And still, we rise: A mixed-methods study examining derailment, posttraumatic stress, and resilience among Black adults during the COVID-19 pandemic.

Mental health care among marginalized populations in the United States

Mental Health in the Context of Health Disparities

The rise of racial minority health apps

Dear Editor, We read with great interest the recent article by Rohilla et al. published in your esteemed journal.[1] We would hereby like to add our perspective of mental health issues during COVID-19 era. The ongoing Coronavirus (COVID-19) pandemic by the novel strain SARS-CoV-2 has dragged the entire world to its feet leaving people scared and anxious. Starting in December 2019 from Wuhan, China, COVID-19 has spread like rapid fire to more than 200 countries.[2] As of July 20, 2020, worldwide there are 14,686,829 confirmed COVID-19 cases and 609,835 deaths.[3] COVID-19 is challenging not just for its medical phenomenon, but also for its capability to affect the financial, mental, emotional wellbeing of the individuals across the globe.[45] National agencies, Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and many other organizations are promoting to follow non-pharmacological interventions (NPIs) to combat the pandemic.[6] However, amidst the challenges of mitigating COVID-19, little has been known about the mental health impact of NPIs. There is significant evidence to suggest the importance of socialization and connectivity in maintaining a good mental wellbeing.[7] Social networking, community engagement, and participation have been shown to be associated with both physical and psychological well-being.[78] Detrimental effects on mental health are expected to arise with isolation, neglect, and loneliness. COVID-19 pandemic has multi-dimensional impact on our physical, mental, social, and emotional wellbeing.[89] Similar experience was reported during previous coronavirus pandemics, namely SARS and MERS pandemic.[101112] Mental health issues like anxiety, depression, post-traumatic stress disorder (PTSD) are some of the mental illnesses that are on rise ever since the COVID-19 pandemic started which needs immediate attention. Usually, people suffering from mental illnesses are advised to socialize as a part of therapy in most of the psychiatric illnesses. However, for containment of the COVID-19 pandemic, almost all countries are endorsing the concept of social distancing, quarantine, and isolation as the most effective strategies.[13] It has been a couple of months since many countries like India, Italy, Spain, France, etc., are on lockdown with citizens sheltering inside their own houses and following the social distancing protocols. With “restriction of movement” and “not socializing with each other” becoming a new normal lifestyle for most of us, mental vulnerability to conditions like anxiety and depression has been increasingly recognized. During previous outbreaks of severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS) outbreak, many studies confirmed that there were worsening mental illness symptoms in an individual with preexisting mental health conditions as well as healthy individuals. For example, in Hong Kong, about 70% of people expressed anxiety about getting SARS and people reported they believed they were more likely to contract SARS than the common cold.[14] Hypervigilance, for example, can arise because of fear and anxiety and, in severe cases, result in post-traumatic stress disorder (PTSD) and/or depression.[15] Another aspect that can complicate mental illness symptoms during such times is discrimination. For example, the 2014 Ebola outbreak was considered an African problem resulting in discrimination against those of African descent.[16] Similarly, the 2009 H1N1 flu outbreak in the USA saw Mexican and migrant workers targeted for discrimination.[17] Since January 2020, the UK and the USA have reported increased reports of violence and hate crimes towards people of Asian descent and an overall rise in Anti-Chinese sentiment because of the spread of COVID-19.[18] Since isolation and quarantine from the loved ones is the norm of the current world situation, it can often precipitate depression and anxiety and often feel they are being ripped off their purpose of living. Isolation is known to cause a lot of stress which can exacerbate feelings of anxiety and uncertainty. Post-Traumatic Stress Having to be isolated from the society being affected with the SARS-CoV-2 virus, and the fear of transmitting it to the loved ones, patients are prone to experience PTSD which could affect the mental wellbeing of an individual in the long run. Psychological trauma can result in mixture of emotional surges like nightmares, self-blame, flashbacks, and experiencing recurrent thoughts of the trauma.[19] This could happen to the patients as well as to the health care providers. Risk factors that makes patients susceptible to PTSD are self-quarantine, self-isolation, fear of death social discrimination, witnessing others becoming sick and dying and so on. Similarly, for health care professionals, COVID-19 has brought innumerous challenges.[6] Witnessing frequent deaths, fear of acquiring the infection, spreading to the other family members, lack of adequate personal protective equipment's etc., can expose them to recurrent mental trauma and to PTSD.[20] A study was conducted in China on patients who were infected with COVID-19.[21] Online assessment using a 17 item self-reported PTSD checklist (PCL-C) was used. A total of PCL-C score of ≥ 50 is an indication of 'having significant posttraumatic stress symptoms. A total of 730 COVID-19 patients were assigned in the study and the prevalence of significant posttraumatic stress symptoms was 996.2% (95% CI: 94.8% -97.6%). In addition to the psychological impact, a recent report suggested immune dysregulation in patients suffering from chronic stress secondary to PTSD which might make them prone to opportunistic infections like COVID-19 pneumonia.[22] Information Adding Anxiety and Fear In a crisis like this, it's a common interest of people to find out as much information as possible to stay tuned on what is going on around them people are consuming information on every platform available like WhatsApp, Facebook, YouTube, Twitter, and many others, which necessarily does not contain accurate information. Subjects who used updates via phone text messages and used social media for critical updates during the lockdown had higher chances of exposing themselves to false information and stress [Figure 1]. Higher acute stress was seen in heavy social media users in the study. This report highlights the importance of releasing substantive official updates at regular intervals during a crisis event and monitoring social media to reduce exposure to misleading information and distress 36.2% (95% CI: 94.8% -97.6%).[21] Other factors that could contribute to the anxiety and mental unrest are fear of losing job, financial crisis, interruption in studies, physical inactivity, running out of medicines, lack of sleep, social isolation, fear of acquiring infection.[23242526]Figure 1: Pictorial description of the potential concerns of a person during COVID-19When we are grappling with this gigantic global crisis humans can get creative with their social interactions and can even have trivia nights with your coworkers or friends or maybe even have a virtual date night. Having this social connection can improve not just your mental health but your physical health as well. These social interactions give us a sense of togetherness as a species in our fight against this virus. Moreover, experts suggest having a daily routine can help fight anxiety during this unprecedented time. Having a routine while maintaining the sleep cycle can have a positive impact.[27] Emerging Role of Telemedicine in Psychiatry The impact of isolation can be more severe in individuals with preexisting mental illness, with worsening of anxiety, depression, despair, and feeling of loss of control. Coping with pandemic can get especially difficult when patient's access to its primary source of support and care is restricted. There is a tremendous role of psychotherapy in the treatment of anxiety, depression, and PTSD, and other mental illnesses. Not only do regular visits to the clinic help in getting appropriate therapy and care, but they also add a good working schedule for individuals. Patients suffering with alcoholism and other substance use disorders who are associated with various deaddiction programs might also find it difficult to refill their prescribed medications like methadone, suboxone, etc., Also, it is difficult to continue their engagement with support groups, and programs due to closure of these societies. However, despite knowing the importance of in person encounter in clinical practice of psychiatry, unfortunately due to the fear of community transmission, cross infections, and other logistic reasons of lockdown, travel restrictions, and limited health care access, health care providers are not able to execute their health services to their patients suffering from various mental health issues. Telemedicine service has proved itself as an important asset, and a way of effective communication between patients and their physicians.[28] It has especially proven to be of great benefit for patients with mental conditions to receive psychoeducation in a timely fashion via using telemedicine and remote medical care services.[29] This will be of utmost importance especially in patients who are having active psychiatric disease flare up.[2930] Kalin et al. recently share their successful institutional experience with telemedicine in the inpatient setting. They shared their experience based on 110 tele encounters during inpatient psychiatry consults.[31] They could successfully accomplish an effective dialogue exchange and were able to execute supportive psychotherapy during tele encounters. Although, in our opinion a telemedicine is certainly an immediate solution to provide the supportive therapy to patients, it can never replace the impact, and positive outcome of an in-person meeting. Also, it might not be possible to communicate and engage in an effective conversation in patients who are mentally challenged or in children with ADHD, autism, etc., A healthy parenting might help in such scenarios till the regular clinic visits services are resumed. Conclusion From the mental health perspective, so far, the COVID-19 pandemic has been extremely challenging. With the uncertainty of the current living situation, people with preexisting mental illnesses like PTSD, anxiety, depression, and severe persistent mental illness are prone to having worsening of their conditions, and studies from the past pandemics reflect the same. Time-bound behavioral therapy should be provided to persons who exhibit signs of mental disorders to reduce the cognitive effects of the pandemic. Psychiatrists and psychotherapists should maximize the use of telemedicine services use to connect to their patients. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

BackgroundNigeria is a country with high risk for traumatic incidences, now aggravated by the COVID-19 pandemic. This study aimed to identify differences in COVID-19 related post-traumatic stress symptoms (PTSS) among people living and not living with HIV; to assess whether PTSS were associated with COVID-19 pandemic-related anger, loneliness, social isolation, and social support; and to determine the association between PTSS and use of COVID-19 prevention strategies.MethodsThe data of the 3761 respondents for this analysis was extracted from a cross-sectional online survey that collected information about mental health and wellness from a convenience sample of adults, 18 years and above, in Nigeria from July to December 2020. Information was collected on the study’s dependent variable (PTSS), independent variables (self-reported COVID-19, HIV status, use of COVID-19 prevention strategies, perception of social isolation, access to emotional support, feelings of anger and loneliness), and potential confounder (age, sex at birth, employment status). A binary logistic regression model tested the associations between independent and dependent variables.ResultsNearly half (47.5%) of the respondents had PTSS. People who had symptoms but were not tested (AOR = 2.20), felt socially isolated (AOR = 1.16), angry (AOR = 2.64), or lonely (AOR = 2.19) had significantly greater odds of reporting PTSS (p < 0.001). People living with HIV (AOR = 0.39), those who wore masks (AOR = 0.62) and those who had emotional support (AOR = 0.63), had lower odds of reporting PTSS (p < .05).ConclusionThe present study identified some multifaceted relationships between post-traumatic stress, HIV status, facemask use, anger, loneliness, social isolation, and access to emotional support during this protracted COVID-19 pandemic. These findings have implications for the future health of those affected, particularly for individuals living in Nigeria. Public health education should be incorporated in programs targeting prevention and prompt diagnosis and treatment for post-traumatic stress disorder at the community level.

The frequent police killings during the COVID-19 pandemic forced a reckoning among Americans from all backgrounds and propelled the Black Lives Matter movement into a global force. This manuscript addresses major issues to aid practitioners in the effective treatment of African Americans via the lens of Critical Race Theory and the Bioecological Model. We place the impacts of racism on Black families in historical context and outline the sources of Black family resilience. We critique structural racism embedded in all aspects of psychology and allied fields. We provide an overview of racial socialization and related issues affecting the parenting decisions in Black families, as well as a detailed overview of impacts of structural racism on couple dynamics. Recommendations are made for engaging racial issues in therapy, providing emotional support and validation to couples and families experiencing discrimination and racial trauma, and using Black cultural strengths as therapeutic resources.

Measuring Trends in Mental Health Care Disparities, 2000 2004

Stroke is the fifth leading cause of death and a leading cause of long-term disability in the United States (1). Although stroke death rates have declined since the 1950s, age-adjusted rates remained higher among non-Hispanic Black or African American (Black) adults than among non-Hispanic White (White) adults (1,2). Despite intervention efforts to reduce racial disparities in stroke prevention and treatment through reducing stroke risk factors, increasing awareness of stroke symptoms, and improving access to treatment and care for stroke (1,3), Black adults were 45% more likely than were White adults to die from stroke in 2018.* In 2019, age-adjusted stroke death rates (AASDRs) (stroke deaths per 100,000 population) were 101.6 among Black adults and 69.1 among White adults aged ≥35 years. Stroke deaths increased during the early phase of the COVID-19 pandemic (March-August 2020), and minority populations experienced a disproportionate increase (4). The current study examined disparities in stroke mortality between Black and White adults before and during the COVID-19 pandemic. Analysts used National Vital Statistics System (NVSS) mortality data accessed via CDC WONDER† to calculate AASDRs among Black and White adults aged ≥35 years prepandemic (2015-2019) and during the pandemic (2020-2021). Compared with that during the prepandemic period, the absolute difference in AASDR between Black and White adults during the pandemic was 21.7% higher (31.3 per 100,000 versus 38.0). During the pandemic period, an estimated 3,835 excess stroke deaths occurred among Black adults (9.4% more than expected) and 15,125 among White adults (6.9% more than expected). These findings underscore the importance of identifying the major factors contributing to the widened disparities; implementing prevention efforts, including the management and control of hypertension, high blood cholesterol, and diabetes; and developing tailored interventions to reduce disparities and advance health equity in stroke mortality between Black and White adults. Stroke is a serious medical condition that requires emergency care. Warning signs of a stroke include sudden face drooping, arm weakness, and speech difficulty. Immediate notification of Emergency Medical Services by calling 9-1-1 is critical upon recognition of stroke signs and symptoms.

Racial Disparities and Excess Cardiovascular Mortality Before and During the COVID-19 Pandemic: Time for a Solution

Health Disparities in Pulmonary Arterial Hypertension and the Impact of the COVID-19 Pandemic

The objectives of this study were to investigate (1) gender and race differences in mental health and psychological well-being among older adults during the COVID-19 pandemic and (2) whether there were significant interaction effects between gender and race. This study used the National Health and Aging Trends Study (NHATS) and COVID-19 public use data files. It focused on mental health and psychological well-being, including loneliness, no time to yourself, poor sleep quality, anxiety, depression, and post-traumatic stress disorder (PTSD). The sample consisted of 2465 older adults, and multivariate logistic and linear regression models were adopted for the analysis. The results show that approximately two out of five older people (43%) experienced poor sleep, followed by loneliness (35%), anxiety (30%), depression (23%), and no time to themselves (11%). The average PTSD score was 11. Mental health and psychological well-being varied by gender and race. There were significant interaction effects on anxiety and depression between females and Black older adults. Black females reported lower levels of anxiety and depressive symptoms than Black males, although the differences were not statistically significant. Black older adults were more likely to experience PTSD but less likely to feel lonely and have poorer sleep than their White counterparts. Female older adults reported poorer mental health and psychological well-being than males, except for Black females. Black females had the lowest levels of anxiety, depression, loneliness, and highest quality of sleep among all females of different ethnic and racial origins.

Disproportionate Use of Psychiatric Emergency Services by African Americans

The COVID-19 Pandemic: Setting the Mental Health Research Agenda

<i>Special Report:</i> Racism and Inequities in Health Care for Black Americans

This study aims to examine whether there are differences in symptoms of posttraumatic stress, depression, anxiety, levels of burnout and resilience in Spanish healthcare staff between the first wave of the COVID-19 pandemic and after it, depending on several demographic and work-related variables. A longitudinal study was conducted in April 2020 (T0), and July 2020 (T1). Symptoms of posttraumatic stress, depression, anxiety, burnout, levels of resilience, along with demographic and work-related variables in 443 workers were assessed. Symptoms and burnout were more pronounced at T0, whereas the levels of resilience were higher at T1. Being women, being young, holding a lower-level job, less years of experience, lower educational level, and/or working rotating shifts are associated with having more posttraumatic stress symptoms and burnout. These variables would be considered in similar situations.