US Pharm. 2021;46(5)4-8.

COVID-19 Pandemic Linked With Unhealthy Eating Behaviors

A new probe into the lingering impacts of the COVID-19 pandemic revealed correlations to six unhealthy eating behaviors, according to a study by the University of Minnesota Medical School and School of Public Health. Researchers say the most concerning finding indicates a slight increase or the re-emergence of eating disorders, which kill roughly 10,200 people every year—about one person every 52 minutes.

University of Minnesota Medical School’s Melissa Simone, PhD, a postdoctoral research fellow in the Department of Psychiatry and Behavioral Sciences, collaborated with School of Public Health Professor and Head of the Division of Epidemiology and Community Health, Dianne Neumark-Sztainer, PhD, MPH, to learn from study participants in Dr. Neumark-Sztainer’s Project EAT between April and May 2020.

“The COVID-19 pandemic has resulted in the rapid implementation of public health policies to reduce transmission of the virus. While these protections are necessary, the disruptions to daily life associated with the ongoing pandemic may have significant negative consequences for the risk of eating disorders and symptoms,” said Dr. Simone, who is the lead author of the study. “Eating disorders have one of the highest mortality rates across all psychiatric health concerns, and therefore, it is important to try to make links between the consequences of the pandemic and disordered eating behaviors.”

The study aimed to understand potential associations between stress, psychological distress, financial difficulties, and changes in eating behaviors during the COVID-19 pandemic through the analysis of both qualitative and quantitative data. Dr. Simone’s findings, published in the International Journal of Eating Disorders, found six key themes of eating behavior changes: mindless eating and snacking; increased food consumption; generalized decrease in appetite or dietary intake; eating to cope; pandemic-related reductions in dietary intake; and a re-emergence or marked increase in eating-disorder symptoms.

Approximately 8% of those studied reported extreme unhealthy weight-control behaviors, 53% had less extreme unhealthy weight-control behaviors, and 14% reported binge eating. The study revealed that these outcomes were significantly associated with poorer stress management, greater depressive symptoms, and moderate or extreme financial difficulties.

“There has been a lot of focus on obesity and its connection with COVID-19. It is also important to focus on the large number of people who have been engaging in disordered eating and are at risk for eating disorders during and following the pandemic,” said Dr. Neumark-Sztainer, who is the principal investigator of Project EAT. “The majority of the young adults in our study are from diverse ethnic/racial and lower income backgrounds, who often do not receive the services they need. To ensure health inequities do not increase, we need to meet the needs of these populations.”

Dr. Simone added, “The economic consequences of the COVID-19 pandemic will likely persist long beyond the dissemination of a vaccine. Because our findings suggest that moderate or severe financial difficulties may be linked with disordered eating behaviors, it is essential that eating-disorder preventive interventions and treatment efforts be affordable, easily accessible, and widely disseminated to those at heightened risk. As such, online or mobile-based interventions may prove to be effective and accessible modes for targeted intervention efforts.”

Children Who Lost a Parent to Pandemic Need Swift Support

Approximately 40,000 children in the United States may have lost a parent to COVID-19 since February 2020, according to a statistical model created by a team of researchers. The researchers anticipate that without immediate interventions, the trauma from losing a parent could cast a shadow of mental health and economic problems well into the future for this vulnerable population.

In the researchers’ model, for approximately every 13th COVID-related death, a child loses one parent. Children who lose a parent are at higher risk of a range of problems, including traumatic prolonged grief and depression, lower educational attainment, economic insecurity, and accidental death or suicide, said Ashton Verdery, associate professor of sociology, demography and social data analytics and Institute for Computational and Data Sciences co-hire, Penn State University.

“When we think of COVID-19 mortality, much of the conversation focuses on the fact that older adults are the populations at greatest risk. About 81% of deaths have been among those ages 65 and older according to the CDC," said Dr. Verdery, who is also an affiliate of the Population Research Institute at Penn State. “However, that leaves 19% of deaths among those under 65 [years]–15% of deaths are among those in their 50s and early 60s and 3% are among those in their 40s. In these younger age groups, substantial numbers of people have children, for whom the loss of a parent is a potentially devastating challenge.”

Three-quarters of the children who lost a parent are adolescents, but one-quarter are elementary-aged children, Dr. Verdery said.

The statistics of parental death are grimmer for Black families, which have been disproportionately impacted by the pandemic, according to the researchers, who reported their findings in the April 5 issue of JAMA Pediatrics. The team estimated that 20% of the children who lost a parent are Black. even though only 14% of children in the U.S. are Black.

The model also suggests that parental deaths due to COVID-19 will increase the country’s total cases of parental bereavement by 18% to 20% over what occurs in a typical year, further straining an already stretched system that does not connect all children who are eligible to adequate resources.

As a historical comparison, the number of children who lost a parent to COVID-19 is about 13 times the approximate 3,000 children who lost a parent in attacks of September 11, 2001. After those attacks, the federal government initiated several programs to support the families of the victims.

Parentally bereaved children in the pandemic may face unique challenges. The social isolation, institutional strain, and economic struggles caused by the pandemic may strain access to potential sources of support for children. Further, with many children out of schools and less connected to other family and community supports, suffering children may be less likely to be recognized. “Teachers are such a vital resource in terms of identifying and helping at-risk children, and it is harder for them to do that when schools are operating remotely and teachers are so overburdened, making it vital to resume in-person instruction safely and support worn-out educators,” Dr. Verdery said.

The researchers added that as pandemic deaths increase, that shadow of mental health and economic ills may only grow longer for children. They suggest that equal—or greater—national efforts are needed to help children who have lost parents in the pandemic.

“I think the first thing we need to do is to proactively connect all children to the available supports they are entitled to, like Social Security child survivor benefits—research shows only about half of eligible children are connected to these programs in normal circumstances, but that those who do fare much better,” said Dr. Verdery. “We should also consider expanding eligibility to these resources. Second, a national effort to identify and provide counseling and related resources to all children who lose a parent is vital.”

Research suggests that brief, evidence-based interventions delivered widely could help prevent severe psychological problems, although some children may need longer term support.

Using kinship networks of white and Black individuals, drawn from demographic simulations, the researchers estimate the expected number of children ages 0 to 17 years who would lose a parent to COVID-19, called the parental bereavement multiplier. The model suggested that .078 children aged 0 to 17 years  would be parentally bereaved for each COVID-19-related death, or about one for each 13 deaths. The team then used the multiplier to estimate the scope of parental bereavement based on various scenarios of COVID-19 casualty figures.


COVID-19 Severely Impacts Mental Health of Young People

The COVID-19 pandemic severely impacted the mental health of young people, with increased levels of clinical depression being identified, a new study published in the journal Psychiatry Research reports. A decrease in alcohol consumption was also identified among young people during the pandemic.

During this unique study researchers from the University of Surrey surveyed 259 young people pre- pandemic (autumn 2019) and in the midst of initial lockdown measures (May/June 2020) on their levels of depression, anxiety, well-being, alcohol use, and sleep quality.

The researchers found evidence of a substantial impact on the mental health of these young adults due to the COVID-19 pandemic, with a significant rise in depression symptoms and a reduction in overall wellbeing during lockdown compared with the previous autumn. Levels of clinical depression in those surveyed were found to have more than doubled, rising from 14.9% in autumn 2019 to 34.7% in May/June 2020.

Sleep quality was not seen to decline in the overall sample, but importantly, a correlation was seen between the rise in depression and lower sleep quality under lockdown. Also of concern, researchers identified a significant shift towards “eveningness” (a preference to go to sleep and wake later), which has previously been associated with higher levels of anxiety and a greater prevalence of minor psychiatric disorders.

Interestingly, despite reports of rising worldwide sales of alcohol during the first lockdown, researchers identified a significant decrease in alcohol consumption among the group that could be attributed to social restrictions in place during this period. Researchers were encouraged by this finding as it suggests that young people were not using alcohol as a coping strategy during that time.

Findings from this study highlight the substantial impact of the COVID-19 pandemic on young people’s mental health. The link to sleep quality could help inform strategies to support their well-being as the COVID-19 situation continues to evolve.

Dr. Simon Evans, lecturer in neuroscience at the University of Surrey, said, “For many years there has been a rise in the number of young people experiencing problems with their mental health, and it is concerning to find that this has been significantly exacerbated due to COVID-19. Supporting the mental health of young people and ensuring they can access the support they need is vital to ensure their overall wellbeing. As social restrictions continue in response to the pandemic, it is crucial that we take steps to proect their mental health.”


How Remote Workers Can Best Manage Work-Home Conflict

What are the secrets to maintaining a productive home office? Run a white-noise machine to mask household clatter, make sure your noisy neighbors know your work schedule, and resist the temptation to check work-related technology after logging off at the end of the workday. These are some of the tips that Timothy D. Golden, a professor in the Lally School of Management at Rensselaer Polytechnic Institute, has gleaned through more than 2 decades of research.

More than a year into the COVID-19 pandemic, millions of remote workers are still struggling to find an efficient work-life balance. In an article published recently in Organizational Dynamics, Dr. Golden offered these workers and their managers research-based solutions and best practices for addressing and managing common issues that impede success while working from home.

“A key challenge most people face when they work from home is how to effectively navigate the boundaries between their work life and home life, all while continuing to be efficient and productive in their job,” said Dr. Golden, a leading expert on remote work. “The need to be able to adeptly manage the boundaries between work and family is absolutely critical today.”

There are two types of remote workers: “segmentors” work best by keeping a rigid distinction between their personal life and job, while “integrators” are at ease mixing together their work and home responsibilities. To work successfully at home, he said, individuals of both types must erect and maintain boundaries to match their desired comfort level.

In the article, Dr. Golden identified four areas—physical, behavioral, temporal, and communication—that must be considered in order for employees and managers to successfully set and manage boundaries between work and home life.

Among other tactics, he recommended setting allowable limits on household noise, starting and ending your day at consistent and regular times, and—importantly—having expectation-setting conversations with family members or those living in the home.

He also identified common pitfalls that cause boundaries created by remote workers to crumble, including being unpredictable in routines and avoiding confronting boundary violators.

“You’re in a different physical and mental space when you’re working remotely or in the home domain,” Dr. Golden said. “Communication becomes particularly crucial when you're immersed in the home environment to balance everything successfully.”

Activity Is Good; Varied Activity Is Better

The recommendations are clear: physical activity is good for mental health. But it also depends on how varied it is. That’s what a new study by researchers at the University of Basel shows, pointing to one of the reasons why well-being suffers during the pandemic.

A walk in the morning, a jog in the evening or even just going out to buy groceries: activity helps the psyche. Many are trying to stay active during the pandemic despite mandatory home office and limited leisure activities. Others find that they are moving significantly less than before the pandemic because previous everyday activities are off-limits due to measures taken against the spread of COVID-19.

Against this backdrop, a study led by Professor Andrew Gloster of the University of Basel provides an indication of what impact restricted movement patterns might have. The results are published in the journal BMC Psychiatry.

That exercise promotes not only physical but also mental health is known from various studies. However, these mostly focused on the influence of deliberate exercise programs. “In contrast, little was known about whether everyday, naturally chosen movement patterns also influence mental health,” Dr. Gloster explains.

To investigate this, he and researchers at the University Psychiatric Clinics in Basel collected GPS data from 106 patients with mental disorders who agreed to participate. For this purpose, the study participants were given extra smartphones that they carried with them for a week. This allowed the researchers to track their movements without interfering with the patients’ daily routine. The research team then compared the movement data with surveys of the participants’ well-being and symptoms of their mental illness.

The results showed that the more people moved and the more varied their movements, the greater their sense of well-being. However, no influence on their symptoms could be determined. “Our results suggest that activity alone is not enough to reduce symptoms of mental disorders, but can at least improve subjective well-being,” Dr. Gloster elaborated.

“Although the data were collected before the pandemic, the results are also relevant in light of the limitations during the coronavirus crisis,” he added. Because many social and recreational activities were discontinued during that time, many people’s physical activity patterns also likely became more monotonous. Various studies by research groups at the University of Basel have been able to show that the pandemic took a toll on the psyche of the population. The results of the team led by Dr. Gloster suggest that the restricted movement patterns could also play a role in this.

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