Previous Mental Health Diagnosis Research Articles

The relationship between stigma and mental health in a population of individuals with COVID-19.

Illness stigma has been observed across previous outbreaks including Ebola, SARS, HIV/AIDS, and now COVID-19. Although both the stigma of having COVID-19 as well as mental health impacts of COVID-19 have been studied, limited research exists regarding the relationship of stigma and mental health in this population. Thus, the primary purpose of the present study was to examine the relationship between stigma and mental health in adults with COVID-19. Adult respondents with a diagnosis of COVID-19 (N = 632) completed an online questionnaire distributed between April 17, 2020, and April 18, 2021. The study measures included the Patient Health Questionnaire 8 (PHQ-8), the Generalized Anxiety Disorder 7-item (GAD-7), and the 8-Item Stigma Scale for Chronic Illness (SSCI-8) tailored to measure perceived stigmatization from a COVID-19 diagnosis. Participants (mean age = 51) were mostly female (71%), White (73%), married (70%), obese (56%), and had a chronic health condition (56%). Female sex, education status, working from home or not working owing to COVID-19, previous mental health diagnosis, history of chronic illness, and being a current/former smoker were associated with higher stigma scores, whereas older age and Black race were associated with lower stigma scores. Greater stigma and psychological distress was observed in females with a previously diagnosed psychiatric illness and/or chronic health condition. Our findings suggest a disproportionate burden of mental health/psychiatric symptoms/sequelae, including stigma and PTSD, among COVID-19 survivors with a history of mental illness. Further studies are needed to fully characterize COVID-19 related stigma and subsequent mental health experiences. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The use of dietary supplements for mental health among the Saudi population: A cross-sectional survey

IntroductionDespite limited evidence about the efficacy and safety of dietary supplements (DSs) for improving mental health, people with or without mental disorders often tend to use them, especially during the ongoing COVID-19 pandemic. Previous studies focused on DS use for maintaining or improving overall health; Therefore, this study aimed to assess the prevalence of DSs for mental health among the SA population and to determine the factors that affect their use. MethodsThis cross-sectional study was based on an online survey of Saudi Arabian participants between July and August 2021 with an anonymous, self-completed questionnaire distributed using convenience sampling. The questionnaire included queries related to demographic information, DS use assessment, and mental health evaluation using the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7), questionnaire, and the Insomnia Severity Index (ISI). ResultsIn total, 443 participants from various regions of Saudi Arabia completed the questionnaire. The prevalence of DS use in the Saudi population was 44%. Vitamin D (28%) and melatonin (20%) were the most commonly reported DSs used for mental health. The odds of DS use were three times higher in responders with previous mental health diagnoses (OR: 2.972; 95% CI: 1.602–5.515). Furthermore, the chances of using DSs almost doubled in patients with sub-threshold and moderate to severe insomnia (OR: 1.930; 95% CI: 1.191–3.126 and OR: 2.485; 95% CI: 1.247–4.954, respectively). ConclusionResponders diagnosed by a specialist with psychiatric disorders or current insomnia had a higher chance of using DSs. Thus, healthcare providers must provide evidence-based information regarding DSs for mental health improvement and encourage the public to consult healthcare professionals before self-medicating for mental health problems.

Benzodiazepine and Stimulant Prescriptions Before Overdose in Youth.

In 2019, 4777 youth died of a drug overdose in the United States.1 Seven-hundred and twenty-seven youth died of overdoses involving benzodiazepines (BZDs) and 902 from overdoses involving psychostimulants.2 Opioid-related overdose deaths frequently involve other substances, and in youth, stimulants and BZDs are the most commonly involved substances.3 Overdoses can involve prescription drugs accessed through medical prescriptions or through illicit means. Among persons aged 18 to 25 years, 5.8% report past-year prescription stimulant misuse and 3.8% prescription BZD misuse.4To inform overdose prevention efforts, we determined how often youth with medically treated overdoses involving BZDs and stimulants had recent BZD or stimulant prescriptions.We included youth (15–24 years) from the MarketScan commercial claims database who experienced an overdose involving stimulants or BZDs (January 01, 2016 to December 31, 2018). MarketScan covers privately insured individuals and captures diagnoses and procedures from inpatient and outpatient visits and dispensed prescriptions.5 Overdose events treated in an emergency department (ED) or inpatient setting were included, defined using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for an unintentional, intentional, or undetermined poisoning initial encounter (Table 1). Stimulant overdoses were limited to overdoses involving amphetamine or methylphenidate. We selected the first overdose per person and required ≥6 months of insurance enrollment with prescription coverage before the overdose.In the 6 months before the overdose, we identified dispensed BZD and stimulant prescriptions and mental health diagnoses (Tables 1 and 2). We summed the number of fills and days’ supply for prescriptions dispensed in the 6 months before the overdose. Results were stratified by intentional self-harm versus unintentional overdoses. In a secondary analysis, class of prescription stimulant was considered with whether the overdose involved amphetamine or methylphenidate.We identified 2986 youth who experienced an overdose involving BZDs and 971 youth with an overdose involving stimulants (amphetamine or methylphenidate). The majority of youth had a previous mental health diagnosis; 56% of overdoses involving BZDs were intentional compared to 40% of overdoses involving stimulants (Table 1).Twenty-nine percent of youth with overdoses involving BZDs had a prescription BZD dispensed in the previous 30 days and 42% in the previous 6 months (Table 1, Fig 1). Among youth with a BZD prescription in the previous 6 months, 33% received >90 days’ supply, and 73% had an anxiety disorder diagnosis (Supplemental Table 3). Youth with intentional BZD overdoses were more likely to have a recent BZD prescription (51%) than those with unintentional overdoses (30%).A quarter of youth with an overdose involving stimulants (amphetamine/methylphenidate) had a stimulant prescription dispensed in the previous 30 days and 39% in the previous 6 months (Table 2, Fig 1). Among youth with a stimulant prescription in the previous 6 months, 56% received >90 days’ supply and 71% had an ADHD diagnosis (Supplemental Table 4). Youth with intentional stimulant overdoses were more likely to have a recent stimulant prescription (56%) than those with unintentional overdoses (28%).A considerable fraction of youth with overdoses involving BZDs and stimulants had recent prescriptions for these drugs. Previous BZD and stimulant prescriptions were more common in youth with intentional overdoses. This underscores the importance of incorporating self-injury assessment into clinical practice for youth prescribed BZDs and stimulants and highlights the need for differing prevention efforts for intentional and unintentional youth overdoses.The majority of youth who received a BZD or stimulant prescription before overdose had a mental health diagnosis. These medications are prescribed for mental health problems common in youth6,7 and can be effective treatments. However, because these drugs are commonly misused4 and involved in overdoses, weighing risks and benefits when prescribing them remains imperative.Primary considerations of this research include that we cannot distinguish amphetamine overdoses related to prescription amphetamine versus an illicit substance. We miss overdoses that did not present to the ED or hospital, including fatal overdoses occurring outside these settings, and events in which BZD or stimulant involvement was not recorded. Without comparator groups, we are unable to assess comparative overdose liability by prescription characteristics.Given that one-fourth of youth who overdose on these drugs receive prescriptions for them in the previous month, results suggest an avenue of prevention and motivate future work examining overdose risk after prescription. Because the potential for harm with BZD and stimulants increases with selected combinations of prescription medications, alcohol, and illicit drugs, and especially concurrent BZD and opioid use,8,9 these concerns warrant attention and discussion at prescription initiation.

Adjustment Disorder in U.S. Service Members: Factors Associated With Early Separation

ABSTRACT Introduction Adjustment disorder (AD) is a time-delimited disorder characterized by excessive emotional distress or impaired functioning in response to an identifiable stressor. Although it is commonly diagnosed in mental health settings, its impact on occupational, social and other areas of functioning is not well understood. As a subthreshold disorder that is frequently diagnosed in conjunction with other physical and mental health disorders, the extent of its contribution to functional impairment may be obscured. During military service, research suggests AD is frequently diagnosed in early-service trainees. To help elucidate the relationship between AD and functional outcome, we explored 2 factors that may be associated with the rate of separation from service in U.S. active duty service members (SMs) with an AD diagnosis: previous mental health diagnoses and time in service when SMs receive an incident AD diagnosis (IADx). Materials and Methods Twenty-thousand SMs with an IADx were grouped by whether or not this was their first mental health diagnosis received in the military. To assess functional impairment, the 2 groups were compared on rate of separation. Those without prior diagnoses were then stratified into 5 groups based on length of time from military entrance to receipt of IADx and were further analyzed for separation rates. The Cox model was used to determine hazard ratios and create survival curves. The study was determined to be “not human subjects research.” Results Nearly half (46.4%) of SMs with an IADx previously had received a mental health diagnosis and had an increased risk of separation [hazard ratio = 1.25 (95% confidence interval: 1.207-1.286)]. Of SMs with IADx as their first diagnosis, 19.3% were diagnosed during the first 6 months of service and had the highest risk of separating [hazard ratio = 1.48 (1.381-1.589)], with a 60% probability of separating within 2 years of diagnosis. Those receiving it during the second 6 months of service (16.2%), second year (20.1%), or third year (18.2%) had approximately a 47% probability of separating within 2 years. Conclusions Previous mental health diagnoses and time in service when diagnosed appear to be important factors associated with functional impairment for SMs with AD. Nearly half of those with an IADx had previously received diagnoses for mood, anxiety, and other disorders and were at higher risk of separation following IADx. Our findings are based on diagnoses entered in electronic health records, so we cannot identify the nature of the stressor that precipitated AD. Nonetheless, early IADx predicted the fastest rate of separation, and it may be an opportune time for interventions to reduce its impact on functional outcomes.

The Mental Health Impacts of COVID-19 on PK–12 Students: A Systematic Review of Emerging Literature

The mental health impact of the coronavirus disease 2019 (COVID-19) pandemic on PK–12 youth is likely an urgent and enduring concern, yet research on this topic is still emerging. To synthesize current knowledge, the researchers conducted a systematic review of empirical studies exploring the mental health impacts of COVID-19. Five themes emerged across 104 included studies: (a) the pandemic proved widely disruptive to PK–12 youth; (b) there was a clear connection between the mental health of caregivers (e.g., parents) and children; (c) the pandemic broadly increased levels of stress, anxiety, and depression in PK–12 youth; (d) students were particularly affected on the basis of age, gender, race/ethnicity, socioeconomic status, and previous mental health or disability diagnosis; and (e) youth demonstrated negative and positive coping strategies and even saw some positive mental health outcomes during the pandemic. Implications for research, practice, and policy are discussed.

Racial disparities in emergency mental healthcare utilization among birthing people with preterm infants

BACKGROUND:Birthing people of color are more likely to deliver low birthweight and preterm infants, populations at significant risk of morbidity and mortality. Birthing people of color are also at higher risk for mental health conditions and emergency mental healthcare utilization postpartum. Although this group has been identified as high risk in these contexts, it is not known whether racial and ethnic disparities exist in mental healthcare utilization among birthing people who have delivered preterm.OBJECTIVE:We sought to determine if racial and ethnic disparities exist in postpartum mental healthcare-associated emergency department visits or hospitalizations for birthing people with preterm infants in a large and diverse population.STUDY DESIGN:This population-based historic cohort study used a sample of Californian live-born infants born between 2011 and 2017 with linked birth certificates and emergency department visit and hospital admission records from the California Statewide Health Planning and Development database. The sample was restricted to preterm infants (<37 weeks’ gestation). Self-reported race and ethnicity groups included Hispanic, non-Hispanic Black, non-Hispanic Asian, non-Hispanic White, and non-Hispanic others. Mental health diagnoses were identified from the International Classification of Diseases Ninth and Tenth revision codes recorded in emergency department and hospital discharge records. Logistic regression analysis was used to estimate the association between mental health-related emergency department visits and rehospitalizations by race or ethnicity compared with non-Hispanic White birthing people and controlling for the following characteristics and health condition covariates: age, parity, previous preterm birth, body mass index, smoking, alcohol use, hypertension, diabetes, previous mental health diagnosis, and prenatal care.RESULTS:Of 204,539 birthing people who delivered preterm infants in California, 1982 visited the emergency department and 836 were hospitalized in the first year after preterm birth for a mental health-related illness. Black birthing people were more likely to have a mental health-related emergency department visit and hospitalization (risk ratio, 1.8; 95% confidence interval, 1.5–2.0 and risk ratio, 1.9; 95% confidence interval, 1.5–2.3, respectively) within the first postpartum year than White birthing people. Hispanic and Asian birthing people were less likely to have mental health-related emergency department visits (adjusted risk ratio, 0.7; 95% confidence interval, 0.7–0.8 and adjusted risk ratio, 0.2; 95% confidence interval, 0.2–0.3, respectively) and hospitalizations (adjusted risk ratio, 0.6; 95% confidence interval, 0.5–0.7 and adjusted risk ratio, 0.2; 95% confidence interval, 0.1–0.3, respectively). When controlling for birthing people with a previous mental health diagnosis and those without, the disparities remained the same.CONCLUSION:Racial and ethnic disparities exist in emergency mental healthcare escalation among birthing people who have delivered preterm infants. Our findings highlight a need for further investigation into disparate mental health conditions, exacerbations, access to care, and targeted hospital and legislative policies to prevent emergency mental healthcare escalation and reduce disparities.

Psychological impact of COVID-19 on emergency department healthcare workers in a tertiary care center during a national economic crisis.

BackgroundSince the declaration of the novel Corona Virus Disease (COVID-19) as a global pandemic by the World Health Organization, frontline healthcare workers (HCWs) and staff in the Emergency Departments (ED) started experiencing feelings of anxiety and fear from the projected exponential spread and the potential burden on the healthcare system and infrastructure. In Lebanon, major local factors contributing to this fear were the rapid escalation of COVID-19 cases across the country, the lack of preparedness, and the shortage of personal protective equipment, in addition to the evolving economic crisis and financial restrictions. This study aims to investigate the immediate psychological impact of the COVID-19 outbreak on ED staff working in a hospital environment in relation to their household income.MethodsSelf-reported cross-sectional survey was delivered to the frontline staff working at the Department of Emergency Medicine of AUBMC in Beirut, Lebanon. General demographic characteristics, scores of Generalized Anxiety Disorder 7 (GAD-7), scores of Patient Health Questionnaire 9 (PHQ-9), and scores of Burnout Measure-Short (BMS) version were collected.Results74 HCWs (49.6%) participated in the study. The mean age for participants was (31.78 ± 9.49). More than half of the participants were nurses and more than 70% reported a monthly salary of less than 2000 USD. The household income was negatively associated with the participants' scores on the GAD-7 and PHQ-9, but not the BMS. Previous mental health diagnosis was positively associated with the PHQ-9 and BMS scores, while seeking mental health care was negatively associated with the PHQ-9 and BMS scores.ConclusionAt our tertiary care center in a low-income, low resource country amidst the COVID-19 pandemic, the HCWs reported marked psychological disturbances on different scales. In particular, the financial burden was associated with increased anxiety and clinical depression, but was not associated with burnout.

Access to Mental Health and Substance Use Resources for 2SLGBTQ+ Youth during the COVID-19 Pandemic.

Previous research has established that gender and sexual minority (2SLGBTQ+) youth experience worse mental health and substance use outcomes than their heterosexual and cisgender counterparts. Research suggests that mental health and substance use concerns have been exacerbated by the COVID-19 pandemic. The current study used self-reported online survey responses from 1404 Canadian 2SLGBTQ+ youth which included, but were not limited to, questions regarding previous mental health experiences, diagnoses, and substance use. Additional questions assessed whether participants had expressed a need for mental health and/or substance use resources since the beginning of the COVID-19 pandemic (March 2020) and whether they had experienced barriers when accessing this care. Bivariate and multinomial logistic regression analyses were conducted to determine associations between variables and expressing a need for resources as well as experiencing barriers to accessing these resources. Bivariate analyses revealed multiple sociodemographic, mental health, and substance use variables significantly associated with both expressing a need for and experiencing barriers to care. Multinomial regression analysis revealed gender identity, sexual orientation, ethnicity, and level of educational attainment to be significantly correlated with both cases. This study supports growing research on the mental health-related harms that have been experienced during the COVID-19 pandemic and could be used to inform tailored intervention plans for the 2SLGBTQ+ youth population.

Mental health and economic stressors associated with high-risk drinking and increased alcohol consumption early in the COVID-19 pandemic in the United States

Physical distancing measures to curb COVID-19 transmission introduced mental health and economic stressors, possibly impacting problematic drinking. This cross-sectional study examines mental health and economic stressors early in the COVID-19 pandemic which may be associated with heavy alcohol use and increased alcohol use. We administered an online survey of U.S. adults via social media April 5 to May 5, 2020. High-risk drinking was defined by WHO risk drinking levels, a daily average of ≥4 drinks for men and ≥3 drinks for women. Participants reported retrospective assessments of increased alcohol use if their past-week alcohol consumption exceeded their past-year average weekly alcohol consumption. We used logistic regression to assess possible covariates of high-risk drinking and increased alcohol use. Among 2175 participants, 10% (n = 222) reported high-risk drinking, and 36% (n = 775) reported increased alcohol consumption. In multivariable analysis, high-risk drinking was significantly associated with household job loss (OR = 1.41, 95%CI = (1.06, 1.88)) and depressive symptoms (OR = 1.05, 95% CI = (1.02, 1.07)), and women had higher odds of high-risk drinking than men (OR = 2.37, 95% CI = (1.32, 4.69)). Previous mental health diagnosis was not significantly associated with high-risk drinking during the pandemic (OR = 1.31, 95% CI = (0.98, 1.76)) in univariable analysis. High-risk drinkers were almost six times as likely to report retrospective assessments of increased alcohol consumption, controlling for mental health and economic stressors (OR = 5.97, 95% CI = (4.35, 8.32)). Findings suggest a need for targeted interventions to address the complex mental health and economic stressors that may increase alcohol consumption and high-risk drinking during and after the pandemic.

State lockdown policies, mental health symptoms, and using substances

ObjectivePrevious literature finds an increase in depressive symptoms, substance use, and suicidal ideation following the COVID-19 pandemic in the US – suicides do not appear to increase. We examine whether 1) state lockdown policies in the US precede an increase in mental health symptoms; and 2) the extent to which using substances amplifies or attenuates the relation. MethodsWe specified, as our exposure variable, the timing of state-level lockdown orders. We used, as the outcome variable, the 4-item Patient Health Questionnaire (PHQ-4) that measures anxiety and depression symptoms. We utilized the Understanding America Study (UAS), a nationally representative sample of 7,597 adults across 50 states in the US, surveyed biweekly between March 10, 2020 and November 11, 2020. Linear fixed effect analyses controlled for time-invariant individual factors, as well as employment status, household income, and previous mental health diagnosis. ResultsRegression results indicate an increase in PHQ-4 scores of approximately 1.70 during lockdown, relative to no lockdown (p < 0.05). Relative to no lockdown, an increase in alcohol use corresponds with a 0.08 unit decrease in PHQ-4 scores during lockdown (p < 0.05). ConclusionState lockdown policies precede greater mental health symptoms. Increases in consuming alcohol attenuates the relation between state lockdown policies and mental health symptoms. Results may portend greater addiction following the pandemic warranting further investigation into utilization of substance use treatment.

Help-Seeking to Cope With Experiences of Violence Among Women Living With HIV in Canada

Using baseline data from a community-collaborative cohort of women living with HIV in Canada, we assessed the prevalence and correlates of help-seeking among 1,057 women who reported experiencing violence in adulthood (≥16 years). After violence, 447 (42%) sought help, while 610 (58%) did not. Frequently accessed supports included health care providers (n = 313, 70%), family/friends (n = 244, 55%), and non-HIV community organizations (n = 235, 53%). All accessed supports were perceived as helpful. Independent correlates of help-seeking included reporting a previous mental health diagnosis, a history of injection drug use, experiencing childhood violence, and experiencing sexism. We discuss considerations for better supporting women who experience violence.

Mental Health and Traumatization of Newly Arrived Asylum Seeker Adults in Finland: A Population-Based Study.

Asylum seekers frequently experience potentially traumatic events (PTEs), but the type and frequency vary depending on the country of origin. The cumulative effect of multiple PTEs and other stressors expose asylum seekers to a significant risk of mental ill health. The aim of the study was to examine the prevalence of PTEs, depression and anxiety symptoms, risk for psychological trauma, psychotropic medication use and previous mental health diagnoses among adult asylum seekers in the Asylum Seekers Health and Wellbeing (TERTTU) Survey (n = 784 respondents, participation rate 78.6%). A substantial majority (88.7%, 95% CI 86.9–90.3) of asylum seekers reported one or more PTEs before arriving to Finland. PTEs during the asylum-seeking journey were reported at 12.0% (95% CI 10.7–13.4), however, when examined by region of origin, the proportion was 34.5% (95% CI 29.5–39.8) for asylum seekers from Africa (excluding North Africa). Significant symptoms of depression were reported by 41.7% (95% CI 39.6–43.9) of asylum seekers and symptoms of anxiety by 34.2% (95% CI 32.1–36.2). Half of the asylum seekers were assessed as having at least a medium-risk for psychological trauma. Prevalence rates were higher among females and asylum seekers from Africa. This study highlights the importance of using screening tools to identify asylum seekers with severe mental health problems that may need referral to further assessment and treatment. Asylum seekers from Africa (excluding North Africa) should be given additional attention in initial health screenings and examinations.

Psychiatric presentations in acute illness with COVID-19: a retrospective analysis

AimsTo assess the psychiatric presentations in patients with a diagnosis of COVID-19 referred to a liaison psychiatry department during a one month period in the peak of the global pandemic.MethodA retrospective analysis of the patients referred to liaison psychiatry during January 2021 who also had a diagnosis of COVID-19. Confirmed cases of COVID-19 were defined as those confirmed by COVID-19 PCR in respiratory samples or clinically suspected cases from chest radiograph or CT. Severe COVID-19 was defined as those requiring supplementary oxygen due to saturations of 93% or less.ResultDuring January 2021, a total of 24 patients were referred to liaison psychiatry with concurrent COVID-19 infection. Out of these patients, 63% had a previous mental health diagnosis. The most common reason for referral was low mood (37.5%), followed by agitation (25%) and psychosis (25%). When considering first psychiatric presentations with concurrent COVID-19 infection, the most common presentation was psychosis (44%). The time course of psychosis was most frequently seen in the seven days prior to a positive swab. In one case a patient was sectioned under the Mental Health Act for psychosis two days prior to developing symptoms. Two of these patients were worked up for possible encephalitis including radiological imaging and lumbar puncture. For patients defined as having severe COVID-19, the most common referral was low mood. In those referred for low mood, 66% had a history of an affective disorder. In two cases low mood was complicated by an acute stress reaction to recent bereavement. For one patient this included the bereavement of two relatives to COVID-19. For patients admitted to intensive care and intubated for respiratory support the most common referrals were low mood and agitation. These factors we found a barrier to successful rehabilitation following periods of significant illness.ConclusionThe impact of COVID-19 on psychiatric presentations extends beyond the socio-economic factors precipitating crises across the nation. Our findings of acute psychiatric illness in the prodromal phase of the viral illness suggest a neuropsychiatric pathogenesis to COVID-19.

The mental health of Australian medical practitioners during Covid-19.

To ascertain whether doctors were experiencing higher rates of distress during Covid-19 and whether this was impacted by demographic factors. Our hypotheses were that being a junior doctor, having a previous mental health diagnosis and treating Covid-19 positive patients would predict higher rates of distress. Cross-sectional survey conducted via Survey Monkey. Voluntary participants were recruited from the mailing list of a national-based referral service for doctors to psychiatrists. Distress was measured using the Kessler Psychological Distress Scale (K10). Demographic factors were analysed for predictive value of a higher rating on the K10. Areas of concern in relation to Covid-19 and preference for support services were measured on a Likert scale and compared to levels of distress. The rate of very high distress was 15%. Being a junior doctor and having a previous mental health diagnosis were predictive factors of a higher K10 score. K10 was not affected by likelihood of contact with Covid-19-positive patients. Social isolation had a larger impact on mental health in the context of a previous psychiatric diagnosis. Face-to-face assessments were preferred. Rates of distress in doctors have been higher than baseline during Covid-19. Some groups have been particularly vulnerable.

Pre-existing and post-pandemic insomnia symptoms are associated with high levels of stress, anxiety, and depression globally during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has led to an increased prevalence of insomnia and mental health symptoms globally. However, most studies to date have not examined mental health symptoms between individuals with insomnia, either pre-existing or developing post-pandemic compared with good sleepers. This study examined differences in stress, anxiety, and depression between individuals with pre-existing insomnia symptoms, post-pandemic insomnia symptoms, and no insomnia symptoms in response to the COVID-19 pandemic. A cross-sectional survey was completed by 2724 participants from 67 countries during the COVID-19 pandemic. Perceived stress, anxiety, and depressive symptoms were compared between individuals with post-pandemic insomnia symptoms (n = 1007), pre-existing insomnia symptoms (n = 804), and no insomnia symptoms (n = 913). Post-pandemic insomnia symptoms were associated with higher levels of stress, anxiety, and depression than pre-existing or no insomnia symptoms (P < .001). Pre-existing insomnia symptoms were also associated with higher levels of stress, anxiety, and depression than no insomnia symptoms (P < .001). Individuals who met likely criteria for acute insomnia also reported higher stress, anxiety, and depression than those with insomnia disorder (P < .001). Across all groups, individuals reporting a previous mental health diagnosis had worse stress, anxiety, and depression than those without a previous mental health diagnosis (P < .001). Last, individuals from South Africa reported higher levels of stress, anxiety, and depression than other countries (P < .01). Internationally, individuals with pre-existing and post-pandemic insomnia symptoms may be more susceptible to stress, anxiety, and depression during the COVID-19 pandemic. Public health initiatives should include insomnia management to improve mental health during the pandemic. Meaklim H, Junge MF, Varma P, Finck WA, Jackson ML. Pre-existing and post-pandemic insomnia symptoms are associated with high levels of stress, anxiety, and depression globally during the COVID-19 pandemic. J Clin Sleep Med. 2021;17(10):2085-2097.

The association between preterm birth and postpartum mental healthcare utilization among California birthing people

While mental health conditions such as postpartum depression are common, little is known about how mental healthcare utilization varies after term versus preterm delivery. This study aimed to determine whether preterm birth is associated with postpartum inpatient and emergency mental healthcare utilization. The study sample was obtained from a database of live-born neonates delivered in California between the years of 2011 and 2017. The sample included all people giving birth to singleton infants between the gestational age of 20 and 44 weeks. Preterm birth was defined as <37 weeks' gestation. Emergency department visits and hospitalizations with a mental health diagnosis within 1 year after birth were identified using International Classification of Diseases codes. Logistic regression was used to compare relative risks of healthcare utilization among people giving birth to preterm infants vs term infants, adjusting for the following covariates: age, race or ethnicity, parity, previous preterm birth, body mass index, tobacco use, alcohol or drug use, hypertension, diabetes mellitus, adequacy of prenatal care, education, insurance payer, and the presence of a mental health diagnosis before birth. Results were then stratified by mental health diagnosis before birth to determine whether associations varied based on mental health history. Of our sample of 3,067,069 births, 6.7% were preterm. In fully adjusted models, compared with people giving birth to term infants, people giving birth to preterm infants had a 1.5 times (relative risk; 95% confidence interval, 1.4-1.7) and 1.3 times (relative risk; 95% confidence interval, 1.2-1.4) increased risk of being hospitalized with a mental health diagnosis within 3 months and 1 year after delivery, respectively. People giving birth to preterm infants also had 1.4 times (95% confidence interval, 1.3-1.5) and 1.3 times (95% confidence interval, 1.2-1.4) increased risk of visiting the emergency department for a mental health diagnosis within 3 months and 1 year after birth, respectively. Stratifying by preexisting mental health diagnosis, preterm birth was associated with an elevated risk of mental healthcare utilization for people with and without a previous mental health diagnosis. We found that preterm birth is an independent risk factor for postpartum mental healthcare utilization. Our findings suggest that screening for and providing mental health resources to birthing people after delivery are crucial, particularly among people giving birth to preterm infants, regardless of mental health history.

A nation-wide Swedish study of opioid analgesic prescribing patterns during pregnancy and associated preexisting mental health conditions

Introduction Research has consistently shown individuals with mental health conditions are more likely to be prescribed opioid analgesic medications and to engage in heavier utilization. However, it is unclear whether these findings apply to pregnant women. Study design We explored opioid analgesic prescription in 689,400 pregnancies occurring in Sweden between 2007 and 2013. We investigated prescription patterns across time and type of source clinic for any opioid analgesic and for strong and weak opioid analgesics. We further evaluated the extent to which receipt of opioid analgesic medications was associated with previous mental health diagnoses and prescriptions of other psychoactive medications. Results The prevalence of pregnant women who filled prescriptions for opioid analgesics (4.5%) was relatively stable across the assessed years. However, among pregnant women who filled opioid analgesic prescriptions, there was a large increase in strong opioid analgesic prescriptions–from 6.1% in 2007 to 17.1% in 2013. The main source of opioid analgesic prescriptions were primary care and obstetrics and gynecology clinics–38.7% of all filled prescriptions originated from primary care providers and 25.3% from obstetrics and gynecology practitioners. Compared to pregnant women who did not fill any opioid analgesic prescriptions, those who did were more likely to have a wide range of preexisting mental health diagnoses (e.g. anxiety disorder odds ratio [OR] = 3.13, 95% confidence interval [CI]:2.98,3.29) and to utilize a wide range of other psychoactive medications (e.g. benzodiazepines OR = 4.26, 95% CI:4.10,4.43). Similarly, those who received strong opioids were more likely to have a wide range of mental health diagnoses and be prescribed a wide range of psychoactive medications compared to those who received weak opioids. Conclusions These results highlight the need for physicians treating pregnant women and women of childbearing age for painful conditions to obtain detailed histories of mental health problems, screen for symptoms of mental health problems, and facilitate integrated care and evidence-based mental health interventions if needed.

Understanding different trajectories of mental health across the general population during the COVID-19 pandemic.

The COVID-19 pandemic and nationally mandated restrictions to control the virus have been associated with increased mental health issues. However, the differential impact of the pandemic and lockdown on groups of individuals, and the personal characteristics associated with poorer outcomes are unknown. Data from 21 938 adults in England who participated in a stratified cohort study were analysed. Trajectories of depression and anxiety symptoms were identified using growth mixture modelling. Multinomial and logistic regression models were constructed to identify sociodemographic and personality-related risk factors associated with trajectory class membership. Four trajectories of depression and five for anxiety were identified. The most common group presented with low symptom severity throughout, other classes were identified that showed: severe levels of symptoms which increased; moderate symptoms throughout; worsening mental health during lockdown but improvements after lockdown ended; and for anxiety only, severe initial anxiety that decreased quickly during lockdown. Age, gender, ethnicity, income, previous diagnoses, living situation, personality factors and sociability were associated with different trajectories. Nearly 30% of participants experienced trajectories with symptoms in the clinical range during lockdown, and did not follow the average curve or majority group, highlighting the importance of differential trajectories. Young, female, outgoing and sociable people and essential workers experienced severe anxiety around the announcement of lockdown which rapidly decreased. Younger individuals with lower incomes and previous mental health diagnoses experienced higher and increasing levels of symptoms. Recognising the likely symptom trajectories for such groups may allow for targeted care or interventions.

Depressive symptoms among Peruvian adult residents amidst a National Lockdown during the COVID-19 pandemic

BackgroundPopulation health and well-being in Latin America, the current epicenter of the COVID-19 pandemic, has been severely affected during the past semester. Despite the growing evidence about the link between the pandemic, its control measures, and mental health worldwide, there is still no regional evidence of the potential mental health impact. We describe the prevalence and distribution of depressive symptoms across demographic and socioeconomic risk factors in the Peruvian population amidst a national lockdown during the COVID-19 pandemic.MethodsCross-sectional study conducted during the community transmission phase and national lockdown in Peru (May 4th–16th, 2020). We recorded 64,493 responses from adult Peruvian residents through an opt-in online questionnaire. All analyses were weighted using raking based on proportions of sociodemographic variables from the last Peruvian census in 2017. The prevalence of depressive symptoms was calculated using the Patient Health Questionnaire (PHQ-9) score of 10 or more. We identified associated demographic and socioeconomic factors by prior mental health diagnosis. Sensitivity analysis considered an alternative cut-off point for depressive symptoms of PHQ-9 ≥ 14.ResultsA total of 57,446 participants were included in the analytical sample. A third of the participants (n = 23,526, unweighted) showed depressive symptoms in the 2 weeks prior to the study. Participants who reported a previous mental health diagnosis doubled the sample prevalence of depressive symptoms (59, 95%CI 56.7, 61.4%) of those without a prior diagnosis. Psychosocial and functioning reactions were largely more prevalent among females and young adults. A dose-response relationship was found between household income and depressive symptoms across previous mental health diagnosis strata, being as low as 32% less in the wealthiest than the most impoverished group (PR: 0.68, 95%CI 0.58,0.79). Other critical factors associated with a higher burden of depressive symptoms were lower education level, single, unemployed, and chronic comorbidity.ConclusionsAn increased burden of depressive symptoms and psychosocial reactions has emerged during the COVID-19 pandemic in Peru compared to previous years. The mental health burden disproportionately affects women, the younger population, and those with low income and education. As the country eases the social distancing measures, it is crucial to use local evidence to adjust public health policies and mental health services to the renewed population needs.

Coping in the Covid-19 pandemia: how different resources and strategies can be risk or protective factors to mental health in the Brazilian population

ABSTRACT Objective The present study's objective was to investigate the pandemic's impact on mental health and identify variables that can increase or decrease the chances of stress, anxiety, and depression, in both a sample with and one without self-reported mental health issues, in a Brazilian population. Design a cross-sectional quantitative study. Data were collected online in May and June of 2020. Participated 1130 adults between 18–78 years old (mean = 37.46 years, SD = 12.18), from 20 Brazilian states, with an average of 58.61 days (SD = 23.2) of social distancing. Main Outcome Measures Depression, anxiety and stress symptoms, characterization of social distancing, and Coping strategies. Results A significantly higher prevalence of severe depression was found in those who practiced social distancing. Multinomial logistic regressions identified the explanatory model with risk and protection variables to mental health. For the group without a previous mental health diagnosis, using confrontation (OR = 1.39, CI95% 1.23–1.58) and escape strategies (OR = 1.48, CI95% 1.19–1.84) increases the odds of presenting severe depression, while positive reappraisal (OR = 0.85, IC95% 0.78–0.93) and problem-solving (OR = 0.75, CI95% 0.63-–0.88) were protective factors. In the group with mental disorders, using confrontation (OR = 1.33, CI95% 1.10–1.60) and escape strategies (OR = 1.49, CI95% 1.12–1.98) were also risk factors for severe depression and no coping protective factors were found. Conclusions Problem-solving and positive reappraisal were protective strategies that potentially reduced the odds of presenting depression and anxiety, but only in people without a previous mental health diagnosis. Public policies must offer psychological support to the most vulnerable, as well as orientation based on scientific evidence, aiming at improving quality of life.