Physical activity, low-grade inflammation, and psychological responses to the COVID-19 pandemic among older adults in England (preprint)

Mental health responses to the COVID-19 pandemic have been widely studied, but less is known about the potentially protective role of physical activity (PA) and the impact of low-grade inflammation. Using a sample of older adults from England, this study tested (1) if pre-pandemic PA and its changes during the pandemic were associated with mental health responses; (2) if older adults with low-grade inflammation experienced greater increases in depression and anxiety, compared to pre-pandemic levels; (3) if PA attenuated the association between inflammation and depression/anxiety. The study used data from the English Longitudinal Study of Ageing, a cohort study following a national sample aged 50+. Information on mental health and PA were collected before the pandemic (2016/17 and 2018/19) and during November and December 2020. Inflammation was ascertained using pre-pandemic C-reactive protein (CRP). Analyses were adjusted for sociodemographic and health-related factors and pre-pandemic mental health. Increasing PA from before to during the pandemic was linked to reduced odds of depression (OR = 0.955, 95%CI [0.937, 0.974]) and anxiety (OR = 0.954, 95%CI [0.927; 0.982]). Higher pre-pandemic PA was associated with reduced odds of depression (OR = 0.964, 95%CI [0.948, 0.981]) and anxiety (OR = 0.976, 95%CI [0.953, 1.000]), whereas elevated CRP was associated with 1.343 times higher odds of depression (95%CI [1.100, 1.641]). PA did not attenuate the inflammation-depression association. The findings suggest that PA may contribute to psychological resilience among older adults, independently of inflammation. Further research is needed to explore the psychobiological pathways underlying this protective mechanism.

Psychosocial Predictors of Sleep Disturbances during COVID-19: differential contributions of demographic, psychological, pandemic-related factors to sleep health. (preprint)

Aim: Since the declaration of COVID-19 as a Public Health Emergency of International Concern on January 30, 2020, the disease escalated into a global pandemic forcing governments around the world to impose measures that affected all aspects of life. Among other countries, Greece adopted social restriction, lockdowns, and quarantines to reduce transmission from person to person.  Subjects and Methods: This cross-sectional study aimed to investigate the impact of those measures on sleep health in a Greek adult sample. An online questionnaire collected data during from 650 participant.  Results: 60% of responders scored below the clinical cut-off on the RU-SATED, indicating they experienced poor sleep health. Better sleep health was reported with increased age and years of education. On the other hand, higher trauma-related distress, depression, anxiety and stress symptomatology were related to poorer sleep health. No gender differences were observed, and degree of compliance to pandemic restrictions did not influence sleep health. Hierarchical regression analysis indicated difficulty in securing enough/healthy food, testing positive for COVID-19, experiencing an increase in verbal arguments/conflicts at home and an increase in responsibilities were the strongest predictors of poor sleep heath.  Conclusions: Results highlight the importance of maintaining good sleep health as a pillar of general physical and mental health.

Online peer support for mental health in individuals with post-acute sequelae of COVID-19: A pre-post pilot study with mixed methods (preprint)

Objective This pilot examined the effect of online peer support on mental health problems among individuals with post-acute sequelae of COVID-2019 (PASC).Methods A single-arm pre-post design of online peer support design consisting of eight sessions of 1 h per week with three to six participants and two facilitators per group was performed. Participants were recruited from online communities, social media, and medical clinics for the PASC between May and August 2023. The degrees of depression, anxiety, loneliness, social withdrawal, and self-esteem were measured pre- and post-intervention. Participants’ statements during the sessions were analyzed using thematic analyses.Results Of the 18 participants, 3 dropped out of the interventions, and 17 (including 2 participants who dropped out) completed the pre- and post-intervention questionnaires. Depression severity significantly decreased in the paired t-test and linear mixed model. The following interactions were extracted: conveying the same feelings, dealing with difficulties, showing empathy, enhancing the atmosphere, and adapting to suit health conditions. Impressions extracted from participating in the interventions included feelings of emotional support, a sense of bonding, changes in perspective, changes in behaviors or new actions through participation, inadequacy during sessions, and adverse effects associated with participation.Conclusion Online peer support may be helpful in treating depression in individuals with PASC.

Similarities between long COVID and cognitive impairment and potential implications; Results from the 2022 BRFSS (preprint)

BackgroundCOVID has been linked to cognitive issues with brain fog a common complaint among adults reporting long COVID (symptoms lasting 3 or more months). ObjectiveTo study similarities and differences between cognitive impairment (CI) (the cognitive disability measure) and long COVID. MethodsUsing 2022 BRFSS data from 50 states and 169,894 respondents in 29 states with COVID vaccine data, respondents with CI and long COVID were compared in unadjusted analysis and logistic regression. Apparent vaccine effectiveness was compared in the 29 states. ResultsPrevalence of long COVID was 7.4% (95% CI 7.3-7.6) and CI was 13.4% (13.2-13.6) with both rates higher among women, ages 18-64 years, Hispanics, American Indians, ever smokers, those with depression, e-cigarette users, and those with more of the co-morbidities of diabetes, asthma, COPD, and obesity. The strong association between long COVID and CI was confirmed. Apparent vaccine effectiveness of 3 or more doses vs <3 was 38% for long COVID and 35% for CI, in both cases reducing rates for 3 or more doses to those comparable to adults with 0 comorbidities and showing dose response gradients. For CI, apparent vaccine effectiveness was similar for respondents with or without long COVID. Logistic regression confirmed most results except the magnitude of vaccine effectiveness on CI was reduced in some models while vaccine effectiveness for long COVID was confirmed. ConclusionsMore research is needed to understand the apparent effectiveness of COVID vaccines on CI but, if confirmed, results could expand the list of non-infectious outcomes for which mRNA vaccines can be effective.

Pre-pandemic Predictivity of Anxious-Depressive Symptoms in Post-surgical Traumatic Distress in Hysterectomy for Benign Disease and COVID-19 Outbreak: A Case-Control Study (preprint)

The Sars-Cov-2 pandemic led to several needed containing measures that conditioned the onset of depressive, anxiety and post-traumatic stress symptoms in population. These symptoms, espe-cially if not diagnosed and treated, can also occur in patients undergoing surgery with high im-pact on people’s lives, like hysterectomy. To evaluate the post-surgical distress and anx-ious-depressive symptoms following hysterectomy for benign disease focusing on the impact of COVID-19 pandemic. The prospective observational cohort study included patients undergoing hysterectomy for benign disease. Psychologic evaluation through social-demographic question-naires was obtained before surgery (T1), postoperatively (T2), and 3 months after surgery (T3). The HADS (Hospital Anxiety and Depression Scale) was used to evaluate anxious-depressive symptoms and the PCL-5 (Post-traumatic Stress Disorder Checklist for DSM-5) compared the on-set of post-surgical distress and anxiety and depressive symptoms. The pre-COVID-19 pan-demic period was compared to the post-COVID-19 pandemic phase. Patients treated after COVID-19 pandemic showed higher depressive symptoms rate compared to those treated before (p-value=0.02); conversely, pre-COVID-19 patients were more prone to develop a PTSD (p-value=0.04). A significative association between the occurrence PTSD and anxiety-depressive symptoms registered at T2 a (p-value=0.007) and T3 (p-value

Life changes and mental health among Chinese children and adolescents during the pandemic: a combination of cross-sectional, longitudinal and clustering studies (preprint)

The measures to prevent COVID-19 pandemic had caused significant life changes, which could be distressing for mental health among children and adolescents. We aimed to evaluate the short- and long-term effects of life changes on children’s mental health in a large Chinese cohort. Survey-based life changes during COVID-19 lockdown were measured among 7,829 Chinese students at Grade 1–9, including social contacts, lifestyles and family financial status. Clustering analysis was applied to identify potential patterns of these changes. Depressive and anxiety symptoms were measured using the Center for Epidemiologic Studies Depression Scale and Screen for Child Anxiety Related Emotional Disorders. Logistic regression models were used to investigate the associations between these changes, their patterns and the presence of depression/anxiety symptoms using both cross-sectional and longitudinal designs. We found that the prevalence of depression and anxiety symptoms decreased during pandemic (34.6–32.6%). However, during and shortly after lockdown, students who reported negative impacts on their study, social and outside activities and diet, and decreased electronic time and sugar-sweetened consumption, as well as family income decline and unemployment had increased risks of depressive/anxiety symptoms, and students with changed sleep time had increased depressive symptoms. These associations attenuated or disappeared one year later. Similar patterns were observed in clustering analysis, while only the group with severe impact on family financial status showed a sustained increase in depression symptoms. In summary, restrictive measures that changed children and adolescents’ daily life during COVID-19 lockdown showed negative effects on their mental health, with some commonalities and distinctions patterns in the manifestation of depression and anxiety symptoms.

Social isolation emanated psychological exhaustion and disconnectedness among physicians during the COVID-19 pandemic: Results of a qualitative study in Pakistan (preprint)

Background: During the COVID-19 pandemic, many healthcare providers remained on call in COVID-19 wards, isolation centres, and emergency departments, caring for both infected and non-infected patients. Physicians have faced various challenges during the pandemic, including the stress of working with limited resources, the physical burden of long work hours and fear of public abuse in terms of stigmatization. Therefore, this study focusses on social-psychological aspects of isolation period of physicians during the COVID-19 pandemic. Methods: It is a qualitative study based on responses from 14 physicians working in two hospitals located in Islamabad, which is the capital city of Pakistan (Pakistan Institute of Medical Sciences [PIMS] and PolyclinicHospital). In-depth interviews were conducted with selected physicians by using an interview guide as a tool of data collection to explore the experiences of those physicians who suffered from COVID-19 and lived in isolation as their quarantine period. The data was analyzed by using thematic analysis technique. Results: The study explored isolation experiences of physicians during the selected period of COVID-19 and significantly found that two major themes emerged, i.e. psychological exhaustion (depression, anxiety and loneliness were subthemes) and disconnectedness (relational detachment and lack of interaction were subthemes). Conclusions: This pandemic crisis has significantly resulted in having adverse impact on the ability of physicians to approach both potential and existing patients. Particularly in times of such a crisis, adequate measures have to be taken to address mental health issues of the health workforce.

Voices on the Edge: Mental Health Status of Unemployed Adults of Working Age during the COVID-19 epidemic- A Retrospective Study Based on Data from the Psychological Assistance Hotline in HCM City (preprint)

OBJECTIVE: To investigate the utilization of psychological hotlines by the unemployed labor force during the COVID-19 epidemic and to explore their mental health status.  METHODS: General demographic data, types of caller problems and other information of unemployed adult labor force callers to the HCM City assistance hotline were collected from 2019 to 2022, and group comparisons were made according to different genders, different age groups, and caller times to understand the mental health status of this group by assessing depressive mood and suicide risk.Taking high-risk calls as outcome variables, multivariate Logistic regression was carried out to explore the related factors affecting the mental health status of this group.  RESULTS: A study of 6,297 cases found that males exhibited higher rates of major depression, suicidal ideation, planning, and behavior compared to females (P < 0.001). The youth group had significantly higher proportions of major depression and suicide risk compared to middle-aged and older individuals (P < 0.001). Calls in the second half of the night were associated with a higher proportion of callers reporting suicidal plans and preparations(P < 0.001). Young callers had an 11.04 times(OR=12.04,95%CI 3.523-41.148,P＜0.001)and senior callers had an 4.039 times (OR=5.039 95%CI 1.476-17.201,P=0.01) higher risk of suicidal behavior compared to middle-aged callers, and men were 1.211 times (OR=2.211 95%CI 1.423-3.435,P < 0.001)more likely to have high-risk calls than women. Gender and age were identified as influential factors for high-risk situations. CONCLUSION: Unemployed callers who were male, in the youth group, and who called in the second half of the night had relatively poorer mental health and were at higher risk for suicide.

Increasing loneliness among children and adolescents from 2018 to 2022: A representative survey before and after the COVID-19 pandemic (preprint)

Background: Loneliness is an increasingly present topic in scientific and public discourse, and has gained relevance, especially due to the COVID-19 pandemic. Nevertheless, there is a lack of representative studies examining the prevalence of loneliness among children and adolescents before and after the pandemic. Accordingly, the present study aimed to determine the prevalence of loneliness among 11- to 15-year-old students before (2018) and after (2022) the onset of the COVID-19 pandemic and to investigate subgroup differences. Methods: In this cross-sectional Health Behaviour in School-aged Children (HBSC) study, the prevalence of loneliness was compared in representative samples in the German federal state of Brandenburg from 2018 and 2022. In 2018, data were collected from 3,057 (51.8% girls, Mage= 13.1, SD = 1.7) and, in 2022, from 3,801 (52.6% girls, Mage= 13.5, SD = 1.6) students in general education schools in grades 5, 7, and 9. Loneliness was assessed using a single item from the Center for Epidemiologic Studies Depression Scale (CES-D). The chi-square test was used to determine bivariate correlations. To validate the bivariate results, we performed a logistic regression in which we also added interaction effects to test whether loneliness developed differently depending on gender, grade, and family affluence. Results: In total, 11.8% of the students reported being lonely in 2018, and 19.3% reported being lonely in 2022. Loneliness was more prevalent among girls, nonbinary students, older adolescents, and students with lower family affluence. The increase in loneliness did not differ depending on age, gender, or family affluence. Conclusion: The findings highlight that loneliness among German children and adolescents is a widespread phenomenon that has increased significantly since 2018. The sharp increase in loneliness clarifies the need for prevention measures and further research into health-related associations of loneliness.

Impact of the COVID-19 Pandemic on Swedish Adolescents’ Mental Health, Psychosocial Functioning, Risk Behaviours, and Victimisation: Gender Differences and Implications (preprint)

The COVID-19 pandemic has shown varying effects on adolescents’ mental health, psychosocial functioning, risk behaviours, and victimisation. This study aims to examine the changes reported by a sample of Swedish adolescents (N=1607) at the end of the first year of the pandemic in relation to these factors. Data was collected with an electronic survey between September 2020 and February 2021, targeting upper-secondary high school students (aged 15-19 years). The results indicate a relatively low overall impact of the pandemic on Swedish upper-secondary school students, with notable gender differences. Compared to females, a higher percentage of male adolescents reported experiencing elevated levels of anxiety, depression, sleep disturbances, anger, and increased illicit drug use as consequences of the pandemic. In contrast, females demonstrated an increase in several salutogenic behaviours. Victimisation rates generally decreased during this period. These findings underscore the importance of heightened awareness among professionals within schools, social services, and healthcare settings regarding the distinct challenges encountered by a larger portion of male adolescents during the COVID-19 pandemic in Sweden.

A qualitative exploration of active ingredients and mechanisms of action of an online singing programme with mothers experiencing postnatal depression during the COVID-19 pandemic: SHAPER-PNDO study. (preprint)

Background Social distancing restrictions and the suspension of in-person treatment and support contributed to an increase in postnatal depression during the coronavirus disease 2019 (COVID-19) pandemic. Creative health interventions can help to alleviate anxiety and depression, with studies showing that singing is particularly effective for supporting the mental health of new mothers. We adapted an in-person group singing programme (Breathe Melodies for Mums (M4M)) to online delivery during the COVID-19 pandemic to support the mental health of new mothers, and, in a feasibility study, found improvements in postnatal depression (PND) symptoms at 6-month follow up. The current qualitative study aimed to explore how and why M4M-online impacted the mental health of those taking part.Methods We took a theory-based approach using the Ingredients in Arts in Health (INNATE) Framework of ‘active ingredients’ and the Multi-level Leisure Mechanisms Framework of ‘mechanisms of action’ to identify and categorise intervention components and change mechanisms. Iterative consensus building between three researchers were complemented by qualitative semi-structured online interviews with 24 women experiencing PND symptoms who took part in M4M-online. Data were analysed inductively using reflexive thematic analysis.Results Consistency was found between the online and in-person interventions in active ingredients relating to project design, content, programme management and the composition of the group. Key differences were in the social and contextual ingredients. Psychological, social and behavioural mechanisms for improved mental health and wellbeing included: 1) Increased self-confidence as a mother, 2) Increased positive emotional responses, 3) A supported change in identity, 4) Reduced loneliness and isolation, 5) Increased social bonding and connections with family and 6) Enhanced sense of time through new routines.Conclusions Participating in online group singing can support new mothers experiencing PND by triggering psychological, social and behavioural responses that lead to improved mental health. Key programme features are identified which can be used to design future online creative health interventions or tailor in-person activities for remote delivery to support populations who may face practical and social barriers to attending in-person.

The Outcome of the Psychological and Therapeutical Care of Hospitalized COVID-19 Patients: National African Pilot Study (preprint)

Introduction: Hospitalization in a COVID-19 unit represents a significant source of stress and psychological distress for patients. Our study aims to determine the factors of psychological distress in the therapeutic and psychosocial management of patients hospitalized with a COVID-19 infection. Methods: This cross-sectional study was carried out over 8 months at the COVID-19 zone of the CHU HASSAN II of FES. 99 patients were evaluated within days of diagnosis by psychometric scales of anxiety, depression, and post-traumatic stress. In the course of this follow-up, we found the presence of psychological impacts in these patients, and we tried to find correlating factors between the occurrence of psychiatric disorders and the set of factors related to sociodemographic data, hospitalization course and treatments taken, as well as family support. Results: 35% of patients had scores in favor of post-traumatic stress disorder, 37% of the patients had definite depression and 50% had anxiety. Post-traumatic stress, depression, and anxiety were correlated with sociodemographic factors, hospitalization, treatments received, and length of stay. Conclusion: The prevalence of anxiety-depressive disorders and post-traumatic stress disorder was high in patients with COVID-19, hence the interest in providing psychological and psychosocial care in the emergency department.

Towards Algorithmic Fidelity: Mental Health Representation across Demographics in Synthetic vs. Human-generated Data (preprint)

Synthetic data generation has the potential to impact applications and domains with scarce data. However, before such data is used for sensitive tasks such as mental health, we need an understanding of how different demographics are represented in it. In our paper, we analyze the potential of producing synthetic data using GPT-3 by exploring the various stressors it attributes to different race and gender combinations, to provide insight for future researchers looking into using LLMs for data generation. Using GPT-3, we develop HEADROOM, a synthetic dataset of 3,120 posts about depression-triggering stressors, by controlling for race, gender, and time frame (before and after COVID-19). Using this dataset, we conduct semantic and lexical analyses to (1) identify the predominant stressors for each demographic group; and (2) compare our synthetic data to a human-generated dataset. We present the procedures to generate queries to develop depression data using GPT-3, and conduct analyzes to uncover the types of stressors it assigns to demographic groups, which could be used to test the limitations of LLMs for synthetic data generation for depression data. Our findings show that synthetic data mimics some of the human-generated data distribution for the predominant depression stressors across diverse demographics.

The Impact of COVID-19 on Depression Among Service Industry Workers: A Comprehensive Analysis Based on the 2021 Korea Community Health Survey (preprint)

Background This study aims to comprehensively explore the factors associated with depression among service industry workers during the COVID-19 pandemic, utilizing data from the 2021 Korea Community Health Survey. A total of 16,553 participants were included in the analysis.Methods The research employed a composite sample logistic regression analysis, with depression as the dependent variable and various general characteristics as independent variables.Results The study's findings highlight a notable prevalence of depression within the service industry (3.3%). Women exhibited a 2.22 times higher risk of depression compared to men (95% Confidence Interval (CI): 1.62–3.05). Service workers aged 40–49, 50–59, and ≥ 60 demonstrated lower odds of depression in comparison to those aged 19–29. Higher income levels were associated with reduced odds of depression. Service workers experiencing job loss (Odds Ratio(OR) = 5.42, 95% CI: 3.07–9.55) and deteriorated job conditions (OR = 1.97, 95% CI: 1.60–2.43) exhibited higher odds of depression than those with stable employment.Conclusion In conclusion, this study pinpoints depression risks in service workers, stressing gender, age, income, and job changes. Urgent action is needed, including targeted interventions and enhanced workplace support during the ongoing pandemic. Valuable insights contribute to understanding mental health disparities in this population.

Long COVID in Children and Adolescents: A Retrospective Controlled Cohort Study from Iran (preprint)

Background: After recovering from the acute phase of COVID-19, some of the infected children manifest long COVID symptoms. The present study aims to identify long COVID symptoms in children and adolescents admitted to hospitals in Bushehr, Iran, during 2021 to 2023, and compare them with the non-affected group. Methods: This retrospective cohort study was conducted on 141 children and adolescents with COVID-19 and 141 non-affected peers. The data were collected using the data recorded in the patients’ records, conducting telephone interviews and completing the prevalent long COVID symptom form. Results: The mean age of the hospitalized children with COVID-19 was 79±5.24 months old, 57.4% of whom were boys. Also, 46 individuals of the infected group (32.6%) manifested long COVID symptoms. The most prevalent symptoms included fatigue (54.3%), impaired attention or concentration (41.3%) and depression or anxiety symptoms (34.7%). Significant correlation was found between disease severity and muscle and joint pain (P=0.025) as well as between length of hospital stay and cough (P=0.022), weight loss (P=0.047) and depression or anxiety symptoms (P=0.008). Older age [(6-11 y; OR=3.18, CI=1.03-9.88); (12≥ y; OR= 4.57, CI=1.40-14.96)] and having history of smoking or being exposed to secondhand smoke (OR= 12.45, CI= 3.14-49.36) were considered as risk factors for long COVID. Conclusions: Informing the public about smoking or being exposed to smoke as risk factors for long COVID, in addition to its other hazards, is of particular importance. Informing the healthcare staff and general public about the most prevalent symptoms of long COVID could be effective in timely diagnosis and treatment as well as reducing families’ stress burden.

Prevalence and influencing factors of sleep disorders in medical students after the COVID-19 pandemic (preprint)

Background The prevalence of sleep disorders among medical students was high during the COVID-19 pandemic. However, there are fewer studies of sleep disorders in medical students after the COVID-19 pandemic. This study aimed to investigate the prevalence and factors influencing sleep disorders among Chinese medical students after COVID-19.Methods We enrolled 1194 medical students. The Self-administered scale was used to collect the demographic characteristics. The Self-rating Depression Scale (SDS), the Self-rating Anxiety Scale (SAS), and the Pittsburgh Sleep Quality Index (PSQI) were used to assess subjects' depression, anxiety, and sleep disorders, respectively. The chi-square test and binary logistic regression were used to identify factors that influence sleep disorders. The receiver operating characteristic (ROC) curve was used to assess the predictive value of relevant variables for sleep disorders.Results We found that the prevalence of sleep disorders among medical students after COVID-19 was 82.3%. According to logistic regression results, medical students with depression were 1.151 times more likely to have sleep disorders than those without depression (OR = 1.151, 95% CI 1.114 to 1.188). Doctoral students were 1.908 times more likely to have sleep disorders than graduate and undergraduate students (OR = 1.908, 95% CI 1.264 to 2.880). In addition, the area under the ROC curve for depression is 0.689.Conclusion The prevalence of sleep disorders among medical students is high after COVID-19. In addition, high academic level and depression are risk factors for sleep disorders. Therefore, medical colleges and administrators should pay more attention to sleep disorders in medical students after the COVID-19 pandemic. Regular assessment of sleep disorders and depression is extremely necessary.

Video Game Play and Mental Health During the COVID-19 Pandemic: A Meta-Analysis of Global Findings (preprint)

During the COVID-19 pandemic, video gaming was often suggested as a way to help maintain physical distancing by encouraging people to stay indoors and play games instead of seeking social activities. However, there was concern about whether the increased time spent on video gaming could negatively affect players' mental health. In our meta-analysis, we synthesized studies to quantify changes in gaming time during the pandemic and examine its association with positive and negative mental health metrics. We searched databases for studies published from March 2020 to December 2021 reporting gaming time and mental health positive (e.g., happiness, positive affect, relaxation) or negative (e.g., depression, anxiety, stress, loneliness, anger) indicators during the pandemic. We employed random effects meta-analyses with robust variance estimates. We accounted for potential moderators (e.g., world region). In 17 studies (26 effects, n = 18026), we found a small increase in time spent gaming during the pandemic versus pre-pandemic, d = 0.26, 95% CI [0.14, 0.37], p = .0004). In 22 studies (100 effects, n = 19752), gaming time was not associated with mental health (r = -0.03, 95% CI [-0.08, 0.02], p = .22), regardless of whether it was for well-being or ill-being measures. Moderator analyses indicated negligible differences across study characteristics (d< 0.20). These findings challenge the simplistic view that more gaming time automatically leads to worse (or better) mental health during pandemics. They provide important insights for researchers, policymakers, educators, and caregivers about the role of digital technologies in easing the impact of pandemics and lockdowns. This research is vital for developing evidence-based public health policies and recommendations regarding video gaming in the event of future pandemics and lockdowns.

COVID-19 Impact on Patients with Immune-Mediated Rheumatic Disease: A Comparative Study of Disease Activity and Psychological Well-Being Over Six Months (preprint)

Objectives: To compare the impact of COVID-19 on clinical status and psychological condition in patients with immune-mediated rheumatic diseases (IMRD) infected by SARS-CoV-2 with IMRD controls not infected, during a 6-month follow-up. Methods: The ReumaCoV Brasil is a longitudinal study designed to follow-up IMRD patients for 6 months after COVID-19 (cases) compared with IMRD patients no COVID-19 (controls). Clinical data, disease activity measurements and current treatment regarding IMRD, and COVID-19 outcomes were evaluated in all patients. Disease activity was assessed through validated tools at inclusion and at 3 and 6 months post-COVID-19. The FACIT-F (Functional Assessment of Chronic Illness Therapy) and DASS 21 (Depression, Anxiety and Stress Scale - 21 Items) questionnaires were also applied at 6 months after COVID-19 in both groups before large-scale vaccination. The significance level was set as p<0.05, with a 95% confidence interval. Results: A total of 601 patients were evaluated, being 321 cases (IMRD COVID-19+) and 280 controls (IMRD COVID-19 -), predominantly female with similar median age. No significant differences were noted in demographic data between the groups, including comorbidities, disease duration, and IMRD. Disease activity assessment over a 6-month follow-up showed no significant difference between cases and controls. While mean activity scores did not differ significantly, some patients reported worsened disease activity post-COVID-19, particularly in rheumatoid arthritis (RA) (32.2%) and systemic lupus erythematosus (SLE) (23.3%). Post-COVID-19 worsening in RA patients correlated with medical global assessment (MGA) and CDAI scores, with a moderate to large effect size. Diabetes mellitus showed a positive association (OR=7.15), while TNF inhibitors showed a protective effect (OR=0.51). Comparing SLEDAI pre- and post-COVID-19, a minority showed increased scores, with few requiring treatment changes. Fatigue, depression, anxiety, and stress were significantly higher in cases compared to controls. Worsening disease activity post-COVID correlated with worsened FACIT-F and DASS-21 stress scale in RA patients. No significant associations were found between COVID-19 outcomes and post-COVID-19 disease activity or psychological assessments. Conclusions: Post-COVID-19 IMRD patients show significant psychological well-being deterioration despite similar disease activity scores. The variability in reports on IMRD flares and the potential trigger of SARS-CoV-2 for autoimmune manifestations underline the need for detailed clinical assessment and a comprehensive approach to managing them.

Mental Health Trends in India from 2020 to 2022: Association with Financial Stress, Food Insecurity, and COVID-19-related Illness Concerns (preprint)

This study examines the impact of pandemic-related worries on mental health in the Indian general adult population from 2020 to 2022. Using data from the Global COVID-19 Trends and Impact Survey (N = 2,576,174 respondents aged >= 18 years in India; an average weekly sample size of around 25,000), it explores the associations between worry variables (namely financial stress, food insecurity, and COVID-19-related health worries) and self-reported symptoms of depression and nervousness. The statistical analysis was conducted using complete cases only (N = 747,996). Our analysis used survey-weighted models, focusing on the three pandemic-related worries as the exposures, while also adjusting for various other covariates, including demographics and calendar time. The study finds significant associations between these worries and mental health outcomes, with financial stress being the most significant factor affecting both depression (adjusted odds ratio: 2.36, 95% confidence interval: [2.27, 2.46]) and nervousness (adjusted odds ratio: 1.91, 95% confidence interval: [1.81, 2.01]) during the first phase of the study period (June 27, 2020, to May 19, 2021). The fully adjusted models also identify additional factors related to mental health, including age, gender, residential status, geographical region, occupation, and education. Moreover, the research highlights that males and urban residents had higher odds ratios for self-reported mental health problems regarding the worry variables than females and rural residents, respectively. Furthermore, the study reveals a rise in the prevalence of self-reported depression and nervousness and their association with COVID-19-related health worries during the lethal second wave of the pandemic in May 2021 compared to the onset of the pandemic. This study shows that social media platforms like Facebook can deploy surveys to a large number of participants globally and can be useful tools in capturing mental health trends and uncovering associations during a public health crisis.

Postpartum suicidal ideation in Austria and Germany during the COVID-19 pandemic (preprint)

Introduction: Postpartum suicidal ideation is a significant concern, as it poses a risk for future suicide attempts, particularly in high income countries, where suicide ranks among the leading causes of death for postpartum mothers. The literature indicates a global average prevalence of postpartum suicidal ideation of approximately 7%, but for Austria and Germany there are few studies on this subject. Methods: In a web-based survey for Austrian and German mothers of children born during the COVID-19 pandemic, several measures of mental health (depression, stress), social support and other parenting and pandemic-related questions were assessed in 1964 mothers. Based on the answers for the last item of the Edinburgh Postpartum Depression Scale, the suicidality risk and the presence or absence of suicidal ideation were computed. Furthermore, possible risk or protective factors for suicidality were investigated. Results: The prevalence of suicidal ideation was 7.3%, which is in the range of the global prevalence reported in the literature, but two times higher than previous reports on German mothers. The three strongest risk factors for suicidal ideation were (i) high levels of stress (increased risk by 350%), (ii) a lack of perceived social support (increased risk by 265%), and (iii) a perceived negative effect of the pandemic on the relationship with the partner (increased risk by 223%). Not receiving help from family and friends, having a lower income, and feeling negatively impacted by the pandemic also significantly increased the risk of suicidal ideation. Discussion and conclusion: The results indicate a higher prevalence of suicidality than previously reported in German mothers, and confirm the risk factors previously associated with depression and suicidality. These risk and protective factors could be targets of social and public health policies, while the first step should be a general screening program for suicidality in this population group.