The COVID-19 pandemic has sparked widespread concern about the need for mental health services. But depression was already becoming increasingly prevalent in the U.S. in the years leading up to the pandemic, particularly among young people between the ages of 12 and 25, according to a study published Monday in the American Journal of Preventive Medicine.
By 2020, depression affected nearly one in 10 Americans over the age of 12 but the number was nearly one in five among those between the ages of 12 and 25, the study found. This new research arrives at a time when advocates in New York are already urging city and state officials to invest more in behavioral health services for young people and address a shortage of childrens mental health professionals.
I think weve always conceptualized mental health as a clinically treated problem where the prevalence is low, said the study's lead author Dr. Renee Goodwin, a clinical psychologist and epidemiologist who teaches at Columbia University and CUNY. But more is needed in terms of a public health approach at this point, because its become so common.
The study was based on the National Survey on Drug Use and Health, an annual survey run by the Substance Abuse and Mental Health Services Administration. The data involved comes from more than 55,000 respondents per year between 2015 and 2020. The survey asked participants about whether they had experienced symptoms of a depressive episode over the past year, such as feeling sad consistently over a two-week period, or not being interested in activities that typically brought joy, Goodwin explained.
From 2015 to 2020, there was a significant gap between the number of participants experiencing depression and those accessing treatment.
In 2020, 9.2% of Americans over 12 had experienced symptoms of depression over the past year, Goodwins study found. That was up from 8.6% in 2019 and 7.3% in 2015.
But the jump primarily took place among young people, with no increase observed among those over 35. In 2019, about 16% of adolescents reported symptoms of depression, up from about 13% in 2015. By 2020 the figure was about 17% for that age group.
An even sharper increase was observed among those aged 18 to 25: The share with depression grew from a little over 10% in 2015 to about 17% in 2020. That year, only about half of the respondents with depression in that age group said they had spoken to a professional about it, a modest improvement from 2015.
The likelihood of getting help was lower for adolescents in that age group only about 40% said they had spoken with a professional.
Terry Hsieh,1 Bradley S Gundlach,2 Sahar Ashrafzadeh,2 David Sarraf,3,4 Irena Tsui3,5,6
1Stein Eye Institute, University of California, Los Angeles, CA, USA; 2David Geffen School of Medicine, University of California, Los Angeles, CA, USA; 3Ophthalmology Department, West Los Angeles Veterans Health Administration, Los Angeles, CA, USA; 4Retinal Disorders and Ophthalmic Genetics - Stein Eye Institute, University of California, Los Angeles, CA, USA; 5Retina Division - Stein Eye Institute, University of California, Los Angeles, CA, USA; 6Doheny Eye Institute, University of California, Los Angeles, CA, USA
Correspondence: Irena Tsui, Ophthalmology Department, West Los Angeles Veterans Health Administration, Los Angeles, CA, USA, Tel +1 310 825 7290, Fax +1 310 825 9946, Email [emailprotected]
Purpose: To examine the return of patients to intravitreal injection clinic after the COVID-19 lockdown.Patients and Methods: The electronic medical records of all patients who received intravitreal injections at a tertiary care Veterans Health Administration (VHA) clinic 14 weeks post-lockdown (5/9/20-8/13/20) in Los Angeles County were reviewed. Reference groups included injection patients during the 7-week COVID-19 lockdown (3/19/20-5/8/20) and a 7-week pre-pandemic period in 2019 (3/19/19-5/8/19). Clinic volume was compared using a one-way ANOVA. Demographic data, medical and psychiatric co-morbidities, injection diagnoses, visual acuities, and clinic volumes were compared between the 3 periods using a generalized estimating equation multivariate analysis.Results: The post-lockdown period group averaged 25.1 visits per week, compared with 12.3/week during lockdown and 25.4/week pre-COVID in intravitreal injection clinic. In the post-lockdown period, the VHA injection clinic returned closer to the pre-lockdown volume compared to the VHA comprehensive clinic (98.9% vs 57.4%, p Conclusion: Injection volume returned to pre-pandemic levels immediately after lockdown ended. However, patients with high-risk comorbidities did not return to intravitreal injection clinic post-lockdown. These results can inform medical organizations, which groups may need increased safety measures and targeted outreach to address their ophthalmic needs.
Keywords: age-related macular degeneration, anti-vascular endothelial growth factor, coronavirus, co-morbidities, diabetic retinopathy, retina
The COVID-19 pandemic required physicians and patients to make difficult decisions about the urgency of ophthalmology care. Los Angeles County enforced a stay-at-home order (referred to as lockdown) early during the pandemic to minimize the spread of COVID-19.1 Clinics quickly adopted symptom screening algorithms, mask enforcement policies, and disinfection protocols.2,3 Many specialties pivoted into telemedicine visits to continue providing care; however, ophthalmology often requires in-person visits with an exam in close proximity.4,5 Intravitreal injection clinics add to that exposure risk as both the injection and the necessary retinal imaging, such as optical coherence tomography (OCT), must be performed within the recommended safe social distancing.6,7
Intravitreal injections are one of the most commonly performed ophthalmological procedure.8 Anti-vascular endothelial growth factor (anti-VEGF) injections are effective treatments for neovascular age-related macular degeneration (nvAMD) and diabetic macular edema (DME), two of the most common indications for injections. These conditions demand regular visits and often require consistent injection intervals to prevent permanent visual impairment.9,10 The high-risk medical comorbidities defined by the Centers for Disease Control and Prevention (CDC) for SARS CoV-2 infection overlap heavily with the patient population receiving intravitreal injections.11 During the lockdown, physicians were forced to triage vision-threatening conditions and allocate treatment based on the risk of permanent functional vision loss.12 On the other hand, patients also faced a difficult choice between losing vision versus risking serious COVID infection. COVID infections have also been linked to a broad range of ocular pathology, including posterior segment pathology. This wide array of uveal and retinal pathology has been reported to range from cotton wool spots and hemorrhages to optic neuritis, retinitis, panuveitis, and even vascular occlusions.13
We previously investigated both ophthalmic and non-ophthalmic factors during the COVID-19 lockdown period in Los Angeles County and found a decrease in patient volume by 50% along with an increased proportion of Hispanic patients, systemically healthier patients, and patients with a diagnosis of AMD compared with the year prior.14 In this current study, we sought to study similar factors in the intravitreal injection clinic in the period immediately after lockdown to identify ophthalmic trends in the post-lockdown era.
This retrospective cohort study was approved by the Institutional Review Board of the Greater Los Angeles Veterans Health Administration (VHA). The veteran population is considered a vulnerable population due to increasing minority composition.15 Given the retrospective nature of this study, patient consent to review medical records was waived by the IRB. The IRB approval number is 2020000187. Confidentiality of patient data was maintained, and this study was compliant with the Declaration of Helsinki.
Patient charts were reviewed using the VHA Computerized Patient Record System (CPRS). Data was collected from intravitreal injection clinic, comprehensive clinic, and retina clinic from the pre-lockdown (March 19th, 2019 to May 8th, 2019), lockdown (March 19th, 2020 to May 8th, 2020), and post-lockdown (May 9th, 2020 to August 13th, 2020) periods. Patient demographic information (eg age, gender, self-reported race, residential zip code, homeless status), ophthalmic status (eg visual acuity, diagnosis, indication for injection), and both medical and psychiatric co-morbidities [eg body mass index (BMI), hypertension, high-risk COVID-19 co-morbidities, mental health diagnoses] were collected. The medical conditions considered high-risk co-morbidities for COVID-19 disease by the Center for Disease Control and Prevention (CDC) were identified including cancer, chronic kidney disease, chronic obstructive pulmonary disease, heart conditions (defined as heart failure, coronary artery disease, cardiomyopathies, arrhythmias, or valvular insufficiencies), BMI (kg/m2), and type 2 diabetes.11 Associated psychiatric conditions, which have a higher prevalence among veterans than in the general population,16 including depression, anxiety, schizophrenia, schizoaffective disorder, post-traumatic stress disorder, psychosis, and others, were also recorded.
During the seven-week lockdown period of March 19th, 2020 to May 8th, 2020, patients were called one week in advance of their clinic appointments. Patients with decreased vision, any new vision complaints, or with a diagnosis of nvAMD or functional monocular status were encouraged to keep their appointments and come in for evaluation. Those with stable vision or other diagnoses [eg diabetic macular edema (DME), diabetic retinopathy (DR), retinal vein occlusion (RVO), or central serous retinopathy (CSR)] were encouraged to reschedule. Non-ophthalmic co-morbidities did not influence providers recommendations. Appointments were not canceled if the patient wanted to come in, regardless of diagnosis or vision. Patients in the same seven-week period from March 19th, 2019 to May 8th, 2019 served as a pre-pandemic control group. The 14-week period immediately following the lifting of the lockdown order from May 9th, 2020 to August 13th, 2020 served as the post-lockdown group.
All patients who attended intravitreal injection clinic during the time periods listed above were included for statistical analysis. One-way Analysis of Variance (ANOVA) with Dunnett correction for multiple comparisons was performed to analyze the proportion of visits per week compared to pre-lockdown. A p-value <0.05 was considered to be statistically significant. Generalized Estimating Equations (GEE) routine was used for analysis to allow for inter-eye correlation and repeat measurements during each follow-up period. The GEE routine used a linear model to analyze the main effects between parameters using a robust estimator covariance matrix with an independent correlation structure. Parameter estimates () were used to calculate odds ratios (OR) with corresponding 95% confidence intervals (CI) and p-values. This routine was used to calculate ORs between two time periods, analyzing the rates of follow-up for each independent variable (demographic information, medical/psychiatric history, ophthalmic history) in a univariable model. This was repeated twice to calculate ORs for each combination of time periods. Bonferroni correction was applied to both analyses for two multiple comparisons: (1) pre- versus post-lockdown and (2) during versus post-lockdown. Thus, a p-value <0.025 was considered statistically significant due to multiple comparisons. A Pearson chi-square test between groups was used to compare the number of patients in each time period whose BMI > 30 or BMI > 40. Study data were managed using Research Electronic Data Capture (REDCap, Vanderbilt University, Nashville, TN). Matlab 2020a (Natick, MA, USA) was used for data handling and processing, and SPSS 27.0 (IBM Corp., Armonk, NY, USA) was used for statistical analysis.17,18
The study sample included a total of 625 visits of 292 patients across all time periods. In the intravitreal injection clinic, the pre-, during, and post-lockdown period groups averaged 25.4, 12.3, and 25.1 visits per week, respectively. Table 1 shows the mean visits per week in the pre-, during, and post-lockdown periods for various clinics as well as percentage of volume in the post-lockdown period compared to the pre-lockdown period. The comprehensive clinic averaged 57.4% (95% CI 0.4280.719), retina clinic 77.2% (95% CI 0.6020.941), and injection clinic 98.8% (95% CI 0.8571.12) of their normal volume in the post-lockdown period. In comparison to the injection clinic, the comprehensive clinic post-lockdown volume was significantly lower (p = 0.0003), while the retina clinic volume only trended towards significance (p = 0.0597). The mean ages of patients in the intravitreal injection clinic for the pre-, during, and post-lockdown periods were 74.3, 72.0, and 74.6 years, respectively. Demographic data for each time period are presented in Supplemental Table 1. No significant difference was found in the gender of the patients between the groups. The proportion of Hispanic patients trended toward more in the lockdown period than in post-lockdown (OR 1.13, p = 0.027). No other significant differences were found between groups for the proportion of those self-identified as White, Black, Asian, or Pacific Islander between each of the time periods (Figure 1).
Table 1 Clinic Volume
Figure 1 Odds ratios of demographic variables. No significant differences were found in demographics when comparing periods against the post-lockdown period (A). Demographic variables of pre- vs post-lockdown time periods (B). Demographic variables of during vs post-lockdown time periods. Significance set at p<0.025 to account for multiple comparisons.
Medical and psychiatric co-morbidities of patients in each time period are provided in Supplemental Table 2. There was no significant difference in the mean BMI (Supplemental Table 2), presence of diabetes, or presence of chronic kidney disease in patients in each of the time periods (Figure 2). As the risk for COVID-19-related morbidity increases with BMI, a chi-square analysis was performed to compare the number of patients in each time period with obesity (BMI > 30) or severe obesity (BMI > 40). This analysis demonstrated no difference in the number of patients between each period (Supplemental Tables 3 and 4).11 Post-lockdown, COPD patients and organ transplant patients were less likely to receive injections compared to 2019 (OR post vs pre-lockdown 0.76 p = 0.008, OR 0.62 p < 0.0001, respectively) (Figure 2). In the pre-pandemic period, 11.2% of patients had a history of organ transplant, but during the lockdown period, zero patients with organ transplant history presented to clinic; after the lockdown, those patients comprised only 4.2% of the patient volume. Patients with cancer diagnoses comprised a lower proportion of pre-pandemic patients compared to post-lockdown patients (OR 0.77, p = 0.007).
Figure 2 Odds ratios of medical and psychiatric co-morbidities. In the pre-lockdown period compared to the post-lockdown period, significantly more patients with COPD or organ transplants received intravitreal injections. Comparison of during vs post-lockdown periods showed significantly decreased patients with solid organ transplants. Patients with cancer were significantly increased in the post-lockdown period in comparison to pre-lockdown. No significant differences were found in the proportion of patients with psychiatric co-morbidities in either of the time period comparisons. (A) Medical co-morbidities of pre- vs post-lockdown time periods (B). Medical co-morbidities of during vs post-lockdown time periods (C). Psychiatric co-morbidities of pre- vs post-lockdown time periods (D). Psychiatric co-morbidities of during vs post-lockdown time periods. Significance set at p<0.025 to account for multiple comparisons. **p < 0.01. ****p < 0.0001.
Our data showed no significant differences in the proportion of patients with psychiatric co-morbidities between the time periods, except for psychosis and schizoaffective disorder though there were very few patients in each group (n 3). The proportion of patients with depression trended toward a decrease from 20.2% in 2019 to 16.3% during lockdown to 14.1% in the post-lockdown period, but these differences were not significant. Similarly, patients with anxiety decreased from 7.3% to 5.8% to 4.2%, but these differences were not statistically significant.
Figure 3 and Supplemental Table 5 contain the proportion by indication for which patients received intravitreal injections during each time period. This analysis demonstrated no significant differences in patients receiving injections for nvAMD when comparing the pre- and post-lockdown periods or the during and post-lockdown periods (OR 0.98 and 0.91, respectively). After lockdown, the proportion of patients receiving injections for diabetic macular edema (DME) increased in the post-lockdown versus the lockdown period (OR for during vs post-lockdown 0.90 with reciprocal OR 1.11, p = 0.01) and was not significantly different from the pre-pandemic period (OR 0.95, p = 0.58). There were no other significant differences found among other indications for injections (eg RVO, CSR or pachychoroid, and other) between the time periods.
Figure 3 Odds ratios of indications for intravitreal injections. Comparison of during vs post-lockdown period showed a significant decrease in the proportion of patients receiving intravitreal injections for diabetic indications during lockdown. There were no significant differences found in the indications for intravitreal injections between pre- and post-lockdown time periods (A). Indications for injections of pre- vs post-lockdown time periods (B). Indications for injections of during vs post-lockdown time periods. Significance set at p<0.025 to account for multiple comparisons. *p < 0.025.
The COVID-19 lockdown, an unprecedented event, was unsustainable, as businesses and healthcare institutions suffered remarkable financial losses and in some cases, operational insolvency.19,20 Despite the lockdown ending in May of 2020, COVID-19 was still a palpable threat without the availability of a vaccine at that time. Physicians and patients had little guidance on how to proceed in the post-lockdown era while still needing to maintain precautionary measures. This study showed that immediately after lockdown, the VHA intravitreal injection clinic returned to its pre-COVID-19 volume but was comprised of systemically healthier patients seeking treatment. Furthermore, there was a rebound in the number and proportion of diabetic patients who had delayed injections during lockdown.
Interestingly, our previous study demonstrated a significant rise in the Latino/Hispanic proportion of patients in injection clinic during the lockdown, which was not true after restrictions were lifted.14 Our previous theory was that Hispanic patients tend to live in multigenerational housing and have a higher proportion of essential workers, which would increase the exposure risk to COVID-19. Though we cannot exactly determine why there was such a difference, we speculate that much higher COVID-19 infection and death rates in the Latino/Hispanic population during March and April21 may have caused this vulnerable population to take more precautions and stay at home in May and June even after the lockdown was lifted.
Our data demonstrate that although overall injection clinic volume returned to baseline after lockdown, even faster than other ophthalmology clinics, patients with COPD and solid organ transplants, both high-risk co-morbidities, were less likely to return to clinic post-lockdown. It makes sense that these groups chose to limit their exposure given the significantly increased mortality and hospitalization risk if infected with COVID-19. It is important for ophthalmologists to be aware of this trend to identify patients with high-risk systemic co-morbidities and accommodate their safe return to intravitreal injection clinic for continued vision care.22 Our data contained a significant proportion of diabetic patients in the intravitreal injection clinic during each period. As diabetes causes widespread microangiopathy, other studies have demonstrated that diabetic retinopathy and nephropathy can be frequently associated and correlate in severity.2326 Attendance in injection clinic by diabetics and patients with chronic kidney disease was not significantly different between periods in our study. Since our data suggest that these patients are likely to continue physician visits even during lockdown measures, it is important that these patients be referred for multifactorial diabetes management to reduce their cardiovascular and overall mortality, especially with emerging data demonstrating long-term elevated cardiovascular risk.25,27
Veterans have a higher incidence of psychiatric co-morbidities and that the pandemic may represent a factor destabilizing mental health, we hypothesized that these patients would be most affected during the pandemic.16 Other studies have shown that the pandemic increased anxiety and depression, as well as creating difficulties in accessing mental health care.28,29 There were statistical differences in those diagnosed with psychosis or schizoaffective, but we caution limited extrapolation given the very small number of patients. Our data showed that there were no significant differences in intravitreal clinic visits among those with a diagnosis of depression or anxiety. This may reflect the accessibility and high quality of mental healthcare within the Veteran healthcare system.
Injection and clinic volumes fell both nationally and worldwide as lockdown measures were enforced.3034 While the VHA injection clinic returned to pre-pandemic volumes in the post-lockdown period, comprehensive and retina clinics at the same site continued to have a decreased volume of about 50%. Our facility opened the standard scheduling grids for these clinics in the post-lockdown period. This demonstrates the priority that both physicians and patients placed on continuing intravitreal injections as a delay in injections can lead to permanent vision loss. Other studies have demonstrated that pandemic-induced delays in care are associated with worse visual outcomes in patients who need injections for treatment across all types of diagnoses.3538 Furthermore, one center reported a significant rise in large submacular hemorrhages as a result of the lockdown.39 Therefore, we are encouraged that injection clinic was able to rebound back to pre-lockdown volumes so quickly.
As with many other groups, we prioritized those with nvAMD over RVO and diabetic indications for injection during the lockdown period.12,33,40 Our results support that nvAMD patients are continuing their treatments during and after the lockdown. Previous randomized trials of patients with DME show that treatment can be delayed in eyes with good visual acuity.41 Telemedicine has been shown to be efficacious in the diagnosis and management of diabetic retinopathy.26,42 Spurred on by the pandemic, telemedicine could offer increased access to care and decentralized monitoring of diabetic retinopathy or macular edema patients via physician review of images instead of face-to-face visits during lockdown times.43 However, post-pandemic studies have demonstrated delays in care resulted in worse short-term visual outcomes for diabetic retinopathy.37,44 Therefore, we view it favorably that immediately after we stopped the triage process post-lockdown, there was a rebound increase in patients receiving injections for diabetic indications, and we expect more to have returned in the post-vaccine area.
This study examined a racially diverse and often underserved, urban population with a high prevalence of medical and psychiatric co-morbidities from a composite EMR. Other studies have examined the visual acuity outcomes, clinic volumes, or indications for injection during the pandemic period, but to our knowledge, this study is the first to analyze and report on the co-morbidities of the patients in the post-lockdown era. A major limitation of this study may be related to ascertainment bias due to the retrospective nature of the study. The cohort studied was predominantly male, as this was a VHA-based study, which may not be representative of the general population. While this was a single-institution study, the West Los Angeles Veterans Affairs ophthalmology clinic is a tertiary care center providing intravitreal injections for a large catchment area and multiple satellite clinics across Southern California.
This study can be expanded into the post-vaccine era along with COVID variant-induced spikes to see whether repeated COVID surges continue to affect patient and physician decision-making on intravitreal injection clinics. Furthermore, during future pandemics, this study and its framework can be used as a starting point to identify at-risk patients when access to ophthalmological care becomes limited.
Intravitreal injection clinic volume rebounded to pre-pandemic levels immediately following the state-mandated COVID-19 lockdown period in the spring of 2020, while other clinics continued at half of their pre-COVID-19 volume. However, patients with high-risk medical co-morbidities were less likely to return to the post-lockdown injection clinic, increasing their risk of permanent vision loss. These results can be used to appropriately allocate clinic resources towards injection clinic and determine which groups may need increased safety measures and targeted outreach to address their fears about returning to clinic and their ophthalmic needs.
Dr David Sarraf reports grants, personal fees from Amgen, personal fees from Bayer, grants from Boehringer, grants from Genentech, non-financial support from Heidelberg, personal fees from Iveric Bio, personal fees from Novartis, grants, personal fees, non-financial support from Optovue, grants from Regeneron, non-financial support from Topcon, outside the submitted work. The authors report no other conflicts of interest in this work.
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40. Carnevali A, Giannaccare G, Gatti V, Scuteri G, Randazzo G, Scorcia V. Intravitreal injections during COVID-19 outbreak: real-world experience from an Italian tertiary referral center. Eur J Ophthalmol. 2021;31(1):1012. doi:10.1177/1120672120962032
41. Baker CW, Glassman AR, Beaulieu WT, et al. Effect of initial management with aflibercept vs laser photocoagulation vs observation on vision loss among patients with diabetic macular edema involving the center of the macula and good visual acuity: a randomized clinical trial. JAMA. 2019;321(19):18801894. doi:10.1001/jama.2019.5790
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44. Ashkenazy N, Goduni L, Smiddy WE. Short-term effects of COVID-19-related deferral of intravitreal injection visits. OPTH. 2021;15:413417. doi:10.2147/OPTH.S296345
Native Hawaiians/Pacific Islanders, or NH/PIs, comprising more than 20 ethnic groups hailing from Polynesia, Micronesia, and Melanesia, are understudied despite being the third fastest growing racial group in the United States. Two studies now report that NH/PIs have been deeply affected by the COVID-19 pandemic.
Andrew Subica at the University of California, Riverside, led research groups that surveyed more than 300 NH/PIs from April-November 2021 in Washington, Utah, Oregon, California, and Arkansas states with large NH/PI populations. Their findings are published in two journals.
Described in the first paper, published in Public Health Reports, the researchers found 30% of the NH/PI participants reported being diagnosed with COVID-19 and approximately 50% of the participants reported having a close family member with COVID-19.
Further, nearly 1 out of 5 NH/PIs reported the death of a close family member due to COVID-19 infection; the overall U.S. COVID-19 mortality rate was 1 death per 400 persons at the end of 2021.
NH/PIs may carry the highest rates of COVID-19 infections and deaths of any U.S. racial/ethnic minority group during the pandemic, said Subica, an associate professor in the School of Medicines Department of Social Medicine, Population, and Public Health. For example, an earlier report found NH/PIs possessed the highest per capita death rate in 90% of states reporting NH/PI COVID-19 deaths.
According to Subica, several factors increase NH/PIs risk for exposure to SARS-CoV-2, the virus that spreads COVID-19. These factors include employment in essential frontline positions, dwelling in dense households and neighborhoods, and traditional sociocultural practices and obligations that result in large in-person group contact.
Our findings call for greater attention and funding of NH/PI research to prevent and reduce NH/PIs glaring health disparities associated with COVID-19, Subica said. Due to their high rates of comorbidities such as obesity, cancer, heart disease, and smoking that increase their risk of severe COVID-19 outcomes, it is crucial that future studies monitor and evaluate long-term COVID-19-related health issues facing NH/PI communities.
The research paper is titled Assessing the Health and Impact of COVID-19 on Native Hawaiians/Pacific Islanders.
In the second paper, published in Drug and Alcohol Review, Subica and his team share their findings after conducting a large-scale investigation of NH/PI substance use, mental health, and treatment need during COVID-19.
The research team found NH/PI communities experienced high levels of alcohol, tobacco, and other drug use, depression, anxiety, and unmet treatment need during COVID-19; 47% and 22% of NH/PI adults reported current alcohol and cigarette use, respectively, while 35% reported lifetime illicit substance use. The national smoking rate during COVID-19 is 13%.
Further, more than 1 in 4 NH/PI adults, or 27%, screened positive for alcohol use disorder, a rate that is more than 2.6 times the national alcohol use disorder rate during the pandemic.
Participants also reported heightened depression, anxiety, and psychological distress during COVID-19 with 27% of NH/PIs screening positive for major depressive disorder and 20% for generalized anxiety disorder, vastly exceeding the general population rates for these disorders.
What our work makes clear is that we need targeted research and treatment services to mitigate COVID-19s negative behavioral health impact on NH/PI communities, Subica said.
The researchers also found that approximately 50% of non-binary NH/PIs in the sample screened positive for probable alcohol use disorder and more than 50% reported needing mental health treatment during COVID-19.
This illuminates the need for further research exploring the behavioral health needs of these at-risk individuals, Subica said. We need to develop and implement culturally responsive prevention, intervention, and recovery programs to reduce NH/PI substance use and mental health disparities during and after the COVID-19 pandemic.
The research paper is titled Native Hawaiian/Pacific Islander alcohol, tobacco, and other drug use, mental health, and treatment need in the United States during COVID-19.
Subica was joined in the first study by Dr. Howard B. Moss of UCR; Nia Aitaoto of Pacific Islander Center of Primary Care Excellence; Quixi Li of Special Services for Groups; Brittany N. Morey of UCI; Li-Tzy Wu of Duke University; Derek K. Iwamoto of the University of Maryland; and Erick G. Guerrero of I-Lead Institute.
Subica, Moss, Guerrero, Aitaoto, Morey, and Wu were joined in the second study by Tammy K. K. Martin and Scott K. Okamoto of Hawaii Pacific University.
Both projects were supported by the National Institute of Drug Abuse and National Institute of Alcohol Abuse and Alcoholism of the National Institutes of Health. None of the content of this news release represents the official views of these institutes.
Header image credit:Solovyova/iStock/Getty Images Plus.
Sen. Tammy Baldwin (D-WI) tested positive for COVID-19 on Sunday.
"Thankfully, I am vaccinated and boosted and only experiencing minor symptoms," Baldwin tweeted. "I will quarantine while I continue to work remotely."
SENATE PUNTS VOTE ON SAME-SEX MARRIAGE TO AFTER MIDTERM ELECTIONS
This makes Baldwin the fourth Democratic senator to test positive for the virus since the Senate returned from its August recess. Sens. Jacky Rosen(D-NV) and Bob Menendez(D-NJ) also tested positive, while the diagnosis for Sen. John Ossoff (D-GA) is keeping him from a week of voting.
Andrew Harnik/AP
Baldwin, the first lesbian senator, is working on finding 10 GOP senators to support her Respect for Marriage Act, a bill codifying same-sex marriage protections. Baldwin had hoped for a vote next week but now expects to put it to a vote following the midterm elections.
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"Weve asked Leader Schumer for additional time, and we appreciate he has agreed," Baldwin and Sens. Kyrsten Sinema (D-AZ), Susan Collins (R-ME), Rob Portman (R-OH), and Thom Tillis (R-NC) said in a joint statement. "We are confident that when our legislation comes to the Senate floor for a vote, we will have the bipartisan support to pass the bill."
This push from Baldwin to codify same-sex marriage comes in the wake of the Supreme Court overturning Roe v. Wade. Democrats have cited Justice Clarence Thomass concurring opinion, which states that the high court should reconsider it, as a reason to codify certain rights specifically on abortion and contraception access, as well as marriage equality.
By NPR News
September 19, 2022National, News from NPR
While cases have decreased dramatically, there are still thousands of cases being reported across the world.
(Image credit: Ted S. Warren/AP)
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An Arizona judge is expected to decide soon whether the state can enforce a 19th
By Elizabeth Hlavinka
An increased number of girls are going through premature sexual development amid the pandemic
Dan Kenyon 2013
The covid-19 pandemic may be triggering early puberty in some girls. Several studies suggest the outbreak is increasing the number of girls going through premature sexual development and experts are unsure why.
In the latest of a string of studies, researchers at the University of Bonn, Germany, reported how the number of girls diagnosed with early puberty at a single medical centre remained constant between 2015 and 2019, at fewer than 10 cases a year.
This more than doubled to 23 in 2020, when the covid-19 outbreak took hold worldwide, rising further still to 30 in 2021, according to results presented at The European Society for Paediatric Endocrinology 2022 meeting today.
The German researchers arent the only ones to see cases double. In the pre-covid year, we had 28 children start treatment and in the covid year, we had 64 children start treatment, says Karen Klein at Rady Childrens Hospital and the University of California, San Diego.
Similar results have also been reported in Turkey and Italy.
Early puberty is rare, affecting one in 5000 to 10,000 children in pre-pandemic times. For every 1 boy, it affects 10 girls. The reasons behind this sexual disparity are unclear.
Regardless of a persons sex, early puberty is linked to short stature in adulthood, as well as serious health conditions, such as heart disease, type 2 diabetes and some cancers. Early puberty has also been associated with certain mental health problems, such as anxiety in boys and depression in girls.
Sezer Acar at Dr. Behet Uz Childrens Education and Research Hospital in Izmir, an author of the Turkish study, says: Previously, I [treated] one or two patients a month due to precocious [early] puberty, but during this period [the early stages of the pandemic before his study was published], I had to treat two or three patients a week.
In addition to an increased number of girls starting puberty early, the age of onset may have also declined.
In the German study, pre-pandemic puberty onset occurred at age 6.8, on average, compared with 7.6 among those diagnosed during the covid-19 outbreak. A statistical analysis suggests this wasnt a chance finding.
We know stress can cause earlier puberty, so thats certainly high on the list of whats going on, says Klein.
The other thing people immediately started to think about was, well, everyone is at home not exercising as much and maybe its weight gain, because we know rapid weight gain can cause earlier puberty. But in our study and in a couple of other studies, we didnt see that the children were heavier.
Increased screen time and changes in sleep cycles due to remote learning could also be at play, says Paul Kaplowitz at the Childrens National Hospital in Washington D.C.
These factors werent assessed in all the studies. However, in a follow-up study to the Italian paper, researchers found that girls who were diagnosed with early puberty during lockdown had more disturbed sleep and later bedtimes than those diagnosed pre-pandemic.
Some have questioned whether SARS-CoV-2 itself could be to blame. Inflammation of the nasal cavity has been documented in both covid-19 cases and people going through early puberty. Although this hypothesis cant be ruled out, especially because many childhood covid-19 cases are mild and may be missed, it seems unlikely, says Kaplowitz.
I dont think the effect of covid on female puberty is restricted to girls who actually had the infection, says Kaplowitz. Especially since, in the earlier stages of the pandemic, children were much less likely to become infected than adults.
The pandemic aside, the age of puberty onset has been declining by about three months per decade since 1977, although there is little data on the effect of other traumatic events like wars or recessions.
Medication can reduce hormone levels and stunt sexual development for several years. However, this is generally only recommended if early puberty is expected to cause emotional or physical problems.
Some doctors hope that the return of in-person schooling and children adapting to pandemic-related challenges will slow the rate of early puberty.
When the data is looked at for the past year, particularly in places where kids almost all went back to school and life returned to more normal, I would predict that the rate of precocious puberty will return to what it had been previously, says Kaplowitz. But we obviously dont know.
More on these topics:
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You may have up to a 50% higher risk of developing long Covid-19 if you suffer from common psychiatric issues such as anxiety or depression, a recent study found.
Signs of the malady can include breathing problems, brain fog, chronic coughing, changes in taste and smell, overwhelming fatigue, difficulties in performing daily life functions, and disruptions in sleep that can last months, even years, after the infection has cleared the body.
People who self-identified as having anxiety, depression or loneliness, or who felt extremely stressed or worried frequently about the coronavirus were more likely to experience long Covid-19, according to the study published this month in JAMA Psychiatry.
We found participants with two or more types of psychological distress before infection had a 50% higher risk of getting long Covid, said study coauthor Dr. Siwen Wang, a research fellow in the department of nutrition at the Harvard T.H. Chan School of Public Health in Boston.
About 40 million adults over 18 in the United States live with an anxiety disorder, while over 21 million have suffered from major depression, according to national statistics. Many mental health conditions often overlap, with concurrent diagnoses, experts say. More than a fifth of adults in the US (22%) and the UK (23%) say they often or always feel lonely, a Kaiser Family Foundation study said.
Having higher levels of psychological distress prior to a Covid infection also increased the risk of getting long Covid by 50%, Wang said. Those people also reported more symptoms seen in long Covid.
Its possible that some could use the studys findings to support a hypothesis that post-Covid illness is psychosomatic, a prevalent belief in the early days of the pandemic, said Dr. Wesley Ely, a professor of medicine and critical care at Vanderbilt University Medical Center in Nashville, Tennessee. He was not involved in the study.
Instead, the studys message should be that people with existing psychological distress are closer to the disaster of long Covid, said Ely, codirector of Vanderbilts Critical Illness, Brain Dysfunction and Survivorship Center.
Imagine 10 people are running a race, and you give five people a head start, Ely said. Those are the people who already had a mental health issue they are just closer to the unfortunate finish line of getting long Covid.
The idea that mental distress can affect the body in negative ways isnt new. Its also a two-way lane: Having a chronic illness is strongly associated with the development of depression and other psychological disorders.
With common noninfectious disorders such as heart disease, depression/anxiety/emotional distress do appear to play a role, said Dr. Joseph Bienvenu, a professor in the department of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine in Baltimore, in an email. He was not involved in the study.
People with major depression can develop blood pressure issues and may be more likely to have a heart attack. Chronic depression, stress and anxiety have been linked to insomnia, and a lack of quality sleep is a major culprit in the development of obesity, type 2 diabetes and other disorders.
And psychological distress has been shown to weaken the immune system, said study coauthor Dr. Angela Roberts, an associate professor of pulmonary and critical care medicine at Stanford University in California.
Your brain and your immune system are very tightly interconnected, Roberts said. Studies have shown when youre depressed or anxious, your immune system doesnt work as well against targets like viruses and bacteria.
To do the new study, researchers worked with nearly 55,000 people with no history of Covid-19 who were enrolled in three major longitudinal studies: the Nurses Health Study II, the Nurses Health Study 3 and the Growing Up Today Study. Participants in those studies tend to be predominantly female and White, which can limit how much the results can be generalized to a wider population, the study said.
Participants were asked about their mental health in April 2020, quite early in the pandemic. They continued to fill out mental health surveys each month for six months, then quarterly. At the end of a year, researchers narrowed the pool of subjects to nearly 3,200 people who had developed Covid-19 and met study requirements.
This study is particularly nice in that participants baseline characteristics were assessed independently in time from their later Covid symptoms, Johns Hopkins Bienvenu said.
Compared with people not having mental distress, those with depression and loneliness had a 1.32 times greater chance of developing long Covid symptoms. Participants who worried a good deal about the coronavirus predominantly people of color, women and asthma sufferers were 1.37 times more likely to develop long Covid, the study found.
Anxiety was associated with a greater risk 1.42 times more likely but people with higher levels of perceived stress were nearly 50% more likely to develop post-Covid symptoms, said Wang, the study coauthor.
All the associations between psychological distress and long Covid remained significant, even after researchers adjusted for demographics, body weight, smoking status and a history of asthma, cancer, diabetes, and high blood pressure or cholesterol.
In addition, all types of psychological distress except loneliness were linked to a higher risk of being unable to complete the actions of daily life due to ongoing long Covid symptoms.
While many cases of long Covid are mild and resolve within a few months, other patients continue to suffer for an extended time. Some still havent recovered their quality of life more than two years into the pandemic, according to Dr. Aaron Friedberg, a clinical assistant professor of internal medicine who works in the Post-Covid Recovery Program at Ohio State Universitys Wexner Medical Center in Columbus.
They cant think, they cant breathe. I have one person whose disease is so severe, they basically cant get out of bed, Friedberg told CNN in an earlier interview. I saw a person recently who is still not working because of Covid symptoms two years later.
At last month's Bloodstock Open Air festival, former MACHINE HEAD and current VIO-LENCE guitarist Phil Demmel was asked by TotalRock if Willie Adler's COVID-19 vaccination status is the reason Phil has been filling in for the LAMB OF GOD guitarist at some of the Virginia metal band's recent non-U.S. concerts. He responded (as transcribed by BLABBERMOUTH.NET): "I think Willie's just in a spot right now, and it's not really my spot to say, but I get the vibe that he's I don't even think I should talk about it. I don't think it's my spot to say anything about Will. But he's making his decisions, and I am the contingent. So here I am."
Demmel went on to praise his involvement with LAMB OF GOD, saying: "They're one of the biggest metal bands in the world. And it feels good to be, like, 'Hey, we'd like for you to step into Willie's shoes,' which Willie writes those riffs and he's an awesome guitar player. And to be, like, 'Hey, we want you to be the guy,' or whatever I get along well with the dudes. In a 'me' way, it feels good to be wanted It's pretty cool. They're all fucking amazing dudes and a great band and a totally pro camp. I love the way they run things. So it's good to be part of that."
Demmel most recently filled in for Adler on nearly a dozen European LAMB OF GOD shows in August. Prior to that, Demmel stepped in for Adler during LOG's January appearance on the ShipRocked cruise and in May for the Canadian portion of LAMB OF GOD's "The Metal Tour Of The Year" with MEGADETH.
When Adler's absence from LAMB OF GOD's summer 2022 European tour was first announced, he released a statement saying that he wasn't able to make the trip" because he had "some things that I need to be home for". He also thanked his bandmates for "supporting my decision."
Although LAMB OF GOD has not officially commented on Adler's absence from the shows, VIO-LENCE singer Sean Killian revealed in an interview in April that Willie is "not down with doing the vaxx," referring to the COVID-19 vaccine, and is being replaced by Demmel for dates in those countries that still require proof of vaccination from U.S. travelers.
In April, Demmel also filled in for LAMB OF GOD's John Campbell when the bassist had to miss a couple of shows on "The Metal Tour Of The Year" in order to "take care a family matter back home."
Demmel's appearance with LAMB OF GOD marked his third high-profile fill-in gig in four years. Demmel stepped in for SLAYER guitarist Gary Holt for four European shows in the fall of 2018 after Gary returned home to be with his dying father. Demmel also subbed for Dave Linsk at OVERKILL's November 13, 2021 concert at The Wellmont Theater in Montclair, New Jersey and on the band's spring 2022 U.S. tour.
In a February 2022 interview with BLABBERMOUTH.NET, Demmel discussed how he became such an in-demand hired gun. "The SLAYER thing happened within 24 hours of me quitting MACHINE HEAD," he said. "I think [SLAYER drummer] Paul Bostaph's girlfriend knew that MACHINE HEAD was done and knew that I was home, so they reached out for that. As the urban legend goes [laughs], I had three hours to learn 19 songs. It was pretty successful; a fill-in trip, one of the higher-profile things you can imagine SLAYER on their final world tour. I filled in for my buddies in NONPOINT, too. The OVERKILL gig was more about me and Bobby [Ellsworth, vocals] doing the BPMD record together [2020's 'American Made']. We're familiar and I got the rep of being able to learn songs pretty quick. The METAL ALLEGIANCE, guys, too. I'll play 25 songs with them in a night. It's one of those quirky things where I can learn songs pretty quickly and I can pick them up pretty quick."
Demmel was then asked whether his nerves for the LAMB OF GOD and OVERKILL gigs were on the same level as playing with SLAYER. "I was pretty confident with the OVERKILL songs," he said. "We had three good rehearsals. I didn't rehearse with SLAYER at all. I played two songs at a soundcheck. [Laughs] 'Okay, we're good!' It's like, 'Fuck!' OVERKILL, we had a couple of days of rehearsal. I had two and a half, three weeks to prepare for that. I felt pretty strong with that.
"The LAMB OF GOD gig, that was a big deal. They had approached me before their MEGADETH States tour last summer and wanted me to learn both parts, Mark [Morton] and Willie's, just in case one got sick, they didn't want to cancel their tour. That's where I am: I'm their bullpen guy when one of them can't make the shows, I'm ready to go. It's such a high-profile band. I didn't want to go out there and blow it. I wanted the band to sound good. I wanted to keep that pride in what they are and not have a drop-off. Willie and I play differently. There's different vibrato in our left hand and pinkies. I didn't want there to be a drop-off. I wanted people to be not bummed that he wasn't there. And that's not a slag on Willie. If I went to see one of my favorite bands, let's say QUEENSRCHE. I want to see [Chris] DeGarmo, I want to see Michael Wilton. No slight against the other dudes, but they better fucking bring it if they're not going to be out there."
LAMB OF GOD singer Randy Blythe discussed Demmel's involvement with the band during an interview with Bloodstock TV's Oran O'Beirne. After O'Beirne noted how talented Demmel is to be able to step in on a moment's notice, Blythe said: "We make him put in work, though, to be fair. The guitar parts aren't easy. We are playing a song tonight, 'The Faded Line', and that's a song that hasn't been in our set for a while because some guys are, like, 'Oh, this is hard.' And it's, like, 'No. We need to do this.' And even he was just, like, 'Oh. We've gotta learn that. That's a fucked up riff.' But we saw Phil fill in for SLAYER on, like, two days' notice in Europe at the end of the SLAYER tour, 'cause Gary Holt's dad was passing away. R.I.P. And Phil came over and killed it. We've known him for many years. There's never really been any question of whether he can do it. He's a phenomenally talented guy."
New York state's Department of Health vaccination portal offers a link to search for appointments. CVS, Walgreens and a number of other chain and independent drug stores offer the boosters. The supply is plentiful.
Are you eligible?
New Yorkers ages 12 and older are eligible for a Pfizer-BioNTech bivalent booster if it is at least two months after their previous booster dose or two months after completing the initial primary vaccine series.
New Yorkers ages 18 and older are eligible for a Moderna bivalent booster if it is at least two months after their previous booster dose or two months after completing the initial primary vaccine series.
The boosters are free and available across the state.
In early September, the Food and Drug Administration authorized the Pfizer and Moderna boosters. The shots target the omicron BA.4 and BA.5 variants, the most recent variants to spread the virus in New York and the U.S.
The original COVID-19 boosters are still recommended for children ages 5-11 who have completed their primary series at least five months ago.
While the vast majority of cases right now are linked to the highly contagious BA.5 strain, BA 4.6, is also gaining traction in much of the country, accounting for about 8 percent of new infections in the U.S. last week, according to the latest state and federal variant analysis.
Monkeypox Shots, Treatments and Tests Are Unavailable in Much of the World The New York Times
