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      Findings from an online survey on the mental health effects of COVID-19 on Canadians with disabilities and chronic health conditions

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          Abstract

          Background

          Although the COVID-19 pandemic has led to worsening mental health outcomes throughout the Canadian population, its effects have been more acute among already marginalized groups, including people with disabilities and chronic health conditions. This paper examines how heightened fears of contracting the virus, financial impacts, and social isolation contribute to declining mental health among this already vulnerable group.

          Objective/hypothesis

          This paper investigates how increases in anxiety, stress, and despair are associated with concerns about getting infected, COVID-19-induced financial hardship, and increased social isolation as a result of adhering to protective measures among people with disabilities and chronic health conditions.

          Methods

          This study uses original national quota-based online survey data (n = 1027) collected in June 2020 from people with disabilities and chronic health conditions. Three logistic regression models investigate the relationship between COVID-19’s effects on finances, concerns about contracting the virus, changes in loneliness and belonging, and measures taken to combat the spread of COVID-19 and reports of increased anxiety, stress, and despair, net of covariates.

          Results

          Models show that increased anxiety, stress, and despair were associated with negative financial effects of COVID-19, greater concerns about contracting COVID-19, increased loneliness, and decreased feelings of belonging. Net of other covariates, increased measures taken to combat COVID-19 was not significantly associated with mental health outcomes.

          Conclusions

          Findings address how the global health crisis is contributing to declining mental health status through heightened concerns over contracting the virus, increases in economic insecurity, and growing social isolation, speaking to how health pandemics exacerbate health inequalities.

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          Most cited references23

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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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            Selection Bias in Web Surveys

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              The COVID-19 response must be disability inclusive

              There are more than 1 billion people living with disabilities (PLWD) worldwide. The coronavirus disease 2019 (COVID-19) pandemic is likely to disproportionately affect these individuals, putting them at risk of increased morbidity and mortality, underscoring the urgent need to improve provision of health care for this group and maintain the global health commitment to achieving Universal Health Coverage (UHC). 1 PLWD, including physical, mental, intellectual, or sensory disabilities, are less likely to access health services, and more likely to experience greater health needs, worse outcomes, and discriminatory laws and stigma. 2 COVID-19 threatens to exacerbate these disparities, particularly in low-income and middle-income countries, where 80% of PLWD reside, and capacity to respond to COVID-19 is limited.3, 4 Preparedness and response planning must be inclusive of and accessible to PLWD, recognising and addressing three key barriers. First, PLWD might have inequities in access to public health messaging. All communication should be disseminated in plain language and across accessible formats, through mass and digital media channels. Additionally, strategies for vital in-person communication must be safe and accessible, such as sign language interpreters and wearing of transparent masks by health-care providers to allow lip reading. Second, measures such as physical distancing or self-isolation might disrupt service provision for PLWD, who often rely on assistance for delivery of food, medication, and personal care. Mitigation strategies should not lead to the segregation or institutionalisation of these individuals. Instead, protective measures should be prioritised for these communities, so care workers and family members can continue to safely support PLWD, who should also be enabled to meet their daily living, health care, and transport needs, and maintain their employment and educational commitments. Third, PLWD might be at increased risk of severe acute respiratory syndrome coronavirus 2 infection or severe disease because of existing comorbidities, and might face additional barriers to health care during the pandemic. 2 Health-care staff should be provided with rapid awareness training on the rights and diverse needs of this group to maintain their dignity, safeguard against discrimination, and prevent inequities in care provision. COVID-19 mitigation strategies must be inclusive of PLWD to ensure they maintain respect for “dignity, human rights and fundamental freedoms,” 5 and avoid widening existing disparities. This necessitates accelerating efforts to include these groups in preparedness and response planning, and requires diligence, creativity, and innovative thinking, to preserve our commitment to UHC, and ensure people living with disabilities are not forgotten.
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                Author and article information

                Journal
                Disabil Health J
                Disabil Health J
                Disability and Health Journal
                Elsevier Inc.
                1936-6574
                1876-7583
                24 February 2021
                July 2021
                24 February 2021
                : 14
                : 3
                : 101085
                Affiliations
                [a ]Department of Sociology and Munk School of Global Affairs and Public Policy, University of Toronto, 725 Spadina Avenue, Toronto, Ontario, M5S 2J4, Canada
                [b ]University of Alberta, 5-21 HM Tory Building, University of Alberta, Edmonton, Alberta, T6G 2H4, Canada
                [c ]University of Toronto, 725 Spadina Avenue, Toronto, Ontario, M5S 2J4, Canada
                Author notes
                []Corresponding author.
                Article
                S1936-6574(21)00031-5 101085
                10.1016/j.dhjo.2021.101085
                9760304
                33744158
                92fffdef-473b-4b61-807a-0a3bfb7c4192
                © 2021 Elsevier Inc. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 10 December 2020
                : 15 February 2021
                : 18 February 2021
                Categories
                Original Article

                covid-19,disability,mental health,economic security,anxiety
                covid-19, disability, mental health, economic security, anxiety

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