Journal Article Annotations
2021, 2nd Quarter
Annotations by Isabella Campusano, Psiquiatra Infanto Juvenil, Katiuska Ramirez, MD, Carlos Fernandez-Robles, MD, MBA
In a study of 322 predominantly Hispanic/LatinX adolescents with mental health symptoms before the pandemic, mental health symptoms improved during the COVID-19 pandemic. Reductions in mental health problems were somewhat unexpected. There are several reasons that this finding may have occurred: Stay-at-home measures may provide an opportunity for increased family time and relationship building. It is possible that being removed from in-person school environment led to a reduction in peer-related stressors. Academic pressures may also have been reduced. It is possible that lack of in-person schooling led to more flexible routines that allowed adolescents to get more sleep. The findings underline the importance of the family environment for promoting child resilience and that there may be protective aspects of Hispanic and Latinx culture for youth mental health not only due to the valuing of familism but also due to the collectivistic nature of Hispanic and Latinx culture. It is possible that increasing collectivistic behavior in communities may promote mental health for children, even in times of crisis. This study provides data demonstrating that in a predominantly Hispanic/Latinx group of adolescents from the southwestern United States, there were reductions in mental health problems from before the pandemic to 1 month into the stay-at-home period, which stayed consistent for 4 weeks thereafter.
Strength and weaknesses:
The sample describes multiple ethnicity or races, understands the different psychosocial and psychopathologic phenomena from the adolescent’s point of view, and analyzes the effects due to the timing of follow-up assessments and the COVID-19 outbreak worsened in the school’s region after that time. “The window of time when this study was conducted may present a unique “natural experiment” with the combination of increased time at home while stress related to COVID-19 in this particular region was not yet at its peak.” However, the sample was collected from 1 school, measures were all collected via self-report, the BPM (Brief Problem Monitor, a 19-item mental health screening measure of youth emotional and behavioral problems) is designed for individuals between 11 and 18 years of age (the sample started at age 10), the changed context of assessments, post hoc analyses in the subsample were likely underpowered, there was no analysis of immigration status, and significantly more girls than boys completed at least 1 follow-up, so there may be gender bias.
Intercultural context is vital in consultation-liaison evaluations and may suggest protective factors based on the different social subsystems in which the adolescent lives. The importance of always evaluating family functioning, the structure of the home, the possibility of maintaining a healthy circadian rhythm, neighborhood context, organizations in support of immigrants, and school support to maintain scheduled academic activities, are all highlighted in order to optimize mental health. The prominence of familism in LatinX communities may be particularly protective for adverse adolescent mental health outcomes.
Type of study:
Spanish healthcare workers active in the first wave of the COVID-19 pandemic (defined as March 2020 – July 2020) were found to be at a significantly elevated risk of developing a mental disorder. Specific risk factors identified include a prior history of a mental disorder, high frequency of contact with COVID-19 patients, and being infected with COVID-19 or needing to be quarantined or isolated. Female workers were also shown to be at increased risk. The investigators also examined the risk that a healthcare worker may develop a disability due to a mental disorder. Respondents with a history of substance use disorders, anxiety disorders, and depressive disorders demonstrated an increased risk of a disabling mental disorder.
Strength and weaknesses:
One of the study’s greatest strengths is its large sample group of workers in multiple roles across multiple healthcare facilities in geographically distinct areas. The study evaluated multiple symptom domains with the use of several well-established screening tools. The decision to screen for disability related to a mental disorder helps to identify symptom severity and may be an important marker when assessing the overall impact of COVID-19 on healthcare workers. Another strength is specifically evaluating “frontline workers” (survey respondents who reported working with patients with COVID-19 “all the time” or “most of the time”) who may be at especially high risk amidst the pandemic. The study has weaknesses that may impact its utility and generalizability, including a low response rate calculated as 12.5%, and it is possible that respondents may not have been representative of the population as whole. Additionally, the use self-report measures to indirectly assess for the presence of mental disorders among healthcare workers. Lastly, although the study looked at whether respondents were from Spain or another country, it did not further explore the potential impact of respondents’ specific race/ethnicity.
Given the wide-reaching effects of the COVID-19 pandemic on healthcare systems around the world, it is important to recognize the impact this pandemic has had on healthcare workers. This study identifies and characterizes specific factors that increase the risk that healthcare providers may develop a new or recurrent mental disorder. Investigating risk factors for disability is also helpful in anticipating certain groups who may need additional support, resources, and/or psychoeducation. This topic is especially important for C-L psychiatrists who may be impacted due to their own work as frontline healthcare providers, their potential role in evaluating and treating healthcare workers, and their liaison work with other healthcare providers.
Type of study (EBM guide):
This study compares the pandemic’s impact on a similar population across five different countries (US, Chile, Argentina, Mexico, and Peru). In the US, Latinos experienced greater financial hardships during the COVD-10 pandemic compared to Whites and Black populations. Black and Latinos reported more positive reframing and coping with the pandemic. Latinos residing in Chile, Mexico, and Peru reported a higher impact of the pandemic than Latinos living in the US. This impact included more difficulties with work and employment, education and training, financial struggles, and hardship related to physical distancing and quarantine. There were no meaningful differences when comparing groups regarding cognition, loneliness, and perception of life purpose in groups within and outside the US. Black populations were more likely to report discrimination compared to other groups.
Strength and weaknesses:
The study includes a large population and uses well-validated instruments . The authors note that social distancing restrictions could have resulted in selection bias at the time of recruitment. The sample, particularly in Latin A merican countries, may not represent the entire population. The cross-sectional nature cannot exclude that the differences observed were already in place and therefore independent of the pandemic. Additional limitations emerge from the intrinsic cultural, social, and economic disparity of each of the countries included.
The COVID-19 pandemic has disproportionately negatively affected non-White groups in the United States and persons in low- and middle-income countries. The C-L psychiatrist must appreciate differences in the pandemic’s impact and coping mechanisms among Latinos living in the US and across Latin American countries.
Type of study (EBM guide):