Does neighbourhood deprivation influence low back pain and arthritis: An empirical study using multilevel twin design.

OBJECTIVE: Neighbourhood deprivation has been found to be associated with many health conditions, but its association with low back pain (LBP) and arthritis is unclear. This study aimed to examine the association between neighbourhood deprivation with LBP and arthritis, and its potential interaction with individual socioeconomic status (SES) on these outcomes. METHODS: Monozygotic (MZ) twins from the Washington State Twin Registry were used to control for genetic and common environmental factors that could otherwise confound the purported relationship. Multilevel models were employed to examine the association between neighbourhood deprivation as well as individual-level SES with LBP/arthritis, adjusting for age, sex, body mass index (BMI) and residence rurality. RESULTS: There were 6,380 individuals in the LBP sample and 2,030 individuals in the arthritis sample. Neighbourhood deprivation was not associated with LBP (P = 0.26) or arthritis (P = 0.61), and neither was its interaction with individual-level SES. People without a bachelor's degree were more likely to report LBP (OR 1.44, 95% CI 1.26-1.65) or both LBP and arthritis (OR 1.67, 95% CI 1.14-2.45) than those with a bachelor's degree, but not for arthritis alone (P = 0.17). Household income was not significantly associated with LBP (P = 0.16) or arthritis (p = 0.23) independent of age, sex, and BMI. CONCLUSION: Our study did not find significant associations between neighbourhood deprivation and the presence of LBP or arthritis. More research using multilevel modelling to investigate neighbourhood effects on LBP and arthritis is recommended.

A Genetically Informed Study of the Association Between Perceived Stress and Loneliness.

Although research shows a strong positive association between perceived stress and loneliness, the genetic and environmental etiology underlying their association remains unknown. People with a genetic predisposition to perceived stress, for example, may be more prone to feeling lonely and vice versa. Conversely, unique factors in people's lives may explain differences in perceived stress levels that, in turn, affect feelings of loneliness. We tested whether genetic factors, environmental factors, or both account for the association between perceived stress and loneliness. Participants were 3,066 individual twins (nFemale = 2,154, 70.3%) from the Washington State Twin Registry who completed a survey during April-May, 2020. Structural equation modeling was used to analyze the item-level perceived stress and loneliness measures. The correlation between latent perceived stress and latent loneliness was .68. Genetic and nonshared environmental variance components underlying perceived stress accounted for 3.71% and 23.26% of the total variance in loneliness, respectively. The genetic correlation between loneliness and perceived stress was .45 and did not differ significantly between men and women. The nonshared environmental correlation was .54 and also did not differ between men and women. Findings suggest that holding constant the strong genetic association between perceived stress and loneliness, unique life experiences underlying people's perceived stress account for individual differences in loneliness.

Epigenome-wide association study of systemic effects of obesity susceptibility in human twins.

The current study was designed to use an epigenome-wide association approach (EWAS) to identify potential systemic DNA methylation alterations that are associated with obesity using 22 discordant twin pairs. Buccal cells (from a cheek swab) were used as a non-obesity relevant purified marker cell for the epigenetic analysis. Analysis of differential DNA methylation regions (DMRs) was used to identify epigenetic associations with metabolic and dietary measures related to obesity with discordant twins. An edgeR analysis provided a DMR signature with p < 1e-04, but statistical significance was reduced due to low sample size and known multiple origins of obesity. A weighted gene coexpression network analysis (WGCNA) was performed and identified modules (p < 0.005) of epigenetic sites that correlated with different metabolic and dietary measures. The DMR and WGCNA epigenetic sites were near genes (e.g., CIDEC, SPP1, ZFPG9, and POMC) with previously identified obesity associated pathways (e.g., metabolism, cholesterol, and fat digestion). Observations demonstrate the feasibility of identifying systemic epigenetic biomarkers for obesity, which can be further investigated for clinical relevance in future research with larger sample sizes. The availability of a systemic epigenetic biomarker for obesity susceptibility may facilitate preventative medicine and clinical management of the disease early in life.

Analysis of differential DNA methylation regions (DMRs) was used to identify epigenetic associations with metabolic and dietary measures related to obesity with discordant twins.A weighted genome coexpression network analysis (WGCNA) was performed and identified modules of epigenetic sites that correlated with different metabolic and dietary measures.Observations demonstrate the feasibility of identifying systemic epigenetic biomarkers for obesity, which can be further investigated for clinical relevance in future research with larger sample sizes.The availability of a systemic epigenetic biomarker for obesity susceptibility may facilitate preventative medicine and clinical management of the disease early in life.

Sex differences in lifetime prevalence of low back pain: A multinational study of opposite-sex twin pairs.

BACKGROUND: Low back pain (LBP) is more likely to occur in people with a family history of this condition, highlighting the importance of accounting for familial factors when studying the individual risk of LBP. We conducted a study of opposite-sex twin pairs investigating sex differences in LBP while accounting for (genetic and shared environmental) familial factors. METHODS: We applied a matched co-twin control design to study 795 adult opposite-sex pairs from Australia, Spain, and the United States (US). We used mixed-effects logistic regression to assess the within-pair association between female sex and lifetime prevalence of LBP in unadjusted and adjusted models for body-mass-index, and depression, as well as interactions between female sex and age (

Cross-Sectional Study of Location-Based Built Environments, Physical Activity, Dietary Intake, and Body Mass Index in Adult Twins.

We examined relationships between walkability and health behaviors between and within identical twin pairs, considering both home (neighborhood) walkability and each twin's measured activity space. Continuous activity and location data (via accelerometry and GPS) were obtained in 79 pairs over 2 weeks. Walkability was estimated using Walk Score® (WS); home WS refers to neighborhood walkability, and GPS WS refers to the mean of individual WSs matched to every GPS point collected by each participant. GPS WS was assessed within (WHN) and out of the neighborhood (OHN), using 1-mile Euclidean (air1mi) and network (net1mi) buffers. Outcomes included walking and moderate-to-vigorous physical activity (MVPA) bouts, dietary energy density (DED), and BMI. Home WS was associated with WHN GPS WS (b = 0.71, SE = 0.03, p < 0.001 for air1mi; b = 0.79, SE = 0.03, p < 0.001 for net1mi), and OHN GPS WS (b = 0.18, SE = 0.04, p < 0.001 for air1mi; b = 0.22, SE = 0.04, p < 0.001 for net1mi). Quasi-causal relationships (within-twin) were observed for home and GPS WS with walking (ps < 0.01), but not MVPA, DED, or BMI. Results support previous literature that neighborhood walkability has a positive influence on walking.

Quasi-causal associations between chronotype and post-traumatic stress disorder symptoms: A twin study.

OBJECTIVE: The evening ("night owl") chronotype is associated with greater severity and lifetime prevalence of post-traumatic stress disorder (PTSD) symptoms compared to morning or intermediate chronotypes. This twin study investigated the gene-environment relationships between chronotype, recent PTSD symptoms, and lifetime intrusive symptoms. METHODS: We used the reduced Horne-Östberg Morningness-Eveningness Questionnaire (rMEQ) to assess chronotype in a sample of 3777 same-sex adult twin pairs raised together (70.4% monozygotic, 29.6% dizygotic) in the community-based Washington State Twin Registry. PTSD symptoms were reported on the Impact of Events Scale (IES) and a single item for lifetime experience of intrusive symptoms after a stressful or traumatic event. RESULTS: Genetic influences accounted for 50% of chronotype variance, 30% of IES score variance, and 14% of lifetime intrusive symptom variance. Bivariate twin models showed a phenotypic association (bp) between evening chronotype and more severe PTSD symptoms (bp = -0.16, SE = 0.02, p < .001) that remained significant even after adjusting for shared genetic and environmental influences (bp = -0.10, SE = 0.04, p = .009), as well as age, sex, and self-reported sleep duration (bp = -0.11, SE = 0.04, p = .004). An association was found between evening chronotype and lifetime intrusive symptoms (bp = -0.11, SE = 0.03, p < .001) that was no longer significant after adjusting for shared genetic and environmental influences (bp = 0.04, SE = 0.06, p = .558). CONCLUSIONS: Our results suggest a "quasi-causal" relationship between evening chronotype and PTSD symptoms that is not purely attributable to genetic or shared environmental factors. Evening chronotype may increase vulnerability to pathologic stress responses in the setting of circadian misalignment, providing potential avenues of prevention and treatment using chronobiological strategies.

Do married and/or cohabiting individuals fare better during the COVID-19 pandemic? Satisfaction with life and depression among adult twins in the United States.

Due to social distancing measures implemented to mitigate the COVID-19 pandemic, individuals are spending more time isolated at home with limited physical social interactions. The current study investigated whether marriage and/or cohabitation is associated with satisfaction with life and depression among 732 adult same-sex twin pairs (monozygotic and dizygotic) in the US using online survey data. Twin analysis showed that married and/or cohabiting individuals were more satisfied with life and less depressed than those not married and/or cohabiting. The association between marriage and/or cohabiting and satisfaction with life was not confounded by between-family factors, whereas that between depression was mediated by familial factors. These findings suggest that being in a close relationship may mitigate some of the adverse consequences of the COVID-19 pandemic. Close relationships may be an essential source of support as individuals rely on their intimate partners when faced with the uncertainty and stress of the pandemic.

Epigenome-wide association study of physical activity and physiological parameters in discordant monozygotic twins.

An epigenome-wide association study (EWAS) was performed on buccal cells from monozygotic-twins (MZ) reared together as children, but who live apart as adults. Cohorts of twin pairs were used to investigate associations between neighborhood walkability and objectively measured physical activity (PA) levels. Due to dramatic cellular epigenetic sex differences, male and female MZ twin pairs were analyzed separately to identify differential DNA methylation regions (DMRs). A priori comparisons were made on MZ twin pairs discordant on body mass index (BMI), PA levels, and neighborhood walkability. In addition to direct comparative analysis to identify specific DMRs, a weighted genome coexpression network analysis (WGCNA) was performed to identify DNA methylation sites associated with the physiological traits of interest. The pairs discordant in PA levels had epigenetic alterations that correlated with reduced metabolic parameters (i.e., BMI and waist circumference). The DNA methylation sites are associated with over fifty genes previously found to be specific to vigorous PA, metabolic risk factors, and sex. Combined observations demonstrate that behavioral factors, such as physical activity, appear to promote systemic epigenetic alterations that impact metabolic risk factors. The epigenetic DNA methylation sites and associated genes identified provide insight into PA impacts on metabolic parameters and the etiology of obesity.

Cross-sectional associations between neighbourhood walkability and objective physical activity levels in identical twins.

OBJECTIVES: Physical activity is a cornerstone of chronic disease prevention and treatment, yet most US adults do not perform levels recommended for health. The neighborhood-built environment (BE) may support or hinder physical activity levels. This study investigated whether identical twins who reside in more walkable BEs have greater activity levels than twins who reside in less walkable BEs (between-twin analysis), and whether associations remain significant when controlling for genetic and shared environmental factors (within-twin analysis). DESIGN: A cross-sectional study. SETTING: The Puget Sound region around Seattle, Washington, USA. PARTICIPANTS: The sample consisted of 112 identical twin pairs who completed an in-person assessment and 2-week at-home measurement protocol using a global positioning system (GPS)monitor and accelerometer. EXPOSURE: The walkability of each participants' place of residence was calculated using three BE dimensions (intersection density, population density and destination accessibility). For each variable, z scores were calculated and summed to produce the final walkability score. OUTCOMES: Objectively measured bouts of walking and moderate-to-vigorous physical activity (MVPA), expressed as minutes per week. RESULTS: Walkability was associated with walking bouts (but not MVPA) within the neighbourhood, both between (b=0.58, SE=0.13, p<0.001) and within pairs (b=0.61, SE=0.18, p=0.001). For a pair with a 2-unit difference in walkability, the twin in a more walkable neighbourhood is likely to walk approximately 16 min per week more than the co-twin who lives in a less walkable neighbourhood. CONCLUSIONS: This study provides robust evidence of an association between walkability and objective walking bouts. Improvements to the neighbourhood BE could potentially lead to increased activity levels in communities throughout the USA.

Measuring and modelling perceptions of the built environment for epidemiological research using crowd-sourcing and image-based deep learning models.

BACKGROUND: Perceptions of the built environment, such as nature quality, beauty, relaxation, and safety, may be key factors linking the built environment to human health. However, few studies have examined these types of perceptions due to the difficulty in quantifying them objectively in large populations. OBJECTIVE: To measure and predict perceptions of the built environment from street-view images using crowd-sourced methods and deep learning models for application in epidemiologic studies. METHODS: We used the Amazon Mechanical-Turk crowdsourcing platform where participants compared two street-view images and quantified perceptions of nature quality, beauty, relaxation, and safety. We optimized street-view image sampling methods to improve the quality and resulting perception data specific to participants enrolled in the Washington State Twin Registry (WSTR) health study. We used a transfer learning approach to train deep learning models by leveraging existing image perception data from the PlacePulse 2.0 dataset, which includes 1.1 million image comparisons, and refining based on new WSTR perception data. Resulting models were applied to WSTR addresses to estimate exposures and evaluate associations with traditional built environment measures. RESULTS: We collected over 36,000 image comparisons and calculated perception measures for each image. Our final deep learning models explained 77.6% of nature quality, 68.1% of beauty, 72.0% of relaxation, and 64.7% of safety in pairwise image comparisons. Applying transfer learning with the new perception labels specific to the WSTR yielded an average improvement of 3.8% for model performance. Perception measures were weakly to moderately correlated with traditional built environment exposures for WSTR participant addresses; for example, nature quality and NDVI (r = 0.55), neighborhood area deprivation (r = -0.16), and walkability (r = -0.20), respectively. SIGNIFICANCE: We were able to measure and model perceptions of the built environment optimized for a specific health study. Future applications will examine associations between these exposure measures and mental health in the WSTR. IMPACT STATEMENT: Built environments influence health through complex pathways. Perceptions of nature quality, beauty, relaxation and safety may be particularly import for understanding these linkages, but few studies to-date have examined these perceptions objectively for large populations. For quantitative research, an exposure measure must be reproducible, accurate, and precise--here we work to develop such measures for perceptions of the urban environment. We created crowd-sourced and image-based deep learning methods that were able to measure and model these perceptions. Future applications will apply these models to examine associations with mental health in the Washington State Twin Registry.

Changing genetic architecture of body mass index from infancy to early adulthood: an individual based pooled analysis of 25 twin cohorts.

BACKGROUND: Body mass index (BMI) shows strong continuity over childhood and adolescence and high childhood BMI is the strongest predictor of adult obesity. Genetic factors strongly contribute to this continuity, but it is still poorly known how their contribution changes over childhood and adolescence. Thus, we used the genetic twin design to estimate the genetic correlations of BMI from infancy to adulthood and compared them to the genetic correlations of height. METHODS: We pooled individual level data from 25 longitudinal twin cohorts including 38,530 complete twin pairs and having 283,766 longitudinal height and weight measures. The data were analyzed using Cholesky decomposition offering genetic and environmental correlations of BMI and height between all age combinations from 1 to 19 years of age. RESULTS: The genetic correlations of BMI and height were stronger than the trait correlations. For BMI, we found that genetic correlations decreased as the age between the assessments increased, a trend that was especially visible from early to middle childhood. In contrast, for height, the genetic correlations were strong between all ages. Age-to-age correlations between environmental factors shared by co-twins were found for BMI in early childhood but disappeared altogether by middle childhood. For height, shared environmental correlations persisted from infancy to adulthood. CONCLUSIONS: Our results suggest that the genes affecting BMI change over childhood and adolescence leading to decreasing age-to-age genetic correlations. This change is especially visible from early to middle childhood indicating that new genetic factors start to affect BMI in middle childhood. Identifying mediating pathways of these genetic factors can open possibilities for interventions, especially for those children with high genetic predisposition to adult obesity.

The pillars of health: influence of multiple lifestyle behaviors on body mass index and depressive symptoms in adult twins.

BACKGROUND: Guidelines promoting healthy lifestyles are cornerstones of chronic disease prevention and treatment. The purpose of this study is to investigate independent and joint associations of five key health behaviors with health outcomes (body mass index (BMI kg/m2) and depressive symptoms) in adult twins. METHODS: We included 6,048 twin pairs from a community-based registry. Five key health behaviors were: (1) ≥ 8 h of sleep per night, (2) ≥ 5 servings of fruits and vegetables daily, (3) ≤ 2 h sedentary time per day, (4) ≥ 150 min of moderate-to-vigorous physical activity (MVPA) per week, and (5) no smoking. We analyzed phenotypic associations between behaviors and outcomes; whether phenotypic associations were confounded by additive genetic and shared environmental factors within twin pairs ("quasi-causal" associations); and which behaviors, considered simultaneously, had the largest associations with outcomes. RESULTS: We found negative phenotypic associations between number of behaviors achieved with BMI and depressive symptoms score (ps < 0.05). Associations remained significant, though attenuated, when controlling for genetic and shared environmental factors, and demographics, for depressive symptoms score but not BMI (p < 0.05). Quantitative variable importance measures derived from regression tree models showed sedentary time and MVPA were the most important variables in partitioning twins with different BMI, and smoking and sedentary time for partitioning twins with different depressive symptoms score. CONCLUSIONS: Achievement of commonly endorsed health behaviors is associated with lower BMI (especially sedentary and MVPA targets) and depressive symptoms score (especially sedentary and smoking targets). This provides further support of health behavior promotion to improve health outcomes.

Changes in physical activity levels and mental health during COVID-19: Prospective findings among adult twin pairs.

BACKGROUND: Physical distancing and other COVID-19 pandemic mitigation strategies have negatively impacted physical activity (PA) levels and mental health in cross-sectional studies. The purpose of this study was to investigate associations between changes in PA and mental health outcomes during the COVID-19 pandemic, following implementation of mitigation strategies, in a sample of adult twins. METHODS: This was a prospective study of 3,057 adult twins from the Washington State Twin Registry. Study participants completed online surveys in 2020, at baseline (March 26 -April 5), and three follow-up waves (W1: April 20 -May 3; W2: Jul 16 -Aug 2; W3: Sept 16 -Oct 1). Physical activity was operationalized as self-reported moderate-to-vigorous PA (MVPA) and neighborhood walking (minutes/week), and mental health outcomes, operationalized as self-reported anxiety and perceived stress were assessed in the three waves of follow-up. Latent growth curve models (LGCMs) were used to assess changes in PA and mental health outcomes over time. Parallel LGCMs were used to estimate the cross-sectional, parallel, and prospective associations between PA and mental health over time. All models took into within-pair correlations and adjusted for age, sex, and race. RESULTS: Individuals' amount of MVPA and walking decreased over time, whereas levels of anxiety remained stable, and stress increased slightly. Cross-sectional associations observed between both PA predictors and mental health outcomes were weak. After taking into account cross-sectional associations between PA and mental health outcomes, changes in PA over time were not associated with changes in mental health outcomes over time. CONCLUSIONS: Over a time period aligned with COVID-19 mitigation strategies and social restrictions, changes in physical activity was not associated with changes in anxiety or stress levels in the current sample. Nonetheless, the average decline in PA over time is worrisome. Public health resources should continue to promote PA as a means to improve physical health during the pandemic.

Educational attainment of same-sex and opposite-sex dizygotic twins: An individual-level pooled study of 19 twin cohorts.

Comparing twins from same- and opposite-sex pairs can provide information on potential sex differences in a variety of outcomes, including socioeconomic-related outcomes such as educational attainment. It has been suggested that this design can be applied to examine the putative role of intrauterine exposure to testosterone for educational attainment, but the evidence is still disputed. Thus, we established an international database of twin data from 11 countries with 88,290 individual dizygotic twins born over 100 years and tested for differences between twins from same- and opposite-sex dizygotic pairs in educational attainment. Effect sizes with 95% confidence intervals (CI) were estimated by linear regression models after adjusting for birth year and twin study cohort. In contrast to the hypothesis, no difference was found in women (ß = -0.05 educational years, 95% CI -0.11, 0.02). However, men with a same-sex co-twin were slightly more educated than men having an opposite-sex co-twin (ß = 0.14 educational years, 95% CI 0.07, 0.21). No consistent differences in effect sizes were found between individual twin study cohorts representing Europe, the USA, and Australia or over the cohorts born during the 20th century, during which period the sex differences in education reversed favoring women in the latest birth cohorts. Further, no interaction was found with maternal or paternal education. Our results contradict the hypothesis that there would be differences in the intrauterine testosterone levels between same-sex and opposite-sex female twins affecting education. Our findings in men may point to social dynamics within same-sex twin pairs that may benefit men in their educational careers.

Differences in Stress and Anxiety Among Women With and Without Children in the Household During the Early Months of the COVID-19 Pandemic.

The COVID-19 pandemic and resulting lockdowns have had a disproportionate impact on parents of children under 18, particularly women. Mandatory school closures and loss of childcare resulted in parents balancing work, teaching, and childcare needs. A number of studies have examined changes in mental health of parents, but to date no studies have compared the differences in stress and anxiety levels between women with and without children in the United States. Adult women from the Washington State Twin Registry (WSTR) (N = 1,014, pair N = 529) and mothers of twin children enrolled in the WSTR (N = 147) completed an online survey examining several health-related behaviors and outcomes and their self-reported changes due to COVID-19. We conducted two studies to examine the impact of children on stress and anxiety levels among women. In study 1, we assessed whether women living in households with children under the age of 18 have higher levels of stress and anxiety than those without children in their household. We found that perceived stress levels did not differ between women with and without children in the household, but anxiety levels were higher among women living with children than those without. In study 2, we assessed whether the correlation between children in the household and stress/anxiety is accounted for by non-random genetic and environmental selection effects, causal processes, or both using a sample of adult female twins. We found that the presence of children in the household was associated with higher levels of stress and anxiety. However, this association is confounded by genetic and shared environmental factors. Our findings highlight the need to provide supporting resources to women living with children in the household during and after the COVID-19 pandemic.

GPS-based built environment measures associated with adult physical activity.

Studies often rely on home locations to access built environment (BE) influences on physical activity (PA). We use GPS and accelerometer data collected for 288 individuals over a two-week period to examine eight GPS-derived BE characteristics and moderate-to-vigorous PA (MVPA) and light-to-moderate-vigorous PA (LMVPA). NDVI, parks, blue space, pedestrian-orientated intersections, and population density were associated with increased odds of LMVPA and MVPA, while traffic air pollution and noise were associated with decreased odds of LMVPA and MVPA. Associations varied by population density and when accounting for multiple BE measures. These findings provide further information on where individuals choose to be physically active.

Measurement of neighborhood-based physical activity bouts.

This study examined how buffer type (shape), size, and the allocation of activity bouts inside buffers that delineate the neighborhood spatially produce different estimates of neighborhood-based physical activity. A sample of 375 adults wore a global positioning system (GPS) data logger and accelerometer over 2 weeks under free-living conditions. Analytically, the amount of neighborhood physical activity measured objectively varies substantially, not only due to buffer shape and size, but by how GPS-based activity bouts are identified with respect to containment within neighborhood buffers. To move the "neighborhood-effects" literature forward, it is critical to delineate the spatial extent of the neighborhood, given how different ways of measuring GPS-based activity containment will result in different levels of physical activity across different buffer types and sizes.

Is COVID-19 Keeping us Up at Night? Stress, Anxiety, and Sleep Among Adult Twins.

In response to the COVID-19 pandemic, a variety of social distancing measures to mitigate the virus outbreak have been implemented. These measures may have unintended consequences on individuals' well-being, such as increased stress, anxiety, and sleep disruptions. We investigated the extent to which individuals' mental health status is associated with perceived changes in sleep amount and sleep quality among a sample of adult twin pairs (N = 909 pairs; 77% MZ, 23% DZ), less than a month after the outbreak was declared a pandemic by the World Health Organization. About half of participants reported no change in sleep amount (50.1%) or sleep quality (55.6%). Approximately one-third of the participants had increased amount of sleep (29.8%), and 32.9% reported a decrease in sleep quality. We found that stress and anxiety levels were associated with sleep reduction (ORs = 2.36 and 3.12 for stress and anxiety, respectively) and poorer sleep quality (ORs = 2.45 and 3.73 for stress and anxiety, respectively), even after taking into account between-family confounds. A much smaller association was observed between levels of stress and anxiety and increased sleep amount (ORs = 1.42 and 1.60 for stress and anxiety, respectively) and sleep quality (OR = 1.21 and 1.29 for stress and anxiety, respectively), which was no longer significant after controlling for between-family confounds. Our results demonstrate that stress and anxiety associated with the COVID-19 pandemic and social distancing measures may be linked to reduced sleep amount and quality.

Fear and depression linked to COVID-19 exposure A study of adult twins during the COVID-19 pandemic.

Millions of people have been impacted by the novel coronavirus (COVID-19) pandemic worldwide. High infection rates and death tolls, combined with social distancing measures, may have unintended psychological consequences on individuals. The goal of this study was to examine the interrelations between COVID-19 exposure, fear of COVID-19, and depression among a community-based sample of adult twins. We further explored whether fear of COVID-19 mediated the association between COVID-19 exposure and depression. 732 same-sex adult twin pairs (78.1% MZ, 21.9% DZ) completed an online survey examining their feelings in May 2020. About one-fifth of the participants reported having any COVID-19 exposure. Most participants (>80%) were somewhat concerned about themselves or their household members being infected by COVID-19. The average depression level was relatively low (M = 0.9 out of 6). We found that COVID-19 exposure was related to increased fears of COVID-19 and depression, and that depressive feelings increased with fear of COVID-19. The correlation between COVID-19 exposure and depression was partially mediated by fear of COVID-19. However, these associations were confounded by familial influences. As society navigates through the pandemic, it is essential to implement public health strategies to help individuals cope with the concerns and fears about COVID-19.

Stress, Anxiety, and Change in Alcohol Use During the COVID-19 Pandemic: Findings Among Adult Twin Pairs.

The novel coronavirus (COVID-19) has impacted the lives of people worldwide since being declared a pandemic on March 11, 2020. Social restrictions aimed at flattening the curve may be associated with an increase in stress and anxiety, which may increase the use of alcohol as a coping mechanism. The objective of this study was to examine if stress and anxiety were associated with changes in alcohol use in a sample of adult twins. Twins allowed us to control for genetic and shared environmental factors that would confound the alcohol - mental health relationship. Twins (N = 3,971; 909 same-sex pairs) from the Washington State Twin Registry (WSTR) completed an online survey examining several health-related behaviors and outcomes and their self-reported changes due to COVID-19. About 14% of the respondents reported an increase in alcohol use. We found an association between both stress and anxiety and increased alcohol use, where twins with higher levels of stress and anxiety were more likely to report an increase in alcohol consumption. The associations were small and confounded by between-family factors and demographic characteristics. However, there was no significant difference in stress or anxiety levels between non-drinkers and those who reported no change in alcohol use. Our findings suggest that individuals' mental health may be associated with changes in alcohol use during the COVID-19 pandemic.