Associations between internet use, internalized ageism and mental health during COVID-19 pandemic among older adults in the Nordic-Baltic region

The uncertainties of the pandemic and the restrictions on social life have a strong impact on mental well-being, and especially on the expression of schizotypal traits, which are further boosted by excessive media consumption.

Editor's evaluation: Investigating the relationship of COVID-19 related stress and media consumption with schizotypy, depression, and anxiety in cross-sectional surveys repeated throughout the pandemic in Germany and the UK

Background and ObjectivesThis study aimed to examine the associations between multimorbidity at the COVID-19 pandemic onset and subsequent longitudinal trajectories of depressive symptoms, anxiety symptoms, and loneliness in middle-aged and older adults over a 12-month follow-up.Research Design and MethodsData were from monthly online questionnaires in the COVID-19 Coping Study of U.S. adults aged ≥55 from April/May 2020 through April/May 2021 (N = 4,024). Multimorbidity was defined as having ≥2 versus <2 chronic conditions at baseline. Mental health outcomes were assessed monthly as depressive symptoms (8-item Center for Epidemiologic Studies Depression scale), anxiety symptoms (5-item Beck Anxiety Inventory), and loneliness (3-item UCLA Loneliness Scale). We used multivariable-adjusted population- and attrition-weighted mixed-effects linear models to examine the longitudinal associations between multimorbidity and mental health symptoms.ResultsMultimorbidity at the pandemic onset was associated with elevated depressive (b = 0.37; 95% CI: 0.16–0.59) and anxiety (b = 0.39; 95% CI: 0.15–0.62) symptoms at baseline. Changes in symptoms for all three mental health outcomes were nonlinear over time, with worsening symptoms over the first 6 months of the pandemic (April/May to September/October 2020), followed by improvement in symptoms over the subsequent 6 months (September/October 2020 to April/May 2021). Middle-aged and older adults with multimorbidity experienced faster rates of change in anxiety symptoms and loneliness than those without multimorbidity, with persistently elevated mental health symptomatology throughout the follow-up.Discussion and ImplicationsResults highlight the unique and persistent mental health risks experienced by middle-aged and older adults with multimorbidity during the COVID-19 pandemic. The observed improvements in symptoms underscore the mental resilience of these individuals, indicating their adaptation to the ongoing pandemic.

BackgroundResearch demonstrates that subjective memory complaints (SMCs) are associated with anxiety and depression; however, few studies have longitudinally examined the relationship between SMCs and new onset of anxiety and depression symptoms in older adults. In the context of the COVID‐19 pandemic, it is also important to consider how existing health conditions may impact these associations. We examined (1) if SMCs predict new onset of anxiety and depression symptoms during the COVID‐19 pandemic in older adults and (2) if physical health problems exacerbate this association.MethodWe performed hierarchical linear regression analyses to evaluate associations between SMCs and depression and anxiety symptoms during the COVID‐19 pandemic, controlling for age, sex, education, income, baseline anxiety and depression, and cognition. Next, we assessed the interaction between SMCs and health conditions on anxiety and depression symptoms.ResultSMCs (β= 0.021, p= .017) and health (β=.165, p<0.001) were directly associated with increased anxiety symptoms; however, the interaction effect was not significant (β=0.002, p=0.697). SMCs (β=0.006, p=0.493) and health (β=0.075, p=0.069) were not directly associated with increased depression symptoms; however, the interaction was significant (β=0.017, p<0.001).ConclusionSMCs and health problems exert independent effects on the development of anxiety symptoms; whereas the effect of SMCs on the development of depression symptoms depends on the presence of health problems. These findings highlight the role health plays in the development of depression and anxiety symptoms in older adults during societal stressors such as the COVID‐19 pandemic.

Background: Understanding the direction and magnitude of mental health-loneliness associations across time is important to understand how best to prevent and treat mental health and loneliness. This study used weekly data collected over 8 weeks throughout the COVID-19 pandemic to expand previous findings and using dynamic panel models with fixed effects which account for all time-invariant confounding and reverse causation.Methods: Prospective data on a convenience and snowball sample from all 50 US states and the District of Colombia (n = 2,361 with ≥2 responses, 63.8% female; 76% retention rate) were collected weekly via online survey at nine consecutive timepoints (April 3–June 3, 2020). Anxiety and depressive symptoms and loneliness were assessed at each timepoint and participants reported the COVID-19 containment strategies they were following. Dynamic panel models with fixed effects examined bidirectional associations between anxiety and depressive symptoms and loneliness, and associations of COVID-19 containment strategies with these outcomes.Results: Depressive symptoms were associated with small increases in both anxiety symptoms (β = 0.065, 95% CI = 0.022–0.109; p = 0.004) and loneliness (β = 0.019, 0.008–0.030; p = 0.001) at the subsequent timepoint. Anxiety symptoms were associated with a small subsequent increase in loneliness (β = 0.014, 0.003–0.025; p = 0.015) but not depressive symptoms (β = 0.025, −0.020–0.070; p = 0.281). Loneliness was strongly associated with subsequent increases in both depressive (β = 0.309, 0.159–0.459; p < 0.001) and anxiety (β = 0.301, 0.165–0.436; p < 0.001) symptoms. Compared to social distancing, adhering to stay-at-home orders or quarantining were not associated with anxiety and depressive symptoms or loneliness (both p ≥ 0.095).Conclusions: High loneliness may be a key risk factor for the development of future anxiety or depressive symptoms, underscoring the need to combat or prevent loneliness both throughout and beyond the COVID-19 pandemic. COVID-19 containment strategies were not associated with mental health, indicating that other factors may explain previous reports of mental health deterioration throughout the pandemic.

Increase in depression and anxiety symptoms and stable levels of compassion among older adults from before to during the COVID-19 pandemic

During the last months of 2019, worldwide attention has focused on a pandemic of COVID-19, and the pandemic spread rapidly, becoming a public health emergency of international concern. The Chinese government has quickly taken quarantine measures and the drastic measures incurred to curtail it, which could have harmful consequences for everyone's behavior and mental health. This study aimed to investigate the correlation of influencing factors and mental health symptoms among Chinese college students according to two rounds of surveys during the COVID-19 pandemic. This study was divided into two stages of cross-sectional investigation. In February 2020 and May 2020, two cross-sectional surveys were conducted on college students in the above areas by means of cluster sampling. From February 4 to February 12, 2020, 14,789 college students completed the first round of online study from 16 cities and universities in 21 in China, excluding participants who completed the questionnaire, and finally included 11,787 college students. After 3 months, we also conducted a large-scale questionnaire survey based on the first study area to observe the behavioral changes and psychological symptoms of college students within 3 months. Using the convenience sampling method, a survey on the cognitive and psychological status of COVID-19 among college students was conducted in 21 universities in 16 regions in May 2020. The regions among the two surveys are divided into Wuhan (District 1), neighboring Hubei (District 2), first-tier cities, namely, Beijing, Shanghai and Guangzhou (District 3), and other provinces (District 4). (1) In the first survey, the average age of the participants was 20.51 ± 1.88 years. One-third of the college students were male. In total, 25.9 and 17.8% of college students reported depression and anxiety symptoms, respectively. College students, who reported higher ST, lower PA, higher soda beverage and tea beverage intake, have Chinese herbal medicine and vitamin drinking, and decreased frequency of diet had higher depression and anxiety symptoms. Moreover, infection risk, perceived resistance to COVID-19, concerns about physical symptoms, family/friends directly/indirectly contacted with confirmed cases, and seeking psychological counseling had significant associations with anxiety and depression symptoms. (2) In the second round of surveys, 6803 males (41.7%) and 9502 females (58.3%) had a mean age of 20.58 ± 1.81 years. The prevalence of depressive symptoms and anxiety symptoms during COVID-19 was 30.7 and 23.9%, respectively. (3) In both surveys, college students who reported having higher ST, lower PA, higher soda beverage and tea beverage intake, Chinese herbal medicine and vitamin drinking, and decreased frequency of diet also had higher depression and anxiety symptoms. Coping styles with COVID-19 partially mediate the association between some related lifestyle behaviors and anxiety and depression. The results of the conditional process model analysis support our hypothesis that lifestyle behaviors, and coping styles are both predictors of anxiety and depression symptoms, with both direct and indirect effects moderated by gender level. In logistic regression analysis, the correlation of depression and anxiety in the second rounds of the survey was higher than that in the first survey. In two surveys, there was a correlation between lifestyle health behaviors and coping style, gender and mental health. Our findings demonstrated that the prevalence of anxiety and depression in the two rounds of surveys was different, and the prevalence in the second round was higher than that in the first round, as well as that in the two rounds of surveys. All survey identified that unhealthy lifestyle behaviors were positively associated with depression and anxiety symptoms. Compared with the emerged city of risk areas, other pandemic regions have a lower risk of mental health problems. The survey findings complement each other. Lifestyle health behaviors and coping style alleviated mental health symptoms. COVID-19-related social stressors were positively associated with mental health symptoms. The study also suggests that at the beginning of the pandemic, the effective management of college students' mental health problems, corresponding coping measures and maintaining a good lifestyle play a key role in the prevention and control of other cities. Understanding the college students' lifestyle behaviors during COVID-19 lockdown will help public health authorities reshape future policies on their nutritional recommendations, in preparation for future pandemics.

Symptoms of Anxiety and Depression Among Teens and Adults in the Thalassemia Longitudinal Cohort Study.

Two years after SARS-COV-2 was declared a public health emergency, global estimates of excess deaths from the Institute for Health Metrics and Evaluation indicate that 18·2 million people died due to the pandemic by Dec 31, 2021—three times higher than official records suggest. 100 million people have been plunged into extreme poverty by the pandemic, according to World Bank estimates. While the true burden of COVID-19 is being unravelled, is a mental health crisis being unmasked? The pandemic has exposed long-standing gaps and a global underinvestment in mental health care and prevention, disproportionately affecting young people and women.

Background: Studies on mental health rates among primary school children are still limited, particularly related to psychological trauma and its relationship to other mental health challenges. Objective: The objective of this study was to 1) examine the prevalence of PTSD, depression, and anxiety symptoms in primary school children before the Covid-19 pandemic; 2) identify the relationship between PTSD, depression and anxiety symptoms; and 3) investigate potential gender differences in PTSD symptoms. Methods: This is the first cross-sectional study examining the rates of trauma exposure, posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in primary school children before the covid-19 pandemic in Malaysia. Two hundred and twenty-one students participated in this study. They were recruited from four primary schools that volunteered to participate in this study. PTSD Checklist for DSM-5 (PCL-5), Child PTSD Symptoms Scale-5 (CPSS-5), The Center for Epidemiologic Studies Depression Scale version (CESD), and the Spence Children's Anxiety Scale (SCAS) were used to survey psychological symptoms. Results: Most of the students, or 54.3% of them, have experienced at least one traumatic event. Of 221 students, 39.4% reported having PTSD symptoms, 38% reported having depressive symptoms, and 19% reported having anxiety symptoms. Female students were more likely to report PTSD symptoms compared to male students. The first regression analysis model indicated that depressive symptoms were the only significant predictors of PTSD. In the second model, religion, family income, anxiety, and PTSD symptoms were significant predictors of depressive symptoms. In the third model, depressive symptoms were the sole significant predictors of anxiety. Conclusion: The study reveals that primary school children experience high levels of trauma, PTSD, depression, and anxiety, especially before the COVID-19 pandemic. During the early phases of the pandemic, these mental health issues have been largely neglected in Malaysia, with limited preventative and therapeutic interventions available. Future research should focus on documenting the prevalence of these issues in relation to the COVID-19 pandemic.

The field of plastic surgery was inevitably affected by the severe acute respiratory syndrome coronavirus 2. Residents in plastic surgery programs, although originally not on the frontline, had significant changes to their schedules and were deployed to other medical services in the hospital to help with the surge of the coronavirus disease of 2019 (COVID-19) patients. In the setting of the COVID-19 pandemic, plastic surgery residents are at higher risk of psychological distress and other mental health symptoms.1 To evaluate this, an American Council of Academic Plastic Surgeons–approved survey was distributed to plastic surgery residents in the United States. The nine-item Patient Health Questionnaire and the seven-item Generalized Anxiety Disorder scale were used to assess the severity of symptoms of depression and anxiety. A total of 116 residents responded to the survey from all four U.S. subregions and all levels of training (Table 1). Table 1. - Demographics of Survey Respondents No. of Respondents Percentage Gender Male 61 53% Female 55 47% Age 20–30 yr 44 38% 30–40 yr 71 62% Level of training PGY-1 15 13% PGY-2 17 15% PGY-3 19 17% PGY-4 16 14% PGY-5 16 14% PGY-6 14 12% Ind. PGY-1 7 6% Ind. PGY-2 3 3% Ind. PGY-3 8 7% U.S. subregion South 33 28% West 24 20% Midwest 29 24% Northeast 34 28% PGY, postgraduate year; Ind. PGY, independent postgraduate year. Ten respondents (8.62 percent) reported chronic symptoms of depression or anxiety before the pandemic. During the pandemic, 57 respondents (49.1 percent) and 48 respondents (41.4 percent) had symptoms of depression (p < 0.0001) and anxiety (p<0.0001), respectively. Respondents with one or more children were more likely to report symptoms of depression (64.3 percent versus 42.9 percent; p = 0.033) and anxiety (66.7 percent versus 41.2 percent; p = 0.029). Increased planned physical activity by at least 30 minutes/week was associated with less severe symptoms of anxiety (30.1 percent versus 55.3 percent; p = 0.039) and depression (40.8 percent versus 52.6 percent; p = 0.272). Respondents who described their program's emphasis on wellness as major compared with those who described it as minor were found to have less severe symptoms of anxiety (38.7 percent versus 57.4 percent, p = 0.006) and depression (44.9 percent versus 59.0 percent, p = 0.140). With regard to counseling, 58.9 percent reported that they did not know if participation in counseling wellness programs was confidential, and the majority (93.0 percent) did not use these activities due to long work hours and the stigma associated. Lastly, 38.7 percent of respondents reported an increase in alcohol intake and 7 percent reported an increase in tobacco product use. These results suggest that plastic surgery residents had symptoms of depression and anxiety at the time of distribution of the survey. Certainly, a rise in symptoms of anxiety and coping responses to stress is expected during extraordinary circumstances; however, the increased prevalence of people with anxiety and depression increases the risk of burnout, which in turn may lead to decreased productivity, slower learning capacity, compromised patient safety, and engaging in harmful behaviors, such as suicide and self-harm.2 Reviewing the mental health outcomes from a structural point of view, residents who had increased physical activity and more emphasis on wellness activities were found to have less severe symptoms of anxiety and depression. Wellness activities have been proven to reduce anxiety, reduce depression, and improve productivity, morale, and overall performance among residents, as well as help to decrease the risks of burnout.3–5 However, these activities must be well implemented and encouraged to avoid conveying feelings of weakness and stigma. Our findings corroborate the importance of established wellness programs and trust between faculty and residents in academic programs, as well as identifying residents at risk for burnout, as these effects can have longstanding sequelae and consequently remain, even when the COVID-19 pandemic is over or under control. DISCLOSURE The authors have no potential conflicts of interest to disclose.

Background. The COVID-19 pandemic and governmental lockdown measures disproportionally impact older adults. This study presents the results from a psychiatric helpline for older adults in Mannheim, Germany, during the lockdown, set up to provide information and psychosocial support. We aim to elucidate the needs of older adults, their reported changes, and the psychological impact during the initial stages of the health crisis. Methods: A total of 55 older adults called the psychiatric helpline between April and June 2020. Information on demographics, medical and psychiatric history. as well as changes in daily life due to the pandemic was collected anonymously. Mental health status was assessed using the 7-Item Hamilton Depression Rating Scale (HAMD-7) and the Hamilton Anxiety Rating Scale (HAM-A). Results: Most callers were women, older adults (M = 74.69 years), single, and retired. In total, 69% of callers reported new or an increase in psychiatric symptoms, with anxiety and depressive symptoms being the most common ones. Age was significantly negatively correlated to higher levels of anxiety and depression symptoms. Individuals with a previous diagnosis of a psychiatric disease reported significantly higher levels of depressive and anxiety symptoms than those without a diagnosis. Conclusion: In older adults, the perceived psychological impact of the COVID-19 crisis appears to ameliorate with age. Individuals with a history of psychiatric disease are most vulnerable to negative mental health outcomes. Rapid response in the form of a geriatric helpline is a useful initiative to support the psychosocial needs of older adults during a health crisis.

Background: The COVID-19 pandemic has led to an increase in the risk of suicide, uncertainty, mental stress, terror, annoyance, weariness, financial issues, and frustration. We aim to determine the prevalence of insomnia, depressive and anxiety symptoms, and their associated factors among Libyan populations during the COVID-19 pandemic and the civil war.Methods: An online cross-sectional survey was conducted among the Libyan population between July 18 and August 23, 2020. The data collected included basic demographic characteristics, level of education, employment status, COVID-19-related questions, and questions about abuse and domestic violence. This study assessed the psychological status of participants who were screened for anxiety symptoms using the seven-item Generalized Anxiety Disorder scale (GAD-7). Depressive symptoms were also screened for using the two-item Patient Health Questionnaire (PHQ-2) and the Insomnia Severity Index (ISI). Binomial logistic regression was used to predict the probability of insomnia, anxiety and depressive symptoms.Results: A total of 10,296 responses were recorded. Among the participants, 4,756 (46.2%) obtained a cut-off score of ≥ 3 which indicated depressive symptoms. For anxiety, 1,952 participants (19%) obtained a cut-off score of ≥ 15, which indicated anxiety symptoms. For the ISI, the mean (SD) was 11.4 (6.1) for the following categories: no clinical insomnia (0–7) 3,132 (30.4%), sub-threshold insomnia (1–7) 3,747 (36.4%), moderate severity clinical insomnia (8–14) 2,929 (28.4%), and severe clinical insomnia (15–21) 488 (4.7%). Logistic regression analysis showed that depressive symptoms were statistically associated with age, marital status, education level, occupational category, financial problems during the COVID-19 pandemic, health status, having a COVID-19 infection, current health status, suicide ideation, abuse or domestic violence, and lockdown compliance (p < 0.05). The regression analysis revealed a statistically significant association between anxiety symptoms and age, education level, occupational status, financial problems during the COVID-19 pandemic, having a COVID-19 infection, health status, suicide ideation, abuse or domestic violence, and lockdown compliance (p < 0.05). The regression analysis revealed a statistically significant association between insomnia and all study variables with the exception of age, educational level, and occupational status (p < 0.05).Conclusion: Confronted with the COVID-19 outbreak, the Libyan population exhibited high levels of psychological stress manifested in the form of depressive and anxiety symptoms, while one-third of the Libyan population suffered from clinical insomnia. Policymakers need to promote effective measures to reduce mental health issues and improve people's quality of life during the civil war and the COVID-19 pandemic.

The Double Burden of Depression and Social Isolation in Older Adults during the COVID-19 Pandemic

Unmet needs in perinatal mental healthcare are an important public health issue particularly in the context of a stressful life event such as the COVID-19 pandemic but data on the extent of this problem are needed. The aim of this study is to determine the (1) proportion of women with clinically significant symptoms of perinatal depression, anxiety or comorbid symptoms of depression and anxiety, receiving mental healthcare overall and by country and (2) factors associated with receiving mental healthcare. Women in the perinatal period (pregnancy or up to 6 months postpartum) participating in the Riseup-PPD-COVID-19 cross-sectional study, reported on sociodemographic, social support health-related factors, and COVID-19 related factors, and on symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (Generalised Anxiety Disorder [GAD-7]) using self-report questionnaires. Clinically significant symptoms were defined as EPDS ≥ 13 for depression and GAD-7 ≥ 10 for anxiety. Mental healthcare was defined as self-reported current mental health treatment. Of the 11 809 participants from 12 countries included in the analysis, 4 379 (37.1%) reported clinically significant symptoms of depression (n = 1 228; 10.4%; EPDS ≥ 13 and GAD-7 ⟨ 10), anxiety (n = 848; 7.2%; GAD-7 ≥ 10 and EPDS ⟨ 13) or comorbid symptoms of depression and anxiety (n = 2 303; 19.5%; EPDS ≥ 13 and GAD-7 ≥ 10). Most women with clinically significant symptoms of depression, anxiety, or comorbid symptoms of depression and anxiety were not receiving mental healthcare (89.0%). Variation in the proportion of women with clinically significant symptoms of depression and/or anxiety reporting mental healthcare was high (4.7% in Turkey to 21.6% in Brazil). Women in the postpartum (vs. pregnancy) were less likely (OR 0.72; 95% CI 0.59-0.88), whereas women with previous mental health problems (vs. no previous mental health problems) (OR 5.56; 95% CI 4.41-7.01), were more likely to receive mental healthcare. There are high unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety across countries during the COVID-19 pandemic. Studies beyond the COVID-19 pandemic and covering the whole range of mental health problems in the perinatal period are warranted to understand the gaps in perinatal mental healthcare.