The psychological consequences of long COVID. The effect of uncertainties, coping strategies, social support systems and quality of life on the onset of depression

Objectives: Many people were infected by COVID-19 and for a minority of them, symptoms persisted beyond twenty days. These symptoms are multi-systemic, fluctuating, and impact the quality of life. Long COVID was first defined by patients themselves in the spring of 2020 to describe their recovery problems. Specifically, long COVID is defined as "a constellation of physical and mental symptoms which can persist or emerge afterwards, generating a multi-systemic and disabling syndrome, which varies from patient to patient and fluctuates over time". The persistence of COVID symptoms, the decrease in the quality of life, the uncertainly about the future sometimes accompanied by a low level of social support perceived in the medical and personal entourage may have triggered the occurrence of a depressive disorder in patients with long COVID. The objective of this research was to study the effect of long COVID symptoms, of uncertainty and the impairment of quality of life on the development of depressive symptoms, while identifying the impact of moderating variables such as coping strategies and social support. Material(s) and Method(s): Two hundred and fourteen participants with long COVID (aged 18-68, M = 44, SD = 11), including 93 % females (n = 200) and 7% males (n = 14), participated in this cross-sectional quantitative study between the months of April and June 2022. They described their symptoms and responded to five scales: the Evaluation of Intolerance of Uncertainty Scale (EII), the Coping Strategies Checklist (WCC), the Medical Outcome Study Short Form 36-item health survey (MOS SF-36), the Perceived Social Support Questionnaire (QSSP), and the Hospital Anxiety and Depression Scale (HADS). Result(s): 91% of the participants reported symptoms of fatigue (n = 171), 52% a loss of concentration (n = 111), 51% pain (n = 110), 49 % trouble sleeping (n = 104), and 41% memory problems (n = 88). Compared with the general population, they presented a poorer quality of life, as well as high scores for anxiety, depression, and intolerance of uncertainty. Scores on coping strategies were also higher than the norms for the general population, and scores on satisfaction with social support were generally good. It was also found that the variables of intolerance of uncertainty, quality of life, and depression all correlated with each other. Furthermore, the regression analysis revealed predictors of depression. The areas of quality of life and emotional well-being (beta = -0.41, t(199) = -6.23, P < 0.01) and fatigue/energy (beta = -0.16, t(199) = -2.83, P < 0.01) were negative predictors of depression, as was the problem-focused coping score (beta = -0.14, t(199) = -2.84, P < 0.05). Symptoms of the disorder related to concentration difficulties (beta = 0.27, t(199) = 5.16, P < 0.01) and those impacting projects (beta = 0.18, t(199) = 3.31, P < 0.01) were positive predictors of depression. The second finding of this study is that people treated specifically for their long COVID had significantly lower scores for anxiety and intolerance of uncertainty despite lower scores for certain dimensions of quality of life. The individuals who took part in our study also developed more problem-based coping strategies and reported more availability of and satisfaction with social support. Lastly, in terms of quality of life, the treated population expressed better mental health. Conclusion(s): The study showed that, in addition to the effects of long COVID symptoms, quality of life, and coping strategies on the onset of symptoms of depression, the specific treatment of patients with long COVID seemed to constitute in itself a protective factor against depression and anxiety. It therefore would seem essential that any patient suffering from long COVID should receive multidisciplinary care specific to this pathology.Copyright © 2023 Elsevier Masson SAS

Relationship of college students' risk perception of COVID-19 and their anxiety and depression: A moderated mediation model.

Objective To explore the effects of perceived risk of COVID-19 of college students on their anxiety and depression, as well as the roles of attention to negative information and perceived social support, so as to provide theoretical basis for colleges and universities to formulate corresponding intervention measures. Methods By the convenience sampling method, totally 1 404 college students from Shaanxi and Henan provinces were investigated online by using General Information Questionnaire, Perceived Risk of COVID-19 Pandemic Scale, Attention to Negative Information Scale, Patient Health Questionnaire, Generalized Anxiety Disorder and Perceived Social Support Scale. SPSS 20. 0 was used for data analysis, Pearson correlation method was used to explore the correlation between variables. The mediating effect of attention to negative information and the moderating effect of perceived social support were analyzed by PROCESS. Results The scores of anxiety and depression of the 1 404 college students included in the study were 4.03 +/- 4.48 and 6.21 +/- 5.41, respectively. The detection rate of anxiety symptom was 29.9%, and that of depression symptom was 44.4%. The risk perception of COVID-19 epidemic of the college students was positively correlated with attention to negative information (r = 0.373, P<0.001), anxiety (r = 0.227, P<0.001), and depression (r = 0.226, P<0.001). Anxiety (r = 0.553, P<0.001) and depression 0 = 0.497, P<0.001) were positively correlated with attention to negative information, while perceived social support was negatively correlated with the risk perception of the COVID-19 (r = - 0.154, P<0.001), attention to negative information (r= - 0.259, P<0.001), anxiety (r = - 0.321, P<0.001) and depression (r=- 0.278, P<0.001). The risk perception of COVID-19 affected the anxiety and depression of the students mainly through the mediating effect of attention to negative information. The total effect of risk perception of COVID-19 and anxiety was 0. 227, and the mediating effect accounted for 80. 18% of the total effect. The total effect of risk perception of COVID-19 and depression was 0. 228, and the mediating effect accounted for 90. 35% of the total effect. Perceived social support played a moderating role in the last half of this mediating model. Conclusion Risk perception of COVID-19 indirectly affects the occurrence of anxiety and depression in college students through attention to negative information, and perceived social support plays a moderating role in this mediating model. The findings suggest that when a risk event occurs, colleges and universities should pay attention to guiding students to adjust their attentional bias to external information, and give students enough care and support to improve their mental health.Copyright © 2023 Xi'an Medical University. All rights reserved.

Thwarted belongingness as a factor of lower anxiety of being infected and power adherence to recommendations in pandemic in female adolescents

Introduction: Poor adherence with recommendations during pandemic is wide-spread and increases populational risk of being infected (Smith et al., 2020, Webster et al., 2020, Freeman et al., 2020). Revealing psychological factors of low adherence in adolescents is important for interventions planning. This study tests the role of perceived social support and belongingness in COVIDrelated anxiety and adherence. Objective(s): The aim was to reveal relationships between COVIDrelated anxiety, monitoring of information about pandemic, adherence to recommendations and interpersonal needs in female adolescents. Method(s): 183 female adolescents (13-21 years old) filled Anxiety Regarding Pandemic Scale, Information Monitoring and Adherence To COVID-related Recommendations Scales (Tkhostov, Rasskazova, 2020), Interpersonal Needs Questionnaire (Van Orden et al., 2012). Result(s): Female adolescents moderately (m+/-sd=3.32+/-1.40 of 1-6- point scale) worried about negative consequences of pandemic on their life and lowly worried about risk of being infected (m+/-sd=2.53+/-1.15). Their adherence to recommendations was upper medium (m+/-sd=3.42+/-1.18). Neither worries nor adherence were related to age. Perceived burdensomeness was unrelated to COVID-related anxiety and adherence while thwarted belongingness was related to lower anxiety of being infected (r=-.23, p<.01) and poorer adherence to recommendations (r=-.19, p<.05). Conclusion(s): In female adolescents thwarted belongingness is a risk factor of poor adherence to COVID-related recommendations because of lower anxiety of being infected.

Evaluation of Sleep Quality before and During COVID-19 Quarantine and Its Relationship with Family Social Support: A Web-based Survey among University Students

Background: The pandemic of COVID-19 quarantined most of the world's population, which severely impacted daily life, especially academic activities. Objective(s): This study aimed to evaluate the sleep quality before and during COVID-19 quarantine and its relationship with family social support among university students. Method(s): This cross-sectional study was performed on 283 university students in Mashhad in 2020. A web-based questionnaire, including demographic information, Pittsburgh sleep quality index (PSQI) and Procidano Perceived Social Support from Family (PSS-Fa) questionnaires were sent to all students. Result(s): The prevalence of PSQI > 5 among students before the quarantine was 80.6% and reached 82.7% during the quarantine. The mean score of PSQI before the quarantine was 10.00 +/- 4.30 and reached 12.30 +/- 5.53 during the quarantine (P-value < 0.001). PSQI score before and during quarantine showed a significant inverse correlation with the PSS-Fa score. The sleep quality in those who did not leave quarantine at all was significantly higher than in those who did. Conclusion(s): This study shows decreased sleep quality in the students during the quarantine. In addition, students with more family social support had higher sleep quality, which could indicate the high impact of family social support on the students' quality of life. Copyright © 2022, Author(s).

Differences in Acceptance to the Kidney Transplant List

Purpose: During the COVID-19 pandemic, kidney transplant (KT) evaluations shifted from in-person evaluation (IPE) to telemedicine evaluation (TME). Given differences in access to electronics and internet, we thought that TME may advantage some social groups' access to the KT list. We evaluated if differences in acceptance to KT listing exist between pre- and post-pandemic eras, or between IPE and TME. We identified associations between other socioeconomic factors and KT listing. Method(s): Demographic and social data were collected from charts of patients evaluated for KT in the pre- (3/13/2019-3/13/2020) and post-pandemic era (3/14/2020- 3/14/2021). Categorical data are presented in proportions and frequencies;continuous data in means+/-SDEV. Independent group t-tests and Fisher's exact tests were used for bivariate comparisons. Result(s): Of 1061 charts, 1015 included data on race/ethnicity: 608 (59.1%) Black, 335 (33.6%) White, 40 (3.9%) Hispanic, 29 (2.8%) Asian, and 3 (0.3%) other. Overall, 629 (59%) evaluations were pre- and 430 (41%) post-pandemic. 734 (72%) were IPE and 288 (28%) TME. 553 (54%) candidates were denied for medical (310, 56%) and social (184, 33%) reasons;469 (46%) were accepted for listing. Employment status was known in 979 candidates: 278 (28%) employed, 368 (38%) disabled, 66 (7%) unemployed, and 267 (27%) retired. Evaluation in the post-pandemic era (p=0.002) was associated with acceptance for listing. TME was also associated with acceptance for listing (p<0.001). Pre-pandemic, there were 604 IPE and 1 TME of whom 253 (42%) were accepted, including the TME (p=0.238). Post-pandemic 130 evaluations were IPE and 287 TME, of whom 215 (52%) were accepted, including 58 (45%) IPE and 157 (55%) TME (p=0.061). Employment status (p<0.001) and mental health status (p=0.009) were associated with acceptance for listing. There was no association between race/ethnicity (p=0.809) or distance from home to the transplant center (p=0.693) and acceptance for listing. There were no differences in race/ ethnicity (p=0.951), employment status (p=0.202), or mental health status (p=0.742) between pre- and post-pandemic eras. Assessment of social support (p=0.002) and overall social work assessment (p<0.001) were associated with acceptance for listing. The level of social support (rated on a 1-5 scale) was associated with being accepted for listing pre-pandemic (p=0.001) but not post-pandemic (p=0.769). Conclusion(s): KT evaluations decreased by about one third during the post-pandemic era. Evaluation in the post-pandemic era, evaluation by TME, employment status, mental health status, assessment of social support and overall social work assessment were all associated with being listed for KT. There were no differences in race/ethnicity, employment status, or mental health status between eras, which is unexpected given the additional stressors of the pandemic on employment and mental health.

Perceived Social Support and Coping Strategies among Bariatric Patients During COVID-19

Alexandra Harvey Philadelphia PA1, Melissa Butt Hershey PA2, Antoinette Hu Hershey PA2, Ann Rogers Hershey PA2, Andrea Rigby Hershey PA2 Penn State College of Medicine1 Penn State Health2 The COVID-19 pandemic increased challenges to bariatric patients’ strict diet and exercise regimen, increasing reliance on social support and effective coping strategies for post-operative success. Social support and adaptive coping can be effective in the prevention and treatment of weight recurrence. Social support is associated with increased weight loss in bariatric patients and has been perceived by patients as necessary for effective post-operative care. The objective of this study is to investigate perceived social support and coping methods among bariatric patients and its association with weight during the COVID-19 pandemic. Adults (n=99) who underwent bariatric surgery prior to March 2020 completed a self-report questionnaire regarding coping strategies and perceived support during the COVID-19 pandemic. Respondents reported a wide range of weight recurrence (0.00 - 31.40 kg) from their lowest recorded weight. Participants also reported a high level of perceived social support, but it was not significantly associated with weight recurrence. Problem-focused coping strategies were significantly associated with weight recurrence (r=0.21, p=0.04), possibly due to an increase in weight prompting patients to engage in problem-focused coping. Weight recurrence was also significantly associated with venting (r=0.21, p=0.04), behavioral disengagement (r=0.20 p=0.048), and planning (r=0.30, p=0.003) coping methods during the pandemic. Our findings suggest that utilization of problem-focused coping methods are associated with weight recurrence regardless of perceived social support. Understanding which coping methods are associated with better post-operative health outcomes (such as increased weight loss) will help clinicians better counsel patients on how to address stressors they may encounter post-operatively.

UNCERTAINTY AND PSYCHOLOGICAL DISTRESS DURING COVID-19: A GLOBAL STUDY TO EXAMINE THE ROLE OF RESILIENCE AND PERCEIVED SOCIAL SUPPORT

Objectives. In this study we examined the relationship between perceived uncertainty and depression/ anxiety symptoms during the COVID-19 pandemic and we tested the moderating roles of resilience and perceived social support in this relationship. Methods. A cross-sectional study was conducted between March 31st and May 15th, 2020, using an online, multi-language, international survey built within Qualtrics. The study included 3786 respondents from 94 different countries, 47.7% of whom reported residence in the United States of America. We collected data on sociodemographic features, perceived uncertainty, perceived social support, depression and anxiety symptoms, and resilience. A moderation model was tested using model 2 of Hayes' PROCESS macro for SPSS. Results. Results demonstrated that higher perceived uncertainty was associated with more symptoms of depression and anxiety (r = 0.54;p< .001). Higher resilience levels and higher perceived social support were associated with fewer depression and anxiety symptoms (r =-0.49, p< .001 and r =-0.25, p< .001, respectively). The moderation hypotheses were supported (F (5, 3780) = 585.6, p< 0.0001);the relationship between uncertainty and symptoms of depression and anxiety decreased as levels of resilience increased (B =-0.16;p< .0001) and as perceived social support increased (B =-0.10;p< .0001). Conclusion. The study confirms the importance of resilience and social support in buffering the impact of major upheaval, such as the COVID-19 pandemic. The results indicate that resilience and social support could be helpful targets to reduce the negative effects of uncertainty on depression and anxiety symptoms.

Experience of COVID-19 and Postpartum Mental Health

Background: Early reports show pregnant and postpartum women have increased rates of anxiety and depression during the COVID-19 pandemic. These elevations could be related to fear of contracting COVID or mitigation strategies, such as social distancing and stay-at-home orders. First-time mothers may be uniquely vulnerable to these stressors. We examined whether 1) exposure to potentially stressful COVID-19 events, perceived impact of COVID-19, and COVID-19 distress are related to anxiety and depression symptoms reported by first-time mothers, and 2) whether the relationship between COVID-19 related stressors and anxiety and depression is stronger for mothers reporting less social support. Methods: We interviewed 125 first-time mothers of infants less than 3 months old from four pediatric primary care offices in Pennsylvania and Delaware (June 2020 - February 2021). Mothers completed a self-report interview asking about social support, COVID-19 experiences, and anxiety and depression symptoms (EPDS Total, Anxiety, Depression). The COVID-19 measure yielded three variables: 1) number of potentially stressful COVID-19 pandemic-related events (Event Exposure), 2) perceived impact of the COVID-19 pandemic on family (Family Impact), and 3) overall perceived distress related to the pandemic (Distress). Results: Participants (mean age = 29.18, SD: 5.50) were racially representative of the recruitment clinics (40.8% White;37.6% Black;11.2% Asian/Asian American;6.4% Latina). Hierarchical linear regression found COVID-19 Event Exposure was unrelated to Depression (β = 0.03, n.s.) and Anxiety (β = 0.04, n.s.). Controlling for Event Exposure, Family Impact was associated with higher EPDS Total (β = 0.32, p = 0.001), Depression (β = 0.29, p =.003), and Anxiety (β = 0.23, p = 0.02). Distress was significantly associated with higher EPDS Total (β = 0.21, p = 0.04) and Depression (β = 0.26, p = 00.01) but not Anxiety (β = 0.08, n.s.). Mothers reporting less social support had higher Depression scores (r = 0.26, p =.003), but social support was unrelated to Anxiety (r = 0.08, p = 0.41). The interaction of Family Impact and social support produced a nonsignificant trend (p = 0.09, Figure). Conclusion: While experience of more COVID-19 related events was unrelated to maternal anxiety and depression symptoms, maternal report of impact of COVID-19 on the family was associated with both anxiety and depression symptoms. Additionally, higher maternal distress reports and less perceived social supports were related to increased maternal depression symptoms. Therefore, future work should explore how to mitigate impact of COVID-19 families and connect mothers to social support to support maternal mental health.

THE COVID-19 PANDEMIC AND MENTAL HEALTH: EFFECTS OF SOCIAL SUPPORT AND SELF-REGULATION

Social support has been widely associated with various morbidity and mortality. How does social support availability help youths cope with the global pandemic of Covid-19 and maintain their mental well-being? Utilizing data from a UK national birth cohort, namely the Millennium Cohort Study, this research investigated the joint role of social support availability and self-regulation against such major life stressors, inclusding G × E mechanisms. Results from 4095 cohort members (399 males (47.20%) and 2602 females (63.54%), others refused to report) suggested that social support availability at the outburst of Covid-19 pandemic, as well as age 7 emotional self-regulation (rated by cohort members' parents) contributes to youths' better mental health (viz., mental well-being and non-specific psychological distress) shortly after the outburst of Covid-19 (;B;s > 0.072, ps < .018). Most importantly, age 7 cognitive self-regulation and social support availability jointly predicted better their well-being 4 months later after the local outbursts of pandemic (for mental well-being, B = 0.309, p = .017, 95% CI = [0.056, 0.562];and for non-specific psychological distress, B =-0.299, p = .043, 95% CI = [-0.587,-0.011]). Johnson-Neyman plots (false discovery rate limited) suggested that it was those high but not low in cognitive self-regulation that benefited more from the perceived social support availability. Within the ranges of significance (81.19% for mental well-being and 80.94% for non-specific psychological well-being), social support availability positively predicted mental health and such effect increased gradually as the increase of age 7 cognitive self-regulation. Findings filled in the research gap such that social support and self-regulation have been investigated separately as two coping mechanisms, by revealing that self-regulation (i.e., internal resources) determines the utility of social support availability (i.e., external resources). Findings here inspired new research questions for the field, such as whether relevant developmental trajectories of self-regulation and social support might intertwin to cast on health trajectories, and whether these processes are subject to potential G × E interactions such as the exposure to childhood adversity or relevant genetic risks. Models to examine these hypotheses will be discussed.

THE IMPACTS OF LONELINESS AND SOCIAL SUPPORT ON THE PHYSICAL HEALTH AND COPING STYLES OF COLLEGE STUDENTS DURING COVID-19

The COVID-19 pandemic and preventive measures such as social distancing and campus closures have brought unprecedented social isolation to college students. Past studies have suggested that being socially isolated may not only have harmful effects on one's mental health but also result in a variety of physical health problems, such as a weakened cardiovascular system. On the other hand, higher perceived social support can lead to more positive health outcomes as it is associated with lower mortality risk and greater use of active coping strategies. The purpose of the present study was to investigate how loneliness and perceived social support are associated with the physical symptoms and coping styles of college students during the COVID-19 pandemic. This study investigated two types of coping strategies: active coping and self-distraction. The variables were measured through an online survey administered across five different time points in 2020 with students (n = 292) enrolled in a university located in Southern California. Linear regression analyses were conducted to predict the students' physical symptoms and coping styles using their levels of loneliness and perceived social support. The analyses used the first wave of data (from May 2020) to predict the second and fifth waves of the survey, which took place in July and December of 2020, in order to examine how baseline levels at the start of the pandemic predicted changes in the beginning of the study compared to at the end of the year. Students who reported higher levels of loneliness in May experienced more physical symptoms in July, b = 2.89, p < .001. However, social support did not significantly predict physical symptoms (p > .05), and neither loneliness nor social support significantly predicted the students' coping styles (ps > .05). When using data from May to predict outcomes in December, there were no significant associations. This study may help improve the physical and psychological well-being of college students during the global health crisis.

SOCIAL SUPPORT MITIGATES THE EFFECT OF STRESS ON SEXUAL AND GENDER MINORITY PEOPLE'S MENTAL HEALTH DURING COVID-19

Sexual and gender minority (SGM) people face pre-existing inequalities that may have been exacerbated by the Coronavirus-19 (COVID-19) pandemic. Canadian sexual minorities are twice as likely to live alone compared to heterosexual people and are more vulnerable to anxiety, depression, self-harm, and substance abuse. Despite these vulnerabilities, several studies suggest that social support and community solidarity can mitigate the effect of stress on SGM mental health. Using a cross-sectional online survey, our team examined SGM and cisgender heterosexual mental health and social support during the first four months of the COVID-19 crisis in Quebec, Canada. A total of 2900 adults (n = 304 SGM people, n = 2596 cisgender heterosexual people) completed questionnaires measuring perceived social support, perceived stress, depressive symptoms, anxiety symptoms, and loneliness. A series of one-way ANOVAs revealed that SGM people presented worse health outcomes than cisgender heterosexual people on all questionnaires (p < .001). Post hoc analyses also showed that some particularly marginalised SGM sub-groups, including bisexual and asexual people, showed the worst health outcomes. Moderation analyses later revealed that social support moderated the relationship between perceived stress and depressive symptoms among both SGM and cisgender heterosexual people - but this effect was four times stronger among SGM people (ΔR2 = .041;p < .001) than among cisgender heterosexual people (ΔR2 = .010;p < .001). These results suggest fostering social connectedness among SGM people may be especially beneficial in buffering against distress in the face of a crisis. To better understand how SGM mental health is evolving during this pandemic, our team is currently conducting a follow-up longitudinal study examining mental health, trauma, coping strategies and resilience among SGM and cisgender heterosexual adults before and after vaccination efforts started in Canada (to date, N = 6083). Preliminary results from time 1 (July 2020) and 2 (Fall 2021) are being treated and will also be presented.

The relationship Between Glycemic Control and Food Insecurity in People with Diabetes Mellitus and Comorbid Psychosis

Background/Significance: In the US, adults with psychosis have increased mortality mostly due to cardiovascular disease (CVD) (Olfson 2015). Diabetes mellitus (DM) is a potent CVD risk factor, which occurs in 28% of individuals with serious mental illnesses (Mangurian 2018). Little is understood of the contribution of social and environmental factors to diabetes health disparities experienced by people with psychosis. Food insecurity has been shown to be an independent risk factor for poor glycemic control (Seligman 2012). Methods: This IRB-approved cross-sectional survey aims to describe the prevalence and correlates of food insecurity among adults with DM and co-morbid psychosis who receive primary care through 12 clinics affiliated with a large academic healthcare system in Washington state. Administrative data was utilized to identify eligible patients: age 18-65;one inpatient or two outpatient diagnoses of schizophrenia (F20-29), bipolar disorder (F31), or major depressive disorder with psychotic features (F32.3;F33.3) and one inpatient or two outpatient diagnoses of DM (E08-E13.9). Patients with diagnoses of dementia or intellectual disability were excluded. All eligible patients were sent a letter with a unique link to a survey in Research Electronic Data Capture. The survey included questions related to diabetes clinical characteristics, self-care behaviors, and psychosis symptom severity in addition to demographics. Food insecurity was measured with the validated USDA’s Food Security Survey Module. Consistent with previous studies, participants will be considered food-insecure if two or more responses are affirmative. We compared food insecure and food secure particpants with level of social support and frequency of psychiatry symptoms. •Regression analysis was applied to examine the associations between food security status, social support, and mental health symptoms. Results: 624 patients with diabetes and psychosis were identified. 156 patients responded, giving a response rate of 26%. 25% of respondents were found to be food insecure. 16% of respondents demonstrated low social support while 43% showed moderate social support and 41% showed high social support. Mean CSI was 19.36, which suggests participants experienced symptoms several times per month (versus daily or weekly). Significantly lower social support was found in participants with food insecurity compared to those without (p=0.008). This relationship was driven by lower social support from family (p<0.001) compared to friends (p=0.61) or significant others (p=0.192). Additionally, greater psychiatric symptom severity was found in people with food insecurity (p <0.001). Regression analysis showed that social support did not significantly moderate the relationship between food security and frequency of psychiatric symptoms. Discussion: This study showed that food insecurity was significantly associated with both low perceived social support and more frequent psychiatric symptoms. However, no evidence of a moderating effect of social support on the relationship between food insecurity and psychiatric symptom severity was found. Rate of food insecurity was found to be lower than previous studies, which showed approximately 50% of individuals who used public mental health services faced food insecurity (Adams et al., 2021). The study sample was not limited to public mental health service users, which is the likely cause of this lower rate. Conclusion/Implications: Food insecurity is associated with poorer mental health outcomes, which have been associated with poorer health outcomes. The presence of perceived social support does not mitigate the need for addressing food insecurity. There is a need for both medical and mental health providers who care for people with co-morbid diabetes and psychosis to specifically address food insecurity. References: 1. Adams WE, Rogers ES, Edwards JP, Lord EM, McKnight L, Barbone M. Impact of COVID-19 on Peer Support Specialists in the United States: Findings From a Cross-Sectional Online Survey. Psychiatr c Services. 2021 Jun 23:appi-ps. 2. Coleman-Jensen AJ. US food insecurity status: toward a refined definition. Social Indicators Research. 2010 Jan 1;95(2):215-30. 3. Hammami N, Leatherdale ST, Elgar FJ. Does social support moderate the association between hunger and mental health in youth? A gender-specific investigation from the Canadian Health Behaviour in School-aged Children study. Nutrition journal. 2020 Dec;19(1):1-1. 4. Mangurian CV et al. Diabetes and prediabetes prevalence by race and ethnicity. Diabetes care. 2018 Jul 1;41(7):e119-20. 5. Na M, Miller M, Ballard T, Mitchell DC, Hung YW, Melgar-Quiñonez H. Does social support modify the relationship between food insecurity and poor mental health? Evidence from thirty-nine sub-Saharan African countries. Public health nutrition. 2019 Apr;22(5):874-81. 6. Olfson M et al. Premature mortality among adults with schizophrenia in the United States. JAMA psychiatry. 2015 Dec 1;72(12):1172-81. Seligman HK et al. Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes care. 2012 Feb 1;35(2):233-8. Stubbs B, Vancampfort D, De Hert M, Mitchell AJ.Acta Psychiatr Scand. 2015 Aug;132(2):144-57. Regression analysis showed that social support did not significantly moderate the relationship between food security and frequency of psychiatric symptoms.

Decreasing Loneliness and Social Isolation during the COVID Pandemic using Cancer Support Services: Case Study of a Geriatric Patient with Diffuse Large B-cell Lymphoma

Background/Purpose: We present a case study demonstrating how cancer support services assisted a patient diagnosed with diffuse large B-cell lymphoma (DLBCL) to cope throughout the COVID-19 pandemic. Perceived social isolation and loneliness were exacerbated for this patient due to the interaction of 1) cancer diagnosis, 2) COVID- 19 social distancing, 3) inability of vaccination to produce immunity to COVID-19, and 4) diminution of her social network due to aging. Methods: We summarize clinical encounters and chart review for an 88-year-old female patient (divorced, living with son) with DLBCL evaluated at a large urban university hospital to illustrate the impact of cancer support service interventions on social isolation and loneliness. Results: Systematic review revealed that interventions such as exercise, mindfulness-based practice, Tai Chi Qigong meditation, and art therapies decrease loneliness and increase perceived social support. The patient consistently observed COVID-19 social distancing precautions throughout the pandemic, receiving Pfizer vaccine immediately once available, and Moderna vaccine thereafter. However, she did not develop antibodies, reinforcing her need to strictly isolate. The patient has participated in a regimen of online cancer support activities: twice-weekly group exercise physiology sessions and gentle chair yoga sessions, twice-monthly individual exercise physiology, weekly music therapy, weekly chaplain meetings, and daily treadmill walking. She recognizes distress and anxiety as temporary feelings and understands how these support activities enhance her repertoire of coping strategies. Despite being restricted to home;she states that regular interaction with her support services team-and attentive care from her son-have decreased feelings of loneliness. Conclusions and Implications: Our patient has demonstrated resilience, overcoming the combined challenges that amplify loneliness and social isolation: DLBCL diagnosis, lack of COVID-19 antibody response, and aging. Although she is unable to socialize in person, her interactions with cancer support services staff and engagement in a suite of activities have mitigated loneliness and isolation.