Self-reported Worry Research Articles

The changing nature of worry about COVID-19 among the English public: a secondary analysis of 73 national, cross-sectional surveys, January 2020 to April 2022

ObjectivesTo investigate worry about COVID-19 during the pandemic, and whether worry was associated with phase of the pandemic, COVID-19 death and incidence rates, Government interventions (including lockdown and advertising), age,...

Patient-Reported Outcomes and Higher Order Aberrations Following Topography-Guided Femtosecond Laser-Assisted In Situ Keratomileusis.

To examine patient-reported outcomes and higher order aberrations following topography-guided laser-assisted in situ keratomileusis (LASIK). This was a prospective, nonrandomized observational study at a single academic center. Sixty eyes from 30 patients underwent bilateral topography-guided femtosecond LASIK for correction of myopia using the VisuMax 500 femtosecond laser (Zeiss; Oberkochen, Germany) and Allegretto Wave Eye-Q 400 Hz Excimer Laser (Alcon/Wavelight; Erlangen, Germany) with the Contoura topography system (Alcon; Geneva, Switzerland) for topography-modified refraction. The main outcomes of this study were higher order aberrations (HOAs) and results from the Patient-Reported Outcomes with LASIK questionnaire. There was a small, significant increase in HOA root mean square, spherical aberration, and coma at 1, 3, 6, and 12 months following topography-guided LASIK (all P < 0.05), but no change in trefoil. In addition, self-reported worry related to vision (P < 0.001) and ability to perform activities (P < 0.001) significantly improved after surgery. The prevalence of double images, glare, halos, or starbursts decreased from 73% preoperatively to 56%, and no participants reported "very" or "extremely" bothersome visual symptoms after 12 months. Dry eye symptoms per Ocular Surface Disease Index score decreased significantly at 6 (P = 0.01) and 12 (P = 0.002) months after surgery. There was a 100% satisfaction rate with visual outcomes and duration of time to improvement in vision following the procedure. Although there was an increase in HOAs following topography-guided LASIK, there were significant improvements in the presence of double images, glare, halos, and starbursts and vision-related quality-of-life metrics. Overall satisfaction rates in this study were high.

The psychological impact of the rise in media reporting of sexual violence after COVID-19 pandemic on Pakistani women's mental health.

Pandemics usually have inequitable effects on the most vulnerable groups of society. Since the start of COVID-19, there has been a horrifying upsurge in cases of sexual and gender-based violence against women, globally. Consequently, frequent breaking news of sexual violence in media aggravated mental distress and worry among women. In this cross-sectional study, we investigated the impact of the rise in active circulation of news of sexual violence on the mental health of working women and students using the validated DASS-21 questionnaire. A total of 303 women with diverse socio-demographic backgrounds participated in the study. We performed a chi-square test to analyze the association of increase in media reporting with DASS-21total and sub-categories scores. Multivariate linear regression was performed on propensity score-matched subjects to identify psychosocial predictors of mental distress. Increased self-reported worries in response to rise in media reports of sexual violence was found to be significant predictor of mental distress (p < 0.002). Moreover, highly significant correlation between the increase in media reports and scores of depression, anxiety, and stress was observed (p < 0.001). The rise in media reporting of sexual violence in the after math of COVID-19 was found to have a significant psychological impact on the mental health of Pakistani women. This is the first study of its kind on the subject and provides fundamental findings for shaping policy change on responsible media reporting of sexual violence.

Communicating climate change as a generational issue: experimental effects on youth worry, motivation and belief in collective action

ABSTRACT Generations differ in their contribution to climate change and susceptibility to its effects. Contextualizing climate change as an intergenerational issue may therefore alter public engagement. We report a pre-registered, online experiment with a youth sample (N = 500, aged 16–24 years) in Ireland that tested whether highlighting generational differences in descriptions of climate change affects (i) worry about climate change, (ii) perception of others’ worry, (iii) belief in collective action and (iv) pro-environmental intentions. We also tested the effect of correcting young people’s misperceptions about how concerned older generations (aged 40+) are. The generational narrative amplified self-reported worry about climate change, from 5.42 (SD = 1.45) on a 7-point rating scale in the control group to 5.76 (SD = 1.18) among those who read the generational narrative (d = 0.26). Those who read the generational narrative also believed their close friends (M = 5.14, SD = 1.32) and other peers (M = 5.28, SD = 1.19) were more worried than those who read the control narrative (M = 4.85, SD = 1.48 and M = 5.03, SD = 1.19, respectively; ds = 0.20). There were no significant effects of contextualizing climate change as an intergenerational issue on perceived worry among older people, belief in collective action or pro-environmental intentions. Providing accurate information on older people’s worry, however, boosted belief in collective action, particularly for the majority who initially underestimated it (M = 4.22 out of 7, SD = 1.14 vs. M = 4.63, SD = 1.18, d = 0.36). The results have implications for communications with young people about climate change. Correcting underestimations of concern about climate change between socio-demographic subgroups may help to foster engagement. Policy highlights Communications that highlight generational differences in the causes and effects of climate change may be unhelpful; they increase worry among young people without motivating them to act. Most young people underestimate how worried older people are about climate change and this misperception correlates with belief that people are less likely to work together to mitigate climate change. Providing accurate information on how worried older people are boosts belief in collective action, but only among the majority of young people who underestimate it. Communications about climate change likely benefit from avoiding highlighting differences between socio-demographic subgroups and correcting misperceptions where they exist.

Factors associated with anxiety during the first two years of the COVID-19 pandemic in the United States: An analysis of the COVID-19 Citizen Science study.

COVID-19 increased the prevalence of clinically significant anxiety in the United States. To investigate contributing factors we analyzed anxiety, reported online via monthly Generalized Anxiety Disorders-7 (GAD-7) surveys between April 2020 and May 2022, in association with self-reported worry about the health effects of COVID-19, economic difficulty, personal COVID-19 experience, and subjective social status. 333,292 anxiety surveys from 50,172 participants (82% non-Hispanic white; 73% female; median age 55, IQR 42-66) showed high levels of anxiety, especially early in the pandemic. Anxiety scores showed strong independent associations with worry about the health effects of COVID-19 for oneself or family members (GAD-7 score +3.28 for highest vs. lowest category; 95% confidence interval: 3.24, 3.33; p<0.0001 for trend) and with difficulty paying for basic living expenses (+2.06; 1.97, 2.15, p<0.0001) in multivariable regression models after adjusting for demographic characteristics, COVID-19 case rates and death rates, and personal COVID-19 experience. High levels of COVID-19 health worry and economic stress were each more common among participants reporting lower subjective social status, and median anxiety scores for those experiencing both were in the range considered indicative of moderate to severe clinical anxiety disorders. In summary, health worry and economic difficulty both contributed to high rates of anxiety during the first two years of the COVID-19 pandemic in the US, especially in disadvantaged socioeconomic groups. Programs to address both health concerns and economic insecurity in vulnerable populations could help mitigate pandemic impacts on anxiety and mental health.

Long-term trajectories of densely reported depressive symptoms during an extended period of the COVID-19 pandemic in Switzerland: Social worries matter

Previous mental health trajectory studies were mostly limited to the months before access to vaccination. They are not informing on whether public mental health has adapted to the pandemic. The aim of this analysis was to 1) investigate trajectories of monthly reported depressive symptoms from July 2020 to December 2021 in Switzerland, 2) compare average growth trajectories across regions with different stringency phases, and 3) explore the relative impact of self-reported worries related to health, economic and social domains as well as socio-economic indicators on growth trajectories. As part of the population-based Corona Immunitas program of regional, but harmonized, adult cohorts studying the pandemic course and impact, participants repeatedly reported online to the DASS-21 instrument on depressive symptomatology. Trajectories of depressive symptoms were estimated using a latent growth model, specified as a generalised linear mixed model. The time effect was modelled parametrically through a polynomial allowing to estimate trajectories for participants' missing time points. In all regions level and shape of the trajectories mirrored those of the KOF Stringency-Plus Index, which quantifies regional Covid-19 policy stringency. The higher level of average depression in trajectories of those expressing specific worries was most noticeable for the social domain. Younger age, female gender, and low household income went along with higher mean depression score trajectories throughout follow-up. Interventions to promote long-term resilience are an important part of pandemic preparedness, given the observed lack of an adaptation in mental health response to the pandemic even after the availability of vaccines in this high-income context.

Self-Reported Worries in Young People During the COVID-19 Pandemic.

COVID-19 pandemic has had long-standing consequences for all aspects of life. Although young people appear less susceptible to severe forms of physical illness due to the coronavirus, they have not escaped unscathed from its' psychological impacts. The present study measured the content of worries in young people residing in the UK during the pandemic and how it varied with sociodemographic factors. Between May and December 2020, UK-residing participants aged 12-25 years completed an online survey that presented participants with free-text fields to describe their top three worries over the last two weeks, in addition to demographic and other information. Cross-sectional data from 2560 participants (Males = 767; Female = 1793) was analyzed. Irrespective of sociodemographic, a majority of the participants reported worries related to academics, followed by social relationships, own physical health, social and work routines, and physical health of others. Significantly more females reported concerns about academics, finances, physical health, social and work routines, social relationships, mental health and emotions, and physical health of others. Expectedly, more older (18-25 years) than younger (12-17 years) participants reported concerns about career-prospects and finances, while more younger than older ones were worried about academics (98.41% vs. 80.90%). With respect to financial worries, a higher percentage of BAME (Black, Asian and Minority Ethnic) communities in the UK reported such worries. Ethnicity significantly predicted more worries about social relationships among White than BAME participants. Significant differences also existed across different SES groups regarding endorsement of a particular category of worry. These findings highlight the need for tailored interventions depending on the major concerns for young people of different ages, sexes, ethnicities, and SES. The online version contains supplementary material available at 10.1007/s10608-023-10396-3.

Impact of COVID-19 on the Sense of Job Security Among Community Pediatric Hospitalists.

The coronavirus disease 2019 (COVID-19) pandemic offers a prime opportunity to examine the ability of community pediatric hospital medicine programs to respond to external stressors. This study aims to characterize the impact of the COVID-19 pandemic on compensation and furlough among community pediatric hospitalists, as well as self-reported sense of job security. This study was part of a larger quantitative project investigating community pediatric hospitalists' career motivators. The survey was drafted through an iterative process by the authors. It was disseminated via e-mail to a convenience sample of community pediatric hospitalists obtained through direct contact with community pediatric hospital medicine programs. Data were collected on changes in compensation and furlough because of COVID-19, as well as worry about job security measured as self-reported worry about one's job being permanently terminated on a 5-point Likert scale. Data were collected from 31 hospitals across the United States with 126 completed surveys. Because of COVID-19, many community pediatric hospitalists experienced reduced base pay and benefits and a minority experienced furlough. Nearly two-thirds (64%) reported some worry about job security. Initial base pay reduction, working in suburban areas compared with rural areas, and affiliation with a university-based center or free-standing children's hospital were significantly associated with greater worry about job security. The initial response to the COVID-19 pandemic resulted in changes in compensation and furlough for some community pediatric hospitalists and many expressed concerns about job security. Future studies should identify protective factors for community pediatric hospitalists' job security.

High Cognitive Ability and Mental Health: Findings from a Large Community Sample of Adolescents.

Whereas it has sometimes been asserted that the intellectually gifted would be more prone to develop mental health problems, empirical studies generally do not seem to support such claims. However, much of the available research has relied on preselected samples, introducing risks for sample selection bias. This study scrutinized the relationship between intellectual giftedness (defined as high cognitive ability) and mental health in a large, non-selective sample of early adolescents (n = 3409; 49.6% boys; Mage = 12.5 years). Using a standardized intelligence test (CoVaT-CHC) to identify participants with a high cognitive ability (IQ ≥ 120; n = 403), we compared self- and parent-reported levels of emotional problems, conduct problems, hyperactivity/inattention, and self-reported worry and global self-esteem between high and average ability adolescents. Findings indicated that adolescents with a high cognitive ability were not at increased risk of psychological maladjustment; if any, differences were in favor of the high ability group. However, adolescents who had been formally identified as gifted (i.e., who had received a gifted label) did report worse adjustment for a number of outcomes.

Reduction in maternal anxiety following prenatal pediatric urology consultation

IntroductionFetal anomalies detected on prenatal ultrasound can elicit maternal psychological distress and may be associated with increased risk of adverse fetal outcomes. Prenatal consultation with pediatric specialists may allay parental worries by improving clarity surrounding a fetal diagnosis, establishing a postnatal management plan, and providing expert advice. We sought to determine whether maternal anxiety and worry decreased following prenatal pediatric urology consultations among a cohort of pregnant women whose fetuses were diagnosed with urologic anomalies.MethodsPregnant women referred to pediatric urologists for prenatal consultation through our Fetal Maternal Center following detection of a urologic anomaly were recruited from February 2021 to March 2022 inclusive. Participants completed questionnaires before and after prenatal pediatric urology consultation assessing maternal current state anxiety (S-Anxiety) on the State-Trait Anxiety Inventory (STAI) and self-reported worry surrounding the fetal diagnosis. Differences in anxiety and worry before versus after prenatal consultation were analyzed using paired t-tests and McNemar’s tests.Results26 pregnant women completed pre- and post-visit questionnaires. Most participants (92.3%) received prenatal pediatric urology consultation for anomalies of the fetal kidney(s), including hydronephrosis and suspected multicystic dysplastic kidney. The proportion of participants reporting extreme or moderate levels of worry surrounding the fetal diagnosis significantly decreased from 69.2% prior to prenatal pediatric urology consultation, to 30.8% after consultation (p=0.02). Reductions in worry after prenatal consultation were reported among 80.8% of participants. Average state anxiety on the STAI similarly significantly decreased from 35.2 ( ± 9.4) before prenatal consultation to 31.4 ( ± 11.1) after consultation. Differences in reductions in anxiety and worry did not significantly differ among participants attending prenatal consultations in-person or via telehealth.ConclusionsAmong a cohort of pregnant women diagnosed with fetal anomalies of the urinary tract, anxiety and worry surrounding the fetal diagnosis significantly decreased after prenatal in-person or telehealth consultations with pediatric urologists.

Examining evidence for the Finite Pool of Worry and Finite Pool of Attention hypotheses

The Finite Pool of Worry (FPW) hypothesis states that humans have finite emotional resources for worry, so that when we become more worried about one threat, worry about other threats decreases. Despite its relevance, no conclusive empirical evidence for the hypothesis exists. We leverage the sudden onset of new worries introduced by the COVID-19 pandemic as a natural experiment to test the FPW hypothesis and a related hypothesis, the Finite Pool of Attention (FPA) hypothesis. The FPA hypothesis proposes that when we pay more attention to one threat, our attention to other threats decreases. To test these two hypotheses, we assessed self-reported attention, self-reported worries, and Twitter/news attention to various threats (climate change, terrorism, economic problems, and others) throughout the pandemic in three countries (USA, Italy, and China). We find that as attention to and worry about COVID-19 increases, attention to climate change decreases, but worry does not. Our results are confirmed by further analysis of a large, longitudinal U.S. sample. We find that public perceptions that COVID-19 and climate change are related do not fully explain the positive relationship in worry between the two hazards. In summary, our findings suggest that while there may be a Finite Pool of Attention to threats, there is limited evidence for a Finite Pool of Worry.

The Academic Cost of Worry Among Socioeconomically Disadvantaged Children.

ObjectivesWorry and loneliness looms large in American schools, especially in the social years of early adolescence where friendships are in flux and children strive to fit in and do well academically. We examine a nationally-representative sample of American 5th graders to document the extent of academic worry and loneliness, its costs for academic performance, and how social class can disrupt or exacerbate its associations.MethodsBased on a nationally representative longitudinal survey (ECLS-K 2010–2011) of childhood (N = 5750), we examine if a child’s self-reported worry and loneliness are associated with standardized math and reading scores using OLS regression. We explore whether these associations vary by socioeconomic status.ResultsWe find that academic worry is a strong predictor of math and reading skill. The association is amplified for disadvantaged students. Patterns hold when accounting for a host of other factors and are replicated in the ECLS-K 1998–1999. Loneliness and its association with math and reading performance was not statistically significant.Conclusions for PracticeAs academic worry is negatively associated with standardized math and reading skills, practitioners can be especially attuned to how these patterns are amplified for children in low socioeconomic households. Utilizing a nationally representative survey of early adolescence, we show that worry (and less so loneliness) is associated with math and reading skills and that these associations are moderated by socioeconomic status—disadvantaged students have a higher negative association with math and reading performance when they worry about their academic performance compared to advantaged students.

Factors associated with self-reported avoidance of harm reduction services during the COVID-19 pandemic by people who use drugs in five cities in the United States and Canada

BackgroundThis study examines individual-level factors associated with avoiding two important health services for people who use drugs—medications for treatment of opioid use disorder and syringe service programs—during the first year of the COVID-19 pandemic. MethodsData come from two subsamples of people who use drugs who were active participants in one of nine cohort studies in Vancouver, British Columbia; Baltimore, Maryland; Los Angeles, California; Chicago, Illinois; and Miami, Florida. Participants were interviewed remotely about COVID-19-associated disruptions to healthcare. We estimated the association of demographic, social, and health factors with each outcome using logistic regression among 702 participants (medication analysis) and 304 participants (syringe service analysis.) Analyses were repeated, stratified by city of residence, to examine geographic variation in risk. ResultsThere were large differences between cities in the prevalence of avoiding picking up medications for opioid use disorder, with almost no avoidance in Vancouver (3%) and nearly universal avoidance in Los Angeles, Chicago, and Miami (>90%). After accounting for between-city differences, no individual factors were associated with avoiding picking up medications. The only factor significantly associated with avoiding syringe service programs was higher levels of self-reported worry about COVID-19. ConclusionDuring the first year of the COVID-19 pandemic, geographic differences in service and policy contexts likely influenced avoidance of health and harm reduction services by people who use drugs in the United States and Canada more than individual differences between people.

Parasympathetic cardiac control during attentional focus and worry in major depressive disorder

Worry, which refers to uncontrollable chains of thoughts and images with negative affective load, is a transdiagnostic symptom of various mental disorders including major depressive disorder (MDD). Current theories relate excessive worry to deficient top-down control of automatically occurring perseverative thinking. This study investigated parasympathetic cardiac control in MDD in the context of worry and cognitive control. Heart rate variability (HRV) was recorded, in the high frequency (HF) and low frequency (LF) bands, in 36 MDD patients and 36 healthy controls while they performed a breathing focus task. The task included two phases during which participants' ability to concentrate on their breathing was assessed before and after an instructed worry phase. In addition to higher self-reported worry, MDD patients exhibited lower HF and LF HRV at rest, and lower LF HRV during the task than controls. MDD was also associated with impaired breathing concentration ability, more negative and neutral thought intrusions, more negative mood during breathing focus and increased stress during instructed worry. In the total sample, LF HRV correlated negatively with self-reported worry and negative thought intrusions, and positively with mood ratings. The reduction of HRV confirms the notion of low parasympathetic cardiac control in MDD. Moreover, low HRV represents a correlate of blunted prefrontal activity and impaired cognitive control that characterize the disorder. Impaired cognitive control may exacerbate worry, which is in turn involved in the genesis of aversive emotional states and maintenance of MDD.

Mixed Method Examination of the Brain Health of Former NCAA Division I Football Players and Former NFL Players

Young American athletes, at risk of sport-related concussion (SRC), represent many races; however, it is unknown how race influences the experience and outcome of SRC. Our objective was to compare White and Black athletes' recovery and subjective experiences after SRC. NA. A retrospective study was performed using the Vanderbilt Sport Concussion registry. Self-reported White (n = 211) and Black (n = 36) athletes (ages 12-23) treated for SRC between 2012 and 15 were included. Athletes with learning disabilities or psychiatric conditions were excluded. Data was collected by EMR review and phone calls to athletes and parents/guardians. The primary outcomes were: (1) days to symptom resolution (SR), (2) days to return-to-school, (3) changes in any daily activity (binary), (4) and sport behavior (binary). Secondary outcomes were changes in specific activities such as sleep, schoolwork, television time, as well as equipment (binary), playing style (more reckless, unchanged, less reckless) and whether the athlete retired from sport. Descriptive analyses, multivariable Cox proportional hazards and logistic regression were performed. A retrospective study was performed using the Vanderbilt Sport Concussion registry. Self-reported White (n = 211) and Black (n = 36) athletes (ages 12-23) treated for SRC between 2012 and 15 were included. Athletes with learning disabilities or psychiatric conditions were excluded. Data was collected by EMR review and phone calls to athletes and parents/guardians. The primary outcomes were: (1) days to symptom resolution (SR), (2) days to return-to-school, (3) changes in any daily activity (binary), (4) and sport behavior (binary). Secondary outcomes were changes in specific activities such as sleep, schoolwork, television time, as well as equipment (binary), playing style (more reckless, unchanged, less reckless) and whether the athlete retired from sport. Descriptive analyses, multivariable Cox proportional hazards and logistic regression were performed. Racial differences appear to exist in the outcomes and experience of SRC for young athletes, as Black athletes reached symptom resolution and return-to-school sooner than White athletes. Race should be considered as an important social determinant in SRC treatment.

Characteristics Associated With Self-Reported Worry Among Adults About Food Availability and Food Safety During the COVID-19 Pandemic-United States, June 2020 Survey Data.

During a pandemic, persons might experience worry because of threats (real or perceived), or as part of stress-related reactions. We aimed to provide insight into Americans' worry about food during COVID-19. Design, Subjects, Measures: Online survey data from June 2020 (n = 4,053 U.S. adults; 62.7% response rate) was used to assess 2 outcomes: worry about food availability (FA); food safety (FS). Adults with missing information about FA and FS were excluded from analysis (final n = 3,652). We used descriptive statistics and multivariable logistic regression to examine characteristics associated with the outcomes and estimate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) for associations between sociodemographic variables and outcomes. 58.3% of respondents reported worry about FA; 57.5% about FS, with higher odds of worry for FA and FS (versus referents) in lower income households (FA: aOR = 1.76 95%CI [1.30, 2.39]; FS: 1.84[1.35, 2.51]); unemployed (1.54[1.05, 2.28]; 1.90[1.26,2.81]); non-Hispanic Black (1.55[1.14,2.12]); 2.25[1.65,3.07]); Hispanic (1.39[1.06,1.82]; 1.94[1.46,2.56]). Findings highlight the importance of strategies to reduce consumer worry about FA and FS and negative food behaviors, and the need for continued access to hunger safety net programs, which could have positive effects on nutrition security.

Patient-reported experiences with telemedicine: ask first

Objectives: To assess patient experiences with the use of a telemedicine program initiated in response to the COVID-19 pandemic and identify factors associated with patient satisfaction with telemedicine. Methods: Patients receiving care at a large, community-based cancer center in Seattle, Washington were sent an email requesting voluntary participation in a survey to assess their experiences with telemedicine. Surveying took place during the interval from March 1, through May 31 2020, in the early phase of the pandemic. The survey queried participants regarding demographic and clinical characteristics, included a panel of questions designed to assess reasons for choosing telemedicine and their satisfaction with care, and a NCCN-validated distress scale. Descriptive statistics were tabulated and multivariable logistic regression was used to identify predictors of satisfaction with telemedicine. Results: Surveys were completed by 155 patients. Mean age of respondents was 65 years old, 69% were female, and 41% were treated for a gynecologic condition. Most used an audiovisual (v audio-only) platform (70%) and stated they were offered the choice to use telehealth (88%). Overall, 82% found the platform easy to use, 87% were satisfied with the care provided, 84% found they could connect emotionally with their provider, and 93% stated they would use telemedicine again. Reasons for continued interest in using telemedicine again included convenience, safety, and transportation issues. In a multivariable model, being offered the choice to use telehealth was the only significant predictor of satisfaction with care (odds ratio 4.81). Male gender, living close to the clinic, and self-reported worry were negatively associated with their ability to connect emotionally with their provider, but high distress scores did not impact having an emotional connection with their provider. Conclusions: Rates of patient satisfaction with telemedicine were high, but not being offered the choice of an in-person visit emerged as an important predictor of dissatisfaction with care. This information may be important for clinics planning to incorporate telemedicine in the future.

Characteristics Associated With Self-Reported Worry Among Adults About Food Availability and Food Safety During the COVID-19 Pandemic — United States, June 2020

ObjectivesDuring the COVID-19 pandemic, U.S. retailers have reported few major, sustained disruptions in food availability (FA); the risk of contracting COVID-19 from eating or handling food is low. Some consumer food behaviors related to FA and food safety (FS), such as panic buying, stockpiling, bleaching food have occurred. During emergencies, assessing consumer nutrition beliefs and developing intervention can prevent unintended negative behaviors. We examined self-reported worry about FA and FS during the pandemic.MethodsSurvey data was collected online in June 2020 from a representative panel of US adults (n = 4,053). Outcome variables (worry about FA and FS) were assessed using collapsed response options (‘Worried at any level’ and ‘Not at all worried) to the question, “How worried are you and your household about each of the following as itrelates to the COVID-19 pandemic?” Multivariable logistic regression analyses were used to estimate adjusted odds ratios (aORs) for the associations between sociodemographic variables and worry about FA and FS.ResultsOver half of respondents reported worry about FA (58.3%) or FS (57.5%). The highest reported worry about FA were among those not employed (74%), those with household income ≤$34,999 (70%), Black adults (68%), adults aged 35–49 years (64%), those with a high school education or less (62%), and those in the South (61%). The highest reported worry about FS was among those not employed (78%), Black adults (73%), household income ≤$34,999 (74%), aged 35–49 years (61%), and those in the Northeast (61%). Compared with their respective referent groups, significantly higher worry for FA and FS respectively were found among lower income households (aOR [CI] = 1.76 [1.30–2.39]; 1.84 [1.35–2.51]), those who were unemployed (1.54 [1.05–2.28]; 1.90 [1.26–2.81]), non-Hispanic Black (1.55 [1.14–2.12]; 2.25 [1.65–3.07]), and Hispanic (1.39 [1.06–1.82]; 1.94 [1.46–2.56]).ConclusionsFindings highlight the importance of strategies and communications that reduce fears and prevent unintended negative behaviors, and stress increasing consumer awareness of food access options during emergencies, including promotion of hunger safety net programs, especially among disproportionately affected groups.Funding SourcesSolely for author's time from their institutions.

Characterizing Health Care Delays and Interruptions in the United States During the COVID-19 Pandemic: Internet-Based, Cross-sectional Survey Study.

BackgroundThe COVID-19 pandemic has broader geographic spread and potentially longer lasting effects than those of previous disasters. Necessary preventive precautions for the transmission of COVID-19 has resulted in delays for in-person health care services, especially at the outset of the pandemic.ObjectiveAmong a US sample, we examined the rates of delays (defined as cancellations and postponements) in health care at the outset of the pandemic and characterized the reasons for such delays.MethodsAs part of an internet-based survey that was distributed on social media in April 2020, we asked a US–based convenience sample of 2570 participants about delays in their health care resulting from the COVID-19 pandemic. Participant demographics and self-reported worries about general health and the COVID-19 pandemic were explored as potent determinants of health care delays. In addition to all delays, we focused on the following three main types of delays, which were the primary outcomes in this study: dental, preventive, and diagnostic care delays. For each outcome, we used bivariate statistical tests (t tests and chi-square tests) and multiple logistic regression models to determine which factors were associated with health care delays.ResultsThe top reported barrier to receiving health care was the fear of SARS-CoV-2 infection (126/374, 33.6%). Almost half (1227/2570, 47.7%) of the participants reported experiencing health care delays. Among those who experienced health care delays and further clarified the type of delay they experienced (921/1227, 75.1%), the top three reported types of care that were affected by delays included dental (351/921, 38.1%), preventive (269/921, 29.2%), and diagnostic (151/921, 16.4%) care. The logistic regression models showed that age (P<.001), gender identity (P<.001), education (P=.007), and self-reported worry about general health (P<.001) were significantly associated with experiencing health care delays. Self-reported worry about general health was negatively related to experiencing delays in dental care. However, this predictor was positively associated with delays in diagnostic testing based on the logistic regression model. Additionally, age was positively associated with delays in diagnostic testing. No factors remained significant in the multiple logistic regression for delays in preventive care, and although there was trend between race and delays (people of color experienced fewer delays than White participants), it was not significant (P=.06).ConclusionsThe lessons learned from the initial surge of COVID-19 cases can inform systemic mitigation strategies for potential future disruptions. This study addresses the demand side of health care delays by exploring the determinants of such delays. More research on health care delays during the pandemic is needed, including research on their short- and long-term impacts on patient-level outcomes such as mortality, morbidity, mental health, people’s quality of life, and the experience of pain.

Paranoia and Grandiosity in the General Population: Differential Associations With Putative Causal Factors.

Worry, negative self-beliefs, and sleep disturbance have been identified as contributory factors to the onset, maintenance, and severity of paranoia. We tested the specificity of these contributory factors to paranoia compared to grandiosity, a different type of delusional ideation. Data were used from 814 adults from the Nathan Kline Institute-Rockland (NKI-Rockland) study, a general population dataset. Paranoid and grandiose delusional ideation was assessed using the Peters Delusions Inventory (PDI-21) and correlated with self-reported worry (n = 228), negative self-beliefs (n = 485), and sleep quality (n = 655). Correlations were compared using Fisher's r-to-z transform to examine whether the magnitude of relationships differed by delusion type. Paranoia was significantly associated with worry, negative self-belief, and sleep quality. Grandiosity demonstrated significantly weaker relationships with worry and negative self-beliefs. Relationships with sleep quality were similar. We replicate previous reports that worry, negative self-beliefs and sleep quality are associated with paranoid ideation in the general population. We extend these findings by demonstrating that these contributory factors, particularly worry and negative self-beliefs, are associated with paranoid ideation to a greater extent than grandiosity. This suggests a degree of specificity of contributory factors to different types of delusional thinking, supporting the pursuit of specific psychological models and treatments for each delusion type.