The role of social support, detachment, and depressive and anxiety symptoms in suicidal thoughts and behaviours during the Covid-19 lockdown: Potential pathways.

During the COVID-19 pandemic, anxiety and depressive symptoms, as well as problems related to social relationships, such as available social support and feelings of detachment from others, have worsened. These factors are strongly associated with suicidal thoughts and behaviours (STB). The effects of feelings of detachment on mental health and on STB have been scarcely studied, together with the relation that it may have with available social support. Therefore, the aim of the present study was to assess potential pathways connecting these conditions. A nationally representative sample of Spanish adults (N = 3305) was interviewed during the COVID-19 pandemic (June 2020). STB, social support, and depressive and anxiety symptoms were measured with the C-SSRS (modified version), OSSS-3, PHQ-8, and GAD-7 scales, respectively. Multivariable logistic regression models and mediation analyses were performed. Social support and some of its components (i.e., social network size and relations of reciprocity) were associated with lower odds of STB. Detachment significantly mediated (22% to 25%) these associations. Symptoms of emotional disorders significantly mediated the association between social support components (29% to 38%) - but not neighbourhood support - with STB, as well as the association between detachment and higher odds of STB (47% to 57%). In both cases, depressive symptoms were slightly stronger mediating factors when compared to anxiety symptoms. Our findings suggest that interventions aimed at lowering depressive and anxiety symptoms, and STB should provide social support and help tackle the feeling of detachment in a complementary way.

The emotional state of young people in northern Spain after one year and a half of the COVID-19 pandemic.

Background and objectives: : Since the beginning of the COVID-19 pandemic, the young population has been suffering from an accumulation of psychological symptoms in northern Spain. The main objectives of this study were (1) to assess whether psychological symptoms persisted after one year and a half of the COVID-19 pandemic in northern Spain sample of young people, and (2) to analyze whether pandemic-specific variables (having a chronic illness, living with a person who has a chronic illness, having been infected with COVID-19, having a close person who has died or believing that people are respecting the measures imposed) are related to psychological symptomatology. Methods: : Symptoms of stress, anxiety, and depression were measured using the Depression and Stress Anxiety Scale-21 (DASS-21). An ad hoc online questionnaire was used to collect socio-demographical information related to chronic illnesses of the participants, living with a chronically ill person, contact with a person diagnosed with COVID-19, having people close to them who have died of COVID-19, and their perception of whether or not people respect the health measures. Results: : Young people have suffered higher stress, anxiety, and depression levels than at the beginning of the pandemic. Conclusions: : The present study highlights the importance of addressing young people's mental health, and ensure that future adults emerge from the COVID-19 pandemic in a psychologically strong state.

The Association Between Substance Use Disorder and Depression During the COVID-19 Lockdown in Spain and the Moderating Role of Social Support: a Cross-Sectional Study.

Substance use disorder is on the rise; it has increased massively during the COVID-19 lockdown and has been found as a risk factor for depressive symptoms and major depressive disorder. Less is known about the hypothetical moderating effect of social support in that association. Three thousand five hundred Spanish adults were interviewed by phone during the COVID-19 lockdown (May-June 2020). The 8-item Patient Health Questionnaire Depression Scale (PHQ-8) was used to measure the symptoms of depression. The CAGE Adapted to Include Drugs (CAGE-AID) questionnaire was used to assess substance use disorder during the previous month. Social support was measured through the Oslo Social Support Scale (OSSS-3). Regression models were constructed to assess factors related to depressive symptoms. People with substance use disorder (alcohol and drugs) showed considerable high levels of depressive symptoms, particularly among those with low levels of social support, which reported levels above major depressive disorder cut-off.

What factors explain the changes in major depressive disorder symptoms by age group during the COVID-19 pandemic? A longitudinal study.

BACKGROUND: Data collected during the COVID-19 pandemic suggest an increase in major depressive disorder (MDD) among younger adults. The current study aims to assess the association of age groups and MDD risk before and during the COVID-19 pandemic and quantify the effect of potential mediating variables such as loneliness, social support, resilience, and socioeconomic factors. METHODS: A representative sample of Spanish adults was interviewed before (2019, N = 1880) and during (2020, N = 1103) the COVID-19 pandemic. MDD was assessed using the CIDI, loneliness through the UCLA scale, social support through the OSSS-3, resilience with the 6-BRS, and worsened economic circumstances and unemployment through a single question. Mixed-models were used to study changes in MDD by age group. Regression models were constructed to quantify the association between age and potential mediators, as well as their mediating effect on the association between age group and MDD. RESULTS: Among the younger age cohorts (18-29 and 30-44 years) the probability of having MDD during the pandemic increased from 0.04 (95 % CI: 0.002-0.09) to 0.25 (0.12-0.39) and from 0.02 (-0.001-0.03) to 0.11 (0.04-0.17), respectively. Some 36.6 % of the association between age and risk of MDD during the pandemic was explained by loneliness (12.0 %), low resilience (10.7 %), and worsened economic situation (13.9 %). LIMITATIONS: Reliance on self-report data and generalizability of the findings limited to the Spanish population. CONCLUSIONS: Strategies to decrease the impact of a pandemic on depressive symptoms among young adults should address loneliness, provide tools to improve resilience, and enjoy improved financial support.

The association of age with depression, anxiety, and posttraumatic stress symptoms during the COVID-19 pandemic in Spain: the role of loneliness and pre-pandemic mental disorder.

OBJECTIVE: Older adults may be at lower risk of common mental disorders than younger adults during the COVID-19 pandemic. Previous researchers have shown differences by age in psychosocial well-being during the pandemic and have highlighted the moderating effect of pre-pandemic mental disorders on that association. In this line, we examined the association of age with self-reported symptoms of loneliness, depression, anxiety, and posttraumatic stress, as well as potential roles of loneliness symptoms and pre-pandemic mental disorders on the association between age and mental disorder symptoms. METHODS: Cross-sectional data of 2,000 Spanish adults interviewed by phone during the COVID-19 pandemic (February-March, 2021) were analyzed. Depression, anxiety, and posttraumatic stress were measured with the 8-item Patient Health Questionnaire, the 7-item GAD, and the 4-item checklist for Diagnostic and Statistical Manual of Mental Disorders (DSM-5), respectively. Loneliness was measured with the 3-item UCLA loneliness scale. Several regression models were constructed to assess factors related to loneliness and mental disorders. RESULTS: According to cut-off points used, 12.4% of participants revealed depression, 11.9% anxiety, and 11.6% posttraumatic stress. Age was negatively related with mental disorder symptoms and loneliness. Loneliness was associated with higher levels of mental disorder symptoms. This association was stronger in younger adults without pre-pandemic mental disorders and in older adults without them. The association between age and loneliness was stronger in those with pre-pandemic mental disorders. Loneliness mediated the association of age with mental disorder symptoms. CONCLUSIONS: Interventions focused on loneliness could alleviate the impact of the COVID-19 pandemic on mental health.

The emotional state of young people in northern Spain after one year and a half of the COVID-19 pandemic

Background and objectives : Since the beginning of the COVID-19 pandemic, the young population has been suffering from an accumulation of psychological symptoms in northern Spain. The main objectives of this study were (1) to assess whether psychological symptoms persisted after one year and a half of the COVID-19 pandemic in northern Spain sample of young people, and (2) to analyze whether pandemic-specific variables (having a chronic illness, living with a person who has a chronic illness, having been infected with COVID-19, having a close person who has died or believing that people are respecting the measures imposed) are related to psychological symptomatology. Methods : Symptoms of stress, anxiety, and depression were measured using the Depression and Stress Anxiety Scale-21 (DASS-21). An ad hoc online questionnaire was used to collect socio-demographical information related to chronic illnesses of the participants, living with a chronically ill person, contact with a person diagnosed with COVID-19, having people close to them who have died of COVID-19, and their perception of whether or not people respect the health measures. Results : Young people have suffered higher stress, anxiety, and depression levels than at the beginning of the pandemic. Conclusions : The present study highlights the importance of addressing young people's mental health, and ensure that future adults emerge from the COVID-19 pandemic in a psychologically strong state.

Mental health symptoms 1 year after the COVID-19 outbreak in Spain: The role of pre-existing mental disorders and their type.

BACKGROUND: The type of pre-existing disorder might determine changes in mental health symptoms (i.e., anxiety, depression) during the COVID-19 pandemic and influence the effect of psychological factors (e.g., social support, resilience, stress) on such symptoms. METHODS: Longitudinal data from two assessments (June-2020 and February/March-2021) collected through telephone interviews (Spanish general population) were analysed. Outcome variables included anxiety (GAD-7) and depressive symptoms (PHQ-8). Psychological factors included COVID-perceived stress (adapted COVID-perceived risk scale), social support (OSSS-3), and resilience (CD-RISC). Pre-existing mental conditions (3 groups: mood, anxiety, and comorbid depression+anxiety) were assessed using the CIDI checklist. Changes in anxiety and depressive symptoms between baseline and follow-up were assessed with the paired samples Wilcoxon test. Tobit regression and interaction models were conducted to test associations between psychological factors and these symptoms in follow-up. RESULTS: Final sample included 1942 participants (mean age 49.6 yrs., ±16.7; 51.7 % females). Anxiety symptoms increased in all groups except for those with pre-existing mood conditions. Depressive symptoms only increased in those without pre-existing mental disorders and in those with pre-existing anxiety. Higher baseline resilience, increases in social support, and decreases in COVID-perceived stress were associated with lower anxiety and depressive symptoms. The type of pre-existing mental disorder did not modify these associations. LIMITATIONS: Lack of pre-pandemic data and the limited number of pre-existing mental conditions. CONCLUSIONS: Having pre-pandemic mental disorders is associated with different patterns of anxiety and depressive symptoms during the pandemic. COVID-related stress, social support, and resilience are key factors in improving mental health regardless of the mental diagnosis.

The Mental Health of Employees with Job Loss and Income Loss during the COVID-19 Pandemic: The Mediating Role of Perceived Financial Stress.

The COVID-19 outbreak, which was followed by home confinement, is expected to have had profound negative impact on the mental health of people. Associated factors, such as losing jobs and income, can be expected to lead to an increased risk of suffering from psychopathological problems. Therefore, this study was aimed at researching the associations of job and income loss with mental health, as well as the possible mediating role of perceived financial stress during the COVID-19 outbreak. The sample included 2381 Spanish workers who were interviewed right after the first COVID-19 lockdown. Measures were taken for generalized anxiety disorder, panic attacks, depression, post-traumatic stress disorder, substance abuse, suicidal thoughts and behaviors, working conditions, sociodemographic variables, and perceived financial stress. Logistic regression models were calculated with psychological variables as outcomes, and with job loss and income loss as predictors. Mediation analyses were performed by adding the financial threat as a mediator. Nineteen point six percent and 33.9% of participants reported having lost their jobs and incomes due to the pandemic, respectively. Only income loss was related to a higher risk of suffering from depression and panic attacks. When adding financial stress as a mediator, the indirect effects of job and income loss on the mental health measures were found to be significant, therefore indicating mediation. These findings pinpoint the vulnerability of this population, and highlight the need for interventional and preventive programs targeting mental health in economic crisis scenarios, such as the current one. They also highlight the importance of implementing social and income policies during the COVID-19 pandemic to prevent mental health problems.

The impact of COVID-related perceived stress and social support on generalized anxiety and major depressive disorders: moderating effects of pre-pandemic mental disorders.

BACKGROUND: We assessed the moderating effect of pre-pandemic mental disorders on the association of COVID-related perceived stress and social support with mental health. METHODS: A nationally representative sample of 3500 Spanish adults was interviewed in June 2020 (mean age 49.25 years, ± 15.64; 51.50% females). Mental health included Generalized Anxiety Disorders (GAD; GAD-7, cut-off point of ≥ 10), Major Depressive Disorders (MDD; PHQ-8, cut-off point of ≥ 10) and the comorbid form (those screening positive for GAD and MDD). COVID-related stress was assessed using an adapted version of the Peri Life Events Scale, and social support using the Oslo Social Support Scale. Logistic regression models were used to assess if COVID-related stress and social support were related to mental health outcomes and interactions were conducted to examine whether these relationships differed according to the presence of pre-pandemic mental disorders. RESULTS: Higher COVID-related stress was associated with a higher risk of lower mental health. The association between COVID-related stress with GAD and MDD was significantly moderated by pre-pandemic mental disorders, except for comorbid GAD + MDD. Higher levels of social support were linked to better mental health. Only the association between social support and GAD was significantly moderated by pre-pandemic mental disorders. That is, for those without pre-pandemic mental disorders, higher levels of social support decreased the odds of GAD, while minor decreases were observed in those with pre-pandemic mental disorders. CONCLUSIONS: The impact of COVID-related stress and social support on specific indicators of mental health may vary depending on the existence of a previous mental disorder.

The association of detachment with affective disorder symptoms during the COVID-19 lockdown: The role of living situation and social support.

INTRODUCTION: There is growing concern about the effect of lockdown and social distancing on mental health. Subjective feelings related to social relationships such as detachment have shown a strong effect on mental health, whereas objective factors might have a moderating role in that association. OBJECTIVE: To investigate whether social support and living situation have a moderating effect on the association between detachment and affective disorder symptoms during the COVID-19 lockdown. METHODS: 3,305 Spanish adults were interviewed by phone at the end of the COVID-19 lockdown (May-June 2020). Detachment during confinement was assessed with a single-item frequency question. Anxiety symptoms were measured through GAD-7, depressive symptoms through PHQ-9, and social support through the Oslo Social Support Scale (OSSS). Associations with anxiety and depressive symptoms were tested through Tobit regression models. Interactions of detachment with living situation and social support were tested as independent variables. RESULTS: People living alone showed significantly lower levels of anxiety whereas people living with another (but not as a couple) showed higher levels of depression. Detachment was strongly associated with both affective disorders. Social support had a statistically significant moderating effect on that association. Those with a low level of social support and a high level of detachment reported means of depression and anxiety above major depression (10.5 CI 95% 9.6, 11.4 at OSSS=10) and generalized anxiety disorders (10.1 CI 95% 9.2, 11.0 at OSSS=9) cut offs CONCLUSION: Interventions centered on improving social support could alleviate feelings of detachment and prevent affective disorders during lockdowns.

Meta-Analysis of Prevalence of Depression in Dental Students during COVID-19 Pandemic.

Background and Objectives: The COVID-19 pandemic has a negative impact on the mental health of the population in general, and in college students in particular. Dental students have seen their teaching altered and their clinical practice reduced. This study was aimed at conducting a systematic review and meta-analysis of studies reporting levels of depression among dental students during the COVID-19 and estimating the pooled prevalence of depression. Materials and Methods: Medline via PubMed and other databases were searched for studies on the prevalence of depression in dental undergraduates, published from 1 December 2019 to 1 September 2021. The pooled proportions of depression were calculated with random effects models. Results: We identified 13 studies from 9 countries. The pooled prevalence of depression in dental students was 37% (95% CI: 26-49%) with no variation due to gender, response rate or methodological quality. We only found a significantly higher prevalence of depression in studies from Asia compared to Europe and America. Conclusions: Our results suggest that dental students are suffering from higher levels of depression compared with the general population or other college students during the COVID-19 pandemic, with differences across regions. Measures to improve mental health and wellbeing of dental students during the pandemic are needed.

Prevalence of Depression among Healthcare Workers during the COVID-19 Outbreak: A Systematic Review and Meta-Analysis.

BACKGROUND: There is evidence of a high psychological toll from the COVID-19 pandemic in healthcare workers. This paper was aimed at conducting a systematic review and meta-analysis of studies reporting levels of depression among healthcare workers during the COVID-19 and estimating the pooled prevalence of depression. METHODS: We searched for cross-sectional studies listed on PubMed from 1 December 2019 to 15 September 2020 that reported prevalence of depression in healthcare workers, nurses, medical doctors, and COVID-19 frontline professionals. The pooled proportions of depression were calculated with random effects models. RESULTS: We identified 57 studies from seventeen countries. The pooled prevalence of depression in healthcare workers was 24% (95% CI: 20-28%), 25% for nurses (95% CI: 18-33%), 24% for medical doctors (95% CI: 16-31%), and 43% for frontline professionals (95% CI: 28-59%). CONCLUSIONS: The proportion of depression in nurses and medical doctors during the COVID-19 pandemic was similar to that found in the general population as previously reported in other meta-analyses conducted with smaller numbers of studies. Importantly, almost half of the frontline healthcare workers showed increased levels of depression. There is need for a comprehensive, international response to prevent and treat common mental health problems in healthcare workers.

Changes in Health Behaviors, Mental and Physical Health among Older Adults under Severe Lockdown Restrictions during the COVID-19 Pandemic in Spain.

We used data from 3041 participants in four cohorts of community-dwelling individuals aged ≥65 years in Spain collected through a pre-pandemic face-to-face interview and a telephone interview conducted between weeks 7 to 15 after the beginning of the COVID-19 lockdown. On average, the confinement was not associated with a deterioration in lifestyle risk factors (smoking, alcohol intake, diet, or weight), except for a decreased physical activity and increased sedentary time, which reversed with the end of confinement. However, chronic pain worsened, and moderate declines in mental health, that did not seem to reverse after restrictions were lifted, were observed. Males, older adults with greater social isolation or greater feelings of loneliness, those with poorer housing conditions, as well as those with a higher prevalence of chronic morbidities were at increased risk of developing unhealthier lifestyles or mental health declines with confinement. On the other hand, previously having a greater adherence to the Mediterranean diet and doing more physical activity protected older adults from developing unhealthier lifestyles with confinement. If another lockdown were imposed during this or future pandemics, public health programs should specially address the needs of older individuals with male sex, greater social isolation, sub-optimal housing conditions, and chronic morbidities because of their greater vulnerability to the enacted movement restrictions.

Prevalence of anxiety in health care professionals during the COVID-19 pandemic: A rapid systematic review (on published articles in Medline) with meta-analysis.

During the COVID-19, healthcare workers are exposed to a higher risk of mental health problems, especially anxiety symptoms. The current work aims at contributing to an update of anxiety prevalence in this population by conducting a rapid systematic review and meta-analysis. Medline and Pubmed were searched for studies on the prevalence of anxiety in health care workers published from December 1, 2019 to September 15, 2020. In total, 71 studies were included in this study. The pooled prevalence of anxiety in healthcare workers was 25% (95% CI: 21%-29%), 27% in nurses (95% CI: 20%-34%), 17% in medical doctors (95% CI: 12%-22%) and 43% in frontline healthcare workers (95% CI: 25%-62%). Our results suggest that healthcare workers are experiencing significant levels of anxiety during the COVID-19 pandemic, especially those on the frontline and nurses. However, international longitudinal studies are needed to fully understand the impact of the pandemic on healthcare workers' mental health, especially those working at the frontline.

Prevalence of depression during the COVID-19 outbreak: A meta-analysis of community-based studies.

Introduction: COVID-19 pandemic, declared on March 11, 2020, constitute an extraordinary health, social and economic global challenge. The impact on people's mental health is expected to be high. This paper sought to systematically review community-based studies on depression conducted during the COVID-19 and estimate the pooled prevalence of depression. Method: We searched for cross-sectional, community-based studies listed on PubMed or Web of Science from January 1, 2020 to May 8, 2020 that reported prevalence of depression. A random effect model was used to estimate the pooled proportion of depression. Results: A total of 12 studies were included in the meta-analysis, with prevalence rates of depression ranging from 7.45% to 48.30%. The pooled prevalence of depression was 25% (95% CI: 18% - 33%), with significant heterogeneity between studies (I 2  = 99.60%, p < .001). Conclusions: Compared with a global estimated prevalence of depression of 3.44% in 2017, our pooled prevalence of 25% appears to be 7 times higher, thus suggesting an important impact of the COVID-19 outbreak on people's mental health. Addressing mental health during and after this global health crisis should be placed into the international and national public health agenda to improve citizens' wellbeing.

Introducción: La pandemia de COVID-19, declarada el 11 de marzo de 2020, representa un reto global extraordinario a nivel sanitario, social y económico. Se espera un impacto alto en la salud mental de las personas. Este artículo tiene como objetivo realizar una revisión sistemática de estudios transversales basados en muestras comunitarias que proporcionaban la prevalencia de depresión durante la crisis del COVID-19. Método: Se realizó una búsqueda de estudios comunitarios publicados en Pubmed y Web of Science desde el 1 de enero del 2020 al 8 de mayo del 2020 y que informaron sobre la prevalencia de depresión. Se usó un modelo de efectos aleatorios para estimar la proporción agrupada de depresión. Resultados: Un total de 12 estudios fueron incluidos en el meta-análisis, con prevalencias de depresión que oscilaban entre 7,45% y 48,30%. La prevalencia agrupada de depresión fue de 25% (95% CI: 18%-33%), con heterogeneidad significativa entre estudios (I 2  = 99,60%, p < 0,001). Conclusiones: En comparación con una estimación global de depresión en 2017 del 3,44%, nuestra prevalencia agrupada del 25% es 7 veces mayor, sugiriendo un impacto importante del brote de COVID-19 en la salud mental de las personas. El abordaje de la salud mental durante y después de esta crisis global sanitaria debe ser parte de las agendas de salud pública nacionales e internacionales para mejorar el bienestar de los ciudadanos.