Changes In Mental Health Status Research Articles

Meta-analysis of the gut-brain axis and mental disorder

The gut-brain axis refers to the bidirectional information communication network between the brain and the gut. Microbiome and gut-brain axis have been implicated in mental disorders and have become the focus of neuroscience research. A meta-analysis was conducted to summarize the evidence regarding this link. A filtering search was performed using Hollis, PubMed, and Google Scholar to identify considered studies and trials. A keyword search identified 5500 articles. Seven provided analytically valuable and eligible data and were finally included for consideration and analysis. The data offered relevant studies on depression or anxiety, Schizophrenia, and Alzheimer's disease. Of the seven papers, four used correlational analysis (n=952) on depression and anxiety, two (n=384) on Schizophrenia, and one (n=80) on Alzheimers disease. These correlation analyses were designed to investigate the differences in gut microbial abundance between normal individuals and patients with mental disorders. In addition, three studies (n=314) identified a causal link by comparing the changes in mental health status by altering or influencing the gut microbiota. These causal analyses aimed to explore the differences in gut microbial abundance before and after the onset of mental disorders. In this case, mental illnesses were 2.8 to 14 times higher in the experimental groups than in the control groups. The findings support the hypothesis that the health of the gut-brain axis (microbial abundance) is inversely correlated to the incidence of many psychological disorders. However, how the gut-brain axis facilitates the pathogenesis of mental disorders remains to be further studied.

Colostrum supplementation enhance mental health status and alleviate pain in patients with acetabular fracture: A randomized, controlled, clinical trial

IntroductionRole of oral colostrum on mental health status, pain, and inflammatory markers in patients with acetabular fracture was investigated. Materials and MethodsFor 21 days, the intervention group received 40 g of colostrum daily and the control group received a placebo. Changes in mental health status, pain, and serum levels of CRP and IL-6 were evaluated over 90 days. ResultsThe risk of depressive symptoms and sleep disturbances in the colostrum group (n = 41) was significantly lower than the control group (n = 39), 14 and 60 days after surgery. The risk of anxiety symptoms in the colostrum group, 2 and 3 months after surgery, was significantly lower than the control group.Generalized estimating equation showed that the mean pain score and serum levels of CRP and IL-6 in the colostrum group were significantly lower than the control group during 90 days of follow-up. ConclusionColostrum improves mental health status, pain, and inflammatory markers.Iranian Registry of Clinical Trials: IRCT20220424054643N1.

COVID-19 Stressors and Cannabis and Alcohol Use in the Canadian Territories

Background: The COVID-19 pandemic and related public health restrictions have been associated with high cannabis and alcohol use among Canadians. Little is known about cannabis and alcohol use in the Canadian territories during the pandemic, despite generally higher substance use rates. This study’s objective was to examine the association between self-reported changes in mental health status and financial stressors resulting from the pandemic on daily/almost daily cannabis use and heavy drinking in the Canadian territories. Methods: This study analyzed data from 993 individuals aged 16 and over residing in the territories collected from September to December 2021 as part of the 2021 Cannabis Policy Study in the Territories. Weighted logistic regression models estimated the association of self-reported mental health status (“worse”/“not worse”) and financial impact (“negative impact”/“no negative impact”) related to the pandemic with daily/almost daily cannabis use (≥5 days per week) and heavy drinking (≥ 4 drinks for women and ≥ 5 drinks for men per occasion at least once a month) in the past 12 months. Models were adjusted for sex, age group, education, perceived income adequacy, territory, ethnicity, living in a capital city, living alone, and having children ≤17 years old. Results: In adjusted models, self-reported worse mental health related to the pandemic had no significant associations with daily/almost daily cannabis use (OR = 1.17, 95% CI:0.72,1.91) and no association with heavy drinking (OR = 1.01, 95% CI:0.63,1.62). Self-reported negative financial impact showed associations above one for daily/almost daily cannabis use (OR = 1.10, 95% CI:0.58,2.08) and with heavy drinking (OR = 1.27, 95% CI:0.75,2.17), though confidence intervals crossed one, indicating no statistical significance. Conclusion: No significant associations were observed between COVID-19 stressors and higher substance use in late 2021. Continued monitoring of the long-term impacts of the pandemic on substance use in the Canadian territories is warranted.

The Effectiveness of EduMind for Mental Health Promotion Among Youths.

Introduction The global surge in mental health issues, particularly among the youth, is evident. Despite the proliferation of digital mental health services, their adoption remains limited, hindered by various barriers. To address this issue, an evidence-based, validated digital mental health intervention is necessary. Although much research has explored the effectiveness of such interventions, there was limited evidence supporting those within the youth population. The objective of this research is to assess the effects of aninterventional module on depression, anxiety, and stress symptoms among youths. Methods The EduMind online mental health intervention contents were developed from a needs assessment and a scoping review of effective psychotherapies, achieving a high content validation index (CVI) of 0.96. The contents were integrated into a web application to assess its effectiveness among the target population which consisted of university students of a local institution. A quasi-experimental study compared the intervention group (n=264) to a waitlist-control group (n=200), evaluating changes in mental health status with the Depression, Anxiety and Stress Scale 21 (DASS-21) questionnaire using analysis of covariance (ANCOVA) to analyse mean differences. Results Participants in the intervention group indicated a significant decrease (p< 0.001) in depression, anxiety, and stress. The pre-test and post-test mean scores in the intervention group were 15.81 and 8.97 for depression, 11.46 and 7.02 for anxiety and 14.64 and 6.33 for stress, respectively. In the control group, there was no significant difference between the pre-test and post-test mean scores for depression. However, there was a slight significant reduction for anxiety with pre- and post-test scores of13.31 and 12.95. Stress mean scores exhibited a slight increase, rising from 13.55 to 14.24. The final phase revealed significant improvements in mental health status between groups, with significant effect sizes for stress (ƞp2= 0.57, p < 0.001), depression (ƞp2= 0.71, p < 0.001), and anxiety (ƞp2= 0.27, p < 0.001). Conclusion The findings contribute to the advancement of technology-assisted health services, facilitating greater uptake among the population.This study utilized a comprehensive module development framework and demonstrated the effectiveness of the expert-guided mental health intervention module.Furthermore, the study suggests potential integration with the National Strategic Plan for Mental Health 2020-2025 and the National Mental Health Policy, proposing the web application as a potential compulsory student screening tool administered by universities. The information gathered by this application could inform future research directions, propelling technological-assisted mental health services to new heights.

Fine grain emotion analysis in Spanish using linguistic features and transformers

Mental health issues are a global concern, with a particular focus on the rise of depression. Depression affects millions of people worldwide and is a leading cause of suicide, particularly among young people. Recent surveys indicate an increase in cases of depression during the COVID-19 pandemic, which affected approximately 5.4% of the population in Spain in 2020. Social media platforms such as X (formerly Twitter) have become important hubs for health information as more people turn to these platforms to share their struggles and seek emotional support. Researchers have discovered a link between emotions and mental illnesses such as depression. This correlation provides a valuable opportunity for automated analysis of social media data to detect changes in mental health status that might otherwise go unnoticed, thus preventing more serious health consequences. Therefore, this research explores the field of emotion analysis in Spanish towards mental disorders. There are two contributions in this area. On the one hand, the compilation, translation, evaluation and correction of a novel dataset composed of a mixture of other existing datasets in the bibliography. This dataset compares a total of 16 emotions, with an emphasis on negative emotions. On the other hand, the in-depth evaluation of this novel dataset with several state-of-the-art transformers based on encoder-only and encoder-decoder architectures. The analysis compromises monolingual, multilingual and distilled models as well as feature integration techniques. The best results are obtained with the encoder-only MarIA model, with a macro-average F1 score of 60.4771%.

The impact of the COVID-19 pandemic on social determinants of health, mental health, and substance use among key populations affected by sexually transmitted and blood-borne infections in Canada

ObjectivesWe assessed the impact of the COVID-19 pandemic on social determinants of health, mental health, substance use, and access to mental health and harm reduction services among key populations disproportionately impacted by sexually transmitted and blood-borne infections (STBBI).MethodsOnline surveys (2021‒2022) were conducted in Canada among people who use drugs or alcohol (PWUD); African, Caribbean, and Black people (ACB); and First Nations, Inuit, and Métis peoples (FNIM). Descriptive analyses were conducted on social determinants of health, substance use, and access to services, stratified by changes in mental health status since the start of the pandemic.ResultsA total of 3773 participants (1034 PWUD, 1556 ACB, and 1183 FNIM) completed the surveys, with 45.6% reporting a major/moderate impact of the pandemic on their ability to pay bills and 53% experiencing food insecurity since the start of the pandemic. Half (49.4%) of participants reported deteriorating mental health. A higher increase in substance use and related behaviours was seen in those with worsening mental health. Among those using substances, two thirds (69.4%) of those with worsening mental health reported increasing their use of substances alone, compared to 46.9% of those with better/similar mental health. Access to mental health and harm reduction services was low.ConclusionThese intersecting health issues are among the risk factors for STBBI acquisition and act as barriers to care. Equitable interventions and policies addressing downstream and upstream determinants of health, with meaningful and sustainable leadership from key populations, may improve their health and well-being, to lower STBBI impact and improve future pandemic responses.

Patient-reported outcome, clinician-reported outcome, and patient satisfaction with treatment by crisis resolution teams: a multicenter pre-post study of outcome and associated factors in Norway

BackgroundCrisis resolution teams (CRTs) have become a part of mental health services in many high-income countries. Many studies have investigated the impact of CRTs on acute admissions to inpatient units, but very few studies have investigated patient-reported and clinician-reported outcomes for CRT service users. Our aims were to study patient-reported and clinician-reported outcomes of CRT treatment, how the outcomes were associated with characteristics of the service user and the treatment, and whether outcomes were different across CRTs.MethodsThe study was a pre-post observational multicenter study of 475 patients receiving treatment from 25 CRTs in urban and rural areas in Norway. There was no control group. Outcomes were change in mental health status reported by service users using CORE-10 and by clinicians using HoNOS. Patient satisfaction was measured using CSQ-8 at the end of the treatment. Components of CRT accessibility and interventions were measured by clinicians reporting details on each session with the service user. CRT model fidelity was measured using the CORE CRT Fidelity Scale version 2. We used paired t-tests to analyze outcomes and linear mixed modeling to analyze associations of the outcomes with the characteristics of service users and the treatment provided. Using independent t-tests, we analyzed differences in outcomes and patient satisfaction between two clusters of CRTs with differences in accessibility.ResultsThe patient-reported outcomes and the clinician-reported outcomes were significantly positive and with a large effect size. Both were significantly positively associated with practical support and medication management and negatively associated with collaboration with mental health inpatient units. Patient satisfaction was high at the end of the treatment. CRTs with higher accessibility had a significantly better clinician-reported outcome, but no significant differences were reported for patient-reported outcomes or patient satisfaction.ConclusionsCRT treatment led to improved symptom status as reported by patients and clinicians, as well as high patient satisfaction. Practical support and medication management were the interventions most strongly associated with positive outcomes. Some of the variations in outcomes were at the team level. Patient- and clinician-reported outcomes should be used more in studies on the effect of treatment provided by crisis resolution teams.

Changes in the diagnosis of depression among nursing professionals during the COVID-19 pandemic: A longitudinal study.

To identify changes in mental health status among nursing professionals in a Brazilian municipality during the COVID-19 pandemic. An observational and longitudinal study. Using the Patient Health Questionnaire-9, the presence of depressive symptoms was evaluated among 690 nursing professionals in the city of Pelotas, Brazil, at two moments: June/July 2020 and June/July 2021. 13.0% incidence of depressive symptoms was identified; as well as 12.2% remission; 24.1% persistence and 50.7% absence. Among the factors associated with the worst prognoses we can mention female gender, greater workload, feeling of overload, illness of family members or friends due to COVID-19 and use of psychotropic drugs CONCLUSIONS: There was significant mobility in the diagnosis of depression among the professionals studied during the period analysed, with incidence of new cases of significant depression and greater than the number of remissions. In addition to sociodemographic aspects, traumatic experiences and exposure to continuous overload were associated with persistence and incidence of new cases. With the advent of the COVID-19 pandemic, several studies have shown an increase in depressive symptoms among nursing professionals; however, understanding the long-term effects of this scenario is still a challenge. What problem did the study address? This study investigates changes in the mental health status of nursing professionals working at different care levels, taking the prevalence of screening for depression as a proxy, during a period of a year during the COVID-19 pandemic. What were the main findings? Between both data collection moments, 2020 e 2021, there was a significant percentage of professionals with persistent depression, in addition to a significant proportion of incident cases that slightly exceeded the number of remissions and the factors associated with the worst prognoses were sociodemographic aspects such as gender and emotional stressors like illness of family members or close friends due to COVID-19, in addition to those related to the organisation and support provided by the services, such as workload and feeling of overload. Where and on whom will the research have an impact? This study will impact the nursing professionals and in role of the health services in order to establishing actions that contribute to minimising the deleterious effects of the pandemic on the mental health of their Nursing teams. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study. No Patient or Public Contribution.

PO-02-194 CHANGES IN ANXIETY AND DEPRESSION IN ATRIAL FIBRILLATION PATIENTS AFTER RECEIVING MULTIDISCIPLINARY CARE AT AN ATRIAL FIBRILLATION CENTER OF EXCELLENCE

Anxiety and depression are known to occur in over one third of patients with atrial fibrillation (AF) and may negatively affect quality of life (QoL) and AF symptom severity. Though highly prevalent, the relationship between anxiety and depression with AF care remains poorly defined. The goal of an Atrial Fibrillation Center of Excellence (AFCoE) is to improve outcomes by delivering team-based multidisciplinary care to streamline risk factor modification while incorporating performance -measures and ongoing quality improvement to facilitate data-driven delivery of high-quality, guideline directed care. In the pilot phase of the AFCoE at the Inova Heart and Vascular Institute, an AF care coordinator and specialists from electrophysiology and sleep medicine were included based on patient need. To investigate changes in mental health status following multidisciplinary AF care received in an AFCoE in patients with AF. 138 patients were referred to the Inova AFCoE pilot between 10/2021 and 4/2022. Demographic and clinical comorbidities were ascertained. The frequency and severity of anxiety and depression were measured in a subset of participants (n=41) using the General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) tools administered at baseline and again between 3 to 6 months after their initial AFCoE visit. Baseline and follow-up summed GAD-7 and PHQ-9 scores were compared using the Wilcoxon test. Additional analyses were performed among patients with clinically significant baseline anxiety (GAD-7 score ≥5 points) or depression (PHQ-9 score ≥5 points). A total of 12/41 (29%) patients had clinically significant depression or anxiety (scores ≥5 points) at baseline. Among patients with clinically significant depression or anxiety at baseline, the median [interquartile range] summed score improved at follow-up from 13[11–15] to 6[1–9] points (p=0.005, score reduction 8[2–14] points). Nearly one third of patients referred to the Inova AFCoE pilot phase had clinically significant anxiety and/or depression at baseline. Multidisciplinary AF treatment without specific behavioral health intervention was associated with clinically significant improvements in anxiety and depression.

Associations between mental health status and labor force transitions in China: A longitudinal study between agricultural and nonagricultural sectors.

No consensus has been reached on the relationship between retirement and mental health, and limited information is available on retirement and mental health in developing countries. This study investigated the associations between short-term changes in mental health status and labor force transitions (retirement and reemployment) in both the agricultural and nonagricultural sectors in China. This study used nationally representative panel data from three waves (2011, 2015, and 2018) of the China Health and Retirement Longitudinal Study on workers and retirees aged 40-70 years in China. The latent change score (LCS) model was employed. The transition from nonagricultural and agricultural sectors to retirement significantly increased the changes in the Center for Epidemiological Studies-Depression scale (CES-D-10) score. Reentering the nonagricultural sectors significantly decreased the changes in the CES-D-10 score, whereas reentering the agricultural sectors had no impact on the changes in the CES-D-10 score. Stronger associations were identified among male workers, while the associations were weaker and less significant for female workers. Findings are consistent with the resource-based dynamic theory and extends the work in developing country by showing the mental health status worsens after retirement transitions and improves after reentering the workforce, especially for nonagricultural male workers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Racial and Ethnic Disparities in the Mental Health Impact of the COVID-19 Pandemic in the United States: Analysis of 3 Million Americans from the National Health Interview Survey and Household Pulse Survey

Background: During the coronavirus (COVID-19) pandemic, racial/ethnic minorities in the United States (US) experienced a disproportionate burden of COVID-19 mortality and hospitalization, job losses, food insecurity, and reduced healthcare access, resulting in increased mental health problems. Given heterogeneous findings on the impact of COVID-19 among racial/ethnic minorities, it is worthwhile to examine the differential effects of the pandemic on mental health by race/ethnicity. Methods: This study examines changes in mental health status among US adults aged ≥18 years before and during the pandemic. We pooled data from the 2019 National Health Interview Survey with the 2020-2021 Household Pulse Survey (N=2,980,511). Logistic regression was used for binary outcomes and linear regression was used for the composite Psychological Distress Index (PDI) measure derived from principal components analysis to estimate changes in mental health after controlling for sociodemographic characteristics. Results: Mental health status worsened during the pandemic compared to the pre-pandemic period. The adjusted predicted probabilities of having little interest increased from 3.29% in 2019 to 10.97% in 2020 and 11.28% in 2021. The adjusted predicted probabilities of being depressed increased from 2.69% in 2019 to 11.00% in 2020 and 11.21% in 2021. The adjusted predicted probabilities of feeling anxious increased from 3.95% in 2019 to 18.35% in 2020 and 16.96% in 2021. The adjusted predicted probabilities of worrying increased from 4.18% in 2019 to 13.15% in 2020 and 12.61% in 2021. The adjusted mean PDI score increased from 87.52 in 2019 to 103.18 in 2020 and 101.13 in 2021. In stratified models, Blacks, Hispanics, and Asians had higher odds of depression, anxiety, and worries, compared with non-Hispanic Whites. Asians experienced 10 times higher odds of depression and 15 times higher odds of anxiety in 2020 than their counterparts before the pandemic. Conclusions and Implications for Translation: US adults experienced a marked increase in mental health problems, including depression and anxiety, in 2020 and 2021, compared with their counterparts in 2019. Racial/ethnic disparities in mental health worsened during the pandemic. Copyright © 2022 Lee and Singh. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Abstract 440: Diet and supplement use changes among male cancer survivors during the COVID-19 pandemic

Abstract Introduction: The COVID-19 pandemic has disrupted the lives of cancer survivors who may be at higher risk than people without cancer of other adverse health outcomes. For many individuals, a cancer diagnosis leads to lower physical activity and change in mental health status. Modifiable health behaviors, such as consumption of a healthy diet, can positively affect cancer survivorship outcomes. Aim: To investigate the individual-level changes in diet and supplement use among male cancer survivors during the COVID-19 pandemic and compared to men without cancer. Methods: Participants of the Health Professionals Follow-up Study, enrolled since 1986, were asked to self-report health behaviors during the pandemic on three web-based questionnaires administered during the COVID-19 pandemic (baseline COVID: October 2020, first follow-up: January 2021, second follow-up: April 2021). Diet and supplement use were analyzed descriptively between cancer survivors and individuals without a history of cancer. Further, outcomes were dichotomized to reflect whether a change was healthful or unchanged/unhealthful; for example, lower fast food consumption was classified as a healthful change. To assess the associations between cancer survivors and other men, logistic regression was used, adjusting for age, race, pre-pandemic body mass index, pre-pandemic physical activity, and other health information. Results: Of 4,416 men who completed the baseline COVID-19 questionnaire, 962 were cancer survivors (after excluding those with non-melanoma skin cancer). Across all eligible men (median age: 78 years), there were considerable proportions of men engaging in healthful changes following the start of the pandemic in intake of fast food (19% decreased), sugary drinks (14% decreased), fresh fruit (26% increased), fresh vegetables (19% increased), fish (13% increased), and red meat (12% decreased) consumption. Similar changes in diet were reported on the second follow-up questionnaire. For most foods, a similar percentage of cancer survivors and individuals without a history of cancer increased healthy eating. Findings from multivariable logistic regression models were reflective of higher odds of cancer survivors to engage in a healthful diet change for unhealthy food categories (i.e., less fast food, less frozen food), though none of which were statistically significant. There was little change in supplement use during the pandemic, except for 6% who started use of vitamin D supplements between the baseline and first follow-up questionnaire. Conclusion: Our findings suggest that older men engaged in healthful diet changes during the COVID-19 pandemic, without noticeable differences among cancer survivors. Citation Format: Alaina H. Shreves, Colleen B. McGrath, Konrad Stopsack, Lilian Cheung, Ann Fisher, Edward Giovannucci, Sarah Markt, Eric Rimm, Lorelei Mucci. Diet and supplement use changes among male cancer survivors during the COVID-19 pandemic [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 440.

Requirement of Mental-health Referral Letters for Staged and Revision Genital Gender-Affirming Surgeries: An Unsanctioned Barrier to Care

ABSTRACT Introduction The World Professional Association for Transgender Health (WPATH) recommends referral letters from two mental-health providers within one year of gender-affirming genital surgery (gGAS) to ensure patient readiness before primary surgeries. Many U.S. health-insurance plans will not authorize second- and third-stage surgeries or revision surgeries without two referral letters. Such requirements are not supported by WPATH guidelines. Objective This study investigates insurance requirements for referral letters and their negative impact on care. Methods We retrospectively reviewed all gGAS cases over a 4-year period at our tertiary care medical center. Referral-letter requirements for insurance authorization were documented. The nation's largest insurance companies, including commercial, state-, and federally funded plans, were contacted to confirm requirements. We prospectively recorded time needed to complete insurance authorization for a patient subset. WPATH publications were reviewed. Results Nearly all reviewed U.S. health-insurance plans required annually updated referral letters for each gGAS procedure, including staged and revision surgeries. No updated letters changed clinical management. Referral-letter requirements delayed care. WPATH states that letters should not be needed for staged surgeries. Some plans required letters even for initial surgical consultation, a practice not supported by WPATH. Conclusions Insurance companies’ requirements for referral letters impede care and contradict WPATH guidelines. We advocate that referral letters should not be required for surgical consultations or for staged or revision surgeries after a patient has already had first-stage primary gGAS. Universal referral-letter requirements for secondary surgeries provide minimal clinical value, delay care, increase costs, and exacerbate gender dysphoria by invalidating gender transition. As with all procedures, surgeons themselves should be responsible for assessing patients’ surgical readiness. Significant changes in mental-health status or social situation should prompt surgeons to seek reassessment. WPATH recommendations regarding referral letters should be clarified and consolidated into a single document. Disclosure No

A Cross-Temporal Meta-Analysis of Changes in Left-Behind Children's Mental Health in China.

A considerable body of research using the Mental Health Test (MHT) has explored the psychological repercussions of the physical separation of children from one or both parents as they pursue better economic prospects in cities. Generally, these studies compare the mental health status (MHS) between left-behind children (LBC) and non-left-behind children (NLBC). That notwithstanding, little is known about the real policy impact of these studies on the ground over the years. Using a relevant search strategy and selection criteria, we identified qualified studies (N = 102: 2004 to 2019). Cross-temporal meta-analysis (CTMA) was performed on these studies for dynamic trends. Our results demonstrate: (1) a slight but significant change in MHS of both LBC and NLBC, with LBC being significantly worse off over time; (2) a significant deterioration in MHS of LBC over time, particularly among left-behind boys (LBBs); (3) a stable and significant decline in MHS of left-behind junior high and elementary school students, respectively; and (4) a more substantial degradation in MHS of LBC with both parents absent compared with LBC with a parent present. The findings reveal that the efforts of, and collaboration among, researchers, policy experts and politicians are producing results. Nevertheless, more targeted research is needed to unearth the underlying issues that generate the differences among subpopulations of LBC to better inform pragmatic interventions for collective psychological wellness of LBC.

Changes in Mental Health among Psychiatric Patients during the COVID-19 Pandemic in Hong Kong-A Cross-Sectional Study.

Background: The COVID-19 pandemic has had substantial impacts on citizens’ daily living. Concerns over mental health issues are rising. Recent studies assessing the psychosocial impact of COVID-19 on the general public revealed alarming results. Meanwhile, the impact of the COVID-19 pandemic on mental health among patients with pre-existing psychiatric disorders remained unclear. Methods: Patients diagnosed with anxiety disorders, depressive disorders, bipolar disorders, or schizophrenia were invited to complete a survey between July and October 2020. The survey collected information on subjects’ demographics, accommodation status, changes in mental health status during the COVID-19 outbreak, and the factors that affect subjects’ mental health during COVID-19. The primary outcome of this study was the change in mental health, defined by psychiatric symptom change and patient satisfaction on symptom control. The secondary outcomes were patients’ emotional status—measured by the Depression, Anxiety and Stress Scale (DASS-21)—during the COVID-19 pandemic and factors that impacted patients’ mental health during the COVID-19 pandemic. Results: Out of the 294 patients recruited, 65.0% were living in hostel while 35.0% were living in the community. The proportion of patients with ‘unsatisfied’ or ‘very unsatisfied’ mental disease control increased from 10.2% to 17.1% after the COVID-19 outbreak (p < 0.001). Under the DASS-21 questionnaire, 24.2% subjects, 32.6% subjects, and 18.9% subjects were classified as severe or extremely severe in terms of the level of depression, anxiety, and stress they experienced, respectively. Patients living in the community, patients with mood disorders, and female patients reported significantly worse control over anxiety and mood symptoms. The three major factors that affected patients’ mental health during COVID-19 were ‘reduced social activities’, ‘worries over people around getting infected’, and ‘reduced exercise’. Conclusion: Psychiatric patients in general have poorer disease control after the COVID-19 outbreak. Patients in the community appeared to be more affected than patients residing in hostels. More efforts should be directed to screening patients with pre-existing mental health disorders to enable timely interventions.

Impact of lockdown relaxation and implementation of the face-covering policy on mental health: A United Kingdom COVID-19 study.

BACKGROUNDPandemic mitigation policies, such as lockdown, are known to impact on mental health of individuals. Compulsory face covering under relaxed lockdown restrictions gives assurance of less transmission of airborne infection and has the potential to improve mental health of individuals affected by restrictions. AIMTo examine the association of the lockdown relaxation and the implementation of the face covering policy on the mental health of the general population and sub-groups in the United Kingdom using interrupted time series model.METHODSUsing a web-based cross-sectional survey of 28890 United Kingdom adults carried out during May 1, 2020 to July 31, 2020, changes in mental health status using generalised anxiety disorder (GAD-7), and impact of events scale-revised (IES-R) scales are examined, at the dates of the first lockdown relaxation (July 4, 2020) and the subsequent introduction of face covering (July 24, 2020) in United Kingdom. A sharp regression discontinuity design is used to check discontinuities in mental health outcomes at policy-change dates.RESULTSAverage GAD-7 scores of participants were 5.6, 5.6 and 4.3 during the lockdown period, the lockdown relaxation phase and the phase of compulsory face covering, respectively, with lower scores indicating lower anxiety levels. Corresponding scores for IES-R were 17.3, 16.8 and 13.4, with lower scores indicating less distress. Easing lockdown measures and subsequent introduction of face covering, on average, reduced GAD-7 by 0.513 (95%CI: 0.913-0.112) and 1.148 (95%CI: 1.800-0.496), respectively. Corresponding reductions in IES-R were 2.620 (95%CI: 4.279-0.961) and 3.449 (95%CI: 5.725-1.172). These imply that both lockdown relaxation and compulsory face-covering have a positive association with mental health scores (GAD-7 and IES-R). CONCLUSIONThe differential impact of lockdown and relaxation on the mental health of population sub-groups is evident in this study with future implications for policy. Introduction of face covering in public places had a stronger positive association with mental health than lockdown relaxation.

Family caregiving and changes in mental health status in Japan during the COVID-19 pandemic

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has had a widespread significant impact on mental health. However, the effect of providing care to family members (informal caregiving) on changes in mental health status during the pandemic remains unclear. MethodsUsing cross-sectional data from a large internet survey conducted between August and September 2020, we investigated the association of informal caregiving status with the incidence of mental health deterioration (increased loneliness, self-reported deterioration in mental health, and new suicidal ideation) in Japan during the COVID-19 pandemic. ResultsAmong 25,482 participants (mean age 48.8 [standard deviation 17.3]; 50.3% women), 2,500 (9.8%) were providing informal care during the pandemic. After adjusting for potential confounders, informal caregivers were more likely than non-caregivers to experience increased loneliness (adjusted odds ratio [aOR] 2.16; 95% confidence interval [CI] 1.70–2.76), self-reported deterioration in mental health (aOR 1.54; 95% CI 1.14–2.08), and new incidence of suicidal ideation (aOR 3.65; 95% CI 1.92–6.92). The degree of mental health deterioration depended on the intensity of care. For example, the incidence rates of new suicidal ideation were 15.0%, 5.2%, and 3.6% for individuals who provided high-intensity caregiving, those who provided low-intensity caregiving, and non-caregivers, respectively (p-for-trend<0.001). The stratified analysis by gender showed that informal caregiving was associated with self-reported deterioration in mental health status among women (aOR 2.19; 95% CI 1.49–3.21) but not men (aOR 1.08; 95% CI 0.75–1.56). ConclusionInformal caregivers were more likely to experience mental health deterioration than non-caregivers during the COVID-19 pandemic.

Requirement of mental health referral letters for staged and revision genital gender-affirming surgeries: An unsanctioned barrier to care.

The World Professional Association for Transgender Health (WPATH) recommends referral lettersfrom two mental health providers within one year of gender-affirming genital surgery(gGAS) to ensure patient readiness before primary surgeries. Many U.S. health insurance plans will not authorize second- and third-stage surgeries or revision surgeries without two referral letters. Such requirementsare not supported by WPATH guidelines. This study investigates insurancerequirements forreferral letters and their negative impact on care. We retrospectively reviewedallgGAScasesover a 4-year period at our tertiary care medical center. Referral letter requirements for insurance authorization were documented.The nation's largest insurance companies, including commercial, state-, and federally funded plans, werecontacted to confirm requirements.We prospectively recorded time needed to complete insurance authorization for a patient subset. WPATHpublicationswere reviewed. Nearly all reviewed U.S. health insurance plans requiredannuallyupdated referral letters for each gGAS procedure, including staged and revision surgeries.No updated letters changed clinical management.Referral letter requirements delayed care.WPATH states that letters should not be needed for staged surgeries.Some plans required letters even for initial surgical consultation, a practice not supported by WPATH. Insurance companies' requirements for referral letters impede care and contradict WPATH guidelines.We advocate that, at minimum,referral letters should not be required for surgical consultations or for staged or revision surgeriesafter a patient has already had first-stage primarygGAS. Universalreferral letterrequirementsprovide minimal clinical value, delay care, increase costs, and exacerbate gender dysphoria by invalidating gender transition.As with all procedures, surgeons themselves should be responsible for assessing patients' surgical readiness.Significant changes in mental health status or social situation should prompt surgeons to seek reassessment.WPATH recommendationsregardingreferral lettersshould be clarified and consolidated into a single document.

Impacts of Digital Healthy Diet Literacy and Healthy Eating Behavior on Fear of COVID-19, Changes in Mental Health, and Health-Related Quality of Life among Front-Line Health Care Workers.

Background: We aimed to examine the impacts of digital healthy diet literacy (DDL) and healthy eating behaviors (HES) on fear of COVID-19, changes in mental health, and health-related quality of life (HRQoL) among front-line healthcare workers (HCWs). Methods: An online survey was conducted at 15 hospitals and health centers from 6–19 April 2020. Data of 2299 front-line HCWs were analyzed—including socio-demographics, symptoms like COVID-19, health literacy, eHealth literacy, DDL, HES, fear of COVID-19, changes in mental health, and HRQoL. Regression models were used to examine the associations. Results: HCWs with higher scores of DDL and HES had lower scores of FCoV-19S (regression coefficient, B, −0.04; 95% confidence interval, 95% CI, −0.07, −0.02; p = 0.001; and B, −0.10; 95% CI, −0.15, −0.06; p < 0.001); had a higher likelihood of stable or better mental health status (odds ratio, OR, 1.02; 95% CI, 1.00, 1.05; p = 0.029; and OR, 1.04; 95% CI, 1.00, 1.07; p = 0.043); and HRQoL (OR, 1.02; 95% CI, 1.01, 1.03; p = 0.006; and OR, 1.04; 95% CI, 1.02, 1.06; p = 0.001), respectively. Conclusions: DDL and HES were found as independent predictors of fear of COVID−19, changes in mental health status, and HRQoL in front-line HCWs. Improving DDL and HES should be considered as a strategic approach for hospitals and healthcare systems.

Development of School-based Mental Health Program

BACKGROUND: Mental health services for school-aged children can help prevent the emergence of more severe problems. AIM: This study aims to create a mental health program for school-aged children. METHODS: An action design was used, and the implementation procedure consisted of four stages, namely reconnaissance, planning, acting, and reflecting. Furthermore, the respondents were 12 teachers, and the samples for the program were 73 students. In the reconnaissance stage, data were recorded and documented in transcript form. RESULT: At the planning stage, the instrument of mental health status, workbooks, and modules were developed. Meanwhile, in the acting stage, psychosocial intervention was conducted, and in the reflecting stage, the child mental health status before and after were measured using a dependent t-test. Furthermore, Focus Group Discussion activity in the Development of School-based Mental Health Program has 6 themes. The analysis results showed significant changes, meaning that there was a change in mental health status in school-aged children (p = 0,000; alpha 0.05). This showed that there was a significant influence of the program implementation on mental health status. CONCLUSION: The programs include identification, assessment, intervention, and mental health facilitation in school-aged children. Therefore, it is recommended for health service and education office to synergize in developing the program to improve achievement.