COVID-19 pandemic and mental health consequences: Systematic review of the current evidence

Woo

et al. 2020

Preprint

BackgroundLittle is known about the impact of the global coronavirus disease-2019 (COVID-19) pandemic on patients with cardiovascular disease (CVD), the biggest global killer and major risk factor for severe COVID-19 infections. We aim to explore the indirect consequences of COVID-19 on health-related quality of life (HRQoL) of patients with CVD. MethodsEighty-one adult outpatients with CVD were assessed using the EQ-5D, a generic health status instrument with five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), before and during the pandemic. Changes in the EQ-5D dimensional responses were compared categorically as well as using the dimension-specific sum-score (range 1 to 3, with a higher score indicates worse health). The responses and sum-score were compared using the exact test of symmetry and the paired t-test, respectively. ResultsThese patients [mean age (SD) 59.8 (10.5); 92.6% males; 56% New York Heart Association (NYHA) functional class I] had coronary artery disease (69%), heart failure (28%), or arrhythmias (15%). None experienced change in NYHA class between assessments. About 30% and 38% of patients reported problems with at least one of the EQ-5D dimensions pre- and during the pandemic, respectively. The highest increase in health problems was reported for anxiety/depression (12.5% pre-pandemic vs 23.5% during pandemic; p = 0.035) with mean domain-specific score from 1.12 (SD 0.33) to 1.25 (SD 0.46) (p = 0.012). There was no meaningful change in other dimensions as well as overall HRQoL. Conclusion The COVID-19 pandemic is associated with a significant worsening of the mental health of patients with CVD.

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on Health-related Quality of Life in Patients With Cardiovascular Disease: A Multi-ethnic Asian Study

Woo

et al. 2020

Preprint

“…38 A recent systematic review evaluating the impact of the COVID-19 pandemic on mental health outcomes, including MWB, concluded that a lower psychological well-being was noted among females and those who self-reported a poor health. 15 In fact, vulnerable people, particularly those with chronic diseases, require special attention. Around 20% of our respondents had a chronic disease and exhibited a lower MWB in the whole group and the workers' subgroup.…”

Section: Discussionmentioning

confidence: 99%

“…Lebanon has high percentages of vulnerable populations, such as elderly, 41 and chronic diseases, [42][43][44] considered at higher risk for COVID-19 and lower MWB. 15,45 Reasons in this context could include panic due unreliable information for patients, 46 especially in an era of massive misinformation in the media, 47,48 added to the economic situation itself.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12] Several studies evaluated MWB related to the COVID-19 pandemic, but none considered the economic context. [13][14][15] Indeed, another impact of the COVID-19 is the slowing down of major world economies with a higher risk for developing ones. Containment strategies of attening the curve most countries adopted to avoid overwhelming the healthcare system, induced a global economic slowdown with layoffs and rms exits generating an abrupt increase in unemployment.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Combined Outcomes of the COVID-19 Pandemic and a Collapsing Economy on Mental Well-Being: A Cross-Sectional Study

Sacre¹,

Hajj

Badro

et al. 2020

Preprint

Objective: To examine the outcomes of COVID-19 and a collapsing economy on mental well-being (MWB) of the general Lebanese population.Design/methods: This cross-sectional study enrolled 502 adults in May 2020.Results: MWB had a mean of 14.80. Female gender, university education, fear of COVID-19, fear of poverty, verbal violence at home, and chronic disease were associated with lower MWB. Better family satisfaction and financial situation were correlated with better MWB. Among workers/looking for a job: physical exercise was associated with better MWB, while previous waterpipe smoking, being self-employed before the crisis, working from home, closure of the institution, and worrying about long-term effects of the crisis on employment status were associated lower MWB. The fear of COVID-19 was not associated with MWB.Practical Implications: The Lebanese government should implement a reliable crisis management strategy that outlines stabilization and recovery measures to help people navigate through this period with minimal impact on mental, physical, and overall quality of life.

Changes in Performance Measures and Service Volume at US Federally Qualified Health Centers During the COVID-19 Pandemic

et al. 2023

ImportanceStay-at-home orders, site closures, staffing shortages, and competing COVID-19 testing and treatment needs all potentially decreased primary care access and quality during the COVID-19 pandemic. These challenges may have especially affected federally qualified health centers (FQHCs), which serve patients with low income nationwide.ObjectiveTo examine changes in FQHCs’ quality-of-care measures and visit volumes in 2020 to 2021 vs prepandemic.Design, Setting, and ParticipantsThis cohort study used a census of US FQHCs to calculate changes in outcomes between 2016 and 2021 using generalized estimating equations.Main Outcomes and MeasuresTwelve quality-of-care measures and 41 visit types based on diagnoses and services rendered, measured at the FQHC-year level.ResultsA total of 1037 FQHCs were included, representing 26.6 million patients (63% 18-64 years old; 56% female) in 2021. Despite upward trajectories for most measures prepandemic, the percentage of patients served by FQHCs receiving recommended care or achieving recommended clinical thresholds showed a statistically significant decrease between 2019 and 2020 for 10 of 12 quality measures. For example, declines were observed for cervical cancer screening (−3.8 percentage points [pp]; 95% CI, −4.3 to −3.2 pp), depression screening (−7.0 pp; 95% CI, −8.0 to −5.9 pp), and blood pressure control in patients with hypertension (−6.5 pp; 95% CI, −7.0 to −6.0 pp). By 2021, only 1 of these 10 measures returned to 2019 levels. From 2019 to 2020, 28 of 41 visit types showed a statistically significant decrease, including immunizations (incidence rate ratio [IRR], 0.76; 95% CI, 0.73-0.78), oral examinations (IRR, 0.61; 95% CI, 0.59-0.63), and supervision of infant or child health (IRR, 0.87; 95% CI, 0.85-0.89); 11 of these 28 visits approximated or exceeded prepandemic rates by 2021, while 17 remained below prepandemic rates. Five visit types increased in 2020, including substance use disorder (IRR, 1.07; 95% CI, 1.02-1.11), depression (IRR, 1.06; 95% CI, 1.03-1.09), and anxiety (IRR, 1.16; 95% CI, 1.14-1.19); all 5 continued to increase in 2021.Conclusions and RelevanceIn this cohort study of US FQHCs, nearly all quality measures declined during the first year of the COVID-19 pandemic, with most declines persisting through 2021. Similarly, most visit types declined in 2020; 60% of these remained below prepandemic levels in 2021. By contrast, mental health and substance use visits increased in both years. The pandemic led to forgone care and likely exacerbated behavioral health needs. As such, FQHCs need sustained federal funding to expand service capacity, staffing, and patient outreach. Quality reporting and value-based care models must also adapt to the pandemic’s influence on quality measures.