Factors Associated with Behavioral and Psychological Symptoms of Dementia during COVID-19.

(1) Background: Preventive measures to control the spread of COVID-19 are essential, but they often cause social isolation and diminish the physical and mental health of older adults. In cognitively impaired individuals, the pandemic has worsened behavioral and psychological symptoms of dementia (BPSD). Here, we explored the factors contributing to the worsening of BPSD during the COVID-19 pandemic. (2) Methods: Potential patients were identified at a memory clinic in Japan between June 2017 and June 2021. Eligible patients had a diagnosis of mild cognitive impairment (MCI) or dementia during the study period. The outcome was BPSD, as assessed by using the Dementia Behavioral Disorders Scale. Information on patients' lifestyle habits and use of care services was obtained for use as primary explanatory variables; multiple regression analysis was performed to examine the relationship between BPSD and care services use or lifestyle habits. The model was adjusted for sociodemographic factors, and the interaction terms of the pandemic period with lifestyle and service use were included to evaluate the effects of COVID-19. (3) Results: We identified 977 participants with MCI and 1380 with dementia (MCI group: 69.8% age 75 years or older, 54.2% female; dementia group: 79.8% age 75 years or older, 64.8% female). After adjustment for possible confounders, significantly worse BPSD was demonstrated in those who used daycare services during COVID-19 (both MCI and dementia patients; p = 0.007 and p = 0.025 respectively) and in those with poor nutritional function (dementia patients; p = 0.040). (4) Conclusions and Implications: During COVID-19, poor nutritional status and use of daycare services were associated with BPSD in those with cognitive decline. These findings indicate the need to fully examine the quantity and quality of care services for people with cognitive decline during emergencies and to continue to provide effective services.

The Role of Telemedicine in the Management of the Behavioral and Psychological Symptoms of Dementia: A Systematic Review.

The first-line management of behavioral and psychological symptoms of dementia (BPSD) is based on nonpharmacologic interventions such as the provision of guidance and medical support to caregivers. However, accessibility to specialized care and medical resources is often scarce. The ongoing COVID-19 pandemic has compromised the delivery of outpatient care (notably in order to minimize the risk of disease transmission), thus making it essential to provide other means of accessing care for these patient populations. The use of telemedicine (TM) may be a means of increasing access to specialist care for patients with disabilities and poor access to health services, such as those with BPSD. The aim of this study is to provide a review of the literature on the use of TM for treatment and follow-up of patients with BPSD and their caregivers. We searched the PUBMED, EMBASE and CINAHL for articles published between January 1st, 2000, and December 31st, 2020, on the applicability of TM support for people with BPSD and their caregivers. We included open-label studies, qualitative studies, and randomized controlled trials . We did not include studies on the use of TM during the COVID-19 pandemic. A total of 22 publications were included and reviewed. TM was found to 1) be acceptable and feasible for both patients and caregivers, 2) decrease the frequency and intensity of BPSD, and 3) improve the caregiver's perceived wellbeing and mental health. Videoconferencing was effective for patient-centered interventions in nursing homes. Telephone-based interventions were more relevant when they were targeted at caregivers. The published studies are lacking in scope and high-quality studies are now needed to confirm these findings and assess TM's cost-effectiveness and ability to improve the management of patients with BPSD. In view of the ongoing COVID-19 pandemic, remote solutions for assessing and monitoring individuals with BPSD are urgently needed - particularly those living in rural areas and so-called "medical deserts."

Reducing behavioral health symptoms by addressing minority stressors in LGBTQ adolescents: a randomized controlled trial of Proud & Empowered.

BACKGROUND: Minority stress may lead to poorer mental health for sexual and gender minority adolescents, yet no interventions have been tested through an RCT to address these concerns. METHODS: We report on an RCT of an intervention-Proud & Empowered-with four high schools. Measures assess the intervention's impact on mental health symptoms. RESULTS: Compared to the control, participants in the treatment condition reported significant differences in minority stress, anxiety, and depressive symptoms. Moderation analyses showed that the intervention significantly moderated the relationship between minority stress and PTSD (b = -1.28, p = .032), depression (b = -0.79, p = .023), and suicidality (b = 0.14, p = .012) symptoms; those in the intervention condition had mitigated relationships between measures of stress and health outcomes compared to those in the control condition. CONCLUSIONS: Results suggest that Proud & Empowered help reduce mental health symptoms and exposure to minority stressors and build coping strategies. TRIAL REGISTRATION: The intervention was registered on clinicaltrials.gov on August 1, 2019 under Trial # NCT04041414 .

COVID-19 pandemic-related aspects and predictors of emotional and behavioural symptoms in youth with pre-existing mental health conditions: results from Georgia, Lithuania, Romania, Serbia, and Turkey.

OBJECTIVE: This study evaluated levels of and predictors of emotional and behavioral symptoms in youth with pre-existing mental health conditions over the early phase of the COVID-19 pandemic in 2020 across Georgia, Lithuania, Romania, Serbia, and Turkey. METHODS: The study included 421 children and adolescents aged 5 - 18 years with pre-existing mental health conditions and corresponding ongoing treatments. We used a parent- and/or child-report, which taps into a broad range of mental health symptoms and contextual factors thought to be particularly pertinent during periods of social restrictions. Data were collected simultaneously across the countries from May 2020 to August 2020. RESULTS: According to parents, 121 (33.1%) children had deteriorations in the overall quality of mental health over the COVID-19, 156 (43.1%) deteriorations in the quantity of mental health care received, while 82 (25.1%) mental health care received did not meet the needs. For 121 (49.8%) of children, there was worsening in the main presenting psychiatric symptom compared to January 2020, while for 64 (26.3%) there was some improvement. In total, 128 (43.9%) children reported worsened emotional and 118 (40.6%) behavioral symptoms. The COVID-related worry, parental emotional difficulties, and parent-child relationships emerged as the most relevant predictors for higher levels of emotional and behavioral difficulties. CONCLUSIONS: This study found that the COVID-19 pandemic has considerably changed the daily lives of some children with pre-existing mental health conditions, where almost every second child had deteriorations in overall mental health or worsening of psychiatric symptoms.

A randomized trial of online single-session interventions for adolescent depression during COVID-19.

The COVID-19 pandemic has potentially increased the risk for adolescent depression. Even pre-pandemic, <50% of youth with depression accessed care, highlighting needs for accessible interventions. Accordingly, this randomized controlled trial (ClinicalTrials.gov: NCT04634903 ) tested online single-session interventions (SSIs) during COVID-19 in adolescents with elevated depression symptoms (N = 2,452, ages 13-16). Adolescents from all 50 US states, recruited via social media, were randomized to one of three SSIs: a behavioural activation SSI, an SSI teaching that traits are malleable and a supportive control. We tested each SSI's effects on post-intervention outcomes (hopelessness and agency) and three-month outcomes (depression, hopelessness, agency, generalized anxiety, COVID-19-related trauma and restrictive eating). Compared with the control, both active SSIs reduced three-month depressive symptoms (Cohen's d = 0.18), decreased post-intervention and three-month hopelessness (d = 0.16-0.28), increased post-intervention agency (d = 0.15-0.31) and reduced three-month restrictive eating (d = 0.12-17). Several differences between active SSIs emerged. These results confirm the utility of free-of-charge, online SSIs for high-symptom adolescents, even in the high-stress COVID-19 context.

Black adolescents' perceptions of COVID-19: Challenges, coping, and connection to family, religious, and school support.

The coronavirus disease 2019 (COVID-19) pandemic swept the nation by surprise, leaving a deep-seated impact on individuals' social, mental, and physical health. Despite there being disparities between Black and White/non-Hispanic individuals, minimal research has been conducted to explore the effects of the virus on marginalized groups. This study aimed to investigate Black adolescents' perceptions of their experiences with COVID-19, including the challenges they encountered, the coping strategies they employed, and their use of religious/spiritual and school-based support. Twelve Black youth between the ages of 12 and 18 years were interviewed during the early stages of the pandemic (June and July of 2020). Participants struggled with adjusting to the changes in their daily routines, navigating virtual learning, and emerging mental health difficulties (e.g., anxiety). To cope with these challenges, participants relied on emotion and problem-focused coping strategies, including strategies that were religious/spiritual in nature. Participants also relied on social support from family, school personnel, and their religious community, though they lamented about the varied support received from the latter two. Findings from this research support calls for mental health providers to employ culturally affirming mental health services and engage in interagency collaboration to support Black youth. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Child Psychological Functioning During the COVID-19 Lockdown: An Ecological, Family-Centered Approach.

OBJECTIVE: To evaluate how sociodemographic characteristics and various aspects of parent well-being, family functioning, parent-child relationship, and child characteristics are related to psychological functioning in children aged 9 to 12 years during the COVID-19 lockdown. METHOD: Participants included 144 children aged 9 to 12 years and their parents who lived in the province of Quebec, Canada, during the COVID-19 mandatory lockdown. Parents and children were administered a phone-based survey in which various child, parent, parent-child, and family characteristics were assessed. RESULTS: Results showed that higher internalizing problems in children were related to greater depressive symptoms in parents, lower attachment security to parents, and greater aversion to aloneness in children. Results on externalizing behavior problems showed that more problems were associated with more family dysfunction and chaos and lower attachment security to parents. Finally, results on children's anxiety toward COVID-19 showed that more anxiety was associated with greater parental anxiety toward COVID-19 and more child aversion to aloneness. CONCLUSION: Our findings showed that even during an unusual and stressful context such as a pandemic, proximal variables such as the attachment relationship that have been known to be closely associated with adaptation are significantly related to child psychological functioning. Such observations are important because they highlight factors that may accentuate child vulnerability in times of a pandemic and shed light on potential intervention targets.

The impact of COVID-19 in an assisted living community.

The purpose of this study was to use routinely collected resident assessment data from a single site to evaluate the impact of COVID-19 restrictions on cognition, physical function and behavioral symptoms of residents with dementia. Specifically, it was hypothesized that controlling for age and sex, there would be a decline in cognition and function and an increase in behavioral symptoms at 12 months post implementation of COVID-19 restrictions. Twelve residents from a single memory care site with required Resident Assessments completed prior to and 12 month post initiation of the pandemic and associated quarantines were included. No significant change was noted in function or behavioral symptoms but there was a statistically significant decline in cognition over the 12 month period. Although this study did not support our hypothesis, the findings supported some prior research also noting little significant change among the majority of individuals over the course of the pandemic regardless of regulations.

Schools on the front lines: School based health centers amidst COVID-19.

School based health centers (SBHCs) are often at the front line of medical and mental health services for students in the schools they serve. Citywide school closures in New York City in March 2020 and ongoing social distancing procedures resulted in significant changes in SBHC services as well as access to these services. Furthermore, the combination of COVID-19 related stressors and the increased likelihood of adverse childhood events experienced by urban youth creates conditions for the exacerbation of mental health concerns among youth in metropolitan areas. The following article will explore the role of SBHCs as community agents focused on prevention and reduction of mental health concerns prior and during the current pandemic, as well as existing health disparities experienced by urban youth populations. The authors will also discuss research examining mental health concerns already present in global populations affected by COVID-19 as it may foreshadow the challenges to be faced by U.S. urban youth. Lastly, the authors describe recommendations, practice implications, and opportunities for preventative strategies and therapeutic interventions in school based health settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Presentation of COVID-19 infection with bizarre behavior and encephalopathy: a case report.

BACKGROUND: Current studies show that patients with severe coronavirus disease 2019 (COVID-19) have neurological symptoms manifesting as acute cerebrovascular diseases, impaired consciousness, and skeletal muscle symptoms. Bizarre behavior is an unusual and unique presenting symptom of COVID-19 infection in our patient. CASE PRESENTATION: We report a case of COVID-19 infection in a middle aged Iranian man without underlying disease who presented with bizarre behavior. Results of brain imaging were normal, but COVID-19 pneumonia was detected on chest computed tomography scan. Given the respiratory problem and positive polymerase chain reaction (PCR) test for COVID-19, treatment with hydroxychloroquine was administered, and after 2 days all of the symptoms resolved. CONCLUSIONS: Encephalopathy and encephalitis may be a possible presentation of COVID-19. Clinicians and health care providers should consider the presence of COVID-19 with bizarre behavior during this COVID-19 pandemic.

Open schools! Weighing the effects of viruses and lockdowns on children.

This review weighs the risk of infection with SARS-CoV-2 against the side effects of school closures on physical and mental health, education, and well-being of those affected by the school closures. Whereas short term effects - decreased learning and food security, and increased anxiety, violence against children, child labor and teen pregnancies - are frequently discussed, the long-term effects of school closures will be much more detrimental across the lifespan of the "Generation Corona": Existing pandemics of inactivity and myopia, already affecting billions of people, are worsening due to less physical exercise and less time spent outdoors, poor diet, weight gain, and increased screen time during lockdowns, causing future increases of stroke, heart attack, cancer, and blindness. Socio-emotional complications of isolation, learned helplessness, economic and existential insecurity will include increased depression and suicide, decreased empathy and increased loneliness. Together with decreased educational attainment and economic productivity, the amount of ensuing increased future global morbidity and mortality justifies immediate action of school reopening.

Symptom and needs assessment screening in oncology patients: Alternate outreach methods during COVID-19.

Patients with cancer are ideally screened for symptoms, including distress, using patient-reported outcome measures (PROMs). This initiative was developed to ensure patients without access to an electronic portal were screened for distress and related symptoms during the COVID-19 pandemic. Prior to the pandemic, these patients could complete screening in clinic. However, many visits transitioned to telehealth. We implemented a standardized telephone outreach process targeting patients without active electronic portal accounts to improve remote symptom monitoring. Outreach resulted in 172 completed screens, identifying 110 needs for 63 individuals. Twenty-eight patients completed patient portal enrollment. Outreach calls captured a higher percentage of Black patients (34%) and a higher percentage of 61-80 year olds (69%) compared to portal users. Telephone outreach during the pandemic captured data that otherwise would have been missed in elderly and minority patients without electronic patient portal access. Patient engagement is vital to the distress screening process.

Behavioural change in Prader-Willi syndrome during COVID-19 pandemic.

BACKGROUND: Prader-Willi syndrome (PWS) is a rare genetic disorder that in many cases is associated with mental health disorders, in addition to characteristic symptoms such as hyperphagia. The current Sars-CoV-2 coronavirus pandemic has led to massive restrictions in health care and social life worldwide. People with PWS represent a particularly vulnerable population group to these restrictions, with unknown impact on their mental health. METHODS: We conducted an online questionnaire to assess the impact of the restrictions associated with the COVID-19 pandemic on the mental health of people with PWS. RESULTS: One hundred and eight caregivers completed the survey about individuals with PWS. Individuals with PWS > 6 years (n = 89) were included for evaluation with regard to psychopathological change. Respondents frequently reported an increase in psychopathological symptoms associated with PWS during the lockdown, with 51.7% reporting increased temper outbursts, 43.8% showing signs of sadness, 38.2% being anxious, 55.0% more irritable, and 39.3% showing more food seeking behaviour. Adjusted for the type of accommodation food seeking behaviour and irritability is increased to a significantly lesser extent in people with PWS accommodated in specialised care facilities compared with those living in their family home. No significant difference could be found between the sexes. CONCLUSION: The COVID-19 pandemic has had a significant effect on the mental health of individuals with PWS, evidenced by an increase in behaviours associated with PWS, including temper outbursts, food-seeking, and irritability, which again underlines their need for specialised care. Individuals living with their families were particularly vulnerable, indicating that they and their families are in special need of support.

Disruptions in the management and care of university students with preexisting mental health conditions during the COVID-19 pandemic.

Students with preexisting mental health conditions or disabilities may fair worse due to virus mitigation strategies during the COVID-19 pandemic. This study was conducted to understand the experiences of students with preexisting mental health conditions or disabilities at a public university during COVID-19. We examined disruptions in the management of preexisting mental health conditions or disabilities and its impact on psychological well-being. Students were surveyed about their health care experiences during the COVID-19 pandemic between June and September 2020. Linear regressions and mediation analyses were conducted to examine the relationships between disruption to care, mental health self-efficacy, and four psychological well-being outcomes (stress, anxiety, depression, and overall distress). Of the total (N = 1,082) study participants, 258 (24%) reported having a preexisting mental health condition(s) or disabilities (81% female; Mage = 23.47). Of those, 155 (61%) reported that COVID-19 disrupted health care delivery and management of their conditions or disabilities. Of those who reported this disruption, 51% (n = 109) of participants reported a disruption in their ability to see a health care professional and 58% (n = 69) reported either that they lost care or that the quality of the new telemedicine care was not sufficient. A series of linear regressions revealed significant relationships between disruption to care and the four psychological outcomes. Mediation analyses revealed that depression, stress, anxiety, and overall distress were mediated by self-efficacy in managing mental health. University administrators and health care providers should evaluate the scope of mental health care and telemedicine services for students to help long-term psychological effects of COVID-19.

Mental health status of healthcare versus other essential workers in Australia amidst the COVID-19 pandemic: Initial results from the collate project.

The novel coronavirus (COVID-19) has necessitated many healthcare workers operating on the frontlines. Another segment of the population whose mental well-being is being tested are the 'other essential workers' (e.g. supermarket workers). The current study aimed to compare the mental health of healthcare versus other essential workers in the early stages of the COVID-19 outbreak. The COVID-19 and you: mentaL heaLth in AusTralia now survEy (COLLATE) project is a nationwide online mental health survey launched on 1 April 2020, aimed at identifying key mental health concerns. Adults currently living in Australia were invited to take part, and non-discriminative snowball sampling was employed. Participants were partitioned into healthcare workers (HCW; n=905), other essential workers (OEW; n=810), and the general population (GNP; n=3443). Across all groups, top COVID-19 related concerns were primarily associated with the health and well-being of loved ones. In terms of current levels of depression, anxiety, stress and quality of life, HCWs fared the best, and OEWs fared the worst (with the GNP falling in between). In the face of this medical crisis, Australian HCWs seem to be managing their mental health relatively well, but more supports need to be devoted to OEWs to safeguard their mental well-being.

Coping and tolerance of uncertainty: Predictors and mediators of mental health during the COVID-19 pandemic.

The current pandemic wave of COVID-19 has resulted in significant uncertainty for the general public. Mental health and examining factors that may influence distress have been outlined as key research priorities to inform interventions. This research sought to examine whether intolerance of uncertainty and coping responses influence the degree of distress experienced by the U.K. general public during the COVID-19 pandemic. Using a cross-sectional online questionnaire design, participants were recruited (N = 842) using snowball sampling over a 10-day period in the early "lockdown" phase of the pandemic. Around a quarter of participants demonstrated significantly elevated anxiety and depression, with 14.8% reaching clinical cutoff for health anxiety. A one-way multivariate analysis of variance indicated those in "vulnerable" groups were significantly more anxious (p < .001), and also more anxious in relation to their health (p < .001). Mediation modeling demonstrated maladaptive coping responses partially mediated the predictive relationship between intolerance of uncertainty and psychological distress. Mental health difficulties have become significantly raised during the first wave of the COVID-19 pandemic in the United Kingdom, particularly for the vulnerable. Findings support emerging research suggesting the general public is struggling with uncertainty, more so than normal. Vulnerable groups are more anxious about their health, but not more intolerant of uncertainty than the nonvulnerable. Finally, this study indicated two modifiable factors that could act as treatment targets when adapting interventions for mental health during the COVID-19 global health crisis. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action.

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).