Prospective examination of mental health in university students during the COVID-19 pandemic

BackgroundThe impact of changing social restrictions on the mental health of students during the COVID-19 pandemic warrants exploration. AimsTo prospectively examine changes to university students mental health during the pandemic. MethodsStudents completed repeated online surveys at three time points (October 2020 (baseline), February 2021, March 2021) to explore relationships between demographic and psychological factors (loneliness and positive mood) and mental health outcomes (depression, anxiety, and stress). ResultsA total of 893 students participated. Depression and anxiety levels were higher at all timepoints than pre-pandemic normative data (p<.001). Scores on all mental health measures were highest in February, with depression and anxiety remaining significantly higher in March than baseline. Female students and those with previous mental health disorders were at greatest risk of poor mental health outcomes. Lower positive mood and greater loneliness at baseline were associated with greater depression and anxiety at follow-ups. Baseline positive mood predicted improvement of depression and anxiety at follow-ups. ConclusionDepression and anxiety were significantly higher than pre-pandemic norms, with female students and those with previous mental health difficulties being at greatest risk. Given these elevated rates, universities should ensure adequate support is available to meet potentially increased demand for services.

The prevalence, incidence, prognosis and risk factors for depression and anxiety in a UK cohort during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic had profound immediate impacts on population mental health. However, in whom the effects may be prolonged is less clear. AimsTo investigate the prevalence, incidence, prognosis, and risk factors for depression and anxiety reported in a UK cohort over three distinct periods in the pandemic in 2020. MethodAn online survey was distributed to a UK community cohort (n=3097) at three points: April (baseline), July-September (T2) and November-December (T3). Participants completed validated measures of depression and anxiety on each occasion and we prospectively explored the role of socio-demographic factors and psychological factors (loneliness, positive mood, perceived risk of and worry about COVID-19) as risk factors. ResultsDepression (PHQ-9 means - baseline: 7.69, T2: 5.53, T3: 6.06) and anxiety scores (GAD-7 means -baseline: 6.59, T2: 4.60, T3: 4.98) were considerably greater than pre-pandemic population norms. Women reported greater depression and anxiety than men. Being younger, having prior mental health disorders, more negative life events due to COVID-19, as well as greater loneliness and lower positive mood at baseline were significant predictors of poorer mental health outcomes. ConclusionThe negative impact of the COVID-19 pandemic on mental health has persisted to some degree. Younger people and individuals with prior mental health disorders were at greatest risk. Easing of restrictions might bring the opportunity for a return to social interaction, which could mitigate the risk factors of loneliness and positive mood.

Understanding and Addressing Vaccine Hesitancy in the Context of COVID-19: Development of a Digital intervention

BackgroundSevere Acute Respiratory Coronavirus 2 (SARS-CoV-2) was identified in late 2019, spreading to over 200 countries and resulting in almost two million deaths worldwide. The emergence of safe and effective vaccines provides a route out of the pandemic, with vaccination uptake of 75-90% needed to achieve population protection. Vaccine hesitancy is problematic for vaccine rollout; global reports suggest only 73% of the population may agree to being vaccinated. As a result, there is an urgent need to develop equitable and accessible interventions to address vaccine hesitancy at the population level. MethodWe report the development of a scalable digital intervention seeking to address COVID-19 vaccine hesitancy and enhance uptake of COVID-19 vaccines. Guided by motivational interviewing (MI) principles, the intervention includes a series of therapeutic dialogues addressing 10 key concerns of vaccine hesitant individuals. Development of the intervention occurred linearly across four stages. During stage 1, we identified common reasons for COVID-19 vaccine hesitancy through analysis of existing survey data, a rapid systematic literature review, and public engagement workshops. Stage 2 comprised qualitative interviews with medical, immunological, and public health experts. Rapid content and thematic analysis of the data provided evidence-based responses to common vaccine concerns. Stage 3 involved the development of therapeutic dialogues through workshops with psychological and digital behaviour change experts. Dialogues were developed to address concerns using MI principles, including embracing resistance and supporting self-efficacy. Finally, stage 4 involved digitisation of the dialogues and pilot testing with members of the public. DiscussionThe digital intervention provides an evidence-based approach to addressing vaccine hesitancy through MI principles. The dialogues are user-selected, allowing exploration of relevant issues associated with hesitancy in a non-judgmental context. The text-based content and digital format allow for rapid modification to changing information and scalability for wider dissemination.

Mental Health of Keyworkers in the UK during the COVID-19 Pandemic: a Cross-sectional Analysis of a Community Cohort

ObjectivesPrevious pandemics have resulted in high levels of psychological morbidity among frontline workers. Here we report on the early mental health impact of the COVID-19 pandemic on keyworkers in the UK, as assessed during the first six weeks of nationwide social distancing measures being introduced. Comparisons are made with non-keyworkers, and psychological factors that may be protective to keyworkers mental health are explored. DesignCross-sectional analysis of a community cohort study. MethodsDuring April 2020, keyworkers (n=1559) and non-keyworkers (n=1436) completed online measures of depression, anxiety, and stress levels as well as explanatory demographic and psychological factors hypothesised to be related to these mental health outcomes. ResultsKeyworkers reported significantly higher depression, anxiety, and stress than pre-pandemic population norms. Compared to non-keyworkers, keyworkers were more likely to worry about COVID-19 and perceived they were at higher risk from the virus. This was particularly evident for health and social care keyworkers. Younger keyworkers and those in a clinically increased risk group were more likely to report poorer mental health. Lower positive mood, greater loneliness and worrying more about COVID-19 were all associated with poorer mental health outcomes amongst keyworkers. ConclusionsThe mental health impact of the COVID-19 pandemic on keyworkers in the UK has been substantial. Worry about COVID-19 and perceived risk from COVID-19 in keyworkers are understandable given potential increased exposure to the virus. Younger and clinically vulnerable keyworkers may benefit most from any interventions that seek to mitigate the negative mental health impacts of the pandemic.

Mental health in the UK during the COVID-19 pandemic: early observations

BackgroundPrevious pandemics have resulted in significant consequences for mental health. Here we report the mental health sequela of the COVID-19 pandemic on the UK population and examine modifiable and non-modifiable explanatory factors associated with mental health outcomes. We focus on the short-term consequences for mental health, as reported during the first four-six weeks of social distancing measures being introduced. MethodsA community cohort study was conducted with adults aged[≥]18 years recruited through a mainstream and social media campaign between 3/4/20-30/4/20. Consenting participants completed an online survey measuring depression, anxiety and stress and explanatory variables hypothesised to be related to these mental health outcomes. OutcomesN = 3097 eligible individuals participated. The cohort was predominantly female (85%); mean age forty-four years; 10% from minority ethnic groups; 50% described themselves as key-workers and 20% identified as having clinical risk factors putting them at increased risk of COVID-19. Mean scores for depression, stress and anxiety significantly exceeded population norms. Analysis of non-modifiable factors indicated that being younger and female were associated with all outcomes, with the final multivariable models accounting for 7-13% of variance. When adding modifiable factors, significant independent effects emerged for positive mood, perceived loneliness and worry about getting COVID-19 for all outcomes, with the final multivariable models accounting for 54-57% of variance. InterpretationIncreased psychological morbidity was evident in this UK cohort, with younger people and women at particular risk. Interventions targeting perceptions of: loneliness, risk of COVID-19, worry about COVID-19, and positive mood may be effective.