scholarly journals Comparison of Mental Health Symptoms prior to and during COVID-19: Evidence from a Living Systematic Review and Meta-analysis

Author(s):  
Ying Sun ◽  
Yin Wu ◽  
Olivia Bonardi ◽  
Ankur Krishnan ◽  
Chen He ◽  
...  

Objectives: The rapid pace, high volume, and limited quality of mental health evidence being generated during COVID-19 poses a barrier to effective decision-making. The objective of the present report is to compare mental health outcomes assessed during COVID-19 to outcomes prior to COVID-19 in the general population and other population groups. Design: Living systematic review. Data Sources: MEDLINE (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), EMBASE (Ovid), Web of Science Core Collection: Citation Indexes, China National Knowledge Infrastructure, Wanfang, medRxiv (preprints), and Open Science Framework Preprints (preprint server aggregator). The initial search was conducted on April 13, 2020 with ongoing weekly updates. Eligibility criteria for selecting studies: For this report, we included studies that compared general mental health, anxiety symptoms, or depression symptoms, assessed January 1, 2020 or later, to the same outcomes collected between January 1, 2018 and December 31, 2019. We required ≥ 90% of participants pre-COVID-19 and during COVID-19 to be the same or the use of statistical methods to address missing data. For population groups with continuous outcomes for at least three studies in an outcome domain, we conducted restricted maximum-likelihood random-effects meta-analyses. Results: As of March 22, 2021, we had identified 36 unique eligible studies with data from 33 cohorts. All reported COVID-19 outcomes between March and June 2020, and 3 studies also reported outcomes between September and November 2020. Estimates of changes in general mental health were close to zero in the general population (standardized mean difference [SMD] = 0.02, 95% CI -0.11 to 0.16, I2 = 94.6%; 4 studies, N = 19,707) and among older adults (SMD = 0.02, 95% CI -0.11 to 0.16, I2 = 90.4%; 4 studies, N = 5,520) and university students (SMD = -0.01, 95% CI -0.33 to 0.30, I2 = 92.0%; 3 studies, N = 3,372). Changes in anxiety symptoms were close to zero and not statistically significant in university students (SMD = 0.00, 95% CI -0.35 to 0.36, I2 = 95.4%; 5 studies, N = 1,537); women or females (SMD = 0.02, 95% CI -0.35 to 0.39, I2 = 92.3%; 3 studies, N = 2,778); and men or males (SMD = 0.07, 95% CI -0.01 to 0.15; I2 = 0.01%; 3 studies, N = 1,250); anxiety symptoms increased, however, among people with pre-existing medical conditions (SMD = 0.27, 95% CI 0.01 to 0.54, I2 = 91.0%; 3 studies, N = 2,053). Changes in depression symptoms were close to zero or small and not statistically significant among university students (SMD = 0.19, 95% CI -0.08 to 0.45, I2 = 91.8%; 5 studies, N = 1,537); people with pre-existing medical conditions (SMD = 0.01, 95% CI -0.15 to 0.17, I2 = 14.9%; 3 studies, N = 2,006); women or females (SMD = 0.21, 95% CI -0.14 to 0.55, I2 = 91.2%; 3 studies, N = 2,843); and men or males (SMD = 0.00, 95% CI -0.21 to 0.22; I2 = 92.3%; 4 studies, N = 3,661). In 3 studies with data from both March to June 2020 and September to November 2020, symptoms were unchanged from pre-COVID-19 at both time points or there were increases at the first assessment that had largely dissipated by the second assessment. Conclusions: Evidence does not suggest a widespread negative effect on mental health symptoms in COVID-19, although it is possible that gaps in data have not allowed identification of changes in some vulnerable groups. Continued updating is needed as evidence accrues.

2019 ◽  
Vol 3 (1) ◽  
pp. 107-123 ◽  
Author(s):  
Douglas H. Schultz ◽  
Takuya Ito ◽  
Levi I. Solomyak ◽  
Richard H. Chen ◽  
Ravi D. Mill ◽  
...  

We all vary in our mental health, even among people not meeting diagnostic criteria for mental illness. Understanding this individual variability may reveal factors driving the risk for mental illness, as well as factors driving subclinical problems that still adversely affect quality of life. To better understand the large-scale brain network mechanisms underlying this variability, we examined the relationship between mental health symptoms and resting-state functional connectivity patterns in cognitive control systems. One such system is the fronto-parietal cognitive control network (FPN). Changes in FPN connectivity may impact mental health by disrupting the ability to regulate symptoms in a goal-directed manner. Here we test the hypothesis that FPN dysconnectivity relates to mental health symptoms even among individuals who do not meet formal diagnostic criteria but may exhibit meaningful symptom variation. We found that depression symptoms severity negatively correlated with between-network global connectivity (BGC) of the FPN. This suggests that decreased connectivity between the FPN and the rest of the brain is related to increased depression symptoms in the general population. These findings complement previous clinical studies to support the hypothesis that global FPN connectivity contributes to the regulation of mental health symptoms across both health and disease.


2020 ◽  
Author(s):  
Brett D. Thombs ◽  
Linda Kwakkenbos ◽  
Richard S. Henry ◽  
Marie-Eve Carrier ◽  
Scott Patten ◽  
...  

ABSTRACTBackgroundNo studies have reported comparisons of mental health symptoms prior to and during COVID-19 in vulnerable populations. Objectives were to compare anxiety and depression symptoms among people with a pre-existing medical condition, the autoimmune disease systemic sclerosis (SSc; scleroderma), including continuous change scores, proportion with change ≥ 1 minimal clinically important difference (MCID), and factors associated with changes, including country.MethodsPre-COVID-19 Scleroderma Patient-centered Intervention Network Cohort data were linked to COVID-19 data collected April 9 to April 27, 2020. Anxiety symptoms were assessed with the PROMIS Anxiety 4a v1.0 scale (MCID = 4 points) and depression symptoms with the Patient Health Questionnaire-8 (MCID = 3 points). Multiple linear and logistic regression were used to assess factors associated with continuous change and change ≥ 1 MCID.FindingsAmong 435 participants (Canada = 98; France = 159; United Kingdom = 50; United States = 128), mean anxiety symptoms increased 4.9 points (95% confidence interval [CI] 4.0 to 5.7). Depression symptom change was negligible (0.3 points; 95% CI −0.7 to 0.2). Compared to France, adjusted scores from the United States and United Kingdom were 3.8 points (95% CI 1.7 to 5.9) and 2.9 points higher (95% CI 0.0 to 5.7); scores for Canada were not significantly different. Odds of increasing by ≥ 1 MCID were twice as high for the United Kingdom (2.0, 95% CI 1.0 to 4.2) and United States (1.9, 95% CI 1.1 to 3.2). Participants who used mental health services pre-COVID had adjusted increases 3.7 points (95% CI 1.7 to 5.7) less than other participants.InterpretationAnxiety symptoms, but not depression symptoms, increased dramatically during COVID-19 among people with a pre-existing medical condition. Increase was larger in the United Kingdom and United States than in Canada and France but substantially less for people with pre-COVID-19 mental health treatment.RESEARCH IN CONTEXTEvidence before this studyWe referred to a living systematic review that is evaluating mental health changes from pre-COVID-19 to COVID-19 by searching 7 databases, including 2 Chinese language databases, plus preprint servers, with daily updates (https://www.depressd.ca/covid-19-mental-health). As of June 13, 2020, only 5 studies had compared mental health symptoms prior to and during COVID-19. In 4 studies of university students, there were small increases in depression or general mental health symptoms but minimal or no increases in anxiety symptoms. A general population study from the United Kingdom reported a small increase in general mental health symptoms but did not differentiate between types of symptoms. No studies have reported changes from pre-COVID-19 among people vulnerable due to pre-existing medical conditions. No studies have compared mental health changes between countries, despite major differences in pandemic responses.Added value of this studyWe evaluated changes in anxiety and depression symptoms among 435 participants with the autoimmune condition systemic sclerosis and compared results from Canada, France, the United Kingdom, and the United States. To our knowledge, this is the first study to compare mental health symptoms prior to and during COVID-19 in any vulnerable population. These are the first data to document the substantial degree to which anxiety symptoms have increased and the minimal changes in depression symptoms among vulnerable individuals. It is also the first study to examine the association of symptom changes with country of residence and to identify that people receiving pre-COVID-19 mental health services may be more resilient and experience less substantial symptom increases than others.Implications of all the available evidenceAlthough this was an observational study, it provided evidence that vulnerable people with a pre-existing medical condition have experienced substantially increased anxiety symptoms and that these increases appear to be associated with where people live and, possibly, different experiences of the COVID-19 pandemic across countries. By comparing with evidence from university samples, which found that depression symptoms were more prominent, these data underline the need for accessible interventions tailored to specific needs of different populations. They also suggest that mental health treatments may help people to develop skills or create resilience, which may reduce vulnerability to major stressors such as COVID-19.


2020 ◽  
Vol 26 (4) ◽  
pp. 370-387 ◽  
Author(s):  
Shannon L. Wagner ◽  
Nicole White ◽  
Cheryl Regehr ◽  
Marc White ◽  
Lynn E. Alden ◽  
...  

2021 ◽  
Author(s):  
Laura Hammond ◽  
Richard Meiser-Stedman ◽  
Anna McKinnon ◽  
Tim Dalgleish ◽  
Patrick Smith ◽  
...  

Post-traumatic stress disorder (PTSD) experienced by children can have a large impact on the wider family. The National Institute for Health and Care Excellence (NICE, 2018) recommend that parents are involved in their child’s PTSD treatment. Studies have found that parents themselves also report high levels of PTSD and other mental health symptoms but few have explored whether these symptoms reduce following their child receiving trauma-focused CBT. In this study, parents (N=29) whose children (ages 8-17 years) were randomly assigned to either 10 sessions of Cognitive Therapy for PTSD (CT-PTSD) or a wait-list control condition (WL) completed the Post Traumatic Stress Diagnostic Scale (PDS), the Patient Health Questionnaire (PHQ-9; to measure depression), the Generalised Anxiety Disorder Questionnaire (GAD-7), and the General Health Questionnaire (GHQ-28; to measure general mental health) for pre-post comparison. Parents whose children were allocated to CT-PTSD reported greater improvements on self-report PTSD, depression, anxiety and general mental health, relative to the WL condition. This trial provides preliminary support for the efficacy of CT-PTSD delivered to children for reducing parent PTSD, depression, anxiety and general mental health symptoms. Replication is needed as well as further exploration of parent factors and frequency of parental involvement required to predict improvements.


Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Kathleen M McTigue ◽  
Elan Cohen ◽  
Alison Hipwell ◽  
Charity Moore ◽  
Rolf Loeber ◽  
...  

Introduction Obesity and mental health problems are increasing in youth; both are often under-treated. The interplay between mental health and body weight development in adolescent girls is not well understood. Hypothesis Bi-directional associations will be established between mental health symptoms (depression and conduct symptoms) and BMI in urban pre-adolescent girls. Methods We examined data from participants in an accelerated longitudinal cohort study of largely disadvantaged urban girls from a single US city (n=2,451; 53% African American). Data were collected annually over 6 years, starting in 2003 when girls were age 8-11. Depression and conduct symptoms (oppositional defiant disorder and conduct disorder symptoms combined) were collected via the validated Child Symptom Inventory (CSI-4) and height and weight were measured. Transitional models assessed for bi-directional associations between mental health symptoms and BMI. Random-effects mixed models identified within-subject and between-subject effects in models examining whether mental health symptoms predicted BMI. All models were adjusted for race, age, and receipt of public assistance, and when applicable, included interaction terms. Results Transitional models showed that prior depression symptoms (β=0.27; p<0.001) predicted an increase in BMI while prior conduct symptoms (β=0.04; p=0.05) showed a small and borderline significant effect on BMI. An increase in prior BMI predicted an increase in depression symptoms (β=0.074, p<0.001) but not conduct symptoms (β=0.028, p=0.125). Mixed models revealed significant between-girl and within-girl effects (β = 0.38 and 0.038, respectively, both with p<0.001) for depression symptoms predicting BMI. Conduct symptoms showed a significant between-girl effect (β=0.51; p=0.045) but a non-significant within-girl effect (β=0.011; p=0.080) when used to predict BMI. Conclusions We identified a clear bi-directional relationship between depression symptoms and BMI in under-privileged girls, and mixed models confirmed that a change in depression score is associated with increased BMI. While an increase in conduct symptoms shows a weak positive association with BMI, the association was not bi-directional. The potential for BMI and depression to each reinforce the other may represent a mechanism for the development of high-risk weight patterns in girls. Early identification of those at risk may facilitate preventive measures for both weight and mental health outcomes.


2021 ◽  
pp. 000486742110653
Author(s):  
Elizabeth M Westrupp ◽  
Christopher J Greenwood ◽  
Matthew Fuller-Tyszkiewicz ◽  
Craig A Olsson ◽  
Emma Sciberras ◽  
...  

Objective: To control a second-wave COVID-19 outbreak, the state of Victoria in Australia experienced one of the world’s first long and strict lockdowns over July–October 2020, while the rest of Australia experienced ‘COVID-normal’ with minimal restrictions. We (1) investigate trajectories of parent/child mental health outcomes in Victoria vs non-Victoria and (2) identify baseline demographic, individual and COVID-19-related factors associated with mental health trajectories. Methods: Online community sample of 2004 Australian parents with rapid repeated assessment over 14 time-points over April 2020 to May 2021. Measures assessed parent mental health (Depression, Anxiety and Stress Scales-21), child depression symptoms (13-item Short Mood and Feelings Questionnaire) and child anxiety symptoms (four items from Brief Spence Children’s Anxiety Scale). Results: Mental health trajectories shadowed COVID-19 infection rates. Victorians reported a peak in mental health symptoms at the time of the second-wave lockdown compared to other states. Key baseline predictors, including parent and child loneliness (standardized regression coefficient [β] = 0.09–0.46), parent/child diagnoses (β = 0.07–0.21), couple conflict (β = 0.07–0.18) and COVID-19 stressors, such as worry/concern about COVID-19, illness and loss of job (β = 0.12–0.15), predicted elevated trajectories. Effects of predictors on parent and child mental health trajectories are illustrated in an online interactive app for readers ( https://lingtax.shinyapps.io/CPAS_trend/ ). Conclusion: Our findings provide evidence of worse trajectories of parent and child mental health symptoms at a time coinciding with a second COVID-19 outbreak involving strict lockdown in Victoria, compared to non-locked states in Australia. We identified several baseline factors that may be useful in detecting high-risk families who are likely to require additional support early on in future lockdowns.


Author(s):  
Chi Young Oh ◽  
Rachel Kornfield ◽  
Emily G. Lattie ◽  
David C. Mohr ◽  
Madhu Reddy

2019 ◽  
Vol 53 (11) ◽  
pp. 707-721 ◽  
Author(s):  
João Mauricio Castaldelli-Maia ◽  
João Guilherme de Mello e Gallinaro ◽  
Rodrigo Scialfa Falcão ◽  
Vincent Gouttebarge ◽  
Mary E Hitchcock ◽  
...  

ObjectiveTo summarise the literature on the barriers to athletes seeking mental health treatment and cultural influencers of mental health in elite athletes.DesignSystematic reviewData sourcesPubMed, Cochrane, Scopus, SportDiscus (Ebsco), and PsycINFO (ProQuest) up to November 2018.Eligibility criteria for selecting studiesQualitative and quantitative original studies of elite athletes (those who competed at the professional, Olympic, or collegiate/university levels), published in any language.ResultsStigma, low mental health literacy, negative past experiences with mental health treatment-seeking, busy schedules, and hypermasculinity are barriers to elite athletes seeking mental health treatment. Cultural influencers of mental health in elite athletes include: (1) the lack of acceptance of women as athletes; (2) lower acceptability of mental health symptoms and disorders among non-white athletes; (3) non-disclosure of religious beliefs; and (4) higher dependence on economic benefits. Coaches have an important role in supporting elite athletes in obtaining treatment for mental illness. Brief anti-stigma interventions in elite athletes decrease stigma and improve literary about mental health.ConclusionThere is a need for various actors to provide more effective strategies to overcome the stigma that surrounds mental illness, increase mental health literacy in the athlete/coach community, and address athlete-specific barriers to seeking treatment for mental illness. In this systematic review, we identified strategies that, if implemented, can overcome the cultural factors that may otherwise limit athletes seeking treatment. Coaches are critical for promoting a culture within elite athletes’ environments that encourages athletes to seek treatment.


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