COVID-19 pandemic linked with worse mental health in teens
In a population study of 13- to 18-year-old Icelandic teens, mental health worsened during the COVID-19 pandemic, according to a study late last week in The Lancet Psychiatry.
The researchers analyzed 59,701 survey responses across two pre-pandemic baselines (2016, 2018) as well as during the pandemic (October 2020) and found that depressive symptoms increased (β 0.57; 95% confidence interval [CI], 0.53 to 0.60) and mental wellbeing worsened (β 0.46; 95% CI, -0.49 to -0.42). The outcomes were significantly worse in girls than in boys (β 4.16 and -1.13, respectively).
Depression was measured with the Symptom Checklist-90, and data showed that symptoms significantly increased over time, with a 3.2% increase between 2016 and 2018 and a 9.5% increase between 2018 and 2020. Similarly, mental wellbeing significantly worsened, with an average decrease of 1.6% between 2016 and 2018 and a 5.4% decrease between 2018 and 2020, according to the Short Warwick Edinburgh Mental Wellbeing Scale.
The researchers also note that, across both sexes, cigarette smoking, e-cigarette smoking, and alcohol intoxication declined by an odds ratio of 2.61, 2.61, and 2.59 in teens 15 to 18, perhaps because of isolation.
“[The] results underline the significance of social relationships in the health and well-being of youth and the importance of nurturing and maintaining strong social support mechanisms in their lives,” said coauthor Alfgeir L. Kristjansson, PhD, in a Columbia University press release.
“The pandemic might have exacerbated trends already present in the adolescent population, thereby highlighting the status of adolescents’ mental health,” writes Gertrud Sofie Hafstad, PhD, and Else-Maria Augusti, PhD, in a commentary. “Moreover, the present study together with other similar studies shows the importance of closely monitoring indicators of risk and resilience, as it enables timely efforts to mitigate the risk for development of mental disorders during adolescence.”
Jun 3 Lancet Psych study and commentary
Jun 3 Columbia University press release
Cancer associated with worse COVID-19 hospitalization outcomes
Hospitalized COVID-19 patients with active cancer are more likely to die than those who have a history of cancer or those who have never received a cancer diagnosis, according to a Cancer study today.
The researchers performed chart reviews on 4,184 COVID-19 patients admitted to the NYU Langone Medical Center from Mar 1 to May 15, 2020, of whom 233 (5.6%) had an active cancer diagnosis and available records and 493 (11.8%) had a history of cancer.
Those with an active diagnosis were more likely to die from COVID-19 (34.3%) than those with a history of cancer (27.6%) or without any cancer (20.0%), data showed. When including intensive care unit (ICU) admission in addition to death, the researchers found that patients with active cancer had higher rates than those without (31.4% vs 39.5%), while no statistically significant relationship was found when comparing active and historical cancer patients.
Although the researchers note that no cancer therapy received within 3 months prior to hospitalization was associated with increased mortality risk, blood-related cancers had the highest mortality risk among cancer types (47.8% vs 28.7%).
Overall, independent risk factors for death were significantly associated with active cancer (odds ratio [OR], 1.89), older age (OR, 1.06), male sex (female vs male OR, 0.70), diabetes (OR, 1.26), morbidly obese body mass index (OR, 1.87), and elevated D-dimer levels, a marker of inflammation (OR, 6.41). While an increased risk was seen in patients with a history of cancer, it was not statistically significant.
“In summary, we found that patients with active cancer had an increased risk of death from COVID-19 independent of age, peak D-dimer levels, and other covariates,” write the researchers. “Our finding that both D-dimer levels and active cancer independently predict worse outcomes suggests that cancer likely affects outcomes through mechanisms beyond just its prothrombotic effects.”
Jun 7 Cancer study
Increased mucormycosis (black fungus) cases tied to COVID uptick
Mucormycosis (black fungus) cases rose 2.1-fold from September to December 2020 compared with corresponding months the year prior because of underlying COVID-19, according to a study last week in Emerging Infectious Diseases.
Mucormycosis is a fungal infection that causes different symptoms depending on where it manifests. In this study’s cohort, most cases of COVID-associated mucormycocis (CAM) were in the rhino-orbital system (58.1%), followed by the rhino-orbito-cerebral (27.2%) and pulmonary systems (7.7%), and the case-fatality rate was 45.7% at 12 weeks.
The study consisted of 287 patients hospitalized from Sep 1 to Dec 31, 2020 in 16 healthcare centers in India, of whom 65.2% had CAM, and the rest had non–COVID-associated mucormycosis. Median time to CAM diagnosis was 18 days. Patients had a mean age of 53.4 years and were mostly men (74.6%), although CAM patients were older (average, 56.9 years) and skewed even more toward men (80.2%). The most common comorbidity was diabetes (62.7%).
The researchers calculated 0.3% CAM prevalence among patients from seven centers with the necessary data, which increased to 1.6% in intensive care unit (ICU) settings. Excluding the number of CAM cases, the researchers add, the number of mucormycosis cases in 2020 would be comparable to those in 2019 (92 vs 112).
Overall, age above 54 years, ICU admission, and Mucorales infection of the pulmonary system or the brain all were independently associated with mortality. The development of late CAM was also associated with hypoxemia due to COVID-19 and inappropriate glucocorticoid use—data showed only 33.6% of CAM patients received steroids at appropriate levels.
Sequential use of antifungal drugs improved survival regardless of where the mucormycosis manifested.
“We found no difference in the risk factors, site of involvement, and outcome of mucormycosis complicating COVID-19 cases compared with non–COVID-19 cases,” write the researchers. “Nevertheless, the prevalence of mucormycosis has increased greatly in India, coinciding with the country’s COVID-19 epidemic. Clinicians should be vigilant for mucormycosis in the patients recovering from COVID-19 illness, especially among patients with new or previously diagnosed diabetes mellitus and clinical manifestations of facial or orbital pain or black or blood-stained nasal discharge.”
Jun 4 Emerg Infect Dis study