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CIHI releases inaugural report exploring priority health care topics in Canada

A news release from the Canadian Institute for Health Information: CIHI releases inaugural report exploring priority health care topics in Canada. Excerpt:

August 2, 2023 —  The Canadian Institute for Health Information (CIHI) has released its inaugural report on priority health care topics, Taking the pulse: A snapshot of Canadian health care, 2023. This report is the first of what will be an annual series — the result of a formal commitment made in early 2023 by the Government of Canada and the provincial and territorial governments to improve health care in Canada in shared priority areas.   

As part of that commitment, governments agreed to work with CIHI to collect, share and learn from health information, with CIHI reporting to Canadians on the priority areas each year. Quebec is not participating in the joint reporting exercise.     

Taking the pulse: A snapshot of Canadian health care, 2023 offers Canadians an initial overview of where we are today in the 4 priority areas:  

• Expanding family health services and improving access to primary health care  

• Increasing the supply of health workers and decreasing backlogs in care to support resilient health systems  Improving access to mental health and substance use services   

• Modernizing health care’s information systems and digital tools for the secure sharing of electronic health information  

The indicator results (none of which include data from Quebec) are based on publicly available data stemming from a partnership between Canada Health Infoway, integrated youth services networks, Statistics Canada and CIHI.  

Selected indicator highlights include the following:  

• 88% of Canadians age 12 and older reported having a regular health care provider.  

• There were about 743,000 fewer surgeries performed in Canada during the first 2.5 years of the pandemic, a drop of about 13% compared with before the pandemic.  

• Half of Canadians who required community mental health counselling received a first appointment in less than a month, while 1 in 10 waited about 4 months (data is not available for Prince Edward Island, Quebec, Ontario and Nunavut).  

• Fewer than 40% of Canadians have accessed their personal health information online.

Mental health and addiction health service use by physicians compared to non-physicians before and during the COVID-19 pandemic

Via PLOS Medicine: Mental health and addiction health service use by physicians compared to non-physicians before and during the COVID-19 pandemic: A population-based cohort study in Ontario, Canada. The abstract:

Background  

The Coronavirus Disease 2019 (COVID–19) pandemic has exacerbated mental health challenges among physicians and non–physicians. However, it is unclear if the worsening mental health among physicians is due to specific occupational stressors, reflective of general societal stressors during the pandemic, or a combination. We evaluated the difference in mental health and addictions health service use between physicians and non–physicians, before and during the COVID–19 pandemic.  

Methods and findings  

We conducted a population–based cohort study in Ontario, Canada between March 11, 2017 and August 11, 2021 using data collected from Ontario’s universal health system. Physicians were identified using registrations with the College of Physicians and Surgeons of Ontario between 1990 and 2020. Participants included 41,814 physicians and 12,054,070 non–physicians. We compared the first 18 months of the COVID–19 pandemic (March 11, 2020 to August 11, 2021) to the period before COVID–19 pandemic (March 11, 2017 to February 11, 2020). The primary outcome was mental health and addiction outpatient visits overall and subdivided into virtual versus in–person, psychiatrists versus family medicine and general practice clinicians. We used generalized estimating equations for the analyses.  

Pre–pandemic, after adjustment for age and sex, physicians had higher rates of psychiatry visits (aIRR 3.91 95% CI 3.55 to 4.30) and lower rates of family medicine visits (aIRR 0.62 95% CI 0.58 to 0.66) compared to non–physicians.  

During the first 18 months of the COVID–19 pandemic, the rate of outpatient mental health and addiction (MHA) visits increased by 23.2% in physicians (888.4 pre versus 1,094.7 during per 1,000 person–years, aIRR 1.39 95% CI 1.28 to 1.51) and 9.8% in non–physicians (615.5 pre versus 675.9 during per 1,000 person–years, aIRR 1.12 95% CI 1.09 to 1.14). Outpatient MHA and virtual care visits increased more among physicians than non–physicians during the first 18 months of the pandemic.  

Limitations include residual confounding between physician and non–physicians and challenges differentiating whether observed increases in MHA visits during the pandemic are due to stressors or changes in health care access.   

Conclusions  

The first 18 months of the COVID–19 pandemic was associated with a larger increase in outpatient MHA visits in physicians than non–physicians. These findings suggest physicians may have had larger negative mental health during COVID–19 than the general population and highlight the need for increased access to mental health services and system level changes to promote physician wellness.

Long Covid in the United States

Via NBER: Long Covid in the United States. Click through to download the full report as a PDF. The abstract:

Although yet to be clearly identified as a clinical condition, there is immense concern at the health and wellbeing consequences of long COVID. Using data collected from nearly half a million Americans in the period June 2022-December 2022 in the US Census Bureau’s Household Pulse Survey (HPS), we find 14 percent reported suffering long COVID at some point, half of whom reported it at the time of the survey.  

It peaks in midlife in the same way as negative affect. Ever having had long COVID is strongly associated with negative affect (anxiety, depression, worry and a lack of interest in things). The effect is larger among those who currently report long COVID, especially if they report severe symptoms.  In contrast, those who report having had short COVID report higher wellbeing than those who report never having had COVID.  

Long COVID is also strongly associated with physical mobility problems, and with problems dressing and bathing. It is also associated with mental problems as indicated by recall and understanding difficulties. Again, the associations are strongest among those who currently report long COVID, while those who said they had had short COVID have fewer physical and mental problems than those who report never having had COVID.  

Vaccination is associated with lower negative affect, including among those who reported having had long COVID.

Research: 1 in 8 adult Canadians experienced depression for first time during pandemic

Via the Helsinki Times: Research: 1 in 8 adult experienced depression for first time during pandemic. Excerpt:

One in eight older persons in Canada, according to recent large-scale research that included more than 20,000, experienced their first episode of depression during the epidemic.  

The statistics were significantly worse for people who had previously struggled with depression. Nearly half (45 per cent) of this population reported having depression by the fall of 2020.  

The analysis of responses from the Canadian Longitudinal Study on Aging, which gathered information from participants for an average of seven years, was published in the International Journal of Environmental Research and Public Health.  

"The high rate of first-onset depression in 2020 highlights the substantial mental health toll that the pandemic caused in a formerly mentally healthy group of older adults." says first author, Andie MacNeil, a recent Master of Social Work graduate from the Factor-Inwentash Faculty of Social Work (FIFSW) and the Institute for Life Course and Aging, University of Toronto.  

Although it is well known that depression among older adults increased during the pandemic, few studies have examined the proportion of people who developed the disorder for the first time or the proportion of people with a history of the condition who had a relapse.  

"The devastation of the pandemic which upended so many aspects of daily life hit those with a history of depression particularly hard," said co-author Sapriya Birk, a researcher formerly based in the Department of Neuroscience, Carleton University, Ottawa who is currently a medical student at McMaster University, Hamilton, Canada, adding, "Health professionals need to be vigilant in screening their patients who had mental health problems at an earlier time in their life."  

The researchers determined that a number of factors, such as low income and savings, loneliness, chronic pain, difficulty accessing healthcare, a history of traumatic childhood experiences, and family conflict, were linked to depression in older adults during the pandemic.

Mental health after China's prolonged lockdowns

An editorial in The Lancet: Mental health after China's prolonged lockdowns. Excerpt:

On June 1, Shanghai reopened after a 2-month lockdown to curb COVID-19. On June 6, Beijing also eased COVID-19 restrictions by allowing restaurant dining and the gradual reopening of schools from June 13 in most districts. Although many countries instituted various forms of lockdown over the past 2 years, China's have often been the most stringent and frequent. Control policies, including school closures and stay-at-home orders, combined with the stress of the pandemic itself, will have exacerbated the already fragile mental health of many Chinese people. 

According to the first national survey on psychological distress in the COVID-19 epidemic in China from 2020, 35% of respondents experienced distress, including anxiety and depression. School closures were associated with adverse mental health symptoms and behaviours among children and adolescents. Amid the relief of lifting restrictions, there is also widespread anxiety over adapting to routine life and fear that transmission of the virus will rebound. This scenario is cause enough for concern, but it plays out against the wider backdrop of mental disorders in China, which remain largely unaddressed.  

Mental health in China has gained attention among the public and academia only in the past 20 years. The first national survey of mental disorders in China, from 2013–15, showed that the lifetime prevalence of mental health conditions in adults is 16·6%. Considering China's population, the clinical need is huge.  

Yet access to treatment is extremely poor. Only 9·5% of people with depressive disorders received treatment, and very rarely (0·5%) was treatment adequate. Mental health services are concentrated in large specialty hospitals rather than community and primary health care, encouraging the long-established pattern in China of going straight to large hospitals for specialist treatment, rather than first seeing a general practitioner.  

This centralised system of care is not adequate to meet China's mental health-care needs. Transitioning from a hospital-centric system to one that is more integrated, anchored in primary health care, and enabled by the newest technology and data (as recommended in a review of quality of primary health care in China by Xi Li and colleagues) is essential.  

Mental health has long been neglected in China, partly because of a deep-rooted cultural stigma. Discussing mental health remains taboo among many communities. Confucianism emphasises the achievement of personal and social harmony. People with mental disorders are often perceived as unable to fulfil this ideal. Families of patients worry about how a disclosure of mental illness might damage their reputation. The fear of being stigmatised and socially isolated will undoubtedly disincentivise people with mental disorders from seeking care.  

The Chinese Government has introduced a mental health law, as well as the 686 programme, aimed at strengthening the mental health-care workforce, raising awareness, and integrating mental health-care services. If patients are unable to voice how they feel openly and frankly, they will be left invisible and untreated.  

Culturally sensitive, stigma reduction interventions and national campaigns are clearly needed to break down barriers to accessing services. What else? The Lancet has convened a Commission of Chinese and international researchers, led by Michael Phillips from Shanghai Mental Health Center and Shuiyuan Xiao from Xiangya School of Public Health, to identify the key challenges that need to be addressed in China's next 5-year plan for mental health, consider how China's rapid economic, social, and technological changes affect mental health and mental health care, and discuss the growing role of China in the global mental health movement. It is due to report its findings in 2023.

Individual and work factors associated with psychosocial health of registered nurses during the Covid-19 pandemic

Via the Journal of Occupational and Environmental Medicine: Individual and Work Factors Associated with Psychosocial Health of Registered Nurses During the Covid-19 Pandemic. The abstract:

Objective:   

To describe the initial influence of the Covid-19 pandemic on U.S. nurses’ psychosocial health, and to identify factors associated with poor psychosocial health outcomes.  

Methods:   

We conducted a convergent (QUAN+qual) mixed methods study. From June-August 2020, we administered surveys (N=629) and conducted semi-structured interviews (N = 34) among nurses working across healthcare settings in 18 states. We developed separate multivariable logistic regression models for three psychosocial outcomes (anxiety, depressive symptoms, insomnia). We used content analysis to process and analyze qualitative data, and integrated results in the final analysis step.  

Results:   

Nurses reported high rates of depressive symptoms (22%), anxiety (52%), and insomnia (55%). Disturbances to sleep were both a contributing factor to, and an outcome of, poor psychosocial health.  

Conclusions:   

Evidence-based interventions addressing work stress and sleep, and proactive monitoring of nurses’ psychosocial health by employers are urgently needed.

Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic

Via The Lancet: Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The summary:

Background  

Before 2020, mental disorders were leading causes of the global health-related burden, with depressive and anxiety disorders being leading contributors to this burden. The emergence of the COVID-19 pandemic has created an environment where many determinants of poor mental health are exacerbated. The need for up-to-date information on the mental health impacts of COVID-19 in a way that informs health system responses is imperative. In this study, we aimed to quantify the impact of the COVID-19 pandemic on the prevalence and burden of major depressive disorder and anxiety disorders globally in 2020.  

Methods  

We conducted a systematic review of data reporting the prevalence of major depressive disorder and anxiety disorders during the COVID-19 pandemic and published between Jan 1, 2020, and Jan 29, 2021. We searched PubMed, Google Scholar, preprint servers, grey literature sources, and consulted experts. Eligible studies reported prevalence of depressive or anxiety disorders that were representative of the general population during the COVID-19 pandemic and had a pre-pandemic baseline. 

We used the assembled data in a meta-regression to estimate change in the prevalence of major depressive disorder and anxiety disorders between pre-pandemic and mid-pandemic (using periods as defined by each study) via COVID-19 impact indicators (human mobility, daily SARS-CoV-2 infection rate, and daily excess mortality rate).  

We then used this model to estimate the change from pre-pandemic prevalence (estimated using Disease Modelling Meta-Regression version 2.1 [known as DisMod-MR 2.1]) by age, sex, and location. We used final prevalence estimates and disability weights to estimate years lived with disability and disability-adjusted life-years (DALYs) for major depressive disorder and anxiety disorders.  

Findings  

We identified 5683 unique data sources, of which 48 met inclusion criteria (46 studies met criteria for major depressive disorder and 27 for anxiety disorders). Two COVID-19 impact indicators, specifically daily SARS-CoV-2 infection rates and reductions in human mobility, were associated with increased prevalence of major depressive disorder (regression coefficient [B] 0·9 [95% uncertainty interval 0·1 to 1·8; p=0·029] for human mobility, 18·1 [7·9 to 28·3; p=0·0005] for daily SARS-CoV-2 infection) and anxiety disorders (0·9 [0·1 to 1·7; p=0·022] and 13·8 [10·7 to 17·0; p<0·0001]. Females were affected more by the pandemic than males (B 0·1 [0·1 to 0·2; p=0·0001] for major depressive disorder, 0·1 [0·1 to 0·2; p=0·0001] for anxiety disorders) and younger age groups were more affected than older age groups (−0·007 [–0·009 to −0·006; p=0·0001] for major depressive disorder, −0·003 [–0·005 to −0·002; p=0·0001] for anxiety disorders). 

We estimated that the locations hit hardest by the pandemic in 2020, as measured with decreased human mobility and daily SARS-CoV-2 infection rate, had the greatest increases in prevalence of major depressive disorder and anxiety disorders. We estimated an additional 53·2 million (44·8 to 62·9) cases of major depressive disorder globally (an increase of 27·6% [25·1 to 30·3]) due to the COVID-19 pandemic, such that the total prevalence was 3152·9 cases (2722·5 to 3654·5) per 100 000 population. We also estimated an additional 76·2 million (64·3 to 90·6) cases of anxiety disorders globally (an increase of 25·6% [23·2 to 28·0]), such that the total prevalence was 4802·4 cases (4108·2 to 5588·6) per 100 000 population. 

Altogether, major depressive disorder caused 49·4 million (33·6 to 68·7) DALYs and anxiety disorders caused 44·5 million (30·2 to 62·5) DALYs globally in 2020. 

Interpretation 

This pandemic has created an increased urgency to strengthen mental health systems in most countries. Mitigation strategies could incorporate ways to promote mental wellbeing and target determinants of poor mental health and interventions to treat those with a mental disorder. Taking no action to address the burden of major depressive disorder and anxiety disorders should not be an option.

All-cause and cause-specific mortality in people with mental disorders and intellectual disabilities, before and during the COVID-19 pandemic: Cohort study

Via The Lancet Regional Health—Europe: All-cause and cause-specific mortality in people with mental disorders and intellectual disabilities, before and during the COVID-19 pandemic: cohort study. The summary:

BACKGROUND 

People with mental disorders and intellectual disabilities experience excess mortality compared with the general population. The impact of COVID-19 on exacerbating this, and in widening ethnic inequalities, is unclear. 

METHODS 

Prospective data (N=167,122) from a large mental healthcare provider in London, UK, with deaths from 2019 to 2020, used to assess age- and gender-standardised mortality ratios (SMRs) across nine psychiatric conditions (schizophrenia-spectrum disorders, affective disorders, somatoform/ neurotic disorders, personality disorders, learning disabilities, eating disorders, substance use disorders, pervasive developmental disorders, dementia) and by ethnicity. 

FINDINGS 

Prior to the World Health Organization (WHO) declaring COVID-19 a public health emergency on 30th January 2020, all-cause SMRs across all psychiatric cohorts were more than double the general population. By the second quarter of 2020, when the UK experienced substantial peaks in COVID-19 deaths, all-cause SMRs increased further, with COVID-19 SMRs elevated across all conditions (notably: learning disabilities: SMR: 9.24 (95% CI: 5.98-13.64), pervasive developmental disorders: 5.01 (95% CI: 2.40-9.20), eating disorders: 4.81 (95% CI: 1.56-11.22), schizophrenia-spectrum disorders: 3.26 (95% CI: 2.55-4.10), dementia: 3.82 (95% CI: 3.42, 4.25) personality disorders 4.58 (95% CI: 3.09-6.53)). Deaths from other causes remained at least double the population average over the whole year. Increased SMRs were similar across ethnic groups. 

INTERPRETATION 

People with mental disorders and intellectual disabilities were at a greater risk of deaths relative to the general population before, during and after the first peak of COVID-19 deaths, with similar risks by ethnicity. Mortality from non-COVID-19/ other causes was elevated before/ during the pandemic, with higher COVID-19 mortality during the pandemic.

Large-scale study of migrant workers’ mental health finds prolonged restrictions worsen depression, stress

Via todayonline.com: Large-scale study of migrant workers’ mental health finds prolonged restrictions worsen depression, stress. Excerpt:

SINGAPORE — Putting migrant workers under prolonged quarantines may be expedient in limiting Covid-19’s spread, but this comes at the cost of poorer mental health, a study has found.  

The study — said to be the first large-scale one here examining the mental health of such workers embroiled in coronavirus clusters — was conducted by a team of Yale-NUS researchers between June 22 and Oct 11 last year.   

The researchers surveyed 1,011 male migrant workers employed in manual jobs here to document their mental health symptoms and identify those at risk of poor mental health.   

They found that complete movement restrictions were associated with increased depression and stress, while being diagnosed with Covid-19 was associated with increased anxiety among the workers.  

At the peak of the outbreak which led Singapore to enter a two-month circuit breaker period last April, more than 1,000 new Covid-19 cases were identified in dormitories daily. 

While the vast majority of Singapore’s population has experienced many twists and turns over the past 15 months, as community restrictions get tightened or loosened in tandem with the pandemic situation, not much has changed for the 275,000-odd migrant workers staying in dormitories.    

These workers have been largely confined to their rooms and only allowed to leave for work or, more recently, to designated recreation centres on some days. 

WHAT RESEARCHERS FOUND 

• Rates of severe or extremely severe depression (3.1 per cent), anxiety (4.1 per cent) and stress in respondents (1.3 per cent) were similar to those observed in the general population in Singapore during the Covid-19 pandemic 

• Higher scores of depression and stress were observed among participants surveyed during complete movement restrictions, as compared to participants surveyed during minimal restrictions In terms of health concerns, being diagnosed with Covid-19 predicted increased anxiety  

• Those who were fearful about their health during the pandemic reported more symptoms of depression, anxiety and stress than those who were not fearful  

• Participants who rated their health status as being good had fewer symptoms than those who rated their health as poor or normal  

• Higher depression, anxiety and stress symptoms were found among participants who feared losing their job during the pandemic  

• Higher depression, anxiety and stress symptoms were also observed among participants with higher exposure to Covid-19 rumours than those with lower exposure

See also this BBC report on the subject.

US public health workers leaving ‘in droves’ amid pandemic burnout

Via The Guardian, a predictable but still alarming report: US public health workers leaving ‘in droves’ amid pandemic burnout. Excerpt:

Alexandra was working in the public health emergencies unit in a major north-eastern American city when the first wave of the pandemic hit. Although her job was in public health policy research, and not treating Coovid-19 patients on the frontlines of the healthcare system, she recalls the spring of 2020 as a blur of 24-hour shifts.

Beginning last March, Alexandra estimates that she and her colleagues worked the equivalent of three full-time years in 12 months. (Her name has been changed to protect anonymity.) 

“There was no overtime, there was no hazard pay,” Alexandra recalls. Throughout the public health department where she worked, symptoms of anxiety, depression and stress-related physical maladies were commonplace among staff.  

This summer, despite the protestations of her superiors, Alexandra quit. She says she’s one of roughly 25 staff members who have left the department since the start of the pandemic.  

Alexandra’s story is not unique. Just as the pandemic has fuelled a burnout crisis among frontline medical staff, it has been calamitous for the mental health of workers in public health – the data analysts and policy advisers whose recommendations are supposed to shape the nation’s pandemic response. Many feel stonewalled by elected officials and scapegoated for the death toll of Covid-19.  

Some, like Alexandra, are opting to leave the job for good.  

The results of a nationwide CDC survey of public health workers, released this July, were revealing. Of the more than 26,000 surveyed individuals working in public health departments across the United States, more than half reported recent symptoms of at least one major mental health condition. Their reported prevalence of PTSD was 10 to 20% higher than in frontline medical workers and the general public. Advertisement  

Some public health workers, including Alexandra, cite a lack of cooperation from elected officials as a driving source of widespread overwork and discontent. Others even say they have faced pressure from elected officials to alter their findings to fit a political agenda.  

“When they didn’t like how our [data on] vaccination coverage by race/ethnicity was looking, they actually asked me – the least senior member of the health department – to edit the data to artificially inflate BIPOC categories,” alleges Kristine, an epidemiologist at a Connecticut health department. (Her name has been changed out of fear for her job.)  

Meanwhile, public health workers are at the receiving end of mounting resentment. Since last March, threats against public health officials have increased. In a high-profile incident this past July, an angry crowd targeted Dr Faisal Khan – the acting director of the St Louis department of health – at a meeting on mask mandates. The disgruntled attendees lobbed racial epithets and surrounded Khan after the meeting like a mob.