Early life risk factors for depression among young adults in the United States general population: Attributable risks and gender differences.

BACKGROUND: This study adopts individual and societal-level approaches to examine the contribution of childhood risk factors to major depressive episodes (MDE) in 2526 American young adults. METHODS: Nationally representative data from the 2017 U.S. Panel Study of Income Dynamics - Transition into Adulthood Supplement were analyzed using multivariate methods to assess the impact of parental mental illness, childhood adversities, childhood mental disorders, and childhood physical conditions. Adjusted odds ratios and population attributable risk proportions (PARPs) are calculated to estimate the proportion of MDE cases related to risk factors. RESULTS: The 12-month prevalence of positive screens for MDE was 25.4 %. Approximately 34 % of these were attributable to childhood mental disorders, 24 % to childhood physical conditions, 21 % to childhood adversities, and 16 % to parental mental illness. Childhood and parental depression were critical risk factors, both at the individual (odds ratio exceeding 2) and societal (PARP approximately 24 %) levels. Gender-specific risk factors were identified, with childhood physical abuse and childhood anxiety disorders constituting risk factors for females, and childhood externalizing disorders and childhood headaches as risk factors for males. Approximately 60 % of U.S. young adult MDE cases are attributable to risk factors before age 18. LIMITATIONS: Possible over reporting of MDE may have biased the associations between predictors and depression. CONCLUSIONS: Exposure to depression at a young age-one's own or parental depression-is a robust risk factor for both genders. Policies and interventions focused at alleviating the societal burden of depression should value its generational transmission.

What predicts willingness to participate in a follow-up panel study among respondents to a national web/mail survey?

The American Family Health Study (AFHS) collected family health and fertility data from a national probability sample of persons aged 18-49 between September 2021 and May 2022, using web and mail exclusively. In July 2022, we surveyed AFHS respondents and gauged their willingness to become part of a national web panel that would create novel longitudinal data on these topics. We focus on predictors of willingness to participate, identifying the potential selection bias that this type of approach may introduce. We found that efforts of this type to create a national web panel may introduce potential selection bias in estimates based on the panel respondents, with individuals having higher socio-economic status being more cooperative. Thus, alternative recruitment strategies and re-weighting of the subsample may be needed to further reduce selection bias. We present methodological implications of our results, limitations of our approach, and suggestions for further research on this topic.

Parental depression and their children's marriage timing: The long-term consequences of parental mental disorders.

Although decades of research documents powerful associations between parents' characteristics and their children's marital behaviors, the role of parental mental health has largely been ignored, despite the high prevalence of mental disorders and their strong potential to shape multiple dimensions of family life. Many studies examine other consequences of mothers' mental disorders, particularly for young children, but rarely do studies investigate the consequences of fathers' mental disorders, especially the potential for long-term consequences. We construct a theoretical framework for the study of intergenerational influences on family formation behaviors, integrating parental mental health, and emphasizing the potential for father's disorders to shape their children's lives. To investigate these associations, we use new intergenerational panel data featuring clinically validated diagnostic measures of parental mental health for both mothers and fathers, assessed independently. Results demonstrate that fathers' major depressive disorder is associated with significantly earlier marriage timing among sons. These important new findings provide insights into key priorities for social research on family formation processes and intergenerational influences across many domains.

Community exposure to armed conflict and subsequent onset of alcohol use disorder.

AIMS: To measure the independent consequences of community-level armed conflict beatings on alcohol use disorders (AUD) among males in Nepal during and after the 2000-2006 conflict. DESIGN: A population-representative panel study from Nepal, with precise measures of community-level violent events and subsequent individual-level AUD in males. Females were not included because of low AUD prevalence. SETTING: Chitwan, Nepal. PARTICIPANTS: Four thousand eight hundred seventy-six males from 151 neighborhoods, systematically selected and representative of Western Chitwan. All residents aged 15-59 were eligible (response rate 93%). MEASUREMENTS: Measures of beatings in the community during the conflict (2000-2006), including the date and distance away, were gathered through neighborhood reports, geo-location and official resources, then linked to respondents' life histories of AUD (collected in 2016-2018) using the Nepal-specific Composite International Diagnostic Interview with life history calendar. Beatings nearby predict the subsequent onset of AUD during and after the armed conflict. Data were analyzed in 2021-2022. FINDINGS: Cohort-specific, discrete-time models revealed that within the youngest cohort (born 1992-2001), those living in neighborhoods where armed conflict beatings occurred were more likely to develop AUD compared with those in other neighborhoods (odds ratio = 1.66; 95% confidence interval = 1.02-2.71). In this cohort, a multilevel matching analysis designed to simulate a randomized trial showed the post-conflict incidence of AUD for those living in neighborhoods with any armed conflict beatings was 9.5% compared with 5.3% in the matched sample with no beatings. CONCLUSIONS: Among male children living in Chitwan, Nepal during the 2000-2006 armed conflict, living in a neighborhood where armed conflict beatings occurred is associated with increased odds of developing subsequent alcohol use disorder. This association was independent of personal exposure to beatings and other mental disorders.

Associations Between Forced Intercourse and Subsequent Depression Among Women in the U.S. General Population.

Forced intercourse is a high prevalence experience among US women, with high potential to produce subsequent major depressive episodes (MDE). However, the extent to which prior risk factors are associated with the timing of both sexual assault experiences and subsequent MDE onset is not known. The aim of this study was to document the associations between childhood depression, subsequent forced intercourse, and later MDE. We used retrospective information on childhood depression, forced intercourse, and MDE after forced intercourse from female respondents in the nationally representative 2017 US Panel Study of Income Dynamics-Transition to Adulthood Supplement (PSID-TAS, N = 1298, response rate: 87%). Multivariable logistic regression estimated these associations, controlling for age, race, poverty, religiosity, family history of depression, and adverse childhood experiences (such as parental physical abuse or parental violence). Women who experienced childhood depression (prevalence: 15%) had 2.57 times the odds of experiencing forced intercourse after depression onset, even after adjusting for these other risk factors. However, even though childhood depression is a powerful risk factor for later MDE, independent of that women who experienced forced intercourse had 2.28 times the odds of experiencing MDE after the occurrence of forced intercourse, adjusting for childhood depression and other risk factors. This study provided the first clear evidence for time-ordered associations between forced intercourse and subsequent MDE among women in the general population.

Visible Cash, a Second Incentive, and Priority Mail? An Experimental Evaluation of Mailing Strategies for a Screening Questionnaire in a National Push-to-Web/Mail Survey.

In push-to-web surveys that use postal mail to contact sampled cases, participation is contingent on the mail being opened and the survey invitations being delivered. The design of the mailings is crucial to the success of the survey. We address the question of how to design invitation mailings that can grab potential respondents' attention and sway them to be interested in the survey in a short window of time. In the household screening stage of a national survey, the American Family Health Study, we experimentally tested three mailing design techniques for recruiting respondents: (1) a visible cash incentive in the initial mailing, (2) a second incentive for initial nonrespondents, and (3) use of Priority Mail in the nonresponse follow-up mailing. We evaluated the three techniques' overall effects on response rates as well as how they differentially attracted respondents with different characteristics. We found that all three techniques were useful in increasing the screening response rates, but there was little evidence that they had differential effects on sample subgroups that could help to reduce nonresponse biases.

Methods for improving participation rates in national self-administered web/mail surveys: Evidence from the United States.

In the United States, increasing access to the internet, the increasing costs of large-scale face-to-face data collections, and the general reluctance of the public to participate in intrusive in-person data collections all mean that new approaches to nationally representative surveys are urgently needed. The COVID-19 pandemic accelerated the need for faster, higher-quality alternatives to face-to-face data collection. These trends place a high priority on the evaluation of innovative web-based data collection methods that are convenient for the U.S. public and yield scientific information of high quality. The web mode is particularly appealing because it is relatively inexpensive, it is logistically flexible to implement, and it affords a high level of privacy and confidentiality when correctly implemented. With this study, we aimed to conduct a methodological evaluation of a sequential mixed-mode web/mail data collection protocol, including modular survey design concepts, which was implemented on a national probability sample in the U.S. in 2020-2021. We implemented randomized experiments to test theoretically-informed hypotheses that 1) the use of mail and increased incentives to follow up with households that did not respond to an invitation to complete a household screening questionnaire online would help to recruit different types of households; and 2) the use of modular survey design, which involves splitting a lengthy self-administered survey up into multiple parts that can be completed at a respondent's convenience, would improve survey completion rates. We find support for the use of mail and increased incentives to follow up with households that have not responded to a web-based screening questionnaire. We did not find support for the use of modular design in this context. Simple descriptive analyses also suggest that attempted telephone reminders may be helpful for the main survey.

Alcohol use and internal migration in Nepal: a cross-sectional study.

BACKGROUND: Alcohol use is a leading cause of disease. Although low- and middle-income countries (LMICs) have lower per capita alcohol consumption, the alcohol-attributable disease burden is high in these settings with consumption increasing. LMICs are also experiencing unprecedented levels of internal migration, potentially increasing mental stress, changing social restrictions on drinking, and increasing alcohol availability. We assessed the relationship between internal migration, opportunity to drink, and the transition from first use to regular alcohol use and alcohol use disorders (AUD) in Nepal, a low-income, South Asian country. METHODS: A representative sample of 7435 individuals, aged 15-59 from Nepal were interviewed in 2016-2018 (93% response rate) with clinically validated measures of alcohol use and disorders and life history calendar measures of lifetime migration experiences. Discrete-time hazard models assessed associations between migration and alcohol use outcomes. RESULTS: Net of individual sociodemographic characteristics, internal migration was associated with increased odds of opportunity to drink (OR 1.32, 95% CI 1.14 to 1.53), onset of regular alcohol use given lifetime use (OR 1.29, 95% CI 1.13 to 1.48) and AUD given lifetime use (OR 1.24, 95% CI 0.99 to 1.57). The statistically significant association between internal migration and opportunity to drink was specific to females, whereas the associations between migration and regular use and disorder were statistically significant for males. CONCLUSIONS: Despite high rates of internal migration worldwide, most research studying migration and alcohol use focuses on international migrants. Findings suggest that internal migrants are at increased risk to transition into alcohol use and disorders. Support services for internal migrants could prevent problematic alcohol use among this underserved population.

Forced intercourse in America: a pandemic update.

BACKGROUND: Measures of forced intercourse from the U.S. National Center for Health Statistics (NCHS) indicate high prevalence among U.S. women, which is likely to produce unintended pregnancies. However, NCHS did not measure forced intercourse during the pandemic, limiting knowledge of recent prevalence rates. METHODS: We use multiple nationally-representative, cross-sectional surveys representing the U.S. population from 2011 to 2022 to document these trends. This includes measures from the National Survey of Family Growth, the Panel Study of Income Dynamics Transition into Adulthood Supplement, and the American Family Health Study (AFHS) to provide population estimates of forced intercourse. RESULTS: Reports of forced intercourse remained high during the pandemic, with more than 25% of U.S. females over 40 reporting lifetime forced intercourse in the AFHS (number of females in AFHS: 1,042). There was a significant increase among females aged 24-28 (p < 0.05) and rates are highest for those who did not complete college. Among females 24-28, 32.5% (S.E. = 5.7%) with less than 4 years of college reported forced intercourse, a significantly (p < 0.05) higher rate than among those with a higher level of education. CONCLUSIONS: Rates of forced intercourse among U.S. women remained high during the pandemic, increasing significantly in early adulthood. This exposure to forced intercourse is likely to produce an increase in unintended pregnancies and other sexual, reproductive, and mental health problems.

Findings From the World Mental Health Surveys of Civil Violence Exposure and Its Association With Subsequent Onset and Persistence of Mental Disorders.

Importance: Understanding the association of civil violence with mental disorders is important for developing effective postconflict recovery policies. Objective: To estimate the association between exposure to civil violence and the subsequent onset and persistence of common mental disorders (in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV]) in representative surveys of civilians from countries that have experienced civil violence since World War II. Design, Setting, and Participants: This study used data from cross-sectional World Health Organization World Mental Health (WMH) surveys administered to households between February 5, 2001, and January 5, 2022, in 7 countries that experienced periods of civil violence after World War II (Argentina, Colombia, Lebanon, Nigeria, Northern Ireland, Peru, and South Africa). Data from respondents in other WMH surveys who immigrated from countries with civil violence in Africa and Latin America were also included. Representative samples comprised adults (aged ≥18 years) from eligible countries. Data analysis was performed from February 10 to 13, 2023. Exposures: Exposure was defined as a self-report of having been a civilian in a war zone or region of terror. Related stressors (being displaced, witnessing atrocities, or being a combatant) were also assessed. Exposures occurred a median of 21 (IQR, 12-30) years before the interview. Main Outcomes and Measures: The main outcome was the retrospectively reported lifetime prevalence and 12-month persistence (estimated by calculating 12-month prevalence among lifetime cases) of DSM-IV anxiety, mood, and externalizing (alcohol use, illicit drug use, or intermittent explosive) disorders. Results: This study included 18 212 respondents from 7 countries. Of these individuals, 2096 reported that they were exposed to civil violence (56.5% were men; median age, 40 [IQR, 30-52] years) and 16 116 were not exposed (45.2% were men; median age, 35 [IQR, 26-48] years). Respondents who reported being exposed to civil violence had a significantly elevated onset risk of anxiety (risk ratio [RR], 1.8 [95% CI, 1.5-2.1]), mood (RR, 1.5 [95% CI, 1.3-1.7]), and externalizing (RR, 1.6 [95% CI, 1.3-1.9]) disorders. Combatants additionally had a significantly elevated onset risk of anxiety disorders (RR, 2.0 [95% CI, 1.3-3.1]) and refugees had an increased onset risk of mood (RR, 1.5 [95% CI, 1.1-2.0]) and externalizing (RR, 1.6 [95% CI, 1.0-2.4]) disorders. Elevated disorder onset risks persisted for more than 2 decades if conflicts persisted but not after either termination of hostilities or emigration. Persistence (ie, 12-month prevalence among respondents with lifetime prevalence of the disorder), in comparison, was generally not associated with exposure. Conclusions: In this survey study of exposure to civil violence, exposure was associated with an elevated risk of mental disorders among civilians for many years after initial exposure. These findings suggest that policy makers should recognize these associations when projecting future mental disorder treatment needs in countries experiencing civil violence and among affected migrants.

Forced Intercourse in America: A Pandemic Update.

Background : Measures of forced intercourse from the U.S. National Center for Health Statistics (NCHS) indicate this a high prevalence among U.S. women that is likely to produce unintended pregnancies. However, NCHS did not measure forced intercourse during the pandemic, limiting knowledge of recent prevalence rates. Methods : We use multiple nationally-representative, cross-sectional surveys representing the U.S. population from 2011 to 2022 to document these trends. This includes measures from the National Survey of Family Growth, the Panel Study of Income Dynamics Transition into Adulthood Supplement, and the American Family Health Study (AFHS) to provide population estimates of forced intercourse. Results : Reports of forced intercourse remained high during the pandemic, with more than 25% of U.S. females over 40 reporting lifetime forced intercourse in the AFHS (number of females in AFHS: 1,042). There was a significant increase among females aged 24-28 (p<.05) and rates are highest for those who did not complete college. Among females 24-28, 32.5% (S.E. = 5.7%) with less than 4 years of college reported forced intercourse, a significantly (p<.05) higher rate than among those with higher education. Conclusions : Rates of forced intercourse among U.S. women remained high during the pandemic, increasing significantly in early adulthood. This exposure to forced intercourse is likely to produce an increase in unintended pregnancies and other sexual, reproductive, and mental health problems.

Abortion Policy in the United States: The New Legal Landscape and Its Threats to Health and Socioeconomic Well-Being.

Policy Points The historic 2022 Supreme Court Dobbs v Jackson Women's Health Organization decision has created a new public policy landscape in the United States that will restrict access to legal and safe abortion for a significant proportion of the population. Policies restricting access to abortion bring with them significant threats and harms to health by delaying or denying essential evidence-based medical care and increasing the risks for adverse maternal and infant outcomes, including death. Restrictive abortion policies will increase the number of children born into and living in poverty, increase the number of families experiencing serious financial instability and hardship, increase racial inequities in socioeconomic security, and put significant additional pressure on under-resourced social welfare systems.

Student reports of attendance at programs to reduce campus sexual assault and harassment.

OBJECTIVE: To identify factors independently associated with program participation and knowledge of campus processes to address sexual assault and harassment complaints. PARTICIPANTS: 1,182 undergraduates who completed the University of Michigan's 2015 campus climate survey on topics of sexual assault and harassment (67% response rate). METHODS: We analyze survey responses to estimate multivariable models that identify subgroups of the student population least likely to have participated in programs or to know campus processes. RESULTS: Students living off campus, not involved in major organizations, and males are less likely to report attending programming. Students not involved in major organizations and females are less likely to report knowing campus processes. CONCLUSIONS: Specific student subpopulations are more difficult to engage in programs designed to reduce sexual assault and harassment. Targeting additional effort to these groups may improve campus sexual climate. Careful analyses of campus climate survey data can help construct campus-specific priorities for these interventions.

Applying Responsive Survey Design to Small-Scale Surveys: Campus Surveys of Sexual Misconduct.

Responsive survey design is a technique aimed at improving the efficiency or quality of surveys by using incoming data from the field to make design changes. The technique was pioneered on large national surveys, but the tools can also be applied on the smaller-scale surveys most commonly used by sociologists. We demonstrate responsive survey design in a small-scale, list-based sample survey of students on the topic of sexual misconduct. We investigate the impact of individual incentive levels and a two-phase responsive design with changes to mode of contact as approaches for limiting the potential of nonresponse bias in data from such surveys. Our analyses demonstrate that a two-phase design introducing telephone and face-to-face reminders to complete the survey can produce stronger change in response rates and characteristics of those who respond than higher incentive levels. These findings offer tools for sociologists designing smaller-scale surveys of special populations or sensitive topics.

The transition to parenthood, opportunity to drink, drinking, and alcohol use disorder.

BACKGROUND: This study used life histories from a setting of near universal marriage and childbearing (Nepal) to identify associations between both marital transitions and the transition into parenthood and alcohol use and disorder (AUD). METHODS: A retrospective, cross-sectional survey using life history calendars documented lifetime marital and childbearing histories of 4876 men and 5742 women aged 15-59 in 2016-18. The clinically validated, Nepal-specific Composite International Diagnostic Interview assessed first alcohol use opportunity, use, and disorder. RESULTS: Being never married increased the odds of having the opportunity to drink for men (OR=1.30, 95% CI=1.14 - 1.48, p < 0.001) and women (OR=1.24, 95% CI=1.08 - 1.43, p = 0.003) compared to being married. While men were never married, widowed, or divorced they were at a greater risk of developing AUD. The transition to parenthood significantly increased the odds of AUD onset for men (OR=1.71, 95% CI=1.12 - 2.61, p = 0.013), independent of marital transitions. For women in this setting, becoming divorced increased the odds of having their first drink (OR=1.77, 95% CI=1.14 - 2.75, p = 0.011). Giving birth to a first child also increased the odds of first opportunity to drink for women (OR=1.30, 95% CI=1.07 - 1.57, p = 0.008). CONCLUSIONS: We found associations between marital transitions and AUD that are consistent with findings worldwide. In this setting of near universal childbearing, the transition into fatherhood increased the odds of postpartum AUD among men.

What can we learn about polytrauma typologies by comparing population-representative to trauma-exposed samples: A Nepali example.

BACKGROUND: Potentially traumatic events (PTEs) are common and associated with detrimental outcomes over the life-course. Previous studies exploring the causes and consequences of PTE-exposure profiles are often from high-income settings and fail to explore the implications of sample selection (i.e., population-representative versus PTE-restricted). METHODS: Among individuals in the Nepal Chitwan Valley Family Study, latent class analyses (LCA) were performed on 11 self-reported PTEs collected by the Nepali version of the World Mental Health Consortium's Composite International Diagnostic Interview 3.0 from 2016 to 2018, in a population-representative sample (N = 10,714), including a PTE-restricted subsample (N = 9183). Multinomial logistic regressions explored relationships between sociodemographic factors and class membership. Logistic regressions assessed relationships between class membership and psychiatric outcomes. RESULTS: On average, individuals were exposed to 2 PTEs in their lifetime. A five-class solution showed optimal fit for both samples; however, specific classes were distinct. No single sociodemographic factor was universally associated with PTE class membership in the population-representative sample; while several factors (e.g., age, age at incident PTE, education, marital status, and migration) were consistently associated with class membership in the PTE-subsample. PTE class membership differentiated psychiatric outcomes in the population-representative sample more than the PTE-subsample. LIMITATIONS: Primary limitations are related to the generalizability to high-income settings, debate on LCA model fit statistic usage for final class selection, and cross-sectional nature of data collection. CONCLUSIONS: Although population-representative samples provide information applicable to large-scale, population-based programming and policy, PTE-subsample analyses may provide additional nuance in PTE profiles and their consequences, important for specialized prevention efforts.

A Web-Based Event History Calendar Approach for Measuring Contraceptive Use Behavior.

Event history calendars (EHCs) are frequently used in social measurement to capture important information about the time ordering of events in people's lives, and enable inference about the relationships of the events with other outcomes of interest. To date, EHCs have primarily been designed for face-to-face or telephone survey interviewing, and few calendar tools have been developed for more private, self-administered modes of data collection. Web surveys offer benefits in terms of both self-administration, which can reduce social desirability bias, and timeliness. We developed and tested a web application enabling the calendar-based measurement of contraceptive method use histories. These measures provide valuable information for researchers studying family planning and fertility behaviors. This study describes the development of the web application, and presents a comparison of data collected from online panels using the application with data from a benchmark face-to-face survey collecting similar measures (the National Survey of Family Growth).

Cohabitation dissolution and psychological distress among young adults: The role of parenthood and gender.

Cohabitation has become a normative experience for American young adults and a common setting for childbearing in recent decades. However, the high dissolution rate of cohabitation exposes young adults to the potential stress of intimate relationship dissolution and single parenthood during early adulthood. Drawing on data from the National Longitudinal Survey of Youth 1997, we apply growth curve models to analyze how cohabitation dissolution associates with trajectories of depressive symptoms and binge drinking behaviors for young adults (aged 17 to 35). We investigate how the presence of children moderates this association for men and women. We find that cohabitation dissolution is associated with increased depressive symptoms for both men and women. However, cohabitation dissolution is only positively associated with binge drinking behaviors for men, and a significant gender difference is observed. The presence of children when cohabitation dissolves strengthens the positive association between cohabitation dissolution and depressive symptoms among women, and this positive moderation fades away as young women age. These findings suggest that gender differences in the association of cohabitation dissolution with psychological distress are contingent on the types of psychological distress under consideration and also reveal that cohabitation dissolution intertwined with non-marital parenthood is harmful to mental health, especially for young women.

Community-Level Social Support Infrastructure and Adult Onset of Major Depressive Disorder in a South Asian Postconflict Setting.

IMPORTANCE: Individual-level social support protects against major depressive disorder (MDD) among adults exposed to trauma. Little is known about the consequences of community-level interventions in the general population. OBJECTIVE: To determine the potential consequences of neighborhood social infrastructure on incident MDD in a high-risk general population. DESIGN, SETTING, AND PARTICIPANTS: This longitudinal, multilevel study estimated associations between a neighborhood-level program in a case-control design and subsequent individual outcomes across 10 years (2006-2015) in a cohort of young adults. Exogenously placed social programs simulate natural experiment conditions in a high-poverty population experiencing armed conflict (1998-2006). The western Chitwan valley in Nepal has a general population at high risk of MDD, with neighborhoods exposed to interventions to improve social support. From a random sample (response rate 93%) selected to represent the general population in 2016, participants aged 25 to 34 years in 2006 were studied. These individuals resided within 149 neighborhoods that varied in their availability of active social support programs. The analyses were conducted between October 2020 and November 2021. EXPOSURES: The Small Farmers Development Program (SFDP) uses shared, joint liability financial credit among neighbors to build social capital and cohesion within neighborhoods. MAIN OUTCOMES AND MEASURES: Onset of DSM-IV MDD after the conflict, assessed by the Nepal-specific, clinically validated World Mental Health Composite International Diagnostic Interview with a life history calendar. The hypothesis tested was that exposure to SFDP reduced adult onset of MDD. RESULTS: Of the 1917 survey participants, 886 (46.2%) were women, and 856 (44.7%) were of Brahmin or Chhetri ethnicity. Of the 149 neighborhoods, 21 had an active SFDP group, and 156 of 1917 (8.1%) participants experienced MDD between 2006 and 2015. Discrete-time hazard models showed participants living in neighborhoods with an SFDP experienced incident MDD at nearly half the rate as others (odds ratio = 0.55; 95% CI, 0.30-1.02; P = .06). A multivariate, multilevel matching analysis showed the incidence of MDD among adults living in neighborhoods with an SFDP was 19 of 256 (7.4%), compared with 33 of 256 (12.9%) in the matched sample with no SFDP (z = 2.05; P = .04). CONCLUSIONS AND RELEVANCE: Living in a neighborhood with community-level social support infrastructure was associated with reduced subsequent rates of adult-onset MDD, even in this high-risk population. Investments in such infrastructure may reduce population-level MDD, supporting clinical focus on potentially unpreventable cases.

COVID-19 worries, concerns and mitigation behaviours: A snapshot of Nepal during the first wave.

OBJECTIVES: To understand COVID-19 worries and how they influence COVID-19 mitigation behaviours, especially in communities prior to case surges, in Nepal. METHODS: Data related to COVID-19 impacts on life disruptions were collected from households in the Chitwan Valley Family Study, a 25-year community panel study, during February-April 2021. COVID-19 worry was measured by the extent of respondent concern for themselves or household members getting COVID-19 in the prior 2 weeks. 11 items examined COVID-19 mitigation behaviours. Logistic regression models assessed associations between socio-demographic characteristics and COVID-19 worry and then the influence of worry on any mitigation behaviour and behaviour type adjusting for age, education, sex, ethnicity and COVID-19 exposure, accounting for neighbourhood clustering. RESULTS: Of 2,678 households with a responding adult, ages 18-88, 394 (14.7%) reported moderate-to-extreme COVID-19 worry and 1,214 (45.3%) engaged in three or more mitigation behaviours. Prevalence of mitigation behaviours was higher among those with COVID-19 worry (e.g. avoided crowds: 62.7% versus 40.5% in those with minimal worry). Respondents self-reporting COVID-19 had higher odds of worry (adjusted odds ratio [aOR]: 2.73, 95% confidence interval [CI]: 1.13, 6.57). Odds of any mitigation behaviour were higher among those with COVID-19 worry compared to those with minimal worry (aOR: 6.19, 95% CI = 1.88, 20.35). CONCLUSIONS: COVID-19 mitigation behaviours were more common in people with COVID-19 worry. To address current and potential future waves of the pandemic, public health efforts should include informational campaigns about mitigation behaviours particularly for those unconcerned with COVID-19 risks.