In February 2020, CDC issued guidance advising persons and health care providers in areas affected by the coronavirus disease 2019 (COVID-19) pandemic to adopt social distancing practices, specifically recommending that health care facilities and providers offer clinical services through virtual means such as telehealth.* Telehealth is the use of two-way telecommunications technologies to provide clinical health care through a variety of remote methods.† To examine changes in the frequency of use of telehealth services during the early pandemic period, CDC analyzed deidentified encounter (i.e., visit) data from four of the largest U.S. telehealth providers that offer services in all states.§ Trends in telehealth encounters during January-March 2020 (surveillance weeks 1-13) were compared with encounters occurring during the same weeks in 2019. During the first quarter of 2020, the number of telehealth visits increased by 50%, compared with the same period in 2019, with a 154% increase in visits noted in surveillance week 13 in 2020, compared with the same period in 2019. During January-March 2020, most encounters were from patients seeking care for conditions other than COVID-19. However, the proportion of COVID-19-related encounters significantly increased (from 5.5% to 16.2%; p<0.05) during the last 3 weeks of March 2020 (surveillance weeks 11-13). This marked shift in practice patterns has implications for immediate response efforts and longer-term population health. Continuing telehealth policy changes and regulatory waivers might provide increased access to acute, chronic, primary, and specialty care during and after the pandemic.

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Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic - United States, January-March 2020.

Structural racism has been and remains a fundamental cause of persistent health disparities in the United States. The coronavirus disease 2019 (COVID-19) pandemic and the police killings of George Floyd, Breonna Taylor, and multiple others have been reminders that structural racism persists and restricts the opportunities for long, healthy lives of Black Americans and other historically disenfranchised groups. The American Heart Association has previously published statements addressing cardiovascular and cerebrovascular risk and disparities among racial and ethnic groups in the United States, but these statements have not adequately recognized structural racism as a fundamental cause of poor health and disparities in cardiovascular disease. This presidential advisory reviews the historical context, current state, and potential solutions to address structural racism in our country. Several principles emerge from our review: racism persists; racism is experienced; and the task of dismantling racism must belong to all of society. It cannot be accomplished by affected individuals alone. The path forward requires our commitment to transforming the conditions of historically marginalized communities, improving the quality of housing and neighborhood environments of these populations, advocating for policies that eliminate inequities in access to economic opportunities, quality education, and health care, and enhancing allyship among racial and ethnic groups. Future research on racism must be accelerated and should investigate the joint effects of multiple domains of racism (structural, interpersonal, cultural, anti-Black). The American Heart Association must look internally to correct its own shortcomings and advance antiracist policies and practices regarding science, public and professional education, and advocacy. With this advisory, the American Heart Association declares its unequivocal support of antiracist principles.

Call to Action: Structural Racism as a Fundamental Driver of Health Disparities: A Presidential Advisory From the American Heart Association.

Importance The coronavirus disease 2019 (COVID-19) pandemic, associated mitigation measures, and social and economic impacts may affect mental health, suicidal behavior, substance use, and violence Objective To examine changes in US emergency department (ED) visits for mental health conditions (MHCs), suicide attempts (SAs), overdose (OD), and violence outcomes during the COVID-19 pandemic Design, setting, and participants This cross-sectional study used data from the Centers for Disease Control and Prevention's National Syndromic Surveillance Program to examine national changes in ED visits for MHCs, SAs, ODs, and violence from December 30, 2018, to October 10, 2020 (before and during the COVID-19 pandemic) The National Syndromic Surveillance Program captures approximately 70% of US ED visits from more than 3500 EDs that cover 48 states and Washington, DC Main outcomes and measures Outcome measures were MHCs, SAs, all drug ODs, opioid ODs, intimate partner violence (IPV), and suspected child abuse and neglect (SCAN) ED visit counts and rates Weekly ED visit counts and rates were computed overall and stratified by sex Results From December 30, 2018, to October 10, 2020, a total of 187 508 065 total ED visits (536% female and 461% male) were captured; 6 018 318 included at least 1 study outcome (visits not mutually exclusive) Total ED visit volume decreased after COVID-19 mitigation measures were implemented in the US beginning on March 16, 2020 Weekly ED visit counts for all 6 outcomes decreased between March 8 and 28, 2020 (March 8: MHCs = 42 903, SAs = 5212, all ODs = 14 543, opioid ODs = 4752, IPV = 444, and SCAN = 1090; March 28: MHCs = 17 574, SAs = 4241, all ODs = 12 399, opioid ODs = 4306, IPV = 347, and SCAN = 487) Conversely, ED visit rates increased beginning the week of March 22 to 28, 2020 When the median ED visit counts between March 15 and October 10, 2020, were compared with the same period in 2019, the 2020 counts were significantly higher for SAs (n = 4940 vs 4656, P = 02), all ODs (n = 15 604 vs 13 371, P Conclusions and relevance These findings suggest that ED care seeking shifts during a pandemic, underscoring the need to integrate mental health, substance use, and violence screening and prevention services into response activities during public health crises

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Trends in US Emergency Department Visits for Mental Health, Overdose, and Violence Outcomes Before and During the COVID-19 Pandemic.

Using a longitudinal dataset linking biometric and survey data from several cohorts of young adults before and during the COVID-19 pandemic ([Formula: see text]), we document large disruptions to physical activity, sleep, time use, and mental health. At the onset of the pandemic, average steps decline from 10,000 to 4,600 steps per day, sleep increases by 25 to 30 min per night, time spent socializing declines by over half to less than 30 min, and screen time more than doubles to over 5 h per day. Over the course of the pandemic from March to July 2020 the proportion of participants at risk for clinical depression ranges from 46% to 61%, up to a 90% increase in depression rates compared to the same population just prior to the pandemic. Our analyses suggest that disruption to physical activity is a leading risk factor for depression during the pandemic. However, restoration of those habits through a short-term intervention does not meaningfully improve mental well-being.

https://www.pnas.org/content/pnas/118/9/e2016632118.full.pdf

Lifestyle and mental health disruptions during COVID-19.

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Older Adults and the Mental Health Effects of COVID-19.


 ObjectiveThis study examined whether resilience capacity moderates the impact of daily perceived stress and affect on cortisol diurnal slope among relocated emerging adults. MethodsRelocated undergraduates (N=98; aged 18-25 years) were recruited from three groups: Resilient, Vulnerable, and Control. Mixed-effects models were used to test the unique effects of perceived stress, negative affect, and positive affect x group interactions on diurnal cortisol slope across 14 consecutive days.ResultsThe Resilient group did not moderate the associations between daily stress or affect on cortisol diurnal slope. Instead, both the Resilient and Vulnerable groups with early family risk, showed a steeper diurnal slope unique to higher stress and a flatter slope unique to higher NA.ConclusionsResults suggest that an adverse early family life was significantly associated with altered cortisol diurnal slope outcomes to stress (i.e., demand) and negative affect (i.e., distress). These associations were not attenuated by current resilience capacity.

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Resilience to Early Family Risk Moderates Daily Stress and Affect on Cortisol Diurnal Slope associations: A 14-Day Ecological Momentary Assessment Study

Author(s): Wiley, Joshua | Advisor(s): Stanton, Annette L | Abstract: Background: The present four studies aimed to develop comprehensive, succinct measures of psychosocial resources and system-wide physiological dysregulation (allostatic load) and integrate these into a conceptual model, a modified form of the Reserve Capacity Model (Gallo a Matthews, 2003), to characterize how socioeconomic status, stress, psychosocial factors, mood, physiology, and health behaviors contribute to health outcomes.Methods: Identification of factors underlying psychosocial resources was conducted in four independent samples in which a range of psychological and social resources were measured. A systematic review of psychosocial resources and allostatic load was conducted by retrieving all articles with "allostasis" or "allostatic load" in the title, abstract, or keywords from major databases. An allostatic load factor was examined using data from the large Midlife in the United States (MIDUS) study, which was also used for the final study linking SES, psychosocial resources, health behaviors, allostatic load, and a health outcome.Results: In the first study, two factors, psychological and social resources, provided the best fit to all the psychosocial resources assessed. In Study 2, evidence of a common factor, allostatic load, underlying 23 biomarkers in MIDUS emerged, although there was also evidence of unique system-specific factors. In the systematic review of psychosocial resources and AL, results were mixed, with some studies finding null effects, and others finding significant positive or negative effects of psychosocial resources on allostatic load. In a fourth study testing the modified Reserve Capacity Model, results largely supported the model's predictions. SES was associated with better health outcomes indirectly via lower allostatic load, lower negative mood, and higher physical activity. These associations were themselves linked to SES via psychological resources and major stressful life events. Psychological resources were associated with higher physical activity, but not directly to allostatic load or health outcomes, and social resources had no association independent of psychological resources.Conclusions: Psychological resources, social resources, and allostatic load form coherent constructs. Psychosocial resources appear more strongly associated with health behaviors than directly to allostatic load or health outcomes. Results generally supported the modified Reserve Capacity Model, suggesting it is a useful conceptual framework to guide future research.

Joshua F. Wiley

Papers

Resilience to Early Family Risk Moderates Daily Stress and Affect on Cortisol Diurnal Slope associations: A 14-Day Ecological Momentary Assessment Study

Measurement of Psychosocial Resources, Allostatic Load, and Their Relations