Prevalence and Factors Associated With Mental Health Symptoms in Adults Undergoing Covid-19 Testing

BACKGROUND AND OBJECTIVE: Understanding the mental health impact of the COVID-19 pandemic on persons receiving COVID-19 testing will help guide mental health interventions. We aimed to determine the association between sociodemographic factors and mental health symptoms at 8 weeks (baseline) after a COVID-19 test, and compare prevalence of mental health symptoms at baseline to those at 16-week follow-up. MATERIALS AND METHODS: Prospective cohort study of adults who received outpatient COVID-19 testing at primary care clinics. Logistic regression analyses were used to assess the association between sociodemographic characteristics and COVID-19 test results with mental health symptoms. Mental health symptoms reported at baseline were compared to symptoms at 16 weeks follow-up using conditional logistic regression analyses. RESULTS: At baseline, a total of 124 (47.51%) participants reported at least mild depressive symptoms, 110 (42.15%) participants endorsed at least mild anxiety symptoms, and 94 participants (35.21%) endorsed hazardous use of alcohol. Females compared to males were at increased risk of at least mild depressive symptoms at baseline (Adjusted Odds Ratio (AOR): 2.08; 95% CI: 1.14-3.79). The odds of at least mild depressive symptoms was significantly lower among those residing in zip codes within the highest quartile compared to lowest quartile of household income (AOR: 0.37; 95% CI: 0.17-0.81). Also, non-Hispanic Whites had significantly higher odds of reporting hazardous alcohol use compared to non-Whites at baseline (AOR: 1.94; 95% CI: 1.05-3.57). The prevalence of mental health symptoms remained elevated after 16 weeks. CONCLUSION AND RELEVANCE: We found a high burden of symptoms of depression and anxiety as well as hazardous alcohol use in a diverse population who received testing for COVID-19 in the primary care setting. Primary care providers need to remain vigilant in screening for symptoms of mental health disorders in patients tested for COVID-19 well after initial testing

The relationship between frailty, nutritional status, co-morbidity, CT-body composition and systemic inflammation in patients with COVID-19

Background: Frailty, determined by the Canadian Study of Health and Aging-Clinical Frailty Scale (CFS), is strongly associated with clinical outcomes including mortality in patients with COVID-19. However, the relationship between frailty and other recognised prognostic factors including age, nutritional status, obesity, sarcopenia and systemic inflammation is poorly understood. Therefore, the aim of this study was to examine the relationship between frailty and other prognostic domains, in patients admitted with COVID-19. Methods: Patients who presented to our institutions between 1st April 2020–6th July 2020 with confirmed COVID-19 were assessed for inclusion. Data collected included general demographic details, clinicopathological variables, CFS admission assessment, Malnutrition Universal Screening Tool (MUST), CT-BC measurements and markers of systemic inflammation. Results: 106 patients met the study inclusion criteria. The majority of patients were aged ≥ 70 years (67%), male (53%) and frail (scoring > 3 on the CFS, 72%). The majority of patients were not malnourished (MUST 0, 58%), had ≥ 1 co-morbidity (87%), were sarcopenic (low SMI, 80%) and had systemic inflammation (mGPS ≥ 1, 81%, NLR > 5, 55%). On multivariate binary logistics regression analysis, age (p < 0.01), COPD (p < 0.05) and NLR (p < 0.05) remained independently associated with frailty. On univariate binary logistics regression, NLR (p < 0.05) was significantly associated with 30-day mortality. Conclusion: Frailty was independently associated with age, co-morbidity, and systemic inflammation. The basis of the relationship between frailty and clinical outcomes in COVID-19 requires further study. Trial registration Registered with clinicaltrials.gov (NCT04484545)

The relationship between micronutrient status, frailty, systemic inflammation, and clinical outcomes in patients admitted to hospital with COVID-19

Abstract Background Micronutrients have been associated with disease severity and poorer clinical outcomes in patients with COVID-19. However, there is a paucity of studies examining if the relationship with micronutrient status and clinical outcomes is independent of recognised prognostic factors, specifically frailty and the systemic inflammatory response (SIR). The aim of the present study was to examine the relationship between micronutrient status, frailty, systemic inflammation, and clinical outcomes in patients admitted with COVID-19. Methods Retrospective analysis of prospectively collected data was performed on patients with confirmed COVID-19, admitted to hospital between the 1st April 2020–6th July 2020. Clinicopathological characteristics, frailty assessment, biochemical and micronutrient laboratory results were recorded. Frailty status was determined using the Clinical Frailty scale. SIR was determined using serum CRP. Clinical outcomes of interest were oxygen requirement, ITU admission and 30-day mortality. Categorical variables were analysed using chi-square test and binary logistics regression analysis. Continuous variables were analysed using the Mann–Whitney U or Kruskal Wallis tests. Results 281 patients were included. 55% (n = 155) were aged ≥ 70 years and 39% (n = 109) were male. 49% (n = 138) of patients were frail (CFS > 3). 86% (n = 242) of patients had a serum CRP > 10 mg/L. On univariate analysis, frailty was significantly associated with thirty-day mortality (p < 0.001). On univariate analysis, serum CRP was found to be significantly associated with an oxygen requirement on admission in non-frail patients (p = 0.004). Over a third (36%) of non-frail patients had a low vitamin B1, despite having normal reference range values of red cell B2, B6 and selenium. Furthermore, serum CRP was found to be significantly associated with a lower median red cell vitamin B1 (p = 0.029). Conclusion Vitamin B1 stores may be depleted in COVID-19 patients experiencing a significant SIR and providing rationale for thiamine supplementation. Further longitudinal studies are warranted to delineate the trend in thiamine status following COVID-19

The contribution of genetic and environmental influences on DNA methylation at autosomal sites differs as a function of average DNA methylation level at that location.

<p>Shown are estimates of additive genetic effects (A), shared environmental effects (C) and non-shared (or unique) environmental effects (E) against mean DNA methylation level. The most heritable sites are characterized by intermediate levels of DNA methylation.</p

The contribution of additive genetic and environmental factors to levels of DNA methylation.

<p>Shown are the results from structural equation models to estimate the mean proportion of variance in DNA methylation explained by additive genetic effects (A), shared environmental effects (C) and unshared (or unique) environmental effects (E) across Illumina 450K probes. Results are presented separately for DNA methylation sites located on the autosomes and X-chromosome, and stratified by whether they have intermediate levels of DNAm and/or are “variable”.</p

DNA methylation at sites associated with tobacco smoking is strongly influenced by additive genetic factors.

<p>Shown is a series of density plots for estimates of (<b>a</b>) additive genetic effects (A), (<b>b</b>) shared environmental effects (C) and (<b>c</b>) non-shared environmental effects (E) at 97 differentially methylated positions (DMPs) associated with smoking (green). Also shown are density plots for A, C and E at ‘background’ sites not associated with smoking (red). Shown below is a series of scatterplots showing the correlation in DNA methylation between MZ twins (x-axis) against DZ twins (y-axis) for sites associated with smoking in (<b>d</b>) all twins, (<b>e</b>) concordant non-smokers (n = 503 twin-pairs), (<b>f</b>) twins discordant for smoking status (n = 123 twin-pairs) and (<b>g</b>) concordant smokers (n = 106 twin-pairs). The shaded area on each plot indicates the heritability estimate (using Falconer’s formula) for each site.</p

Brainchild 2017

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DNA methylation sites at which inter-individual variation is correlated across tissues are characterized by higher levels of heritability.

<p>(<b>a</b>) A density plot of heritability estimates for DNA methylation at sites split by the extent to which DNA methylation co-varies between whole blood and the prefrontal cortex using data from Hannon et al (2015). Heritability is significantly higher in probes where the cross-tissue covariation in DNA methylation is high (r² > 0.5, red). (<b>b-h</b>) An example of a probe (cg08449049) at which DNA methylation is strongly influenced by additive genetic effects and also co-varies between blood and multiple regions of the human brain. Shown are scatterplots of DNA methylation values at cg08449049 for (<b>b</b>) MZ (corr = 0.851) and <b>c)</b> DZ (corr = 0.364) twin pairs. Each point represents an individual twin-pair. (<b>d</b>) A boxplot of the distribution of DNA methylation levels at cg08449049 in blood and four brain regions (PFC = prefrontal cortex, EC = entorhinal cortex, STG = superior temporal gyrus, CER = cerebellum) from the same individual donors using data generated by Hannon et al (2015). (<b>e-h</b>) Scatterplots of the DNA methylation values in blood against the DNA methylation values in each of the four brain regions showing that there is significant covariation across tissues.</p