Lockdowns to control the spread of the coronavirus disease 2019 (COVID-19) have had profound effects on everyday life worldwide, but their effect on mental health remains unclear because available meta-analyses and reviews rely mostly on cross-sectional studies. We conducted a rapid review and meta-analysis of longitudinal studies and natural experiments investigating the relationship between COVID-19 lockdowns and mental health. A total of 25 studies involving 72 004 participants and 58 effect sizes were analyzed. Using a random effects model, we found that lockdowns had small effects on mental health symptoms, g = 0.17, s.e. = 0.05, 95% CI (0.06-0.24), p = 0.001, but the effects on positive psychological functioning, g = -0.12, s.e. = 0.11, 95% CI (-0.33 to 0.09), p = 0.27, were not significant. Multivariate analysis of effect sizes revealed significant and relatively small effect sizes for anxiety and depression, while those for social support, loneliness, general distress, negative affect, and suicide risk were not significant. The results indicated substantial heterogeneity among studies, but meta-regression analyses found no significant moderation effects for mean age, gender, continent, COVID-19 death rate, days of lockdown, publication status or study design. The psychological impact of COVID-19 lockdowns is small in magnitude and highly heterogeneous, suggesting that lockdowns do not have uniformly detrimental effects on mental health and that most people are psychologically resilient to their effects.

/pdf/the-psychological-impact-of-covid-19-pandemic-lockdowns-a-50fjqwjgbo.pdf

The psychological impact of COVID-19 pandemic lockdowns: a review and meta-analysis of longitudinal studies and natural experiments.

Although overweight and obesity are widespread across most of the developed world, a considerable body of research has now accumulated, which suggests that adiposity often goes undetected. A substantial proportion of individuals with overweight or obesity do not identify they are overweight, and large numbers of parents of children with overweight or obesity fail to identify their child as being overweight. Lay people and medical practitioners are also now poor at identifying overweight and obesity in others. A visual normalization theory of the under-detection of overweight and obesity is proposed. This theory is based on the notion that weight status is judged relative to visual body size norms. Because larger body sizes are now common, this has caused a recalibration to the range of body sizes that are perceived as being 'normal' and increased the visual threshold for what constitutes 'overweight'. Evidence is reviewed that indicates this process has played a significant role in the under-detection of overweight and obesity. The public health relevance of the under-detection of overweight and obesity is also discussed.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/obr.12570

Overweight but unseen: a review of the underestimation of weight status and a visual normalization theory.

It is commonly assumed that a person identifying that they are ‘overweight’ is an important prerequisite to successful weight management. However, there has been no systematic evaluation of evidence supporting this proposition. The aim of the present research was to systematically review evidence on the relationship between perceived overweight and (i) weight loss attempts, (ii) weight control strategies (healthy and unhealthy), (iii) weight‐related behaviours (physical activity and eating habits), (iv) disordered eating and (v) weight change. We synthesized evidence from 78 eligible studies and evaluated evidence linking perceived overweight with outcome variables separately according to the gender, age and objective weight status of study participants. Results indicated that perceived overweight was associated with an increased likelihood of attempting weight loss and with healthy and unhealthy weight control strategies in some participant groups. However, perceived overweight was not reliably associated with physical activity or healthy eating and was associated with greater disordered eating in some groups. Rather than being associated with improved weight management, there was consistent evidence that perceived overweight was predictive of increased weight gain over time. Individuals who perceive their weight status as overweight are more likely to report attempting weight loss but over time gain more weight.

/pdf/a-systematic-review-of-the-relationship-between-weight-2bi10f1o29.pdf

A systematic review of the relationship between weight status perceptions and weight loss attempts, strategies, behaviours and outcomes.

Background and aims Cannabis products are becoming increasingly diverse, and vary considerably in concentrations of ∆9 -tetrahydrocannabinol (THC) and cannabidiol (CBD). Higher doses of THC can increase the risk of harm from cannabis, while CBD may partially offset some of these effects. Lower Risk Cannabis Use Guidelines currently lack recommendations based on quantity of use, and could be improved by implementing standard units. However, there is currently no consensus on how units should be measured or standardized among different cannabis products or methods of administration. Argument Existing proposals for standard cannabis units have been based on specific methods of administration (e.g. joints) and these may not capture other methods, including pipes, bongs, blunts, dabbing, vaporizers, vape pens, edibles and liquids. Other proposals (e.g. grams of cannabis) cannot account for heterogeneity in THC concentrations among different cannabis products. Similar to alcohol units, we argue that standard cannabis units should reflect the quantity of primary active pharmacological constituents (dose of THC). On the basis of experimental and ecological data, public health considerations and existing policy, we propose that a 'standard THC unit' should be fixed at 5 mg THC for all cannabis products and methods of administration. If supported by sufficient evidence in future, consumption of standard CBD units might offer an additional strategy for harm reduction. Conclusions Standard ∆9 -tetrahydrocannabinol (THC) units can potentially be applied among all cannabis products and methods of administration to guide consumers and promote safer patterns of use.

/pdf/standard-thc-units-a-proposal-to-standardize-dose-across-all-529wsm18c2.pdf

'Standard THC units': a proposal to standardize dose across all cannabis products and methods of administration.

https://research.birmingham.ac.uk/portal/files/41243478/Robinson_et_al_Bogus_taste_test_Appetite_Published_Version.pdf

The bogus taste test: Validity as a measure of laboratory food intake.

AIM: To examine changes in smoking, drinking and quitting/reduction behaviour following the COVID-19 lockdown in England. DESIGN/SETTING: Monthly cross-sectional surveys representative of the adult population in England, aggregated before (April 2019-February 2020) versus after (April 2020) lockdown. PARTICIPANTS: A total of 20 558 adults (≥ 16 years). MEASUREMENTS: The independent variable was the timing of the COVID-19 lockdown (before versus after March 2020). Dependent variables were: prevalence of smoking and high-risk drinking, past-year cessation and quit attempts (among past-year smokers), past-year attempts to reduce alcohol consumption (among high-risk drinkers) and use of evidence-based (e.g. prescription medication/face-to-face behavioural support) and remote support [telephone support/websites/applications (apps)] for smoking cessation and alcohol reduction (among smokers/high-risk drinkers who made a quit/reduction attempt). Covariates included age, sex, social grade, region and level of nicotine and alcohol dependence (as relevant). FINDINGS: The COVID-19 lockdown was not associated with a significant change in smoking prevalence [17.0% (after) versus 15.9% (before), odds ratio (OR) = 1.09, 95% CI = 0.95-1.24], but was associated with increases in quit attempts [39.6 versus 29.1%, adjusted odds ratio (ORadj ) = 1.56, 95% CI = 1.23-1.98], quit success (21.3 versus 13.9%, ORadj  = 2.01, 95% CI = 1.22-3.33) and cessation (8.8 versus 4.1%, ORadj  = 2.63, 95% CI = 1.69-4.09) among past-year smokers. Among smokers who tried to quit, there was no significant change in use of evidence-based support (50.0 versus 51.5%, ORadj  = 1.10, 95% CI = 0.72-1.68) but use of remote support increased (10.9 versus 2.7%, ORadj  = 3.59, 95% CI = 1.56-8.23). Lockdown was associated with increases in high-risk drinking (38.3 versus 25.1%, OR = 1.85, CI = 1.67-2.06), but also alcohol reduction attempts by high-risk drinkers (28.5 versus 15.3%, ORadj  = 2.16, 95% CI = 1.77-2.64). Among high-risk drinkers who made a reduction attempt, use of evidence-based support decreased (1.2 versus 4.0%, ORadj  = 0.23, 95% CI = 0.05-0.97) and there was no significant change in use of remote support (6.9 versus 6.1%, ORadj  = 1.32, 95% CI = 0.64-2.75). CONCLUSIONS: Following the March 2020 COVID-19 lockdown, smokers and high-risk drinkers in England were more likely than before lockdown to report trying to quit smoking or reduce alcohol consumption and rates of smoking cessation and use of remote cessation support were higher. However, high-risk drinking prevalence increased post-lockdown and use of evidence-based support for alcohol reduction by high-risk drinkers decreased with no compensatory increase in use of remote support.

Association of the COVID-19 lockdown with smoking, drinking and attempts to quit in England: an analysis of 2019-20 data.

Aim: To examine changes in smoking, drinking, and quitting/reduction behaviour following the Covid-19 lockdown in England.
Design/setting: Monthly cross-sectional surveys representative of the adult population in England, aggregated before (April 2019 through February 2020) versus after (April 2020) the lockdown.
Participants: 20,558 adults (≥16y).
Measurements: The independent variable was the timing of the Covid-19 lockdown in England (before vs. after March 2020). Dependent variables were: prevalence of smoking and high-risk drinking; past-year cessation and quit attempts (among past-year smokers); past-year attempts to reduce alcohol consumption (among high-risk drinkers); and use of evidence-based (e.g., prescription medication/face-to-face behavioural support) and remote support (telephone support/websites/apps) for smoking cessation and alcohol reduction (among smokers/high-risk drinkers who made a quit/reduction attempt). Covariates included age, sex, social grade, region, and level of nicotine and alcohol dependence (as relevant).
Findings: The Covid-19 lockdown was not associated with a significant change in smoking prevalence (17.0% (after) vs. 15.9% (before), OR=1.09[95%CI 0.95-1.24]), but was associated with increases in the rate of quit attempts (39.6% vs. 29.1%, ORadj=1.56[1.23-1.98]) and cessation (8.8% vs. 4.1%, ORadj=2.63[1.69-4.09]) among past-year smokers. Among smokers who tried to quit, there was no significant change in use of evidence-based support (50.0% vs. 51.5%, ORadj=1.10[0.72-1.68]) but use of remote support increased (10.9% vs. 2.7%, ORadj=3.59[1.56-8.23]). Lockdown was associated with increases in the prevalence of high-risk drinking (38.3% vs. 25.1%, OR=1.85[1.67-2.06]) but also alcohol reduction attempts by high-risk drinkers (28.5% vs. 15.3%, ORadj=2.16[1.77-2.64]). Among high-risk drinkers who made a reduction attempt, use of evidence-based support decreased (1.2% vs. 4.0%, ORadj=0.23[0.05-0.97]) and there was no significant change in use of remote support (6.9% vs. 6.1%, ORadj=1.32[0.64-2.75]).
Conclusions: In England, prevalence of high-risk drinking but not smoking has increased since the Covid-19 lockdown. Smokers and high-risk drinkers are more likely than before lockdown to report trying to quit smoking or reduce their alcohol consumption, and rates of smoking cessation are higher. Smokers are no less likely than before lockdown to use cessation support, with increased uptake of remote support. However, use of evidence-based support for alcohol reduction by high-risk drinkers has decreased, with no compensatory increase in use of remote support.

https://medrxiv.org/content/10.1101/2020.05.25.20112656v1.full.pdf

Association of the Covid-19 lockdown with smoking, drinking, and attempts to quit in England: an analysis of 2019-2020 data

Factors associated with drinking behaviour during COVID-19 social distancing and lockdown among adults in the UK.

Visual exposure to large and small portion sizes and perceptions of portion size normality: Three experimental studies.

Aim: To assess what factors were associated with reported changes to usual alcohol drinking behaviour during the start of lockdown in the UK. /

Design: Online cross-sectional survey from 21st March to 4th April 2020. /

Setting: UK. /

Participants: 30,375 adults aged ≥ 18y. /

Measurements: Changes in drinking over the past week, sociodemographic characteristics, diagnosed or suspected COVID-19, adherence to COVID-19 protective behaviours, stress about COVID-19, finances or boredom, recent drop in household income, key worker status, and health conditions. /

Findings: Of 22,113 drinkers (65.7% of analytic sample), 48.1% (95% CI=47.0-49.1%) reported drinking about the same as usual, 25.7% (24.8-26.6%) reported drinking less than usual, and 26.2% (25.4-27.1%) reported drinking more than usual over the past week. Drinking less than usual was independently associated with being younger (OR=0.88 [95% CI=0.83-0.93]), male (OR=0.76 [0.68-0.84]), of an ethnic minority (OR=0.76 [0.61-0.97]), low annual household income (OR=0.74 [0.66-0.83]), having diagnosed or suspected COVID-19 (OR=2.04 [1.72-2.41]), adhering to COVID-19 protective behaviours (OR=1.58 [1.08-2.32]), being significantly stressed about becoming seriously ill from COVID-19 (OR=1.26 [1.08-1.48]) and not being a key worker (OR=0.87 [0.76-0.99]). Drinking more than usual was independently associated with being younger (OR=0.73 [0.69-0.78]), female (OR=1.36 [1.22-1.51]), post-16 qualifications (OR=1.21 [1.04-1.40]), high annual household income (OR=1.43 [1.27-1.61]), being significantly stressed about catching (OR=1.22 [1.03-1.45]) or becoming seriously ill from COVID-19 (OR=1.28 [1.10-1.48]), being significantly stressed about finances (OR=1.43 [1.24-1.66]), and having a diagnosed anxiety disorder (OR=1.24 [1.05-1.46]). /

Conclusions: In a representative sample of adults in the UK, about half of drinkers reported drinking the same amount of alcohol as usual during the start of the COVID-19 related lockdown, with a quarter drinking more and a quarter drinking less than usual. Drinking more than usual was associated with being younger, female, high socioeconomic position, having an anxiety disorder, and being stressed about finances or COVID-19. These groups may benefit targeted alcohol reduction support if there are further periods of lockdown. /

Registration: The analysis plan was pre-registered on Open Science Framework (https://osf.io/pnrhq/).

/pdf/factors-associated-with-drinking-behaviour-during-covid-19-5d5eq5wq5a.pdf

Melissa Oldham

Papers

Association of the COVID-19 lockdown with smoking, drinking and attempts to quit in England: an analysis of 2019-20 data.

Association of the Covid-19 lockdown with smoking, drinking, and attempts to quit in England: an analysis of 2019-2020 data

Factors associated with drinking behaviour during COVID-19 social distancing and lockdown among adults in the UK.

Visual exposure to large and small portion sizes and perceptions of portion size normality: Three experimental studies.

Factors associated with drinking behaviour during COVID-19 social distancing and lockdown among adults in the UK