User Dynamics and Thematic Exploration in r/Depression During the COVID-19 Pandemic: Insights From Overlapping r/SuicideWatch Users.

BACKGROUND: In 2023, the United States experienced its highest- recorded number of suicides, exceeding 50,000 deaths. In the realm of psychiatric disorders, major depressive disorder stands out as the most common issue, affecting 15% to 17% of the population and carrying a notable suicide risk of approximately 15%. However, not everyone with depression has suicidal thoughts. While "suicidal depression" is not a clinical diagnosis, it may be observed in daily life, emphasizing the need for awareness. OBJECTIVE: This study aims to examine the dynamics, emotional tones, and topics discussed in posts within the r/Depression subreddit, with a specific focus on users who had also engaged in the r/SuicideWatch community. The objective was to use natural language processing techniques and models to better understand the complexities of depression among users with potential suicide ideation, with the goal of improving intervention and prevention strategies for suicide. METHODS: Archived posts were extracted from the r/Depression and r/SuicideWatch Reddit communities in English spanning from 2019 to 2022, resulting in a final data set of over 150,000 posts contributed by approximately 25,000 unique overlapping users. A broad and comprehensive mix of methods was conducted on these posts, including trend and survival analysis, to explore the dynamic of users in the 2 subreddits. The BERT family of models extracted features from data for sentiment and thematic analysis. RESULTS: On August 16, 2020, the post count in r/SuicideWatch surpassed that of r/Depression. The transition from r/Depression to r/SuicideWatch in 2020 was the shortest, lasting only 26 days. Sadness emerged as the most prevalent emotion among overlapping users in the r/Depression community. In addition, physical activity changes, negative self-view, and suicidal thoughts were identified as the most common depression symptoms, all showing strong positive correlations with the emotion tone of disappointment. Furthermore, the topic "struggles with depression and motivation in school and work" (12%) emerged as the most discussed topic aside from suicidal thoughts, categorizing users based on their inclination toward suicide ideation. CONCLUSIONS: Our study underscores the effectiveness of using natural language processing techniques to explore language markers and patterns associated with mental health challenges in online communities like r/Depression and r/SuicideWatch. These insights offer novel perspectives distinct from previous research. In the future, there will be potential for further refinement and optimization of machine classifications using these techniques, which could lead to more effective intervention and prevention strategies.

Investigating COVID-19's Impact on Mental Health: Trend and Thematic Analysis of Reddit Users' Discourse.

BACKGROUND: The COVID-19 pandemic has resulted in heightened levels of depression, anxiety, and other mental health issues due to sudden changes in daily life, such as economic stress, social isolation, and educational irregularity. Accurately assessing emotional and behavioral changes in response to the pandemic can be challenging, but it is essential to understand the evolving emotions, themes, and discussions surrounding the impact of COVID-19 on mental health. OBJECTIVE: This study aims to understand the evolving emotions and themes associated with the impact of COVID-19 on mental health support groups (eg, r/Depression and r/Anxiety) on Reddit (Reddit Inc) during the initial phase and after the peak of the pandemic using natural language processing techniques and statistical methods. METHODS: This study used data from the r/Depression and r/Anxiety Reddit communities, which consisted of posts contributed by 351,409 distinct users over a period spanning from 2019 to 2022. Topic modeling and Word2Vec embedding models were used to identify key terms associated with the targeted themes within the data set. A range of trend and thematic analysis techniques, including time-to-event analysis, heat map analysis, factor analysis, regression analysis, and k-means clustering analysis, were used to analyze the data. RESULTS: The time-to-event analysis revealed that the first 28 days following a major event could be considered a critical window for mental health concerns to become more prominent. The theme trend analysis revealed key themes such as economic stress, social stress, suicide, and substance use, with varying trends and impacts in each community. The factor analysis highlighted pandemic-related stress, economic concerns, and social factors as primary themes during the analyzed period. Regression analysis showed that economic stress consistently demonstrated the strongest association with the suicide theme, whereas the substance theme had a notable association in both data sets. Finally, the k-means clustering analysis showed that in r/Depression, the number of posts related to the "depression, anxiety, and medication" cluster decreased after 2020, whereas the "social relationships and friendship" cluster showed a steady decrease. In r/Anxiety, the "general anxiety and feelings of unease" cluster peaked in April 2020 and remained high, whereas the "physical symptoms of anxiety" cluster showed a slight increase. CONCLUSIONS: This study sheds light on the impact of COVID-19 on mental health and the related themes discussed in 2 web-based communities during the pandemic. The results offer valuable insights for developing targeted interventions and policies to support individuals and communities in similar crises.

Cigarette and e-cigarette use as a function of psychological distress following COVID-19 related university campus closures.

Background: Individuals experienced increased social isolation resulting from the COVID-19 pandemic. Studies have found social isolation and loneliness to be strongly associated with anxiety and depression, which have been associated with increased smoking and vaping rates among young adults, including college students.Objectives: To examine relationships between psychological distress and nicotine use within the context of the COVID-19 pandemic.Methods: A cross-sectional online survey (n = 4634; 77.9% female) was used to collect nicotine use and psychological measures from students enrolled at a large Midwestern university. Timeline follow-back data were collected from students reporting current cigarette or electronic cigarette (e-cigarette) use in the week before and immediately following the closure of campus due to the pandemic. Generalized estimating equations were used to examine the interaction between nicotine use and psychological symptoms across the 2-week period.Results: Both cigarette (Rate ratio (RR) = 1.115, 95% CI = 1.061, 1.171, p < .0001) and e-cigarette (ß = 0.258, 95% CI = 0.166, 0.351, p < .0001) use increased significantly following campus closure. Students experiencing higher levels of depression reported greater increases in e-cigarette use frequency over time as compared to students reporting fewer symptoms of depression (ß = 0.018, 95% CI = 0.006, 0.030, p = .004).Conclusions: Increases in nicotine use were found immediately following the implementation of public health safety measures that closed most university campuses. Additional and/or increased stressors have potentially impacted young adults who are college students as a result of campus closures resulting from the pandemic, which may have contributed to further increases in nicotine use.

Increases in Risky Drinking During the COVID-19 Pandemic Assessed via Longitudinal Cohort Design: Associations With Racial Tensions, Financial Distress, Psychological Distress and Virus-Related Fears.

BACKGROUND: The COVID-19 pandemic has created disruptions to daily life resulting in wide-spread unemployment and psychological distress. Recent studies have reported high rates of alcohol use during this time; however, longitudinal data remain scarce and factors associated with increases in high-risk drinking observed over time are unknown. AIMS: The current study examined changes in high-risk drinking patterns across four 7-day observation periods, prior to and following a university wide campus closure. Additionally, factors associated with changes in alcohol use patterns were examined including financial distress, psychological distress, impact of racial tensions and virus-related fears. METHOD: Students (N = 1001) in the Midwestern USA completed repeated assessments between March and June 2020. Each survey included a timeline follow-back measure of alcohol use. Pandemic-related distress spanning several factors was assessed at the final follow-up. RESULTS: Risky drinking patterns increased significantly over time. Overall, psychological distress and impact of racial tensions were associated with higher rates of risky drinking, whereas COVID-19-related fears were associated with lower rates. However, only financial-related distress was associated with an increase in risky drinking patterns over time. CONCLUSIONS: Increased risky drinking patterns observed in the current study may signal problems that are likely to persist even after the direct impact of the COVID-19 pandemic on daily life ends. Individuals experiencing financial distress may represent a particularly high-risk group. Interventions targeting the cross-section of job loss, financial stress and problematic alcohol use will be important to identify.

Perceptions of Harm and Reasons for Misuse of Prescription Opioid Drugs and Reasons for Not Seeking Treatment for Physical or Emotional Pain Among a Sample of College Students.

BACKGROUND: Since the early 1990s, the United States has seen a significant increase in the prevalence of prescription opioid misuse. Despite benefits prescription opioids provide, misuse can be fatal. OBJECTIVES: The current study was designed to investigate the prevalence of prescription opioid misuse, perceived harm of misuse, and reasons for misuse for physical or emotional pain instead of seeking professional medical or mental health treatment. METHODS: Survey data were collected in the fall of 2013 via an online survey to a random sample of 668 students from a public Midwestern university. RESULTS: Lifetime prevalence of prescription opioid misuse was 9.5%. Misusers of prescription opioid drugs generally reported lower ratings of perceived harm as compared to individuals not reporting misuse of prescription opioid drugs. Primary reasons for misuse of prescription opioid drugs was to relieve pain (33.9%), "to feel good/get high" (23.2%) and experimentation (21.4%). Lifetime misuse of a prescription opioid drug for physical or emotional pain was reported by 8.1% and 2.2% of respondents, respectively. Primary reasons for misuse for physical pain included because pain was temporary, immediate relief was needed, and no health insurance/financial resources. Primary reasons for misuse for emotional pain included not wanting others to find out, embarrassment and fear. Conclusions/Importance: Reasons for misuse of prescription opioid drugs vary by type of prescription opioid drug. Reasons for not seeking treatment that ultimately lead to misuse, vary by type of pain being treated and may be important considerations in the effort to stem the misuse of prescription opioid drugs among college students.

Assessment of psychological distress as a function of positive psychological variables during the COVID-19 pandemic: A university longitudinal study.

Objective: To examine changes in psychological distress of college students as a function of demographic and psychological variables over time during the COVID-19 pandemic. Participants: Subjects were recruited from a large public university in Northeast Ohio using electronic surveys administered at three time points in 2020. Methods: Demographics, positive psychological metrics (flourishing, perceived social support, and resilience) and psychological distress were collected and a mixed linear model was run to estimate their effect on change in distress. Results: Psychological distress did not change significantly across time. Females experienced more psychological distress than males. Higher levels of flourishing, perceived social support, and resilience were associated with less distress overall. Conclusions: Although psychological distress did not change across observed time, previous data suggests heightened psychological distress that remained elevated across observed time during the COVID-19 pandemic. Positive psychological variables were shown to mitigate psychological distress, and the relationship was stable over time.

Tobacco Use Status as a Function of Transgender Identity: The Mediating Role of Psychological Distress.

AIM: The current study examined differences between individuals identifying as transgender and people identifying as cisgender in terms of (1) psychological distress (eg, anxiety, depression, and suicidal ideation), (2) rates of combustible and e-cigarette use, and (3) the potential for elevated psychological distress stemming from transgender identification to be associated with increased rates of smoking and vaping. METHOD: This was a secondary analysis of data from a study examining behavioral health, perceptions and behaviors associated with alcohol and other drug use, and mental health status at a large mid-western university. Differences in current use of cigarette and e-cigarette products were examined between self-identified transgender (n = 253) and cisgender (n = 18 371) respondents. RESULTS: Overall, 17.2% (n = 2727) of the sample endorsed past 30-day use of cigarettes or e-cigarettes. Results demonstrated a significant effect of gender identity, with individuals identifying as transgender reporting higher odds of using cigarettes or e-cigarettes (AOR = 2.82, 95% CI 1.26-6.31). Regression analyses revealed significant effects of transgender identity on symptoms of anxiety (b = 3.45, 95% CI = 1.64, 5.25, P < .001.); depression, (b = 4.14, 95% CI = 2.21, 6.07, P < .001); and suicidal ideation, (b = 2.51, 95% CI = 1.48, 3.55, P < .001.), respectively. Finally, we observed significant indirect effects of transgender identity on cigarette and e-cigarette product use via increased symptoms of depression (indirect effect = 0.13, 95% CI [0.07, 0.19], P < .05), and suicidal ideation (indirect effect = 0.22, 95% CI [0.15, 0.28], P < .05), but not symptoms of anxiety. DISCUSSION: This is the first study of our knowledge to examine the association between psychological symptoms and smoking and vaping products with transgender identity. The results of this study support previous findings that transgender individuals are at risk for elevated substance use and extend the literature by demonstrating this this risk is associated with elevated psychological distress.

Changes in alcohol use as a function of psychological distress and social support following COVID-19 related University closings.

Amidst the coronavirus pandemic, universities across the country abruptly closed campuses and transitioned to remote learning. The effects of these unprecedented closures are unknown. The current study examined reported alcohol consumption during the week prior to and after campus closure at a public university in Northeast Ohio. Analysis of data from 1,958 students, who endorsed using alcohol in the past 30 days, demonstrates that alcohol consumption (amount and frequency) increased as time progressed. Those with more symptoms of depression and anxiety reported greater increases in alcohol consumption (assessed via retrospective timeline follow-back) compared to students with fewer symptoms. Furthermore, students with greater perceived social support reported less alcohol consumption. Together, these findings highlight the need for universities to offer services and programs to students that will minimize risk factors and maximize protective factors in order to reduce or prevent alcohol abuse during the coronavirus pandemic.

Nonmedical use of prescription drugs during sexual activity as a predictor of condom use among a sample of college students.

Objective: To examine the impact of nonmedical use of prescription drugs (NMUPD) during sexual activity on the frequency of condom use among a sample of college students. Participants: Students attending a large Midwestern University (N = 4284) during April 2015. Methods: Retrospective cross-sectional analysis of survey data using logistic regression. Results: Respondents and/or their sexual partners who engaged in NMUPD during sexual activity were significantly less likely to use condoms during 75% or more of past 12-month sexual encounters compared to respondents who had not engaged in lifetime and past 12-month NMUPD. Although not statistically significant, trends suggest that respondents who engaged in NMUPD during sexual activity may be less likely to use condoms than those who engaged in lifetime or past 12-month NMUPD but not during sexual activity. Conclusions: Findings suggest a need for specific strategies for reducing risk behaviors related to prescription drugs and sexual activity.

Pregnant or recently pregnant opioid users: contraception decisions, perceptions and preferences.

BACKGROUND: Multiple factors are linked to extremely high unintended pregnancy rates among women who use opioids, including various barriers to contraception adherence. These include patient level barriers such as lack of knowledge and education about highly effective contraception, and potential provider barriers. Using a mixed-methods framework to examine the contraception-related perceptions and preferences of opioid using women is a necessary next step to understanding this phenomenon. METHODS: A mixed-method study was conducted which included both self-report questionnaires along with a semi-structured qualitative interview of opioid-using pregnant or recently pregnant women in two drug treatment facilities in Ohio. RESULTS: Forty-two women completed the study. The majority of recent (75%) and total pregnancies were unintended. Male condoms were reported as the highest form of lifetime contraception used within the present sample (69%). Participants reported low lifetime use of long acting reversible contraception (LARC) (ranging from 5 to 12%). Participants preferred hormonal injections first (40%), followed by IUDs (17%). Reasons for preferences of injections and LARC were similar: not needing to remember, side effects, and long-term effectiveness. CONCLUSIONS: Most of the study population participants stated they would utilize contraception, particularly Tier 1 LARC methods, if freely available; however, high rates of unintended pregnancy were observed in this sample. This indicates the need for contraception education, and addressing the procedural, logistical and economic barriers that may be preventing the use of LARC among this population.

Methamphetamine use in Dayton, Ohio: preliminary findings from the Ohio Substance Abuse Monitoring Network.

Since the 1990s, methamphetamine manufacturing and use have been spreading into midwestern and southern United States. However, most research on methamphetamine use has been conducted in the western United States. This exploratory study is based on qualitative interviews with 26 people recruited in Dayton, Ohio, for the Ohio Substance Abuse Monitoring Network, a statewide epidemiological surveillance system. Participants ranged in age from 21 to 57 years. The majority were White and male. The participants reported increases in methamphetamine availability and identified powder-type locally manufactured methamphetamine as the most commonly seen form of the drug. The participants reported extensive drug use histories, and were introduced to methamphetamine in the context of their involvement with pharmaceutical stimulants, crack, powder cocaine, and/or club drug scene. A large proportion of the participants continued to use crack or powder cocaine in addition to methamphetamine. Many primary methamphetamine users felt they were able to moderate methamphetamine use and fulfill their daily responsibilities related to work and family life. Ranking results and consensus analysis revealed that participants shared high agreement about drug-related risks, and perceived methamphetamine as a serious drug, although not as risky as heroin, crack or OxyContin. Implications for treatment and prevention are discussed.

The Use of Substances Other Than Nicotine in Electronic Cigarettes Among College Students.

INTRODUCTION: Electronic cigarettes (e-cigarettes) have grown in popularity, especially among youth and young adults. Although e-cigarettes were originally intended to vaporize a liquid mixture containing nicotine, there appears to be an increasing trend in other substance use in e-cigarettes (OSUE). MATERIALS AND METHODS: Cross-sectional data from 1542 undergraduate college student e-cigarette users from a large Midwestern university were collected via online survey to assess prevalence of e-cigarette use, reasons for use, perceived harm, and prevalence and predictors of OSUE. RESULTS: Nearly 7% (6.94%) reported using an e-cigarette to vaporize and inhale a substance other than nicotine. Current tobacco cigarette smokers were significantly more likely to report OSUE (51.0%) as compared with never (33.7%) and former (15.4%) smokers. Among respondents reporting OSUE, the primary reason for e-cigarette use was "safer than cigarettes" (21.7%), followed by "experimentation" (18.9%) and "friends use" (17.0%). Most (77.9%) reported using cannabis or some derivative of cannabis in an e-cigarette. Binomial logistic regression found that women were less likely to report OSUE by a factor of 0.60, former tobacco cigarette smokers as compared with never smokers were more likely to report OSUE by a factor of 1.87, and e-cigarette users who reported using e-cigarettes for "cool or trendy" reasons were more likely to report OSUE by a factor of 2.89. DISCUSSION: Little is known regarding the health effects of cannabis and cannabis derivatives delivered through e-cigarettes. Concern may also be warranted regarding the potential dangers of this young population using substances more dangerous than cannabis in e-cigarettes. Knowledge is limited regarding the public health impact of vaping cannabis or other illicit substances among college student populations. This study stresses the need for continued research regarding the vaping of cannabis and other illicit substances among college students.

Associations of attitudes towards electronic cigarettes with advertisement exposure and social determinants: a cross sectional study.

BACKGROUND: The exposure of young adults to electronic cigarette (e-cigarette) advertisements has risen rapidly. E-cigarette ads have been shown to increase short term perceived acceptability of using e-cigarettes in places where traditional cigarettes are banned. We set out to investigate if advertising exposure was related to perceptions of harm, addictiveness, and acceptability of use of e-cigarettes in places where traditional cigarettes are banned. METHODS: Using a cross-sectional design, 6037 students at a large Midwestern university between the ages of 18-24 were surveyed about e-cigarette use and smoking status. Bivariate analyses were performed associating perception of harm, addictiveness, and acceptability of e-cigarette use in places where smoking is banned with demographic and other background factors, and e-cigarette advertising exposure through different media channels. Logistic regression analyses were used to explore the relationship of these factors on perceptions of harm, addictiveness and acceptability of e-cigarette use in places where smoking is banned. RESULTS: More than a quarter (27.4%) of respondents had used an e-cigarette, greater than half (53.2%) had seen an advertisement on TV and 42.0% had seen an advertisement on the Internet. Logistic regressions revealed that being white, male, an e-cigarette user, a smoker, having a mother who smoked, and Internet advertisement exposure were associated with lower perceived harm of e-cigarettes. The same factors, plus having seen advertisements on TV, were associated with increased likelihood of perceiving e-cigarette use in bars, stores, at work and in a dorm as acceptable. Perceiving use of e-cigarettes as acceptable in classrooms was also associated with the aforementioned factors and also included race. Only being male and an e-cigarette user were associated with lower perceived addictiveness of e-cigarettes. CONCLUSIONS: E-cigarette use is increasing in adolescents and young adults, as is exposure to e-cigarette advertising. Independent of nicotine use and demographics factors, e-cigarette advertising is associated with increased beliefs in acceptability of e-cigarette use in places where cigarettes are banned. E-cigarette advertisements may be responsible for normalizing e-cigarette use. Exposure to internet e-cigarette advertisements was associated with lower perceived harm; this may be due to the false health claims often made in internet advertisements.

Examining the relationships between posttraumatic stress disorder symptoms, positive smoking outcome expectancies, and cigarette smoking in people with substance use disorders: a multiple mediator model.

Cigarette smoking is highly prevalent in people with substance use disorders (SUDs) and is associated with significant physical health problems. Posttraumatic stress disorder (PTSD) is also highly associated with both SUDs and cigarette smoking and may serve as a barrier to smoking cessation efforts. In addition, people with PTSD are more likely to hold positive smoking outcome expectancies (i.e., beliefs that smoking cigarettes results in positive outcomes); these beliefs may contribute to cigarette smoking in people with SUDs experiencing PTSD symptoms. The present study examined the relationship between PTSD symptoms and typical daily cigarette smoking/cigarette dependence symptoms in a sample of 227 trauma-exposed current smokers with SUDs (59.9% male, 89.4% Caucasian) seeking detoxification treatment services. Additionally, the indirect effects of multiple types of positive smoking outcome expectancies on these relationships were examined. Participants completed questionnaires assessing PTSD symptoms, positive smoking outcome expectancies, cigarette consumption, and cigarette dependence symptoms. Results indicated that PTSD symptoms were not directly related to cigarette consumption or cigarette dependence symptoms. However, negative affect reduction outcome expectancies were shown to have a significant indirect effect between PTSD symptoms and cigarette consumption, while negative affect reduction, boredom reduction, and taste-sensorimotor manipulation outcome expectancies were all found to have significant indirect effects between PTSD symptoms and cigarette dependence symptoms. The indirect effect involving negative affect reduction outcome expectancies was statistically larger than that of taste sensorimotor manipulation outcome expectancies, while negative affect reduction and boredom reduction outcome expectancies were comparable in magnitude. These results suggest that expectancies that smoking can manage negative affective experiences are related to cigarette smoking in people with SUDs experiencing PTSD symptoms and suggest that effective smoking cessation treatments should take into account these expectancies.

Characteristics of opiate users leaving detoxification treatment against medical advice.

Substance-dependent patients leaving against medical advice (AMA) pose a unique challenge to detoxification programs. Most notably, AMA patients fail to access residential or outpatient treatment needed after detoxification and often return to detoxification treatment multiple times which has deleterious results for the patient and is taxing to the healthcare system. Using retrospective data from 89 daily opiate-using detoxification patients completing detoxification and 95 patients leaving AMA, we sought to identify patient characteristics useful in predicting AMA discharges from detoxification. Bivariate analyses indicated that AMA patients reported drug use did not impair their health, were injection drug users, younger and had fewer previous treatment admissions. Binomial logistic regression indicated that AMA patients were more likely to be unemployed and report that drug use did not impair their health. Patients completing detoxification were less likely to be injection drug users and less likely to be self-referred to treatment. Identifying patients at risk of leaving AMA provides an opportunity for clinicians to intervene in an effort to increase treatment engagement for these patients.