Impact of work arrangements during the COVID-19 pandemic on mental health in France.

•Symptoms of anxiety/depression were found in 28.8% of the participants at least once.•Unemployment and financial difficulties were associated with anxiety/depression.•Targeted mental health support could lessen mental health impact.

Application of machine learning to predict transport modes from GPS, accelerometer, and heart rate data.

BACKGROUND: There has been an increased focus on active transport, but the measurement of active transport is still difficult and error-prone. Sensor data have been used to predict active transport. While heart rate data have very rarely been considered before, this study used random forests (RF) to predict transport modes using Global Positioning System (GPS), accelerometer, and heart rate data and paid attention to methodological issues related to the prediction strategy and post-processing. METHODS: The RECORD MultiSensor study collected GPS, accelerometer, and heart rate data over seven days from 126 participants living in the Ile-de-France region. RF models were built to predict transport modes for every minute (ground truth information on modes is from a GPS-based mobility survey), splitting observations between a Training dataset and a Test dataset at the participant level instead at the minute level. Moreover, several window sizes were tested for the post-processing moving average of the predicted transport mode. RESULTS: The minute-level prediction rate of being on trips vs. at a visited location was 90%. Final prediction rates of transport modes ranged from 65% for public transport to 95% for biking. Using minute-level observations from the same participants in the Training and Test sets (as RF spontaneously does) upwardly biases prediction rates. The inclusion of heart rate data improved prediction rates only for biking. A 3 to 5-min bandwidth moving average was optimum for a posteriori homogenization. CONCLUSION: Heart rate only very slightly contributed to better predictions for specific transport modes. Moreover, our study shows that Training and Test sets must be carefully defined in RF models and that post-processing with carefully chosen moving average windows can improve predictions.

Housing environment and mental health of Europeans during the COVID-19 pandemic: a cross-country comparison.

Many studies have investigated the impact of the COVID-19 pandemic on mental health. Throughout the pandemic, time spent at home increased to a great extent due to restrictive measures. Here we set out to investigate the relationship between housing conditions and the mental health of populations across European countries. We analyzed survey data collected during spring 2020 from 69,136 individuals from four cohorts from Denmark, France, and the UK. The investigated housing conditions included household density, composition, and crowding, access to outdoor facilities, dwelling type, and urbanicity. The outcomes were loneliness, anxiety, and life satisfaction. Logistic regression models were used, and results were pooled using random-effects meta-analysis. In the meta-analysis, living alone was associated with higher levels of loneliness (OR = 3.08, 95% CI 1.87-5.07), and lower life satisfaction (OR = 1.27, 95% CI 1.05-0.55), compared to living with others. Not having access to an outdoor space and household crowding were suggestively associated with worse outcomes. Living in crowded households, living alone, or lacking access to outdoor facilities may be particularly important in contributing to poor mental health during a lockdown. Addressing the observed fundamental issues related to housing conditions within society will likely have positive effects in reducing social inequalities, as well as improving preparedness for future pandemics.

Longitudinal survey on the Psychological Impact of the COVID-19 Pandemic in Healthcare Workers (PsyCOVer) in France: study protocol.

INTRODUCTION: In the pandemic, healthcare professionals face even higher levels of stress. It is therefore a priority to estimate the impact of the pandemic on mental health and to propose targeted strategies to improve resilience. The aims of the study were to (1) assess the mental health of healthcare professionals working with patients with COVID-19 and identify social determinants that may increase the risk of negative outcomes; and (2) test the effectiveness of an intervention to improve the resilience of healthcare professionals in France. METHODS AND ANALYSIS: To evaluate the first objective, a national longitudinal study will be carried out among healthcare professionals working with patients with COVID-19. Participants will be recruited via an internet link that will be widely disseminated on social media, mailing lists, medical boards and French medical journals. Primary outcomes are mental health distress/symptoms and resilience. Secondary outcomes are burnout, social and occupational supports and substance use. To meet the second objective, an interventional study will be conducted. The main outcome is the effectiveness of the PsySTART-Responder and the Anticipate.Plan.Deter program. Qualitative analyses will be conducted to understand the strategies used to cope with the pandemic. ETHICS AND DISSEMINATION: The study protocol was approved by the Sorbonne Université Ethical Committee (No 2020-CER-2020-27) and was declared to French Commission on Information Technology and Liberties, CNIL (N°2222413, 20-05-2021). The results of this study will provide a better understanding of mental health and social inequalities in mental health among healthcare professionals working in the pandemic; data about the effectiveness of the PsySTART-Responder and the Anticipate.Plan.Deter interventional program in France.

Risk and protective factors related to children's symptoms of emotional difficulties and hyperactivity/inattention during the COVID-19-related lockdown in France: results from a community sample.

OBJECTIVE: The COVID-19 epidemic has spread worldwide since December 2019. To contain it, preventive measures including social distancing, economic shutdown, and school closures were introduced, carrying the risk of mental health burden in adults and children. Although the knowledge base regarding children's response to trauma and adverse events in general has broadened, descriptions of their mental health during epidemics remain scarce. In particular, the role of family socioeconomic characteristics and parental mental health are poorly understood. METHODS: We assessed the correlates of children's emotional difficulties and symptoms of hyperactivity/inattention during the COVID-19 lockdown in a French community-based sample. Data came from 432 community-based parents (27-46 years, TEMPO cohort) and their children (mean age 6.8 ± 4.1) interviewed online. Children's symptoms of emotional difficulties and hyperactivity/inattention were assessed using the parent-reported Strengths and Difficulties Questionnaire during the 5th week of home confinement. Family socioeconomic characteristics and parental mental health and substance use were assessed weekly during the first 5 weeks of home confinement. Data were analyzed using logistic regression models. RESULTS: 7.1% of children presented symptoms of emotional difficulties and 24.7% symptoms of hyperactivity/inattention. Family financial difficulties and parental symptoms of anxiety and depression, as well as children's sleeping difficulties and screen time, were associated with the presence of psychological difficulties. CONCLUSION: Children's emotional and behavioural difficulties are associated with parental mental health and socioeconomic difficulties. In the unprecedented situation of the COVID-19 epidemic, parents and professionals involved in caring for children should pay special attention to their mental health needs.

Smoking cessation using preference-based tools among socially disadvantaged smokers: study protocol for a pragmatic, multicentre randomised controlled trial.

INTRODUCTION: Many smoking cessation aids such as nicotine replacement treatments and e-cigarettes have been proven effective in aiding smoking cessation attempts. Encouraging smokers with low socioeconomic position (SEP) to choose their smoking aid tool based on their preferences, and giving that tool free of charge, might increase the odds of smoking cessation. This trial examines the effectiveness of the 'STOP' (Sevrage Tabagique à l'aide d'Outils dédiés selon la Préférence: Smoking cessation using preference-based tools), a preference-based smoking cessation intervention for smokers with low SEP. METHODS AND ANALYSIS: The STOP study is a randomised, multicentre, controlled trial (RCT). Smokers with low SEP and wishing to quit will be randomised to either the intervention or the control group (standard care). Participants in the intervention group will be asked to choose between different types of nicotine substitutes (patches, inhalers, gum, tablets, etc) and/or an electronic cigarette which will be delivered free of charge to aid their smoking cessation attempt.The primary outcome will be smoking abstinence at 6 months after inclusion, defined as self-reported 7-day point prevalence of tobacco abstinence. Secondary outcomes include the total number of days of abstinence at 6 months after inclusion, 7-day point prevalence tobacco abstinence at 1 and 3 months after inclusion and number of relapses.The study will also include an economic evaluation, and a process evaluation using a mixed methods approach. ETHICS AND DISSEMINATION: The study was approved by the 'Île de France II' Institutional Review Board on 8 September 2020 (CPP Île de France II; Ref No: 20.01.31.65528 RIPH2 HPS), and results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT04654585.

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

BACKGROUND: To cope with the COVID-19 pandemic, social distancing restrictions where implemented in France, which could have led to social isolation. This is expected to have affected the mental health situation, including increasing risk of symptoms of anxiety and depression in the general population. Persons with prior mental health difficulties could be an especially vulnerable group, however, few studies have tested this empirically considering preexisting mental health difficulties. We examine the association between preexisting symptoms of anxiety/depression and anxiety/depression during lockdown due to the COVID-19 pandemic in a longitudinal community sample. METHODS: A longitudinal follow-up during lockdown (data collection March-June 2020) was implemented among participants of the TEMPO cohort. Prior knowledge of anxiety/depression was included from prior waves of data collection. 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. RESULTS: Individuals with symptoms of anxiety/depression measured prior to lockdown had 6.73 higher odds [95% CI = 4.45-10.17] of symptoms of anxiety/depression during lockdown. Additionally, the likelihood 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 being lonely (OR = 3.94 [95% CI = 2.47-6.28]). CONCLUSIONS: Our study underlines the role of preexisting symptoms of anxiety/depression as a vulnerability factor of anxiety/depression during lockdown. Interventions focusing on individuals with mental health difficulties as well as people feeling lonely should be considered, to reduce the psychological impact of the COVID-19 pandemic.

Impact of COVID-19-like symptoms on occurrence of anxiety/depression during lockdown among the French general population.

BACKGROUND: The outbreak of the COVID-19 epidemic lead to high levels of morbidity and mortality around the globe. Consequences of this outbreak and possible associated infection are an increase in mental health disorders and an increased likelihood of internalizing problems, particularly depression. However, to date few studies have tested this hypothesis while taking into account individuals' preexisting mental health difficulties. METHODS: We used longitudinal data collected among 729 persons in the context of the French TEMPO cohort between March and June 2020 (7 waves of data collection). COVID-19-like symptoms as well as anxiety/depression (assessed by the Adult Self Report), were reported at each wave of data collection. To study the relationship between COVID-19-like symptoms and anxiety/depression, we used generalized estimation equation (GEE) models controlled for socio-demographic and health-related characteristics, including anxiety/depression prior to 2020. RESULTS: Overall, 27.2% of study participants reported anxiety/depression during lockdown. 17.1% of participants reported COVID-19-like symptoms during the course of follow-up, 7.3% after the beginning of lockdown, with an average number of 2.7 symptoms, and 3.6% reported respiratory distress. In multivariate analyses, nearly all the considered indicators of COVID-19-like symptoms were associated with higher odds of symptoms of anxiety/depression (symptoms Yes/No: OR = 1.66, 95% CI = 1.08-2.55; symptoms after the beginning of lockdown: OR = 1.91, 95% CI = 1.03-3.52; number of symptoms: OR for each additional symptom = 1.19, 95% CI = 1.02-1.39. This relationship exists after taking into account prior symptoms of anxiety/depression, which are associated with a 5-fold increased likelihood of psychological distress. And this impact is stronger among men than women. CONCLUSIONS: Our study shows higher risk of anxiety/depression among persons who experienced COVID-19-like symptoms, even after accounting for prior mental health difficulties. COVID-19 infection could have both a direct and indirect impact on the occurrence of psychological difficulties, and this association should be studied in greater detail.

The short-term association between exposure to noise and heart rate variability in daily locations and mobility contexts.

BACKGROUND: Personal exposure to noise has been shown to be associated with concomitant increases and lagged decreases of short-term heart rate variability (HRV). It is however unknown whether this association differs between contexts defined by visited places or mobility as both exposure sources and expectations may be different between these contexts. METHOD: Between July 2014 and June 2015, the RECORD MultiSensor Study collected sound level and heart rate data for 75 participants, aged 34-74 years, in their living environments for 7 days using a personal dosimeter and electrocardiography sensor on the chest. Their whereabouts were collected using a GPS receiver and a mobility survey. Short-term concomitant and lagged associations between sound level and HRV parameters were assessed within types of visited places and transport modes using mixed effects models with a random intercept for participants. RESULTS: Increases in sound level were associated with a concomitant increase in all HR/HRV parameters, and delayed decreases in the overall HRV. Interactions between the sound level and the visited place/mobility context were documented. Compared with home, the concomitant association of sound level with HR and rMSSD was doubled within active and private-motorized transport modes, respectively. CONCLUSIONS: The association of sound level with HR/HRV varies between visited places/mobility contexts. Future studies investigating these context-dependent associations in ambulatory settings will need to assess additional acoustical factors relating to the visited environments as well as non-acoustical factors impacting the perception of noise.

Spatial access to sport facilities from the multiple places visited and sport practice: Assessing and correcting biases related to selective daily mobility.

BACKGROUND: Studies investigating the association between spatial accessibility to environmental resources from the various places a person visits during daily activities and use of corresponding resources often do not account for potential biases related to selective daily mobility. This bias occurs when accessibility is also measured from places intentionally visited to access the resources of interest. The aim of this study was to examine associations between spatial accessibility to sports facilities from multiple places and sport practice while addressing the selective daily mobility bias. METHODS: The second wave of the RECORD Cohort was used to examine the relationship between the spatial accessibility to sport facilities and the practice of three sport categories (swimming, racket, and team sports), using multilevel linear probability models (n = 5327 participants) adjusted for individual and contextual characteristics. Street network distance to the nearest sport facility was considered as a measure of spatial accessibility [from the residence; from the residence and workplace; from all visited locations (full activity space), biased; and from all locations excluded those visited for sports (truncated activity space), corrected]. RESULTS: The residential and residential-workplace accessibility to facilities was not associated with sport practice. The spatial accessibility to facilities from all places visited (full activity space) was associated with the practice of the three categories of sports (biased relationships). After correcting the bias (truncated activity space), the strength of the relationships was markedly reduced. An association remained only for swimming sports. CONCLUSION: This study underlines the need to account for selective daily mobility bias when determining spatial accessibility to resources from the various places visited. Such bias, if not addressed, may result in overestimated associations between spatial accessibility and use, leading to potentially erroneous conclusions in terms of planning.

Short-term association between personal exposure to noise and heart rate variability: The RECORD MultiSensor Study.

BACKGROUND: Studies revealed long-term associations between noise exposure and cardiovascular health, but the underlying short-term mechanisms remain uncertain. OBJECTIVES: To explore the concomitant and lagged short-term associations between personal exposure to noise and heart rate variability (HRV) in a real life setting in the Île-de-France region. METHODS: The RECORD MultiSensor Study collected between July 2014 and June 2015 noise and heart rate data for 75 participants, aged 34-74 years, in their living environments for 7 days using a personal dosimeter and electrocardiography (ECG) sensor on the chest. HRV parameters and noise levels were calculated for 5-min windows. Short-term relationships between noise level and log-transformed HRV parameters were assessed using mixed effects models with a random intercept for participants and a temporal autocorrelation structure, adjusted for heart rate, physical activity (accelerometry), and short-term trends. RESULTS: An increase by one dB(A) of A-weighted equivalent sound pressure level (Leq) was associated with a 0.97% concomitant increase of the Standard deviation of normal to normal intervals (SDNN) (95% CI: 0.92, 1.02), of 2.08% of the Low frequency band power (LF) (95% CI: 1.97, 2.18), of 1.30% of the High frequency band power (HF) (95% CI: 1.17, 1.43), and of 1.16% of the LF/HF ratio (95% CI: 1.10, 1.23). The analysis of lagged exposures to noise adjusted for the concomitant exposure illustrates the dynamic of recovery of the autonomic nervous system. Non-linear associations were documented with all HRV parameters with the exception of HF. Piecewise regression revealed that the association was almost 6 times stronger below than above 65 Leq dB(A) for the SDNN and LF/HF ratio. CONCLUSION: Personal noise exposure was found to be related to a concomitant increase of the overall HRV, with evidence of imbalance of the autonomic nervous system towards sympathetic activity, a pathway to increased cardiovascular morbidity and mortality.

A GPS-Based Methodology to Analyze Environment-Health Associations at the Trip Level: Case-Crossover Analyses of Built Environments and Walking.

Environmental health studies have examined associations between context and health with individuals as statistical units. However, investigators have been unable to investigate momentary exposures, and such studies are often vulnerable to confounding from, for example, individual-level preferences. We present a Global Positioning System (GPS)-based methodology for segmenting individuals' observation periods into visits to places and trips, enabling novel life-segment investigations and case-crossover analysis for improved inferences. We analyzed relationships between built environments and walking in trips. Participants were tracked for 7 days with GPS receivers and accelerometers and surveyed with a Web-based mapping application about their transport modes during each trip (Residential Environment and Coronary Heart Disease (RECORD) GPS Study, France, 2012-2013; 6,313 trips made by 227 participants). Contextual factors were assessed around residences and the trips' origins and destinations. Conditional logistic regression modeling was used to estimate associations between environmental factors and walking or accelerometry-assessed steps taken in trips. In case-crossover analysis, the probability of walking during a trip was 1.37 (95% confidence interval: 1.23, 1.61) times higher when trip origin was in the fourth (vs. first) quartile of service density and 1.47 (95% confidence interval: 1.23, 1.68) times higher when trip destination was in the fourth (vs. first) quartile of service density. Green spaces at the origin and destination of trips were also associated with within-individual, trip-to-trip variations in walking. Our proposed approach using GPS and Web-based surveys enables novel life-segment epidemiologic investigations.