Food insecurity and mental health among US adults during the COVID-19 pandemic: Results from National Health Interview Survey, 2020-2021.

OBJECTIVE: To examine socio-demographic disparities in food insecurity during the COVID-19 pandemic and the association between food insecurity and mental health among US adults overall and communities vulnerable to food insecurity. METHODS: A cross-sectional study was conducted using the 2020-2021 National Health Interview Survey of 57,456 US adults. Weighted multivariable logistic regression models were used to estimate the association between food insecurity and anxiety or depression symptoms in overall US adults and subgroups including young adults (18-34 years), females, Hispanic people, non-Hispanic Black people, individuals with prior COVID-19 infection, the unemployed, low-income participants, participants with children, and Supplemental Nutrition Assistance Program (SNAP) participants. RESULTS: Young or middle age, female sex, Hispanic/non-Hispanic Black/other race/ethnicity, lower education level, unmarried/other marital status, unemployment, being below the federal poverty level, and greater number of persons in the household were associated with food insecurity (AOR ranged from 1.35 to 2.70, all p < 0.05). Food insecurity was independently associated with anxiety (AOR = 2.67, 99 % CI: 2.33, 3.06) or depression (AOR = 3.04, 99 % CI: 2.60, 3.55) symptoms in the overall adults. Significant associations between food insecurity and anxiety or depression symptoms were also observed in all subgroups (AOR ranged from 1.95 to 3.28, all p < 0.0001). Compared with overall adults, the magnitude of the association was greater for participants with children, females (for depression only), and non-Hispanic Black people (for depression only). LIMITATIONS: The cross-sectional design prevents inference of causality. CONCLUSIONS: Comprehensive policies are needed to ensure accessible and affordable food resources to reduce disparities in food insecurity and improve mental health, especially for those socioeconomically disadvantaged communities.

Assessment of quality of life, psychosocial, and epidemiological aspects in patients diagnosed with tuberculous uveitis.

PURPOSE: To assess the quality of life in patients diagnosed as having tuberculous uveitis and its association with sociodemographic, clinical, and psychosocial aspects. METHOD: By conducting standardized interviews, clinical and demographic data were collected using a measure developed in this study. This measure was applied in addition to other measures, namely SF-12, Hospital Anxiety and Depression Scale, and NEI-VFQ-39, which were used to assess health-related quality of life, anxiety and depression symptoms, and visual functioning. RESULTS: The study included 34 patients [mean age: 46.5 ± 15.1 years, female patients: 21 (61.8%)]. The mean of the VFQ-39 score was 74.5 ± 16.6 and that of SF-12 physical and mental component scores were 45.8 ± 10.1 and 51.6 ± 7.5, respectively, for the health-related quality of life. Anxiety symptoms were the most prevalent compared with depression symptoms and were found in 35.3% of the participants. CONCLUSION: Tuberculous uveitis affects several scales of quality of life, thereby affecting a population economically active with a social, psychological, and economic burden.

The effect of actual and expected income shocks on mental wellbeing: Evidence from three East Asian countries during COVID-19.

This paper evaluates the effects of economic shocks to current and expected income reduction on mental wellbeing. We use individual-level data from three East Asian countries; China, Japan, and South Korea, during the early phases of the pandemic when the COVID-induced economic shocks were severe. The findings reveal significant causal effects from current and expected income reduction on different aspects of mental health deterioration, including anxiety, trouble sleeping, boredom, and loneliness. Interestingly, we found that expectations of future income loss have a significantly larger effect on people's mental wellbeing compared to current falls in income. This has significant implications for the design of policies to support income during pandemics.

COVID-19-Related Financial Hardship Is Associated With Depression and Anxiety in Substance Use Treatment Across Gender and Racial Groups.

ABSTRACT: Many individuals lost their employment during the COVID-19 pandemic and experienced financial hardship. These experiences may increase risk for co-occurring conditions, including substance use disorders (SUDs) and related symptoms of depression and anxiety. This study aimed to examine the associations between COVID-19-related financial hardship and/or job loss and co-occurring symptoms, across gender and racial groups. Respondents (N = 3493) included individuals entering SUD treatment in the United States in March-October of 2020. Results demonstrated that COVID-19-related financial hardship and unemployment in the household was associated with greater depression and anxiety severity among people in SUD treatment (p's < 0.05). Our findings highlight financial hardship and loss of employment as risk factors for co-occurring depression and anxiety. However, additive effects between marginalized identity status and COVID-19 economic hardship on co-occurring symptoms were not observed.

Economic costs of perinatal depression and anxiety in a lower middle income country: Pakistan.

BACKGROUND: Women's mental health during the perinatal period is a major public health problem in Pakistan. Many challenges and competing priorities prevent progress to address the large treatment gap. Aim To quantify the long-term impacts of untreated perinatal depression and anxiety in economic terms, thus highlighting its overall burden based on country-specific evidence. METHODS: Cost estimates were generated for a hypothetical cohort of women giving birth in 2017, and their children. Women and children experiencing adverse events linked to perinatal mental health problems were modelled over 40 years. Costs assigned to adverse events included were those linked to losses in quantity and quality-of-life, productivity, and healthcare-related expenditure. Present values were derived using a discount rate of 3 %. Data were taken from published cohort studies, as well as from sources of population, economic and health indicators. RESULTS: The total costs were $16.5 billion for the cohort and $2680 per woman giving birth. The by far largest proportion referred to quality-of-life losses ($15.8 billion). Productivity losses and out-of-pocket expenditure made up only a small proportion of the costs, due to low wages and market prices. When the costs of maternal suicide were included, total costs increased to $16.6 billion. LIMITATIONS: Important evidence gaps prevented the inclusion of all cost consequences linked to perinatal mental health problems. CONCLUSIONS: Total national costs are much higher compared with those in other, higher middle-income countries, reflecting the excessive disease burden. This study is an important first step to inform resource allocations.

A prospective study of financial worry, mental health changes and the moderating effect of social support among Canadian adolescents during the COVID-19 pandemic. / Étude prospective des préoccupations financières, des changements de l'état de santé mentale et de l'effet modérateur du soutien social chez les adolescents canadiens pendant la pandémie de COVID-19.

INTRODUCTION: The COVID-19 pandemic intensified the impact of risk factors for adolescent mental health, including financial worry. Social support has shown to protect from negative mental health during times of stress. We examined the effect of financial worry on changes in anxiety and depression symptoms among Canadian adolescents prior to and during the pandemic, and assessed whether social support from family and friends moderated any changes. METHODS: We analyzed 2-year linked data from the 2018/19 (pre-pandemic) and 2020/21 (during-pandemic) waves of the COMPASS study, with reports from 12 995 Canadian secondary school students. A series of multilevel linear regressions were conducted to examine the main hypotheses under study. RESULTS: Students scored an average (SD) of 7.2 (5.8) on the anxiety (GAD-7) and 10.0 (6.5) on the depression (CESD-10) scales; 16.1% reported they experienced financial worry during the pandemic. Financial worry was a strong and significant predictor of increased anxiety scores (+1.7 score between those reporting "true/mostly true" versus "false/mostly false") during the pandemic, but not for depression scores. Low family and friend support were associated with anxiety, and low family support was associated with depression. No significant interactions were detected between social support and financial worry. CONCLUSIONS: Pandemic-related financial worry was significantly associated with anxiety in our large sample of Canadian adolescents. Clinical and public health initiatives should be aware of adolescents' financial worry and its associations with anxiety during times of crisis.

Assessment of sleep disturbance in patients with Wilson's disease.

BACKGROUND: Wilson's disease (WD) is frequently manifested with anxiety, depression and sleep disturbance; this investigation aimed to elucidate these manifestations and identify the influencing factors of sleep disturbance. METHODS: Sleep disturbance, anxiety and depression were compared in 42 WD and 40 age- and gender-matched healthy individuals. 27 individuals indicated a neurological form of the disease (NV), and 15 had a non-neurological variant (NNV). RESULTS: This investigation revealed that the Parkinson's disease sleep scale (PDSS) score of WD individuals was lower, whereas their Epworth Sleepiness Scale (ESS), Pittsburgh sleep quality index (PSQI), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD) scores were higher than the healthy individuals (p < 0.05). Furthermore, the WD subjects had markedly increased prevalence of poor sleep quality, anxiety, and depression than healthy individuals (p < 0.05). Subgroup analysis showed that NV subjects had significantly higher scores on the UWDRS, PSQI, HAMA, and HAMD scales than those in the NV group, as well as higher rates of EDS, anxiety, and depression (p < 0.05). In patients with sleep disturbance, we identified UWDRS, neurological variant, and depression as associated factors. The linear regression model demonstrated depression as the dominant risk factor. CONCLUSIONS: Depression is highly correlated with and is a determinant of sleep disturbance in WD patients.

The "bubbles"-study: Validation of ultra-short scales for the assessment of depression, anxiety and stress symptoms.

Depression, anxiety and stress symptoms cause substantial psychological and economic burdens around the globe. To mitigate the negative consequences, the negative symptoms should be identified at an early stage. Therefore, the implementation of very brief valid screening tools in mental health prevention programs and in therapeutic settings is advantageous. In two studies on representative German population samples, we developed and validated three ultra-short scales-the "bubbles"-that consist of only one item based on the Depression Anxiety Stress 21 subscales (DASS-21) for the assessment of depression, anxiety and stress symptoms. The results of Study 1 (N = 1,001) and Study 2 (N = 894) revealed that the bubbles are valid instruments that fit the DASS-21 subscales on the factor level. Moreover, the bubbles replicated the association pattern of the DASS-21 subscales with demographic variables, and with variables that belong to the negative and the positive dimension of mental health. Thus, due to their time- and cost-efficiency, the bubbles can be used as brief screening tools in research (e.g., large-scale studies, longitudinal studies, experience sampling paradigms) and in praxis. Their shortness can prevent fatigue, motivation decrease, and participants' drop-out.

Assessment of physicians' career satisfaction in the Silesian Voivodeship, Poland.

OBJECTIVE: Aim: To assess the career satisfaction of physician's in the Silesian Voivodeship, Poland, in relation to selected factors. PATIENTS AND METHODS: Materials and Methods: The questionnaire survey was conducted among 701 physicians and dentists from the Silesian Voivodeship, Poland, in the period from January to December 2018, using the PAPI (Paper and Pencil Interview) method. Physicians' Career Satisfaction was measured and basic socio-demographic, economic and occupational data, concerning lifestyle and health, and also the level of life satisfaction according to the SWLS (Satisfaction with Life Scale) were collected. Moreover, the occurrence of anxiety and/or depressive symptoms according to the HADS (Hospital Anxiety and Depression Scale) were included in the analyses. RESULTS: Results: The career satisfaction of the surveyed Silesian physicians and dentists was moderate. Wages and combining personal life with work were rated the lowest, while interpersonal opportunities were rated the highest. The predictors: age, economic status and body mass index (BMI) were significant; in addition, in younger age group (25-49 years) - practicing sports and chronic fatigue, and in older age group (50-80 years) - the presence of a chronic disease. A moderate correlation between the level of career satisfaction and life satisfaction was revealed, as well as a lower score in people with the occurrence of anxiety and/or depression symptoms. CONCLUSION: Conclusions: The diversified level of career satisfaction of physicians in separated aspects makes it necessary to verify them both at the level of health care units and at higher levels.

The Association between High-Caffeine Drink Consumption and Anxiety in Korean Adolescents.

BACKGROUND: As excessive caffeine intake may be associated with anxiety disorders, one of the most prevalent mental illnesses among adolescents globally, this study investigated the association between high caffeine consumption and anxiety in a nationally representative sample of South Korean adolescents. METHODS: 46,873 participants from the Korea Youth Risk Behavior Web-based Survey (KYRBS) 2022 were included. The Generalized Anxiety Disorder-7 (GAD-7) questionnaire was used to evaluate anxiety symptoms. Survey questions determined the number of times each participant consumed high-caffeine drinks per week. The chi-square test was used to investigate and compare the general characteristics of the study population, and a modified Poisson regression was used to analyze the relationship. RESULTS: Both male and female participants reporting excessive high-caffeine drink consumption exhibited higher anxiety levels (adjusted prevalence ratio [aPR]: 1.19, 95% confidence interval [CI]: 1.08-1.31 in males; aPR: 1.14, CI: 1.05-1.23 in females). This association remained statistically significant in subgroup analyses, particularly among high school students and those with a shorter sleep duration. The relationship between high-caffeine drink consumption and anxiety strengthened with increasing anxiety levels. Additionally, there was a dose-dependent relationship between the prevalence of anxiety and high-caffeine drinks. CONCLUSION: High caffeine consumption increases anxiety in South Korean adolescents. This association proved consistent regardless of sex or other socioeconomic factors.

The Association of Frequency of Worry About Financial Debt With Substance Use Among Adults in Ontario, Canada.

BACKGROUND: Financial debt and associated stress might increase the risk of substance use problems or exacerbate existing ones. Little evidence is available about the degree of debt stress and its association with substance use. The objective of this study was to examine the associations of the frequency of worry about debt with heavy episodic drinking (HED), daily smoking, e-cigarette use, and cannabis use in the past 30 days. METHODS: Data were utilized from the 2020/2022 Monitor study, a repeated cross-sectional survey of adults 18 years and older in Ontario, Canada. The surveys employed a web-based panel survey of 6038 adults and collected data on debt-related stress, HED, tobacco smoking, e-cigarettes, and cannabis use in the past 30 days. Odds ratios (OR) were estimated from logistic regression models accounting for sociodemographic factors. RESULTS: Overall, 18.4% of respondents reported that they were worried about their debt most or all of the time. Accounting for household income, educational status, employment status, and other factors, the results revealed that there was a dose-response relationship between the frequency of worry about debt and substance use including daily smoking, e-cigarette use, and cannabis use in the past 30 days compared to those who were not worried at all about their debt. Sex differences were also found in the association between worry about debt and e-cigarette use. CONCLUSIONS: The frequency of worry about debt might have an important role in substance use, which suggests that financial well-being is vital in substance use prevention and harm reduction.

Prevalence, assessment and correlates of mental health problems in neglected tropical diseases: a systematic review.

Neglected tropical diseases (NTDs) are a group of disease conditions that affect the world's poorest people in low- and middle-income countries. NTDs are associated with negative behavioural experiences, including discrimination, rejection and stigmatization, that predisposes those affected to mental health problems. Consequently, researchers have shown profound interest in elucidating the mental health burden associated with NTDs. To address pertinent issues in the burgeoning literature relating to the prevalence, assessment and correlates of mental health problems in NTDs, a systematic review methodology was used. Underpinned by the PRISMA guidelines, a search was conducted of electronic databases, individual journals and bibliographies for articles that were screened and subjected to predetermined inclusion and exclusion criteria. Sixteen articles from African, Asian and South American countries were included in the review. Depression was the most widely investigated mental health issue, followed by stress and anxiety, with prevalence estimates of 7-54%, 8-43% and 19-53%, respectively. The PHQ-9 and GAD-7 and Self-Reporting Questionnaire were the most widely administered mental health screening tools. The major correlates of mental health problems are lower education and economic status and female gender. We recommend multisectoral and multilayered mental health and related interventions to address the increasing burden of mental health in NTDs.

A Fresh Perspective on Examining Population Emotional Well-Being Trends by Internet Search Engine: An Emerging Composite Anxiety and Depression Index.

Traditional assessments of anxiety and depression face challenges and difficulties when it comes to understanding trends in-group psychological characteristics. As people become more accustomed to expressing their opinions online, location-based online media and cutting-edge algorithms offer new opportunities to identify associations between group sentiment and economic- or healthcare-related variables. Our research provides a novel approach to analyzing emotional well-being trends in a population by focusing on retrieving online information. We used emotionally enriched texts on social media to build the Public Opinion Dictionary (POD). Then, combining POD with the word vector model and search trend, we developed the Composite Anxiety and Depression Index (CADI), which can reflect the mental health level of a region during a specific time period. We utilized the representative external data by CHARLS to validate the effectiveness of CADI, indicating that CADI can serve as a representative indicator of the prevalence of mental disorders. Regression and subgroup analysis are employed to further elucidate the association between public mental health (measured by CADI) with economic development and medical burden. The results of comprehensive regression analysis show that the Import-Export index (-16.272, p < 0.001) and average cost of patients (4.412, p < 0.001) were significantly negatively associated with the CADI, and the sub-models stratificated by GDP showed the same situation. Disposable income (-28.389, p < 0.001) became significant in the subgroup with lower GDP, while the rate of unemployment (2.399, p < 0.001) became significant in the higher subgroup. Our findings suggest that an unfavorable economic development or unbearable medical burden will increase the negative mental health of the public, which was consistent across both the full and subgroup models.

Social participation of rheumatoid arthritis patients: Does illness perception play a role?

OBJECTIVE: Social participation is an important aspect associated with health-related outcomes in chronic diseases. However, little is known about the factors that may affect participation in patients with rheumatoid arthritis (RA). We aimed to examine whether pain, fatigue, anxiety, depression, and illness perception are associated with social participation in patients with RA when controlled for clinical and sociodemographic variables. We also analysed the mediating role of illness perception in the association between physical and psychological variables on social participation. METHOD: We included 157 RA patients (84.7% females; mean age 56.4 ± 13.9 years) who completed the Participation Scale, Brief Illness Perception Questionaire, Generalized Anxiety Disorder Scale, Patient Health Questionnaire, 36-item Short Form Health Survey, and the Visual Analogue Scale. Multiple linear regressions and mediation analyses were used to analyze the data. RESULTS: In the final regression models, illness perception (ß = .42; p ≤ .001) and functional disability (ß = .21; p ≤ .05) were associated with social participation. Income (ß = -.18; p ≤ .05) lost its significance when physical variables were added to the model, and pain (ß = .24; p ≤ .05) and fatigue (ß = -.24; p ≤ .05) when psychological distress was added. No significant role of anxiety, depression, disease activity, or age was identified using regression analyses. Illness perception mediated the association of pain, fatigue, anxiety, and depression with social participation, and the indirect effect varied from 65% to 98%. CONCLUSIONS: Illness perceptions may significantly diminish the impacts of pain, fatigue, anxiety, and depression on social participation in individual RA patients. Therefore, RA patients could benefit from psychological interventions aimed at tackling negative illness perceptions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Trends in the disease burden of anxiety disorders in middle-aged and older adults in China.

BACKGROUND: Anxiety disorders in middle-aged and older adults are an important public health concern in China. Based on the data in the global disease burden (GDB) research database, this study evaluated and analyzed the trend of the disease burden of middle-aged and older patients living with anxiety in China in the past 30 years. METHODS: The incidence and disability-adjusted life years (DALYs) data of anxiety disorders in China for individuals aged 45-89 years were collected from the Global Burden of Disease Study 2019, and the effects of age, period, and cohort on the incidence of and DALY rate for anxiety disorders were analysed using an age-period-cohort model. Because of the COVID-19 pandemic, the global disease burden research database has not been updated since 2019. However, this did not affect the analysis of future trends in this study, which combined data in the past three decades from 1990 to 2019. RESULTS: (1) The overall age-standardised incidence rate (ASIR) and age-standardised DALY rate (ASDR) for anxiety disorders in middle-aged and older adults in China decreased by 4.0 and 7.7% from 1990 to 2019, respectively, and the ASIR and ASDR were always higher in women than in men. (2)Age-period-cohort analysis showed that the net drifts for incidence and DALY rate were - 0.27% and - 0.55% per year, respectively. For both genders, the local drifts for incidence were lower than zero in those aged 45-79 years and higher than zero in those aged 80-89 years; the local drifts for the DALY rate were lower than zero in all groups. (3) From the 1990-1994 to 2015-2019, the relative risks of anxiety disorder incidence and DALY decreased by 5.6 and 7.3% in men and 4.3 and 11.7% in women, respectively. CONCLUSION: The disease burden of anxiety disorders in middle-aged and older adults in China has been relieved over the past 30 years; however, recent ASDR, ASDR, period, and cohort effects have shown adverse trends. The incidence and DALY rate decreased with age in women, while men showed a trend of increasing first and decreasing afterwards.

Assessment of health-related quality of life in patients with burns injuries during the COVID-19 epidemic: A critical topic for burn survivors.

PURPOSE: It is well known that the coronavirus disease 19 (COVID-19) epidemic had an adverse effect on the health-related quality of life (HRQOL) of patients with disabilities, or neurological or chronic conditions. The aim of this study was to examine the possible factors affecting HRQOL in patients with burn injuries during COVID-19 epidemic. METHODS: The study included a total of 40 burns patients. The demographic and burn injury information of the patients were recorded. The active range of motion was measured with a goniometer. The HRQOL, community integration, scar tissue quality and anxiety level were evaluated using the Burn-Specific Health Scale (BSHS), the Community Integration Questionnaire Revised (CIQ-R), Patient and Observer Scar Assessment Scale, and the State-Trait Anxiety Inventory, respectively. RESULTS: The history of COVID-19 infection, total burn surface area (TBSA), community integration level, work-related burns, the presence of trunk burn injury, the presence of face burn injury, and the presence of a major burn injury were determined to be significantly associated with the HRQOL of burns patients (p < 0.05). CONCLUSION: The history of COVID-19 infection, community integration level, and burn-related parameters (TBSA, localization, severity etc.) were found to be factors associated with the HRQOL during the epidemic. The history of COVID-19 and community integration level should be evaluated in addition to the burn injury parameters to improve the quality of life of burn survivors. It can be recommended that these clinical parameters should be considered when planning the treatment program during and after the epidemic.

Depression, anxiety and stress among female student-athletes: a systematic review and meta-analysis.

OBJECTIVE: To identify, quantify and analyse determinants of depression, anxiety and stress symptoms among female student-athletes. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Five online databases (PubMed, CINAHL, PsychInfo, SportDiscus and Web of Science) searched from inception through 14 September 2023. Hand-searches and contacting authors for eligible studies. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Articles were included if they were published in English, included female student-athletes competing at National Collegiate Athletic Association institutions, and measured symptom-level depression, anxiety and/or stress. RESULTS AND SUMMARY: We screened 2415 articles; 52 studies (N=13 849) were included in the systematic review with 13 studies qualifying for meta-analysis. Seventeen determinants were identified including injury (eg, concussions), health (eg, sleep hygiene) and social factors (eg, social support). As data specific to female student-athletes was delineated from studies that included other populations, we observed 16 studies (30.7%) reported that identifying as female was a meaningful determinant of depression, anxiety and stress in athletes. Results of the meta-analysis (k=13, N=5004) suggested a small but significant association (r=0.15, 95% CI 0.05 to 0.24, p=0.004) between other determinants and depression, anxiety, and stress among female student-athletes. CONCLUSION: Coaches, trainers and clinicians are key contributors in supporting female student-athlete mental health, with responsibilities for integrating mental skill training, sleep hygiene education and regular assessments. Comprehensive mental health and tailored education programmes considering determinants such as injury, health and social factors specific to female student-athletes are needed to enhance mental health equity in sport. PROSPERO REGISTRATION NUMBER: CRD42022362163.

Management of polycystic ovary syndrome must include assessment and treatment of mental health symptoms.

Polycystic ovary syndrome (PCOS) is an endocrine disorder with reproductive and metabolic manifestations affecting millions of women worldwide. The health risks associated with PCOS, however, go beyond physical health. Over the past decade, data have emerged demonstrating a high risk of concurrent mental health conditions, specifically depression and anxiety, but extending into other aspects of psychological health, including body image distress, eating disorders, and sexual dysfunction. International surveys suggest physician knowledge about the mental health associations with PCOS is poor and that patients are often dissatisfied regarding counseling-related psychological issues. We performed a review of mental health comorbidities in individuals with PCOS, including depression, anxiety, body image distress, eating disorders, psychosexual dysfunction, and decreased quality of life, as well as evaluated the impact of common PCOS treatments on these conditions. Most meta-analyses in reproductive age women demonstrate increased risks of these conditions, although data are more limited in adolescents and older adults. In addition, the impact of PCOS treatments on these conditions as well as data on first-line treatments in the PCOS population is limited. All providers involved in the multidimensional care of individuals with PCOS should be aware of these mental health risks to provide appropriate screening, counseling and referral options. Future studies should be designed to evaluate targeted treatment for individuals with PCOS.

Prevalence of anxiety and depression and the association with self-management behaviour in >12 000 patients with inflammatory rheumatic disease: a cross-sectional nationwide study.

OBJECTIVE: To investigate the prevalence of anxiety and depression among patients with inflammatory arthritis (IA) and evaluate the association of these mental health issues with self-management behaviour. METHODS: In this nationwide cross-sectional study, we analysed data from 12 713 adult Danish patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) or spondyloarthritis (SpA). Patients received an electronic questionnaire covering sociodemographics, self-management behaviour and mental health status. Questionnaire data were linked to clinical data from the Danish Rheumatology database (DANBIO) and the Danish National Patient Registry. The prevalence of anxiety and depression (by the Hospital Anxiety and Depression Scale for Anxiety (HADS-A) and Depression (HADS-D)) was estimated separately for RA/PsA/SpA. The association between mental health status and low self-management behaviour (adherence to treatment, health activation and physical activity) was estimated using multivariable logistic regression, adjusting for age, sex, educational level and comorbidity. RESULTS: The prevalence of anxiety (HADS-A≥8) was highest for patients with SpA (34.5% (95% CI 32.4% to 36.6%)) and lowest for patients with RA (22.1% (95% CI 21.2% to 23.0%)), it was higher for women, younger (<55 years) and recently diagnosed (<3 years) patients and those with basic education. Similar prevalence estimates were found for depression. Across diagnoses, the clinically relevant symptoms of anxiety and depression (HADS≥8) were significantly associated with low self-management behaviour. CONCLUSION: Patients with IA showed substantial levels of anxiety and depression. A statistically significant association between anxiety and depression and low self-management behaviour was identified. These findings call for a systematic approach to identifying mental health issues in patients with IA.

Health care access, psychosocial outcomes and mental health in adults living with epilepsy during the COVID-19 pandemic.

PURPOSE: People living with epilepsy (PLWE) have a higher prevalence of mental health comorbidities and poorer psychosocial outcomes compared to the general population. The aim of this study was to examine psychosocial outcomes, mental health, healthcare accessibility, and seizure burden in PLWE during the COVID-19 pandemic. METHODS: We conducted a cross-sectional study of adults with epilepsy treated in an urban multicenter health system from 2021 to 2022. A standardized questionnaire assessed for COVID-19 history, comorbidities, access to antiseizure medications (ASMs) and neurological care, seizure burden, and psychosocial outcomes (e.g., employment, social and financial support). The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were administered to evaluate for depression and anxiety. Frequency and proportions for categorical variables and median and interquartile ranges for continuous variables were calculated. RESULTS: Fifty-five PLWE participated (95 % response rate). Median age was 40 years (IQR 31.5-66.5), 61.8 % were women, 47.3 % had a bachelor's degree or higher and 29.1 % each had Medicaid and Medicare insurance. Race (from highest to lowest %) was: 32.7 % White, 20 % Black, 20 % Latinx, 14.5 % Asian, and 12.7 % selected "other" or "prefer not to say." COVID-19 had been diagnosed in 21.8 % of participants. Symptoms of anxiety and depression were self-reported by 43.6 % and 34.5 % of patients, respectively, with many describing this symptom as new post-pandemic (37.5 % and 31.6 %, respectively). Using validated scales, 52.7 % had depression (PHQ-9 score ≥ 5) with 30.9 % having moderate/severe depression (PHQ-9 score ≥ 10), while 29.1 % had probable generalized anxiety disorder (GAD-7 score ≥ 8). Seizure burden increased in 21.8 % of participants, while 20 % reported fewer seizures and 29.1 % were seizure free since the COVID-19 pandemic. Economic impacts of the pandemic included job loss (25 % amongst those employed at onset of pandemic), new or worsened financial difficulties (40 %), and new or worsened social support issues (30.9 %). Of all participants, 18.2 % reported difficulties accessing ASMs and 25.5 % cancelled visits, but of those with cancelled visits, 78.6 % had their appointments rescheduled as a telehealth visit. CONCLUSION: Our cohort of PLWE experienced some challenges during the COVID-19 pandemic including poorer mental health and financial and employment-related stressors. Encouragingly, healthcare access was relatively spared during the COVID-19 crisis, with some patients even reporting a reduction in seizure burden. However, PLWE require ongoing psychosocial support with particular attention to decompensation of mental health and social stressors that may be exacerbated by the COVID-19 pandemic.