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Mental disorders and COVID-19 deaths: Clinical, public health, and human rights implications
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Publication date (Electronic):
11 April 2023
Journal:
PLOS Medicine
Publisher:
Public Library of Science
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Abstract
Shekhar Saxena and Cindy Chwa discuss the neglect of care for people living with mental disorders during the pandemic, and highlight relevant implications for policy-makers.
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Most cited references12
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Dementia care during COVID-19
Huali Wang, Tao Li, Paola Barbarino … (2020)
Older adults are vulnerable at the onset of natural disasters and crisis, and this has been especially true during the coronavirus disease 2019 (COVID-19) pandemic. 1 With the aggressive spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the death toll has risen worldwide. According to an interactive online tool that estimates the potential number of deaths from COVID-19 in a population, by age group, in individual countries and regional groupings worldwide under a range of scenarios, most of those who have died were older adults, most of whom had underlying health problems. 2 Globally, more than 50 million people have dementia, and one new case occurs every 3 s. 3 Dementia has emerged as a pandemic in an ageing society. 4 The double hit of dementia and COVID-19 pandemics has raised great concerns for people living with dementia. People living with dementia have limited access to accurate information and facts about the COVID-19 pandemic. They might have difficulties in remembering safeguard procedures, such as wearing masks, or in understanding the public health information issued to them. Ignoring the warnings and lacking sufficient self-quarantine measures could expose them to higher chance of infection. Older people in many countries, unlike in China, tend to live alone or with their spouse, either at home or in nursing homes. As more and more businesses stop non-essential services or initiate telecommuting work in an attempt to maintain social distancing limit the further spread of SARS-CoV-2, people living with dementia, who have little knowledge of telecommunication and depend primarily on in-person support might feel lonely and abandoned, and become withdrawn. To lessen the chance of infection among older people in nursing homes, more local authorities are banning visitors to nursing homes and long-term care facilities. 5 In January, 2020, the Chinese Ministry of Civil Affairs implemented similar social-distancing measures. 6 As a result, older residents lost face-to-face contact with their family members. Group activities in nursing homes were also prohibited. As a consequence, the residents of nursing homes became more socially isolated. We have observed that under the dual stress of fear of infection and worries about the residents' condition, the level of anxiety among staff in nursing homes increased and they developed signs of exhaustion and burnout after a month-long full lockdown of the facilities. Some people infected with COVID-19 have had to receive intensive care in hospital. A new environment can lead to increased stress and behavioural problems. 7 Delirium caused by hypoxia, a prominent clinical feature of COVID-19, could complicate the presentation of dementia 8 , increasing the suffering of the people living with dementia, the cost of medical care, and the need for dementia support. During the COVID-19 outbreak in China, five organisations, including the Chinese Society of Geriatric Psychiatry and Alzheimer's Disease Chinese, promptly released expert recommendations and disseminated key messages on how to provide mental health and psychosocial support. 9 Multidisciplinary teams started counselling services free of charge for people living with dementia and their carers. These approaches minimised the complex impact of both COVID-19 outbreak and dementia. As recommended by international dementia experts and Alzheimer's Disease International, 10 support for people living with dementia and their carers is needed urgently worldwide. In addition to physical protection from virus infection, mental health and psychosocial support should be delivered. For example, mental health professionals, social workers, nursing home administrators, and volunteers should deliver mental health care for people living with dementia collaboratively. Within such a team, dementia experts could take the lead and support team members from other disciplines. Self-help guidance for reducing stress, such as relaxation or meditation exercise, could be delivered through electronic media. Service teams could support behavioural management through telephone hotlines. Psychological counsellors could provide online consultation for carers at home and in nursing homes. 11 In addition, we encourage people who have a parent with dementia to have more frequent contact or spend more time with their parent, or to take on some of the caregiving duties so as to give the carer some respite time. China has contained the epidemic, and business is starting to return to normal. We believe that learning lessons from China would empower the world to tackle the COVID-19 pandemic, with little risk of compromising the quality of life of people living with dementia and their carers.
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Disparities in COVID-19 Outcomes by Race, Ethnicity, and Socioeconomic Status : A Systematic-Review and Meta-analysis
Shruti Magesh, Daniel John, Wei Li … (2021)
Question Are race and ethnicity–based COVID-19 outcome disparities in the United States associated with socioeconomic characteristics? Findings In this systematic review and meta-analysis of 4.3 million patients from 68 studies, African American, Hispanic, and Asian American individuals had a higher risk of COVID-19 positivity and ICU admission but lower mortality rates than White individuals. Socioeconomic disparity and clinical care quality were associated with COVID-19 mortality and incidence in racial and ethnic minority groups. Meaning In this study, members of racial and ethnic minority groups had higher rates of COVID-19 positivity and disease severity than White populations; these findings are important for informing public health decisions, particularly for individuals living in socioeconomically deprived communities. This systematic review and meta-analysis examines the association between race, ethnicity, COVID-19 outcomes, and socioeconomic determinants. Importance COVID-19 has disproportionately affected racial and ethnic minority groups, and race and ethnicity have been associated with disease severity. However, the association of socioeconomic determinants with racial disparities in COVID-19 outcomes remains unclear. Objective To evaluate the association of race and ethnicity with COVID-19 outcomes and to examine the association between race, ethnicity, COVID-19 outcomes, and socioeconomic determinants. Data Sources A systematic search of PubMed, medRxiv, bioRxiv, Embase, and the World Health Organization COVID-19 databases was performed for studies published from January 1, 2020, to January 6, 2021. Study Selection Studies that reported data on associations between race and ethnicity and COVID-19 positivity, disease severity, and socioeconomic status were included and screened by 2 independent reviewers. Studies that did not have a satisfactory quality score were excluded. Overall, less than 1% (0.47%) of initially identified studies met selection criteria. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Associations were assessed using adjusted and unadjusted risk ratios (RRs) and odds ratios (ORs), combined prevalence, and metaregression. Data were pooled using a random-effects model. Main Outcomes and Measures The main measures were RRs, ORs, and combined prevalence values. Results A total of 4 318 929 patients from 68 studies were included in this meta-analysis. Overall, 370 933 patients (8.6%) were African American, 9082 (0.2%) were American Indian or Alaska Native, 101 793 (2.4%) were Asian American, 851 392 identified as Hispanic/Latino (19.7%), 7417 (0.2%) were Pacific Islander, 1 037 996 (24.0%) were White, and 269 040 (6.2%) identified as multiracial and another race or ethnicity. In age- and sex-adjusted analyses, African American individuals (RR, 3.54; 95% CI, 1.38-9.07; P = .008) and Hispanic individuals (RR, 4.68; 95% CI, 1.28-17.20; P = .02) were the most likely to test positive for COVID-19. Asian American individuals had the highest risk of intensive care unit admission (RR, 1.93; 95% CI, 1.60-2.34, P < .001). The area deprivation index was positively correlated with mortality rates in Asian American and Hispanic individuals ( P < .001). Decreased access to clinical care was positively correlated with COVID-19 positivity in Hispanic individuals ( P < .001) and African American individuals ( P < .001). Conclusions and Relevance In this study, members of racial and ethnic minority groups had higher risks of COVID-19 positivity and disease severity. Furthermore, socioeconomic determinants were strongly associated with COVID-19 outcomes in racial and ethnic minority populations.
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A model of disparities: risk factors associated with COVID-19 infection
Yelena Rozenfeld, Jennifer Beam, Haley Maier … (2020)
Background By mid-May 2020, there were over 1.5 million cases of (SARS-CoV-2) or COVID-19 across the U.S. with new confirmed cases continuing to rise following the re-opening of most states. Prior studies have focused mainly on clinical risk factors associated with serious illness and mortality of COVID-19. Less analysis has been conducted on the clinical, sociodemographic, and environmental variables associated with initial infection of COVID-19. Methods A multivariable statistical model was used to characterize risk factors in 34,503cases of laboratory-confirmed positive or negative COVID-19 infection in the Providence Health System (U.S.) between February 28 and April 27, 2020. Publicly available data were utilized as approximations for social determinants of health, and patient-level clinical and sociodemographic factors were extracted from the electronic medical record. Results Higher risk of COVID-19 infection was associated with older age (OR 1.69; 95% CI 1.41–2.02, p < 0.0001), male gender (OR 1.32; 95% CI 1.21–1.44, p < 0.0001), Asian race (OR 1.43; 95% CI 1.18–1.72, p = 0.0002), Black/African American race (OR 1.51; 95% CI 1.25–1.83, p < 0.0001), Latino ethnicity (OR 2.07; 95% CI 1.77–2.41, p < 0.0001), non-English language (OR 2.09; 95% CI 1.7–2.57, p < 0.0001), residing in a neighborhood with financial insecurity (OR 1.10; 95% CI 1.01–1.25, p = 0.04), low air quality (OR 1.01; 95% CI 1.0–1.04, p = 0.05), housing insecurity (OR 1.32; 95% CI 1.16–1.5, p < 0.0001) or transportation insecurity (OR 1.11; 95% CI 1.02–1.23, p = 0.03), and living in senior living communities (OR 1.69; 95% CI 1.23–2.32, p = 0.001). Conclusion sisk of COVID-19 infection is higher among groups already affected by health disparities across age, race, ethnicity, language, income, and living conditions. Health promotion and disease prevention strategies should prioritize groups most vulnerable to infection and address structural inequities that contribute to risk through social and economic policy.
Author and article information
Journal
Journal ID (nlm-ta): PLoS Med
Journal ID (iso-abbrev): PLoS Med
Journal ID (publisher-id): plos
Title:
PLOS Medicine
Publisher:
Public Library of Science
(San Francisco, CA USA
)
ISSN
(Print):
1549-1277
ISSN
(Electronic):
1549-1676
Publication date
(Electronic):
11
April
2023
Publication date Collection:
April
2023
Volume: 20
Issue: 4
Electronic Location Identifier: e1004220
Affiliations
Author notes
* E-mail:
ssaxena@
123456hsph.harvard.edu
Author information
Shekhar Saxena
https://orcid.org/0000-0001-9385-0212
Cindy Chwa
https://orcid.org/0000-0002-1038-8972
Article
Publisher ID: PMEDICINE-D-23-00591DOI: 10.1371/journal.pmed.1004220
PMC ID: 10089307
PubMed ID: 37040331
SO-VID: c8d3ba45-bdb6-43a0-831f-9de67436c298
Copyright © © 2023 Saxena, Chwa
License:
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
Related
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nationwide cohort study
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Tables: 0,
Pages: 3
Funding
The author(s) received no specific funding for this work.
Categories
Subject:
Perspective
Subject:
Medicine and Health Sciences
Subject:
Medical Conditions
Subject:
Infectious Diseases
Subject:
Viral Diseases
Subject:
Covid 19
Subject:
Medicine and Health Sciences
Subject:
Epidemiology
Subject:
Medical Risk Factors
Subject:
Medicine and Health Sciences
Subject:
Mental Health and Psychiatry
Subject:
Mental Health Therapies
Subject:
Biology and Life Sciences
Subject:
Population Biology
Subject:
Population Metrics
Subject:
Death Rates
Subject:
Medicine and Health Sciences
Subject:
Epidemiology
Subject:
Pandemics
Subject:
Medicine and Health Sciences
Subject:
Public and Occupational Health
Subject:
Social Sciences
Subject:
Philosophy
Subject:
Human Rights
Subject:
Medicine and Health Sciences
Subject:
Health Care
Subject:
Socioeconomic Aspects of Health
Subject:
Medicine and Health Sciences
Subject:
Public and Occupational Health
Subject:
Socioeconomic Aspects of Health
Custom metadata
Outbreaks COVID-19
ScienceOpen disciplines: Medicine
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ScienceOpen disciplines: Medicine