Megan E. Marziali

Bio: Megan E. Marziali is an academic researcher from Columbia University. The author has contributed to research in topics: Mental health & Population. The author has an hindex of 5, co-authored 15 publications receiving 95 citations. Previous affiliations of Megan E. Marziali include University of British Columbia.

Investigating the effect of national government physical distancing measures on depression and anxiety during the COVID-19 pandemic through meta-analysis and meta-regression.

Abstract: BACKGROUND: COVID-19 physical distancing measures can potentially increase the likelihood of mental disorders. It is unknown whether these measures are associated with depression and anxiety. OBJECTIVES: To investigate meta-analytic global levels of depression and anxiety during the COVID-19 pandemic and how the implementation of mitigation strategies (i.e. public transportation closures, stay-at-home orders, etc.) impacted such disorders. DATA SOURCES: PubMed, MEDLINE, Web of Science, BIOSIS Citation Index, Current Content Connect, PsycINFO, CINAHL, medRxiv, and PsyArXiv databases for depression and anxiety prevalences; Oxford Covid-19 Government Response Tracker for the containment and closure policies indexes; Global Burden of Disease Study for previous levels of depression and anxiety. STUDY ELIGIBILITY CRITERIA: Original studies conducted during COVID-19 pandemic, which assessed categorical depression and anxiety, using PHQ-9 and GAD-7 scales (cutoff ⩾10). PARTICIPANTS AND INTERVENTIONS: General population, healthcare providers, students, and patients. National physical distancing measures. STUDY APPRAISAL AND SYNTHESIS METHODS: Meta-analysis and meta-regression. RESULTS: In total, 226 638 individuals were assessed within the 60 included studies. Global prevalence of both depression and anxiety during the COVID-19 pandemic was 24.0% and 21.3%, respectively. There were differences in the prevalence of both anxiety and depression reported across regions and countries. Asia (17.6% and 17.9%), and China (16.2% and 15.5%) especially, had the lowest prevalence of both disorders. Regarding the impact of mitigation strategies on mental health, only public transportation closures increased the prevalence of anxiety, especially in Europe. LIMITATIONS: Country-level data on physical distancing measures and previous anxiety/depression may not necessarily reflect local (i.e. city-specific) contexts. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Mental health concerns should not be viewed only as a delayed consequence of the COVID-19 pandemic, but also as a concurrent epidemic. Our data provide support for policy-makers to consider real-time enhanced mental health services, and increase initiatives to foster positive mental health outcomes.

Physical Distancing in COVID-19 May Exacerbate Experiences of Social Isolation among People Living with HIV.

Abstract: Since late 2019, pandemic coronavirus disease (COVID-19) has spread rapidly across the globe [1]. In response, the United States Centers for Disease Control and Prevention and other health organizations have advocated for both voluntary and enforced control measures. Among basic public health recommendations, social distancing measures have been recommended, involving avoiding social gatherings with ten or more people, keeping a physical distance of at least 2 m, and cancelling non-essential in-person activities [2, 3]. More extreme measures have since been implemented, including statewide “shelter-in-place” or “stay-athome” orders [4, 5]. Residents are allowed to leave their houses for essential services (e.g. grocery stores, pharmacies) but are otherwise expected to remain at home [4]. At the time of writing this Note, nearly all U.S. states have some form of stay-at-home order in place [6]. The influence of these restrictions on physical connection, while necessary, may have an unforeseen impact on the well-being of the entire population. Such quarantine measures have never before occurred at this scale, and many individuals may be finding themselves unprepared to cope with the circumstances. Individuals may experience unfamiliar challenges in receiving social support, as they are not able to gather in person. It is thus likely that rates of social isolation and loneliness will increase dramatically during the COVID-19 outbreak. Social isolation, or disconnectedness at the individual level, can be quantified objectively by measuring level of engagement with peers [7, 8]. Loneliness, on the other hand, is a subjective experience relating to one’s perceived (versus actual) degree of social connectedness [9]. It is thus possible for someone to experience loneliness while also reporting high levels of social engagement. Both social isolation and loneliness have been found to have notable impacts on health within the general population. Specifically, previous research has highlighted that social isolation is comparable to wellestablished risk factors for mortality, such as smoking and high blood pressure [10–12]. We have discussed that people living with HIV (PLHIV) are at greater risk of experiencing social isolation [13]. It has been suggested that this is primarily due to both experienced and perceived stigma inhibiting the formation of social networks [14, 15]. This has been shown to occur through mechanisms such as fear of rejection and concealment of HIV status, or the use of social isolation as a coping mechanism to avoid HIV disclosure [14, 16]. PLHIV may have experienced the loss of social network members in the early years of the HIV epidemic [17], further heightening potential vulnerability to experiencing isolation. As a matter of example, we have examined data from the Longitudinal Investigation into Supportive and Ancillary Health Services (LISA) Study (2007–2010), regarding the extent of social isolation among PLHIV [18, 19]. Social isolation was measured using latent class analysis. Our analytical sample included 936 LISA respondents. Five indicators of social isolation were employed to fully capture this construct: How many people live with you?; Are you in a relationship?; Who do you count on for support and friendship?; Who is the most reliable to count on for support and friendship?; and I’ve been satisfied with how socially active I am. We identified three classes of social isolation: (1) Socially Connected (SC), (2) Minimally Isolated (MI), and (3) Socially Isolated (SI). The SC class (N = 340, 36.3%) included PLHIV who: were likely to live with at least one * Megan E. Marziali mem2371@cumc.columbia.edu

Investigating the effect of national government physical distancing measures on depression and anxiety during the COVID-19 pandemic through meta-analysis and meta-regression

Abstract: (following PRISMA statement) Background COVID-19 physical distancing measures can potentially increase the likelihood of mental disorders. It is unknown whether these measures are associated with depression and anxiety. Objectives To investigate meta-analytic global levels of depression and anxiety during the COVID-19 pandemic and how implementation of mitigation strategies (i.e. public transportation closures, stay-at-home orders, etc.) impacted such disorders. Data sources Pubmed, MEDLINE, Web of Science, BIOSIS Citation Index, Current Content Connect, PsycINFO, CINAHL, medRxiv, and PsyArXiv databases for depression and anxiety prevalences; Oxford Covid-19 Government Response Tracker for the containment and closure policies indexes; Global Burden of Disease Study for previous levels of depression and anxiety. Study eligibility criteria Original studies conducted during COVID-19 pandemic, which assessed categorical depression and anxiety, using PHQ-9 and GAD-7 scales (cutoff ≥ 10). Participants and interventions General population, healthcare providers, students, and patients. National physical distancing measures. Study appraisal and synthesis methods Meta-analysis and meta-regresssion. Results In total, 226,638 individuals were assessed within the 60 included studies. Global prevalence of both depression and anxiety during COVID-19 pandemic were 24.0% and 21.3%, respectively. There was a wide variance in the prevalence of both anxiety and depression reported in different regions of the world and countries. Asia, and China particularly, had the lowest prevalence of both disorders. Regarding the impact of mitigation strategies on mental health, only public transportation closures increased anxiety prevalence. Limitations Country-level data on physical distancing measures and previous anxiety/depression may not necessarily reflect local (i.e., city-specific) contexts. Conclusions and implications of key findings Mental health concerns should not be viewed only as a delayed consequence of the COVID-19 pandemic, but also as a concurrent epidemic. Our data provides support for policy-makers to consider real-time enhanced mental health services, and increase initiatives to foster positive mental health outcomes. Systematic review registration number https://doi.org/10.17605/OSF.IO/JQGSF

Post-infection depressive, anxiety and post-traumatic stress symptoms: A prospective cohort study in patients with mild COVID-19.

Abstract: Background It remains unclear whether COVID-19 is associated with psychiatric symptoms during or after the acute illness phase. Being affected by the disease exposes the individual to an uncertain prognosis and a state of quarantine. These factors can predispose individuals to the development of mental symptoms during or after the acute phase of the disease. There is a need for prospective studies assessing psychiatric symptoms in COVID-19 patients in the post-infection period. Methods In this prospective cohort study, nasopharyngeal swabs for COVID-19 tests were collected at patients' homes under the supervision of trained healthcare personnel. Patients who tested positive for COVID-19 and were classified as mild cases (N = 895) at treatment intake were further assessed for the presence of psychiatric symptoms (on average, 56.6 days after the intake). We investigated the association between the number of COVID-19 symptoms at intake and depressive, anxiety and post-traumatic symptoms approximately two months later, adjusting for previous mental health status, time between baseline and outcome, and other confounders. Multivariate logistic regression and generalized linear models were employed for categorical and continuous outcomes, respectively. Results A clinically significant level of depressive, anxiety and post-traumatic stress symptoms were reported by 26.2% (N = 235), 22.4% (N = 201), and 17.3% (N = 155) of the sample. Reporting an increased number of COVID-related symptoms was associated with the presence of clinically significant levels of depressive (aOR = 1.059;95%CI = 1.002–1.119), anxiety (aOR = 1.072;95%CI = 1.012–1.134), and post-traumatic stress (aOR = 1.092;95%CI = 1.024–1.166) symptoms. Sensitivity analyses supported findings for both continuous and categorical measures. Conclusion Exposure to an increased number of COVID-19 symptoms may be associated with depressive, anxiety and post-traumatic symptoms after the acute phase of the disease. These patients should be monitored for the development of psychiatric symptoms after COVID-19 treatment discharge. Early interventions, such as brief interventions of psychoeducation on coping strategies, could benefit these individuals.

Maternal obesity alters uterine NK activity through a functional KIR2DL1/S1 imbalance.

Abstract: In pregnancy, uterine natural killer cells (uNK) play essential roles in coordinating uterine angiogenesis, blood vessel remodeling and promoting maternal tolerance to fetal tissue. Deviances from a normal uterine microenvironment are thought to modify uNK function(s) by limiting their ability to establish a healthy pregnancy. While maternal obesity has become a major health concern due to associations with adverse effects on fetal and maternal health, our understanding into how obesity contributes to poor pregnancy disorders is unknown. Given the importance of uNK in pregnancy, this study examines the impact of obesity on uNK function in women in early pregnancy. We identify that uNK from obese women show a greater propensity for cellular activation, but this difference does not translate into increased effector killing potential. Instead, uNK from obese women express an altered repertoire of natural killer receptors, including an imbalance in inhibitory KIR2DL1 and activating KIR2DS1 receptors that favors HLA-C2-directed uNK activation. Notably, we show that obesity-related KIR2DS1 skewing potentiates TNFα production upon receptor crosslinking. Together, these findings suggest that maternal obesity modifies uNK activity by altering the response toward HLA-C2 antigen and KIR2DL1/2DS1-controlled TNFα release. Furthermore, this work identifies alterations in uNK function resulting from maternal obesity that may impact early developmental processes important in pregnancy health.

Depression and anxiety.

Abstract: Depression and anxiety are the most common psychiatric conditions in late life. Despite their prevalence, we know relatively little about their unique manifestation in older adults. And, Although the most common intervention for late-life depression and anxiety continues to be medication, research on psychosocial interventions for late-life depression and anxiety has burgeoned in the past several years. Unfortunately, this growing body of intervention research has yet to be widely translated into improved systems of care for late-life depression. This article is one step toward synthesizing the knowledge in this growing area of research. The review of literature presents the conclusions of several meta-analyses that have reviewed psychosocial interventions for late-life depression and anxiety. In addition, intervention studies concerning the effectiveness of cognitive behavioral therapy, interpersonal therapy, reminiscence therapy, and alternative therapies with depressed and/or anxious older adults are reviewed. A brief description of various approaches to psychosocial intervention with anxious and/or depressed older adults is also presented.

Regulation of Placental Extravillous Trophoblasts by the Maternal Uterine Environment.

Abstract: During placentation invasive extravillous trophoblasts (EVTs) migrate into the maternal uterus and modify its vessels. In particular, remodeling of the spiral arteries by EVTs is critical for adapting blood flow and nutrient transport to the developing fetus. Failures in this process have been noticed in different pregnancy complications such as preeclampsia, intrauterine growth restriction, stillbirth, or recurrent abortion. Upon invasion into the decidua, the endometrium of pregnancy, EVTs encounter different maternal cell types such as decidual macrophages, uterine NK (uNK) cells and stromal cells expressing a plethora of growth factors and cytokines. Here, we will summarize development of the EVT lineage, a process occurring independently of the uterine environment, and formation of its different subtypes. Further, we will discuss interactions of EVTs with arteries, veins and lymphatics and illustrate how the decidua and its different immune cells regulate EVT differentiation, invasion and survival. The present literature suggests that the decidual environment and its soluble factors critically modulate EVT function and reproductive success.

Coronavirus disease 2019 (COVID-19) outcomes in HIV/AIDS patients: a systematic review.

Abstract: Objectives The aim of the study was to systematically review current studies reporting on clinical outcomes in people living with HIV (PLHIV) infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A comprehensive literature search was conducted in Global Health, SCOPUS, Medline and EMBASE using pertinent key words and Medical Subject Headings (MeSH) terms relating to coronavirus disease 2019 (COVID-19) and HIV. A narrative synthesis was undertaken. Articles are summarized in relevant sections. Results Two hundred and eighty-five articles were identified after duplicates had been removed. After screening, eight studies were analysed, totalling 70 HIV-infected patients (57 without AIDS and 13 with AIDS). Three themes were identified: (1) controlled HIV infection does not appear to result in poorer COVID-19 outcomes, (2) more data are needed to determine COVID-19 outcomes in patients with AIDS and (3) HIV-infected patients presenting with COVID-19 symptoms should be investigated for superinfections. Conclusions Our findings suggest that PLHIV with well-controlled disease are not at risk of poorer COVID-19 disease outcomes than the general population. It is not clear whether those with poorly controlled HIV disease and AIDS have poorer outcomes. Superimposed bacterial pneumonia may be a risk factor for more severe COVID-19 but further research is urgently needed to elucidate whether PLHIV are more at risk than the general population.