health effects of the COVID-19. Implications for Further Research: The health of gender minorities during the COVID-19 pandemic is a crucial and understudied topic. Additionally, further research can explore what this novel data source can tell us about other factors that may be contributing to sexual minority mental health disparities during the COVID-19 pandemic, including employment differences, housing disparities, and food insecurity.
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Background: Limited research has examined mental health outcomes related to regional differences in COVID response type and Medicaid expansion status in the United States. This is a salient concern as states in the southern U.S. consistently report the highest rates of COVID-19 transmission. State-level political ideologies are associated with compliance with federal distancing orders and mask mandates. Furthermore, eight out of the twelve states that still have not expanded Medicaid coverage under the Affordable Care Act are in the south. Aims of the Study: The objectives of this study are to describe variation in mental health outcomes during the COVID-19 pandemic by Medicaid expansion status. This study also examines how employment status and health insurance coverage affect the degree of distress, depression, and anxiety. Methods: This repeated cross-sectional study analyzes data from the U.S. Census Bureau's COVID-19 Household Pulse Survey, a nationally representative survey of non-institutionalized adults aged 18 years and older. Our primary exposure variable is Medicaid expansion status. Our mental health outcomes of interest are: (i) frequent mental distress (i.e., ≥14 days of ''not good'' mental health in the past 30 days), (ii) generalized anxiety disorder using the GAD-2 criteria, and (iii) major depression based on the PHQ-2 screening instrument. Statistical analyses include testing demographic differences using chi-squared tests and multivariable logistic regression models to identify risk factors for frequent mental distress, anxiety, and depression by Medicaid expansion status. Results: Our sample included 61,243 adults aged 18 years and older. Adults living in Medicaid expansion states were more likely to be uninsured and from racial/ethnic minority populations. The average prevalence of depression (22.1% vs 21.3%) and anxiety (27.07% vs. 23.25%) across southern states without Medicaid expansion were higher than the national average. Preliminary analyses suggest that states without Medicaid expansion and Republican party affiliation report greater odds for adverse mental health outcomes. Discussion and Limitations: These results suggest that adults living in Medicaid non-expansion states have higher levels of frequent mental health distress, depression, and anxiety during the COVID- 19 pandemic than those in states with Medicaid expansion. Analyses by Medicaid expansion and robustness checks by governor political affiliation and popular vote in the last presidential election yield related outcomes. One limitation of this study is the inability to identify changes in health insurance status, which would strengthen inferences about actual uptake of Medicaid coverage and access to mental health services. Implications for Health Care Provision and Use: Results indicate high levels of need for mental health services, especially among Medicaid non-expansion states. Digital resources such as mental health mobile applications and telehealth may help with triage clinical resources. Implications for Health Policies: Medicaid expansion under supplemental funds from the American Rescue Plan during the COVID- 19 pandemic have not led to new Medicaid expansions. Additional financing and payment mechanisms should be explored to extend coverage to uninsured individuals. Implications for Further Research: Analyses with Medicaid administrative data may identify trends in access to and utilization of mental health services during the COVID- 19 pandemic.
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INTRODUCTION: Patients affected with severe forms of coronavirus disease 2019 (COVID-19) suffer from a wide range of sequelae, from limited airway diseases to multiple organ failure. These sequelae may create exercise limitation, impair the daily activity and thus impact the mental health and the social life. However, the extent of functional limitations and depressive symptoms are understudied especially in patients with COVID-19 after intensive care unit (ICU) hospitalization. METHODS: The Intermediate versus Standard-dose Prophylactic anticoagulation In cRitically-ill pATIents with COVID-19: An opeN label randomized controlled trial (INSPIRATION) was a clinical trial that randomized ICU patients with COVID-19 to intermediate-dose vs standard-dose anticoagulation. In the current study, we assessed the interval change in 30-day and 90-day functional limitations based on the post-COVID-19 functional status scale (PCFS) and depressive symptoms based on the Patient Health Questionnaire-2 (PHQ-2) in the trial participants. We also assessed the effect of intermediate-dose vs standard-dose prophylactic anticoagulation on the functional outcomes and depressive symptoms. RESULTS: Of 600 randomized patients in INSPIRATION, 375 (age: 62 years; 42% women) participated in the functional status study. 195 patients died during the 90-day follow up (191 by day 30). Among survivors, between day 30 and day 90, the proportion of patients with moderate-to-severe functional limitation (PCSF grade 3-or-4) decreased from 20.0% to 4.8% (P <0.001) and PHQ-2 ≥ 3 decreased from 25.5% to 16.6% (P = 0.05). The proportion of patients with no functional limitations (PCFS grade 0) increased (4.2% to 15.4%, P<0.001). Intermediate-dose compared with standard-dose prophylactic anticoagulation did not impact the 90-day proportion of patients with PCFS grade 3-or-4 (5.3% vs 4.2%; odds ratio (OR), 1.20, [95% CI, 0.46-3.11]; P = 0.80) or PHQ-2 ≥ 3 (17.9% vs 15.3%; OR, 1.14, [95% CI, 0.79-1.65]; P = 0.14), with similar results when accounting for study center. CONCLUSION: In patients with COVID-19 admitted to the ICU, functional limitations and depressive symptoms were common at 30-day follow-up and had some improvement by 90-day follow-up among survivors. Intermediate-dose compared to standard-dose prophylactic anticoagulation did not improve functional outcomes.
Subject(s)
COVID-19 , Anticoagulants , Critical Care , Female , Hospitalization , Humans , Male , Middle Aged , SARS-CoV-2ABSTRACT
Background. Long term sequelae across multiple medical domains, including the respiratory, psychiatric, and neurocognitive have been reported after COVID-19. Studies evaluating the impact of this symptom burden, however, are lacking. We aimed to describe the self-reported occurrence of symptoms and their effect on patient functioning six months after their acute hospitalization for COVID-19. Methods. From a historical cohort study of patients hospitalized for COVID-19 between March 8, and June 14, 2020, we identified patients discharged home. The purpose of the study was explained, and they were asked to consent to a telephone questionnaire. We used a modified version of a previously validated general symptom questionnaire (GSQ-30) to assess multi-system symptom burden. The Patient Health Questionnaire-2 (PHQ-2) was used to screen for major depression. Results. Of the original 565 patients, 258 patients were discharged home (45%). Of these, 57 (22%) patients were able to be contacted and agreed to participate in the survey. The mean (SD) age of the respondents was 55.1 (14.8) years, and 37 (64.9%) were female. The most common symptoms at follow-up were fatigue (60.0%), dyspnea (57.1%), feeling irritable, sad or decreased pleasure (56.4%), and memory difficulty (56.4%). Females had a significantly higher GSQ score (0.02) than males. Patients ages < 60 years tended to experience similar, if not greater, impaired functioning (p=0.07) compared with those ages ≥ 60 years (Table 1). Females were more likely to be irritable or sad (p=0.007), not feel rested on awakening (p=0.04), have shooting, stabbing and burning pain (p=0.02), have discomfort with normal light and sound (p=0.04), and have memory difficulty (p=0.04) than males (Table 2). Conclusion. Our study describes the clinical burden of post-acute sequelae of COVID-19 (PASC) in four core domains: fatigue, neurologic, neuro-psychiatric and viral-like symptoms. Over 45% of patients ages < 60 years suffered impaired functioning, compared with 21.1% of patient's ages 60 years and above. Females had significantly higher GSQ scores than men which strongly corelates with the functional impairment among the females. Larger studies are needed to further validate our findings.