Medicine (Austin & Northern Health) - Research Publications
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ItemPrior sleep-wake behavior predicts mental health resilience among adults in the United States during the COVID-19 pandemic( 2021)Rigorous nonpharmaceutical interventions (e.g., stay-at-home orders, remote-work directives) were implemented in early 2020 for coronavirus disease 2019 (COVID-19) pandemic containment in the U.S. During this time, increased sleep duration and delayed sleep timing were reported through surveys (Leone et al., 2021) and wearable data (Rezaei and Grandner, 2021), as were elevated adverse mental health symptom (Czeisler et al., 2020). Inter-relationships between sleep and mental health have not been examined using longitudinal objective sleep-wake data, during these abruptly imposed lifestyle changes. We examined objective sleep-wake data and surveyed mental health data collected among 4,912 U.S. adult users of a validated sleep wearable (WHOOP, Boston, Massachusetts) before and during the COVID-19 pandemic. Comparing the pre-pandemic (January 1 to March 12, 2020) and acute pandemic-onset intervals (March 13 to April 12, 2020), participants exhibited increased mean sleep duration (0.25h [95% CI = 0.237-0.270]), later sleep onset (18m [17.378-20.045]) and offset (36m [35.111-38.106]), and increased consistency of sleep timing (3.51 [3.295-3.728] out of 100); all P < 0.0001. Generally, participants with persistent sleep deficiency and low sleep consistency had higher odds of symptoms of anxiety or depression, burnout, and new or increased substance use during the pandemic. Decreases in sleep duration (adjusted odds ratio [aOR] = 1.30, 95% CI = 1.03-1.65, P = 0.025) and sleep consistency (2.05 [1.17-3.67], P = 0.009) were associated with increased anxiety and depression symptoms during the pandemic. We suggest that sleep duration and consistency may be important predictors of risk of adverse mental health outcomes during a pandemic. M.J. Leone, M. Sigman, D.A. Golombek. Effects of lockdown on human sleep and chronotype during the COVID-19 pandemic. Curr Biol 30 (16), R930–R931 (2020). N. Rezaei N, M.A. Grandner. Changes in sleep duration, timing, and variability during the COVID-19 pandemic: Large-scale Fitbit data from 6 major US cities. Sleep Health 10.1016/j.sleh.2021.02.008. (2021). M.É. Czeisler, R.I. Lane, E. Petrosky, et al., Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic - United States, June 24-30, 2020. MMWR Morb Mortal Wkly Rep 69 (32), 1049–1057 (2020).
Significance Statement
The coronavirus disease 2019 (COVID-19) pandemic has had profound effects on health, including increased sleep duration and worsened mental health. We examined associations between (1) objective sleep-wake data before and during the COVID-19 pandemic and (2) adverse mental health symptoms and substance use among users of a validated sleep wearable. We found that, in general, participants with persistent sleep deficiency and low sleep consistency had higher odds of symptoms of anxiety or depression, new or increased substance use, and burnout. Our findings suggest that sleep of sufficient duration and consistent timing are associated with mental health resilience, exemplified in this case by the impact of the pandemic and related abrupt lifestyle changes on adverse mental health symptoms. -
ItemCOVID-19 Vaccine Intentions in the United States—December 2020 to March 2021( 2021)
Importance
SARS-CoV-2 containment is estimated to require attainment of high (>80%) post-infection and post-vaccination population immunity.Objective
To assess COVID-19 vaccine intentions among US adults and their children, and reasons for vaccine hesitancy among potential refusers.Design
Internet-based surveys were administered cross-sectionally to US adults during December 2020 and February to March 2021 (March-2021).Setting
Surveys were administered through Qualtrics using demographic quota sampling.Participants
A large, demographically diverse sample of 10,444 US adults (response rate, 63.9%).Main Outcomes and Measures
COVID-19 vaccine uptake, intentions, and reasons for potential refusal. Adults living with or caring for children aged 2 to 18 years were asked about their intent to have their children vaccinated. Multivariable weighted logistic regression models were used to estimate adjusted odds ratios for vaccine refusal.Results
Of 5256 March-2021 respondents, 3467 (66.0%) reported they would definitely or most likely obtain a COVID-19 vaccine as soon as possible (ASAP Obtainers), and an additional 478 (9.1%) reported they were waiting for more safety and efficacy data before obtaining the vaccine. Intentions for children and willingness to receive a booster shot largely matched personal COVID-19 vaccination intentions. Vaccine refusal (ie, neither ASAP Obtainers nor waiting for more safety and efficacy data) was most strongly associated with not having obtained an influenza vaccine in 2020 (adjusted odds ratio, 4.11 [95% CI, 3.05-5.54]), less frequent mask usage (eg, rarely or never versus always or often, 3.92 [2.52-6.10]) or social gathering avoidance (eg, rarely or never versus always or often, 2.65 [1.95-3.60]), younger age (eg, aged 18-24 versus over 65 years, 3.88 [2.02-7.46]), and more conservative political ideology (eg, very conservative versus very liberal, 3.58 [2.16-5.94]); all P <.001.Conclusions and Relevance
Three-quarters of March-2021 respondents in our large, demographically diverse sample of US adults reported they would likely obtain a COVID-19 vaccine, and 60% of adults living with or caring for children plan to have them vaccinated as soon as possible. With an estimated 27% of the US population having been infected with SARS-CoV-2, once vaccines are available to children and they have been vaccinated, combined post-infection and post-vaccination immunity will approach 80% of the US population in 2021, even without further infections.Key Points
Question
What are COVID-19 vaccines intentions, for adults and for children under their care?Findings
Two-thirds of 5256 US adults surveyed in early 2021 indicated they would obtain a COVID-19 vaccine as soon as possible. Intentions for children and booster vaccines largely matched personal vaccine intentions. Refusal was more common among adults who were younger, female, Black, very politically conservative, less educated, less adherent with COVID-19 prevention behaviors (eg, wearing masks), had more medical mistrust, or had not received influenza vaccines in 2020.Meaning
Tailored vaccine promotion efforts and vaccine programs may improve vaccine uptake and contribute to US immunity against COVID-19. -
ItemMental Health, Substance Use, and Suicidal Ideation Among Unpaid Caregivers in the United States During the COVID-19 Pandemic: Relationships to Age, Race/Ethnicity, Employment, and Caregiver Intensity( 2021)
Objectives
To estimate the prevalence of unpaid caregiving during the coronavirus disease 2019 (COVID-19) pandemic, and to identify factors associated with adverse mental health symptoms, substance use, and suicidal ideation in this population, which provides critical support in health care systems by providing care to older adults and those with chronic conditions.Methods
In June 2020, Internet-based surveys with questions about demographics, caregiving responsibilities, and mental health were administered to US adults aged ≥18 years. Demographic quota sampling and survey weighting to improve cross-sectional sample representativeness of age, gender, and race/ethnicity. Prevalence ratios for adverse mental health symptoms were estimated using multivariable Poisson regressions.Results
Of 9,896 eligible invited adults, 5,412 (54.7%) completed surveys; 5,011 (92.6%) respondents met screening criteria and were analysed, including 1,362 (27.2%) caregivers. Caregivers had higher prevalences of adverse mental health symptoms than non-caregivers, including anxiety or depressive disorder symptoms (57.6% vs 21.5%, respectively, p<0.0001) having recently seriously considered suicide (33.4% vs 3.7%, p<0.0001). Symptoms were more common among caregivers who were young vs older adults (e.g., aged 18–24 vs ≥65 years, aPR 2.75, 95% CI 1.95–3.88, p<0.0001), Hispanic or Latino vs non-Hispanic White (1.14, 1.04–1.25, p=0.0044), living with vs without disabilities (1.18, 1.10–1.26, p<0.0001), and with moderate and high vs low Caregiver Intensity Index scores (2.31, 1.65–3.23; 2.81, 2.00–3.94; both p<0.0001). Suicidal ideation was more prevalent among non-Hispanic Black vs non-Hispanic White caregivers (1.48, 1.15–1.90, p=0.0022).Conclusions
Caregivers, who accounted for one in four US adult respondents in this nationally representative sample, more commonly reported adverse mental health symptoms than non-caregivers. Increased visibility of and access to mental health care resources are urgently needed to address mental health challenges of caregiving.