E-Cigarette Use among Sexual Minoritized Women and Nonbinary People Assigned Female at Birth: Assessing the Roles of Discrimination, Perceived Stress, and Social Support.

Background: Young adult sexual minoritized women (SMW) are at disproportionate risk for e-cigarette use, which may in part be due to excess minority stress imposed by discrimination exposure. While discrimination exposure is associated with risk for combustible tobacco/nicotine use among SMW, similar associations have yet to be tested with e-cigarettes. Moreover, it is unknown if discrimination-related risk may be mitigated by protective factors such as social support. This study examined concurrent associations of discrimination, perceived stress, and social support with past 30-day e-cigarette use in a sample of young adult SMW during the COVID-19 pandemic. Methods: N = 501 SMW and nonbinary people assigned female at birth (AFAB) aged 18-30 completed an online survey. A series of logistic regressions examined associations of discrimination, perceived stress, and four forms of social support received during the COVID-19 pandemic with past-30-day e-cigarette use. Results: Among SMW, greater perceived stress (OR = 1.10, p = .03), but not discrimination exposure, was associated with e-cigarette use. Associations of discrimination with e-cigarette use were nonsignificant when most forms of social support (emotional, material/financial, and virtual) were accounted for. Associations of perceived stress with e-cigarette use were strongest among those who needed but did not receive material support. Conclusions: Perceived stress, but not discrimination exposure, was associated with risk for e-cigarette use among young SMW during the COVID-19 pandemic. Effects of nonspecific stress may be compounded by insufficient material/financial support.

Sociodemographic and COVID-Related Predictors for Mental Health Condition of Mainland Chinese in Canada Amidst the Pandemic.

The current study investigates the mental health condition of Mainland Chinese in Canada and identifies the associated sociodemographic and COVID-19-related predictors. A sample of 471 Mainland Chinese aged 18 or older completed an online survey that collected information on demographics, experience, cognition, and behaviours related to the COVID-19 pandemic and mental health condition. Mental health condition was assessed with the Depression, Anxiety, and Stress Scale-21 (DASS-21) for the depression, anxiety, and stress levels of Mainland Chinese during the pandemic. Moderate to severe depression, anxiety, and stress levels were respectively reported by 11.30%, 10.83%, and 5.10% of respondents. Univariate analysis of variance models (ANOVAs) were conducted to assess mental health condition variance as stratified by independent sociodemographic- or COVID-19-related explanatory variables, to identify possible predictors to be entered into the subsequent regression models. The regression models identified age, income level, health status, and perceived discrimination as significant sociodemographic predictors (absolute value of ßs = 1.19-7.11, ps < 0.05), whereas self-infection worry, attitude towards Canadian measures, information confusion, food/goods stocking, and room cleaning/sanitizing were identified as significant COVID-19-reltaed predictors (absolute value of ßs = 1.33-3.45, ps < 0.05) for mental health outcomes. The results shed light on our understanding of the major factors associated with the mental health condition of Mainland Chinese in Canada during the COVID-19 pandemic.

Perceived discrimination based on the symptoms of covid-19, mental health, and emotional responses-the international online COVISTRESS survey.

BACKGROUND: Despite the potential detrimental consequences for individuals' health and discrimination from covid-19 symptoms, the outcomes have received little attention. This study examines the relationships between having personally experienced discrimination based on the symptoms of covid-19 (during the first wave of the pandemic), mental health, and emotional responses (anger and sadness). It was predicted that covid-19 discrimination would be positively related to poor mental health and that this relationship would be mediated by the emotions of anger and sadness. METHODS: The study was conducted using an online questionnaire from January to June 2020 (the Covistress network; including 44 countries). Participants were extracted from the COVISTRESS database (Ntotal = 280) with about a half declaring having been discriminated due to covid-19 symptoms (N = 135). Discriminated participants were compared to non-discriminated participants using ANOVA. A mediation analysis was conducted to examine the indirect effect of emotional responses and the relationships between perceived discrimination and self-reported mental health. RESULTS: The results indicated that individuals who experienced discrimination based on the symptoms of covid-19 had poorer mental health and experienced more anger and sadness. The relationship between covid-19 personal discrimination and mental health disappeared when the emotions of anger and sadness were statistically controlled for. The indirect effects for both anger and sadness were statistically significant. DISCUSSION: This study suggests that the covid-19 pandemic may have generated discriminatory behaviors toward those suspected of having symptoms and that this is related to poorer mental health via anger and sadness.

Social Support for Acculturative Stress, Job Stress, and Perceived Discrimination Among Migrant Workers Moderates COVID-19 Pandemic Depression.

Objectives: This study aimed to investigate the practical moderating effect of social support on the relationship between acculturative stress, job stress, and perceived discrimination, and depression among migrant workers during the coronavirus disease-19 pandemic as a vulnerable group susceptible to mental health problems. Methods: Data for this cross-sectional descriptive study were collected using an online survey from 214 Vietnamese and Cambodian migrant workers, who are among the largest migrant groups residing in South Korea. Participants were asked to report on acculturative stress, job stress, perceived discrimination, depression, and social support through questionnaires in their native languages. Results: The findings showed that acculturative stress affected depression, and this effect was moderated by social support. The impact of acculturative stress on depression was significant in the group with low mean scores of social support. However, the effect of the interaction of social support on the relationship of job stress and perceived discrimination to depression was not statistically significant. Conclusion: Our findings suggest the need for differentiated strategies to improve the mental health of migrant workers based on the level of social support.

Perceived discrimination as a modifier of health, disease, and medicine: empirical data from the COVID-19 pandemic.

Increasing reports of long-term symptoms following COVID-19 infection, even among mild cases, necessitate systematic investigation into the prevalence and type of lasting illness. Notably, there is limited data regarding the influence of social determinants of health, like perceived discrimination and economic stress, that may exacerbate COVID-19 health risks. Here, 1,584 recovered COVID-19 patients that experienced mild to severe forms of disease provided detailed medical and psychosocial information. Path analyses examined hypothesized associations between discrimination, illness severity, and lasting symptoms. Secondary analyses evaluated sex differences, timing of infection, and impact of prior mental health problems. Post hoc logistic regressions tested social determinants hypothesized to predict neurological, cognitive, or mood symptoms. 70.6% of patients reported presence of one or more lasting symptom after recovery. 19.4% and 25.1% of patients reported lasting mood or cognitive/memory problems. Perceived discrimination predicted increased illness severity and increased lasting symptom count, even when adjusting for sociodemographic factors and mental/physical health comorbidities. This effect was specific to stress related to discrimination, not to general stress levels. Further, patient perceptions regarding quality of medical care influenced these relationships. Finally, illness early in the pandemic is associated with more severe illness and more frequent lasting complaints. Lasting symptoms after recovery from COVID-19 are highly prevalent and neural systems are significantly impacted. Importantly, psychosocial factors (perceived discrimination and perceived SES) can exacerbate individual health risk. This study provides actionable directions for improved health outcomes by establishing that sociodemographic risk and medical care influence near and long-ranging health outcomes. All data from this study have been made publicly available.

Perceived Epidemic Risk and Depression Symptoms during the COVID-19 Pandemic: The Mediating Role of Security and the Moderation Role of Perceived Discrimination.

The 2019 coronavirus disease pandemic has resulted in a significant increase in the incidence and prevalence of mental health problems such as anxiety and depression, posing a threat to peoples' lives and health safety all over the world. Research suggests some potential relationships among perceived risk, discrimination, security, and depression symptoms. However, little attention has been paid to the complex mechanisms of the associations between these variables. This study aimed to examine the mediating role of security and moderation role of perceived discrimination in the prediction of perceived epidemic risk on depression symptoms. Thus, we aimed to identify if perceived epidemic risk is a positive predictor of depression. A cross-sectional study was conducted through an anonymous online survey in China during the COVID-19 pandemic which measured perceived epidemic risk, discrimination, security, and depression symptoms. A total of 3443 valid questionnaires were obtained. The results indicated that depression symptoms were predicted by perceived epidemic risk through the mediating role of security, and this mediating role of security was moderated by perceived discrimination. Specifically, high levels of perceived discrimination may lead to a significant decrease in personal security, thus clustering depressive symptoms. These findings shed light on the influence of the perceived risk of the epidemic on depression symptoms in the context of the epidemic situation, which may help to develop targeted interventions.

Mask Wearing and Perceived Discrimination Associated With COVID-19 in the United States From March 2020 to May 2021: Three-Level Longitudinal Analyses.

Although mask wearing has been demonstrated to be an effective strategy to combat the COVID-19 pandemic, it has become a contentious issue. This is evident in the policy shift regarding mask wearing during the pandemic and the varying mask mandates across different states in the United States. This study investigates the relationship between mask wearing and COVID-19-associated discrimination (CAD) over the course of the pandemic (March 2020 through May 2021), and differences between states with and without mask mandates. This study utilized three-level longitudinal analyses to analyze a longitudinal panel data from a nationally representative sample of U.S. adults enrolled in the Understanding America Study (UAS). The experiences of CAD were much higher for those wearing a mask than those not wearing a mask before August 2020, but this pattern was reversed afterward. Another notable finding was that mask wearers reported greater CAD in states with no mask-wearing mandate than the ones in states with mask mandates. In contrast, the pattern was reversed for nonmask wearers. The findings highlight the importance of inclusiveness and openness when relatively new health practice is introduced during a public health crisis.

Assessment of Psychological Responses and Related Factors of Discharged Patients Who Have Been Hospitalized with COVID-19.

BACKGROUND: COVID-19 is the biggest pandemic of the last century. While a large number of cases and mortality rates direct the research to the clinic and prognosis of the disease, the mental health of these patients has recently become a matter of concern. This study aims to predict psychiatric morbidity and possible associated markers in COVID-19 survivors. SUBJECTS AND METHODS: A total of 102 survivors with COVID-19 infection participated in this study. A questionnaire was applied to the participants to evaluate demographic variables, history of comorbid diseases, smoking, loss of a relative due to COVID-19, and environmental attitudes after the discharge. Length of hospitalization, lung findings, intensive care history and treatments were recorded. Psychiatric morbidities were evaluated with General Anxiety Disorder-7, Patient Health Questionnaire-9 and The National Stressful Events Survey PTSD Short Scale. RESULTS: Anxiety was found in 20.6%, depression in 13.7% based on moderate and above levels, 21.6% had significant PTSD. Female gender, history of psychiatric and comorbid diseases, smoking, perceived discrimination, and lack of long-lasting immunity posed a risk in terms of psychological response. There was a negative correlation between age and depression scores. No relation was found between the duration of hospitalization, presence of lung involvement, receiving intensive care treatment, losing a relative due to COVID-19 and psychological response. CONCLUSIONS: On patients treated for COVID-19 infection, psychological response continue after discharge. Mental health support and efforts to reduce stigma among infected subjects can reduce the psychological impact caused by the pandemic.

COVID-19 patient accounts of illness severity, treatments and lasting symptoms.

First-person accounts of COVID-19 illness and treatment can complement and enrich data derived from electronic medical or public health records. With patient-reported data, it is uniquely possible to ascertain in-depth contextual information as well as behavioral and emotional responses to illness. The Novel Coronavirus Illness Patient Report (NCIPR) dataset includes complete survey responses from 1,584 confirmed COVID-19 patients ages 18 to 98. NCIPR survey questions address symptoms, medical complications, home and hospital treatments, lasting effects, anxiety about illness, employment impacts, quarantine behaviors, vaccine-related behaviors and effects, and illness of other family/household members. Additional questions address financial security, perceived discrimination, pandemic impacts (relationship, social, stress, sleep), health history, and coping strategies. Detailed patient reports of illness, environment, and psychosocial impact, proximal to timing of infection and considerate of demographic variation, is meaningful for understanding pandemic-related public health from the perspective of those that contracted the disease.

COVID-19 Experiences and Social Distancing: Insights From the Theory of Planned Behavior.

PURPOSE: The objective of this study is to identify the relationship between COVID-19 experiences, perceived COVID-19 behavioral control, social norms and attitudes, and future intention to follow social distancing guidelines. DESIGN: This is a cross-sectional study. SETTING: Participants responded to an on-line survey in June 2020. SUBJECTS: The study included 3,183 residents within Quebec, Canada aged 18 and over. MEASURES: Measures include perceived COVID-19 related discrimination, fear of COVID-19 infection, prior exposure to COVID-19, and prior social distancing behavior. Participants self-reported attitudes, perceived behavioral control, and perceived norms related to social distancing. Finally, we measured social distancing behavioral intention. ANALYSIS: We evaluated a theory of planned behavior (TPB) measurement model of social distancing using confirmatory factor analysis (CFA). The association between COVID-19 perceived discrimination, fear of infection, previous social distancing behavior, exposure to COVID-19, TPB constructs and behavioral intentions to social distance were estimated using SEM path analysis. RESULTS: TPB constructs were positively associated with intention to follow social distancing guidelines. Fear of COVID-19 infection and prior social distancing behavior were positively associated with behavioral intentions. In contrast, perceived discrimination was negatively associated with the outcome. Associations between fear of COVID-19, perceived COVID-19 discrimination and behavioral intentions were partially mediated by constructs of TPB. CONCLUSIONS: COVID-19 prevention efforts designed to emphasize positive attitudes, perceived control, and social norms around social distancing should carefully balance campaigns that heighten fear of infection along with anti- discrimination messaging.

Occupational Stress and Mental Health Among Healthcare Workers Serving Socially Vulnerable Populations During the COVID-19 Pandemic.

The purpose of this study was to analyze occupational and personal stressors, mental health indicators, perceived discrimination and help-seeking behaviors among healthcare workers and providers (HCWPs) serving socially vulnerable groups such as immigrants, refugees, farmworkers, homeless individuals, people living in poverty, and other disadvantaged populations in the United States (U.S.) during the COVID-19 pandemic. Using a cross-sectional descriptive approach, we gathered information between July and September 2020, from a sample of 407 affiliates of two national organizations of clinic-based HCWPs who worked at federally funded and community safety-net clinics. Informed consent was obtained from all participants who completed a self-administered online survey available in English and Spanish. Our results indicated that the HCWPs serving vulnerable groups in the midst of the pandemic experienced high levels of occupational and personal stressors as well as anxiety and depressive symptomology. Major occupational stressors were excessive workload, long working-hours, and institutional barriers to refer and follow-up on their clients' access to needed social services. High-rated personal stressors included sleep disorders, lack of and child-care, partner's loosing job, and other family related situations. Our findings suggest that HCWPs working with vulnerable populations need specialized interventions that bolster their mental health and well-being as the pandemic continues to unfold. We recommend implementing initiatives that encourage HCWPs' to be actively involved in clinic decisions regarding employee safety and protection as well as in management decisions to improve work place infrastructure and capacity to respond to the social needs of their clients. Lessons learned from the pandemic are useful tools in designing protocols for addressing the mental-health needs of HCWPs in health-care organizations that attend to socially underprivileged populations.

Subjective Well-Being among Parents of Children with Special Educational Needs in Hong Kong: Impacts of Stigmatized Identity and Discrimination under Social Unrest and COVID-19.

The COVID-19 pandemic and social unrest have posed a unique set of challenges to Hong Kong. During these two social events, parents of children with special educational needs (SEN) who were already experiencing caregiving pressure, likely coped with additional stressors; they were at a higher risk of mental health problems. A pre-registered, cross-sectional survey study was carried out among 234 Hong Kong parents of children with SEN, investigating the associations of stigmatized identity, perceived discrimination, and subjective well-being under the impact of these social events. Utilizing the Bayesian modelling, we found that highly self-stigmatized parents not only perceived more daily-life discriminating behaviors against them, but also reported having higher distress, more negative emotions, and lower life satisfaction. A higher perceived impact of social events and more discrimination were also associated with lower well-being. Additionally, stigmatized identity, perceived discrimination, and perceived impact of social events demonstrated unique associations with well-being variables, indicating they were substantial stressors. The study called out for public attention to the mental health conditions among parents of children with SEN and other disadvantaged groups in society.

Relation of perceived discrimination with depression, insomnia and post-traumatic stress in COVID-19 survivors.

The study's objective was to study the association of perceived discrimination with depression, insomnia and post-traumatic stress in people recovered from coronavirus disease (COVID-19) in Santa Marta, Colombia. COVID-19 survivors were invited to participate. The authors measured perceived discrimination related to COVID-19 (COVID-19 Perceived Stigma Scale), depression (PHQ-9), insomnia (Athens Insomnia Scale), and post-traumatic stress (Brief Davidson Trauma Scale). Three hundred thirty COVID-19 survivors participated in the research; the participants were between 18 and 89 years; 61.52% were females. 32.12% of the participants reported high perceived discrimination; 49.70%, depression; 60.61%, insomnia; and 13.33% post-traumatic stress. After adjusting for age, gender, and income, depression, insomnia, and post-traumatic stress were associated significantly with discrimination perceived by COVID-19. Perceived discrimination is a social stressor that affects the psychological well-being of people recovered from COVID-19. In the follow-up of this group of patients, it is important to consider the impact of perceived discrimination on psychological well-being.

Mental Health Burden of the COVID-19 Pandemic in Healthcare Workers in Four Latin American Countries.

The aim of the study was to assess the mental health burden of the COVID-19 pandemic in healthcare workers in four Latin American countries in 2020.An online survey was carried out with 1721 participants from Argentina, Chile, Colombia and Mexico in 2020. A non-probabilistic convenience sampling method was used to recruit voluntary participants. Post-traumatic stress symptoms were assessed with the SPRINT-E scale, Perceived Discrimination was assessed with a Spanish version of the scale developed by Molero, and anxiety toward death was assessed with the Spanish version of the Templer scale. All instruments were assessed for internal consistency.The overall frequency of post-traumatic stress symptoms was 23.9%. The frequency by countries was 26.4% in Argentina, 29.8% in Chile, 19.9 in Colombia, and 23.8% in Mexico. Post-traumatic stress symptoms were associated with individual subtle discrimination, anxiety toward the death of the elderly, lack of Personal Protective Equipment, and exposition to the death.The COVID-19 pandemic has imposed a mental health burden on health workers in the countries included in the study, not only due to the implications of the disease in the face of exposure to death, but also due to institutional conditions and in which they carry out their work.

The COVID-19/racial injustice syndemic and mental health among Black Americans: The roles of general and race-related COVID worry, cultural mistrust, and perceived discrimination.

This study explored intersecting concerns about COVID-19 and racial injustice against Black people in the United States using a syndemic perspective. Findings from a multistate COVID-19 needs assessment project examined the association of general and race-related concerns about COVID-19 and concerns about police violence against Black people with mental health symptoms in a sample of 2480 Black Americans. The role of cultural mistrust in vaccination status was also examined. Concerns about COVID-19 were positively associated with concerns about police violence and associated with worse mental health. Nonvaccinated individuals were higher in cultural mistrust but lower in perceived discrimination than vaccinated individuals. Perceived discrimination partially mediated the relationship between race-related concerns about COVID-19 and mental health symptoms. Findings can inform the development of culturally responsive strategies to address the syndemic effects of COVID-19 and racial injustice.

Stress and perceived discrimination among the Arab population in Israel: the mediation role of the perceived COVID-19 threat and trust in the healthcare system.

During pandemics, minorities may experience high stress levels, which could harm their mental and physical health. However, to the best of our knowledge, this has not been examined among minorities in Israel during the COVID-19 pandemic. This study, therefore, explores stress among the Arab minority in Israel during the first wave of the COVID-19 outbreak, and its association with the population's perceived COVID-19 threat, trust in the healthcare system, adherence to preventative guidelines, and perceived discrimination.The study analyzed a cross-sectional online survey of 626 Israeli Arabs. Most participants (65%) reported moderate levels of stress, and 10% reported severe levels. The Bedouin population reported significantly higher levels of stress compared to other minority groups. The participants also reported a high degree of perceived threat, a moderate-to-high level of discrimination, a moderate level of trust in the healthcare system, and very high adherence to guidelines.Hierarchical regression analysis showed that age, religion, trust in the healthcare system, perceived threat, and adherence to guidelines were all significant predictors of stress [F(11,600), p < .001]. The model explained 24% of the variance in stress. Structural equation modeling (SEM) revealed that the participants' perceived threat and trust mediated the association between their perceived discrimination and stress [indirect effect = 0.13, SE = 0.03 CI = (0.08, 0.18)], whereby discrimination was negatively associated with trust (ß = -0.52), which, in turn, was negatively associated with stress (ß = -0.10). Furthermore, discrimination was positively associated with perceived threat (ß = 0.21), which, in turn, was positively associated with stress (ß = 0.35). Discrimination is an important social determinant of health - especially during health emergencies when trust in healthcare systems and perceived threats are crucial. As such, our findings could assist policymakers in developing fair policies that are tailored to various population groups and that may reduce stress levels among minorities, thereby improving both their mental and physical health.

Evolution of intersectional perceived discrimination and internalized stigma during COVID-19 lockdown among the general population in Spain.

BACKGROUND: Stigma and discrimination have been associated with different diseases and pandemics, with negative consequences for the people who suffered them and for their communities. Currently, COVID-19 has become a new source of stigmatization. AIMS: The aim of the present study is to analyze longitudinally the evolution of intersectional perceived discrimination and internalized stigma among the general population of Spain, at three points in time throughout the confinement. METHOD: Participants completed an online survey. RESULTS: Results show an increase in both variables from the first to the second evaluation, and a slight decrease from the second to the third evaluation. Moreover, these changes are explained by depression, anxiety and family support. CONCLUSIONS: These findings indicate the factors that need to be considered to reduce the perception of discrimination and the internalization of stigma, and their detrimental consequences, during an especially stressful event such as the current pandemic outbreak.