Search

This paper is the second of two in a series. In our first paper, we presented a social justice framework emerging from an extensive literature review and incorporating core social determinants specific to mental health in the age of COVID-19 and illustrated specific social determinants impacting mental health (SDIMH) of our resettled Bhutanese refugee population during the pandemic. This second paper details specific barriers to the SDIMH detrimental to the basic human rights and social justice of this population during this pandemic. The SDIMH, as described, further informs the need for social justice measures and cultural humility in mental healthcare, public health, law, and community engagement. This work concludes with a proposed call to action toward mental health improvement and fair treatment for refugee populations in three core areas: communication and education, social stigma and discrimination, and accessibility and availability of resources.

Objectives This study evaluates the effectiveness of a mindfulness-based intervention (MBI), called Koru mindfulness, among college students. Methods Undergraduate students (N = 34) participated in a 4-week mindfulness curriculum embedded within a college course, while a control group (N = 35) taking a different course did not. Notably, the intervention coincided with the start of a state-wide lockdown due to the COVID-19 pandemic. Results Despite the additional external stress, there was a significant main effect and a significant interaction between the intervention and time for state mindfulness, (the treatment group experienced increased state mindfulness). There was a significant main effect (higher for the control group) on coronavirus worry and a significant interaction between the intervention and time for perceived stress, with the treatment/control group experiencing decreased/increased stress over time. There was also a significant interaction between the intervention and time for sleep problems with the intervention group experiencing declines in sleep problems over time and also being more likely to experience optimal amounts of sleep over time. Conclusions The Koru intervention effectively increased state mindfulness, decreased stress, and improved sleep, suggesting that it is robust even under extremely stressful conditions. This study adds to the growing evidence that MBIs can play an important role in addressing rising concerns regarding the mental health of college students.

For medical students first entering the clinical space in July 2020, the unique challenges related to the coronavirus pandemic threatened to amplify the psychological distress associated with clerkship rotations. This study aimed to characterize the mental health of third-year medical students starting clinical clerkships in the midst of a pandemic by assessing symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) as well as risk, coping, and protective factors associated with psychological outcomes. Of 147 third-year medical students at the Icahn School of Medicine at Mount Sinai in New York City, 110 (75%) participated in this prospective survey-based study with 108 included in the final analysis. 43 (39.8%) respondents screened positive for symptoms of either MDD, GAD, or PTSD. Multiple regression analyses revealed that greater overall symptom severity was associated with more avoidant coping, more traumatic events witnessed, poorer student and leisure functioning, lower trait emotional stability, and lower social support. Worries related to COVID-19 did not significantly influence outcome variables. To better understand the role of the pandemic on psychological outcomes in third-year medical students, additional research should focus on the trajectory of these outcomes over the year during the coronavirus pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s11126-021-09955-2.

Asian Americans have experienced compounding stressors during the pandemic as a result of racial discrimination. We aim of to investigate the prevalence of depression symptoms among Asian Americans before and during the COVID-19 pandemic and examine differences based on socio-demographic factors. Data are from a cross-sectional study (N = 636) among Chinese and South Asian adults in Chicago collected between February and May 2020. One cohort of participants were surveyed from each ethnic group before the pandemic and a second cohort of participants were surveyed during the pandemic. Depression symptoms increased more than two-fold, from 9% pre-pandemic to 21% during the COVID-19 pandemic. We found an increase in depression symptoms during the pandemic for South Asians, men and adults older than 30 years. These findings call for public health education that effectively addresses anti-Asian harassment and violence and ensure that culturally competent mental health services are provided to Asian Americans from diverse ethnic backgrounds.

Objectives At the end of 2019, an acute infectious pneumonia (coronavirus disease 2019 [COVID-19]) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in Wuhan, China, and subsequently spread around the world starting a pandemic. Globally, to date, there have been >118 million confirmed cases, including >2 million deaths. In this context, it has been shown that the psychological impact of the pandemic is important and that it can be associated with an increase in internet searches related to fear, anxiety, depression, as well as protective behaviours, health knowledge and even maladaptive behaviours. Study design This is a systematic review. Methods This review aims to collect, analyse and synthesise available evidence on novel data streams for surveillance purposes and/or their potential for capturing the public reaction to epidemic outbreaks, particularly focusing on mental health effects and emotions. Results At the end of the screening process, 19 articles were included in this systematic review. Our results show that the COVID-19 pandemic had a great impact on internet searches for mental health of entire populations, which manifests itself in a significant increase of depressed, anxious and stressed internet users’ emotions. Conclusions Novel data streams can support public health experts and policymakers in establishing priorities and setting up long-term strategies to mitigate symptoms and tackle mental health disorders., Graphical abstract Image 1

Coronavirus disease 2019 (COVID-19) is a public health emergency affecting the lives of millions of people globally. Different measures and extraordinary steps are being taken to contain the transmission of the virus. The levels of knowledge and implementation of preventive practices related to COVID-19 in sub-Saharan African countries are unclear. Additionally, there is a lack of evidence regarding the impacts of the pandemic on mental health. This study aimed to describe knowledge and practices related to COVID-19 and to assess mental health status among adults in three sub-Saharan African countries: Burkina Faso, Ethiopia, and Nigeria. A total of 1,797 adults were included in the survey, and data were collected using computer-assisted telephone interviews. The proportions of adults who identified more than 80% of COVID-19 symptoms, transmission methods, and prevention mechanisms were 69.9%, 79.2%, and 90.7%, respectively. The practice of preventive measures was relatively lower for avoiding social gatherings and disinfecting contaminated surfaces. Better education, urban residence, and believing the pandemic is real were factors associated with good knowledge on COVID-19 symptoms, transmission methods, and preventive actions. Additionally, being male was associated with good knowledge on symptoms and transmission methods, whereas being in an older age group was associated with knowledge of transmission methods. Mild, moderate, and severe psychological distress was reported by 20.6%, 5.9%, and 1.1% of the participants, respectively. Although this study found high levels of knowledge regarding COVID-19, interventions are needed to increase the uptake of recommended preventive practices among adults in sub-Saharan Africa.

Approximately 80% of Americans identify as religious. As physicians caring for patients with COVID-19, we have seen both positive and negative effects of religious activity during the pandemic. Religious worship generally supports close social interaction, which provides many benefits, especially in mental health, but it can also contradict infection control measures. These forces do not necessarily have to be in opposition to each other. Herein, we present three case vignettes of religious patients who were infected with and recovered from COVID-19. We review the potential benefits and risks of religious activity in the current pandemic, as supported by the medical literature. Finally, we offer some thoughts on how to engage with patients so that the benefits of both religious activity and public health measures are optimized.

Mental health impacts of the COVID-19 pandemic for people living with HIV are poorly understood, especially in low-income settings. We conducted qualitative semi-structured in-depth interviews among people living with HIV (n = 16) and health workers (n = 10) in rural Rakai, southcentral Uganda. Data were analyzed thematically. We found mental stress during COVID-19 was compounded by worry about antiretroviral therapy (ART) access, distress over inadvertent disclosure of HIV status, fear that coronavirus infection would have more severe outcomes for immunocompromised individuals, and exacerbated poverty and economic stress. Mental health support for people living with HIV deserves greater attention during the COVID-19 pandemic and beyond.

Caregivers of a child with a neurodevelopmental disability are more vulnerable to mental health difficulties. These difficulties are influenced by the child’s challenging behaviours, and the caregiver’s coping strategies; factors impacted by the COVID-19 pandemic. An online mixed methods survey was conducted on caregivers of children with neurodevelopmental disabilities (n = 43) and children who are typically developing (n = 67). The results showed that presence of challenging behaviours related to neurodevelopmental disability, and caregiver coping strategies predicted caregiver psychological distress during lockdown. Themes that emerged included ‘confusing messages and guidance’, ‘loss of freedom’ and ‘unsupported and forgotten’. The results demonstrate the pressing need for the implementation of appropriate support to protect the mental health of caregivers across the UK.

The current study aimed to investigate the impact of the COVID-19 pandemic on the mental health of people with OCD and the degree of family accommodation (FA) by live-in family members across phases of the lockdown measures imposed by the Belgian government. Forty-nine OCD patients and 26 live-in family members participated in the study. We assessed OCD symptom severity and FA of the live-in family members, as well as depressive symptoms, anxiety and stress levels and COVID-19 related psychological distress of patients and family members at four different timepoints: one month after the start of the lockdown (T1), during the gradual relaxation (T2), between the two waves (T3) and during the second wave (T4). Results showed that although COVID-19 related stress increased and decreased in accordance with the waxing and waning pattern of the pandemic, OCD symptoms showed an initial slight increase followed by a decrease at T3 and again at T4. Changes in family members’ accommodation of symptoms followed the same course as the OCD symptoms. Furthermore, OCD symptoms correlated with depressive symptoms, anxiety and stress levels and COVID-19 related distress at all timepoints. It is important to involve family members in the treatment of OCD even during a pandemic. Clinicians should also pay attention to symptoms of depression, anxiety and stress during OCD treatment. Further research is necessary to entangle the causal relationship between OCD symptoms, FA and symptoms of depression, anxiety and stress.

Highlights • Google search data are increasingly used to assess trends in population mental health • Few studies have assessed the validity of this approach • Search trends did not follow changes in measured mental health during the COVID-19 pandemic • Google searches and self-reported loneliness were associated, Background Google Trends data are increasingly used by researchers as an indicator of population mental health, but few studies have investigated the validity of this approach during a public health emergency. Methods Relative search volumes (RSV) for the topics depression, anxiety, self-harm, suicide, suicidal ideation, loneliness, and abuse were obtained from Google Trends. We used graphical and time-series approaches to compare daily trends in searches for these topics against population measures of these outcomes recorded using validated self-report scales (PHQ-9; GAD-7; UCLA-3) in a weekly survey (n = ~70,000) of the impact COVID-19 on psychological and social experiences in the UK population (21/03/2020 to 21/08/ 2020). Results Self-reported levels of depression, anxiety, self-harm/suicidal ideation, self-harm, loneliness and abuse decreased during the period studied. There was no evidence of an association between self-reported anxiety, self-harm, abuse and RSV on Google Trends. Trends in Google topic RSV for depression and suicidal ideation were inversely associated with self-reports of these outcomes (p = 0.03 and p = 0.04, respectively). However, there was statistical and graphical evidence that self-report and Google searches for loneliness (p, Graphical abstract Image, graphical abstract

This article is dedicated to the WHO International Year of Health and Care Workers in 2021 in recognition of their commitment during the COVID-19 pandemic. The study aims to strengthen health workforce preparedness, protection and ultimately resilience during a pandemic. We argue for a health system approach and introduce a tool for rapid comparative assessment based on integrated multi-level governance. We draw on secondary sources and expert information, including material from Denmark, Germany, Portugal and Romania. The results reveal similar developments across countries: action has been taken to improve physical protection, digitalization and prioritization of healthcare worker vaccination, whereas social and mental health support programmes were weak or missing. Developments were more diverse in relation to occupational and organizational preparedness: some ad-hoc transformations of work routines and tasks were observed in all countries, yet skill-mix innovation and collaboration were strongest in Demark and weak in Portugal and Romania. Major governance gaps exist in relation to education and health integration, surveillance, social and mental health support programmes, gendered issues of health workforce capacity and integration of migrant healthcare workers (HCW). There is a need to step up efforts and make health systems more accountable to the needs of HCW during global public health emergencies.

Background The COVID-19 pandemic has arguably facilitated a shift toward increased sedentariness and reduced physical activity. Moreover, there is mounting evidence that mental health has also declined during the pandemic. However, it remains unknown to what extent social distancing (SD) behaviors and mental health have affected the physical activity levels of the general population. Objective The purpose of this study was to determine the influence of SD behaviors and prevailing mental health on the odds of being physically active during the early COVID-19 pandemic response. Methods A total of 4819 adults (2474/4819, 51.3%, female) from the US population with a median age of 46 (IQR 35-59) completed an online survey during the early pandemic response (April-June 2020). The survey included questions on adherence to 11 SD behaviors, and validated questionnaires which assessed self-reported physical activity, depression, anxiety, and mental well-being. Respondents were categorized into 2 physical activity groups: inactive (0-599 metabolic equivalent of task [MET]-minutes/week) and active (≥600 MET-minutes/week). A logistic generalized additive model (GAM) was used to determine which SD factors and mental health outcomes were associated with physical activity level. Results The GAM analysis revealed that wearing a facemask in public (odds ratio [OR] 1.46, 95% CI 1.14-1.79; P=.003), limiting the use of public transport (OR 1.47, 95% CI 1.19-1.83; P=.001), and restricting travel outside the house (OR 1.56, 95% CI 1.19-2.05; P=.002) were SD behaviors associated with higher odds of being more physically active. Conversely, avoiding physical activity outside the house was associated with higher odds of being inactive (OR 0.52, 95% CI 0.46-0.63; P Conclusions Based on the findings of our study, we suggest that future public health messaging of SD guidelines should include (1) a clear portrayal of the benefits of regular exercise on mental health; and (2) a specific focus on how to be physically active outdoors in a COVID-safe manner.

Background Adverse mental and emotional health outcomes are increasingly recognized as a public health challenge associated with the COVID-19 pandemic. Objective The goal of this study was to examine the association of COVID-19 risk misperceptions with self-reported household isolation, a potential risk factor for social isolation and loneliness. Methods We analyzed data from the Franklin Templeton-Gallup Economics of Recovery Study (July to December 2020) of 24,649 US adults. We also analyzed data from the Gallup Panel (March 2020 to February 2021), which included 123,516 observations about loneliness. The primary outcome was self-reported household isolation, which we defined as a respondent having no contact or very little contact with people outside their household, analogous to quarantining. Results From July to December 2020, 53% to 57% of respondents reported living in household isolation. Most participants reported beliefs about COVID-19 health risks that were inaccurate, and overestimation of health risk was most common. For example, while deaths in persons younger than 55 years old accounted for 7% of total US deaths, respondents estimated that this population represented 43% of deaths. Overestimating COVID-19 health risks was associated with increased self-reported household isolation, with percentage differences ranging from 5.6 to 11.8 (P Conclusions Pandemic-related harms to emotional and mental well-being may be attenuated by reducing risk overestimation and household isolation preferences that exceed public health guidelines.

Background The coronavirus disease 2019 (COVID-19) global pandemic caused mental health services to be downscaled to abide by the public health restrictions issued., Aims The aim of this study was to investigate whether the pandemic and resultant restrictions had an impact on Malta's admissions to hospital for mental health issues by assessing the number and nature of psychiatric admissions to our only national mental health hospital., Method Data collection was carried out retrospectively for the 13-week period between 7 March 2020 and 4 June 2020, compared with the equivalent in 2019. Demographic data was obtained and descriptive statistical analysis through the use of the χ²-test, z-test and logistic regression model were used to compare both data-sets, using a P-value of 0.05., Results An overall reduction in admissions to hospital was noted in 2020 when compared with 2019, recorded to be lowest in March 2020 with a steady acceleration of admissions up until May 2020 (χ2(3) = 22.573, P < 0.001). This coincided with a decelerated rate of positive COVID-19 cases locally. In 2020, there were significantly higher female admissions (χ2(1) = 10.197, P < 0.001), increased presentations of self-harm/suicidal ideation (P < 0.001) and higher involuntary admissions using the Mental Health Act (χ2(1) = 4.904, P = 0.027). The logistic regression model identified total length of stay in hospital, primary mental health diagnosis, gender and month of admission as variables significantly associated with an admission., Conclusions Our first population-wide study confirms that the COVID-19 pandemic and subsequent public health restrictions had an impact on the population's hospital admissions for mental health issues., peer-reviewed

Background During the COVID-19 pandemic, public health restrictions such as social distancing, isolation and self-quarantine have been implemented for several months. Because of these restrictions, in-person contact with friends, family, and mental health supports had been limited, potentially impacting mental wellbeing. Objectives In this study, we examined the impact of the pandemic on the mental health of adults and investigated the types of activities people engage in to manage and maintain their mental health. Methods An online survey was circulated in Canada and had a total of 221 participants from September 24 to December 8, 2020. Results The majority of participants were females (73.2%), between the ages of 18 and 34 (51.1%), and employed full-time (56.1%). Individuals who are unemployed and those with an annual income less than $25,000 had the highest scores in depression, anxiety and psychological distress. Around 19.4% of the sample scored above the cutpoint for depression, which is higher compared to a pre-pandemic population prevalence of 4.7%. Similarly, higher prevalence of anxiety and distress symptoms were observed: 16.3% of the sample had moderate anxiety symptoms compared to a pre-pandemic population prevalence of 11.6%; and 37.7% of the sample had moderate distress symptoms compared to a pre-pandemic population prevalence of 20%. Conclusions Our findings suggest that the COVID-19 pandemic has negatively impacted the mental health of many adults and that individuals engage in a wide range of activities that may maintain and promote mental wellness during the pandemic, such as exercising, reading, and listening to music.

Background The COVID-19 pandemic and countries’ response measures have had a globally significant mental health impact. This mental health burden has also been fueled by an infodemic: an information overload that includes misinformation and disinformation. Suicide, the worst mental health outcome, is a serious public health problem that can be prevented with timely, evidence-based, and often low-cost interventions. Suicide ideation, one important risk factor for suicide, is thus important to measure and monitor, as are the factors that may impact on it. Objective This investigation had 2 primary aims: (1) to estimate and compare country-specific prevalence of suicide ideation at 2 different time points, overall and by gender and age groups, and (2) to investigate the influence of sociodemographic and infodemic variables on suicide ideation. Methods A repeated, online, 8-country (Canada, the United States, England, Switzerland, Belgium, Hong Kong, Philippines, and New Zealand), cross-sectional study was undertaken with adults aged ≥18 years, with measurement wave 1 conducted from May 29, 2020 to June 12, 2020 and measurement wave 2 conducted November 6-18, 2021. Self-reported suicide ideation was derived from item 9 of the Patient Health Questionnaire-9 (PHQ-9). Age-standardized suicide ideation rates were reported, a binomial regression model was used to estimate suicide ideation indication rates for each country and measurement wave, and logistic regression models were then employed to relate sociodemographic, pandemic, and infodemic variables to suicide ideation. Results The final sample totaled 17,833 adults: 8806 (49.4%) from measurement wave 1 and 9027 (50.6%) from wave 2. Overall, 24.2% (2131/8806) and 27.5% (2486/9027) of participants reported suicide ideation at measurement waves 1 and 2, respectively, a difference that was significant (P Conclusions Suicide ideation is prevalent and significantly increasing over time in this COVID-19 pandemic era, with considerable variability between countries. Younger adults and those residing in Hong Kong carried disproportionately higher rates. Social media appears to have an increasingly detrimental association with suicide ideation, although having a stronger SOC had a larger protective effect. Policies and promotion of SOC, together with disseminating health information that explicitly tackles the infodemic’s misinformation and disinformation, may importantly reduce the rising mental health morbidity and mortality triggered by this pandemic.

Background Early in the pandemic, in 2020, Koehlmoos et al completed a framework synthesis of currently available self-reported symptom tracking programs for COVID-19. This framework described relevant programs, partners and affiliates, funding, responses, platform, and intended audience, among other considerations. Objective This study seeks to update the existing framework with the aim of identifying developments in the landscape and highlighting how programs have adapted to changes in pandemic response. Methods Our team developed a framework to collate information on current COVID-19 self-reported symptom tracking programs using the “best-fit” framework synthesis approach. All programs from the previous study were included to document changes. New programs were discovered using a Google search for target keywords. The time frame for the search for programs ranged from March 1, 2021, to May 6, 2021. Results We screened 33 programs, of which 8 were included in our final framework synthesis. We identified multiple common data elements, including demographic information such as race, age, gender, and affiliation (all were associated with universities, medical schools, or schools of public health). Dissimilarities included questions regarding vaccination status, vaccine hesitancy, adherence to social distancing, COVID-19 testing, and mental health. Conclusions At this time, the future of self-reported symptom tracking for COVID-19 is unclear. Some sources have speculated that COVID-19 may become a yearly occurrence much like the flu, and if so, the data that these programs generate is still valuable. However, it is unclear whether the public will maintain the same level of interest in reporting their symptoms on a regular basis if the prevalence of COVID-19 becomes more common.

Background Although focus groups are a valuable qualitative research tool, face-to-face meetings may be difficult to arrange and time consuming. This challenge has been further compounded by the global COVID-19 pandemic and the subsequent lockdown and physical distancing measures implemented, which caused exceptional challenges to human activities. Online focus groups (OFGs) are an example of an alternative strategy and require further study. At present, OFGs have mostly been studied and used in high-income countries, with little information relating to their implementation in low- and middle-income countries (LMICs). Objective The aim of this study is to share our experiences of conducting OFGs through a web conferencing service and provide recommendations for future research. Methods As part of a broader study, OFGs were developed with adults and adolescents in Colombia during the COVID-19 pandemic. Through a convenience sampling method, we invited eligible participants via email in two different cities of Colombia to participate in OFGs conducted via Microsoft Teams. Researcher notes and discussion were used to capture participant and facilitator experiences, as well as practical considerations. Results Technical issues were encountered, but various measures were taken to minimize them, such as using a web conferencing service that was familiar to participants, sending written instructions, and performing a trial meeting prior to the OFG. Adolescent participants, unlike their adult counterparts, were fluent in using web conferencing platforms and did not encounter technical challenges. Conclusions OFGs have great potential in research settings, especially during the current and any future public health emergencies. It is important to keep in mind that even with the advantages that they offer, technical issues (ie, internet speed and access to technology) are major obstacles in LMICs. Further research is required and should carefully consider the appropriateness of OFGs in different settings.

Black Americans have been disproportionately affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) pandemic. Since the pandemic's start, we have observed compounded health, social, and economic impacts for communities of color, fueled in part by profound residential segregation in the United States that, for centuries prior to the pandemic, created differences in access to opportunity and resources. Based on a longitudinal cohort of Black residents living in two racially isolated Pittsburgh neighborhoods, we sought to: 1) describe the experiences of behavioral responses to COVID-19 conditions (e.g., closures of businesses, schools, government offices) and illness experiences reported by residents within these disinvested, urban areas and 2) determine if these experiences were associated with perceptions of risk, negative mental health outcomes, and food insecurity; and 3) examine whether any of the associations were explained by social isolation or modified by neighborhood walkability. We found direct associations between residents' experience with COVID-19-related closures and with the illness, with perceived risk, and change in psychological distress, sleep quality, and food insecurity from pre-COVID-19 levels. Social isolation was a statistically significant mediator of all of these associations, most strongly mediating the pathway to psychological distress. We found neighborhood walkability to be a significant moderator of the association between closure experiences and sleep quality. The results suggest that experiences of COVID-19 closures and illness were associated with serious threats to public health in Black, disinvested, urban neighborhoods, beyond those caused directly by the virus. Outcomes of the pandemic appear very much dependent on the extent to which social and physical resources are available to meet the demands of stress.

Background The COVID-19 outbreak has induced negative emotions among people. These emotions are expressed by the public on social media and are rapidly spread across the internet, which could cause high levels of panic among the public. Understanding the changes in public sentiment on social media during the pandemic can provide valuable information for developing appropriate policies to reduce the negative impact of the pandemic on the public. Previous studies have consistently shown that the COVID-19 outbreak has had a devastating negative impact on public sentiment. However, it remains unclear whether there has been a variation in the public sentiment during the recovery phase of the pandemic. Objective In this study, we aim to determine the impact of the COVID-19 pandemic in mainland China by continuously tracking public sentiment on social media throughout 2020. Methods We collected 64,723,242 posts from Sina Weibo, China’s largest social media platform, and conducted a sentiment analysis based on natural language processing to analyze the emotions reflected in these posts. Results We found that the COVID-19 pandemic not only affected public sentiment on social media during the initial outbreak but also induced long-term negative effects even in the recovery period. These long-term negative effects were no longer correlated with the number of new confirmed COVID-19 cases both locally and nationwide during the recovery period, and they were not attributed to the postpandemic economic recession. Conclusions The COVID-19 pandemic induced long-term negative effects on public sentiment in mainland China even as the country recovered from the pandemic. Our study findings remind public health and government administrators of the need to pay attention to public mental health even once the pandemic has concluded.

Introduction The COVID-19 pandemic has affected the behavior and practice of planned and structured physical exercises. This study aimed to investigate the association between changes in physical exercise behavior and subjective well-being during the COVID-19 pandemic in Brazil. Methods This cross-sectional study was performed in Brazil and included a total of 595 individuals recruited through social media platforms, personal and professional contacts. Each participant responded to self-completed questionnaire via an online survey between March 29 and May 7, 2020. The characteristics of physical exercise (frequency, intensity, and duration) were collected before and during the pandemic. The subjective state of mood was measured through the Profile of Mood States (POMS) questionnaire during the pandemic. A generalized linear model was employed for the analysis. Results Exercising during the pandemic only promoted protective effects on the subjective mood. An exercise frequency of 3-5 days/week was associated with improved vigor and between 6-7 days/week with improved vigor and total mood when compared to not exercising at all (p

This paper seeks to examine how the perception and use of Nairobi’s urban green spaces (UGS) have been impacted by the Covid- 19 pandemic. The question of how the current pandemic and the resulting government policies will affect urban green spaces has remained elusive. Similarly, the relationship between public health crises and urban green spaces has not been well integrated in the current literature. This paper identifies a nexus between government response to the Covid-19 pandemic and (Un) sustainability of UGS. The authors further reflect on the potential role UGS could play to mitigate the negative effects of the pandemic. Findings of the study show that UGS in Nairobi have not been fully exploited to provide citizens with sufficient access to green spaces yet as the pandemic has shown these spaces could significantly improve physical and mental health for the citizens as well as act as logistical areas for humanitarian activities during a pandemic. The paper therefore concludes with policy recommendations that can give rise to short and long term reforms in the provision and management of UGS.

Little is known about the association between mental health and diminished food worry during the COVID-19 pandemic. This paper examines worry about having enough food to meet household needs and its association with mental health during the early months of the pandemic in Canada.Data are drawn from the first round of a multi-round mental health monitoring survey. Online surveys were administered between May 14 and 29, 2020, to a nationally representative sample of Canadian adults (n = 3000). Logistic regression models were used to examine associations between food worry and mental health indicators (anxious/worried, depressed, worse mental health compared with pre-pandemic, and suicidal thoughts/feelings), after adjusting for socio-demographic characteristics and pre-existing mental health conditions. Fully adjusted models explored the impact of controlling for financial worry due to the pandemic in the previous 2 weeks.Overall, 17.3% of the sample reported food worry due to the pandemic in the previous 2 weeks, with the highest prevalence found among those with a reported disability (29.3%), Indigenous identity (27.1%), or pre-existing mental health condition (25.3%). Compared with participants who did not report food worry, those who did had higher odds of reporting feeling anxious/worried (OR=1.36, 95% CI: 1.08-1.71) and suicidal thoughts/feelings (OR=1.87, 95% CI: 1.24-2.80) when controlling for socio-demographics, pre-existing mental health conditions, and financial worry.This paper provides insights about the associations between food worry and mental health in Canada during the COVID-19 pandemic and indicates the need for improved policies and social supports to mitigate food worry and associated mental health outcomes.RéSUMé: OBJECTIF: On en sait peu sur l’association entre la santé mentale et la diminution des inquiétudes liées à la nourriture durant la pandémie de COVID-19. Notre article porte sur l’inquiétude de ne pas avoir suffisamment de nourriture pour répondre aux besoins du ménage et son association avec la santé mentale au cours des premiers mois de la pandémie au Canada. MéTHODE: Nos données proviennent du premier cycle d’une enquête de surveillance de la santé mentale. Des sondages en ligne ont été administrés entre le 14 et le 29 mai 2020 à un échantillon national représentatif de Canadiennes et de Canadiens adultes (n = 3 000). Des modèles de régression logistique ont servi à examiner les associations entre les inquiétudes liées à la nourriture et quelques indicateurs de santé mentale (anxiété/inquiétude, dépression, santé mentale pire qu’avant la pandémie, pensées/sentiments suicidaires) après l’apport d’ajustements pour tenir compte du profil sociodémographique et des troubles de santé mentale préexistants. À l’aide de modèles entièrement ajustés, nous avons exploré l’effet de la prise en compte des soucis financiers dus à la pandémie au cours des deux semaines antérieures. RéSULTATS: Dans l’ensemble, le pourcentage de l’échantillon ayant fait état d’inquiétudes liées à la nourriture dues à la pandémie au cours des deux semaines antérieures était de 17,3 %, la plus forte prévalence ayant été constatée chez les répondants ayant un handicap déclaré (29,3 %), une identité autochtone (27,1 %) ou un trouble de santé mental préexistant (25,3 %). Comparativement aux participants n’ayant fait état d’aucune inquiétude liée à la nourriture, ceux qui ont fait état de telles inquiétudes présentaient une plus forte probabilité d’avoir déclaré des sentiments d’anxiété ou d’inquiétude (RC = 1,36, IC de 95 % : 1,08-1,71) et des pensées ou sentiments suicidaires (RC = 1,87, IC de 95 % : 1,24-2,80) après la prise en compte du profil sociodémographique, des troubles de santé mentale préexistants et des soucis financiers. CONCLUSION: Notre article jette un éclairage sur les associations entre les inquiétudes liées à la nourriture et la santé mentale au Canada durant la pandémie de COVID-19 et montre qu’il faudrait améliorer les politiques et les mesures de soutien social pour atténuer les inquiétudes liées à la nourriture et les résultats de santé mentale associés.

Purpose Self-harm, including death from suicide, remains a significant public health challenge. The prison population is known to be a high-risk group for self-harm and suicide. The purpose of this study is to explore the trends in the frequency of self-harm over the course of the COVID-19 pandemic within a high-secure hospital. The authors hypothesised that the pandemic could adversely affect the mental health of patients, which could increase the rates of self-harm. Reasons for changes in the frequency of self-harm and the strategies used in response to the pandemic were also investigated. Design/methodology/approach This paper encompasses findings from a quality improvement project that investigated self-harming behaviours from February 2020 to February 2021 in a high-secure psychiatric hospital. Incidents of self-harm were recorded based on the hospital’s ward structure. Data was collected on the incidence of self-harm rates over the COVID-19 pandemic, with a focus on how the pandemic may have had an effect on self-harm. Findings This paper found an increase in the incidents of self-harm during the initial stages of the pandemic. The first national lockdown period yielded a rise in self-harm incidents from pre-COVID levels. The frequency of self-harm reduced following the first lockdown and returned to pre-COVID levels. The authors explored the psychological effects of COVID, isolation, interpersonal dynamics and changes in the delivery of care as reasons for these trends. Practical implications This study demonstrates the substantial challenges of the COVID-19 pandemic to secure psychiatric services. Having an awareness of how the pandemic can impact on self-harm is important, as it allows the correct balance of restriction of our patients’ liberty to a degree deemed necessary to control the pandemic and the delivery of effective patient care. The key clinical implications include the importance of direct face-to-face patient contact, effective communication, therapeutic interventions and activities, the psychological impact of quarantine and the influence the pandemic can have on an individual’s function of self-harm. Originality/value This paper is the first, to the authors’ knowledge, to explore the impact of COVID-19 in a high-security psychiatric hospital. The authors also explore possible explanations for the changes in the trends of self-harm and include the consideration of strategies for improving the prevention and management of self-harm in high-secure settings during a pandemic.

PurposeThis paper aims to explore the mental health impact of domestic violence and abuse within the context of the global pandemic. This paper will explore factors contributing to rising rates of violence and mental health problems exacerbated by stressors related to the global pandemic, including public health measures implemented to prevent the spread of coronovirus disease (COVID-19). It will also explore what can be learnt from the current pandemic situation to prevent domestic violence and abuse in future emergency situations and pandemics and will provide suggestions, for policy, practice and future research.Design/methodology/approachThis paper is informed by discussion between authors as experts in the field, their reflection on the current situation and review of available literature. Synthesising information from best practice guidance across the global literature, this paper proposes a best practice framework using an ecological approach to address intimate partner violence in times of pandemic, crisis or natural disaster.FindingsThis paper aimed to explore the mental health impact of domestic violence and abuse within the context of the global pandemic.Originality/valueThis paper provides an analysis of available literature and explains impact of COVID-19 on domestic violence and abuse.

Background Since the beginning of the COVID-19 pandemic, a great number of papers have been published in the pediatric field. Objective We aimed to assess research around the globe on COVID-19 in the pediatric field by bibliometric analysis, identifying publication trends and topic dissemination and showing the relevance of publishing authors, institutions, and countries. Methods The Scopus database was comprehensively searched for all indexed documents published between January 1, 2020, and June 11, 2020, dealing with COVID-19 in the pediatric population (0-18 years). A machine learning bibliometric methodology was applied to evaluate the total number of papers and citations, journal and publication types, the top productive institutions and countries and their scientific collaboration, and core keywords. Results A total of 2301 papers were retrieved, with an average of 4.8 citations per article. Of this, 1078 (46.9%) were research articles, 436 (18.9%) were reviews, 363 (15.8%) were letters, 186 (8.1%) were editorials, 7 (0.3%) were conference papers, and 231 (10%) were categorized as others. The studies were published in 969 different journals, headed by The Lancet. The retrieved papers were published by a total of 12,657 authors from 114 countries. The most productive countries were the United States, China, and Italy. The four main clusters of keywords were pathogenesis and clinical characteristics (keyword occurrences: n=2240), public health issues (n=352), mental health (n=82), and therapeutic aspects (n=70). Conclusions In the pediatric field, a large number of articles were published within a limited period on COVID-19, testifying to the rush to spread new findings on the topic in a timely manner. The leading authors, countries, and institutions evidently belonged to the most impacted geographical areas. A focus on the pediatric population was often included in general articles, and pediatric research about COVID-19 mainly focused on the clinical features, public health issues, and psychological impact of the disease.

INTRODUCTION: The COVID-19 (coronavirus disease 2019)-related pandemic represents a global source of societal and health burden. Yet, the impact of the pandemic on people with severe mental illness, including bipolar disorder (BD), remains unclear, warranting scoping review on the matter. METHODS: The MEDLINE and EMBASE databases were systematically searched from inception up to April 24, 2021, adopting broad inclusion criteria to assess a variety of clinical and public health themes related to people with a primary diagnosis of BD during the COVID-19 pandemics. The present work complying with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) registered in the Open Science Framework (OSF) repository (https://osf.io/7evpx/). RESULTS: Fourteen papers informed the present scoping review. Four major themes were identified: (i) impact of COVID-19-related stressors on BD; (ii) impact of COVID-19 on mental health service utilization among people with BD; (iii) impact of BD on the risk of acquiring SARS-CoV-2 infection; (iv) engagement in preventative behaviors among people with BD. Additional themes warranting further research were nonetheless detected. LIMITATIONS: Further original studies are needed. CONCLUSION: The present study confirmed the high-vulnerability hypothesis concerning people with BD versus the general population, reinforcing the need for further research related to the COVID-19 pandemic. Additional information is warranted to compare the impact of the pandemic period among BD people against pre-pandemic records, the general population, and other severe mental illnesses, namely people with schizophrenia or major depressive disorder, to inform the public health and the delivery of patient-tailored interventions.

Nurses caring for patients who contract coronavirus disease 2019 (COVID-19) have experienced significant traumas in the form of increased workloads, negative patient outcomes, and less social support system access. Nurses should be provided with information regarding early detection, coping skills and treatment for anxiety, depression, post-traumatic stress syndrome (PTSS)/post-traumatic stress disorder (PTSD), and other mental health disorders. Early intervention is important as mental health disorders can cause dysfunction, internal suffering, and in the most extreme situations, lead to death if not properly cared for. Healthcare corporations should consider providing coverage for mental health treatment for employees who experience COVID-19 traumas. With the implementation of healthy coping skills and therapeutic intervention, nurses will be able to let go of the negative impacts that the COVID-19 pandemic has caused and reintegrate into their roles as caring and entrusted health care providers. The current paper evaluates the mental health disorders encountered by nurses in the COVID-19 era based on the current medical literature and aims to provide practical coping strategies.

Purpose of Review This paper reviews the literature on the psychological effects of the COVID-19 pandemic on children and the reactions of vulnerable children. Recent Findings Research reveals increases in clinically significant depression, suicidal ideation and behavior, and some anxiety symptoms. Substance use studies suggest an inadvertent decrease in substance use in some youth though findings are inconsistent across substances and for males and females. Children with pre-existing emotional and behavioral problems are especially vulnerable though some children appear to improve in the context of public health measures which have decreased the stresses associated with school and socialization. In addition, children with pre-existing problems are likely to have established resources and relationships that may protect them relative to other children. Summary COVID-19 has had a major effect on the mental health of children around the world, but findings should be considered preliminary until more rigorous research has been conducted.

Objectives: This paper reviews the mental health policies that have been implemented in Chile in response to the COVID-19 pandemic and the international context of countries' responses. Even before the start of the pandemic, there were significant barriers to access mental health services in Chile, coupled with a scenario of nationwide social unrest and protests that questioned the legitimacy of public institutions; now the rapidly worsening outbreaks of COVID-19 are exacerbating the pre-existing mental health crisis.Methods: We conducted a bibliometric and content analysis of the Chilean mental health public policies implemented during the COVID-19 pandemic and then compared these policies with international experiences and emerging scientific evidence on the mental health impact of pandemics.Results: Our analysis of the policies identifies five crucial points of action developed in Chile: (i) an established framework to address mental health in emergency and disaster situations; (ii) a timely COVID-19 Mental Health Action Plan; (iii) inclusion of mental health in the public health agenda; (iv) development of a presidential strategy during the pandemic for comprehensive mental health and well-being; and (v) emerging research assessing the mental health implications of COVID-19.Conclusions: In Chile, the public policy responses to address the mental health consequences of the COVID-19 pandemic has been characterized by the coordinated implementation of mental health plans, ranging from a health sectoral initiative to inter-agency and intersectoral efforts. However, it is imperative that increased funding is allocated to mental health, and efforts should be made to promote the participation of people with lived experiences and communities in the design and implementation of the proposed actions. This aspect could be of key importance to social peace and community recovery after the pandemic.

The recent COVID-19 pandemic has caused unprecedented impact across the globe. We have also witnessed millions of people with increased mental health issues, such as depression, stress, worry, fear, disgust, sadness, and anxiety, which have become one of the major public health concerns during this severe health crisis. For instance, depression is one of the most common mental health issues according to the findings made by the World Health Organisation (WHO). Depression can cause serious emotional, behavioural and physical health problems with significant consequences, both personal and social costs included. This paper studies community depression dynamics due to COVID-19 pandemic through user-generated content on Twitter. A new approach based on multi-modal features from tweets and Term Frequency-Inverse Document Frequency (TF-IDF) is proposed to build depression classification models. Multi-modal features capture depression cues from emotion, topic and domain-specific perspectives. We study the problem using recently scraped tweets from Twitter users emanating from the state of New South Wales in Australia. Our novel classification model is capable of extracting depression polarities which may be affected by COVID-19 and related events during the COVID-19 period. The results found that people became more depressed after the outbreak of COVID-19. The measures implemented by the government such as the state lockdown also increased depression levels. Further analysis in the Local Government Area (LGA) level found that the community depression level was different across different LGAs. Such granular level analysis of depression dynamics not only can help authorities such as governmental departments to take corresponding actions more objectively in specific regions if necessary but also allows users to perceive the dynamics of depression over the time.

Purpose of Review The closure of schools during the COVID-19 pandemic has interrupted the education of children worldwide. This paper reviews the psychological effects of this action on children and the impact on school-based services. Recent Findings Emerging epidemiologic findings have generated an intense debate about the need for, and potential benefit of, school closure in the context of COVID-19. International research reveals reactions in children that are not typically considered in the disaster literature as well as those that arise in other disasters. School closure also has curtailed the delivery of mental health services commonly offered in schools. Summary The debate about school closure will likely persist depending on local disease conditions and school readiness. Moreover, school closure is a possibility in future epidemics and pandemics and other disasters. The benefit of school closure must be balanced against the risk to children’s education and psychosocial development.

Background: The COVID-19 pandemic has had monumental effects on the mental health of populations worldwide. Previous research indicated that programs and interventions using social networks can play a positive role in promoting mental health. Nevertheless, current evidence is largely derived from high-income regions, reflecting an urgent need for more studies in low- and middle-income settings.Objectives: This paper aims to (a) describe the potential value of a hybrid health carnival in promoting mental health and increasing access to screening services; (b) assess the level of community engagement with the digital platform.Methods: A mental health carnival was conducted with the theme of “Mind Your Mental Health” (Cakna Kesihatan Mental) in conjunction with the World Mental Health Day in Malaysia. This was a hybrid carnival that combined elements of face-to-face interactions and virtual learning. Free online therapy sessions were offered to high-risk groups identified during the screening process. Social media metrics were utilized to report the levels of community engagement and participants completed pre-and post-assessments to measure the program's impact on their knowledge.Results: The carnival was attended by 515 participants (78.8% virtual participants). Social media metrics reported more than 5,585 reaches on Facebook for all the activities held throughout the event. Results from pre-and post-assessments showed significant improvement in the mean knowledge scores (p < 0.05).Conclusion: This digital approach will continue to evolve by releasing new features and tools as a new frontier for high-risk populations and all individuals seeking mental health support and treatment.

The U.S. COVID-19 Trends and Impact Survey (CTIS) is a large, cross-sectional, Internet-based survey that has operated continuously since April 6, 2020. By inviting a random sample of Facebook active users each day, CTIS collects information about COVID-19 symptoms, risks, mitigating behaviors, mental health, testing, vaccination, and other key priorities. The large scale of the survey – over 20 million responses in its first year of operation – allows tracking of trends over short timescales and allows comparisons at fine demographic and geographic detail. The survey has been repeatedly revised to respond to emerging public health priorities. In this paper, we describe the survey methods and content and give examples of CTIS results that illuminate key patterns and trends and help answer high-priority policy questions relevant to the COVID-19 epidemic and response. These results demonstrate how large online surveys can provide continuous, real-time indicators of important outcomes that are not subject to public health reporting delays and backlogs. The CTIS offers high value as a supplement to official reporting data by supplying essential information about behaviors, attitudes toward policy and preventive measures, economic impacts, and other topics not reported in public health surveillance systems.Significance statementThe U.S. COVID-19 Trends and Impact Survey (CTIS) has operated continuously since April 6, 2020, collecting over 20 million responses. The largest public health survey ever conducted in the United States, CTIS was designed to facilitate detailed demographic and geographic analyses, track trends over time, and accommodate rapid response to emerging priorities. Using examples of CTIS results illuminating trends in symptoms, risks, mitigating behaviors, testing and vaccination in relation to evolving high-priority policy questions over 12 months of the pandemic, we illustrate the value of online surveys for tracking patterns and trends in COVID outcomes as an adjunct to official reporting, and showcase unique insights that would not be visible through traditional public health reporting.

OBJECTIVES: Language can shape the way we perceive the world. In this paper, we investigated how exposure to media texts containing alarming and militaristic language affects peoples’ notions regarding coronavirus disease 2019 (COVID-19) and the consequences of this effect for public health.METHODS: After reading a passage including either alarming and militaristic or neutral terminology on COVID-19, participants completed a questionnaire in which they answered 4 questions on a 7-point Likert scale. The questions assessed participants’ notions on the end of the pandemic, vaccine effectiveness, and the consequences of COVID-19 for economies and mental health. Ordinal regression models in R were used for the analysis.RESULTS: Individuals who were exposed to alarming and militaristic language expressed more pessimistic notions regarding COVID-19 than those who were exposed to more neutral language. However, both groups of individuals had similar notions regarding vaccine effectiveness.CONCLUSIONS: The media should redefine the language they use for the description of the pandemic, considering that the extensive use of alarming and militaristic terminology may have a negative impact on public health.

The 2020 global outbreak of COVID-19 exposed and heightened threats to mental health across societies. Research has indicated that individuals with chronic physical health conditions are at high risk for suffering from severe COVID-19 illness and from the adverse consequences of public health responses to COVID-19, such as social isolation. This paper reports on the findings of a rapid realist review conducted alongside a scoping review to explore contextual factors and underlying mechanisms or drivers associated with effective mental health interventions within and across macro–meso–micro systems levels for individuals with chronic physical health conditions. This rapid realist review extracted 14 qualified studies across 11 countries and identified four key mechanisms from COVID-19 literature—trust, social connectedness, accountability, and resilience. These mechanisms are discussed in relation to contextual factors and outcomes reported in the COVID literature. Realist reviews include iterative searches to refine their program theories and context–mechanism–outcome explanations. A purposive search of pre-COVID realist reviews on the study topic was undertaken, looking for evidence of the robustness of these mechanisms. There were differences in some of the pre-COVID mechanisms due to contextual factors. Importantly, an additional mechanism—power-sharing—was highlighted in the pre-COVID literature, but absent in the COVID literature. Pre-existing realist reviews were used to identify potential substantive theories and models associated with key mechanisms. Based on the overall findings, implications are provided for mental health promotion policy, practice, and research.

Background : Infectious disease outbreaks affect physical and mental health of humans worldwide. Studies showed that the prevalence of post-traumatic stress disorder (PTSD) symptoms increased in these conditions. This systematic-review and meta-analysis aimed to assess the prevalence of PTSD related symptoms in coronavirus outbreaks. Methods : Systematic search of literature was conducted in Scopus, Embase, PubMed, and Web of Science. Google Scholar and Grey literature including conference proceedings were also checked. Published articles from November 1, 2012 until May 18, 2020 were searched. Subgroup analysis, meta-regression and sensitivity analysis were also conducted to assess heterogeneity. Results : We found 38 articles with 19,428 individuals met the eligibility criteria. Of these papers, 35 studies were included in meta-analysis. The prevalence of PTSD symptoms was estimated to be about 18% (95%CI: 15% to 20%). These symptoms were more frequent in cohort studies (29%) compared to cross-sectional (15%) and case-control (11%) studies. Prevalence rates of PTSD symptoms in MERS (36%) outbreaks were higher than SARS (18%) and COVID-19 (9%) outbreaks. Meta-regression showed that the geographical location of study was the source of heterogeneity (R2: 19.8%, P-value: 0.003). Meta-analysis reported that about three in every ten survivors of coronavirus infection, about two in every ten healthcare workers, and about one in every ten individuals of general population experienced PTSD symptoms in outbreaks. Limitations : PTSD cannot be objectively assessed and this can lead to information bias of included studies. Conclusion : PTSD symptoms are shown to be common in coronavirus outbreaks. Mental care should be, therefore, considered in the present COVID-19 pandemic.