When the Road Is Covered in Nails: Making Sense of Madness in an Urban Mosque

This study returns to the classic interactionist approach of earlier work on mental illness to understand how communities attribute nonconforming behaviors as symptoms of mental illnesses and how their informal labels shape the ways in which they interact with people perceived as ill. It draws on six years of in-depth fieldwork in a low-income urban mosque community, where members frequently interacted with fellow Muslims they labeled “crazy.” Through repeated interaction, members come to understand madness as part of living in a poor neighborhood and then perceive themselves as also at risk of developing mental health problems. Many members avoided getting close to people with mental illnesses, but their shared religious identities meant that at the end of life someone who had previously been excluded from social networks could receive burial care. I discuss the implications of their responses for understanding the role of community care

Where Would You Go? Race, Religion, and the Limits of Pastor Mental Health Care in Black and Latino Congregations

A growing body of literature explores how religious congregations shape attitudes toward mental health in racial/ethnic minority communities. Such research has primarily focused on the views of Black clergy and congregants, limiting our ability to understand how the views of Black Christians might differ from Christians in other racial/ethnic minority communities. We drew on focus groups with 14 pastors and interviews with 20 congregants from Black and Latino churches in Houston, Texas, to examine how church members make decisions about where to seek mental health care or direct others for help. We found that both Black and Latino Christians prefer seeking spiritual resources, like their pastor, when dealing with mental health issues, even though pastors feel limited in their ability to help congregants. The preferences of members of each racial/ethnic group, however, were driven by different logics. While Black Christians in this study sought spiritual resources based on perceived norms within the broader Black community, Latino Christians relied on pastoral care due to norms in their individual congregation. The results shed light on how religious beliefs, race/ethnicity, and social class intersect to shape attitudes toward mental health care in ways that have implications for potential partnerships between churches and mental health care providers

“If no one grieves, no one will remember”: Cultural palimpsests and the creation of social ties through rituals

Classic sociological theories hold that rituals offer opportunities for community integration and cohesion. Rituals allow people to come together across many differences and experience similar thoughts and feelings. Death rituals raise existential questions about the purpose of society and generally foster preexisting social ties. This paper examines the efforts of a US community of volunteers who gather to bury unclaimed, or “abandoned,” babies. Drawing on ethnographic research over a two‐year period, we advance the concept of cultural palimpsest to capture the process by which a gathering of strangers turns a potentially divisive political issue in to a community forming event. We find that in their efforts to mourn babies to whom they have no connection, these volunteers temporarily foster new social bonds that allow them to work through unresolved grief. Similar processes of ritualistically inverting social meanings occur whenever people gather to turn potentially negative into group forming events

Cognitive and psychiatric symptom trajectories 2–3 years after hospital admission for COVID-19: a longitudinal, prospective cohort study in the UK

Background COVID-19 is known to be associated with increased risks of cognitive and psychiatric outcomes after the acute phase of disease. We aimed to assess whether these symptoms can emerge or persist more than 1 year after hospitalisation for COVID-19, to identify which early aspects of COVID-19 illness predict longer-term symptoms, and to establish how these symptoms relate to occupational functioning. Methods The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study of adults (aged ≥18 years) who were hospitalised with a clinical diagnosis of COVID-19 at participating National Health Service hospitals across the UK. In the C-Fog study, a subset of PHOSP-COVID participants who consented to be recontacted for other research were invited to complete a computerised cognitive assessment and clinical scales between 2 years and 3 years after hospital admission. Participants completed eight cognitive tasks, covering eight cognitive domains, from the Cognitron battery, in addition to the 9-item Patient Health Questionnaire for depression, the Generalised Anxiety Disorder 7-item scale, the Functional Assessment of Chronic Illness Therapy Fatigue Scale, and the 20-item Cognitive Change Index (CCI-20) questionnaire to assess subjective cognitive decline. We evaluated how the absolute risks of symptoms evolved between follow-ups at 6 months, 12 months, and 2–3 years, and whether symptoms at 2–3 years were predicted by earlier aspects of COVID-19 illness. Participants completed an occupation change questionnaire to establish whether their occupation or working status had changed and, if so, why. We assessed which symptoms at 2–3 years were associated with occupation change. People with lived experience were involved in the study. Findings 2469 PHOSP-COVID participants were invited to participate in the C-Fog study, and 475 participants (191 [40·2%] females and 284 [59·8%] males; mean age 58·26 [SD 11·13] years) who were discharged from one of 83 hospitals provided data at the 2–3-year follow-up. Participants had worse cognitive scores than would be expected on the basis of their sociodemographic characteristics across all cognitive domains tested (average score 0·71 SD below the mean [IQR 0·16–1·04]; p<0·0001). Most participants reported at least mild depression (263 [74·5%] of 353), anxiety (189 [53·5%] of 353), fatigue (220 [62·3%] of 353), or subjective cognitive decline (184 [52·1%] of 353), and more than a fifth reported severe depression (79 [22·4%] of 353), fatigue (87 [24·6%] of 353), or subjective cognitive decline (88 [24·9%] of 353). Depression, anxiety, and fatigue were worse at 2–3 years than at 6 months or 12 months, with evidence of both worsening of existing symptoms and emergence of new symptoms. Symptoms at 2–3 years were not predicted by the severity of acute COVID-19 illness, but were strongly predicted by the degree of recovery at 6 months (explaining 35·0–48·8% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); by a biocognitive profile linking acutely raised D-dimer relative to C-reactive protein with subjective cognitive deficits at 6 months (explaining 7·0–17·2% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); and by anxiety, depression, fatigue, and subjective cognitive deficit at 6 months. Objective cognitive deficits at 2–3 years were not predicted by any of the factors tested, except for cognitive deficits at 6 months, explaining 10·6% of their variance. 95 of 353 participants (26·9% [95% CI 22·6–31·8]) reported occupational change, with poor health being the most common reason for this change. Occupation change was strongly and specifically associated with objective cognitive deficits (odds ratio [OR] 1·51 [95% CI 1·04–2·22] for every SD decrease in overall cognitive score) and subjective cognitive decline (OR 1·54 [1·21–1·98] for every point increase in CCI-20). Interpretation Psychiatric and cognitive symptoms appear to increase over the first 2–3 years post-hospitalisation due to both worsening of symptoms already present at 6 months and emergence of new symptoms. New symptoms occur mostly in people with other symptoms already present at 6 months. Early identification and management of symptoms might therefore be an effective strategy to prevent later onset of a complex syndrome. Occupation change is common and associated mainly with objective and subjective cognitive deficits. Interventions to promote cognitive recovery or to prevent cognitive decline are therefore needed to limit the functional and economic impacts of COVID-19. Funding National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Wolfson Foundation, MQ Mental Health Research, MRC-UK Research and Innovation, and National Institute for Health and Care Research

Post-acute COVID-19 neuropsychiatric symptoms are not associated with ongoing nervous system injury

A proportion of patients infected with severe acute respiratory syndrome coronavirus 2 experience a range of neuropsychiatric symptoms months after infection, including cognitive deficits, depression and anxiety. The mechanisms underpinning such symptoms remain elusive. Recent research has demonstrated that nervous system injury can occur during COVID-19. Whether ongoing neural injury in the months after COVID-19 accounts for the ongoing or emergent neuropsychiatric symptoms is unclear. Within a large prospective cohort study of adult survivors who were hospitalized for severe acute respiratory syndrome coronavirus 2 infection, we analysed plasma markers of nervous system injury and astrocytic activation, measured 6 months post-infection: neurofilament light, glial fibrillary acidic protein and total tau protein. We assessed whether these markers were associated with the severity of the acute COVID-19 illness and with post-acute neuropsychiatric symptoms (as measured by the Patient Health Questionnaire for depression, the General Anxiety Disorder assessment for anxiety, the Montreal Cognitive Assessment for objective cognitive deficit and the cognitive items of the Patient Symptom Questionnaire for subjective cognitive deficit) at 6 months and 1 year post-hospital discharge from COVID-19. No robust associations were found between markers of nervous system injury and severity of acute COVID-19 (except for an association of small effect size between duration of admission and neurofilament light) nor with post-acute neuropsychiatric symptoms. These results suggest that ongoing neuropsychiatric symptoms are not due to ongoing neural injury