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      Mental health before and during the COVID-19 pandemic in two longitudinal UK population cohorts

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          Abstract

          Background

          The COVID-19 pandemic and mitigation measures are likely to have a marked effect on mental health. It is important to use longitudinal data to improve inferences.

          Aims

          To quantify the prevalence of depression, anxiety and mental well-being before and during the COVID-19 pandemic. Also, to identify groups at risk of depression and/or anxiety during the pandemic.

          Method

          Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC) index generation ( n = 2850, mean age 28 years) and parent generation ( n = 3720, mean age 59 years), and Generation Scotland ( n = 4233, mean age 59 years). Depression was measured with the Short Mood and Feelings Questionnaire in ALSPAC and the Patient Health Questionnaire-9 in Generation Scotland. Anxiety and mental well-being were measured with the Generalised Anxiety Disorder Assessment-7 and the Short Warwick Edinburgh Mental Wellbeing Scale.

          Results

          Depression during the pandemic was similar to pre-pandemic levels in the ALSPAC index generation, but those experiencing anxiety had almost doubled, at 24% (95% CI 23–26%) compared with a pre-pandemic level of 13% (95% CI 12–14%). In both studies, anxiety and depression during the pandemic was greater in younger members, women, those with pre-existing mental/physical health conditions and individuals in socioeconomic adversity, even when controlling for pre-pandemic anxiety and depression.

          Conclusions

          These results provide evidence for increased anxiety in young people that is coincident with the pandemic. Specific groups are at elevated risk of depression and anxiety during the COVID-19 pandemic. This is important for planning current mental health provisions and for long-term impact beyond this pandemic.

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          Most cited references42

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            The PHQ-9: validity of a brief depression severity measure.

            While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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              The psychological impact of quarantine and how to reduce it: rapid review of the evidence

              Summary The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.
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                Author and article information

                Journal
                Br J Psychiatry
                Br J Psychiatry
                BJP
                The British Journal of Psychiatry
                Cambridge University Press (Cambridge, UK )
                0007-1250
                1472-1465
                24 November 2020
                : 1-10
                Affiliations
                [1 ]MRC Integrative Epidemiology Unit, University of Bristol , UK; Population Health Sciences, Bristol Medical School, University of Bristol , UK; and Division of Psychiatry, University of Edinburgh , UK
                [2 ]MRC Integrative Epidemiology Unit, University of Bristol , UK; and Population Health Sciences, Bristol Medical School, University of Bristol , UK
                [3 ]Division of Psychiatry, University of Edinburgh , UK
                [4 ]Population Health Sciences, Bristol Medical School, University of Bristol , UK
                [5 ]Department of Psychology, University of Edinburgh , UK
                [6 ]Population Health Sciences, Bristol Medical School, University of Bristol , UK; and Gloucestershire Health and Care NHS Foundation Trust, UK
                [7 ]Population Health Sciences, Bristol Medical School, University of Bristol , UK; and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University , UK
                [8 ]Population Health Sciences, Bristol Medical School, University of Bristol , UK; and National Institute of Health Research Biomedical Research Centre, University of Bristol , UK
                [9 ]Population Health Sciences, Bristol Medical School, University of Bristol , UK; National Institute of Health Research Biomedical Research Centre, University of Bristol , UK; and Avon and Wiltshire Mental Health Partnership NHS Trust, UK
                [10 ]Great Ormond Street Institute of Child Health, University College London , UK; Department of Psychiatry, Faculty of Medicine, University of Geneva , Switzerland; and Department of Paediatrics Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva , Switzerland
                [11 ]Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, USA
                [12 ]1MRC Integrative Epidemiology Unit, University of Bristol , UK; and Population Health Sciences, Bristol Medical School, University of Bristol , UK
                [13 ]Centre for Genomic and Experimental Medicine, Institute of Genetics & Molecular Medicine, University of Edinburgh , UK; and Usher Institute for Population Health Sciences and Informatics, University of Edinburgh , UK
                [14 ]Centre for Genomic and Experimental Medicine, Institute of Genetics & Molecular Medicine, University of Edinburgh , UK
                [15 ]MRC Integrative Epidemiology Unit at the University of Bristol , UK; Population Health Sciences, Bristol Medical School, University of Bristol , UK; and National Institute of Health Research Biomedical Research Centre, University of Bristol , UK
                [16 ]MRC Integrative Epidemiology Unit at the University of Bristol , UK; and Population Health Sciences, Bristol Medical School, University of Bristol , UK
                Author notes
                Correspondence: Alex S. F. Kwong. Email: alex.kwong@ 123456bristol.ac.uk
                [*]

                These authors contributed equally to this work.

                Author information
                https://orcid.org/0000-0003-1953-2771
                https://orcid.org/0000-0002-3599-6018
                https://orcid.org/0000-0001-6160-8982
                https://orcid.org/0000-0001-5571-2273
                https://orcid.org/0000-0002-0198-4588
                Article
                S0007125020002421
                10.1192/bjp.2020.242
                7844173
                33228822
                5c4e07fd-2ccd-407d-9f89-9209f0009dab
                © The Author(s) 2021

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 July 2020
                : 10 November 2020
                : 10 November 2020
                Page count
                Figures: 3, Tables: 1, References: 58, Pages: 10
                Categories
                Paper

                Clinical Psychology & Psychiatry
                covid-19,alspac,generation scotland,anxiety disorders,depressive disorders

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