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      Mental health and the overall tendency to follow official recommendations against COVID-19: A U-shaped relationship?

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          Abstract

          This paper investigates the association between several mental health indicators (depression, anxiety, stress, and loneliness) and the overall tendency to follow official recommendations regarding self-protection against COVID-19 (i.e., overall compliance). We employ panel data from the COME-HERE survey, collected over four waves, on 7,766 individuals (22,878 observations) from France, Germany, Italy, Spain, and Sweden. Employing a flexible specification that allows the association to be non-monotonic, we find a U-shaped relationship, in which transitions to low and high levels of mental health are associated with higher overall compliance, while transitions to medium levels of mental health are associated with less overall compliance. Moreover, anxiety, stress, and loneliness levels at baseline (i.e., at wave 1) also have a U-shaped effect on overall compliance later (i.e., recommendations are followed best by those with lowest and highest levels of anxiety, stress, and loneliness at baseline, while following the recommendations is lowest for those with moderate levels of these variables). These U shapes, which are robust to several specifications, may explain some of the ambiguous results reported in the previous literature. Additionally, we observe a U-shaped association between the mental health indicators and a number of specific health behaviours (including washing hands and mask wearing). Importantly, most of these specific behaviours play a role in overall compliance. Finally, we uncover the role of gender composition effects in some of the results. While variations in depression and stress are negatively associated with variations in overall compliance for men, the association is positive for women. The U-shaped relation in the full sample (composed of males and females) will reflect first the negative slope for males and then the positive slope for females.

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          Most cited references31

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            The PHQ-9: validity of a brief depression severity measure.

            While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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              COVID-19 pandemic and mental health consequences: systematic review of the current evidence

              Highlights • COVID-19 patients displayed high levels of PTSS and increased levels of depression. • Patients with preexisting psychiatric disorders reported worsening of psychiatric symptoms. • Higher levels of psychiatric symptoms were found among health care workers. • A decrease in psychological well-being was observed in the general public. • However, well conducted large-scale studies are highly needed.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draft
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – original draft
                Role: ConceptualizationRole: Funding acquisitionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                2024
                25 June 2024
                : 19
                : 6
                : e0305833
                Affiliations
                [1 ] Paris School of Economics (PSE), Paris, France
                [2 ] Centre National de la Recherche Scientifique (CNRS), Paris, France
                [3 ] University of Luxembourg, Esch-sur-Alzette, Luxembourg
                [4 ] UMR 1393 Paris - Jourdan Sciences Économiques, Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, Paris, France
                [5 ] Economics Department, Leeds University Business School, Leeds, United Kingdom
                [6 ] International Public Economics Department, Freie Universität Berlin, Berlin, Germany
                [7 ] Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
                University of Glasgow, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0003-1575-8423
                https://orcid.org/0000-0003-3388-5848
                https://orcid.org/0000-0001-8086-0788
                Article
                PONE-D-23-02104
                10.1371/journal.pone.0305833
                11198746
                38917072
                90121602-4e10-4faf-8961-430b2f176672
                © 2024 Apouey et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 24 January 2023
                : 5 June 2024
                Page count
                Figures: 8, Tables: 2, Pages: 20
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100020183, André Losch Fondation;
                Funded by: Art2Cure
                Funded by: Cargolux
                Funded by: Agence Nationale de la Recherche
                Award ID: ANR-21-CO16-0002
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100001866, Fonds National de la Recherche Luxembourg;
                Funded by: University of Luxembourg
                Funded by: AXA Research Award 2015
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100001665, Agence Nationale de la Recherche;
                Award ID: ANR-17-EURE-0001
                The research reported in this manuscript was financially supported by "Agence Nationale de la Recherche" (ANR; https://anr.fr/en/; grant ANR-21-CO16-0002; recipient: BA). The COME-HERE data collection was funded by the Luxembourg National Research Fund (FNR; https://www.fnr.lu/), the Losch Foundation ( https://www.loschfondation.lu/), Art2Cure ( https://www.bil.com/galerie-lindependance/art2cure/index.html), Cargo Lux ( https://www.cargolux.com/), and the University of Luxembourg ( https://wwwen.uni.lu/). FE benefited from funding from AXA Research Award 2015 ( https://axa-research.org/en/project/fabrice-etile). BA and FE acknowledge administrative support from the Paris School Economics via the "Agence Nationale de la Recherche" EUR grant ANR-17-EURE-0001 ( https://anr.fr/ProjetIA-17-EURE-0001). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Medicine and Health Sciences
                Public and Occupational Health
                Behavioral and Social Aspects of Health
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mood Disorders
                Depression
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Psychological Stress
                Biology and Life Sciences
                Psychology
                Psychological Stress
                Social Sciences
                Psychology
                Psychological Stress
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Covid 19
                Biology and Life Sciences
                Psychology
                Emotions
                Anxiety
                Social Sciences
                Psychology
                Emotions
                Anxiety
                Medicine and Health Sciences
                Epidemiology
                Pandemics
                Medicine and Health Sciences
                Public and Occupational Health
                Hygiene
                Hand Washing
                Custom metadata
                The COME-HERE data contain sensitive individual information and cannot be made publicly available (Ethic Research Panel of the University of Luxembourg, decision number ERP 20-026 C/A COME-HERE). Data access to the University of Luxembourg server can be obtained on request for noncommercial research purposes (contact persons: Conchita D’Ambrosio, conchita.dambrosio@ 123456uni.lu ; Claus Vögele, claus.voegele@ 123456uni.lu ).
                COVID-19

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