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The emergence of COVID-19 has resulted in a notable rise in mortality rates, consequently affecting various sectors, including the insurance industry. This paper analyzes the reflections of a sudden increase in mortality rates on the financial performance of a survival benefit scenario under the International Financial Reporting Standard 17. For this purpose, we thoroughly examined a single insurance scenario under four different states by modifying the interest and jump elements. We use Poisson-log bilinear Lee–Carter and Vasicek models for mortality and stochastic interest rate, respectively. Integrating the mortality model with a jump model that incorporates COVID-19 deaths we constructed a temporary mortality jump model. As a result, the temporary mortality jump model reflects the effects of the pandemic more realistically. We observe that even in this case mortality has a minor impact, whereas interest rates significantly still affect the financial position and performance of insurance companies.
Schools are central places for adolescent social lives, which is a major factor greatly affecting adolescent mental health; school climate (i.e. quality of the school social environments) can be a proximal social determinant for adolescent mental health. Supportive school environments may serve as a protective factor during crises like COVID-19, which disrupt social lives and worsen adolescent mental health. This is the first study examining whether the pandemic effects differed based on the levels of school climate on depressive symptoms (DS) and psychotic experiences (PEs) among adolescents.
Methods
School climate (score range: 0–28), DS (0–26), and PEs (0–5) were self-reported in a population-based cohort (Tokyo Teen Cohort; N = 3171) at four timepoints (10y, 12y, 14y, and 16y) before and during COVID-19. COVID-19 occurred midway through the 16y survey, allowing us to examine its impact and interaction effect with school climate while accounting for within-person changes over time using mixed-effects models.
Results
Significant interaction effects were found on DS (unstandardized coefficient [B] = −0.166, 95% confidence interval [CI] −0.225 to −0.107) and PEs (B = −0.020, 95% CI −0.028 to −0.012). The pandemic effects were not significant for adolescents with high school climate scores (around the 80th percentile or higher), although the pandemic significantly worsened these outcomes among the overall sample.
Conclusions
The negative mental health effects of the pandemic were significantly mitigated among adolescents experiencing a supportive school climate. A positive school climate can protect adolescent mental health during challenging social conditions, such as pandemics.
In 2020, COVID-19 modeling studies predicted rapid epidemic growth and quickly overwhelmed health systems in humanitarian and fragile settings due to preexisting vulnerabilities and limited resources. Despite the growing evidence from Bangladesh, no study has examined the epidemiology of COVID-19 in out-of-camp settings in Cox’s Bazar during the first year of the pandemic (March 2020-March 2021). This paper aims to fill this gap.
Methods
Secondary data analyses were conducted on case and testing data from the World Health Organization and the national health information system via the District Health Information Software 2.
Results
COVID-19 in Cox’s Bazar was characterized by a large peak in June 2020, followed by a smaller wave in August/September and a new wave from March 2021. Males were more likely to be tested than females (68% vs. 32%, P < 0.001) and had higher incidence rates (305.29/100 000 males vs. 114.90/100 000 female, P < 0.001). Mortality was significantly associated with age (OR: 87.3; 95% CI: 21.03-350.16, P < 0.001) but not sex. Disparities existed in testing and incidence rates among upazilas.
Conclusions
Incidence was lower than expected, with indicators comparable to national-level data. These findings are likely influenced by the younger population age, high isolation rates, and low testing capacity. With testing extremely limited, true incidence and mortality rates are likely higher, highlighting the importance of improving disease surveillance in fragile settings. Data incompleteness and fragmentation were the main study limitations.
To describe the economic, lifestyle and nutritional impact of the COVID-19 pandemic on parents, guardians and children in Malaysia, Indonesia, Thailand and Vietnam.
Design:
Data from the SEANUTS II cohort were used. Questionnaires, including a COVID-19 questionnaire, were used to study the impact of the pandemic on parents/guardians and their children with respect to work status, household expenditures and children’s dietary intake and lifestyle behaviours.
Setting:
Data were collected in Malaysia, Indonesia, Thailand and Vietnam between May 2019 and April 2021.
Participants:
In total, 9203 children, aged 0·5–12·9 years, including their parents/guardians.
Results:
Children and their families were significantly affected by the pandemic. Although the impact of lockdown measures on children’s food intake has been relatively mild in all countries, food security was negatively impacted, especially in Indonesia. Surprisingly, in Malaysia, lockdown resulted in overall healthier dietary patterns with more basic food groups and less discretionary foods. Consumption of milk/dairy products, however, decreased. In the other countries, intake of most food groups did not change much during lockdown for households based on self-reporting. Only in rural Thailand, some marginal decreases in food intakes during lockdown persisted after lockdown. Physical activity of children, monthly household income and job security of the parents/guardians were negatively affected in all countries due to the pandemic.
Conclusion:
The COVID-19 pandemic has significantly impacted societies in South-East Asia. To counteract negative effects, economic measures should be combined with strategies to promote physical activity and eating nutrient-adequate diets to increase resilience of the population.
This article examines premature withdrawals from pension funds that were initiated as responses to the COVID-19 pandemic. It looks at withdrawal programmes both in emerging market and in advanced economies. Although measures might have been expedient in countries where social protection systems (social assistance and job furlough schemes) are relatively underdeveloped, they could also be regressive. Furthermore, they undermined the concept of pension funds as retirement income resources and, in some cases, they might threaten people’s living standards once they became old. The paper also suggests that such withdrawal programmes have a populist flavour.
The global healthcare landscape faces mounting challenges, from resource constraints and rural healthcare access in Uzbekistan, to aging populations and rising chronic disease rates in Europe. Amidst these, the digital transformation in healthcare and the study of international legal aspects governing telemedicine services have emerged as crucial priorities. This article examines the international legal framework for telemedicine, analyzing key documents of the United Nations (UN), World Health Organization (WHO), International Telecommunication Union (ITU), and various regional bodies. It highlights the absence of a universal agreement that comprehensively addresses telemedicine regulation and data protection issues. The article explores national regulatory efforts and identifies gaps in the current fragmented approach. Recommendations include establishing a dedicated subsidiary body under the UN Committee on Economic, Social and Cultural Rights (CESCR) to oversee telemedicine-related matters and codifying scattered norms into a coherent framework. Strengthening the international legal basis for telemedicine can help expand access to vital healthcare services and improve global health outcomes.
Using Northeastern University School of Law’s Domestic Violence Institute’s (DVI) virtual clinic as a case study, this chapter contends that service design methods can address systemic and pernicious access to justice issues that have a chilling effect on survivors seeking legal services. It details foundational information about domestic violence survivors and the work of the clinic pre-COVID-19, before detailing the danger, disruption, and delays that the public health measures and Court closures had on survivors’ lives. It then details the process and outcomes of a rapid-response service design intervention that quickly overhauled DVI’s operations and created a survivor-centered framework that remains in place today, tackling systemic and pernicious access to justice issues while simultaneously amplifying the voices, experiences, and needs of survivors.
This Element compares crisis-specific policymaking, its causes and consequences, at the two levels of the EU polity during the COVID-19 and the refugee crisis 2015–16. In both crises, EU policymaking responded to exogenous pressure and was dominated by executive decision-making. Still, it also differed in three critical aspects: it was much more salient, consensual, and effective during the COVID-19 than the refugee crisis. The present study accounts for both similarities and differences, which it attempts to explain by features of the nature of the crises. The key argument of the study is that the policymaking process during crises is, to a large extent, determined by the crisis situation – the crisis-specific functional problem pressure, the institutional context (of the EU polity), and the corresponding political pressure at the origin of a given crisis. This title is also available as Open Access on Cambridge Core.
Substance use may be associated with the onset of psychotic symptoms, necessitating treatment for individuals with comorbid mental health and substance use disorders (MHD/SUD). COVID-19 significantly impacted individuals with MHD/SUD, reducing access to appropriate care and treatment. Changes in drug availability and prices during the pandemic may have influenced drug consumption. This study aimed to determine the frequency of substance-induced psychosis (SIP) during COVID-19 among individuals with MHD/SUD and to explore substance fidelity by following patterns of SIP over time.
Method
In this retrospective cohort study, we analyzed data from all individuals with MHD/SUD registered in 2019–2021 in the Norwegian Patient Register. We used graphical approaches, descriptives, and Poisson regression to study occurrence and risk of SIP episodes in the three-year observation period. Sankey diagrams were used to examine trajectories of psychotic episodes induced by various substances.
Results
Despite a decrease in individuals diagnosed with SIP during COVID-19, SIP episodes increased overall. We observed a decline in cannabis-induced psychosis, but a rise in SIP episodes involving amphetamines and multiple substances. Among individuals with recurrent SIP episodes, the psychosis was more often induced by different substances during COVID-19 (2020: RR, 1.50 [95% CI, 1.34–1.67]; 2021: RR, 1.30 [95% CI, 1.16–1.46]) than in 2019.
Conclusion
During COVID-19, fewer individuals were hospitalized with SIP, but those patients experienced more episodes. There were fewer cannabis-induced psychotic episodes, but more SIP hospitalizations caused by central stimulants and more SIP diagnoses caused by different substances, possibly reflecting changes in drug availability and pricing.
During the COVID-19 pandemic, the European Union (EU) observed a major centralisation of competence in public health policy – the EU Vaccines Strategy. Yet increased centralisation or integration is not always desirable because the EU lacks a layer of democratic control to ensure transparency and accountability. This feature highlights the need to better understand and assess the EU’s actions during the pandemic. This paper aims to assess the effectiveness of the EU Vaccines Strategy and contributes to the wider debate on the centralisation of power at Union level. The joint procurement of COVID-19 vaccines is considered a success, as it avoided a “vaccine scramble” by the EU Member States. However, the fact that the Member States were obliged to purchase more than they needed and the lack of transparency in the negotiations with companies on the procurement of vaccines have raised questions about the integrity of the Commission’s exercise of executive power.
To examine if the COVID-19 pandemic had a differential impact longitudinally over four years on psychological and functional impact in individuals with a pre-existing anxiety, bipolar or emotionally unstable personality Disorder (EUPD).
Methods:
Semi-structured interviews were conducted with 52 patients attending the Galway-Roscommon Mental Health Services with an International Classification of Diseases (ICD)-10 diagnosis of an anxiety disorder (n = 21), bipolar disorder (n = 18), or EUPD (n = 13) at four time points over a four-year period. Patients’ impression of the impact of the COVID-19 pandemic was assessed in relation to anxiety and mood symptoms, social and occupational functioning and quality of life utilising psychometric instruments and Likert scale data, with qualitative data assessing participants’ subjective experiences.
Results:
Individuals with EUPD exhibited higher anxiety (BAI) symptoms compared to individuals with bipolar disorders and anxiety disorders (F = 9.63, p = 0.001), with a more deleterious impact on social functioning and quality of life also noted at all time points. Themes attained from qualitative data included isolation resulting from COVID-19 mandated restrictions (N = 22), and these same restrictions allowing greater appreciation of family (n = 19) and hobbies/nature (n = 13).
Conclusions:
Individuals with EUPD reported increased symptomatology and reduced functioning and quality of life as a consequence of the COVID-19 pandemic over a four-year period compared to individuals with either an anxiety or bipolar disorder. This could be related to the differing interaction of the COVID-19 pandemic’s restrictions on the symptoms and support requirements of this cohort.
This research examines how Beijing uses social media to publicize donations and engage in nation branding as it responds to the global backlash sparked by Covid-19. It argues that self-reports of medical donations aim to enhance China’s national brand, leading to an expectation that reports about donations will primarily target countries more severely affected by the virus. To test its claims, the research analyzes over 55,000 tweets published by Chinese diplomatic missions. The results—controlled for Chinese donation exports—show a positive and significant relationship between self-reports of medical donations and the host’s spread of Covid-19. In contrast, donations are not correlated with political or economic allies. A comparison of government (CCP, ministries, etc.) and non-government donors (immigrants, firms, etc.) shows that only donations by the latter are positively correlated with the spread of the virus. This research advances our knowledge of Chinese diplomats’ online political behavior.
Public health crises like Covid-19 profoundly influence informal care-givers of older adults with functional health limitations. This study deepens existing understanding of care-giving processes during the pandemic to uncover insights useful for developing effective care-giving interventions for the post-pandemic era and future public health crises. Specifically, it examined (1) how care-giving activities during the pandemic impacted care-giver psychological wellbeing by affecting caregiving burden and the positive aspects of caregiving and (2) the moderating effect of pandemic-specific factors (i.e., care recipients’ unmet health-care needs due to the pandemic). Multiple-group analyses were conducted on data on 906 informal care-givers of older adults with functional health limitations, obtained from the Covid-19 Supplement and Round 10 Survey of the National Health and Aging Trends Study conducted in the United States. The mean age of participants was approximately 60 years, and most were white women. Positive aspects of care-giving significantly mediated the relationships between providing assistance in activities of daily living (ADL), instrumental ADL, and emotional support and positive affect. Care-giving burden significantly mediated the relationship between assistance in ADL and positive and negative affect. Care recipients’ unmet health-care needs moderated the relationships between assistance in ADL and burden, assistance in ADL and negative affect, and emotional support and positive affect. In sum, this study underscores the positive aspects of care-giving as well as care-giving burden and demonstrates that greater attention should be paid to care-givers caring for individuals with unmet health-care needs during public health crises. The results suggest that more-effective responses to public health crises must be developed, especially within health-care systems.
This article appraises cultural understanding and controversies regarding hikikomori (prolonged social withdrawal), with reference to research over the past 20 years. Initially viewed as a uniquely Japanese phenomenon, hikikomori is now recognised globally, prompting a re-evaluation of its cultural, psychological and socioeconomic demographics. A revision in lifestyle after the COVID-19 pandemic and ongoing technological advancements – particularly the rise of social media, gaming and the internet – have paradoxically both exacerbated isolation and provided new forms of social interaction for young adults who confine themselves at home. This phenomenon underlines the complex interplay between putative individual psychopathology, neurodiversity and broader societal shifts across the globe.
To assess the impact of the COVID-19 pandemic on first-episode psychosis (FEP) presentations across two Early Intervention in Psychosis (EIP) services in Ireland, by comparing pre-pandemic and post-pandemic cohorts.
Methods:
A cross-sectional observational design with retrospective medical record review was employed. The study population comprised 187 FEP patients (77 in pre-pandemic and 110 in post-pandemic cohort). Outcomes measured included duration of untreated psychosis (DUP), FEP presentation numbers, referral sources, global assessment of functioning scores, inpatient admissions, substance misuse and service delivery methods. Statistical analyses utilised chi-square tests to assess categorical variables, Mann–Whitney U tests to compare non-normally distributed continuous variables and Kruskal–Wallis tests to examine interactions between categorical and continuous variables.
Results:
A significant increase in FEP presentations was observed in the post-pandemic cohort (p = 0.003), with an increase in all urban areas and a decrease in the study’s only rural area. The difference in DUP between cohorts was not significant. However, significant interaction between gender, cohort and DUP was shown (p = 0.008), with women in the post-pandemic cohort experiencing longer DUP (p = 0.01). A significant rise in telephone (p = 0.05) and video consultations (p = 0.001) offered was observed, in the post-pandemic cohort. A similar number of in-person appointments were attended across both cohorts.
Conclusions:
This study highlights the impact of the pandemic on FEP presentations, particularly rurally and regarding increased DUP among women. These findings underscore the need for flexible EIP services to respond to public health crises. Despite increased presentations, services adapted, maintaining service continuity through telehealth and modified in-person contact.
The COVID-19 pandemic brought to light the need to address the psychosocial and mental health needs of refugees and internally displaced persons in low- and middle-income countries. COVID-19 prevention measures slowed essential services and healthcare, creating unique challenges for refugees and IDPs, including economic insecurity and societal instability. All of these factors may contribute to the reported declines in their psychosocial well-being.
Methods
To effectively define the problems of low-and middle-income countries (LMICs) in addressing the needs of these populations, we conducted a systematic literature review of literature on the mental health and psychosocial well-being of refugees and displaced persons who have migrated between LMICs in the context of COVID-19.
Findings
Our findings indicate that mental health interventions, such as digital healthcare and community-focused solutions, have the potential to address the problems faced by refugees and IDPs. Nevertheless, these community-based support networks are overextended, continuously developing to meet the needs of these vulnerable populations while considering the limited digital literacy of the subject population, internet accessibility, and overall limits in reach. We found that the efficacy of interventions varied according to the distinctive needs and challenges of various refugee and IDP populations.
Implications
The findings indicate a need for an intersectional policy approach to address the complex network of factors influencing mental health outcomes, including gender, housing, employment status, and social inequalities. Global agencies, policymakers, and local governments must prioritize the development of comprehensive mental health support systems, assuring refugees and IDPs have sustainable and equitable access.
The mental health of paramedics is critical for disaster response in order to provide rapid and effective interventions. This study aimed to determine the prevalence of post-traumatic stress disorder (PTSD) and related individual and occupational factors in Turkish paramedics during the eleventh month of the COVID-19 pandemic.
Methods
The “Sociodemographic Information Form,” “Life Events Checklist,” and “Post-Traumatic Stress Disorder Checklist” were used to collect data from 440 randomly selected paramedics in this cross-sectional study.
Results
The prevalence of PTSD was 59.8% in the 11th month of the COVID-19 pandemic. Multiple regression analysis revealed that approximately 25% of the total PTSD score could be independently explained by paramedics’ general health situation and sociodemographic characteristics; 27% by crisis management skills, long working hours, a lack of equipment, and intensive work; and 40% by past traumatic experiences due to difficult life events during their professional practice, such as responding to gunshot wounds, becoming a victim of a gunshot attack, or sexual assault (P < 0.05).
Conclusions
Integrating a mental health monitoring system into the health and safety program, providing paramedics with supervision and psychological assistance, and engaging them in disaster preparedness planning would be beneficial.
The COVID-19 pandemic challenged older adults’ health behaviours, making it even more difficult to engage in healthy diets and physical activity than it had been prepandemic. A resource to promote these could be social support. This study uses data from 136 older adults (Mage = 71.39 years, SD = 5.15, range: 63–87) who reported their daily fruit and vegetable consumption, steps, and health-behaviour-specific support from a close other every evening for up to 10 consecutive days. Findings show that on days when participants reported more emotional support than usual, fruit and vegetable consumption and step counts were higher. Daily instrumental support was positively associated with step counts, only. Participants receiving more overall emotional support across the study period consumed more fruit and vegetables; no parallel person-level association was found for overall steps. There were no significant interactions between dyad type and support links for our outcomes.
The COVID-19 pandemic had an unprecedented impact on healthcare systems and exists globally. To control pandemic progression, COVID-19 vaccines were developed and licensed for use in the adult population in early 2021 and became available in paediatric cohorts several months later. Since then, several studies have reported adverse events and severe adverse events in the adult and paediatric cohorts. The question remains whether there exists a significant risk to paediatric COVID-19 vaccination. This study reviews the classification and presentation of severe adverse events and discusses relevant reports in the literature. An emphasis is put on cardiovascular severe adverse events and adverse events. This paper also provides current and future perspectives relative to the pandemic, its control, and the future of vaccine immunology.
Assessing the risk of subsequent self-harm after hospitalisation for COVID-19 is critical for mental health care planning during and after the pandemic.
Aims
This study aims to compare the risk of admission to hospital for self-harm within 12 months following a COVID-19 hospitalisation during the first half of 2020, with the risk following hospitalisations for other reasons.
Method
Using the French administrative healthcare database, logistic regression models were employed to analyse data from patients admitted to hospitals in metropolitan France between January and June 2020. The analysis included adjustments for sociodemographic factors, psychiatric history and the level of care received during the initial hospital stay.
Results
Of the 96 313 patients hospitalised for COVID-19, 336 (0.35%) were subsequently admitted for self-harm within 12 months, compared to 20 135 (0.72%) of 2 797 775 patients admitted for other reasons. This difference remained significant after adjusting for sociodemographic factors (adjusted odds ratio (aOR) = 0.66, 95% CI: 0.59–0.73), psychiatric disorder history (aOR = 0.65, 95% CI: 0.58–0.73) and the level of care received during the initial hospital stay (aOR = 0.70, 95% CI: 0.63–0.78). History of psychiatric disorders and intensive care were strongly correlated with increased risk, while older age was inversely associated with self-harm admissions.
Conclusions
Hospitalisation for COVID-19 during the early pandemic was linked to a lower risk of subsequent self-harm than hospitalisation for other reasons. Clinicians should consider psychiatric history and intensive care factors in evaluating the risk of future suicide.