Increase in Mental Disorders During the COVID-19 Pandemic - Role of Occupational & Financial Strains

Abstract Background Numerous studies reported an increase in mental disorders during the COVID-19 pandemic, but the specific causes for this increase are unclear. We therefore investigate whether pandemic-related occupational and financial changes (e.g., reduced working hours, working from home, financial losses) were associated with increased symptoms of depression and anxiety compared with the situation before the pandemic. Methods We analyzed data from the German National Cohort Study (NAKO). Between May and November 2020, 161,849 participants answered questions on their mental state and social circumstances. Responses were compared with data from the baseline survey before the pandemic (2014-2019). Linear fixed-effects models were used to determine whether individual changes in the symptoms of depression (PHQ-9) or anxiety (GAD-7) were associated with occupational/financial changes (controlling for covariates). Results A pronounced increase in symptoms was observed among those who became unemployed during the pandemic (+ 1.16 points on the depression scale, 95% confidence interval [0.91; 1.41], range 0-27). Increases were also seen for reduced working hours without short-term working allowance, increased working hours, working from home, insecurity regarding employment, and financial strain. The deterioration in mental health was largely statistically explained by the occupational and financial changes investigated in the model. Conclusions Depressive symptoms and anxiety disorders increased in the study population during the first year of the COVID-19 pandemic and occupational and financial difficulties were an essential contributory factor. These strains should be taken into account both in the care of individual patients and in the planning of targeted prevention measures. Results suggest that welfare state benefits such as short-time allowance in times of crises may reduce mental load in affected populations.


Background:
The mental health status of populations (public mental health) and its effect on societies has gained considerable attention in recent years, especially during the current pandemic. The measurement of depressive symptoms is at core of the assessment of mental health. The detailedness of this assessment defines the range of public mental health problems that can be answered.

Methods:
Between 2014 and 2019 the German National Cohort (NAKO) recruited 205,000 participants aged 20-70 years into the baseline examination in 18 study centers. Depression and depressive symptoms were assessed by different instruments including a lifetime diagnosis of depression and current treatment, the Major Depressive Disorder (MDD) section of the Mini-International-Neuropsychiatric-Interview (M.I.N.I. 5.0) and the depression scale of the Patient Health Questionnaire (PHQ-9). These instruments include different time periods and interpretations. Associations between these depression outcomes and age, gender and education are analysed in linear and logistic regression models.

Results:
A lifetime physician's diagnosis of depression was reported by 14.7% of participants with considerable regional variation and almost 50% of this group received treatment within the last 12 months. Based on PHQ-9 7.9% of the participants were classified as depressive according to the dimensional assessment (score10) and 3% of them as having a major depression subtype. In contrast 32.8% screened positive based on the MINI and 15.4% of those receiving the full MINI had a diagnosis MDD. Associations with important socioeconomic determinants for these different depression outcomes will be reported.

Conclusions:
The large NAKO sample size and the detailed assessment of depression symptoms and status enables the analysis of a broad range of public mental health questions. The analysis of depression frequencies and the distribution of depressive symptoms allow the establishment of population references.

Background:
Numerous studies reported an increase in mental disorders during the COVID-19 pandemic, but the specific causes for this increase are unclear. We therefore investigate whether pandemic-related occupational and financial changes (e.g., reduced working hours, working from home, financial losses) were associated with increased symptoms of depression and anxiety compared with the situation before the pandemic.

Methods:
We analyzed data from the German National Cohort Study (NAKO). Between May and November 2020, 161,849 participants answered questions on their mental state and social circumstances. Responses were compared with data from the baseline survey before the pandemic (2014-2019). Linear fixedeffects models were used to determine whether individual changes in the symptoms of depression (PHQ-9) or anxiety (GAD-7) were associated with occupational/financial changes (controlling for covariates).

Results:
A pronounced increase in symptoms was observed among those who became unemployed during the pandemic (+ 1.16 points on the depression scale, 95% confidence interval [0.91; 1.41], range 0-27). Increases were also seen for reduced working hours without short-term working allowance, increased working hours, working from home, insecurity regarding employment, and financial strain. The deterioration in mental health was largely statistically explained by the occupational and financial changes investigated in the model.

Conclusions:
Depressive symptoms and anxiety disorders increased in the study population during the first year of the COVID-19 pandemic and occupational and financial difficulties were an essential contributory factor. These strains should be taken into account both in the care of individual patients and in the

Background:
Whole-body magnetic resonance imaging (MRI) permits noninvasive, non-ionizing phenotyping of the human body and ideally complements the epidemiological assessment of the NAKO participants. As such, it allows for the detection of morphologic or functional predisposition, early disease stages prior to overt clinical events as well as evident pathological changes. The assessment of progression and regression of imaging phenotypes over time will provide the basis to identify and understand the relevance of imaging-based risk factor profiles for disease development.

Methods:
Integrated in the general NAKO study program and managed by a central Imaging Core, study participants underwent whole-body imaging at five dedicated MR imaging sites. Imaging was performed on five identical 3 Tesla scanners (Magnetom Skyra, Siemens Healthineers, Erlangen, Germany) applying a one hour protocol, including sequences for the brain, the cardiovascular and musculoskeletal system as well as for the thorax and abdomen. Comprehensive measures to assure high image quality and management of incidental findings were established.

Results:
As part of the baseline examination program, a total of 30,861 participants successfully underwent the MR imaging program. All measures of quality assurance and incidental findings management were successfully employed throughout the study period and obtained image quality and completeness of all MR sequences was excellent (>94.2% completeness). While MR imaging as part of the first re-examination is ongoing, baseline MRI data is currently accessible for scientific analyses.

Conclusions:
The MRI-Study of the NAKO will provide a comprehensive imaging phenotypic biobank covering different organ systems with highest morphological and functional detail. MRI data analysis will gain novel insights into the natural history of disease development, the role of subclinical disease burden, and revolutionize our understanding of imaging biomarkers of risk.

Background:
In the UK, chronic conditions such as cancer, heart disease, stroke, and chronic obstructive pulmonary disease are driving health inequalities in life expectancy and were responsible for two-thirds of premature mortality in 2017. Voices that stress the importance of primary care in reducing health inequalities have been strengthening during the last decade. However, defining the most effective strategies to reduce health inequalities through general practice remains a challenge.

Aims:
This study examines the evidence on interventions in primary care that are likely to decrease inequalities in NCDs and especially cancer, diabetes, cardiovascular and chronic obstructive pulmonary disease and will provide healthcare organisations with guiding principles on what should be commissioned.

Methods:
The study is a realist review following Pawson's model. Based on a programme theory, we screened systematic reviews of interventions delivered in primary care and through their references, we identified primary studies reporting on inequalities across PROGRESS-Plus criteria. The data were analysed in light of the initial program theory and organised in a model informed by Collins' Domains of Power framework.

Results:
Out of 251 included reviews we retrieved 6,555 primary studies which resulted in 333 studies for data extraction. We found that there are five guiding principles operating simultaneously across four different domains which can reduce health inequalities in General Practice. The principles include flexibility, continuity, inclusivity, intersectionality, and community and operate simultaneously across the domains of structures and policies; narratives and ideas; rules and practices; and relationships and experience. Conclusions: Flexibility, continuity, inclusivity, intersectionality, and community are the five principles which should guide the design and delivery of General Practice for the reduction of health inequalities. Key messages: Flexibility, continuity, inclusivity, intersectionality, and community are the five principles which should guide the design and delivery of General Practice for the reduction of health inequalities.
Action to reduce health inequalities should be taken simultaneously across the domains of structures and policies; narratives and ideas; rules and practices; and relationships and experience.