Increased Difficulties Managing Chronic Medical Conditions During the COVID-19 Pandemic Are Associated With Increased Alcohol and Cannabis Use Among Unhoused and Unstably Housed Women.

OBJECTIVES: The COVID-19 pandemic caused dramatic upsurges in stress and anxiety across the United States, as well as increased substance use to cope with pandemic-related stress. Few studies have focused exclusively on extremely disadvantaged individuals who are already at risk for substance use. We sought to understand factors associated with increased alcohol and cannabis use during the first 10 months of the COVID-19 pandemic among unsheltered and unstably housed women. METHODS: Between July and December 2020, we conducted phone surveys with San Francisco unhoused and unstably housed women regarding substance use, health, and health services use since the beginning of the pandemic (March 2020). RESULTS: Among 128 participants, increased use of alcohol and cannabis were reported by 15% and 23%, respectively. The odds of increased use of both substances were 4 times higher in participants who also had increased difficulties managing symptoms of a chronic medical condition during the pandemic. CONCLUSIONS: An intentional and comprehensive approach to managing the health of particularly vulnerable individuals during the COVID pandemic could help alleviate its exacerbating influences. Such an approach should include resources, tools and interventions for managing substance use, as well as chronic, non-COVID medical conditions, which are common and strongly tied to substance use in unhoused and unstably housed women.

Depression, anxiety, and burnout among hospital workers during the COVID-19 pandemic: A cross-sectional study.

OBJECTIVES: Healthcare personnel have faced unprecedented mental health challenges during the COVID-19 pandemic. The study objective is to assess differences in depression, anxiety, and burnout among healthcare personnel with various occupational roles and whether financial and job strain were associated with these mental health outcomes. METHODS: We employed an anonymous survey between July and August 2020 at an urban county hospital in California, USA. We assessed depression, anxiety, and burnout using validated scales, and asked questions on financial strain and job strain. We performed logistic and linear regression analyses. RESULTS: Nurses (aOR 1.93, 95% CIs 1.12, 3.46), social workers (aOR 2.61, 95% CIs 1.35, 5.17), service workers (aOR 2.55, 95% CIs 1.20, 5.48), and administrative workers (aOR 2.93, 95% CIs 1.57, 5.61) were more likely than physicians to screen positive for depression. The odds of screening positive for anxiety were significantly lower for ancillary workers (aOR 0.32, 95% CIs 0.13-0.72) compared with physicians. Ancillary (aB = -1.77, 95% CIs -1.88, -0.47) and laboratory and pharmacy workers (aB -0.70, 95% CI -1.34, -0.06) reported lower levels of burnout compared with physicians. Financial strain partially accounted for differences in mental health outcomes across job categories. Lack of time to complete tasks and lack of supervisory support were associated with higher odds of screening positive for depression. Less job autonomy was associated with higher odds of screening positive for anxiety and higher burnout levels. CONCLUSIONS: We found significant disparities in mental health outcomes across occupational roles. Policies to mitigate the adverse impact of COVID-19 on health workers' mental health should include non-clinical staff and address financial support and job characteristics for all occupational roles.

Clinical sequelae among individuals with pauci-symptomatic or asymptomatic Ebola virus infection and unrecognised Ebola virus disease in Liberia: a longitudinal cohort study.

BACKGROUND: Whether or not individuals with pauci-symptomatic or asymptomatic Ebola virus infection and unrecognised Ebola virus disease develop clinical sequelae is unknown. We assessed current symptoms and physical examination findings among individuals with pauci-symptomatic or asymptomatic infection and unrecognised Ebola virus disease compared with Ebola virus disease survivors and uninfected contacts. METHODS: Between June 17, 2015, and June 30, 2017, we studied a cohort of Ebola virus disease survivors and their contacts in Liberia. Surveys, current symptoms and physical examination findings, and serology were used to characterise disease status of reported Ebola virus disease, unrecognised Ebola virus disease, pauci-symptomatic or asymptomatic Ebola virus infection, or no infection. We pre-specified findings known to be differentially prevalent among Ebola virus disease survivors versus their contacts (urinary frequency, headache, fatigue, muscle pain, memory loss, joint pain, neurological findings, chest findings, muscle findings, joint findings, abdominal findings, and uveitis). We estimated the prevalence and incidence of selected clinical findings by disease status. FINDINGS: Our analytical cohort included 991 reported Ebola virus disease survivors and 2688 close contacts. The median time from acute Ebola virus disease onset to baseline was 317 days (IQR 271-366). Of 222 seropositive contacts, 115 had pauci-symptomatic or asymptomatic Ebola virus infection and 107 had unrecognised Ebola virus disease. At baseline, prevalent findings of joint pain, memory loss, muscle pain, and fatigue were lowest among those with pauci-symptomatic or asymptomatic infection or no infection, higher among contacts with unrecognised Ebola virus disease, and highest in reported survivors of Ebola virus disease. Joint pain was the most prevalent finding, and was reported in 434 (18%) of 2466 individuals with no infection, 14 (12%) of 115 with pauci-symptomatic or asymptomatic infection, 31 (29%) of 107 with unrecognised Ebola virus disease, and 476 (48%) of 991 with reported Ebola virus disease. In adjusted analyses, this pattern remained for joint pain and memory loss. Survivors had an increased odds of joint pain compared with unrecognised Ebola virus disease contacts (adjusted odds ratio [OR] 2·13, 95% CI 1·34-3·39); unrecognised Ebola virus disease contacts had an increased odds of joint pain compared with those with pauci-symptomatic or asymptomatic infection and uninfected contacts (adjusted OR 1·89, 95% CI 1·21-2·97). The adjusted odds of memory loss was more than four-times higher among survivors than among unrecognised Ebola virus disease contacts (adjusted OR 4·47, 95% CI 2·41-8·30) and two-times higher among unrecognised Ebola virus disease contacts than in those with pauci-symptomatic or asymptomatic infection and uninfected contacts (adjusted OR 2·05, 95% CI 1·10-3·84). By 12 months, prevalent findings had decreased in the three infected groups. INTERPRETATION: Our findings provide evidence of post-Ebola virus disease clinical sequelae among contacts with unrecognised Ebola virus disease but not in people with pauci-symptomatic or asymptomatic Ebola virus infection. FUNDING: National Cancer Institute and National Institute of Allergy and Infectious Diseases of the National Institutes of Health.

Food insufficiency and mental health service utilisation in the USA during the COVID-19 pandemic.

OBJECTIVE: To estimate the association between food insufficiency and mental health service utilisation in the USA during the COVID-19 pandemic. DESIGN: Cross-sectional study. Multiple logistic regression models were used to estimate the associations between food insufficiency and mental health service utilisation. SETTING: US Census Household Pulse Survey data collected in October 2020. PARTICIPANTS: Nationally representative sample of 68 611 US adults. RESULTS: After adjusting for sociodemographic factors, experiencing food insufficiency was associated with higher odds of unmet mental health need (adjusted OR (AOR) 2·90; 95 % CI 2·46, 3·43), receiving mental health counselling or therapy (AOR 1·51; 95 % CI 1·24, 1·83) and psychotropic medication use (AOR 1·56; 95 % CI 1·35, 1·80). Anxiety and depression symptoms mediated most of the association between food insufficiency and unmet mental health need but not the associations between food insufficiency and either receiving mental health counselling/therapy or psychotropic medication use. CONCLUSIONS: Clinicians should regularly screen patients for food insufficiency, especially in the wake of the COVID-19 pandemic. Expanding access to supplemental food programmes may help to mitigate the need for higher mental health service utilisation during the COVID-19 pandemic.

Prevalence and Sociodemographic Correlates of Unmet Need for Mental Health Counseling Among Adults During the COVID-19 Pandemic.

OBJECTIVE: This study aimed to determine the prevalence and correlates of unmet need for mental health counseling among U.S. adults during the COVID-19 pandemic. METHODS: Data from the December 9-21, 2020, cross-sectional Household Pulse Survey (N=69,944) were analyzed. RESULTS: Overall, 12.8% of adults reported an unmet need for mental health counseling in the past month, including 25.2% of adults with a positive screen for depression or anxiety. Among adults with a positive screen, risk factors associated with an unmet need for mental health counseling included female sex, younger age, income below the federal poverty line, higher education, and household job loss during the pandemic, while protective factors included Asian and Black race. CONCLUSIONS: Over one-quarter of U.S. adults with a positive screen for depression or anxiety experienced an unmet need for mental health counseling during the pandemic. Policy makers should consider increasing funding for mental health services as part of pandemic relief legislation.

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.

Job Insecurity and Symptoms of Anxiety and Depression Among U.S. Young Adults During COVID-19.

PURPOSE: This study aimed to estimate the associations between job insecurity and symptoms of anxiety and depression among U.S. young adults amidst the COVID-19 pandemic. METHODS: We analyzed data on young adults aged 18-26 years from June 15 to June 30, 2020, from the weekly, cross-sectional Household Pulse Survey (n = 4,852) conducted by the U.S. Census Bureau. Two job insecurity measures and four anxiety and depression measures were analyzed using multivariable Poisson regression models adjusting for age, sex, race/ethnicity, education, and marital status. RESULTS: Fifty-nine percent of participants experienced direct or household employment loss since the start of the COVID-19 pandemic, and 38% were expected to experience direct or household employment loss in the coming 4 weeks. Recent direct or household employment loss and expected direct or household employment loss, among participants who did not experience recent employment loss, were associated with a greater risk of poor mental health on all four measures. CONCLUSIONS: U.S. young adults experience a significant mental health burden as a result of job insecurity amidst the COVID-19 pandemic.

Perspective: The Convergence of Coronavirus Disease 2019 (COVID-19) and Food Insecurity in the United States.

During the coronavirus disease 2019 (COVID-19) pandemic, food insecurity has doubled overall and tripled among households with children in the United States. Food insecurity and COVID-19 may exacerbate one another through bidirectional links, leading to a syndemic, or sequential disease clusters, which exacerbate one another. Experiencing food insecurity may be associated with macronutrient and micronutrient deficiencies, which can weaken host defenses, thus increasing susceptibility to COVID-19. Food insecurity is associated with chronic medical conditions, which may afford a higher risk of severe COVID-19 illness. People experiencing food insecurity may have increased exposure to COVID-19 while procuring food. People with COVID-19 may be unable to work, generate income, and procure food while quarantined, which may exacerbate food insecurity. Clinicians should screen for food insecurity during the COVID-19 pandemic and provide referrals to food-assistance programs when appropriate. Policymakers should expand benefits for the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to address increases in the depth and breadth of food insecurity during the COVID-19 pandemic.

A conceptual model for understanding the rapid COVID-19-related increase in food insecurity and its impact on health and healthcare.

Food insecurity, a well-established determinant of chronic disease morbidity and mortality, is rapidly increasing due to the coronavirus disease 2019 (COVID-19) pandemic. We present a conceptual model to understand the multiple mechanisms through which the economic and public health crises sparked by COVID-19 might increase food insecurity and contribute to poor health outcomes in the short- and long-term. We hypothesize that, in the short-term, increased food insecurity, household economic disruption, household stress, and interruptions in healthcare will contribute to acute chronic disease complications. However, the impact of the pandemic on food security will linger after social-distancing policies are lifted and the health system stabilizes, resulting in increased risk for chronic disease development, morbidity, and mortality among food-insecure households in the long-term. Research is needed to examine the impact of the pandemic-related increase in food insecurity on short- and long-term chronic health outcomes, and to delineate the underlying causal mechanisms. Such research is critical to inform the development of effective programs and policies to address food insecurity and its downstream health impacts during COVID-19 and future pandemics.