- Record: found
- Abstract: found
- Article: found
The predictive role of psychotic-like experiences in suicidal ideation among technical secondary school and college students during the COVID-19 pandemic
research-article
Publication date (Electronic):
19 July 2023
Journal:
BMC Psychiatry
Publisher:
BioMed Central
Keywords:
Psychotic-like experiences,
Suicide,
Resilience,
Social support,
Students,
Young adults,
Fear
Read this article at
There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.
Abstract
Background
Previous research has shown the strong association between psychotic-like experiences (PLEs) and suicide. However, the predictive role of PLEs in suicidal ideation (SI) during the COVID-19 pandemic remains unclear.
Aims
This study aimed to explore the association between PLEs before the pandemic and SI during the pandemic among late adolescents.
Methods
A total of 938 technical secondary school and college students completed both waves of the online survey before and during the pandemic. PLEs were assessed through the 15-item Positive Subscale of the Community Assessment of Psychic Experiences. SI was evaluated by the frequency of SI during the pandemic.
Results
In early stage of the pandemic, most students had low frequent SI, and only 3.3% students showed high frequent SI. Compared to the low frequent group, the high frequent group exhibited significantly higher levels of PLEs ( p < 0.001) and scored lower in resilience ( p = .001) and perceived social support ( p = .008) across the two timepoints. PLEs were significantly associated with higher risk of high frequent SI (OR = 2.56, 95%: 1.07–6.13), while better resilience (OR: 0.93, 95% CI: 0.88–0.99) and stronger perceived social support (OR: 0.96, 95% CI: 0.93–0.99) appeared to be protective factors. No interactions were found among PLEs and other psychosocial and psychological factors.
Related collections
Most cited references40
- Record: found
- Abstract: found
- Article: found
Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020
Mark Czeisler, Rashon Lane, Emiko Petrosky … (2020)
The coronavirus disease 2019 (COVID-19) pandemic has been associated with mental health challenges related to the morbidity and mortality caused by the disease and to mitigation activities, including the impact of physical distancing and stay-at-home orders.* Symptoms of anxiety disorder and depressive disorder increased considerably in the United States during April–June of 2020, compared with the same period in 2019 ( 1 , 2 ). To assess mental health, substance use, and suicidal ideation during the pandemic, representative panel surveys were conducted among adults aged ≥18 years across the United States during June 24–30, 2020. Overall, 40.9% of respondents reported at least one adverse mental or behavioral health condition, including symptoms of anxiety disorder or depressive disorder (30.9%), symptoms of a trauma- and stressor-related disorder (TSRD) related to the pandemic † (26.3%), and having started or increased substance use to cope with stress or emotions related to COVID-19 (13.3%). The percentage of respondents who reported having seriously considered suicide in the 30 days before completing the survey (10.7%) was significantly higher among respondents aged 18–24 years (25.5%), minority racial/ethnic groups (Hispanic respondents [18.6%], non-Hispanic black [black] respondents [15.1%]), self-reported unpaid caregivers for adults § (30.7%), and essential workers ¶ (21.7%). Community-level intervention and prevention efforts, including health communication strategies, designed to reach these groups could help address various mental health conditions associated with the COVID-19 pandemic. During June 24–30, 2020, a total of 5,412 (54.7%) of 9,896 eligible invited adults** completed web-based surveys †† administered by Qualtrics. §§ The Monash University Human Research Ethics Committee of Monash University (Melbourne, Australia) reviewed and approved the study protocol on human subjects research. Respondents were informed of the study purposes and provided electronic consent before commencement, and investigators received anonymized responses. Participants included 3,683 (68.1%) first-time respondents and 1,729 (31.9%) respondents who had completed a related survey during April 2–8, May 5–12, 2020, or both intervals; 1,497 (27.7%) respondents participated during all three intervals ( 2 , 3 ). Quota sampling and survey weighting were employed to improve cohort representativeness of the U.S. population by gender, age, and race/ethnicity. ¶¶ Symptoms of anxiety disorder and depressive disorder were assessed using the four-item Patient Health Questionnaire*** ( 4 ), and symptoms of a COVID-19–related TSRD were assessed using the six-item Impact of Event Scale ††† ( 5 ). Respondents also reported whether they had started or increased substance use to cope with stress or emotions related to COVID-19 or seriously considered suicide in the 30 days preceding the survey. §§§ Analyses were stratified by gender, age, race/ethnicity, employment status, essential worker status, unpaid adult caregiver status, rural-urban residence classification, ¶¶¶ whether the respondent knew someone who had positive test results for SARS-CoV-2, the virus that causes COVID-19, or who had died from COVID-19, and whether the respondent was receiving treatment for diagnosed anxiety, depression, or posttraumatic stress disorder (PTSD) at the time of the survey. Comparisons within subgroups were evaluated using Poisson regressions with robust standard errors to calculate prevalence ratios, 95% confidence intervals (CIs), and p-values to evaluate statistical significance (α = 0.005 to account for multiple comparisons). Among the 1,497 respondents who completed all three surveys, longitudinal analyses of the odds of incidence**** of symptoms of adverse mental or behavioral health conditions by essential worker and unpaid adult caregiver status were conducted on unweighted responses using logistic regressions to calculate unadjusted and adjusted †††† odds ratios (ORs), 95% CI, and p-values (α = 0.05). The statsmodels package in Python (version 3.7.8; Python Software Foundation) was used to conduct all analyses. Overall, 40.9% of 5,470 respondents who completed surveys during June reported an adverse mental or behavioral health condition, including those who reported symptoms of anxiety disorder or depressive disorder (30.9%), those with TSRD symptoms related to COVID-19 (26.3%), those who reported having started or increased substance use to cope with stress or emotions related to COVID-19 (13.3%), and those who reported having seriously considered suicide in the preceding 30 days (10.7%) (Table 1). At least one adverse mental or behavioral health symptom was reported by more than one half of respondents who were aged 18–24 years (74.9%) and 25–44 years (51.9%), of Hispanic ethnicity (52.1%), and who held less than a high school diploma (66.2%), as well as those who were essential workers (54.0%), unpaid caregivers for adults (66.6%), and who reported treatment for diagnosed anxiety (72.7%), depression (68.8%), or PTSD (88.0%) at the time of the survey. TABLE 1 Respondent characteristics and prevalence of adverse mental health outcomes, increased substance use to cope with stress or emotions related to COVID-19 pandemic, and suicidal ideation — United States, June 24–30, 2020 Characteristic All respondents who completed surveys during June 24–30, 2020 weighted* no. (%) Weighted %* Conditions Started or increased substance use to cope with pandemic-related stress or emotions¶ Seriously considered suicide in past 30 days ≥1 adverse mental or behavioral health symptom Anxiety disorder† Depressive disorder† Anxiety or depressive disorder† COVID-19–related TSRD§ All respondents 5,470 (100) 25.5 24.3 30.9 26.3 13.3 10.7 40.9 Gender Female 2,784 (50.9) 26.3 23.9 31.5 24.7 12.2 8.9 41.4 Male 2,676 (48.9) 24.7 24.8 30.4 27.9 14.4 12.6 40.5 Other 10 (0.2) 20.0 30.0 30.0 30.0 10.0 0.0 30.0 Age group (yrs) 18–24 731 (13.4) 49.1 52.3 62.9 46.0 24.7 25.5 74.9 25–44 1,911 (34.9) 35.3 32.5 40.4 36.0 19.5 16.0 51.9 45–64 1,895 (34.6) 16.1 14.4 20.3 17.2 7.7 3.8 29.5 ≥65 933 (17.1) 6.2 5.8 8.1 9.2 3.0 2.0 15.1 Race/Ethnicity White, non-Hispanic 3,453 (63.1) 24.0 22.9 29.2 23.3 10.6 7.9 37.8 Black, non-Hispanic 663 (12.1) 23.4 24.6 30.2 30.4 18.4 15.1 44.2 Asian, non-Hispanic 256 (4.7) 14.1 14.2 18.0 22.1 6.7 6.6 31.9 Other race or multiple races, non-Hispanic** 164 (3.0) 27.8 29.3 33.2 28.3 11.0 9.8 43.8 Hispanic, any race(s) 885 (16.2) 35.5 31.3 40.8 35.1 21.9 18.6 52.1 Unknown 50 (0.9) 38.0 34.0 44.0 34.0 18.0 26.0 48.0 2019 Household income (USD) <25,000 741 (13.6) 30.6 30.8 36.6 29.9 12.5 9.9 45.4 25,000–49,999 1,123 (20.5) 26.0 25.6 33.2 27.2 13.5 10.1 43.9 50,999–99,999 1,775 (32.5) 27.1 24.8 31.6 26.4 12.6 11.4 40.3 100,999–199,999 1,301 (23.8) 23.1 20.8 27.7 24.2 15.5 11.7 37.8 ≥200,000 282 (5.2) 17.4 17.0 20.6 23.1 14.8 11.6 35.1 Unknown 247 (4.5) 19.6 23.1 27.2 24.9 6.2 3.9 41.5 Education Less than high school diploma 78 (1.4) 44.5 51.4 57.5 44.5 22.1 30.0 66.2 High school diploma 943 (17.2) 31.5 32.8 38.4 32.1 15.3 13.1 48.0 Some college 1,455 (26.6) 25.2 23.4 31.7 22.8 10.9 8.6 39.9 Bachelor's degree 1,888 (34.5) 24.7 22.5 28.7 26.4 14.2 10.7 40.6 Professional degree 1,074 (19.6) 20.9 19.5 25.4 24.5 12.6 10.0 35.2 Unknown 33 (0.6) 25.2 23.2 28.2 23.2 10.5 5.5 28.2 Employment status†† Employed 3,431 (62.7) 30.1 29.1 36.4 32.1 17.9 15.0 47.8 Essential 1,785 (32.6) 35.5 33.6 42.4 38.5 24.7 21.7 54.0 Nonessential 1,646 (30.1) 24.1 24.1 29.9 25.2 10.5 7.8 41.0 Unemployed 761 (13.9) 32.0 29.4 37.8 25.0 7.7 4.7 45.9 Retired 1,278 (23.4) 9.6 8.7 12.1 11.3 4.2 2.5 19.6 Unpaid adult caregiver status§§ Yes 1,435 (26.2) 47.6 45.2 56.1 48.4 32.9 30.7 66.6 No 4,035 (73.8) 17.7 16.9 22.0 18.4 6.3 3.6 31.8 Region ¶¶ Northeast 1,193 (21.8) 23.9 23.9 29.9 22.8 12.8 10.2 37.1 Midwest 1,015 (18.6) 22.7 21.1 27.5 24.4 9.0 7.5 36.1 South 1,921 (35.1) 27.9 26.5 33.4 29.1 15.4 12.5 44.4 West 1,340 (24.5) 25.8 24.2 30.9 26.7 14.0 10.9 43.0 Rural-urban classification*** Rural 599 (10.9) 26.0 22.5 29.3 25.4 11.5 10.2 38.3 Urban 4,871 (89.1) 25.5 24.6 31.1 26.4 13.5 10.7 41.2 Know someone who had positive test results for SARS-CoV-2 Yes 1,109 (20.3) 23.8 21.9 29.6 21.5 12.9 7.5 39.2 No 4,361 (79.7) 26.0 25.0 31.3 27.5 13.4 11.5 41.3 Knew someone who died from COVID-19 Yes 428 (7.8) 25.8 20.6 30.6 28.1 11.3 7.6 40.1 No 5,042 (92.2) 25.5 24.7 31.0. 26.1 13.4 10.9 41.0 Receiving treatment for previously diagnosed condition Anxiety Yes 536 (9.8) 59.6 52.0 66.0 51.9 26.6 23.6 72.7 No 4,934 (90.2) 21.8 21.3 27.1 23.5 11.8 9.3 37.5 Depression Yes 540 (9.9) 52.5 50.6 60.8 45.5 25.2 22.1 68.8 No 4,930 (90.1) 22.6 21.5 27.7 24.2 12.0 9.4 37.9 Posttraumatic stress disorder Yes 251 (4.6) 72.3 69.1 78.7 69.4 43.8 44.8 88.0 No 5,219 (95.4) 23.3 22.2 28.6 24.2 11.8 9.0 38.7 Abbreviations: COVID-19 = coronavirus disease 2019; TSRD = trauma- and stressor-related disorder. * Survey weighting was employed to improve the cross-sectional June cohort representativeness of the U.S. population by gender, age, and race/ethnicity according to the 2010 U.S. Census with respondents in which gender, age, and race/ethnicity were reported. Respondents who reported a gender of “Other” or who did not report race/ethnicity were assigned a weight of one. † Symptoms of anxiety disorder and depressive disorder were assessed via the four-item Patient Health Questionnaire (PHQ-4). Those who scored ≥3 out of 6 on the Generalized Anxiety Disorder (GAD-2) and Patient Health Questionnaire (PHQ-2) subscales were considered symptomatic for each disorder, respectively. § Disorders classified as TSRDs in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) include posttraumatic stress disorder (PTSD), acute stress disorder (ASD), and adjustment disorders (ADs), among others. Symptoms of a TSRD precipitated by the COVID-19 pandemic were assessed via the six-item Impact of Event Scale (IES-6) to screen for overlapping symptoms of PTSD, ASD, and ADs. For this survey, the COVID-19 pandemic was specified as the traumatic exposure to record peri- and posttraumatic symptoms associated with the range of stressors introduced by the COVID-19 pandemic. Those who scored ≥1.75 out of 4 were considered symptomatic. ¶ 104 respondents selected “Prefer not to answer.” ** The Other race or multiple races, non-Hispanic category includes respondents who identified as not being Hispanic and as more than one race or as American Indian or Alaska Native, Native Hawaiian or Pacific Islander, or “Other.” †† Essential worker status was self-reported. The comparison was between employed respondents (n = 3,431) who identified as essential vs. nonessential. For this analysis, students who were not separately employed as essential workers were considered nonessential workers. §§ Unpaid adult caregiver status was self-reported. The definition of an unpaid caregiver for adults was a person who had provided unpaid care to a relative or friend aged ≥18 years to help them take care of themselves at any time in the last 3 months. Examples provided included helping with personal needs, household chores, health care tasks, managing a person’s finances, taking them to a doctor’s appointment, arranging for outside services, and visiting regularly to see how they are doing. ¶¶ Region classification was determined by using the U.S. Census Bureau’s Census Regions and Divisions of the United States. https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf. *** Rural-urban classification was determined by using self-reported ZIP codes according to the Federal Office of Rural Health Policy definition of rurality. https://www.hrsa.gov/rural-health/about-us/definition/datafiles.html. Prevalences of symptoms of adverse mental or behavioral health conditions varied significantly among subgroups (Table 2). Suicidal ideation was more prevalent among males than among females. Symptoms of anxiety disorder or depressive disorder, COVID-19–related TSRD, initiation of or increase in substance use to cope with COVID-19–associated stress, and serious suicidal ideation in the previous 30 days were most commonly reported by persons aged 18–24 years; prevalence decreased progressively with age. Hispanic respondents reported higher prevalences of symptoms of anxiety disorder or depressive disorder, COVID-19–related TSRD, increased substance use, and suicidal ideation than did non-Hispanic whites (whites) or non-Hispanic Asian (Asian) respondents. Black respondents reported increased substance use and past 30-day serious consideration of suicide in the previous 30 days more commonly than did white and Asian respondents. Respondents who reported treatment for diagnosed anxiety, depression, or PTSD at the time of the survey reported higher prevalences of symptoms of adverse mental and behavioral health conditions compared with those who did not. Symptoms of a COVID-19–related TSRD, increased substance use, and suicidal ideation were more prevalent among employed than unemployed respondents, and among essential workers than nonessential workers. Adverse conditions also were more prevalent among unpaid caregivers for adults than among those who were not, with particularly large differences in increased substance use (32.9% versus 6.3%) and suicidal ideation (30.7% versus 3.6%) in this group. TABLE 2 Comparison of symptoms of adverse mental health outcomes among all respondents who completed surveys (N = 5,470), by respondent characteristic* — United States, June 24–30, 2020 Characteristic Prevalence ratio ¶ (95% CI¶) Symptoms of anxiety disorder or depressive disorder † Symptoms of a TSRD related to COVID-19 § Started or increased substance use to cope with stress or emotions related to COVID-19 Serious consideration of suicide in past 30 days Gender Female vs. male 1.04 (0.96–1.12) 0.88 (0.81–0.97) 0.85 (0.75–0.98) 0.70 (0.60–0.82)** Age group (yrs) 18–24 vs. 25–44 1.56 (1.44–1.68)** 1.28 (1.16–1.41)** 1.31 (1.12–1.53)** 1.59 (1.35–1.87)** 18–24 vs. 45–64 3.10 (2.79–3.44)** 2.67 (2.35–3.03)** 3.35 (2.75–4.10)** 6.66 (5.15–8.61)** 18–24 vs. ≥65 7.73 (6.19–9.66)** 5.01 (4.04–6.22)** 8.77 (5.95–12.93)** 12.51 (7.88–19.86)** 25–44 vs. 45–64 1.99 (1.79–2.21)** 2.09 (1.86–2.35)** 2.56 (2.14–3.07)** 4.18 (3.26–5.36)** 25–44 vs. ≥65 4.96 (3.97–6.20)** 3.93 (3.18–4.85)** 6.70 (4.59–9.78)** 7.86 (4.98–12.41)** 45–64 vs. ≥65 2.49 (1.98–3.15)** 1.88 (1.50–2.35)** 2.62 (1.76–3.9)** 1.88 (1.14–3.10) Race/Ethnicity†† Hispanic vs. non-Hispanic black 1.35 (1.18–1.56)** 1.15 (1.00–1.33) 1.19 (0.97–1.46) 1.23 (0.98–1.55) Hispanic vs. non-Hispanic Asian 2.27 (1.73–2.98)** 1.59 (1.24–2.04)** 3.29 (2.05–5.28)** 2.82 (1.74–4.57)** Hispanic vs. non-Hispanic other race or multiple races 1.23 (0.98–1.55) 1.24 (0.96–1.61) 1.99 (1.27–3.13)** 1.89 (1.16–3.06) Hispanic vs. non-Hispanic white 1.40 (1.27–1.54)** 1.50 (1.35–1.68)** 2.09 (1.79–2.45)** 2.35 (1.96–2.80)** Non-Hispanic black vs. non-Hispanic Asian 1.68 (1.26–2.23)** 1.38 (1.07–1.78) 2.75 (1.70–4.47)** 2.29 (1.39–3.76)** Non-Hispanic black vs. non-Hispanic other race or multiple races 0.91 (0.71–1.16) 1.08 (0.82–1.41) 1.67 (1.05–2.65) 1.53 (0.93–2.52) Non-Hispanic black vs. non-Hispanic white 1.03 (0.91–1.17) 1.30 (1.14–1.48)** 1.75 (1.45–2.11)** 1.90 (1.54–2.36)** Non-Hispanic Asian vs. non-Hispanic other race or multiple races 0.54 (0.39–0.76)** 0.78 (0.56–1.09) 0.61 (0.32–1.14) 0.67 (0.35–1.29) Non-Hispanic Asian vs. non-Hispanic white 0.62 (0.47–0.80)** 0.95 (0.74–1.20) 0.64 (0.40–1.02) 0.83 (0.52–1.34) Non-Hispanic other race or multiple races vs. non-Hispanic white 1.14 (0.91–1.42) 1.21 (0.94–1.56) 1.05 (0.67–1.64) 1.24 (0.77–2) Employment status Employed vs. unemployed 0.96 (0.87–1.07) 1.28 (1.12–1.46)** 2.30 (1.78–2.98)** 3.21 (2.31–4.47)** Employed vs. retired 3.01 (2.58–3.51)** 2.84 (2.42–3.34)** 4.30 (3.28–5.63)** 5.97 (4.20–8.47)** Unemployed vs. retired 3.12 (2.63–3.71)** 2.21 (1.82–2.69)** 1.87 (1.30–2.67)** 1.86 (1.16–2.96) Essential vs. nonessential worker§§ 1.42 (1.30–1.56)** 1.52 (1.38–1.69)** 2.36 (2.00–2.77)** 2.76 (2.29–3.33)** Unpaid caregiver for adults vs. not¶¶` 2.55 (2.37–2.75)** 2.63 (2.42–2.86)** 5.28 (4.59–6.07)** 8.64 (7.23–10.33)** Rural vs. urban residence*** 0.94 (0.82–1.07) 0.96 (0.83–1.11) 0.84 (0.67–1.06) 0.95 (0.74–1.22) Knows someone with positive SARS-CoV-2 test result vs. not 0.95 (0.86–1.05) 0.78 (0.69–0.88)** 0.96 (0.81–1.14) 0.65 (0.52–0.81)** Knew someone who died from COVID-19 vs. not 0.99 (0.85–1.15) 1.08 (0.92–1.26) 0.84 (0.64–1.11) 0.69 (0.49–0.97) Receiving treatment for anxiety vs. not 2.43 (2.26–2.63)** 2.21 (2.01–2.43)** 2.27 (1.94–2.66)** 2.54 (2.13–3.03)** Receiving treatment for depression vs. not 2.20 (2.03–2.39)** 1.88 (1.70–2.09)** 2.13 (1.81–2.51)** 2.35 (1.96–2.82)** Receiving treatment for PTSD vs. not 2.75 (2.55–2.97)** 2.87 (2.61–3.16)** 3.78 (3.23–4.42)** 4.95 (4.21–5.83)** Abbreviations: CI = confidence interval; COVID-19 = coronavirus disease 2019; PTSD = posttraumatic stress disorder; TSRD = trauma- and stressor-related disorder. * Number of respondents for characteristics: gender (female = 2,784, male = 2,676), age group in years (18–24 = 731; 25–44 = 1,911; 45–64 = 1,895; ≥65 = 933), race/ethnicity (non-Hispanic white = 3453, non-Hispanic black = 663, non-Hispanic Asian = 256, non-Hispanic other race or multiple races = 164, Hispanic = 885). † Symptoms of anxiety disorder and depressive disorder were assessed via the four-item Patient Health Questionnaire (PHQ-4). Those who scored ≥3 out of 6 on the Generalized Anxiety Disorder (GAD-2) and Patient Health Questionnaire (PHQ-2) subscales were considered to have symptoms of these disorders. § Disorders classified as TSRDs in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) include PTSD, acute stress disorder (ASD), and adjustment disorders (ADs), among others. Symptoms of a TSRD precipitated by the COVID-19 pandemic were assessed via the six-item Impact of Event Scale (IES-6) to screen for overlapping symptoms of PTSD, ASD, and ADs. For this survey, the COVID-19 pandemic was specified as the traumatic exposure to record peri- and posttraumatic symptoms associated with the range of stressors introduced by the COVID-19 pandemic. Persons who scored ≥1.75 out of 4 were considered to be symptomatic. ¶ Comparisons within subgroups were evaluated on weighted responses via Poisson regressions used to calculate a prevalence ratio, 95% CI, and p-value (not shown). Statistical significance was evaluated at a threshold of α = 0.005 to account for multiple comparisons. In the calculation of prevalence ratios for started or increased substance use, respondents who selected “Prefer not to answer” (n = 104) were excluded. ** P-value is statistically significant (p<0.005). †† Respondents identified as a single race unless otherwise specified. The non-Hispanic, other race or multiple races category includes respondents who identified as not Hispanic and as more than one race or as American Indian or Alaska Native, Native Hawaiian or Pacific Islander, or ‘Other’. §§ Essential worker status was self-reported. The comparison was between employed respondents (n = 3,431) who identified as essential vs. nonessential. For this analysis, students who were not separately employed as essential workers were considered nonessential workers. ¶¶ Unpaid adult caregiver status was self-reported. The definition of an unpaid caregiver for adults was having provided unpaid care to a relative or friend aged ≥18 years to help them take care of themselves at any time in the last 3 months. Examples provided included helping with personal needs, household chores, health care tasks, managing a person’s finances, taking them to a doctor’s appointment, arranging for outside services, and visiting regularly to see how they are doing. *** Rural-urban classification was determined by using self-reported ZIP codes according to the Federal Office of Rural Health Policy definition of rurality. https://www.hrsa.gov/rural-health/about-us/definition/datafiles.html. Longitudinal analysis of responses of 1,497 persons who completed all three surveys revealed that unpaid caregivers for adults had a significantly higher odds of incidence of adverse mental health conditions compared with others (Table 3). Among those who did not report having started or increased substance use to cope with stress or emotions related to COVID-19 in May, unpaid caregivers for adults had 3.33 times the odds of reporting this behavior in June (adjusted OR 95% CI = 1.75–6.31; p<0.001). Similarly, among those who did not report having seriously considered suicide in the previous 30 days in May, unpaid caregivers for adults had 3.03 times the odds of reporting suicidal ideation in June (adjusted OR 95% CI = 1.20–7.63; p = 0.019). TABLE 3 Odds of incidence* of symptoms of adverse mental health, substance use to cope with stress or emotions related to COVID–19 pandemic, and suicidal ideation in the third survey wave, by essential worker status and unpaid adult caregiver status among respondents who completed monthly surveys from April through June (N = 1,497) — United States, April 2–8, May 5–12, and June 24–30, 2020 Symptom or behavior Essential worker† vs. all other employment statuses (nonessential worker, unemployed, retired) Unpaid caregiver for adults§ vs. not unpaid caregiver Unadjusted Adjusted¶ Unadjusted Adjusted** OR (95% CI)†† p-value†† OR (95% CI)†† p-value†† OR (95% CI)†† p-value†† OR (95% CI)†† p-value†† Symptoms of anxiety disorder§§ 1.92 (1.29–2.87) 0.001 1.63 (0.99–2.69) 0.056 1.97 (1.25–3.11) 0.004 1.81 (1.14–2.87) 0.012 Symptoms of depressive disorder§§ 1.49 (1.00–2.22) 0.052 1.13 (0.70–1.82) 0.606 2.29 (1.50–3.50) <0.001 2.22 (1.45–3.41) <0.001 Symptoms of anxiety disorder or depressive disorder§§ 1.67 (1.14–2.46) 0.008 1.26 (0.79–2.00) 0.326 1.84 (1.19–2.85) 0.006 1.73 (1.11–2.70) 0.015 Symptoms of a TSRD related to COVID–19¶¶ 1.55 (0.86–2.81) 0.146 1.27 (0.63–2.56) 0.512 1.88 (0.99–3.56) 0.054 1.79 (0.94–3.42) 0.076 Started or increased substance use to cope with stress or emotions related to COVID–19 2.36 (1.26–4.42) 0.007 2.04 (0.92–4.48) 0.078 3.51 (1.86–6.61) <0.001 3.33 (1.75–6.31) <0.001 Serious consideration of suicide in previous 30 days 0.93 (0.31–2.78) 0.895 0.53 (0.16–1.70) 0.285 3.00 (1.20–7.52) 0.019 3.03 (1.20–7.63) 0.019 Abbreviations: CI = confidence interval, COVID–19 = coronavirus disease 2019, OR = odds ratio, TSRD = trauma– and stressor–related disorder. * For outcomes assessed via the four-item Patient Health Questionnaire (PHQ–4), odds of incidence were marked by the presence of symptoms during May 5–12 or June 24–30, 2020, after the absence of symptoms during April 2–8, 2020. Respondent pools for prospective analysis of odds of incidence (did not screen positive for symptoms during April 2–8): anxiety disorder (n = 1,236), depressive disorder (n = 1,301) and anxiety disorder or depressive disorder (n = 1,190). For symptoms of a TSRD precipitated by COVID–19, started or increased substance use to cope with stress or emotions related to COVID–19, and serious suicidal ideation in the previous 30 days, odds of incidence were marked by the presence of an outcome during June 24–30, 2020, after the absence of that outcome during May 5–12, 2020. Respondent pools for prospective analysis of odds of incidence (did not report symptoms or behavior during May 5–12): symptoms of a TSRD (n = 1,206), started or increased substance use (n = 1,408), and suicidal ideation (n = 1,456). † Essential worker status was self–reported. For Table 3, essential worker status was determined by identification as an essential worker during the June 24–30 survey. Essential workers were compared with all other respondents, not just employed respondents (i.e., essential workers vs. all other employment statuses (nonessential worker, unemployed, and retired), not essential vs. nonessential workers). § Unpaid adult caregiver status was self–reported. The definition of an unpaid caregiver for adults was having provided unpaid care to a relative or friend 18 years or older to help them take care of themselves at any time in the last 3 months. Examples provided included helping with personal needs, household chores, health care tasks, managing a person’s finances, taking them to a doctor’s appointment, arranging for outside services, and visiting regularly to see how they are doing. ¶ Adjusted for gender, employment status, and unpaid adult caregiver status. ** Adjusted for gender, employment status, and essential worker status. †† Respondents who completed surveys from all three waves (April, May, June) were eligible to be included in an unweighted longitudinal analysis. Comparisons within subgroups were evaluated via logit–linked Binomial regressions used to calculate unadjusted and adjusted odds ratios, 95% confidence intervals, and p–values. Statistical significance was evaluated at a threshold of α = 0.05. In the calculation of odds ratios for started or increased substance use, respondents who selected “Prefer not to answer” (n = 11) were excluded. §§ Symptoms of anxiety disorder and depressive disorder were assessed via the PHQ–4. Those who scored ≥3 out of 6 on the two–item Generalized Anxiety Disorder (GAD–2) and two-item Patient Health Questionnaire (PHQ–2) subscales were considered symptomatic for each disorder, respectively. ¶¶ Disorders classified as TSRDs in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) include posttraumatic stress disorder (PTSD), acute stress disorder (ASD), and adjustment disorders (ADs), among others. Symptoms of a TSRD precipitated by the COVID–19 pandemic were assessed via the six–item Impact of Event Scale (IES–6) to screen for overlapping symptoms of PTSD, ASD, and ADs. For this survey, the COVID–19 pandemic was specified as the traumatic exposure to record peri– and posttraumatic symptoms associated with the range of potential stressors introduced by the COVID–19 pandemic. Those who scored ≥1.75 out of 4 were considered symptomatic. Discussion Elevated levels of adverse mental health conditions, substance use, and suicidal ideation were reported by adults in the United States in June 2020. The prevalence of symptoms of anxiety disorder was approximately three times those reported in the second quarter of 2019 (25.5% versus 8.1%), and prevalence of depressive disorder was approximately four times that reported in the second quarter of 2019 (24.3% versus 6.5%) ( 2 ). However, given the methodological differences and potential unknown biases in survey designs, this analysis might not be directly comparable with data reported on anxiety and depression disorders in 2019 ( 2 ). Approximately one quarter of respondents reported symptoms of a TSRD related to the pandemic, and approximately one in 10 reported that they started or increased substance use because of COVID-19. Suicidal ideation was also elevated; approximately twice as many respondents reported serious consideration of suicide in the previous 30 days than did adults in the United States in 2018, referring to the previous 12 months (10.7% versus 4.3%) ( 6 ). Mental health conditions are disproportionately affecting specific populations, especially young adults, Hispanic persons, black persons, essential workers, unpaid caregivers for adults, and those receiving treatment for preexisting psychiatric conditions. Unpaid caregivers for adults, many of whom are currently providing critical aid to persons at increased risk for severe illness from COVID-19, had a higher incidence of adverse mental and behavioral health conditions compared with others. Although unpaid caregivers of children were not evaluated in this study, approximately 39% of unpaid caregivers for adults shared a household with children (compared with 27% of other respondents). Caregiver workload, especially in multigenerational caregivers, should be considered for future assessment of mental health, given the findings of this report and hardships potentially faced by caregivers. The findings in this report are subject to at least four limitations. First, a diagnostic evaluation for anxiety disorder or depressive disorder was not conducted; however, clinically validated screening instruments were used to assess symptoms. Second, the trauma- and stressor-related symptoms assessed were common to multiple TSRDs, precluding distinction among them; however, the findings highlight the importance of including COVID-19–specific trauma measures to gain insights into peri- and posttraumatic impacts of the COVID-19 pandemic ( 7 ). Third, substance use behavior was self-reported; therefore, responses might be subject to recall, response, and social desirability biases. Finally, given that the web-based survey might not be fully representative of the United States population, findings might have limited generalizability. However, standardized quality and data inclusion screening procedures, including algorithmic analysis of click-through behavior, removal of duplicate responses and scrubbing methods for web-based panel quality were applied. Further the prevalence of symptoms of anxiety disorder and depressive disorder were largely consistent with findings from the Household Pulse Survey during June ( 1 ). Markedly elevated prevalences of reported adverse mental and behavioral health conditions associated with the COVID-19 pandemic highlight the broad impact of the pandemic and the need to prevent and treat these conditions. Identification of populations at increased risk for psychological distress and unhealthy coping can inform policies to address health inequity, including increasing access to resources for clinical diagnoses and treatment options. Expanded use of telehealth, an effective means of delivering treatment for mental health conditions, including depression, substance use disorder, and suicidal ideation ( 8 ), might reduce COVID-19-related mental health consequences. Future studies should identify drivers of adverse mental and behavioral health during the COVID-19 pandemic and whether factors such as social isolation, absence of school structure, unemployment and other financial worries, and various forms of violence (e.g., physical, emotional, mental, or sexual abuse) serve as additional stressors. Community-level intervention and prevention efforts should include strengthening economic supports to reduce financial strain, addressing stress from experienced racial discrimination, promoting social connectedness, and supporting persons at risk for suicide ( 9 ). Communication strategies should focus on promotion of health services §§§§ , ¶¶¶¶ , ***** and culturally and linguistically tailored prevention messaging regarding practices to improve emotional well-being. Development and implementation of COVID-19–specific screening instruments for early identification of COVID-19–related TSRD symptoms would allow for early clinical interventions that might prevent progression from acute to chronic TSRDs. To reduce potential harms of increased substance use related to COVID-19, resources, including social support, comprehensive treatment options, and harm reduction services, are essential and should remain accessible. Periodic assessment of mental health, substance use, and suicidal ideation should evaluate the prevalence of psychological distress over time. Addressing mental health disparities and preparing support systems to mitigate mental health consequences as the pandemic evolves will continue to be needed urgently. Summary What is already known about this topic? Communities have faced mental health challenges related to COVID-19–associated morbidity, mortality, and mitigation activities. What is added by this report? During June 24–30, 2020, U.S. adults reported considerably elevated adverse mental health conditions associated with COVID-19. Younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers reported having experienced disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation. What are the implications for public health practice? The public health response to the COVID-19 pandemic should increase intervention and prevention efforts to address associated mental health conditions. Community-level efforts, including health communication strategies, should prioritize young adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers.
- Record: found
- Abstract: found
- Article: found
Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality
Jörg Fegert, Benedetto Vitiello, Paul L. Plener … (2020)
Background The coronavirus disease 2019 (COVID-19) is profoundly affecting life around the globe. Isolation, contact restrictions and economic shutdown impose a complete change to the psychosocial environment in affected countries. These measures have the potential to threaten the mental health of children and adolescents significantly. Even though the current crisis can bring with it opportunities for personal growth and family cohesion, disadvantages may outweigh these benefits. Anxiety, lack of peer contact and reduced opportunities for stress regulation are main concerns. Another main threat is an increased risk for parental mental illness, domestic violence and child maltreatment. Especially for children and adolescents with special needs or disadvantages, such as disabilities, trauma experiences, already existing mental health problems, migrant background and low socioeconomic status, this may be a particularly challenging time. To maintain regular and emergency child and adolescent psychiatric treatment during the pandemic is a major challenge but is necessary for limiting long-term consequences for the mental health of children and adolescents. Urgent research questions comprise understanding the mental health effects of social distancing and economic pressure, identifying risk and resilience factors, and preventing long-term consequences, including—but not restricted to—child maltreatment. The efficacy of telepsychiatry is another highly relevant issue is to evaluate the efficacy of telehealth and perfect its applications to child and adolescent psychiatry. Conclusion There are numerous mental health threats associated with the current pandemic and subsequent restrictions. Child and adolescent psychiatrists must ensure continuity of care during all phases of the pandemic. COVID-19-associated mental health risks will disproportionately hit children and adolescents who are already disadvantaged and marginalized. Research is needed to assess the implications of policies enacted to contain the pandemic on mental health of children and adolescents, and to estimate the risk/benefit ratio of measures such as home schooling, in order to be better prepared for future developments.
- Record: found
- Abstract: found
- Article: not found
COVID-19: towards controlling of a pandemic
Juliet Bedford, Delia Enria, Johan Giesecke … (2020)
During the past 3 weeks, new major epidemic foci of coronavirus disease 2019 (COVID-19), some without traceable origin, have been identified and are rapidly expanding in Europe, North America, Asia, and the Middle East, with the first confirmed cases being identified in African and Latin American countries. By March 16, 2020, the number of cases of COVID-19 outside China had increased drastically and the number of affected countries, states, or territories reporting infections to WHO was 143. 1 On the basis of ”alarming levels of spread and severity, and by the alarming levels of inaction”, on March 11, 2020, the Director-General of WHO characterised the COVID-19 situation as a pandemic. 2 The WHO Strategic and Technical Advisory Group for Infectious Hazards (STAG-IH) regularly reviews and updates its risk assessment of COVID-19 to make recommendations to the WHO health emergencies programme. STAG-IH's most recent formal meeting on March 12, 2020, included an update of the global COVID-19 situation and an overview of the research priorities established by the WHO Research and Development Blueprint Scientific Advisory Group that met on March 2, 2020, in Geneva, Switzerland, to prioritise the recommendations of an earlier meeting on COVID-19 research held in early February, 2020. 3 In this Comment, we outline STAG-IH's understanding of control activities with the group's risk assessment and recommendations. To respond to COVID-19, many countries are using a combination of containment and mitigation activities with the intention of delaying major surges of patients and levelling the demand for hospital beds, while protecting the most vulnerable from infection, including elderly people and those with comorbidities. Activities to accomplish these goals vary and are based on national risk assessments that many times include estimated numbers of patients requiring hospitalisation and availability of hospital beds and ventilation support. Most national response strategies include varying levels of contact tracing and self-isolation or quarantine; promotion of public health measures, including handwashing, respiratory etiquette, and social distancing; preparation of health systems for a surge of severely ill patients who require isolation, oxygen, and mechanical ventilation; strengthening health facility infection prevention and control, with special attention to nursing home facilities; and postponement or cancellation of large-scale public gatherings. Some lower-income and middle-income countries require technical and financial support to successfully respond to COVID-19, and many African, Asian, and Latin American nations are rapidly developing the capacity for PCR testing for COVID-19. Based on more than 500 genetic sequences submitted to GISAID (the Global Initiative on Sharing All Influenza Data), the virus has not drifted to significant strain difference and changes in sequence are minimal. There is no evidence to link sequence information with transmissibility or virulence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 1 the virus that causes COVID-19. SARS-CoV-2, like other emerging high-threat pathogens, has infected health-care workers in China4, 5 and several other countries. To date, however, in China, where infection prevention and control was taken seriously, nosocomial transmission has not been a major amplifier of transmission in this epidemic. Epidemiological records in China suggest that up to 85% of human-to-human transmission has occurred in family clusters 4 and that 2055 health-care workers have become infected, with an absence of major nosocomial outbreaks and some supporting evidence that some health-care workers acquired infection in their families.4, 5 These findings suggest that close and unprotected exposure is required for transmission by direct contact or by contact with fomites in the immediate environment of those with infection. Continuing reports from outside China suggest the same means of transmission to close contacts and persons who attended the same social events or were in circumscribed areas such as office spaces or cruise ships.6, 7 Intensified case finding and contact tracing are considered crucial by most countries and are being undertaken to attempt to locate cases and to stop onward transmission. Confirmation of infection at present consists of PCR for acute infection, and although many serological tests to identify antibodies are being developed they require validation with well characterised sera before they are reliable for general use. From studies of viral shedding in patients with mild and more severe infections, shedding seems to be greatest during the early phase of disease (Myoung-don Oh and Gabriel Leung, WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, China, personal communication).8, 9 The role, if any, of asymptomatic carriers in transmitting infection is not yet completely understood. 4 Presymptomatic infectiousness is a concern (Myoung-don Oh and Gabriel Leung, personal communication)8, 9 and many countries are now using 1–2 days of symptom onset as the start day for contact identification. A comprehensive report published by the Chinese Center for Disease Control and Prevention on the epidemiological characteristics of 72 314 patients with COVID-19 confirmed previous understanding that most known infections cause mild disease, with a case fatality ratio that ranged from 2·9% in Hubei province to 0·4% in the other Chinese provinces. 5 This report also suggested that elderly people, particularly those older than 80 years, and people with comorbidities, such as cardiac disease, respiratory disease, and diabetes, are at greatest risk of serious disease and death. The case definition used in China changed several times as COVID-19 progressed, making it difficult to completely characterise the natural history of infection, including the mortality ratio. 4 Information on mortality and contributing factors from outbreak sites in other countries varies greatly, and seems to be influenced by such factors as age of patients, associated comorbidities, availability of isolation facilities for acute care for patients who need respiratory support, and surge capacity of the health-care system. Individuals in care facilities for older people are at particular risk of serious disease as shown in the report of a series of deaths in an elderly care facility in the USA. 10 The pandemic of COVID-19 has clearly entered a new stage with rapid spread in countries outside China and all members of society must understand and practise measures for self-protection and for prevention of transmission of infection to others. STAG-IH makes the following recommendations. First, countries need to rapidly and robustly increase their preparedness, readiness, and response actions based on their national risk assessment and the four WHO transmission scenarios 11 for countries with no cases, first cases, first clusters, and community transmission and spread (4Cs). Second, all countries should consider a combination of response measures: case and contact finding; containment or other measures that aim to delay the onset of patient surges where feasible; and measures such as public awareness, promotion of personal protective hygiene, preparation of health systems for a surge of severely ill patients, stronger infection prevention and control in health facilities, nursing homes, and long-term care facilities, and postponement or cancellation of large-scale public gatherings. Third, countries with no or a few first cases of COVID-19 should consider active surveillance for timely case finding; isolate, test, and trace every contact in containment; practise social distancing; and ready their health-care systems and populations for spread of infection. Fourth, lower-income and middle-income countries that request support from WHO should be fully supported technically and financially. Financial support should be sought by countries and by WHO, including from the World Bank Pandemic Emergency Financing Facility and other mechanisms. 12 Finally, research gaps about COVID-19 should be addressed and are shown in the accompanying panel and include some identified by the global community and by the Research and Development Blueprint Scientific Advisory Group. Panel Research gaps that need to be addressed for the response to COVID-19 • Fill gaps in understanding of the natural history of infection to better define the period of infectiousness and transmissibility; more accurately estimate the reproductive number in various outbreak settings and improve understanding the role of asymptomatic infection. • Comparative analysis of different quarantine strategies and contexts for their effectiveness and social acceptability • Enhance and develop an ethical framework for outbreak response that includes better equity for access to interventions for all countries • Promote the development of point-of-care diagnostic tests • Determine the best ways to apply knowledge about infection prevention and control in health-care settings in resource-constrained countries (including identification of optimal personal protective equipment) and in the broader community, specifically to understand behaviour among different vulnerable groups • Support standardised, best evidence-based approach for clinical management and better outcomes and implement randomised, controlled trials for therapeutics and vaccines as promising agents emerge • Validation of existing serological tests, including those that have been developed by commercial entities, and establishment of biobanks and serum panels of well characterised COVID-19 sera to support such efforts • Complete work on animal models for vaccine and therapeutic research and development The STAG-IH emphasises the importance of the continued rapid sharing of data of public health importance in medical journals that provide rapid peer review and online publication without a paywall. It is sharing of information in this way, as well as technical collaboration among clinicians, epidemiologists, and virologists, that has provided the world with its current understanding of COVID-19.
Author and article information
Contributors
Liang Zhou: liangzhou_csu@vip.163.com
Journal
Journal ID (nlm-ta): BMC Psychiatry
Journal ID (iso-abbrev): BMC Psychiatry
Title:
BMC Psychiatry
Publisher:
BioMed Central
(London
)
ISSN
(Electronic):
1471-244X
Publication date
(Electronic):
19
July
2023
Publication date PMC-release: 19
July
2023
Publication date Collection: 2023
Volume: 23
Electronic Location Identifier: 521
Affiliations
[1
]GRID grid.410737.6, ISNI 0000 0000 8653 1072, Department of Social Psychiatry, , the Affiliated Brain Hospital of Guangzhou Medical University, ; 36 Mingxin Road, Fangcun, Liwan District, Guangzhou, 510370 China
Article
Publisher ID: 5025DOI: 10.1186/s12888-023-05025-y
PMC ID: 10357784
PubMed ID: 37468833
SO-VID: 60454b16-4000-4194-a225-0d5fed4be394
Copyright © © The Author(s) 2023
License:
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
History
Date
received
: 22
March
2023
Date
accepted
: 13
July
2023
Funding
Funded by: the National Natural Science Foundation of China
Award ID: 82101575
Funded by: Science and Technology Program of Guangzhou
Award ID: 202102020702
Categories
Subject:
Research
Custom metadata
issue-copyright-statement © BioMed Central Ltd., part of Springer Nature 2023
ScienceOpen disciplines: Clinical Psychology & Psychiatry
Data availability:
ScienceOpen disciplines: Clinical Psychology & Psychiatry
Keywords: psychotic-like experiences, suicide, resilience, social support, students, young adults, fear