Factors related to COVID-19 vaccine hesitancy among middle-income and low-income adults in the USA.

BACKGROUND: Vaccine hesitancy has been an ongoing challenge in campaigns, especially the rapid development and approval of the COVID-19 vaccines. The goal of this study was to understand the characteristics, perceptions and beliefs of COVID-19 vaccination prior to its widespread rollout among middle-income and low-income US adults. METHODS: Using a national sample of 2101 adults who completed an online assessment in 2021, this study examines the association of demographics, attitudes and behaviours related to COVID-19 vaccination intentions. Adaptive least absolute shrinkage and selection operator models were used to select these specific covariate and participant responses. Poststratification weights were generated using raking procedures and applied to improve generalisability. RESULTS AND CONCLUSION: Vaccine acceptance was high at 76% with 66.9% reporting intent to receive the COVID-19 vaccine when available. Only 8.8% of vaccine supporters screened positive for COVID-19-related stress compared with 9.3% among the vaccine hesitant. However, there were more people with vaccine hesitancy who screened positive for poor mental health and alcohol and substance misuse. The three main vaccine concerns were side effects (50.4%), safety (29.7%) and mistrust of vaccine distribution (14.8%).Factors influencing vaccine acceptance included age, education, children, region, mental health and social support, threat perception, opinion of governmental response, risk exposure and prevention activities and rejecting COVID-19 vaccine concerns. The results indicated acceptance was more strongly associated with beliefs and attitudes about the vaccine than sociodemographics, which are noteworthy and may lead to targeted interventions to increase COVID-19 vaccine acceptance among subgroups who are vaccine hesitant.

Legal, mental health and psychosocial outcomes of the RePresent Games: a quasi-experimental study.

This study evaluated a pair of video games called the RePresent games that taught users how to represent themselves in civil court. A quasi-experimental study was conducted that compared 69 RePresent game users and 78 non-game users with civil legal issues across four U.S. states on legal, mental health and psychosocial outcomes over 3 months. The results revealed that RePresent game users reported greater legal knowledge, better mental health and higher quality of life than non-game users across time, and a greater rate of improvement in legal knowledge than non-game users over time. These findings suggest that gamifying education about legal procedures for the general public holds great potential in helping individuals obtain self-help legal assistance although some formal mental health treatment may be needed for many seeking legal aid.

Evictions and tenant-landlord relationships during the 2020-2021 eviction moratorium in the US.

This study provisionally examined the effects of the US eviction moratorium instituted in response to the Coronavirus Disease 2019 (COVID-19) pandemic. Three waves of data collected May 2020-April 2021 from a nationally representative sample of middle- and low-income US tenants (n = 3393 in Wave 1, n = 1311 in Wave 2, and 814 in Wave 3) were analyzed. Across three waves, 4.3% of tenants reported experiencing an eviction during the moratorium and 6%-23% of tenants reported delaying paying rent because of the moratorium. Multivariable analyses found that tenants who delayed paying their rent, were female, or had a history of mental illness or substance use disorder were more likely to report the eviction moratorium had a negative effect on their landlord relationship. COVID-19 infection was not predictive of eviction but tenants with a history of homelessness were more than nine times as likely to report an eviction than those without such a history. Together, these findings suggest the eviction moratorium may have had some unintended consequences on rent payments and tenant-landlord relationships that need to be considered with the end of the federal eviction moratorium.

The impact of China-to-US immigration on structural and cultural determinants of HIV-related stigma: implications for HIV care of Chinese immigrants.

Objectives: Asian Americans have poor HIV-related outcomes, yet culturally salient barriers to care remain unclear, limiting development of targeted interventions for this group. We applied the 'what matters most' theory of stigma to identify structural and cultural factors that shape the nature of stigma before and after immigration from China to the US.Design: Semi-structured interviews were conducted with 16 immigrants to New York from China, recruited from an HIV clinic and community centers. Deductive followed by focal inductive qualitative analyses examined how Chinese cultural values (lian, guanxi, renqing) and structural factors influenced stigma before and after immigration.Results: In China, HIV stigma was felt through the loss of lian (moral status) and limited guanxi (social network) opportunities. A social structure characterized by limited HIV knowledge, discriminatory treatment from healthcare systems, and human rights violations impinged on the ability of people living with HIV to fulfill culturally valued goals. Upon moving to the US, positions of structural vulnerability shifted to enable maintenance of lian and formation of new guanxi, thus ameliorating aspects of stigma.Conclusions: HIV prevention and stigma reduction interventions among Chinese immigrants may be most effective by both addressing structural constraints and facilitating achievement of cultural values through clinical, peer, and group interventions.

Prospective association between receipt of the economic impact payment and mental health outcomes.

BACKGROUND: The Coronavirus Aid, Relief, and Economic Security Act of 2020 provided 'economic impact payments' (EIPs) of $1200 to US adults with annual personal income of $75 000 or less. This study examined the prospective association between EIP receipt and mental health outcomes. METHODS: A nationally representative sample of 3169 middle-income and low-income US adults completed a baseline assessment of their health and well-being in May-June 2020 and a 3-month follow-up assessment during the period of the COVID-19 pandemic when EIPs were distributed. RESULTS: Controlling for sociodemographic characteristics, EIP recipients had higher odds of reporting a positive COVID-19 test, endorsing a history of post-traumatic stress disorder and reporting any illicit drug use in the past month than participants who did not receive EIP. Participants who did not receive EIP were more likely to report a history of anxiety disorder or alcohol use disorder and recent suicidal ideation than EIP recipients. There was no association between EIP receipt and financial distress, although over one-third to over half of EIP recipients were not employed at baseline. Between baseline and 3-month follow-up, receipt of EIP was significantly associated with reduced medical conditions and alcohol use problems, but increased depression, suicidal ideation and COVID-19 era-related stress. CONCLUSION: The EIP provided a brief income stimulus to many adults in need but was not associated with improvements in financial distress or mental health among middle-income and low-income recipients. Long-term income security and employment may be more important to improving and sustaining positive mental health outcomes.

Graduation practices and outcomes in intensive case management programs for severe mental illness: A systematic review.

OBJECTIVE: Intensive case management (ICM) is important in psychiatric rehabilitation but there is a need to "graduate" clients. The purpose of this research was to review the literature on criteria used and outcomes of graduating clients with severe mental illness from ICM programs. METHOD: A systematic review conducted in 2019 used keyword searches in all major research databases. This search yielded 1,142 articles which were distilled to 20 studies that reported a graduation process from an ICM program (11 studies), and/or reported clinical or psychosocial outcomes after graduation (15 studies). RESULTS: Three main methods have been used to determine graduation: Clinician judgment (n = 8 studies), rating scales (n = 4), or shared decision-making (n = 3). Across studies, graduation rates ranged from 1% to 25% over a 1-year period, 44% to 65% over a 2-year period, and 9% to 29% over a 4-year period. After graduation, 4%-14% of graduates had to be readmitted to ICM but 60% of studies reported positive client outcomes after graduation which included significant reductions in hospitalizations, and improvements in quality of life, unmet needs for care, and family relationships. Only two studies reported negative outcomes after graduation which included hospitalizations, homelessness, incarceration, and treatment drop-out. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: ICM programs can successfully graduate clients to less intensive services, and there are procedures available to guide graduation decisions but no universally agreed-upon method. Additional research is needed to identify optimal methods for graduation for different client populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Online video psychoeducation for electroconvulsive therapy in India: A randomized controlled trial.

Despite its effectiveness, electroconvulsive therapy (ECT) has been widely but diminishingly used in India. The current study evaluated a video psychoeducation on ECT offered to adults in India who screened positive for depression. Participants were randomly assigned to receive either video or brochure psychoeducation. Both video and brochure psychoeducation significantly improved participants' perceptions, knowledge, and willingness to receive ECT with only a few significant differences between the two modalities. Together, these findings suggest that psychoeducation is effective. Video psychoeducation which can be inexpensive and widely distributed may represent an important way to encourage patients to consider ECT as an option.

Receipt, Spending, and Clinical Correlates of the Economic Impact Payment Among Middle- and Low-Income U.S. Adults.

OBJECTIVE: This study examined characteristics and planned expenses of U.S. adults who received the economic impact payment (EIP) during the COVID-19 pandemic. METHODS: Using a nationally representative sample of 6,607 middle- and low-income U.S. adults, the authors examined the proportion and correlates of EIP receipt among eligible adults and the associations among planned EIP-financed expenses, challenges with paying expenses, and clinical characteristics. RESULTS: Of the sample, 78.8% reported that they received the EIP, and 82.3% of EIP recipients reported that it had a positive impact on their life. Being a veteran (odds ratio [OR]=2.59), being married (OR=1.82), having a history of schizophrenia spectrum disorder (OR=1.74) or posttraumatic stress disorder (OR=1.51), and screening negative for recent suicidal ideation (OR=0.49) were associated with EIP receipt. Planned expenses with the EIP were savings, paying debt, and rent and accounted for 63.4% of the total amount. Screening positive for mental health or drug use problems was positively associated with greater planned expenses for substances and gambling. EIP receipt also was associated with fewer problems paying daily expenses, but participants who screened positive for mental health or alcohol use problems were more likely to report problems paying past-month daily expenses. CONCLUSIONS: Unconditional cash transfers such as the EIP may be important for sustaining the living situation of middle- and low-income populations. The management of funds is important to consider, especially among adults experiencing mental health and substance abuse problems, and such cash transfers may represent opportunities for financial literacy and money management interventions.

Cross-cultural Comparison of Perceptions and Knowledge About Electroconvulsive Therapy Among Adults Who Screened Positive for Depression in the United States, India, and China.

OBJECTIVE: Despite the established efficacy of electroconvulsive therapy (ECT), negative perceptions and inaccurate knowledge about ECT in the United States and other countries persist. This study examined ECT perceptions and knowledge in the 3 most populous countries in the world. METHODS: We recruited participants who screened positive for depression on the Patient Health Questionnaire 9 (PHQ-9) in the United States (n = 1643), India (n = 1469), and China (n = 328) and compared responses on the ECT-Perception and Knowledge Scale. RESULTS: Although the US sample had significantly higher PHQ-9 scores than the India and China samples, the US sample was less likely to have been offered ECT or to have ever received ECT. Moreover, the US sample scored lower on the ECT Perception and Knowledge subscales than the other samples indicating more negative perceptions and inaccurate knowledge about ECT. Across samples, there were moderate fears about ECT being painful or causing brain damage, and misconceptions about ECT being outdated and adverse effects of induced seizures. Higher PHQ-9 scores were correlated with more negative perceptions. CONCLUSIONS: Greater public education is needed about ECT, particularly in the United States. Misperceptions and lack of knowledge may hinder utilization of ECT in India, China, and the United States.

Psychological distress and alcohol use disorder during the COVID-19 era among middle- and low-income U.S. adults.

PURPOSE: This study examined how exposure to events during the Coronavirus Disease-19 (COVID-19) era is linked to symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), COVID-19 era-related stress (CS), alcohol use disorder (AUD), and suicidal ideation (SI) in low and middle-income U.S adults. METHODS: A national sample of 6,607 adults (4.4% who reported testing positive for COVID-19, 25.3% testing negative, and 70.3% untested) were recruited an online platform andcompleted the Patient Health Questionnaire-2, Generalized Anxiety Disorder-2, PTSD-Checklist for DSM-5, the Alcohol Use Disorder Identification-Consumption scale, and an item assessing SI in May-June 2020. A series of multivariable analyses were conducted. RESULTS: In the total sample, 35.3% screened positive for current AUD, 33.6% for MDD, 33.6% for GAD, 24.6% for SI, and 20.2% for CS. Past 2-week SI (adjusted odds ratios [AORs]= 1.49-12.06), number of close friends (AORs= 1.40-2.72), history of AUD (AORs= 1.15-1.92), history of anxiety disorder (AORs= 1.07-2.63), and younger age (AORs= 0.97-0.98) were significantly associated with screening positive for MDD, GAD, CS, and AUD. COVID-19 status was not independently associated with these conditions, but the combination of testing positive for COVID-19, meeting criteria for AUD, and screening positive for MDD, GAD, or CS predicted a 96% probability for SI. CONCLUSION: Predisposing factors are stronger predictors of psychological distress than personal COVID-19 infection or exposure. The additive effects of COVID-19 infection, alcohol use, and psychiatric problems in predicting SI suggest screening, monitoring, and treating these conditions in population-based prevention and treatment efforts may be important.

Mental Health and Psychosocial Characteristics Associated With COVID-19 Among U.S. Adults.

OBJECTIVE: This study examined psychosocial and mental health characteristics associated with COVID-19 infection. METHODS: An online survey that asked about COVID-19 status, social support, and mental health was used to recruit a national sample of 6,607 low- and middle-income adults; 354 reported a positive COVID-19 test, 1,819 reported a negative test, and 4,434 reported not being tested in May or June 2020. RESULTS: Psychiatric history and current social support and mental health were not statistically significantly associated with testing positive for COVID-19 after analyses controlled for other characteristics. In order of magnitude, having any friends or family who had COVID-19, being a veteran, having a greater number of close friends or relatives, having any history of homelessness, having an advanced degree, or being a student was significantly associated with testing positive for COVID-19. CONCLUSIONS: Clinical risk for COVID-19 infection and the medical needs of veterans and of unstably housed populations should be considered.

Perceptions and knowledge related to electroconvulsive therapy: A systematic review of measures.

Electroconvulsive therapy (ECT) is one of the most effective treatments for mood disorders, but patients and the general public often have negative perceptions and inaccurate knowledge about ECT. A systematic review of measures assessing perceptions and knowledge about ECT was conducted, including all published peer-reviewed journal articles from 1938 to 2018. Inclusion criteria were studies that included psychiatric patient samples and reported quantitative measures assessing perceptions and/or knowledge related to ECT. An initial 112 articles identified were distilled to 31 studies that were ultimately selected for inclusion in the review. Selected studies spanned 15 countries across 5 decades and included 570 individual measurement items. Items were categorized into 8 content domains under 2 overarching concepts of perceptions (97% of studies) and knowledge (77% of studies). Among gaps in content domains, the role of health-care providers in ECT within perceptions domains was rarely assessed by existing measures. And among knowledge domains, the scientific evidence for ECT was least assessed by existing measures. Among all studies reviewed, only 3 studies reported the psychometric properties of the measures used. Together, these findings demonstrate that a variety of measures have been used to assess a range of psychosocial domains related to ECT. However, not one measure comprehensively examined all domains and reported psychometric properties. Thus, there is great potential for new measures to be developed both for research and as patient education tools for ECT treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychosocial and Mental Health Characteristics of RePresent Game Users.

The RePresent games are online video games that are publicly available and designed to educate people about legal self-representation in civil court. This study was part of a project to examine use of the RePresent games in Connecticut, Massachusetts, Maine, and New Hampshire from January 2018 to May 2018. Data on game use across the four states were analyzed, and an online survey was conducted to examine characteristics of RePresent game users and nonusers seeking civil legal aid (n = 277). The RePresent games were accessed more than 7,000 times in five months. The most common legal problems reported were related to debt, family, and housing. Compared with nonusers, RePresent game users were significantly more likely to be nonwhite, to have an incarceration history, to have more legal problems, and to screen positive for alcohol use problems. In the total sample, 83 percent screened positive for depression, 81 percent for generalized anxiety disorder, and 45 percent for drug problems. Only 34 percent reported use of mental health services, and 17 percent reported substance abuse treatment in the past year. These findings demonstrate that products like the RePresent games can be widely accessible to adults from disadvantaged backgrounds. In addition, civil legal settings may be a new area for mental health screening and intervention.

A Randomized Controlled Trial of Video Psychoeducation for Electroconvulsive Therapy in the United States.

OBJECTIVE: Electroconvulsive therapy (ECT) is a highly effective psychiatric treatment that remains largely underutilized. Patient psychoeducation about ECT may improve uptake of this treatment. METHODS: This randomized controlled trial compared two forms of psychoeducation about ECT: video psychoeducation and an informational brochure. In 2019, a national sample of 556 U.S. adults who screened positive for depression were recruited and randomly assigned to receive one of these educational interventions online. Participant perceptions, knowledge, and willingness to receive ECT were assessed before and after psychoeducation. RESULTS: Both the video psychoeducation and brochure groups showed significantly more positive perceptions and knowledge about ECT following the intervention, with no significant differences between groups. The proportion of participants who reported being willing to receive ECT increased significantly after receipt of psychoeducation (from 31% to 63% in the video psychoeducation group and from 29% to 56% in the brochure group). Female gender, severity of depression, and comorbid mental and substance use disorders were associated with positive changes in ECT perceptions and increased willingness to receive ECT. CONCLUSIONS: These findings suggest brief psychoeducation for ECT is needed and may improve acceptance of this robust treatment.

Effects of video psychoeducation on perceptions and knowledge about electroconvulsive therapy.

This study examined the effects of video psychoeducation about electroconvulsive therapy (ECT) on perceptions and knowledge about ECT. A pre-post design was used with a national sample of 1,068 adults who screened positive for depression. Participants' perceptions and knowledge about ECT were assessed before and after watching a psychoeducational video about ECT. Participants showed significant increases in positive perceptions and accurate knowledge about ECT after watching the psychoeducational video. In the perception domain, the items "ECT can be lifesaving" and "fears that ECT can be painful" showed the largest positive increases. In the knowledge domain, items related to "ECT is one of the safest procedures performed" and "ECT can be given safely to older persons" showed the largest increases. Over 20% of participants changed their mind and reported they were willing to try ECT after watching the video. Together, these findings suggest video psychoeducation about ECT holds great potential to improve perceptions and knowledge about ECT, particularly as new technologies are developed to create, distribute, and host videos to reach large audiences.

A Measure to Assess Perceptions and Knowledge About Electroconvulsive Therapy: Development and Psychometric Properties.

OBJECTIVES: Although electroconvulsive therapy (ECT) has been found to be one of the most robust and rapid treatments for severe depression, it is widely underused partly because of negative perceptions and inaccurate knowledge about the treatment. METHODS: The 18-item ECT Perception and Knowledge (ECT-PK) measure was developed through a systematic review of the literature, subject matter expert ratings, and examination of content validity. The ECT-PK consists of Perception and Knowledge subscales, which were tested on a national sample of 1091 US adults who screened positive for depression in 2018 through Amazon's Mechanical Turk platform. RESULTS: Evaluation of the ECT-PK subscales found that both subscales demonstrated good construct validity, criterion validity, and internal consistency reliability. Participants who had higher Perception and Knowledge subscale scores were significantly more likely to report that they were willing to try ECT. The ECT-PK revealed that many participants reported fears about pain, brain damage, and memory loss resulting from ECT, and had inaccurate knowledge about ECT being outdated or lacking scientific evidence. CONCLUSIONS: Together, these results showed that the ECT-PK is an efficient and effective contemporary tool to measure the perception and knowledge of ECT, and highlights areas in need of psychoeducation.

Systematic review of psychosocial factors associated with evictions.

Evictions from rented accommodations are a common pathway to homelessness and can negatively impact the lives of individuals and communities worldwide. There have been only few interventions developed to address evictions, and it is important to first understand factors associated with evictions. This systematic review included all available peer-reviewed articles on the topic published in the international literature from 1900 to 2017 and identified 10 peer-reviewed studies of evictions conducted in the United States, Canada, Amsterdam and Britain. From these studies, four categories of factors associated with evictions were identified. These factors were financial hardships, sociodemographic characteristics, substance use and other health problems. While many studies had large sample sizes, the majority of studies were cross-sectional. Together, our review found that there were several salient factors known to be associated with evictions which may benefit from intervention. However, more prospective studies on evictions and development of interventions are needed.

Addressing Veteran Homelessness to Prevent Veteran Suicides.

The U.S. Department of Veterans Affairs (VA) is shifting its focus from ending veteran homelessness to preventing veteran suicides. With supporting data, this Open Forum argues that VA homelessness services also help address veteran suicides. Analysis of a nationally representative survey of U.S. veterans in 2015 shows that veterans with a history of homelessness attempted suicide in the previous two years at a rate >5.0 times higher compared with veterans without a history of homelessness (6.9% versus 1.2%), and their rates of two-week suicidal ideation were 2.5 times higher (19.8% versus 7.4%). Because the majority of veterans who die by suicide are not engaged in VA care, VA services for the homeless that include outreach efforts to engage new veterans may be reaching some of these veterans. Thus continued federal support for VA homelessness services not only may help address homelessness but also may help prevent suicide of veterans.