Time trends in mental health indicators during the initial 16 months of the COVID-19 pandemic in Denmark

Background The COVID-19 pandemic and its associated national lockdowns have been linked to deteriorations in mental health worldwide. A number of studies analysed changes in mental health indicators during the pandemic; however, these studies generally had a small number of timepoints, and focused on the initial months of the pandemic. Furthermore, most studies followed-up the same individuals, resulting in significant loss to follow-up and biased estimates of mental health and its change. Here we report on time trends in key mental health indicators amongst Danish adults over the course of the pandemic (March 2020 - July 2021) focusing on subgroups defined by gender, age, and self-reported previously diagnosed chronic and/or mental illness. Methods We used time-series data collected by Epinion (N=8,261) with 43 timepoints between 20 March 2020 and 22 July 2021. Using a repeated cross-sectional study design, independent sets of individuals were asked to respond to the Copenhagen Corona-Related Mental Health questionnaire at each timepoint, and data was weighted to population proportions. The six mental health indicators examined were loneliness, anxiety, social isolation, quality of life, COVID-19-related worries, and the mental health scale. Gender, age, and the presence of previously diagnosed mental and/or chronic illness were used to stratify the population into subgroups for comparisons. Results Poorer mental health were observed during the strictest phases of the lockdowns, whereas better outcomes occurred during reopening phases. Women, young individuals (<34 yrs), and those with a mental- and/or chronic illness demonstrated poorer mean time-series than others. Those with a pre-existing mental illness further had a less reactive mental health time-series. The greatest differences between women/men and younger/older age groups were observed during the second lockdown. Conclusions People with mental illness have reported disadvantageous but stable levels of mental health indicators during the pandemic thus far, and they seem to be less affected by the factors that result in fluctuating time-series in other subgroups.

Time trends with response-adaptive randomization: The inevitability of inefficiency

Response-adaptive randomization, which changes the randomization ratio as a randomized clinical trial progresses, is inefficient as compared to a fixed 1:1 randomization ratio in terms of increased required sample size. It is also known that response-adaptive randomization leads to biased treatment effects if there are time trends in the accruing outcome data, for example, due to changes in the patient population being accrued, evaluation methods, or concomitant treatments. Response-adaptive-randomization analysis methods that account for potential time trends, such as time-block stratification or re-randomization, can eliminate this bias. However, as shown in this Commentary, these analysis methods cause a large additional inefficiency of response-adaptive randomization, regardless of whether a time trend actually exists.

Impact of Hypertensive Disorders of Pregnancy on the Risk of Stroke Stratified by Subtypes and Follow-Up Time

Background and Purpose: Hypertensive disorders of pregnancy (HDP) comprise 4 subtypes. Previous studies have not investigated the relationship between stroke risk, different HDP subtypes, and follow-up time, which was the purpose of this study. Methods: Data of 17 588 women aged 18 to 45 years who had a history of HDP in Taiwan from 2000 to 2017 was retrospectively reviewed. After matching with confounders, 13 617 HDP women and 54 468 non-HDP women were recruited. Results: HDP women had an adjusted hazard ratio (aHR) of 1.71 (95% CI, 1.46−2.00) for stroke, and 1.60 (1.35−1.89) and 2.98 (2.13−4.18) for ischemic and hemorrhagic stroke, respectively ( P <0.001 for all). The overall stroke risk in the HDP group was still 2.04 times 10 to 15 years after childbirth (1.47−2.83, P <0.001). Although the risks of both ischemic and hemorrhagic stroke persisted, their risk time trends were different. The risk of ischemic stroke reached peak during 1 to 3 years after childbirth with an aHR of 2.14 (1.36–3.38), while hemorrhagic stroke risk gradually increased and had an aHR of 4.64 (2.47−8.73) after 10 to 15 years of childbirth (both P <0.001). Among the 4 HDP subtypes, chronic hypertension with superimposed preeclampsia had the highest stroke risk (aHR=3.86, 1.91−7.82, P <0.001), followed by preeclampsia–eclampsia (aHR=2.00, 1.63−2.45, P <0.001), and gestational hypertension (aHR=1.68, 1.13−2.52, P <0.05); chronic preexisting hypertension had the lowest stroke risk (aHR=1.27, 0.97−1.68, P >0.05). Furthermore, multiple HDP combined with preeclampsia had aHR of 5.48 (1.14−26.42, P <0.05). Conclusions: The effect of HDP on the risk of future stroke persisted for up to 17 years, both for ischemic and hemorrhagic strokes. The presence of multiple HDP and preeclampsia further increase the stroke risk.

Time trends, factors associated with, and reasons for COVID-19 vaccine hesitancy: A massive online survey of US adults from January-May 2021

Importance COVID-19 vaccine hesitancy has become a leading barrier to increasing the US vaccination rate. Objective To evaluate time trends in COVID-19 vaccine intent during the US vaccine rollout, and identify key factors related to and self-reported reasons for COVID-19 vaccine hesitancy in May 2021. Design, participants and setting A COVID-19 survey was offered to US adult Facebook users in several languages yielding 5,088,772 qualifying responses from January 6 to May 31, 2021. Data was aggregated by month. Survey weights matched the sample to the age, gender, and state profile of the US population. Exposure Demographics, geographic factors, political/COVID-19 environment, health status, beliefs, and behaviors. Main outcome measures “If a vaccine to prevent COVID-19 were offered to you today, would you choose to get vaccinated.” Hesitant was defined as responding probably or definitely would not choose to get vaccinated (versus probably or definitely would, or already vaccinated). Results COVID-19 vaccine hesitancy decreased by one-third from 25.4% (95%CI, 25.3, 25.5) in January to 16.6% (95% CI, 16.4, 16.7) in May, with relatively large decreases among participants with Black, Pacific Islander or Hispanic race/ethnicity and ≤high school education. Independent risk factors for vaccine hesitancy in May (N = 525,644) included younger age, non-Asian race, < 4 year college degree, living in a more rural county, living in a county with higher Trump vote share in the 2020 election, lack of worry about COVID-19, working outside the home, never intentionally avoiding contact with others, and no past-year flu vaccine. Differences in hesitancy by race/ethnicity varied by age (e.g., Black adults more hesitant than White adults <35 years old, but less hesitant among adults ≥45 years old). Differences in hesitancy by age varied by race/ethnicity. Almost half of vaccine hesitant respondents reported fear of side effects (49.2% [95%CI, 48.7, 49.7]) and not trusting the COVID-19 vaccine (48.4% [95%CI, 48.0, 48.9]); over one-third reported not trusting the government, not needing the vaccine, and waiting to see if safe. Reasons differed by degree of vaccine intent and by race/ethnicity. Conclusion COVID-19 vaccine hesitancy varied by demographics, geography, beliefs, and behaviors, indicating a need for a range of messaging and policy options to target high-hesitancy groups.

Time trends and social inequalities in child malnutrition: nationwide estimates from Brazil’s Food and Nutrition Surveillance System, 2009-2017

Objective: In Brazil, national estimates of childhood malnutrition have not been updated since 2006. The use of health information systems is an important complementary data source for analysing time trends on health and nutrition. This study aimed to examine temporal trends and sociodemographic inequalities in the prevalence of malnutrition in children attending primary health care services between 2009 and 2017. Design: Time trends study based on data from Brazil’s Food and Nutrition Surveillance System. Malnutrition prevalence (stunting, wasting, overweight, and double burden) was annually estimated by sociodemographic variables. Prais-Winsten regression models were used to analyse time trends. Annual percent change (APC) and 95% confidence intervals (95%CI) were calculated. Setting: Primary health care services, Brazil. Participants: Children under five years old. Results: In total, 15,239,753 children were included. An increase in the prevalence of overweight (APC=3.4%; p=0.015) and a decline in the prevalence of wasting (-6.2%; p=0.002) were observed. The prevalence of stunting (-3.2%, p=0.359) and double burden (-1.4%, p=0.630) had discrete and non-significant reductions. Despite the significant reduction in the prevalence of undernutrition among children in the most vulnerable subgroups (black, conditional cash transfer’s recipients, and residents of poorest and less developed areas), high prevalence of stunting and wasting persist alongside a disproportionate increase in the prevalence of overweight in these groups. Conclusions: The observed pattern in stunting (high and persistent prevalence) and increase in overweight elucidates setbacks in advances already observed in previous periods and stress the need for social and political strategies to address multiple forms of malnutrition.

Diversity in Psychological Research Activities: Quantitative Approach With Topic Modeling

Recent cultural studies have discussed universality and diversity in human behavior using numerous samples investigated worldwide. We aimed to quantitatively extend this discussion to various research activities in psychology in terms of geographic regions and time trends. Most psychology departments have specialists in various fields of psychology. Further, research institutions in all regions typically aim to provide systematic and balanced research education. Nevertheless, most researchers recognize universal features and patterns of diversity in research activities in psychology in terms of regional differences and time trends. However, these arguments remain intuitive and vague, and no studies have conducted quantitative analyses. To this end, we conducted topic modeling for the abstracts of psychological articles with the regions of author affiliations and publication periods as covariates. The results showed that the topic proportions related to basic research were high in North-Central America, whereas those related to clinical research were high in Europe. Interestingly, the regional differences shown by topic modeling were not observed in the frequency analysis of keywords, indicating that topic modeling revealed implicit characteristics. Moreover, we observed an increasing trend of neuroscience topics across publication periods. However, this trend was not valid for the psychology journal Psychological Science. Taken together, our results suggest diversity of geographic regions and periods in research activities in psychology. More importantly, our findings indicate that universality holds neither for human behavior nor research activities on human mental processes.