Pre-existing Mental Health Problems Research Articles

Commentary: Climate change worry among adolescents-on the importance of going beyond the constructive-unconstructive dichotomy to explore coping efforts-a commentary on Sciberras and Fernando (2021).

This opinion piece comments on Sciberras and Fernando's (2021) article in which an 8-year longitudinal study is presented. The authors investigate trajectories of climate change worry through adolescence and associations with measures of depression and engagement with news and politics in late adolescence. Their objective is to explore whether climate change worry is a constructive or unconstructive psychological phenomenon. Their conclusion is that it is mainly an adaptive response but, for some groups, such as young people with pre-existing mental health problems, climate change worry could exacerbate their difficulties. In this commentary, it is argued that since research has found diverse results regarding whether climate worry is adaptive or not, one should perhaps not focus so much on the emotion itself, but rather on how people cope with their worry. Some examples of how young people cope with climate change are presented, and it is argued that taking account of these coping strategies in future longitudinal studies would be beneficial.

Nationwide assessment of the mental health of UK Doctoral Researchers

Doctoral Researchers (DRs) are an important part of the academic community and, after graduating, make substantial social and economic contributions. Despite this importance, DR wellbeing has long been of concern. Recent studies have concluded that DRs may be particularly vulnerable to mental health problems, yet direct comparisons of the prevalence of mental health problems between this population and control groups are lacking. Here, by comparing DRs with educated working controls, we show that DRs report significantly greater anxiety and depression, and that this difference is not explained by a higher rate of pre-existing mental health problems. Moreover, most DRs perceive poor mental health as a ‘normal’ part of the PhD process. Thus, our findings suggest a hazardous impact of PhD study on mental health, with DRs being particularly at risk of developing common mental health problems. This provides an evidence-based mandate for universities and funders to reflect upon practices related to DR training and mental health. Our attention should now be directed towards understanding what factors may explain heightened anxiety and depression among DRs so as to inform preventative measures and interventions.

Therapeutic termination of pregnancy and women's mental health: Determinants and consequences.

The therapeutic termination of pregnancy (TToP) is an induced abortion following a diagnosis of medical necessity. TToP is applied to avoid the risk of substantial harm to the mother or in cases of fetal unviability. This type of induced abortion is provided after the second semester of gestation if fetal illness or the pregnancy cause physical danger or pathological mental distress to the mother. Socio-cultural and economic determinants could influence the desire for children and family planning in couples, as well as the use of effective contraception and the choice to perform an induced abortion. Also, pre-existing mental health problems could affect the decision between carrying on a problematic pregnancy or having TToP. Furthermore, the TToP is a reproductive event with an important traumatic burden, but also with an intrinsic therapeutic effect and it can produce different psychological and psychopathological effects on women and couples. The aim of this review is to evaluate what demographic, reproductive and psychopathological determinants are involved in the choice of undergoing a TToP in women. Also, we will examine both positive and negative consequences of this procedure on women’s mental health, underlying which factors are related to a worse outcome in order to provide the best clinical support to vulnerable groups.

Validation of the fear of COVID-19 scale in South Africa: Three complementary analyses

Fear is the most common response to disease outbreaks. Persistent and prolonged fear can elevate the levels of psychological distress and aggravate preexisting mental health problems. Therefore, prompted by the central role of fear in psychological responses to COVID-19, the Fear of COVID-19 Scale was developed, which is the only instrument that can assess emotional fear reactions in relation to the current pandemic. In this study, we extend research on the psychometric properties of this instrument by adopting three complementary approaches: classical test theory, Rasch analysis, and Mokken analysis. Combining these methods allows for a more nuanced overview of the psychometric properties of the instrument. The sample comprised South African teachers (n=355) who completed the Fear of COVID-19 Scale. All three approaches confirmed the reliability and the construct, convergent, and concurrent validity of the scale as used with South African teachers. In addition, all three approaches confirmed that the scale is sufficiently homogenous to be considered unidimensional.

An Analysis of the #CovidPain Tweet Chat During the First Wave of the COVID-19 Pandemic in 2020

Introduction: In March 2020, we organized two tweet chats to discuss the COVID-19 pandemic and its impact on people affected by chronic pain. The objective of this study is to evaluate the #CovidPain tweet chat activities that took place at the early stages of the COVID-19 pandemic.Methods: We performed a quantitative analysis of the magnitude, range, engagement, and sentiment of each tweet chat. The data was extracted from Twitter and analyzed in Twitter Analytics and Symplur Signals using frequency and distributions. Then, we conducted a qualitative content analysis of the narrative tweets generated in response to the questions posted during the tweet chats.Results: The two tweet chats attracted 2305 participants, which generated 4351 tweets. The participants were healthcare providers, patient advocates, researchers/academics, and caregivers. COVID-19 had both negative and positive impacts. The negative consequences of COVID-19 included the reduction of physical activity, canceled appointments and treatments, more isolation, deterioration of preexisting mental health problems, and economic consequences. The positive consequences included efficient use of telemedicine, innovative methods for self-management, and at-home interventions.Conclusion: Twitter and tweet chats are useful in involving a diverse group of stakeholders for taking a deep dive into the topical issues relevant to a community that might be disproportionately affected by a public health crisis.

Mental health and related service use by sex workers in rural and remote Australia: ‘there’s a lot of stigma in society’

Sex workers experience risk and protective factors that affect their psychological well-being, yet little is known about sex workers’ mental health and their experiences with related services in rural and remote Tasmania, Australia. Semi-structured interviews were conducted with six current or former sex workers with pre-existing mental health problems, and thematic analysis was used to identify their experiences with mental health and related care. Generally, sex work does not contribute to participants’ mental health concerns; rather, social exclusion and systemic issues cause psychological harm. Ineffective mental health professionals and the lack of tailored or culturally competent support serve as barriers to care. Significantly, widespread stigma was both a risk factor to participants’ mental health and a barrier to help seeking and resulted in isolation and identity concealment. Resilience, self-awareness and social inclusion reduce the psychological impact of exogenous oppression and encourage help seeking. The decriminalisation of sex work could improve sex worker mental health and reduce stigma by normalising sex work.

Loneliness and mental health in children and adolescents with pre-existing mental health problems: A rapid systematic review.

Periods of social isolation are associated with loneliness in children and young people, and loneliness is associated with poor mental and physical health. Children and young people with pre-existing mental health difficulties may be prone to loneliness. Containment of COVID-19 has necessitated widespread social isolation, with unprecedented school closures and restrictions imposed on social interactions. This rapid review aimed to establish what is known about the relationship between loneliness and mental health problems in children and young people with pre-existing mental health problems. We sought to identify all primary research that examined the cross-sectional and longitudinal associations between loneliness/perceived social isolation and mental health in children and young people with pre-existing mental health problems. We also aimed to identify effective interventions that reduce the adverse impact of loneliness. A rapid systematic search was conducted using MEDLINE, PsycINFO, and Web of Science. Of 4,531 papers screened, 15 included children and young people with pre-existing mental health conditions. These 15 studies included 1,536 children and young people aged between 6 and 23 years with social phobia, anxiety and/or depression, and neurodevelopmental disorders. Loneliness was associated with anxiety and depression both cross-sectionally and prospectively in children and young people with mental health problems and neurodevelopmental conditions. We found preliminary evidence that psychological treatments can help to reduce feelings of loneliness in this population. Loneliness is associated with depression and anxiety in children and young people with pre-existing mental health conditions, and this relationship may be bidirectional. Existing interventions to address loneliness and/or mental health difficulties in other contexts may be applied to this population, although they may need adaptation and testing in younger children and adolescents. Loneliness is common in children and young people, and during periods of enforced social isolation such as during COVID-19, children and young people report high levels of loneliness (or increased rates of loneliness). The review showed that loneliness is associated, both cross-sectionally and prospectively, in children and young people with mental health problems and also in children and young people with neurodevelopmental conditions, such as autism spectrum disorder. Thus, loneliness is a possible risk factor of which mental health providers should be aware. Maintaining social contact both by direct and by indirect means, especially through the Internet, could be important in mitigating loneliness. Interventions to address loneliness should be further developed and tested to help children and young people with pre-existing mental health problems who are lonely by preventing exacerbation of their mental health difficulties, in particular anxiety and depression.

Risk Factors of Domestic Violence in Pregnancy and its Correlation with Mental Health Disorders

ABSTRACT
 
 Domestic violence during pregnancy is a neglected & underreported problem having grave consequences. The world health organization (WHO) defines domestic violence as “the range of sexually, psychologically and physically coercive acts used against adult and adolescent women by current or former male intimate partners”. Physical & verbal abuse during pregnancy is a frequent phenomenon encountered by women of both developed and underdeveloped country, belonging to all cultural communities. There is a strong evidence that domestic violence is related to maternal mental health disorders. The aim of this literature study is to find the best available research evidence on risk factors of domestic violence in pregnancy and its correlation to mental health disorders.
 To achieve the goal of this study, researcher searched for all studies published between January 2010 until August 2021 using the databases such as google scholar and PubMed. The inclusion criteria were studies that describe risk factors of domestic violence in pregnancy and its correlation with maternal mental health and written in English languange. Condition such as mental retardation, substance abuse and pre-existing mental health problems before were excluded from this study. After a long review of the titles and abstracts of 358 studies, 20 studies were identified for potential inclusion in the review. In the end, a total of 10 trials that fulfil researcher criteria were used in this literature review. The number of participants in each study varied, ranged from 300 to 1000 and the characteristics of the sample are similar.
 Domestic violence against women and mental disorders amongst pregnant women are extremely prevalent in under-resourced, urban areas and ultimately, have detrimental effects on birth outcomes. Mental health disorders are significantly associated with having experienced domestic violence in pregnancy. High risk population needs to be identified so that preventive strategies can be planned & implemented to stop the violence and improve mental health during pregnancy.

COVID-19 Related Psychological Distress, Fear and Coping: Identification of High-Risk Groups in Bangladesh.

Background: The COVID-19 pandemic has imposed psychological distress and fear across the globe; however, factors associated with those issues or the ways people cope may vary by country or context. This study aimed to investigate the factors associated with psychological distress, fear, and coping strategies for people living in Bangladesh during the COVID-19 pandemic.Methods: A cross-sectional study conducted in August-September 2020 using online platforms in Bangladesh. People residing in Bangladesh, aged ≥18 years, who were proficient in English and able to respond to online questionnaire. The Kessler Psychological Distress Scale was used to assess the psychological stress. Level of fear was assessed using the Fear of COVID-19 Scale, and strategies to cope were assessed using the Brief Resilient Coping Scale.Results: Of the 962 participants, half of them were aged between 30 and 59 years. Being born in Bangladesh, having graduate education, perceived distress due to employment change, effect of COVID-19 on financial situation, having multiple comorbidities, and visiting a healthcare provider in the last 4 weeks were associated with higher levels of both psychological distress and fear of COVID-19. Furthermore, higher psychological distress was associated with being a female (AOR 1.81, 95% CI 1.33–2.47, p < 0.001), being a frontline worker (AOR 1.50, 95% CI 1.04–2.15, p < 0.05), having pre-existing psychiatric problems (AOR 4.03, 95% CI 1.19–13.7, p < 0.05), being a smoker (AOR 2.02, 95% CI 1.32–3.09, p < 0.01), providing care to a known/suspected COVID-19 patient (AOR 1.96, 95% CI 1.40–2.72, p < 0.001), having a recent overseas travel history and being in self-quarantine (AOR 4.59, 95% CI 1.23–17.2, p < 0.05), self-isolation without COVID-19 (AOR 2.63, 95% CI 1.68–4.13, p < 0.001) or being COVID-19 positive (AOR 2.53, 95% CI 1.19–5.34, p < 0.05), and having high levels of fear of COVID-19 (AOR 3.27, 95% CI 2.29–4.66, p < 0.001). A higher level of fear was associated with moderate to high levels of psychological distress (AOR 3.29, 95% CI 2.31–4.69, p < 0.001). People with pre-existing mental health problems were less likely to be resilient (AOR 0.25, 95% CI 0.11–0.54, p < 0.01), whereas those with having an income were more likely to be resilient (AOR 1.46, 95% CI 1.02–2.11, p < 0.05).Conclusion: Effective interventions to support the vulnerable groups including improved access to mental health services are of utmost importance during the pandemic.

Intervention options: Depression & Cardiovascular Disease during Covid-19 Pandemia

An attempt to review links of cardiovascular disease (CVD) and depression and present appropriate treatment methods for handling depression in the COVID-19 pandemic is made. Although depression constitutes one of the major mental health challenges that humankind must encounter in the 21st century it remains undiagnosed and untreated in CVD patients. Its great influence on the progress of CVD led to its classification as a risk factor along with dyslipidemia, arterial hypertension, diabetes, obesity, substance use, sedentary lifestyle (poor diet, stress) making imperative the need for treatment methods. As during COVID 19 pandemic we witnessed the elevation of mental distress as involving both lifestyle choices and dealing with unprecedented life situations while inducing psychological distress or exacerbating pre-existing physical and mental health problems – depression could act both as a contributor to and as the result of CVD. A 4-step intervention program is suggested.

A Qualitative Study of COVID-19 Distress in University Students

The psychological effect of the pandemic and measures taken in response to control viral spread are not yet well understood in university students; in-depth qualitative analysis can provide nuanced information about the young adult distress experience. Undergraduate students ( N = 624) in an early US outbreak “hotspot” completed an online narrative writing about the impact and distress experienced due to the COVID-19 pandemic. Data were collected April-May 2020. A random selection of 50 cases were sampled for thematic analysis. Nine themes were identified: viral outbreak distress, fear of virus contraction/transmission, proximity to virus, dissatisfaction with public response, physical distancing distress, social distancing distress, academic and school-related distress, disruptive changes in health behavior and routines, financial strain and unemployment, worsening of pre-existing mental health problems, and social referencing that minimizes distress. Future work is needed to understand the persistence of the distress, in addition to developing methods for assessment, monitoring, and mitigation of the distress.

Worry and mental health in the Covid-19 pandemic: vulnerability factors in the general Norwegian population

BackgroundThere is an urgent need for knowledge about the mental health consequences of the ongoing pandemic. The aim of this study was to identify vulnerability factors for psychological distress and reduced life satisfaction in the general population. Furthermore, we aimed to assess the role of COVID-related worries for psychological distress and life satisfaction.MethodsA presumed representative sample for the Norwegian population (n = 1041, response rate = 39.9%) responded to a web-survey in May 2020. The participants were asked about potential vulnerability factors including increased risk for severe illness from COVID-19 (underlying illness, older age), socioeconomic disadvantage (living alone, unemployment, economic problems), and pre-existing mental health vulnerability (recent exposure to violence, previous mental health challenges). Additional measures included COVID-related worry, psychological distress, and life satisfaction.ResultsMore than one out of four reported current psychological distress over the threshold for clinically significant symptoms. Socioeconomic disadvantages, including living alone and pre-existing economic challenges, and pre-existing mental health vulnerabilities, including recent exposure to violence and previous mental health problems, were associated with a higher level of psychological distress and a lower level of life satisfaction. A higher level of COVID-related worry was significantly associated with a higher level of psychological distress, and a lower level of life satisfaction, even when adjusting for all the vulnerability factors.ConclusionThis study identified several vulnerability factors for mental health problems in the pandemic. Individuals recently exposed to violence and individuals with pre-existing mental health problems are at particular risk. Worrying about the consequences of the pandemic contributes negatively to current mental health. However, worry cannot explain the excess distress in vulnerable groups. Future research should focus on how COVID-related strains contribute to mental health problems for vulnerable groups.

Adolescents' symptoms of anxiety and depression before and during the Covid-19 outbreak - A prospective population-based study of teenagers in Norway.

BackgroundLockdown policies related to the Sars-Cov-2 pandemic has potential negative consequences for mental health in youths.MethodsAnxiety and depressive symptoms were assessed in 3 572 adolescents, age 13 to 16 using the Hopkins Symptom Checklist (HSCL-10), in a representative longitudinal survey of Norwegian youths between February 2019 (T1) and June 2020 (T2). Predictors for symptom change were analysed with linear mixed-effects models.FindingsOverall, clinical levels of anxiety and depression increased slightly from 5.5% at T1 to 6.3% at T2; Chi square 224.4 (df = 1), p<.001. However, the observed change was driven by the increase in age between assessments. Being a girl, having pre-existing mental health problems, and living in a single-parent household at T1, predicted higher levels of anxiety and depressive symptoms at T2 (p<.001). Living in a single-parent household was associated with a significant increase in symptoms, also when age was controlled for (p<.001). Living in a poor family however, or having a history of maltreatment, was associated with a significantly lower increase in symptoms (p<.001).InterpretationAnxiety and depressive symptoms increased slightly in Norwegian youths between 2019 and 2020, but this change seemed to be driven by increase in age rather than pandemic-related measures. Symptom levels were unevenly distributed across demographic groups both before and during the pandemic outbreak, indicating that health disparities persist for adolescents in risk groups during a pandemic . Health inequities related to living conditions need to be addressed in future action plans, and intensified measures to mitigate inequities are needed.FundingThe study was funded by the Norwegian Directorate for Children, Adolescents and Family affairs (Bufdir).

Examining Criteria for Defining Persistent Post-concussion Symptoms in Children and Adolescents.

Researchers operationalize persistent post-concussion symptoms in children and adolescents using varied definitions. Many pre-existing conditions, personal characteristics, and current health issues can affect symptom endorsement rates in the absence of, or in combination with, a recent concussion, and the use of varied definitions can lead to differences in conclusions about persistent symptoms and recovery across studies. This study examined how endorsement rates varied by 14 different operational definitions of persistent post-concussion symptoms for uninjured boys and girls with and without pre-existing or current health problems. This cross-sectional study included a large sample (age range: 11–18) of girls (n = 21,923) and boys (n = 26,556) without a recent concussion who completed the Post-Concussion Symptom Scale at preseason baseline. Endorsements rates varied substantially by definition, health history, and current health issues. The most lenient definition (i.e., a single mild symptom) was endorsed by most participants (54.5% of boys/65.3% of girls). A large portion of participants with pre-existing mental health problems (42.7% of boys/51.5% of girls), current moderate psychological distress (70.9% of boys/72.4% of girls), and insufficient sleep prior to testing (33.4% of boys/47.6% of girls) endorsed symptoms consistent with mild ICD-10 postconcussional syndrome; whereas participants with no current or prior health problems rarely met this definition (1.6% of boys/1.6% of girls). The results illustrate the tremendous variability in the case definitions of persistent symptoms and the importance of harmonizing definitions across future studies.

Does peritraumatic distress predict PTSD, depression and anxiety symptoms during and after COVID-19 lockdown in France? A prospective longitudinal study

BackgroundCOVID-19 peritraumatic distress (CPD), an emerging trauma-related psychopathology, involves immediate physiological arousal as well as emotional and cognitive responses to the threat of the COVID-19 outbreak. This study examined the prevalence of and temporal changes in CPD, its early and follow-up predictors and the extent to which it was predictive of mental health problems. MethodsThe study took a two-wave design approach and was conducted during and 3–4 months after the nationwide lockdown in France. Baseline participants were 1123 (79.5% women; M age = 33.82; range: 18–80). They completed validated measures assessing CPD, posttraumatic stress (PTS), depression, and anxiety symptoms. Descriptive, correlational, and path model analyses were used. FindingsBoth baseline and follow-up groups presented similar psychosocial profiles. Overall, 35.5% (95% Confidence Interval [CI]: 32.7–38.4) baseline participants and 17.2% (95% CI: 12.6–22.7) follow-up participants developed clinical cases of CPD. The baseline CPD levels predicted 14–20% of the variances of PTS (b = 0.55), depression (b = 0.16) and anxiety symptoms (b = 0.16). After accounting for the effect of the baseline CPD levels, the current CPD levels predicted the three investigated mental health outcomes in high proportions (43–47%). Further findings revealed important temporal changes in baseline predictors of CPD. However, the chronic CPD and PTS symptoms were prevalent among students and individuals developing worries about the COVID-19 crisis while depression and anxiety symptoms were prevalent among single people and those with pre-existing mental health problems. LimitationsData from self-report measures of mental health were used. The dropout rate between the two time assessments was relatively high. ConclusionsThese longitudinal findings call for clinical efforts in assessment of and intervention in trauma-related distress. These efforts should be put into the predictive role of CPD in subsequent development of PTS symptoms and comorbidities as long as the health, social and economic consequences of the pandemic linger.

The Psychological Burden of COVID-19 Stigma: Evaluation of the Mental Health of Isolated Mild Condition COVID-19 Patients.

BackgroundThe objective of this article is to assess the mental health issues of the mild condition coronavirus disease 2019 (COVID-19) patients admitted to a community treatment center (CTC) in Korea.MethodsA total of 107 patients admitted to a CTC were included as the study population, and their mental health problems including depression (patient health questionnaire-9), anxiety (generalized anxiety disorder scale-7), post-traumatic stress disorder (PTSD) (PTSD checklist-5) and somatic symptoms (by patient health questionnaire-15) were evaluated every week during their stay. The stigma related to COVID-19 infection was evaluated with an adjusted version of the Middle East respiratory syndrome (MERS) stigma scale.ResultsDuring the first week of isolation, the prevalence of more-than-moderate depression was 24.3%, more-than-moderate anxiety was 14.9%, more-than-moderate somatic symptoms was 36.5% and possible PTSD was 5.6% of total population. For depression and anxiety, previous psychiatric history and stigma of COVID-19 infection were significant risk factors. For PTSD, previous psychiatric history and stigma of COVID-19 infection as well as total duration of isolation were found to be significant risk factors. Prevalence of depression, anxiety and possible PTSD remained similar across the four weeks of observations, though the prevalence of severe depression, increased after four weeks of stay. Somatic symptoms seemed to decrease during their stay.ConclusionThe results suggest that social mitigation of COVID-19 related stigma, as well as care of patients with pre-existing mental health problems are important mental health measures during this crisis period. It is also important that clinical guidelines and public health policies be well balanced over the protection of the public and those quarantined to minimize the negative psychosocial consequences from isolation of the patients.

How Student’s Mental Health Affected During the COVID-19 Pandemic : A literature review

As the world continues to battle the day to day issues of the coronavirus pandemic, one aspect is the increasing problem of mental health for students. As schools have closed down and had suddenly transitioned to online classes. The model is currently the best alternative as keeping schools open poses a safety risk for students. Students with pre-existing mental health problems such as stress disorder, general anxiety disorder, post traumatic stress disorder, depression, or loneliness have become more vulnerable due to lockdown policies and showed itself in different ways. Lockdowns, travel restrictions, school closings and social/physical distancing have created a level of social isolation previously unseen across the globe. This upend, for many, can have profound consequences on one’s mental health.&#x0D; This paper aims to investigate the mental health status of student due to the policy response to Covid-19 Pandemic. The database searches used include Google Scholar, Research Gate, Science Direct, frontiersin, World Journal of Pharmaceutical and Medical Research.&#x0D; Keywords used in the search of the article was student, covid-19, mental health, epidemic, college by getting 19 articles and only 9 articles that were used through goal analysis, topic suitability , research methods used, sample size, the results of each article, and limitations that occur.&#x0D; This study found that mental health of college students is significantly affected when faced with a public health emergency. Student are likely to be experiencing stress, anxiety and depression. They need attention, help, and support from the community, family, and tertiary institutions.&#x0D; Therefore, the nurse need to consider planning for acute and long-term subsequent psychological interventions should focus on strengthening psychological counseling and emotional comfort for students through the involvement of counselors, psychologists. It is suggested that the mental health of college students should be monitored during epidemics.

Mental health and well-being during the COVID-19 pandemic: longitudinal analyses of adults in the UK COVID-19 Mental Health & Wellbeing study.

The effects of coronavirus disease 2019 (COVID-19) on the population's mental health and well-being are likely to be profound and long lasting. To investigate the trajectory of mental health and well-being during the first 6 weeks of lockdown in adults in the UK. A quota survey design and a sampling frame that permitted recruitment of a national sample was employed. Findings for waves 1 (31 March to 9 April 2020), 2 (10 April to 27 April 2020) and 3 (28 April to 11 May 2020) are reported here. A range of mental health factors was assessed: pre-existing mental health problems, suicide attempts and self-harm, suicidal ideation, depression, anxiety, defeat, entrapment, mental well-being and loneliness. A total of 3077 adults in the UK completed the survey at wave 1. Suicidal ideation increased over time. Symptoms of anxiety, and levels of defeat and entrapment decreased across waves whereas levels of depressive symptoms did not change significantly. Positive well-being also increased. Levels of loneliness did not change significantly over waves. Subgroup analyses showed that women, young people (18-29 years), those from more socially disadvantaged backgrounds and those with pre-existing mental health problems have worse mental health outcomes during the pandemic across most factors. The mental health and well-being of the UK adult population appears to have been affected in the initial phase of the COVID-19 pandemic. The increasing rates of suicidal thoughts across waves, especially among young adults, are concerning.

COVID-19's multipronged attack on mental health: Months of uncertainty and threats to health, social, and financial security have contributed to intense anxiety, depression, posttraumatic stress disorder, and even suicide. Here, in part 2 of a 2-part series, we investigate the pandemic's growing mental health toll on the general public and efforts to address it.

COVID-19's multipronged attack on mental health: Months of uncertainty and threats to health, social, and financial security have contributed to intense anxiety, depression, posttraumatic stress disorder, and even suicide. Here, in part 2 of a 2-part series, we investigate the pandemic's growing mental health toll on the general public and efforts to address it.

Systematic Review of Preinjury Mental Health Problems as a Vulnerability Factor for Worse Outcome After Sport-Related Concussion.

Background:It is difficult to predict who will experience prolonged health problems after sustaining a sport-related concussion.Purpose:To synthesize the literature and conduct a gap analysis on the association between preinjury mental health problems and clinical outcome from sport-related concussion.Study Design:Systematic review; Level of evidence, 4.Methods:Data sources were PubMed, PsycINFO, MEDLINE (and MEDLINE in Process), CINAHL, Cochrane Library, EMBASE, SPORTDiscus, Scopus, and Web of Science. Studies published before February 2019 that addressed preinjury mental health problems as a possible predictor of worse clinical outcome or clinical recovery from concussion were eligible for inclusion.Results:Of 4013 studies screened, 358 full texts were reviewed, and 12 studies involving 3761 participants (n = 471 [12.5%] with preexisting mental health problems) were ultimately included. The participants with a preinjury history of mental health problems were at greater risk for having persistent symptoms or worse outcome in 9 of 12 studies. The studies had major methodological differences, and most studies were not focused on mental health as a primary predictor or prognostic factor. Rather, they included it as a secondary or tertiary predictor. The sample sizes with preinjury mental health problems in most studies were small or very small (ie, <25). The age of onset, type, course, severity, and duration of mental health problems were not defined. The extent to which mental health problems were present before the season, during baseline testing, was not reported.Conclusion:Preinjury mental health problems appear to confer risk for worse clinical outcome after sport-related concussion. Future research is needed to (1) examine this risk factor in large representative populations of middle school students, high school students, and collegiate athletes; (2) quantify the risk for each mental health condition; (3) understand the mechanisms underlying this increased risk; and (4) develop more refined treatment and rehabilitation approaches for these student-athletes.