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The transition to active sexuality is both an important milestone (Berard & Salle, 2016; Zimmer-Gembeck & Helfand, 2008) and a developmental task of adolescence (Boislard et al., 2016; Tolman & [...], According to the social clock and statistical norms, a transition into sexual activity after age 18 years is considered late. This longitudinal study examines whether late sexual transition is related to delays in the achievement of developmental tasks and lower psychological well-being in emerging adulthood for heterosexual individuals. A sample of 300 participants (61.3% women) was assessed annually from age 15 to 22 years and again at age 25, of which 43 reported sexual intercourse at age 19 or older or remained virgins in emerging adulthood. Results indicate that late sexual transition, particularly for men, is prospectively associated with still being at school, working fewer hours per week, being single and having no kids at age 25. It is also positively associated with depression and anxiety symptoms, interpersonal sensitivity, hostility, lower self-esteem, and lower happiness. This study enriches the understanding of slower developmental trajectories and the associations between late sexual transition and subsequent trajectories in emerging adulthood. KEYWORDS: Sexuality, developmental tasks, emerging adulthood, longitudinal, quantitative research, well-being

Author(s): Céleste Dubé [sup.1] , Alexandre J. S. Morin [sup.1] , Elizabeth Olivier [sup.2] , István Tóth-Király [sup.1] , Danielle Tracey [sup.3] , Rhonda G. Craven [sup.4] , Christophe Maïano [...], This study investigates associations between initial levels and change in the quality of the relationships youth with intellectual disabilities (ID) share with their parents and teachers, and changes in their levels of depression over time. A sample of 395 youth with mild (48.3%) and moderate (51.7%) ID, aged between 11 and 22 (M = 15.69), were recruited in Canada (n = 142) and Australia (n = 253). Youth completed self-report measures of relationship quality and depression twice over a one-year period. Initial levels of warmth ([beta] = - .109) and conflict ([beta] = - .302) predicted decreases in depression. Increases in warmth predicted decreases in depression ([beta] = - .179), while increases in conflict predicted increases in depression ([beta] = .268). Discrepancies between youth relationships with their parents and teachers predicted decreases in depression ([beta].sub.warmth = - .732; [beta].sub.conflict = - .608).

Author(s): Laura J. Faherty [sup.1] [sup.2] , Violet Gwokyalya [sup.3] , Akena Dickens [sup.3] , Ryan McBain [sup.1] , Vicky Ngo [sup.4] , Janet Nakigudde [sup.3] , Juliet Nakku [sup.3] [...], Introduction Perinatal depression is common among women living with HIV, but depression care is limited in low-resource settings. We examined (1) characteristics of women receiving Problem Solving Therapy (PST) versus antidepressant therapy (ADT), (2) treatment response by modality, and (3) correlates of treatment response. Methods This analysis used data from 191 Ugandan women in the intervention arm of a cluster randomized controlled trial of task-shifted, stepped-care depression treatment for pregnant women living with HIV (PWLWH). Treatment response was defined as scoring < 5 on the nine-item Patient Health Questionnaire (PHQ-9). Bivariate analysis and multivariable logistic regression were used to examine characteristics of women by treatment group and correlates of treatment response. Results Of 134 participants with depression, 129 (96%) were treated: 84 (65%) received PST and 45 (35%) received ADT. Severe depression at treatment initiation was more common in those receiving ADT (28.9% versus 4.8%, Fischer&apos;s Exact Test < 0.001). Treatment response was higher for PST (70/84; 83.3%) than ADT (30/45; 66.7%; p = .03). ADT side effects were rare and minor; no infants had serious congenital defects. Of 22 participants (19%) who did not respond to treatment, only five received intensified management. Social support and interpersonal violence were associated with treatment response (adjusted odds ratio, [aOR] = 3.06, 95% CI = 1.08-8.66 and aOR = 0.64, 95% CI = 0.44-0.93). Discussion Both depression treatment modalities yielded high response rates in Ugandan PWLWH; ADT was well-tolerated. Our results highlight a need to build capacity to implement the stepped-care protocol for non-responders and screen for social support and interpersonal violence.

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&apos;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): Feifei Bu, Andrew Steptoe, Daisy Fancourt * Introduction The Coronavirus Disease 2019 (COVID-19) pandemic has caused unprecedented disruptions to the global economy and people's everyday lives. It has presented [...], Background There has been much research into the mental health impact of the Coronavirus Disease 2019 (COVID-19) pandemic and how it is related to time-invariant individual characteristics. However, there is still a lack of research showing long-term trajectories of mental health across different stages of the pandemic. And little is known regarding the longitudinal association of time-varying factors with mental health outcomes. This study aimed to provide a longitudinal profile of how mental health in adults changed across different stages of the COVID-19 pandemic and to examine their longitudinal associations with time-varying contextual (e.g., COVID-19 policy response and pandemic intensity) and individual level factors. Methods and findings This study used data from a large panel study of over 57,000 adults living in England, who were followed up regularly for 2 years between March 2020 and April 2022. Mental health outcomes were depressive and anxiety symptoms. Depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-9) and anxiety symptoms by the Generalized Anxiety Disorder assessment (GAD-7). Entropy balancing weights were applied to restore sample representativeness. After weighting, approximately 50% of participants were female, 14% from ethnic minority backgrounds, with a mean age of 48 years. Descriptive analyses showed that mental health changes were largely in line with changes in COVID-19 policy response and pandemic intensity. Further, data were analysed using fixed-effects (FE) models, which controlled for all time-invariant confounders (observed or not). FE models were fitted separately across 3 stages of the COVID-19 pandemic, including the first national lockdown (21/03/2020-23/08/2020), second and third national lockdowns (21/09/2020-11/04/2021), and "freedom" period (12/04/2021-14/11/2021). We found that more stringent policy response (measured by stringency index) was associated with increased depressive symptoms, in particular, during lockdown periods ([beta] = 0.23, 95% confidence interval (CI) = [0.18 to 0.28], p < 0.001; [beta] = 0.30, 95% CI = [0.21 to 0.39], p < 0.001; [beta] = 0.04, 95% CI = [-0.03 to 0.12], p = 0.262). Higher COVID-19 deaths were also associated with increased depressive symptoms, but this association weakened over time ([beta] = 0.29, 95% CI = [0.25 to 0.32], p < 0.001; [beta] = 0.09, 95% CI = [0.05 to 0.13], p < 0.001; [beta] = -0.06, 95% CI = [-0.30 to 0.19], p = 0.655). Similar results were also found for anxiety symptoms, for example, stringency index ([beta] = 0.17, 95% CI = [0.12 to 0.21], p < 0.001; [beta] = 0.13, 95% CI = [0.06 to 0.21], p = 0.001; [beta] = 0.10, 95% CI = [0.03 to 0.17], p = 0.005), COVID-19 deaths ([beta] = 0.07, 95% CI = [0.04 to 0.10], p < 0.001; [beta] = 0.04, 95% CI = [0.00 to 0.07], p = 0.03; [beta] = 0.16, 95% CI = [-0.08 to 0.39], p = 0.192). Finally, there was also evidence for the longitudinal association of mental health with individual level factors, including confidence in government/healthcare/essentials, COVID-19 knowledge, COVID-19 stress, COVID-19 infection, and social support. However, it is worth noting that the magnitudes of these longitudinal associations were generally small. The main limitation of the study was its non-probability sample design. Conclusions Our results provided empirical evidence on how changes in contextual and individual level factors were related to changes in depressive and anxiety symptoms. While some factors (e.g., confidence in healthcare, social support) clearly acted as consistent predictors of depressive and/or anxiety symptoms, other factors (e.g., stringency index, COVID-19 knowledge) were dependent on the specific situations occurring within society. This could provide important implications for policy making and for a better understanding of mental health of the general public during a national or global health crisis.

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 Darren Cheng, BSc, MSc, Maarij Ullah, Henry Gage, Rahim Moineddin, PhD, Golale Modarresi, MD, Abhimanyu [...], Context: Chronic pain (CP) and depression are comorbid conditions that are commonly seen in primary care settings, but guidance for management is very limited. In recent years, there has been an increase in measuring depression outcomes in CP clinical trials, but it is unknown how often these studies include people with depression. Previous research has demonstrated that people with comorbid mental illness are often excluded from clinical trials, limiting the application of this research to primary care settings Objective: To (1) investigate the proportion of CP clinical trials with depression outcomes that included participants with depression at baseline, and (2) examine variations in inclusion proportion by pain type, intervention type, gender, country, and time. Study Design: A secondary analysis of studies identified in a recent umbrella review of interventions for depression in CP. Methods: Randomized control trials (RCTs) captured by systematic reviews in an umbrella review were reviewed. RCTs with at least 50% adult participants and which used validated depression scales were eligible for this analysis. Study screening and data extraction were completed by two independent authors and in duplicate. Conflicts were resolved by a third author. RCTs with populations that met commonly cited minimum thresholds at baseline were considered to have included participants with depression. Preliminary Findings: From 67 systematic reviews, 437 studies were identified, of which 346 RCTs were selected for analysis. A total of 142 (41%) RCTs included participants with depression. RCTs investigating fibromyalgia and mixed CP had the highest depression inclusion proportion, whereas studies of arthritis pain had amongst the lowest. US RCTs had a significantly lower inclusion proportion compared to non-US studies, especially for arthritis studies. Significant trends over time and across gender were attenuated when fibromyalgia studies were excluded. Conclusions: Existing CP research often excludes participants with depression and subsequent guidance developed from these findings should be considered with caution. Systemic biases around psychological conditions and gender are important drivers of differences in the study of depression in fibromyalgia compared to other common pain conditions such as arthritis. Future research must intentionally include individuals with comorbid depression in trials of common CP conditions to better inform clinical practice.

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.

Presenters Samuel Ofei-Dodoo, PhD, MA, MPA, CPH, Rick Kellerman, MD, Colleen Loo- Gross, MD, MPH, Leah [...], Introduction: Given the significant turmoil during the COVID-19 pandemic, the authors evaluated burnout and other types of emotional distress experienced by family physicians in Kansas during the second year of the pandemic. The authors compared findings of this study to a similar study conducted three months into the pandemic. Methods: A cross-sectional online survey of 272 actively practicing family physicians in Kansas was conducted from September 15 to October 18, 2021. A 34-item questionnaire was used to measure the physicians&apos; levels of burnout, personal depression, anxiety, and stress. A mixed method approach was used to collect, analyze, and interpret the data. Descriptive statistics, Mann-Whitney U test/independent samples t-test, Chi-square, adjusted odds ratio, and immersion-crystallization methods were used to analyze the data. Results: The response rate was 48.9% (n=133). In aggregate, 69.2% of respondents reported at least one manifestation of professional burnout in 2021 compared with 50.4% in 2020; P Conclusion: As the COVID-19 pandemic continues, there are significant and worsening rates of professional burnout and other forms of emotional distress among family physicians. These findings suggest particularly timely need for appropriate psychological supports.

Presenters Vidush Athyal, MD, FAAFP, MPH, Ngoc Ho, PhD, Sharon Stinis, [...], Context: Patients who are diagnosed with depression often do not get any follow-up care. This deficiency led to a national HEDIS measure that calls for patients to get follow-up care within the first 30 days of being screened positive for depression. Studies have shown that depression outcomes improve with closer follow-up care. Objective: To compare the change in percentage of follow-up care in newly diagnosed depression over a two-year period, specifically examining the pre-pandemic and pandemic eras. To determine if the increased usage of telemedicine in the pandemic era led to an increase in HEDIS-defined follow-up care for newly diagnosed patients with depression. Study Design and Analysis: Prospective observational design. Chi-square and T-tests were used to determine statistical significance at p-value