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Author(s): Anke B. Witteveen 1,*, Susanne Y. Young 1,2, Pim Cuijpers 1, José Luis Ayuso-Mateos 3,4, Corrado Barbui 5, Federico Bertolini 5, Maria Cabello 3,4, Camilla Cadorin 5, Naomi Downes [...], Background There remains uncertainty about the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on mental health. This umbrella review provides a comprehensive overview of the association between the pandemic and common mental disorders. We qualitatively summarized evidence from reviews with meta-analyses of individual study-data in the general population, healthcare workers, and specific at-risk populations. Methods and findings A systematic search was carried out in 5 databases for peer-reviewed systematic reviews with meta-analyses of prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms during the pandemic published between December 31, 2019 until August 12, 2022. We identified 123 reviews of which 7 provided standardized mean differences (SMDs) either from longitudinal pre- to during pandemic study-data or from cross-sectional study-data compared to matched pre-pandemic data. Methodological quality rated with the Assessment of Multiple Systematic Reviews checklist scores (AMSTAR 2) instrument was generally low to moderate. Small but significant increases of depression, anxiety, and/or general mental health symptoms were reported in the general population, in people with preexisting physical health conditions, and in children (3 reviews; SMDs ranged from 0.11 to 0.28). Mental health and depression symptoms significantly increased during periods of social restrictions (1 review; SMDs of 0.41 and 0.83, respectively) but anxiety symptoms did not (SMD: 0.26). Increases of depression symptoms were generally larger and longer-lasting during the pandemic (3 reviews; SMDs depression ranged from 0.16 to 0.23) than those of anxiety (2 reviews: SMDs 0.12 and 0.18). Females showed a significantly larger increase in anxiety symptoms than males (1 review: SMD 0.15). In healthcare workers, people with preexisting mental disorders, any patient group, children and adolescents, and in students, no significant differences from pre- to during pandemic were found (2 reviews; SMD's ranging from -0.16 to 0.48). In 116 reviews pooled cross-sectional prevalence rates of depression, anxiety, and PTSD symptoms ranged from 9% to 48% across populations. Although heterogeneity between studies was high and largely unexplained, assessment tools and cut-offs used, age, sex or gender, and COVID-19 exposure factors were found to be moderators in some reviews. The major limitations are the inability to quantify and explain the high heterogeneity across reviews included and the shortage of within-person data from multiple longitudinal studies. Conclusions A small but consistent deterioration of mental health and particularly depression during early pandemic and during social restrictions has been found in the general population and in people with chronic somatic disorders. Also, associations between mental health and the pandemic were stronger in females and younger age groups than in others. Explanatory individual-level, COVID-19 exposure, and time-course factors were scarce and showed inconsistencies across reviews. For policy and research, repeated assessments of mental health in population panels including vulnerable individuals are recommended to respond to current and future health crises.

Author(s): Nursena Aksunger 1, Corey Vernot 2, Rebecca Littman 3, Maarten Voors 4, Niccolò F. Meriggi 5, Amanuel Abajobir 6, Bernd Beber 7, Katherine Dai 8, Dennis Egger 9, Asad [...], Background The Coronavirus Disease 2019 (COVID-19) pandemic and associated mitigation policies created a global economic and health crisis of unprecedented depth and scale, raising the estimated prevalence of depression by more than a quarter in high-income countries. Low- and middle-income countries (LMICs) suffered the negative effects on living standards the most severely. However, the consequences of the pandemic for mental health in LMICs have received less attention. Therefore, this study assesses the association between the COVID-19 crisis and mental health in 8 LMICs. Methods and findings We conducted a prospective cohort study to examine the correlation between the COVID-19 pandemic and mental health in 10 populations from 8 LMICs in Asia, Africa, and South America. The analysis included 21,162 individuals (mean age 38.01 years, 64% female) who were interviewed at least once pre- as well as post-pandemic. The total number of survey waves ranged from 2 to 17 (mean 7.1). Our individual-level primary outcome measure was based on validated screening tools for depression and a weighted index of depression questions, dependent on the sample. Sample-specific estimates and 95% confidence intervals (CIs) for the association between COVID-19 periods and mental health were estimated using linear regressions with individual fixed effects, controlling for independent time trends and seasonal variation in mental health where possible. In addition, a regression discontinuity design was used for the samples with multiple surveys conducted just before and after the onset of the pandemic. We aggregated sample-specific coefficients using a random-effects model, distinguishing between estimates for the short (0 to 4 months) and longer term (4+ months). The random-effects aggregation showed that depression symptoms are associated with a increase by 0.29 standard deviations (SDs) (95% CI [-.47, -.11], p-value = 0.002) in the 4 months following the onset of the pandemic. This change was equivalent to moving from the 50th to the 63rd percentile in our median sample. Although aggregate depression is correlated with a decline to 0.21 SD (95% CI [-0.07, -.34], p-value = 0.003) in the period thereafter, the average recovery of 0.07 SD (95% CI [-0.09, .22], p-value = 0.41) was not statistically significant. The observed trends were consistent across countries and robust to alternative specifications. Two limitations of our study are that not all samples are representative of the national population, and the mental health measures differ across samples. Conclusions Controlling for seasonality, we documented a large, significant, negative association of the pandemic on mental health, especially during the early months of lockdown. The magnitude is comparable (but opposite) to the effects of cash transfers and multifaceted antipoverty programs on mental health in LMICs. Absent policy interventions, the pandemic could be associated with a lasting legacy of depression, particularly in settings with limited mental health support services, such as in many LMICs. We also demonstrated that mental health fluctuates with agricultural crop cycles, deteriorating during "lean", pre-harvest periods and recovering thereafter. Ignoring such seasonal variations in mental health may lead to unreliable inferences about the association between the pandemic and mental health.

Presenters Elias Arellano, Susan Franks, PhD, ABPP, Kimberly Fulda, DrPH, Fan Zhang, Sravan Mattevada, MS, Damon Schranz, DO, [...], Context: The COVID-19 pandemic led to an unprecedented lockdown of millions of Americans from the spring of 2020 to the fall of 2020. Studies done on the impact of COVID-19 on mental health and body weight have been important to our understanding of the effects of the pandemic. However, these studies on depression and BMI change have not identified a possible direction of the causality of the relationship between depression and body weight as affected by lockdown measures during a pandemic. Objective: The purpose of this study was to examine whether a diagnosis of depression is associated with changes in BMI during the COVID-19 pandemic for adults (aged [greater than or equal to] 18 years). Study Design and Analysis: Retrospective cohort study Setting or Dataset: EHR data from a family medicine university clinic. Population Studied: Adults >18 years who visited the clinic within a 6- month period prior to lockdown (October 2019-March 2020) and at least once in the 6-month post-lockdown period (September 2020-March 2021). The lockdown period started in March 2020. 1,211 patients were included. Outcome Measures: Dependent variable: change in BMI; Primary independent variable: diagnosis of depression; Confounding variables: age, race/ethnicity, sex, medications, and chronic conditions Results: Mean age was 59.9 (sd=16.5). Patients were mostly female (n=770, 63.6%), white (n=678, 56.0%), and non-Hispanic (n=622, 51.4%). 18.7% (n=227) had a diagnosis of depression. There was a significant difference in BMI change (p0.001]). This association remained while including confounding variables in the model (p=0.009). Further statistical analysis showed that age between 31 and 50 significantly predicted BMI changes in those patients with no depression diagnosis while controlling for confounding variables (p=0.027). Conclusion: Individuals with depression had significant changes in BMI during the COVID-19 pandemic, and age predicted these changes in middle-aged adults (30-50 years old). These findings highlight the importance of identifying and following up with individuals with a diagnosis of depression to alleviate effects on their BMI during extended isolation. Identifying patients who might be susceptible to these changes could lead to patient health outcomes.

Systematic screening of depression in primary care settings that have adequate follow-up and treatment is recommended. The Patient Health Questionnaire (PHQ-9) was developed as a depression screening measure for use [...]

Introduction Adolescent parenting remains a challenging public health issue and despite decreases in adolescent pregnancy rates over the last decade, approximately 400,000 American women aged 15-19 give birth each year [...], Given the high co-occurrence of depression and parental stress among adolescent mothers, we evaluated the relationship between parental stress and postpartum depression among primiparous adolescent mothers. We conducted an observational analysis among a cohort of 106 adolescent mothers at 289 postpartum visits who were enrolled in a randomized controlled trial to prevent postpartum depression. Parental stress was measured using the Parenting Stress Index, short form. The Structured Clinical Interview for DSM-IV Childhood Diagnoses was administered to assess for postpartum depression; sub threshold depression was assessed using the Children&apos;s Depression Rating Scale, revised version. Generalized estimating equations were utilized to assess the relationship of parental stress on postpartum depression during the first 6 months postpartum. We present adjusted odds ratios (AOR) controlling for study arm, age, born in the United States, prior history of depression, and number of study visits. The median age was 16 years, 53% were Latina, and 16% reported a past history of depression. Nineteen adolescents (19%) were diagnosed with postpartum depression and 25% experienced high levels of parental stress through 6 months postpartum. Adolescent mothers who reported higher levels of parental stress were at significantly increased risk for postpartum depression [AOR 1.06 (95% CI 1.04-1.09); p < 0.0001]. High levels of parental stress predicted subsequent postpartum depression when assessing parental stress at visits prior to a depression diagnosis to determine whether we could establish a temporal association [AOR 1.06 (95% CI 1.02-1.09); p < 0.01]. Parental stress was also a risk factor for sub threshold depression [AOR 1.04 (95% CI 1.01-1.07); p < 0.01]. Parental stress was a significant risk factor for developing both postpartum depression as well as sub threshold depression among adolescent mothers. Interventions that target a reduction in parental stress may lead to less depression severity among primiparous adolescent mothers. Keywords Teenage * Pregnancy * Depression * Social support * Parental stress

Introduction An estimated 15 million children live in households with parents who have major or severe depression [1]. Depressive symptoms are more common among women, and affect an estimated 13-24 [...], This study examined associations between mothers&apos; depressive symptoms and parenting behaviors related to children&apos;s nutrition and physical activity. Data from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative study of children from infancy through kindergarten entry. Contemporaneous and lagged associations between maternal depressive symptoms and mothers&apos; parenting behaviors were tested, controlling for background characteristics. The mediating effect of use of a physician&apos;s office or clinic as a source for routine care was tested. At each wave, between 18 and 20 % of mothers were considered as having moderate or severe depressive symptoms. These mothers were 1.3 percentage points more likely to put their infants to bed with a bottle, 2.6 percentage points less likely to have rules about the foods their children eat, and their children were 3.0 percentage points less likely to be in bed by 9:00 p.m. than mothers lacking depressive symptoms. These mothers also reported that their families ate dinner together fewer nights per week, and their children watched more television per day, than non-depressed mothers. The use of a physician&apos;s office or clinic partially mediated associations between maternal depressive symptoms and whether infants went to bed with a bottle. Interventions that identify maternal depression early may be useful in promoting healthy parenting behaviors and weight outcomes among young children. Keywords Maternal depressive symptoms * Parenting * Nutrition * Physical activit

Introduction Neuroimaging studies have provided an essential contribution to our understanding of the neurobiologic underpinnings of major depressive disorder (MDD). A network comprised mainly of the limbic, frontal and cingulate [...], Background: We investigated the differential effects of serotonergic and noradrenergic antidepressants on brain activation in patients with major depressive disorder during a Stroop task. We predicted that pretreatment hyperactivity in the rostral anterior cingulate cortex would predict better treatment outcomes. Methods: In total, 20 patients underwent naturalistic open-label clinical treatment with citalopram (n = 12) or reboxetine (n = 8). We performed functional magnetic resonance imaging at baseline and after 6 weeks of treatment. Results: There were no significant group differences in clinical characteristics, treatment outcomes or baseline fMRI activations. The group by time interaction revealed significant voxels in the right amygdala-hippocampus complex (p < 0.05, family-wise error corrected by use of the bilateral amygdala and hippocampus mask image as a small volume), indicating a posttreatment blood oxygen level-dependent signal decrease in the citalopram group. Pretreatment hyperactivity in the rostral anterior cingulate cortex was not related to symptom improvement. Limitations: Our study was a nonrandomized clinical trial. Conclusion: These results indicate that serotonergic and noradrenergic antidepressants have a differential effect on brain activity, especially in the amygdala and hippocampus.