Highlights What is the primary question addressed by this study? The primary purpose of the study was to investigate which methods of communication during the COVID-19 pandemic were associated with more positive and less negative emotional experiences and perceptions of resident experiences of family members and friends of older adults in long-term care facilities in the United States. What is the main finding of this study? Using the phone more frequently was associated with less negative emotional experiences for participants, and using email more frequently was associated with more positive perceived resident experiences. Having letters delivered more frequently was associated with more participant and perceived resident negative emotions. What is the meaning of the findings? Connecting with family members and friends in long-term care facilities, especially via phone, may contribute to better emotional experiences for family members, friends, and long-term care residents.

Purpose Delay in receiving effective treatment for psychosis adversely impacts outcomes. We investigated the timing of the first help-seeking attempt in individuals with recent onset non-affective psychosis by comparing those who sought help during the prodrome to those who sought help after psychosis onset across sociodemographic and clinical characteristics, overall functioning, and occurrence of aversive events during their pathways to care. Methods Patients were admitted from February 1st, 2014 to January 31st, 2019 to the Program for Specialized Treatment Early in Psychosis (STEP) in New Haven, CT. Psychosis-onset date was ascertained using the Structured Interview for Psychosis-risk Syndromes. Key dates before and after psychosis onset, along with initiators and aversive events, were collected via semi-structured interview. Results Within 168 individuals, 82% had their first help-seeking episode after psychosis onset and did not differ in terms of sociodemographic characteristics from prodrome help seekers. When the first help-seeking episode started before (i.e., during prodrome) vs after psychosis onset it was mostly initiated by patients vs family members (Cramer's V = 0.23, p = 0.031) and led to a faster prescription of an antipsychotic once full-blown psychosis emerged (time to antipsychotic since psychosis onset = 21 vs 56 days, p = 0.03). No difference in aversive events before STEP enrollment was detected across groups. Conclusion Help seeking during the prodrome is associated with faster initiation of antipsychotic treatment and is more likely to be self-initiated, compared to help seeking after psychosis onset. Early detection efforts that target prodromal samples may improve the length and experience of pathways to care.

Background In the U.S., individuals affected by a first episode psychosis endure 74 mean weeks of delay in receiving effective treatment. Facilitating their access to care has become a public health priority. This delay has proven to have adverse consequences both in short and long-term outcomes. Moreover, aversive pathways to care can imperil subsequent engagement with treatment. A better understanding of how a patient’s characteristics might influence interactions with healthcare systems could help tailor early detection interventions and target delays in treatments. By comparing the timing of the first help seeking attempt initiated in a sample of first episode psychosis participants of an early detection campaign, we aim to investigate if people starting to seek help before psychosis will have shorter delays to care, and if an earlier help-seeking attempt correlates with a lower rate of adverse pathways to care (e.g. police involvement, involuntary admissions). Methods Participants were recruited starting February 1st, 2014 to January 31st, 2019, to STEP, a Coordinated Specialty Care Program in New Haven, CT. Based on the date of the first help-seeking episode, demographic, clinical, and socioeconomic data were used to compare participants who had their first help-seeking attempt before or after psychosis onset (psychosis onset defined using the POPS criteria at the SIPS Interview). Chi-square test was used to compare categorical variables; non-parametric or Student’s t test was used to compare the continuous variables. Results The sample comprised 168 subjects, the majority of which were male, African American, young adults (mean age was 22.4, SD=3.8), with a median time from psychosis onset to first antipsychotic of 52 days [IQ range, 15 – 196], and had their first help-seeking attempt after psychosis onset (70%). Between the two groups there was no difference in sociodemographic characteristics, in psychosis diagnosis, and in the global assessment of functioning (at baseline and 12 months prior). Help-seeking attempts made before psychosis onset were mostly initiated by the patients themselves, while attempts made after onset had the family as the prime initiator. Once the first help-seeking attempt was initiated, it took longer to get prescribed an antipsychotic for subjects seeking help before onset compared to those who sought help after (median 245 days [5 – 1400] vs. 1 day [0 – 999], p<0.0001). By contrast, it took less time for those who sought help before POPS to have their first antipsychotic prescribed once they became psychotic (median 21 days [0 – 445] vs. 56 days [0 – 1153], p=0.03). However, both groups had no significant difference in delay to STEP (p=0.30). Help-seekers after psychosis onset had a trend of longer patient side delay (defined as the time interval from when patients noticed a change-patient’s term for psychotic symptoms- to the day they sought help) compared to participants seeking help before onset (median 75 days [0 – 3928] vs. 14 days [0 – 1093], p=0.09). Compared to those who had their first help seeking episode before psychosis onset, the group who sought help after onset had more contacts with the police (64 vs 10), more involuntary admissions (40 vs 6), and same median number of nights spent in a psychiatric hospital six months before STEP enrollment (n=14). Discussion Timing of first help seeking in early psychosis can be crucial in shaping the individual experience of care. Longer delays in receiving the appropriate treatment and aversive pathways might be associated with help seeking which started only after psychosis onset, compared to first help seeking started before psychosis onset. Tailored interventions are needed to improve psychosis detection and referral of first episodes to specialized services.

According to many prior studies, informal caregivers are at risk for heightened loneliness and distress. Moreover, the COVID-19 pandemic has introduced new challenges that may be accentuated among caregivers. This study examined caregiving frequency and its relation to loneliness, perceived stress, and negative affect during the COVID-19 pandemic. We then investigated the moderating roles of COVID-19 concerns and impacts, anticipating magnified effects among caregivers. Participants included respondents from the Health and Retirement Study (HRS) COVID-19 project sample (n=2108, mean age=69) who reported their caregiving frequency, general concern about COVID-19, related concerns about family members’ health, and social disruptions caused by the pandemic. Controlling for age, gender, and health status, daily caregivers reported significantly greater distress during COVID-19 compared to non-caregivers (p=.036). Higher levels of concern about family members’ health during COVID-19 was significantly associated with greater loneliness among daily caregivers (p = .009), but not among non-caregivers, such that daily caregivers with greater concerns had the highest levels of loneliness. On the other hand, unexpectedly, daily caregivers who experienced fewer social disruptions due to the pandemic reported higher levels of loneliness (p = .002); however, the association was null for non-caregivers. Findings suggest that daily caregivers may be particularly vulnerable to greater loneliness and stress during the COVID-19 pandemic. These experiences may exacerbate existing mental health disparities for those providing daily care.