Uncovering Survivorship Bias in Longitudinal Mental Health Surveys During the COVID-19 Pandemic

AbstractAimsMarkedly elevated adverse mental health symptoms were widely observed early in the coronavirus disease 2019 (COVID-19) pandemic. Unlike the U.S., where cross-sectional data indicate anxiety and depression symptoms have remained elevated, such symptoms reportedly declined in the U.K., according to analysis of repeated measures from a largescale longitudinal study. However, nearly 40% of U.K. respondents (those who did not complete multiple follow-up surveys) were excluded from analysis, suggesting that survivorship bias might partially explain this discrepancy. We therefore sought to assess survivorship bias among participants in our longitudinal survey study as part of The COVID-19 Outbreak Public Evaluation (COPE) Initiative.MethodsSurvivorship bias was assessed 4,039 U.S. respondents who completed surveys including the assessment of mental health as part of The COPE Initiative in April 2020 and were invited to complete follow-up surveys. Participants completed validated screening instruments for symptoms of anxiety, depression, and insomnia. Survivorship bias was assessed for (1) demographic differences in follow-up survey participation, (2) differences in initial adverse mental health symptom prevalences adjusted for demographic factors, and (3) differences in follow-up survey participation based on mental health experiences adjusted for demographic factors.ResultsAdjusting for demographics, individuals who completed only one or two out of four surveys had higher prevalences of anxiety and depression symptoms in April 2020 (e.g., one-survey versus four-survey, anxiety symptoms, adjusted prevalence ratio [aPR]: 1.30, 95% confidence interval [CI]: 1.08-1.55, P=0.0045; depression symptoms, aPR: 1.43, 95% CI: 1.17-1.75, P=0.00052). Moreover, individuals who experienced incident anxiety or depression symptoms had higher odds of not completing follow-up surveys (adjusted odds ratio [aOR]: 1.68, 95% CI: 1.22-2.31, P=0.0015, aOR: 1.56, 95% CI: 1.15-2.12, P=0.0046, respectively).ConclusionsOur findings revealed significant survivorship bias among longitudinal survey respondents, indicating that restricting analytic samples to only respondents who provide repeated assessments in longitudinal survey studies could lead to overly optimistic interpretations of mental health trends over time. Cross-sectional or planned missing data designs may provide more accurate estimates of population-level adverse mental health symptom prevalences than longitudinal surveys.

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COVID-19 Related Media Consumption and Mental Health in Older Adults

Innovation in Aging ◽

10.1093/geroni/igab046.3576 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 1006-1006

Author(s):

Erta Cenko ◽

Christopher Kaufmann ◽

Todd Manini

Keyword(s):

Mental Health ◽

Older Adults ◽

Social Media ◽

Depressive Symptoms ◽

Anxiety And Depression ◽

Media Consumption ◽

Depression Symptoms ◽

Negative Consequences ◽

Cross Sectional Survey ◽

Cross Sectional

Abstract At the beginning of the COVID-19 pandemic, consuming media was critical to identify precautionary behaviors to reduce the spread of the virus, particularly for older adults. Media consumption leads to heightened awareness, but may also negatively affect mental health. We examined whether non-social and social media consumption impacted anxiety and depression relative to pre-COVID-19 symptoms. We conducted an anonymous, cross-sectional survey in May and June 2020. Participants (n=1,168, 73.2 years, 56.8% women, 94.9% White), were asked to estimate their amount of time spent consuming pandemic-related media each day, and to report on anxiety and depressive symptoms both before and after the pandemic onset. We characterized change in anxiety and depression by subtracting scores on current anxiety and depressive symptoms from their recalled symptoms prior to the pandemic. Respondents with high pandemic-related media consumption (>3hrs) were more likely to have increased anxiety, compared to those with low (<1hr) media consumption (OR:1.57, 95%CI:1.09-2.23). Similarly, respondents with increased social media consumption during the pandemic were 64% more likely to have depression, compared to those who did not use social media. This association was bi-directional— those who reduced their social media use were 45% less likely to have depression and 26% less likely to have anxiety, compared to those who never used social media. Older adults consuming more pandemic-related media had increased anxiety. Increased social media consumption was associated with elevated depression symptoms. The potential benefits of media consumption about the COVID-19 pandemic may have unintended negative consequences on mental health.

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The Influence of Illness Perception, Anxiety and Depression Disorders on Students Mental Health during COVID-19 Outbreak in Pakistan: A Web-Based Cross-Sectional Survey

10.21203/rs.3.rs-30128/v1 ◽

2020 ◽

Author(s):

Muhammad Aqeel ◽

Kanwar Hamza Shuja ◽

Jaffar Abbas ◽

Tasnim Rehna ◽

Arash Ziapour

Keyword(s):

Mental Health ◽

Mental Health Problems ◽

Illness Perception ◽

Well Being ◽

Health Problems ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Cross Sectional ◽

Web Based ◽

Depression Disorders

Abstract Background: Since the emergence of a coronavirus disease (2019-nCoV) in December 2019, the whole world is in a state of chaos. Isolation strategy with quarantine is a useful model in controlling transmission and rapid spread. As a result, people remained at homes and disrupted their outside daily activities. It led to the closure of educational institutes, which is a source of many students to cope with numerous personal and familial issues. This study focuses on exploring the relationships and potential mediational pathways between mental health problems, illness perception, anxiety, and depression disorders.Method: The study incorporated snowball sampling techniques through a cross-sectional, web-based survey and recruited 500 students from different public and private universities from twin cities, Rawalpindi, and Islamabad from March 23 to April 15, 2020, during the coronavirus outbreak lockdown. The study used four instruments, Beck Depression Scale, Beck Anxiety Inventory, Revised Illness Perception Questionnaire, and The Warwick-Edinburgh Mental Well-being Scale for assessing depression, anxiety, illness perception, and mental health disorders.Results: The findings indicated normal (43.2%) mild (20.5%), moderate (13.6%), and severe (22.7%) level of anxiety prevalence in students. Results specified a normal (65.9%), mild (9.10%), moderate (9.12%), and severe (15.90%) depression prevalence, and findings stipulated that anxiety disorder prevalence was higher than the depression disorder. The correlational results specified a negative and significant relationship between mental health, illness perception, anxiety, and depression symptoms. The multiple regression analysis stated that anxiety and depression disorders mediated the relationship between mental health and present illness perception. The perception of illness exhibited a relation to depression and anxiety disorders.Conclusion: The study proposed a model to address mental health problems during the lockdown. The (2019-nCoV) illness perception developed mental disorders, including anxiety and depression, which has declined individuals' mental health. There is an urgent need for ongoing clinical examination and management to address psychological disorders, and findings suggest assessing mental health to combatting the pandemic worldwide. Findings recommend developing strategies to promote mental healthcare facilities during COVID-19 wide-ranging disasters. These results highlight the impending importance of devising strategies to treat mental health problems.

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Symptoms of depression at discharge after PCI are associated with an increased risk of 1-year mortality: findings from the national DenHeart study

European Heart Journal ◽

10.1093/ehjci/ehaa946.3417 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

B Borregaard ◽

S.N Nielsen ◽

J.F Lassen ◽

L.O Jensen ◽

L Thrysoe ◽

...

Keyword(s):

Mental Health ◽

Depression Scale ◽

Adverse Outcomes ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Symptoms Of Depression ◽

Increased Risk ◽

All Cause Mortality

Abstract Background Although survival rates among patients with coronary artery disease have increased since the introduction of treatment with percutaneous coronary intervention, PCI, the effect of psychological factors such as symptoms of anxiety and depression on adverse outcomes are sparsely described. Purpose The objective of the current study was to investigate the association between symptoms of anxiety and depression and 1-year mortality after PCI. Methods A national cross-sectional survey at hospital discharge (responders, n=3,366) with register-based follow-up among patients having undergone elective or emergency PCI. Mental health was measured using the Hospital Anxiety and Depression Scale, HADS, and divided into symptoms of anxiety (HADS-A) and symptoms of depression (HADS-D). The association between mental health (HADS-A and HADS-D) and 1-year all-cause mortality were investigated with Cox Proportional Hazard models with time to death as the underlying time scale. The results are presented as hazard ratios (HR) with 95% confidence intervals (CI) and adjusted for sex, age and Tu-comorbidity score. Results At discharge, 32% of the population reported symptoms of anxiety (HADS-A ≥8) and 19% reported symptoms of depression (HADS-D ≥8). After one year, the mortality rate among patients being alive at discharge was 2.1%. All-cause mortality did not differ among patients reporting symptoms of anxiety compared to patients without symptoms of anxiety (2.3% vs 1.9%, p=0.454), whereas all-cause mortality was higher among patients reporting symptoms of depression compared to those, who did not (4.3% vs 1.6%, p≤0.001). In the regression analyses, symptoms of anxiety (HADS-A ≥8) was not associated with 1-year mortality (HR 1.16 95% CI 0.70–1.92); however, symptoms of depression was (HADS-D ≥8, HR 2.27 95% CI 1.38–3.73, adjusted analyses). Based on the continuous scores of HADS-D, a one-point increase in scores was associated with a 12% higher risk of 1-year mortality (HR 1.12 95% CI 1.05–1.18) (Figure 1). Conclusion After PCI, nearly one-third of patient report symptoms of anxiety and one-fifth symptoms of depression. Symptoms of anxiety was not associated with 1-year mortality, whereas symptoms of depression increased the risk of 1-year mortality. Figure 1 Funding Acknowledgement Type of funding source: None

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The influence of illness perception, anxiety and depression disorders on students mental health during COVID-19 outbreak in Pakistan: a Web-based cross-sectional survey

International Journal of Human Rights in Healthcare ◽

10.1108/ijhrh-10-2020-0095 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Muhammad Aqeel ◽

Jaffar Abbas ◽

Kanwar Hamza Shuja ◽

Tasnim Rehna ◽

Arash Ziapour ◽

...

Keyword(s):

Mental Health ◽

Mental Health Problems ◽

Illness Perception ◽

Health Problems ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Cross Sectional ◽

Web Based ◽

Content Type ◽

Depression Disorders

Purpose Since the emergence of a coronavirus disease (2019-nCoV) in December 2019, the whole world is in a state of chaos. Isolation strategy with quarantine is a useful model in controlling transmission and rapid spread. As a result, people remained at home and disrupted their outside daily activities. It led to the closure of educational institutes, which is a source of many students to cope with numerous personal and familial issues. This study aims to focus on exploring the relationships and potential mediational pathways between mental health problems, illness perception, anxiety and depression disorders. Design/methodology/approach The study incorporated snowball sampling techniques through a cross-sectional, Web-based survey and recruited 500 students from different universities of twin cities, Rawalpindi and Islamabad from March 23 to April 15, 2020, during the coronavirus outbreak lockdown. The study used four instruments, Beck Depression Scale, Beck Anxiety Inventory, Revised Illness Perception Questionnaire and The Warwick-Edinburgh Mental Well-being Scale for assessing depression, anxiety, illness perception and mental health disorders. Findings The findings indicated normal (43.2%), mild (20.5%), moderate (13.6%) and severe (22.7%) levels of anxiety prevalence in students. Results specified a normal (65.9%), mild (9.10%), moderate (9.12%) and severe (15.90%) depression prevalence and findings stipulated that anxiety disorder prevalence was higher than depression disorder. The correlational results specified a negative and significant relationship between mental health, illness perception, anxiety and depression symptoms. The multiple regression analysis stated that anxiety and depression disorders mediated the relationship between mental health and present illness perception. The perception of illness exhibited a relation to depression and anxiety disorders. Originality/value The study proposed a model to address mental health problems during the lockdown. The (2019-nCoV) illness perception developed mental disorders, including anxiety and depression, which has declined individuals’ mental health. There is an urgent need for ongoing clinical examination and management to address psychological disorders and findings suggest assessing mental health to combatting the pandemic worldwide. Findings recommend developing strategies to promote mental health-care facilities during COVID-19 wide-ranging disasters. These results highlight the impending importance of devising strategies to treat mental health problems.

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Predictors of Adolescent Engagement and Outcomes: A cross-sectional study using the Togetherall (formerly Big White Wall) digital mental health platform

10.1101/2021.08.20.21262337 ◽

2021 ◽

Author(s):

Nushka Marinova ◽

Tim Rogers ◽

Angus MacBeth

Keyword(s):

Mental Health ◽

Common Mental Disorder ◽

Cross Sectional Study ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Sectional Study ◽

Activity Data ◽

Cross Sectional ◽

Self Help ◽

White Wall

Online mental health platforms can improve access to, and use of, mental health support for young people who may find it difficult to engage with face-to-face delivery. We modelled engagement and change in anxiety and depression symptoms in adolescent users of the Togetherall (formerly Big White Wall) anonymous digital mental health peer-support platform. A cross-sectional study assessed online activity data from members of Togetherall in UK adolescents referred from mental health services (N=606). Baseline demographics, depression, anxiety, and usage statistics were assessed. Symptom levels among participants who chose to take validated anxiety and depression measures were measured. And participant characteristics were used to predict engagement. Mean number of logins for adolescent members was higher for older adolescents, and for a longer duration than younger adolescents. Mean number of logins and usage time was higher in female adolescents than males. For the total sample, 47.9% of users accessed more than one course, and 27% accessed at least one self-help resource. Gender and age predicted number of joined courses. Greater accessed self-help materials predicted reduced anxiety symptoms. Members mean baseline symptom levels were: GAD-7 between 13.63 and 14.79; PHQ-9 between 16.8 and 18.58. Data were derived from a naturalistic design and modelling of multiple symptom scores should be interpreted with caution. Findings show that adolescents readily engage with an anonymous online platform for common mental disorder, with scope for tailored pathways for different symptom profiles. Members benefit from engagement with Togetherall materials and courses.

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A survey on anxiety and depression level among South Indian medical students during the COVID 19 pandemic

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl1.3082 ◽

2020 ◽

Vol 11 (SPL1) ◽

pp. 779-786

Author(s):

Nihmath Nisha S ◽

Yuvaraj Maria Francis ◽

Balaji K ◽

Gunapriya Raghunath ◽

Kumaresan M

Keyword(s):

Mental Health ◽

Medical Students ◽

Depression Scale ◽

Cross Sectional Study ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Cross Sectional ◽

General Anxiety Disorder ◽

Indian Medical ◽

South Indian

The COVID-19 pandemic is being a global Heath crisis. The rate of transmission of the disease is very high. At this time there is no specific vaccine or treatment. This widespread outbreak is also associated with psychological distress like depression and anxiety. The effect of COVID 19 on medical students is considerable. The medical students are in a transitory period which could be one of the most stressful times in a person’s life. The aim of this study is to assess the mental health of South Indian medical students during the COVID-19 pandemic and to see if there is any influence of gender on mental health. A cross sectional study was conducted using convenient sampling method. A total of 359 responses were analysed. Anxiety and depression symptoms were assessed based on four point Likert scale. GAD-7 (General Anxiety Disorder-7) scale and CES-D (Center for Epidemiology Studies for Depression) scale is used to assess anxiety and depression symptoms with a small modification respectively. Data analysis was performed using IBM SPSS statistics version 25. Out of 359 participants 50.4% of participants were male and 49.6% of them were females; majority of them (95.3%) were between the age group of 18-21. In total 75.5% and 74.6% of participants showed varying levels of anxiety and depression symptoms respectively. Anxiety and depression symptoms are found to have a mild association with gender. Symptoms are slightly higher among females than males.

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Mental Health Point Prevalence in International Committee of the Red Cross Employees: The cases of Lebanon, Myanmar, and Nigeria

10.31219/osf.io/29ay8 ◽

2021 ◽

Author(s):

Peter Deli ◽

Simone Aeschlimann ◽

Grazia Ceschi

Keyword(s):

Mental Health ◽

Risk Factors ◽

Online Survey ◽

Psychosocial Support ◽

International Committee ◽

Point Prevalence ◽

Red Cross ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Cross Sectional

Like employees of any company or organization, humanitarian aid workers (HAW) are subject to mental health (MH) issues, such as posttraumatic stress disorder (PTSD), anxiety, and depression. MH issues can be challenging at individual and organizational levels and, ultimately, can also have adverse consequences on the people HAW try to help.The objectives of this study were to measure the point prevalence of PTSD, anxiety, and depression symptoms among HAW and compare the results to those found in the literature.A cross-sectional online survey was conducted on 432 International Committee of the Red Cross (ICRC) employees, both national and international, deployed in three countries. Results show an overall prevalence for PTSD symptoms ranging from 11.3% to 14.6%, for anxiety symptoms from 13.0% to 56.7%, and for depression symptoms from 19.9% to 41.9%. Sub-group analyses show that risk factors of developing PTSD are being national rather than international staff, being younger rather than older, and having a lower income/salary rather than a higher one. Anxiety risk factors are being a woman, not being in a relationship, working in Lebanon and Myanmar rather than Nigeria, being younger rather than older, and having a higher income/salary rather than a lower one. Depression risk factors are not being in a relationship, being national staff rather than international staff, working in Lebanon and Myanmar rather than Nigeria, being younger rather than older, and being senior rather than junior staff.Further investigation is needed to assess additional key variables in order to better pinpoint risk and protective factors, target the sub-groups most at risk, and suggest adequate psychosocial support in order to reduce MH issues prevalence.

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Mental Health among Adults during the COVID-19 Pandemic Lockdown: A Cross-Sectional Multi-Country Comparison

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052686 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2686

Author(s):

Kele Ding ◽

Jingzhen Yang ◽

Ming-Kai Chin ◽

Lindsay Sullivan ◽

Giyasettin Demirhan ◽

...

Keyword(s):

Mental Health ◽

Health Anxiety ◽

Significant Risk ◽

Significant Risk Factor ◽

Study Data ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Country Level

Despite the global impact of COVID-19, studies comparing the effects of COVID-19 on population mental health across countries are sparse. This study aimed to compare anxiety and depression symptoms during the COVID-19 lockdown among adults from 11 countries and to examine their associations with country-level COVID-19 factors and personal COVID-19 exposure. A cross-sectional survey was conducted among adults (≥18 years) in 11 countries (Brazil, Bulgaria, China, India, Ireland, North Macedonia, Malaysia, Singapore, Spain, Turkey, United States). Mental health (anxiety, depression, resilient coping, hope) and other study data were collected between June–August 2020. Of the 13,263 participants, 62.8% were female and 51.7% were 18–34 years old. Participants living in Brazil had the highest anxiety and depression symptoms while participants living in Singapore had the lowest. Greater personal COVID-19 exposure was associated with increased anxiety and depression symptoms, but country-level COVID-19 factors were not. Higher levels of hope were associated with reduced anxiety and depression; higher levels of resilient coping were associated with reduced anxiety but not depression. Substantial variations exist in anxiety and depression symptoms across countries during the COVID-19 lockdown, with personal COVID-19 exposure being a significant risk factor. Strategies that mitigate COVID-19 exposure and enhance hope and resilience may reduce anxiety and depression during global emergencies.

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Prevalence of Anxiety and Depression Among Medical Students During the Covid-19 Pandemic: A Cross-Sectional Study

Journal of Medical Education and Curricular Development ◽

10.1177/2382120521991150 ◽

2021 ◽

Vol 8 ◽

pp. 238212052199115 ◽

Cited By ~ 1

Author(s):

Scott J Halperin ◽

Matthew N Henderson ◽

Sofia Prenner ◽

Jonathan N Grauer

Keyword(s):

Mental Health ◽

Medical Students ◽

Demographic Data ◽

Cross Sectional Study ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Physical And Mental Health ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Patient Health

Purpose: The Covid-19 pandemic is a public health emergency with both physical and mental health risks. Medical students have baseline elevated rates of anxiety, depression and burnout. As such, they may be especially susceptible to the psychological stresses of Covid-19. The current study aimed to evaluate the prevalence of anxiety and depression among United States medical students during the Covid-19 pandemic. Methods: A cross-sectional, survey-based study collected demographic data as well as the 7-item Generalized Anxiety Disorder (GAD-7) and the 9-item Patient Health Questionnaire (PHQ-9) to assess anxiety and depression symptoms, respectively. The survey was administered from April 13, 2020 to April 28, 2020 amidst the height of the Covid-19 pandemic. Results: A total of 1,428 students from 40 US medical schools completed the survey. From those surveyed, 30.6% and 24.3% of respondents screened positive for anxiety and depression, respectively. Median GAD-7 scores were higher among females (7.0 vs 5.0, P < .00001), pre-clinical students (7.0 vs 6.0, P < .00004), and those with a friend or relative diagnosed with Covid-19 (7.0 vs 6.0, P=.001). Median PHQ-9 scores were higher among females (6.0 vs 4.0, P < .00001) and pre-clinical students (6.0 vs 4.0, P < .00001). Conclusion: When compared to previous medical student studies, these results are 61% higher for anxiety and 70% higher for depression during the Covid-19 era. The current study suggests that there should be a heightened awareness of and sensitivity to student’s mental health during the Covid-19 pandemic with certain cohorts at greater potential risk.

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Impact of the COVID-19 Pandemic on the Mental Health of College Students in India: Cross-sectional Web-Based Study (Preprint)

10.2196/preprints.28158 ◽

2021 ◽

Author(s):

Amar Prashad Chaudhary ◽

Narayan Sah Sonar ◽

Jamuna TR ◽

Moumita Banerjee ◽

Shailesh Yadav

Keyword(s):

Mental Health ◽

College Students ◽

Severe Depression ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Mental Health Crisis ◽

Cross Sectional ◽

Web Based ◽

Health Crisis ◽

Psychometric Scales

BACKGROUND The COVID-19 pandemic has created a mental health crisis among college students in India due to lockdown restrictions, overwhelming numbers of COVID-19 cases, financial difficulty, etc. This mental health crisis has led to high degrees of fear, anxiety, and depression among college students. OBJECTIVE The aim of this study is to investigate symptoms of fear, depression, and anxiety due to the COVID-19 pandemic among college students in India. METHODS This cross-sectional web-based study was conducted using a Google Forms questionnaire. The Google Form included a sociodemographic questionnaire and psychometric scales evaluating the psychological and behavioral impacts of the COVID-19 pandemic. Thus, both qualitative and quantitative analyses were performed in the study. RESULTS A total of 324 college students participated in this study, of whom 180 (55.6%) were male and 144 (44.4%) were female. After assessment of the psychometric scales, it was found that of the 324 students, 223 (68.8%) had high fear of COVID-19, 93 (28.7%) had moderate to severe depression, and 167 (51.5%) had mild to severe anxiety. Among the identified risk factors, having a family member who was infected with COVID-19 was significantly associated with anxiety and depression, with P values of .02 and .001, respectively. In addition, the correlations of the Fear of COVID-19 Scale with the Generalized Anxiety Disorder-7 scale and the Patient Health Questionnaire-9 were found to be 0.492 and 0.474, respectively. CONCLUSIONS This research concludes that there is a very high fear of COVID-19 among students, along with anxiety and depression symptoms. This study also concludes that the Fear of COVID-19 Scale has a moderate positive correlation with the anxiety and depression scales, respectively.

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