Prevalence and predictors of general psychiatric disorders and loneliness during COVID-19 in the United Kingdom #covid19rftlks

Prevalence and predictors of general psychiatric disorders and loneliness during COVID-19 in the United Kingdom | Psychiatry Research | Volume 291, September 2020

Despite ample research on the prevalence of specific psychiatric disorders during COVID-19, we know little about the broader psychological impact of the pandemic on a wider population. The study investigates the prevalence and predictors of general psychiatric disorders measured by the 12-item General Health Questionnaire (GHQ-12) and frequency of loneliness during COVID-19 in the United Kingdom, a country heavily hit by the pandemic.

The study found:

  • Over one-fourth of British have general psychiatric disorders during COVID-19.
  • Over one-third of British sometimes or often feel lonely during COVID-19.
  • People with COVID-19 symptoms have more psychiatric disorders and are lonelier.
  • Women and young people are risky for psychiatric disorders and loneliness.
  • Employment and living with a partner reduce psychiatric disorders and loneliness.

Full paper: Prevalence and predictors of general psychiatric disorders and loneliness during COVID-19 in the United Kingdom

The divergence of mental health experiences during the pandemic #covid19rftlks

via Mental Health Foundation 

This briefing reports findings from the Coronavirus: Mental Health in the Pandemic study as of the fifth wave of data collection carried out between 18th and 22nd June. The study is led by the Mental Health Foundation, in collaboration with the University of Cambridge, Swansea University, the University of Strathclyde and Queen’s University Belfast.

While most people will exit the pandemic with good mental health, the findings of the study clearly suggest that the benefits of exiting the lockdown measures will not be enjoyed equally by all.

Divergence of experience presents a big policy challenge as there are many different groups, areas, impacts and experiences to consider. This huge variety of individual and group identities is difficult to capture in research and it is challenging to produce nuanced policy recommendations that recognise all these different experiences and their effects.  A recovery response needs to take a holistic approach that addresses social, systemic and structural inequalities rather than placing the onus on the individual.

Full detail: Coronavirus: The divergence of mental health experiences during the pandemic

NIHR: Combined drug and psychological therapies may be most effective for depression

NIHR | July 2020 | Combined drug and psychological therapies may be most effective for depression

The most effective treatment for adults with moderate depression is likely to be a combination of antidepressant drugs and psychological interventions. A new summary provides the strongest evidence to date that the combination of treatments work better than either alone.

The most recent advice from National Institute for Health and Care Excellence (NICE) comes in a clinical knowledge summary (March 2020). It suggests low-intensity psychosocial interventions such as self-help, computerised cognitive behavioural therapy (CBT), or group exercise programmes for mild to moderate depression. Routine use of antidepressants is not suggested for this group. The combination of drug and high intensity psychological therapy is reserved for those with severe depression.

Routine use of combination treatment will require increased access to psychological therapies, including computerised and group CBT as well as individual treatment.

What’s the issue?

There is clear evidence that drug-based and psychological therapies are effective treatments for depression. How these therapies compare with each other, alone or in combination, is less clear. Previous studies suggested the combination might be more effective than either alone but were not conclusive.

Combination treatment is likely to be more expensive to deliver than a single treatment. Psychological therapies are more expensive than drug treatments. Commissioners need good evidence if they are to fund psychological therapies and combination treatment. This study was designed to give more precise estimates of how effective each treatment is, to allow treatments to be ranked.

What’s new?

This meta-analysis included 101 trials, with 11,910 participants. The most commonly used psychotherapy was CBT, and the most commonly used group of drugs were the selective serotonin reuptake inhibitors (SSRIs).

The researchers considered that patients had responded to therapy if their symptoms of depression were reduced by half. They found that patients receiving combination psychological and drug therapy were most likely to respond. They were:

  • 27% more likely to respond than those receiving psychotherapy alone
  • 25% more likely to respond than those receiving drug treatment alone

There were no significant differences in response rates between psychotherapy alone and drug treatment.

Treatment acceptability was based on the number of patients who dropped out of studies. The study found that:

  • combined treatment was 23% more acceptable than drug treatment alone
  • psychological therapy alone was 17% more acceptable than drug treatment alone
  • combined treatment and psychological therapy alone were equally as acceptable

Combination treatment was superior overall for both moderate and severe depression. There were too few studies to calculate the effectiveness of these treatments on mild depression.

Why is this important?

This research suggests that, for people with moderate depression, combination treatment should be offered before antidepressants alone. Where a single treatment is chosen, the results suggest that psychological treatment is more acceptable to patients than drug treatment.

The added benefit of combined treatment is greatest for those with the highest chance of responding to either therapy alone. When considering treatment options, patient preferences, individual circumstances, and treatment history also need to be taken into account.

What’s next?

New NICE guidelines on depression in adults are planned. The existing NICE guidelines, published in 2009, recommend a stepped-care model for those with mild to moderate depression. Either psychological therapy or antidepressant drugs were offered only after earlier steps have been exhausted.

The recent NICE clinical knowledge summary (March 2020) recommends low-intensity psychosocial therapies in newly-diagnosed mild-to-moderate depression. Routine use of antidepressants is not recommended for mild-to-moderate depression unless people have a history of the condition, persistent symptoms, or another ongoing physical health problem. Combination therapy with an antidepressant and a high-intensity psychological intervention is reserved for those with severe depression.

Further research needs to focus on long-term results. Most studies included in this meta-analysis lasted eight to 16 weeks, which is not long enough to consider relapse rates. Further analysis could identify the specific groups likely to benefit from one or another treatment approach.

Source: NIHR

Prevalence of and risk factors associated with mental health symptoms during the Coronavirus disease pandemic #covid19rftlks

Prevalence of and Risk Factors Associated With Mental Health Symptoms Among the General Population in China During the Coronavirus Disease 2019 Pandemic | JAMA Network | 1st July 2020

Question:  What are the patterns of and factors associated with mental health conditions among the general population during the coronavirus disease 2019 (COVID-19) outbreak in China?

Findings:  In this survey study with 56 679 participants across all 34 province-level regions in China, 27.9% of participants had symptoms of depression, 31.6% had symptoms of anxiety, 29.2% had symptoms of insomnia, and 24.4% had symptoms of acute stress during the outbreak. Factors independently associated with negative mental health outcomes included having confirmed or suspected COVID-19, having a relative with confirmed or suspected COVID-19, having occupational exposure risks, living in Hubei province, and experiencing quarantine and delays in returning to work.

Meaning:  The mental health burden associated with COVID-19 is considerable among the general population of China, suggesting that mental health interventions are in urgent demand during the COVID-19 pandemic, especially for some at-risk populations.

Full detail: Prevalence of and Risk Factors Associated With Mental Health Symptoms Among the General Population in China During the Coronavirus Disease 2019 Pandemic

Royal College of Physicians: First UK study of COVID-19 neurological and psychiatric complications warns of mental health problems in younger patients #covid19rftlks

Royal College of Physicians | June 2020| First UK study of COVID-19 neurological and psychiatric complications warns of mental health problems in younger patients

Abstract

A study of 153 patients treated in UK hospitals during the acute phase of the COVID-19 pandemic describes a range of neurological and psychiatric complications that may be linked to the virus.

The research carried out by the CoroNerve Studies Group, including the Royal College of Psychiatrists, and published today in The Lancet Psychiatry journal reveals that while stroke was the most commonly reported neurological complication in hospitalised COVID-19 patients, many younger patients developed an altered mental state such as psychosis or catatonia.

 To investigate the breadth of COVID-19 complications that affect the brain, researchers set up a secure, UK-wide online network for specialist doctors to report details of specific cases. These portals were hosted by professional bodies representing specialists in neurology, stroke, psychiatry and intensive care. Data was collected between 2 April and 26 April 2020, during the exponential phase of the pandemic

Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study

Varatharaj, A. et al. (25 June 2020). Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study| The Lancet Psychiatry|

Summary

Background

Concerns regarding potential neurological complications of COVID-19 are being increasingly reported, primarily in small series. Larger studies have been limited by both geography and specialty. Comprehensive characterisation of clinical syndromes is crucial to allow rational selection and evaluation of potential therapies. The aim of this study was to investigate the breadth of complications of COVID-19 across the UK that affected the brain.

Methods

During the exponential phase of the pandemic, we developed an online network of secure rapid-response case report notification portals across the spectrum of major UK neuroscience bodies, comprising the Association of British Neurologists (ABN), the British Association of Stroke Physicians (BASP), and the Royal College of Psychiatrists (RCPsych), and representing neurology, stroke, psychiatry, and intensive care. Broad clinical syndromes associated with COVID-19 were classified as a cerebrovascular event (defined as an acute ischaemic, haemorrhagic, or thrombotic vascular event involving the brain parenchyma or subarachnoid space), altered mental status (defined as an acute alteration in personality, behaviour, cognition, or consciousness), peripheral neurology (defined as involving nerve roots, peripheral nerves, neuromuscular junction, or muscle), or other (with free text boxes for those not meeting these syndromic presentations). Physicians were encouraged to report cases prospectively and we permitted recent cases to be notified retrospectively when assigned a confirmed date of admission or initial clinical assessment, allowing identification of cases that occurred before notification portals were available. Data collected were compared with the geographical, demographic, and temporal presentation of overall cases of COVID-19 as reported by UK Government public health bodies.

Findings

The ABN portal was launched on April 2, 2020, the BASP portal on April 3, 2020, and the RCPsych portal on April 21, 2020. Data lock for this report was on April 26, 2020. During this period, the platforms received notification of 153 unique cases that met the clinical case definitions by clinicians in the UK, with an exponential growth in reported cases that was similar to overall COVID-19 data from UK Government public health bodies. Median patient age was 71 years (range 23–94; IQR 58–79). Complete clinical datasets were available for 125 (82%) of 153 patients. 77 (62%) of 125 patients presented with a cerebrovascular event, of whom 57 (74%) had an ischaemic stroke, nine (12%) an intracerebral haemorrhage, and one (1%) CNS vasculitis. 39 (31%) of 125 patients presented with altered mental status, comprising nine (23%) patients with unspecified encephalopathy and seven (18%) patients with encephalitis. The remaining 23 (59%) patients with altered mental status fulfilled the clinical case definitions for psychiatric diagnoses as classified by the notifying psychiatrist or neuropsychiatrist, and 21 (92%) of these were new diagnoses. Ten (43%) of 23 patients with neuropsychiatric disorders had new-onset psychosis, six (26%) had a neurocognitive (dementia-like) syndrome, and four (17%) had an affective disorder. 18 (49%) of 37 patients with altered mental status were younger than 60 years and 19 (51%) were older than 60 years, whereas 13 (18%) of 74 patients with cerebrovascular events were younger than 60 years versus 61 (82%) patients older than 60 years.

Interpretation

To our knowledge, this is the first nationwide, cross-specialty surveillance study of acute neurological and psychiatric complications of COVID-19. Altered mental status was the second most common presentation, comprising encephalopathy or encephalitis and primary psychiatric diagnoses, often occurring in younger patients. This study provides valuable and timely data that are urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy.

Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study

House of Lords Library: Coronavirus: the impact on mental health #covid19rftlks

House of Lords Library | June 2020 | Coronavirus: the impact on mental health

The House of Lords Library has produced a briefing on Coronavirus: the impact on mental health.

The coronavirus outbreak has affected mental health in a variety of ways. These include:

  • the impact of lockdown on an individual’s mental health;
  • the impact on individuals with pre-existing mental health conditions prior to the pandemic; and
  • loss of funding and operational capacity for mental health services and charities.

Why is mental health affected by the Covid-19 outbreak?

The lockdown, imposed from 23 March, has significantly limited many activities that have been shown to improve mental wellbeing. These include exercise, contact with the natural world, contact with friends and relatives, and a loss of everyday routine. Generalised fear and anxiety around the Covid-19 pandemic itself may also have an impact on an individual’s mental health.

While research on the mental health impact of the current pandemic is limited, studies of previous epidemics have shown that changes in health behaviour can lead to long lasting damage to mental health. These include:

  • enduring changes in health behaviours, such as insomnia and alcohol abuse;
  • fragmentation of social engagement, such as continued avoidance of public spaces and contact with others; and
  • adverse effects on work and working routines, such as isolation caused by remote working, and stress caused by change in working patterns.

Research into previous outbreaks has also shown that health workers and patients are at increased risk of long-term mental health problems.

Read the full briefing from the House of Lords Library

Neurological and neuropsychiatric complications of COVID-19 #covid19rftlks

Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study | The Lancet Psychiatry | 25th June 2020

Concerns regarding potential neurological complications of COVID-19 are being increasingly reported, primarily in small series. Larger studies have been limited by both geography and specialty. Comprehensive characterisation of clinical syndromes is crucial to allow rational selection and evaluation of potential therapies.

The aim of this study was to investigate the breadth of complications of COVID-19 across the UK that affected the brain.

To our knowledge, this is the first nationwide, cross-specialty surveillance study of acute neurological and psychiatric complications of COVID-19. Altered mental status was the second most common presentation, comprising encephalopathy or encephalitis and primary psychiatric diagnoses, often occurring in younger patients.

This study provides valuable and timely data that are urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy.

Full article: Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study

Life after lockdown: tackling loneliness among those left behind #covid19rftlks

British Red Cross | June 2020 | Life after lockdown: tackling loneliness among those left behind

The British Red Cross has published its report, Life after lockdown: tackling loneliness among those left behind draws on findings from a collection of national-level polling, interviews and evaluations from British Red Cross services during Covid-19.

The report highlights that although social distancing and lockdown measures will continue to be eased, loneliness will remain. And for those most left behind, it may continue to grow.

To truly meet the challenge ahead, policy makers and civil society must now consider recovery and refocus our efforts on supporting those most affected by this crisis.

Key findings
  • Before the Covid-19 crisis one in five people reported being often or always lonely. Now, 41 per cent of UK adults report feeling lonelier since lockdown.
  • More than a quarter of UK adults agree that they worry something will happen to them and no one will notice.
  • Thirty-one per cent of UK adults often feel alone, as though they have no one to turn to.
  • A third of UK adults haven’t had a meaningful conversation in the last week.
  • The loneliest people feel the least able to cope and recover from the Covid-19 crisis. 
  • A lack of meaningful contact, a reduction of informal and formal support, and increased anxiety have exacerbated loneliness during the crisis. 
  • Some communities have been at greater risk of loneliness than others – people from Black, Asian and minority ethnic (BAME) communities, parents with young children, young people, those living with long term physical and mental health conditions, people on lower incomes and those with limited access to digital technology and the internet.
  • Covid-19 has also meant a loss in social support for refugees and people seeking asylum. 

Download the report (PDF)

Download the recommendations (PDF)

View the key findings

View an overview of British Red Cross’ recommendations

Childhood Trust report warns of serious mental health conditions in children due to COVID-19 #covid19rftlks

The Childhood Trust | June 2020 | Childhood Trust report warns of serious mental health conditions in children due to COVID-19

This report draws on emerging evidence from available studies highlighting some of teh most pressing concerns that government and third sector organisations need to address to mitigate this crisis for children. These include the risk of emotional and physical abuse, mental health concerns, educational learning loss, hunger and food insecurity, homelessness and temporary housing, and lack of outdoor physical activity.

Read the report from The Childhood Trust

In the news:

BBC News Coronavirus: Children ‘developing post-traumatic stress’ from pandemic

Covid-19: understanding inequalities in mental health during the pandemic #covid19rftlks

Covid-19: understanding inequalities in mental health during the pandemic | Centre for Mental Health

The Covid-19 pandemic has brought health inequalities into sharp focus. The unequal impacts of the virus are also extending inequalities in mental health.

This briefing paper, produced by Centre for Mental Health and supported by 13 other national mental health charities, explores the mental health inequalities that are associated with the pandemic in the UK. It finds that the virus and the lockdown are putting greater pressure on groups and communities whose mental health was already poorer and more precarious.

Full paper: Covid-19: understanding inequalities in mental health during the pandemic