Population mental health in Burma after 2021 military coup: online non-probability survey.

BACKGROUND: Humanitarian crises and armed conflicts lead to a greater prevalence of poor population mental health. Following the 1 February 2021 military coup in Burma, the country's civilians have faced humanitarian crises that have probably caused rising rates of mental disorders. However, a dearth of data has prevented researchers from assessing the extent of the problem empirically. AIMS: To better understand prevalence of depressive and anxiety disorders among the Burmese adult population after the February 2021 military coup. METHOD: We fielded an online non-probability survey of 7720 Burmese adults aged 18 and older during October 2021 and asked mental health and demographic questions. We used the Patient Health Questionnaire-4 to measure probable depression and anxiety in respondents. We also estimated logistic regressions to assess variations in probable depression and anxiety across demographic subgroups and by level of trust in various media sources, including those operated by the Burmese military establishment. RESULTS: We found consistently high rates of probable anxiety and depression combined (60.71%), probable depression (61%) and probable anxiety (58%) in the sample overall, as well as across demographic subgroups. Respondents who 'mostly' or 'completely' trusted military-affiliated media sources (about 3% of the sample) were significantly less likely than respondents who did not trust these sources to report symptoms of anxiety and depression (AOR = 0.574; 95% CI 0.370-0.889), depression (AOR = 0.590; 95% CI 0.383-0.908) or anxiety (AOR = 0.609; 95% CI 0.390-0.951). CONCLUSIONS: The widespread symptoms of anxiety and depression we observed demonstrate the need for both continuous surveillance of the current situation and humanitarian interventions to address mental health needs in Burma.

Methods for improving participation rates in national self-administered web/mail surveys: Evidence from the United States.

In the United States, increasing access to the internet, the increasing costs of large-scale face-to-face data collections, and the general reluctance of the public to participate in intrusive in-person data collections all mean that new approaches to nationally representative surveys are urgently needed. The COVID-19 pandemic accelerated the need for faster, higher-quality alternatives to face-to-face data collection. These trends place a high priority on the evaluation of innovative web-based data collection methods that are convenient for the U.S. public and yield scientific information of high quality. The web mode is particularly appealing because it is relatively inexpensive, it is logistically flexible to implement, and it affords a high level of privacy and confidentiality when correctly implemented. With this study, we aimed to conduct a methodological evaluation of a sequential mixed-mode web/mail data collection protocol, including modular survey design concepts, which was implemented on a national probability sample in the U.S. in 2020-2021. We implemented randomized experiments to test theoretically-informed hypotheses that 1) the use of mail and increased incentives to follow up with households that did not respond to an invitation to complete a household screening questionnaire online would help to recruit different types of households; and 2) the use of modular survey design, which involves splitting a lengthy self-administered survey up into multiple parts that can be completed at a respondent's convenience, would improve survey completion rates. We find support for the use of mail and increased incentives to follow up with households that have not responded to a web-based screening questionnaire. We did not find support for the use of modular design in this context. Simple descriptive analyses also suggest that attempted telephone reminders may be helpful for the main survey.

Ecological risk and protective factors for food insufficiency in Los Angeles County during the COVID-19 pandemic.

OBJECTIVE: The COVID-19 pandemic increased food insufficiency: a severe form of food insecurity. Drawing on an ecological framework, we aimed to understand factors that contributed to changes in food insufficiency from April to December 2020, in a large urban population hard hit by the pandemic. DESIGN: We conducted internet surveys every 2 weeks in April-December 2020, including a subset of items from the Food Insecurity Experience Scale. Longitudinal analysis identified predictors of food insufficiency, using fixed effects models. SETTING: Los Angeles County, which has a diverse population of 10 million residents. PARTICIPANTS: A representative sample of 1535 adults in Los Angeles County who are participants in the Understanding Coronavirus in America tracking survey. RESULTS: Rates of food insufficiency spiked in the first year of the pandemic, especially among participants living in poverty, in middle adulthood and with larger households. Government food assistance from the Supplemental Nutrition Assistance Program was significantly associated with reduced food insufficiency over time, while other forms of assistance such as help from family and friends or stimulus funds were not. CONCLUSIONS: The findings highlight that during a crisis, there is value in rapidly monitoring food insufficiency and investing in government food benefits.

An Experimental Evaluation of Two Approaches for Improving Response to Household Screening Efforts in National Mail/Web Surveys.

Survey researchers have carefully modified their data collection operations for various reasons, including the rising costs of data collection and the ongoing Coronavirus disease (COVID-19) pandemic, both of which have made in-person interviewing difficult. For large national surveys that require household (HH) screening to determine survey eligibility, cost-efficient screening methods that do not include in-person visits need additional evaluation and testing. A new study, known as the American Family Health Study (AFHS), recently initiated data collection with a national probability sample, using a sequential mixed-mode mail/web protocol for push-to-web US HH screening (targeting persons aged 18-49 years). To better understand optimal approaches for this type of national screening effort, we embedded two randomized experiments in the AFHS data collection. The first tested the use of bilingual respondent materials where mailed invitations to the screener were sent in both English and Spanish to 50 percent of addresses with a high predicted likelihood of having a Spanish speaker and 10 percent of all other addresses. We found that the bilingual approach did not increase the response rate of high-likelihood Spanish-speaking addresses, but consistent with prior work, it increased the proportion of eligible Hispanic respondents identified among completed screeners, especially among addresses predicted to have a high likelihood of having Spanish speakers. The second tested a form of nonresponse follow-up, where a subsample of active sampled HHs that had not yet responded to the screening invitations was sent a priority mailing with a $5 incentive, adding to the $2 incentive provided for all sampled HHs in the initial screening invitation. We found this approach to be quite valuable for increasing the screening survey response rate.

Black Americans demonstrate comparatively low levels of depression and anxiety during the COVID-19 pandemic.

INTRODUCTION: During public health crises like the COVID-19 pandemic, populations can experience worsening mental health. Prior reports have suggested that Black Americans experienced lower rates of anxiety and depression than White Americans before the pandemic; however, during the pandemic, outcomes may be different as Black Americans have been disproportionately affected in terms of mortality, hospitalization, COVID-19 infection, and job loss. We documented the differential mental health impact of COVID-19 on Black and Non-Black Americans. METHODS: We analyzed nationally representative longitudinal data from the Understanding America Study COVID-19 Tracking Survey spanning March through November of 2020 to assess differences over time in prevalence of anxiety and depression between Black and non-Black Americans. RESULTS: We found that Black Americans were significantly less likely to report symptoms for anxiety, depression, or both during the pandemic. In a given month between March through November of 2020, the odds of Black Americans reporting such symptoms was on average about half that of Non-Black Americans. We also found that in September 2020, the gap in reporting symptoms for depression began to widen gradually. Specifically, since that time, prevalence of depression remained stable among non-Black Americans while it declined gradually among Black Americans. Our main results were robust to adjusting for demographics, risk perceptions, and baseline pre-pandemic mental health status. CONCLUSIONS: Black Americans maintained significantly better mental health than Non-Black Americans despite their struggle against economic, health, and racial inequalities during the pandemic. We discuss the significance and implications of our results and identify opportunities for future research.

Political polarization in US residents' COVID-19 risk perceptions, policy preferences, and protective behaviors.

When the novel coronavirus entered the US, most US states implemented lockdown measures. In April-May 2020, state governments started political discussions about whether it would be worth the risk to reduce protective measures. In a highly politicized environment, risk perceptions and preferences for risk mitigation may vary by political inclinations. In April-May 2020, we surveyed a nationally representative sample of 5517 members of the University of Southern California's Understanding America Study. Of those, 37% identified as Democrats, 32% as Republican, and 31% as Third Party/Independent. Overall, Democrats perceived more risk associated with COVID-19 than Republicans, including for getting infected, being hospitalized and dying if infected, as well as running out of money as a result of the pandemic. Democrats were also more likely than Republicans to express concerns that states would lift economic restrictions too quickly, and to report mask use and social distancing. Generally, participants who identified as Third Party/Independent fell in between. Democrats were more likely to report watching MSNBC or CNN (vs. not), while Republicans were more likely to report watching Fox News (vs. not), and Third Party/Independents tended to watch neither. However, political inclinations predicted reported policy preferences, mask use, and social distancing, in analyses that accounted for differences in use of media sources, risk perceptions, and demographic background. In these analyses, participants' reported media use added to the partisan divide in preferences for the timing of lifting economic restrictions and reported protective behaviors. Implications for risk communication are discussed. SUPPLEMENTARY INFORMATION: The online version of this article (10.1007/s11166-020-09336-3) contains supplementary material, which is available to authorized users.