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.

Effect of online peer support on mental health among patients of post-acute sequelae of SARS-CoV-2 infection: A systematic review (preprint)

Background Psychosocial burdens of the post-acute sequelae of SARS-CoV-2 infection (PASC) are an emerging public health concern. Online peer support is expected to be effective in improving the mental health of PASC patients. However, the effectiveness of these treatments remains unclear. This study investigated the effectiveness of online peer support for improving the mental health of PASC patients.Methods We searched the MEDLINE, PsycINFO/PsycArticles, and Japan Medical Abstracts Society electronic databases for studies on June 12, 2023. The inclusion criteria for studies were as follows: 1) patients with post-COVID-19 conditions over 18 years of age; 2) conducted online peer support exposure or intervention; 3) measured mental health-related outcomes using quantity scales; and 4) peer-reviewed original articles written in English or Japanese. We excluded qualitative studies that did not use quantitative scales to measure outcomes and original peer-reviewed articles. We conducted risk of bias assessments with the Risk of Bias Assessment instrument designed for non-randomized studies (RoBANS).Results A total of 157 studies were retrieved, and two met the inclusion criteria. The total numbers of participants in the two studies were 239 and 47, respectively. One was a cohort study, and the other was a pre-post study; neither had a control group. Most participants in both studies were middle-aged women or female from high-income European countries. Exposure or intervention included sharing sources of support (e.g., experiences, knowledge, and expertise) and peer support combined with workshops for the self-management of physical and mental health facilitated by trained medical experts. The effectiveness of online peer support on mental health outcomes was also assessed. Two studies reported significant improvements in work productivity, functional status, quality of life, self-efficacy, and well-being. Both studies were rated as high or unclear in most risk-of-bias domains. No meta-analysis was performed because of the small number of included studies.Conclusions Few studies examine online peer support for improving mental health-related outcomes among PASC patients, and evidence of its effectiveness is unclear. Well-designed studies are required to conduct meta-analyses to evaluate the effectiveness of online peer support for PASC patients.

Psychological distress after COVID-19 recovery and subsequent prolonged post-acute sequelae of COVID-19: A longitudinal study with 1-year follow-up in Japan. (preprint)

Background: This study investigated the longitudinal association between psychological distress in the post-acute phase and the subsequent prolonged post-acute sequelae of COVID-19 (PASC) among individuals with PASC. Methods: An online longitudinal survey with 1-year interval was conducted from July to September 2021 (T1) and July to September 2022 (T2). Individuals who were 20-years-old or older, had a positive Polymerase Chain Reaction test, were one month post-infection, and did not select 'Nothing' to a question regarding PASC presence were included. The primary outcome was the presence of PASC at T2. The presence of general, respiratory, muscular, neurological, gastrointestinal, dermatological, and cardiac symptoms at T2 was also used as an outcome among patients with relevant symptoms at time 1 (T1). Exposure was measured using the Kessler distress scale (K6) at T1, and those whose K6 was 13 or higher were identified as having psychological distress. Marginal structure models with robust standard errors were used to examine the association between psychological distress at T1 and any PASC symptoms at T2, and the associations between psychological distress and each symptom at T2 among participants with relevant symptoms at T1. Results: A total of 1674 patients were analyzed; 17% had psychological distress. ; In total, 818 (48.9%), 523 (31.2%), and 672 (40.1%) patients reported general, respiratory, and neurological symptoms at T1, respectively. Individuals with psychological distress had higher odds of any symptoms at T2 (Odds Ratio [OR] =1.81, 95% Confidence Interval [CI]= 1.08 - 3.03) and general and respiratory symptoms at T2 among participants with relevant symptoms at T1 (OR = 1.95, 95% CI = 1.02 - 3.76; OR = 2.44, 95% CI = 1.03 - 5.80). Conclusion: Psychological distress in the post-acute phase may lead to prolonged PASC symptoms, mainly general and respiratory symptoms, at the 1-year follow-up in individuals with PASC.

Inequality on the frontline: A multi-country study on gender differences in mental health among healthcare workers during the COVID-19 pandemic (preprint)

Purpose Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with data from previous crises suggesting women may be particularly vulnerable. The objective of the study was to examine individual and social factors that may be associated with gender differences in psychological distress and depressive symptoms among HCWs during the initial COVID-19 pandemic outbreak and to examine the consistency of these differences across a diverse range of countries.Methods Data were collected in a cross-sectional design between March 2020 and February 2021 as part of the COVID-19 HEalth caRe wOrkErS (HEROES) study. 32,410 HCWs recruited across 22 countries completed the General Health Questionnaire-12 (GHQ-12), the Patient Health Questionnaire-9 (PHQ-9), and questions about pandemic-relevant exposures.Results Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including less access to sufficient personal protective equipment and less support from colleagues than men; however, men reported increased contact with COVID-19 patients. At the country-level, HCWs working in countries with higher gender inequality reported lower levels of mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress among women but not among men.Conclusion Our findings suggest that among HCWs, women may have been disproportionately exposed to several COVID-19-relevant stressors at the individual and country-level. This highlights the importance of considering gender in emergency response efforts to protect women’s well-being and ensure adequate healthcare system preparedness during future public health crises.

Difference in the Risk of Discrimination on Psychological Distress Experienced by Early Wave Infected and Late Wave Infected COVID-19 Survivors (preprint)

The psychological distress experienced by coronavirus disease of 2019 (COVID-19) survivors after recovery from the illness is amplified by discrimination endured because of their infection status. However, the difference in the risk of facing discrimination and risk of experiencing psychological distress in the early and late waves of the COVID-19 pandemic remain unclear. This study aimed to investigate whether the risk of facing discrimination because of infection status was lower in the early or late waves and whether risk of discrimination on psychological distress was more serious in later, rather than earlier waves. We conducted two online surveys to collect data from survivors divided into two groups. The participants with scores of five or more on the Kessler Psychological Distress Scale were identified as having experienced psychological distress. The participants were identified as having experienced discrimination based on infection status if they had endured being blamed, some type of discrimination, or having themselves or their families maligned. The timing of infection was split into infected during early waves of the pandemic for 2021 participants and infected during later waves of the pandemic for 2022 participants. Modified Poisson regression analyses were performed using experiences of discrimination as dependent variables and timing of infection as independent variables. Modified Poisson regression analyses were further performed using the presence of psychological distress as a dependent variable and experiences of discrimination and timing of infection as dependent variables, in addition to interaction effect of these independent variables. The data of 6,010 participants who were infected in early waves and 5,344 participants who were infected in later waves were analyzed. The risks of being blamed, some forms of discrimination, and participants and their families being maligned were significantly lower in the group who were infected in later waves than those infected in earlier waves. Experiences of discrimination were highly associated with psychological distress in those infected in later waves than those infected in earlier waves, while only being blamed showed a significant association. Risk of discrimination was found to be lower in those infected in later waves, whereas risk of discrimination on psychological distress was shown to be more serious in those infected in later waves. Therefore, we submit that it is more important to support COVID-19 survivors who face discrimination, than it is to attempt to decrease the current discriminatory climate caused by the COVID-19 pandemic.

Adverse Childhood Experiences and living in the socially deprived areas in adulthood: A cross-sectional study of the nationwide data in Japan (preprint)

Objectives: This study aimed to examine whether having adverse childhood experiences (ACEs) was associated with living in a deprived area in adulthood.  Methods: The cross-sectional study was conducted by using nationwide data in 2022 of the Japan COVID-19 and Society Internet Survey (JACSIS). Participants were community dwelling people 18 years or older. ACEs were assessed by Japanese version of 15-items ACE measurement tool (ACE-J). Living condition was measured by Area Deprived Index (ADI) and Densely Inhabited District (DID) based on zip code. Multivariable logistic regression to analyze the associations between ADI and ACE 4+ was conducted, controlling for individual-level factors, such as age, sex, marital status, and education, as an additional analysis.  Results: The total of 27,967 participants were included in the analysis. The prevalence of emotional neglect, childhood poverty, and school bullying were 34.5%, 21.9%, 20.0%, respectively. More than 70.1% of the population had one or more ACE(s). The number of ACEs was associated with significantly higher risk of living in deprived area in the adulthood (p<0.001). ACEs were not associated with living in density area. The association between ADI and ACEs 4+ was non-significant after controlling the individual-level factors.  Conclusion: People with higher number of ACEs tend to live in deprived areas in adulthood. Policy makers in highly deprived areas can apply the trauma-informed approach for the community care and support, which is critical to mitigating deficit perspectives and facilitating comprehensive support for those who experience ACEs.

Effect of a Smartphone-Based Stress Management Program on Depression and Other Health- and Work-Related Outcomes among Hospital Nurses in the COVID-19 Pandemic in Vietnam and Thailand: A Protocol of a Randomized Controlled Trial of the COCONATS Project (preprint)

The aim of this study is to describe a research protocol of a multi-country randomized controlled trial to investigate the effect of a smartphone CBT stress management program on improving depression and other health- and work-related outcomes among hospital nurses in Vietnam and Thailand during the COVID-19 epidemic as a part of the COCONATS project. The study is a two-arm, parallel randomized control trial. Hospital nurses (N = 1,500) will be recruited in Vietnam and Thailand, and those who meet the criteria will be randomly allocated to the intervention or control (treatment as usual) group. A seven-week, seven-module smartphone-based stress management program will be developed to teach CBT skills. The intervention group will participate in the program for 10 weeks. Depression as the primary outcome will be measured using the DASS21 at baseline and in 3- and 6-month follow-up surveys. A mixed model repeated measures analysis will be used to test the intervention effect in the total combined sample, on an intention-to-treat basis. This is the first study to investigate the effectiveness of a self-guided smartphone CBT program on improving depression among hospital nurses using a RCT design in South-East Asian middle-income countries during the COVID-19 pandemic.

Relationship between cognition and emotions caused by the COVID-19 infection, and depression and anxiety (preprint)

Background Although negative cognition and emotions are known to develop with experiences of COVID-19 infection, it remains unclear whether such cognitions and emotions contribute to depression and anxiety as post-acute symptoms of COVID-19. We aimed to investigate the relationships between cognition and emotions caused by COVID-19 infection and depression and anxiety.Methods A cross-sectional survey of COVID-19 recovered patients was conducted from July to September 2021 in Japan. Outcome variables, depression and anxiety were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7); scores of 10 and above were identified as having symptoms of depression and anxiety, respectively. Exposure variables were whether participants were experiencing the following cognition and emotions strongly: threat to life due to COVID-19 infection, helplessness regarding COVID-19 infection, blaming a third party who did not restrain from going outside, blaming themselves for their COVID-19 infection, worry about spreading the infection to others, and self-stigma (Self-Stigma Scale-Short). Modified Poisson regression analyses were performed to analyze the findings.Results A total of 6016 responses were included in the analyses. The proportion of depression was 19.88%, and anxiety was 11.47%. The threat of life due to COVID-19 infection, helplessness regarding COVID-19 infection, blaming oneself for their COVID-19 infection, and self-stigma were significantly associated with depression and anxiety after adjusting covariates. Blaming the third party who did not restrain from going outside was associated with anxiety. There was no association between the worry about spreading to others and depression or anxiety.Conclusion Negative cognition and emotions, including self-stigma with the experience of COVID-19 infection, were related to depression and anxiety. Countermeasures for preventing or decreasing the cognition and emotions may be needed to mitigate these symptoms.

Differences in the Course of depression and anxiety After COVID-19 Infection Between Recovered Patients With and Without a Psychiatric History: A Cross-Sectional Study (preprint)

Background: This study aimed to examine the course of Depression and anxiety in COVID-19 survivors with a psychiatric history compared with those without a psychiatric history. Methods: A web-based cross-sectional survey for COVID-19 survivors was conducted from July to September 2021. 6016 COVID-19 survivors, the accuracy of whose responses was determined to be assured, were included in analyses. Exposures included psychiatric history and time since COVID-19 infection, and the main outcomes and measures included severity of depression and anxiety, as assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Results: Mean severity of PHQ-9 and GAD-7 were significantly higher in participants with a psychiatric history than in those without a psychiatric history. Two-way analysis of covariance for PHQ-9 showed a significant main effect of the presence of psychiatric history and a significant interaction effect of psychiatric history × time since infection. Two-way analysis of covariance for the GAD-7 score revealed a significant main effect of the presence of psychiatric history and time since COVID-19 infection and the interaction effect of these factors. Conclusions: The course of depression and anxiety was more severe in COVID-19 survivors with a psychiatric history than in those without a psychiatric history.

The effect of social restrictions, loss of social support, and loss of maternal autonomy on postpartum depression in 1 to 12-months postpartum women during the COVID-19 pandemic (preprint)

Background This study focuses on postpartum women, who are one of the most vulnerable populations during the COVID-19 pandemic, aiming to reveal mental health consequences of social restrictions, loss of social support, or loss of autonomy. Methods A cross-sectional study for postpartum women was conducted in October 2020 (N = 600). The Edinburgh Postpartum Depression Scale (EPDS) was used to measure postpartum depression. The prevalence ratios were estimated by log-binomial regression models, adjusting for age, education, household income, residence area, parity, the timing of delivery, and a prior history of depression. Results The prevalence of postpartum depression was 28.7% (EPDS ≥ 9), 18.6% (≥ 11), and 13.1% (≥ 13). Social restrictions including cancellation of home visits by health care professionals, or cancellation of infant checkups or vaccinations, loss of support during pregnancy or after delivery including loss of opportunities to consult with health care professionals or friends, or cancellation of parents or other family members’ visits to support, and loss of autonomy about delivery or breastfeeding, were associated with postnatal depression. Conclusion About 30% of women who delivered and raised a baby during the COVID-19 pandemic had postpartum depression, which is much higher than a pre-pandemic meta-analysis. COVID-19 related social restrictions or loss of social support from healthcare professionals, family, and friends were significantly associated with postpartum depression. Also, loss of maternal autonomy in delivery and breastfeeding is associated with postpartum depression. The results indicate that both formal and informal support should not be limited to prevent postpartum depression during the pandemic.