Food Security, Financial Resources, and Mental Health: Evidence during the COVID-19 Pandemic.

COVID-19 has negatively impacted many households' financial well-being, food security, and mental health status. This paper investigates the role financial resources play in understanding the relationship between food security and mental health among U.S. households using data from a survey in June 2020. Results show job loss and savings draw down to pay for household bills had a significant relationship with both lower food security and greater numbers of poor mental health days during the pandemic.

COVID-19 impacts on drinking and mental health in emerging adults: Longitudinal changes and moderation by economic disruption and sex.

BACKGROUND: There are significant concerns that the COVID-19 pandemic may have negative effects on substance use and mental health, but most studies to date are cross-sectional. In a sample of emerging adults, over a two-week period during the pandemic, the current study examined: (1) changes in drinking-related outcomes, depression, anxiety, and posttraumatic stress disorder and (2) differences in changes by sex and income loss. The intra-pandemic measures were compared to pre-pandemic measures. METHODS: Participants were 473 emerging adults (Mage  = 23.84; 41.7% male) in an existing longitudinal study on alcohol misuse who were assessed from June 17 to July 1, 2020, during acute public health restrictions in Ontario, Canada. These intra-pandemic data were matched to participant pre-pandemic reports, collected an average of 5 months earlier. Assessments included validated measures of drinking, alcohol-related consequences, and mental health indicators. RESULTS: Longitudinal analyses revealed significant decreases in heavy drinking and adverse alcohol consequences, with no moderation by sex or income loss, but with substantial heterogeneity in changes. Significant increases in continuous measures of depression and anxiety were present, both of which were moderated by sex. Females reported significantly larger increases in depression and anxiety. Income loss >50% was significantly associated with increases in depression. CONCLUSIONS: During the initial phase of the pandemic, reductions in heavy drinking and alcohol consequences were present in this sample of emerging adults, perhaps due to restrictions on socializing. In contrast, there was an increase in internalizing symptoms , especially in females, highlighting disparities in the mental health impacts of the pandemic.

Gender-affirming care, mental health, and economic stability in the time of COVID-19: A multi-national, cross-sectional study of transgender and nonbinary people.

BACKGROUND: Transgender and nonbinary people are disproportionately affected by structural barriers to quality healthcare, mental health challenges, and economic hardship. This study examined the impact of the novel coronavirus disease (COVID-19) crisis and subsequent control measures on gender-affirming care, mental health, and economic stability among transgender and nonbinary people in multiple countries. METHODS: We collected multi-national, cross-sectional data from 964 transgender and nonbinary adult users of the Hornet and Her apps from April to August 2020 to characterize changes in gender-affirming care, mental health, and economic stability as a result of COVID-19. We conducted Poisson regression models to assess if access to gender-affirming care and ability to live according to one's gender were related to depressive symptoms, anxiety, and changes in suicidal ideation. RESULTS: Individuals resided in 76 countries, including Turkey (27.4%, n = 264) and Thailand (20.6%, n = 205). A majority were nonbinary (66.8%, n = 644) or transfeminine (29.4%, n = 283). Due to COVID-19, 55.0% (n = 320/582) reported reduced access to gender-affirming resources, and 38.0% (n = 327/860) reported reduced time lived according to their gender. About half screened positive for depression (50.4%,442/877) and anxiety (45.8%, n = 392/856). One in six (17.0%, n = 112/659) expected losses of health insurance, and 77.0% (n = 724/940) expected income reductions. The prevalence of depressive symptoms, anxiety, and increased suicidal ideation were 1.63 (95% CI: 1.36-1.97), 1.61 (95% CI: 1.31-1.97), and 1.74 (95% CI: 1.07-2.82) times higher for individuals whose access to gender-affirming resources was reduced versus not. DISCUSSION: The COVID-19 crisis is associated with reduced access to gender-affirming resources and the ability of transgender and nonbinary people to live according to their gender worldwide. These reductions may drive the increased depressive symptoms, anxiety, and suicidal ideation reported in this sample. To improve health of transgender and nonbinary communities, increased access to gender-affirming resources should be prioritized through policies (e.g., digital prescriptions), flexible interventions (e.g., telehealth), and support for existing transgender health initiatives.

Editorial: 'No pain - No gain' - Towards the inclusion of mental health costs in balanced "lockdown" decision-making during health pandemics.

Since the beginning of the COVID-19 pandemic in early 2020, many governments have implemented national or regional lockdowns to slow the spread of infection. The widely anticipated negative impact these interventions would have on families, including on their mental health, were not included in decision models. The purpose of this editorial is, therefore, to stimulate debate by considering some of the barriers that have stopped governments setting the benefits of lockdown against, in particular, mental health costs during this process and so to make possible a more balanced approach going forward. First, evidence that lockdown causes mental health problems needs to be stronger. Natural experimental studies will play an essential role in providing such evidence. Second, innovative health economic approaches that allow the costs and benefits of lockdown to be compared directly are required. Third, we need to develop public health information strategies that allow more nuanced and complex messages that balance lockdown's costs and benefits to be communicated. These steps should be accompanied by a major public consultation/engagement campaign aimed at strengthening the publics' understanding of science and exploring beliefs about how to strike the appropriate balance between costs and benefits in public health intervention decisions.

Food Insufficiency and Mental Health in the U.S. During the COVID-19 Pandemic.

INTRODUCTION: During the COVID-19 pandemic, the rates of food insecurity and mental illness have been projected to increase in the U.S. owing to significant social and economic disruption. This study aims to estimate the prevalence of food insufficiency (often the most extreme form of food insecurity), the correlates of food insufficiency, and the associations between food insufficiency and symptoms of poor mental health in the U.S. during the COVID-19 pandemic. METHODS: Cross-sectional data from 63,674 participants of the U.S. Census Household Pulse Survey were collected and analyzed in 2020. Multiple Poisson regression models were used to estimate associations with food insufficiency. RESULTS: Food insufficiency rose from 8.1% to 10.0% from March to June 2020. Factors associated with food insufficiency included lower age, Black/African American or Latinx race/ethnicity, being unmarried, larger household size, recent employment loss, income below the federal poverty line, and lower education (all p<0.001). Food insufficiency was independently associated with all symptoms of poor mental health, adjusting for socioeconomic and demographic factors (adjusted RRs ranged from 1.16 to 1.42, all p<0.001). The association between food insufficiency and poor mental health was attenuated among people who received free groceries or meals. CONCLUSIONS: Food insufficiency has increased during the COVID-19 pandemic and affects vulnerable populations, placing individuals at higher risk for symptoms of poor mental health. Particularly in the current crisis, clinicians should regularly screen patients for food insufficiency and mental health outcomes as well as provide support in accessing appropriate resources.

Employment and economic outcomes of persons with mental illness and disability: The impact of the Great Recession in the United States.

Objective: To examine variation in employment and economic outcomes before, during, and after the great recession by disability and mental health status. Methods: Using a sample of adults in the 1999 to 2016 National Health Interview Survey (N = 419,336), we examined changes in labor force and economic outcomes by mental health and physical disability status. We employed difference-in-differences analyses to determine whether the changes in these outcomes during and after the recession for each comparison group (those with moderate mental illness, serious psychiatric disability, or physical disability) were significantly different from the changes for persons with neither a mental illness nor a disability. Findings: While the recession impacted all groups, those with mental illnesses or physical disabilities were hardest hit. Persons with disabilities were disadvantaged on all outcomes at each period, but persons with mental illnesses were the most disadvantaged. Unemployment, poverty, and use of food stamps increased for all groups, but the increase was greatest for persons with mental health problems who also saw a more substantial decline in wage income. Conclusions and Implications for Practice: The effects of the recession persist well after the recovery period. Practitioners should be aware that although most persons with mental illnesses want to work, they face significant barriers to employment. Following economic shocks such as those brought on by the current coronavirus pandemic, interventions should focus on people who are the most vulnerable, especially those with mental health problems. Renewed focus on employment for people with mental disorders is important. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Whither economic evaluation in the case of COVID-19: What can the field of mental health economics contribute within the Australian context?

COVID-19 has resulted in broad impacts on the economy and aspects of daily life including our collective mental health and well-being. The Australian health care system already faces limitations in its ability to treat people with mental health diagnoses. Australia has responded to the COVID-19 outbreak by, among other initiatives, providing reimbursement for telehealth services. However, it is unclear if these measures will be enough to manage the psychological distress, depression, anxiety and post-traumatic distress shown to accompany infectious disease outbreaks and economic shocks. Decision making has focused on the physical health ramifications of COVID-19, the avoidance of over-burdening the health care system and saving lives. We propose an alternative framework for decision making that combines life years saved with impacts on quality of life. A framework that simultaneously includes mental health and broader economic impacts into a single decision-making process would facilitate transparent and accountable decision making that can improve the overall welfare of Australian society as we continue to address the considerable challenges that the COVID-19 pandemic is creating.

How to Mitigate the Mental Health Care Consequences of the COVID-19 Financial Crisis.

The COVID-19 pandemic has led to record unemployment claims and a weakened U.S. economy. This column reviews results of past research to examine how a recession might affect behavioral health and the treatment of mental and substance use disorders and suggests potential policy solutions. Despite increases in suicide and substance use, losses in employment-related health insurance could dampen treatment seeking. Federal, state, and local officials should be vigilant regarding suicide prevention. Individuals who lose employee insurance coverage should be protected through insurance marketplaces and Medicaid outreach and enrollment. Public and private coverage of telehealth, which has already been expanded, should continue beyond the pandemic. Federal support for community behavioral health organizations should continue to offset state and local budget cuts and ensure provision of needed treatment. The capacity of social services should be expanded as well as systems that facilitate client connection to social services.

The mortality and psychological burden caused by response to COVID-19 outbreak.

The world is experiencing a severe COVID-19 outbreak. To control this outbreak, many governments in the world have imposed lockdown or quarantine measures. We hypothesize that these measures may cause additional mortality and morbidity in the (near) future due to delay in diagnosing diseases and other indirect effect on health (such as economic crisis). To support this hypothesis and to estimate the additional mortality that may linked to the COVID-19 controlling policy, we performed a step-by-step pragmatical approach. First, we chose a country (The Netherlands), and looked at the most common causes of mortality in this country. Then, we performed a literature study on the additional mortality when these causes were diagnosed late, and selected a paper with the most severe scenario. We also performed a literature study on the effect of economic crisis on additional mortality. The mortality data were then extrapolated to the demography of The Netherlands, and the results were compared with the present data on deaths directly due to COVID-19. Roughly, we forecast 388 additional deaths a week in The Netherlands in 5 years due to the direct and indirect effects of the lockdown measures. The most important implications of this hypothesis is that the additional mortality and increased mental health problem should be considered in evaluating the necessity of lock down and quarantine policy.