Factors associated with suicidal ideation in the French nationwide EPICOV study

Introduction: The COVID-19 pandemic seems associated with a worsening in mental health issues as well as a widening of preexisting social and health inequalities. Assessment of its impact on suicidal behavior might therefore be relevant. Objective(s): To assess factors associated with suicidal ideation in the general population, using data from the French nationwide Epicov study Methods: In the nationally representative Epicov study, data on occurrence of suicidal ideation from November 2019 to November 2020 were available, including timing with respect to France's lockdown periods. We studied the incidence of suicidal ideation among participants without a prior history of suicidal behavior, after May 11, 2020, when first COVID-19 related lockdown was suspended. Studied factors assessed sociodemographic and health status, including mental health, as well as COVID-19 related information such as symptom. Associations between selected factors and suicidal ideation were assessed in sex-stratified adjusted logistic regression models. Result(s): In the Epicov study, prevalence of suicidal ideation was of 2,9%, as opposed to around 4% pre-pandemic.Among 48 702 female and 41 016 male participants, health or financial issues were associated with a higher incidence of suicidal ideation. Interestingly, Covid19-like symptoms were also associated with higher risk of suicidal ideation.While an impairedmental health has been observed in survivors of past pandemics, given the unprecedented context of the current pandemic, this association needs further investigation. Conclusion(s): While the COVID-19 pandemic might have lowered suicidal ideation, it's aftermaths may reverse the trend. To prevent this rise, identification of vulnerable groups is crucial to promote tailored public health strategies.

Non-participation to a longitudinal and interventional survey on the psychological impact of the COVID-19 pandemic among healthcare workers (PSYCOVER) in France

Introduction: We conducted a national longitudinal survey among healthcare workers in the context of the Covid-19 pandemic, (1) to assess mental health and (2) to describe the results of an intervention to improve capacity of resilience. Non-participation is rarely studied despite being an important methodological matter when performing studies on mental health. Objective(s): The study aims to describe and identify the factors associated with non-participation of healthcare workers to the intervention part of a national longitudinal study on the psychological impact of the COVID-19 pandemic. Method(s): Participants were recruited from April to October 2021 via an Internet link widely disseminated. Data collected include participant' socio-demographic, occupational and working conditions, general health, professional burnout and mental health. The intervention proposed the use of tools for self-management of stress and resilience (PsySTART-Responder and Anticipate.Plan.DeterTM program). A robust Poisson regression was used to identify factors associated with non-participation. Result(s): Among 724 participants, 41% participated to the intervention part. Factors associated to non-participation to the intervention were to work with few or no COVID-19 patients, and low scores in the anxiety scale. Social determinants, occupational characteristics or general health were not associated with non-participation. Conclusion(s): Our study provides a better understanding of the participation of healthcare workers that was not frequently studied. The results logically suggest lower participation among those with better mental health and not directly concerned with management of COVID-19 patients. Non-participation to the intervention was not associated with social factors, which is an argument in favour of using such a design/intervention in a socially heterogeneous population.

Symptoms of anxiety/depression during the COVID-19 pandemic and associated lockdown in the community: longitudinal data from the TEMPO cohort in France

Introduction: The COVID-19 pandemic and associated preventive measures have an impact on the persons' mental health, including increasing risk of symptoms of anxiety and depression in particular. Individual experiencing mental health difficulties in the past could be especially vulnerable during lockdown, however, few studies have tested this empirically considering preexisting mental health difficulties using longitudinal data. Objective(s): The objective of this study is to examine the longitudinal association between preexisting symptoms of anxiety/depression and symptoms of anxiety/depression during lockdown due to the COVID-19 pandemic in a community sample. Method(s): Seven waves of data collection were implemented from March-May 2020. Generalized estimation equations models were used to estimate the association between preexisting symptoms of anxiety/depression and symptoms of anxiety/depression during lockdown among 662 mid-aged individuals from the French TEMPO cohort. Result(s): We found an elevated odds ratio of symptoms of anxiety/ depression (OR=6.73 95% [CI=4.45-10.17]) among individuals experiencing such symptoms prior lockdown. Furthermore, the odds of symptoms of anxiety/depression during lockdown was elevated among women (OR=2.07 [95% CI=1.32-3.25]), subjects with low household income (OR=2.28 [1.29-4.01]) and persons who reported loneliness (OR=3.94 [2.47-6.28]). Conclusion(s): This study demonstrates a strong relationship between preexisting symptoms of anxiety/depression and anxiety/depression during the COVID-19 outbreak among mid-aged French adults. The findings underline the role of preexisting symptoms of anxiety/depression as a vulnerability factor of anxiety/depression during lockdown. Furthermore, the study shows that loneliness is independently associated with symptoms of anxious/depression, when controlling for prior anxiety/ depression symptoms.

Remote mental health care interventions during the COVID-19 pandemic: An umbrella review.

Mitigating the COVID-19 related disruptions in mental health care services is crucial in a time of increased mental health disorders. Numerous reviews have been conducted on the process of implementing technology-based mental health care during the pandemic. The research question of this umbrella review was to examine what the impact of COVID-19 was on access and delivery of mental health services and how mental health services have changed during the pandemic. A systematic search for systematic reviews and meta-analyses was conducted up to August 12, 2022, and 38 systematic reviews were identified. Main disruptions during COVID-19 were reduced access to outpatient mental health care and reduced admissions and earlier discharge from inpatient care. In response, synchronous telemental health tools such as videoconferencing were used to provide remote care similar to pre-COVID care, and to a lesser extent asynchronous virtual mental health tools such as apps. Implementation of synchronous tools were facilitated by time-efficiency and flexibility during the pandemic but there was a lack of accessibility for specific vulnerable populations. Main barriers among practitioners and patients to use digital mental health tools were poor technological literacy, particularly when preexisting inequalities existed, and beliefs about reduced therapeutic alliance particularly in case of severe mental disorders. Absence of organizational support for technological implementation of digital mental health interventions due to inadequate IT infrastructure, lack of funding, as well as lack of privacy and safety, challenged implementation during COVID-19. Reviews were of low to moderate quality, covered heterogeneously designed primary studies and lacked findings of implementation in low- and middle-income countries. These gaps in the evidence were particularly prevalent in studies conducted early in the pandemic. This umbrella review shows that during the COVID-19 pandemic, practitioners and mental health care institutions mainly used synchronous telemental health tools, and to a lesser degree asynchronous tools to enable continued access to mental health care for patients. Numerous barriers to these tools were identified, and call for further improvements. In addition, more high quality research into comparative effectiveness and working mechanisms may improve scalability of mental health care in general and in future infectious disease outbreaks.

Are we socially equally at risk of smoking during the COVID-19 pandemic? French data from 2009-2021 : Astrid Juhl Andersen

Background Since 2020, the COVID-19 pandemic has greatly affected people including a significant increase in mental health difficulties. Cigarette smoking is found to be strongly associated with mental health conditions, which is why the pandemic might have influenced the secular decline in smoking rates observed over recent years. Persons belonging to socioeconomically disadvantaged groups may be particularly affected, both because the pandemic is found to exacerbate existing social inequalities and because this group was more likely to smoke before the pandemic. We examined the prevalence of smoking in a French cohort study, focusing on differences between educational attainment. In addition, we examined the association between educational level and interpersonal changes in tobacco consumption from 2018 to 2021. Methods The TEMPO cohort study included 1785 French adults followed between 1991 and 2021. With four assessments of smoking status available before and two after the onset of COVID-19, we estimated the smoking prevalence over time stratified by highest obtained diploma. We studied interpersonal change in smoking status between 2018 and 2021 among 148 smokers, using multinomial logistic regression. Results The prevalence of smokers was higher among those with low educational attainment compared with those with higher diploma at all timepoints. The difference between the two groups increased from 2020 to 2021 (4.8% to 9.4%). Smokers with high educational level were more likely to decrease their tobacco consumption from 2018-2021 compared to low educated smokers (aOR=2.72 [1.26;5.89]). Conclusions Current findings showed a widening of the socioeconomic gap over time in smoking rates, which emphasizes the vulnerability of persons with low educational attainment to smoking, also during the pandemic. Key messages • The existing gap in smoking prevalence between lower and higher diploma groups has increased from 2020 to 2021, which may be a consequence of the COVID-19 pandemic. • From 2018 to 2021, people with high school as highest qualification were less likely to decrease their tobacco use compared to higher educated people.

Comportements de prévention et recours aux soins des personnes en centre d'herbegement social durant la première vague de COVID-19 en France

Introduction La première vague de la pandémie COVID-19 a surpris par sa rapidité et son ampleur et a conduit au confinement de la population à compter du 17/03/2020. Nous savons maintenant que cette épidémie a creuser les inégalités sociales de santé et limité l'accès aux soins des plus vulnérables. Une des mesures prises par les autorités sanitaires a été d'ouvrir des centres d'hébergement pour les personnes sans abris Covid-19 positives. L'objectif de ce travail était de décrire l'application des mesures barrières et d'objectiver les renoncements aux soins chez les personnes hébergées durant la première vague. Matériels et méthodes L'étude épidémiologique transversale ECHO a été mise en place du 2/05/2020 au 10/06/2020 au sein de 18 centres d'hébergements d'Ile de France et de Lyon et a inclus des personnes hébergées majeures consentantes à qui un questionnaire était administré en français ou dans la langue du participant à l'aide d'Interservice migrants par téléphone. Résultats Au total, parmi les 929 personnes éligibles, 666 personnes se sont vues proposées l'enquete et 535 ont participé. Les participants étaient le plus souvent des hommes (75,3 %), jeunes (âge médian 31 ans), célibataires (86 %) et sans enfants (79 %), nés à l'étranger (89 %) dont 59 % en Afrique et 74 % sans titre de séjour, avec une faible maitrise du français (54 %) et un niveau scolaire inférieur au égal au secondaire (84 %), sans emploi 73 % et 33 % sans couverture maladie. Au total 33 % ignorait que le coronavirus pouvait être transmis par des personnes asymptomatiques, 66 % avaient peur d'attraper le covid, et 22 % déclaraient manquer d'informations officielles ou de confiance dans celles ci. Les gestes barrières étaient bien connu, mais seuls 68 % savaient qu'il était préférable d'éviter les transports en commun et/ou de sortir. La moindre connaissance des gestes barrière était associée à l'utilisation des réseaux sociaux et à un page de moins de 24 ans. L'intention vaccinale contre le Covid-19 était de 59 %, meilleur chez les femmes et plus faible en cas de meilleure littératie en santé. Un besoin de soins non lié au Covid-19 a été rapporté par 33 % des participants, plus souvent en cas de maladie chronique ou de syndrome dépressif. Un renoncement aux soins a été rapporté par 19 % des participants, plus souvent en cas de situation administrative irrégulière ou d'antécédent de renoncement aux soins. Conclusion Les personnes en hébergement social adhéraient globalement aux gestes barrières mais étaient nombreux à avoir renoncer aux soins pendant la première vague. Les facteurs expliquant les comportements de santé étaient multifactoriels, liés à la fois à la connaissance et à la perception de l'épidemie, qu'à l'état de santé et à la situation administrative. Aucun lien d'intérêt

Children's mental and behavioral health, schooling, and socioeconomic characteristics during school closure in France due to COVID-19: the SAPRIS project

COVID-19 limitation strategies have led to widespread school closures around the world. The present study reports children's mental health and associated factors during the COVID-19 school closure in France in the spring of 2020. We conducted a cross-sectional analysis using data from the SAPRIS project set up during the COVID-19 pandemic in France. Using multinomial logistic regression models, we estimated associations between children's mental health, children's health behaviors, schooling, and socioeconomic characteristics of the children's families. The sample consisted of 5702 children aged 8-9 years, including 50.2% girls. In multivariate logistic regression models, children's sleeping difficulties were associated with children's abnormal symptoms of both hyperactivity-inattention (adjusted Odds Ratio (aOR) 2.05;95% Confidence Interval 1.70-2.47) and emotional symptoms (aOR 5.34;95% CI 4.16-6.86). Factors specifically associated with abnormal hyperactivity/inattention were: male sex (aOR 2.29;95% CI 1.90-2.76), access to specialized care prior to the pandemic and its suspension during school closure (aOR 1.51;95% CI 1.21-1.88), abnormal emotional symptoms (aOR 4.06;95% CI 3.11-5.29), being unschooled or schooled with assistance before lockdown (aOR 2.13;95% CI 1.43-3.17), and tutoring with difficulties or absence of a tutor (aOR 3.25;95% CI 2.64-3.99;aOR 2.47;95% CI 1.48-4.11, respectively). Factors associated with children's emotional symptoms were the following: being born pre-term (aOR 1.34;95% CI 1.03-1.73), COVID-19 cases among household members (aOR 1.72;95% CI 1.08-2.73), abnormal symptoms of hyperactivity/inattention (aOR 4.18;95% CI 3.27-5.34) and modest income (aOR 1.45;95% CI 1.07-1.96;aOR 1.36;95% CI 1.01-1.84). Multiple characteristics were associated with elevated levels of symptoms of hyperactivity-inattention and emotional symptoms in children during the period of school closure due to COVID-19. Further studies are needed to help policymakers to balance the pros and cons of closing schools, taking into consideration the educational and psychological consequences for children.

Symptoms of emotional difficulties and hyperactivity/inattention among children during the COVID-19 epidemic and associated lockdown: data from the SAPRIS project

Background COVID-19 limitation strategies led to widespread school closures around the world. The present study aims to provide a description of children's mental health and associated factors during the COVID-19 school closure in France. Methods We conducted a cross-sectional analysis in the SAPRIS study during the COVID-19 pandemic in France, relying on 2 ongoing national birth cohorts, ELFE and EPIPAGE 2. Using weighted multinomial logistic regression models, we estimated associations between children's mental health (i.e., hyperactivity/inattention and emotional symptoms;assessed by the Strengths and Difficulties Questionnaire), children's health behaviors, schooling, as well as sociodemographic and socioeconomic characteristics of children family. Results The sample consisted of 5702 children aged 8 - 9 years and 49.3% girls. Sleep disturbance and parents' dominant socio-professional category were associated with both hyperactivity-inattention (adjusted Odds Ratio (aOR)=2.10 95%Confidence Interval [1.85-2.38];aOR=0.45 [0.33-0.61] respectively) and emotional symptoms and (aOR=6.33 [5.26-7.63];aOR=0.62 [0.39-0.98] respectively). Specifically associated with hyperactivity/inattention were: male sex (aOR=2.51 [2.24-2.82]), presence of regular care and its pursuit during school closure (aOR=1.69 [1.33-2.15]), emotional symptoms (aOR=2.74 [2.23-3.37]), school situation (aOR=2.19 [1.69-2.82]), presence of tutoring and difficulties with it (aOR=2.56 [2.13-3.08]), type of housing (aOR=0.79 [0.70-0.89]). Factors associated with emotional symptoms were: presence of covid cases in the household (aOR=2.33 [1.92-2.82]), hyperactivity/inattention (aOR=2.94 [2.45-3.52]) and financial difficulties (aOR=1.71 [1.39-2.11]). Conclusions Policy makers need to balance pros and cons of closing schools, taking into consideration educational and psychological consequences for children and the various factors associated with mental health.

COVID-19 vaccine hesitancy among persons living in homeless shelters in France.

COVID-19 vaccine hesitancy is frequent and can constitute a barrier to the dissemination of vaccines once they are available. Unequal access to vaccines may also contribute to socioeconomic inequalities with regard to COVID-19. We studied vaccine hesitancy among persons living in homeless shelters in France between May and June 2020 (n = 235). Overall, 40.9% of study participants reported vaccine hesitancy, which is comparable to general population trends in France. In multivariate regression models, factors associated with vaccine hesitancy are: being a woman (OR = 2.55; 95% CI 1.40-4.74), living with a partner (OR = 2.48, 95% CI 1.17-5.41), no legal residence in France (OR = 0.51, 95% CI 0.27-0.92), and health literacy (OR = 0.38, 95% CI 0.21, 0.68). Our results suggest that trends in vaccine hesitancy and associated factors are similar among homeless persons as in the general population. Dissemination of information on vaccine risks and benefits needs to be adapted to persons who experience severe disadvantage.

Knowledge, attitudes, practices and impact of COVID-19 among persons living in homeless shelters in France: first results of the echo study

Introduction - People experiencing socioeconomic disadvantage appear to have been especially impacted by the COVID-19 epidemic. Multiple factors could constitute obstacles to the implementation of preventive measures of SARS-CoV-2 infection and to access to health care. Persons experiencing socioeconomic disadvantage could also be more impacted by the social and economic consequences of the sanitary crisis. We aimed to study the knowledge, attitudes and practices related to the COVID-19 epidemic and its impact among persons living in homeless shelters in France. Methods - ECHO is a cross-sectional study conducted in 18 homeless shelters mostly in the Paris and Lyon regions from the 2d of May to the 7th of June 2020, during and just after the first COVID-19-related lockdown. The questionnaire was delivered by trained interviewers, with the help of an interpreter whenever needed. Results - Among the 535 participants who were included, we observed a good level of knowledge of COVID-19 symptoms and satisfactory acceptance of preventive and curative measures (ex. tests, isolation). Associated factors include age, schooling level, health literacy, duration of residence in the shelter and region of origin. An important proportion of participants reported not being able to access healthcare for non-related COVID-19 reasons during lockdown, and seeing their mental health and socioeconomic situation deteriorate.