Reflections, resilience and recovery: a qualitative study of Covid-19's impact on an international adult population's mental health and priorities for support.

The impact of the coronavirus 2019 (Covid-19) pandemic on different countries and populations is well documented in quantitative studies, with some studies showing stable mental health symptoms and others showing fluctuating symptoms. However, the reasons behind why some symptoms are stable and others change are under-explored, which in turn makes identifying the types of support needed by participants themselves challenging. To address these gaps, this study thematically analysed 925 qualitative responses from five open-ended responses collected in the UCL-Penn Global COVID Study between 17 April and 31 July 2021 (Wave 3). Three key themes that comprised 13 codes were reported by participants across countries and ages regarding the impact of Covid-19 on their health, both mental and physical, and livelihoods. These include: (1) Outlook on self/life, (2) Self-improvement, and (3) Loved ones (friends and family). In terms of support, while 2.91% did not require additional support, 91% wanted support beyond financial support. Other unexpected new themes were also discussed regarding vulnerable populations suffering disproportionately. The pandemic has brought into sharp focus various changes in people's mental health, physical health and relationships. Greater policy considerations should be given to supporting citizens' continued access to mental health when considering pandemic recovery.

Financial and Work Burden, Psychosocial Functioning, and Family Interactions During the COVID-19 Pandemic in Indonesia: Effects on Child Outcomes.

The COVID-19 pandemic has profoundly affected all aspects of family life worldwide. This study aimed to examine the effects of several family factors on child outcomes during the pandemic in Indonesia, a country with approximately 260 million people. A range of child maladjustment and child competency variables were examined, along with a set of associated variables, including family income, psychosocial functioning, and family interactions, which were modelled via Structural Equation Modelling to understand the interrelationships between variables associated with child adjustment. Using an online survey, a total of 354 parents with at least one typically developing child between the age of 2 and 10 years participated in this study. Results showed that psychosocial functioning and family interactions appeared as successive mediators between family income, financial and work burden, and child adjustment. This study highlights some key concerns to support children's and families' wellbeing during the pandemic in Indonesia.

COVID-19-Related Employment Disruptions and Increased Financial Burden Among Survivors of Adolescent and Young Adult Cancer.

Background: Financial burden is a major concern for survivors of adolescent and young adult (AYA) cancers. We identified if employment disruptions during the COVID-19 pandemic affected AYA survivors' financial burden. Methods: AYAs who were enrolled in a cancer patient navigation program were e-mailed a survey in fall 2020. Survey items included sociodemographics, employment disruption, and two measures of financial burden: COmprehensive Score for Financial Toxicity (COST) and material and behavioral financial hardship items (for any reason, COVID-19 induced, cancer induced). Financial burden outcomes were dichotomized at the median (COST = 21; financial hardship = 3). The association of employment disruptions and sociodemographics with financial burden was assessed using multivariable logistic regression models. Results: Reduced hours/job loss was reported by 24.0% of 341 participants. Survivors with a high school education or less (odds ratio [OR]: 2.70; 95% confidence interval [CI]: 1.21-6.03) or who had decreased hours or job loss (OR: 3.97; 95% CI: 2.01-7.84) had greater odds for high financial toxicity. Reduced hours/job loss was the only factor associated with high material and behavioral financial hardship for both any reason (OR: 2.75; 95% CI: 1.41-5.33) and owing to COVID-19 (OR: 4.98; 95% CI: 2.28-10.92). Cancer treatment since March 2020 was associated with cancer-induced high material and behavioral financial hardship (OR: 3.31; 95% CI: 1.96-5.58). Conclusion: Employment disruptions owing to the COVID-19 pandemic, lower education levels, and cancer treatment were associated with high financial burden among AYA cancer survivors. Our findings suggest the need for multilevel interventions to identify and address financial burden among vulnerable cancer survivors.

"Are your employees mentally prepared for the pandemic?” Wellbeing-oriented human resource management practices in a developing country

Employees are the most valuable asset of any service business because of its human-centric nature. However, in the crisis situations, the human side in crisis management strategy, particularly in the areas of human resource management is largely overlooked. The present study explores how human resource management (HRM) practices in the pre-crisis stage could build a good foundation of psychological capital (PsyCap) for tourism and hospitality staff to be mentally resilient during the COVID-19 pandemic. Grounded on the conservation of resource (COR) theory, research hypotheses are developed and then empirically tested using a sample of 760 employees in various tourism and hospitality companies. Research outcomes demonstrate that wellbeing-oriented HRM policies (specifically employee development and employee empowerment policies) in the pre-crisis stage increases employee PsyCap during the pandemic, leading to the preservation of their wellbeing. More importantly, employees' family financial burden is found as a moderating factor, altering the influences of HRM policies on employee PsyCap and their in-crisis wellbeing. Therefore, wellbeing-oriented HRM could be part of crisis preparedness strategy for tourism and hospitality businesses as well as crucial element of the internal corporate social responsibility portfolio in tourism and hospitality businesses. In developing countries, where less financial support and fewer job security policies are available during crises than in the developed world, the application of wellbeing-oriented HRM becomes even more critical. © 2023

Poverty Reduction Effects of Medical Insurance on Middle-Aged and Elderly Families under the Goal of Common Prosperity in China.

Eliminating poverty due to illness is an important way for China to pursue common prosperity. The high medical expenditure caused by the aging population has brought severe challenges to governments and families of all countries, especially in China, where the entire population has just been lifted out of poverty in 2020 and then hit by COVID-19. How to prevent the possible return of poor boundary families to poverty in China has become a difficult research topic. Based on the latest data from the China Health and Retirement Longitudinal Survey, this paper discusses the poverty reduction effect of medical insurance on middle-aged and elderly families from the absolute index and relative index. Medical insurance had a poverty reduction effect on middle-aged and elderly families, especially the poor boundary families. For example, people who participated in medical insurance reduced their financial burden by 2.36% for middle-aged and older families compared to people who did not participate in medical insurance. Furthermore, the poverty reduction effect had heterogeneity in gender and age. This research brings some policy implications. For example, the government should give more protection to vulnerable groups such as the elderly and low-income families and improve the fairness and effectiveness of the medical insurance system.

‘THIS UNPAID PLACEMENT MAKES YOU POOR': Australian social work students' experiences of the financial burden of field education

While there is growing evidence about the financial burden of completing long, compulsory (mostly unpaid) placements for social work students, this Australian study contemporizes existing research by exploring this issue in the current context (2020–2022), during which time we have experienced the COVID-19 pandemic, the related economic problems, and modified ASWEAS standards. The data is drawn from 372 undergraduate and Masters (qualifying) students across four universities in different states and explores their experiences of financial stress associated with current placement arrangements;their sources of income and employment arrangements;and how they navigated balancing paid work around placement, or how they supported themselves if they did not work alongside placement. The study evidences no improvement in the situation facing social work students in Australia despite modest ASWEAS modifications that offered limited flexibility around placement requirements during 2020 and 2021 due to the COVID-19 pandemic. The findings contribute to an expanding body of research that indicates the current model of field education is unsustainable for both social work students and the profession and confirms that urgent changes are required for the social work profession to consider our student population in its social justice mandate. [ FROM AUTHOR]

Profiles of a COVID-19 Syndemic: Anti-Asian Racism, Economic Challenges, and Mental and Physical Health.

BACKGROUND: During the COVID-19 pandemic, Asians/Asian Americans have experienced co-occurring threats of anti-Asian racism, economic challenges, and negative mental and physical health symptoms. OBJECTIVES: We examined the co-occurrence of COVID-19-related anti-Asian discrimination and collective racism, economic stressors, and mental and physical health challenges for Asians/Asian Americans during the COVID-19 pandemic. We also examined Asian/Asian American subgroups associated with these threats. METHODS: Nationally representative data from the 2021 Asian American and Native Hawaiian/Pacific Islander COVID-19 Needs Assessment Project (unweighted N = 3,508) were used to conduct a latent profile analysis to identify unique typologies of the co-occurrence of these threats. We also conducted chi-square analyses to investigate subgroup differences by latent profile. RESULTS: We identified five distinct latent profiles: multi-threat impact, low impact, collective racism, health challenges, and economic/health challenges. Forty percent of Asians/Asian Americans were in the multi-threat impact profile, indicating high levels across COVID-19-related threats. Subgroup analyses revealed significant differences in profile membership. East Asians, US-born Asians/Asian Americans, and those aged 25-44 seemed to be particularly affected by the proposed syndemic; results also differed by income. CONCLUSION: Asians/Asian Americans have experienced co-occurring and interrelated threats during COVID-19 that suggest the presence of a syndemic. Results from our study point to vulnerable Asian/Asian American subgroups and the need for targeted public health efforts to address racism, health challenges, and economic challenges in the context of COVID-19.

"Are your employees mentally prepared for the pandemic?” Wellbeing-oriented human resource management practices in a developing country

Employees are the most valuable asset of any service business because of its human-centric nature. However, in the crisis situations, the human side in crisis management strategy, particularly in the areas of human resource management is largely overlooked. The present study explores how human resource management (HRM) practices in the pre-crisis stage could build a good foundation of psychological capital (PsyCap) for tourism and hospitality staff to be mentally resilient during the COVID-19 pandemic. Grounded on the conservation of resource (COR) theory, research hypotheses are developed and then empirically tested using a sample of 760 employees in various tourism and hospitality companies. Research outcomes demonstrate that wellbeing-oriented HRM policies (specifically employee development and employee empowerment policies) in the pre-crisis stage increases employee PsyCap during the pandemic, leading to the preservation of their wellbeing. More importantly, employees' family financial burden is found as a moderating factor, altering the influences of HRM policies on employee PsyCap and their in-crisis wellbeing. Therefore, wellbeing-oriented HRM could be part of crisis preparedness strategy for tourism and hospitality businesses as well as crucial element of the internal corporate social responsibility portfolio in tourism and hospitality businesses. In developing countries, where less financial support and fewer job security policies are available during crises than in the developed world, the application of wellbeing-oriented HRM becomes even more critical.

Economic Perspective of Cancer Care and Its Consequences for Vulnerable Groups.

Within healthcare systems in all countries, vulnerable groups of patients can be identified and are characterized by the reduced utilization of available healthcare. Many different reasons can be attributed to this observation, summarized as implementation barriers involving acceptance, accessibility, affordability, acceptability and quality of care. For many patients, cancer care is specifically associated with the occurrence of vulnerability due to the complex disease, very different target groups and delivery situations (from prevention to palliative care) as well as cost-intensive care. Sociodemographic factors, such as educational level, rural/remote location and income, are known determinants for these vulnerable groups. However, different forms of financial burdens likely influence this vulnerability in cancer care delivery in a distinct manner. In a narrative review, these socioeconomic challenges are summarized regarding their occurrence and consequences to current cancer care. Overall, besides direct costs such as for treatment, many facets of indirect costs including survivorship costs for the cancer patients and their social environment need to be considered regarding the impact on vulnerability, treatment compliance and abundance. In addition, individual cancer-related financial burden might also affect the society due to the loss of productivity and workforce availability. Healthcare providers are requested to address this vulnerability during the treatment of cancer patients.

Financial Burden and Catastrophic Health Expenditure Associated with COVID-19 Hospitalizations in Kerala, South India.

Introduction: Catastrophic health expenditure during COVID-19 hospitalization has altered the economic picture of households, especially in low resource settings with high rates of COVID-19 infection. This study aimed to estimate the out of pocket (OOP) expenditure and the proportion of households that incurred catastrophic health expenditure due to COVID-19 hospitalization in Kerala, South India. Materials and Methods: A cross-sectional study was conducted among a representative sample of 155 COVID-19 hospitalized patients in Kottayam district over four months, using a pretested interview schedule. The direct medical and non-medical costs incurred by the study participants during hospitalization and the total monthly household expenditure were obtained from the respective COVID-19 affected households. Catastrophic health expenditure was defined as direct medical expenditure exceeding 40% of the household's capacity to pay. Results: From the study, median and mean OOP expenditure was obtained as USD 93.57 and USD 502.60 respectively. The study revealed that 49.7% of households had catastrophic health expenditure, with 32.9% having incurred distress financing. Multivariate analysis revealed being below poverty line, hospitalization in private healthcare facility, and presence of co-morbid conditions as significant determinants of catastrophic health expenditure. Conclusion: High levels of catastrophic health expenditure and distress financing revealed by the study have unveiled major unaddressed challenges in the road to universal health coverage.

Correlates of Positivity Among a Sample of Lebanese University Students.

Background: People say it is hard to stay truly positive in Lebanon. Studies showed that 63% of Lebanese young adults are highly dissatisfied with their country. In fact, young adults are the most vulnerable population to stressors in Lebanon since their future is at stake and it is their time to shape their lives in a country that cripples them. This study aimed to assess factors (flourishing, religious coping, experiences in life, and the economic burden) associated with positivity among a sample of Lebanese university students despite the various stressors they are facing on top of the economic collapse and the COVID-19 pandemic. Methods: This cross-sectional study was conducted between November and December 2021. A total of 333 participants (219 females and 114 males; mean age = 22.95 ± 4.79 years) was recruited through convenience sampling and snowball technique through several areas in Lebanon's governorates. A linear regression taking the positivity score as the dependent variable was adopted and all variables that showed a correlation > │0.24│ in absolute value were entered in the final model as independent. Results: A linear regression taking the positivity score as the dependent variable showed that more positive experiences in life (Beta = 0.49; 95% CI 0.35-0.62), more flourishing (Beta = 0.10; 95% CI 0.05-0.14), living in rural area compared to urban (Beta = 3.06; 95% CI 2.02-4.11), and female gender (Beta = 1.56; 95% CI 0.50-2.61) were significantly associated with more positivity (Nagelkerke R 2 of the model = 45.8%). Conclusion: This study demonstrated that the youth's positivity is strongly affected by age, gender, residency, and the country they live in that will both directly and indirectly shape their life experiences and their ability to flourish and prosper. Along with all the efforts done to help during this collapse and alleviate the stress that young adults are enduring, follow-up studies are still needed to determine accurate coping techniques that pushes these young adults to think positively in a country where negativity reigns and all else fails.

Effects of various medical expense characteristics on the occurrence of household debt burden

Medical expenses can aggravate the debt burden of households and in severe cases also lead to household bankruptcy. Using longitudinal data, this study identified various characteristics of medical expenses that could lead to household debt burden. In particular, we investigated whether household debt burden varied according to the beneficiary of medical expenses based on mental accounting. Data of 5007 households (number of observations = 34,071) from 2010 (13th wave) to 2018 (21st wave) surveys of the Korean Labor Panel were analysed using descriptive statistics and a random effect logistic regression model. Descriptive statistics showed that 8.3% of households began to feel debt burden during the survey period. The results of the random effects model revealed that the size of medical expense and debt impacted the probability of debt burden. Although medical expense support for parents or children living separately did not affect the household debt burden significantly, medical expense support for the spouse's parents increased the debt burden probability. The results showed that the household conducted mental accounting and it was driven by the subject with whom the household had a relationship. These results imply the necessity of expanding the medical insurance coverage to reduce the burden of medical expenses, and policies to supplement the gap or decrease in income caused by the occurrence of a medical event.

Financial burden for caregivers of adolescents and young adults with cancer.

OBJECTIVE: Adolescent and young adult (AYA) cancer survivors are vulnerable to cancer-related financial burden, which is likely shared by their caregivers. This study aims to enhance an existing conceptual model of financial burden by conducting concept elicitation interviews with caregivers to generate knowledge that can be translated to inform instrumental and psychosocial support in cancer care. METHODS: Qualitative concept elicitation interviews were conducted with 24 caregivers of AYA cancer survivors (caregivers of adolescents, n = 12; caregivers of emerging adults, n = 12) recruited from four sites. Constant comparative methods were used to identify themes, and results were interpreted and organized into domains of the conceptual model. We also explored COVID-19 related financial impacts among a subset (n = 12) of caregivers. RESULTS: Seven themes emerged, which varied by age group and strengthened the conceptualization of the model. Themes centered on: (1) direct and indirect costs of cancer; (2) impact of socioeconomic status on financial burden; (3) caregiver desire to shield AYAs from distress due to financial burden; (4) strategies to manage cancer-related costs; (5) worries about AYAs' financial future; (6) seeking and receiving financial support; and (7) navigating the healthcare system. Findings also revealed that COVID-19 exacerbates financial burden for some caregivers. CONCLUSIONS: Building upon our prior work, we have adapted the conceptual model of financial burden to reflect perspectives of AYAs, oncology providers, and now, caregivers. An important next step is to develop a reliable and valid self-report measure of financial burden among caregivers of AYA cancer survivors.

Assessment of Financial Toxicity Among Patients With Advanced Lung Cancer in Western China.

Background: Lung cancer is the leading source of cancer-caused disability-adjusted life years. Medical cost burden impacts the well-being of patients through reducing income, cutting daily expenses, curtailing leisure activities, and depleting exhausting savings. The COmprehensive Score for Financial Toxicity (COST) was created and validated by De Souza and colleagues. Our study intends to measure the financial burdens of cancer therapy and investigate the link between financial toxicity and health-related quality of life (HRQoL) in an advanced lung cancer population. Methods: Patients aged ≥ 18 years with confirmed stage III to IV lung cancer were eligible. The COST questionnaire verified by de Souza et al. was used to identify financial toxicity. Multivariable linear regression analysis with log transformation univariate analysis and Pearson correlations were used to perform the analysis. Results: The majority of the patients (90.8%, n = 138/152) had an annual income of $50,000 ($7,775). The cohort's insurance situation was as follows: 64.5% of the cohort had social insurance, 20.4% had commercial insurance, and 22.0% had both. Patients who were younger age (50-59, P < 0.001), employed but on sick leave, and had lower income reported increased levels of financial toxicity (P < 0.05). The risk factors for high financial toxicity: (i) younger age (50-59), (ii) <1 month of savings, and (iii) being employed but on sick leave. Increased financial toxicity is moderately correlated with a decrease in QoL. Conclusion: Poorer psychological status and specific demographics are linked to increased financial toxicity (lower COST). Financial toxicity has a modest relationship with HRQoL and may have a clear link with HRQoL measurements.

COVID-19 and access to cancer care in Kenya: patient perspective.

COVID-19 disruptions severely impacted access to health services for noncommunicable diseases, including cancer, but few studies have examined patient perspectives of COVID-19-induced barriers to care in low/middle-income countries. Data come from a survey completed online, over the phone or in person of 284 adult people with cancer in Kenya. One-third (36%) of participants had primary or no education and 34% had some or complete secondary education. Half of the participants (49%) were aged 40 to 59, 21% were 18 to 39 and 23% were 60 or older. Two-thirds were female (65%) and most visited a national referral hospital in Nairobi to receive care (84%). Mean travel time to Nairobi from the respondent county of residence was 2.47 hours (±2.73). Most participants reported decreased household income (88%) and were worried about their ability to afford cancer treatment due to COVID-19 (79%). After covariate adjustment, participants who lost access to hospitals due to COVID-19 travel restrictions were 15 times more likely to experience a cancer care delay (OR = 14.90, 95% CI: 7.44-29.85) compared to those with continued access to hospitals. Every additional hour of travel time to Nairobi from their county of residence resulted in a 20% increase in the odds of a cancer care delay (OR = 1.20, 95% CI: 1.06-1.36). Transportation needs and uninterrupted access to cancer care and medicines should be accounted for in COVID-19 mitigation strategies. These strategies include permits for cancer patients and caregivers to travel past curfew time or through block posts to receive care during lockdowns, cash assistance and involving patient navigators to improve patient communication.

Stress and Financial Burden Faced by Dentists Amidst COVID 19 Pandemic

Introduction: The Covid-19 pandemic, initiated in Wuhan, China, had devastating effects on the dental industry world-wide. The mode of transmission of SARS Cov-2, causative agent of Covid-19, was through aerosol and saliva contamination putting dentists at high risk of contracting Covid-19. The measures taken to contain the spread of virus had financial repercussion on the dental industry. The survey was conducted to understand the mental health of dentists amidst Covid-19 pandemic. Aim: To analyse the concerns and anxiety faced by dental surgeons regarding vaccination and the psychological and socio-economic impact Covid-19 pandemic had on dental setups. Methods: A cross-sectional study was conducted for a period of 3 months. A sample size of 300 dentists belonging to age group of 25years to 45years was analysed. The dentists included in the sample practiced in Maharashtra, India. A questionnaire was formulated in Google forms and circulated through social media platform. The result was analysed and demonstrated in pie-charts. Results: The survey analysed that majority of dentists were apprehensive to carry out dental procedures. Along with the risk of contracting and being a source of transmission of Covid-19, dentists had huge financial burden of clinic rents, EMI loan pending bills, the cost of preventive kits and reduced patient flow. Conclusion: The survey was successful in analysing the monetary and safety concerns faced by dentists amidst Covid-19 pandemic. The survey also pointed out the mental stress dentists had to overcome to practice dental procedures.