#Knowledge, #Concerns, and #Behaviors of Individuals During the First Week of the #Coronavirus Disease 2019 Pandemic in #Italy (JAMA Netw Open, abstract)

[Source: JAMA Network Open, full page: (LINK). Abstract, edited.]

Knowledge, Concerns, and Behaviors of Individuals During the First Week of the Coronavirus Disease 2019 Pandemic in Italy

Francesco Pagnini, PsyD, PhD1,2; Andrea Bonanomi, PhD3; Semira Tagliabue, PhD1;  Michela Balconi, PhD1; Mauro Bertolotti, PhD1; Emanuela Confalonieri, PhD1; Cinzia Di Dio, PhD1; Gabriella Gilli, PhD1; Guendalina Graffigna, PhD1,4; Camillo Regalia, PhD1; Emanuela Saita, PhD1; Daniela Villani, PhD1

Author Affiliations: 1 Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy; 2 Department of Psychology, Harvard University, Cambridge, Massachusetts; 3 Department of Statistical Sciences, Università Cattolica del Sacro Cuore, Milan, Italy”; 4 EngageMinds HUB, Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy

JAMA Netw Open. 2020;3(7):e2015821. doi:10.1001/jamanetworkopen.2020.15821

 

Key Points

  • Question  – What were the worries and perceptions experienced by residents of different exposure areas during the first week of outbreak of the coronavirus disease 2019 (COVID-19) in Italy?
  • Findings  – This survey study including 2886 participants found that people were well informed about COVID-19 and its implications. Higher scores for cognitive rigidity and emotional instability were associated with more worries and concerns regarding the COVID-19 outbreak regardless of exposure region.
  • Meaning  – These findings suggest that at the beginning of the COVID-19 outbreak, people who were cognitively flexible and emotionally stable were more likely to be more resilient to worries and concerns relating to COVID-19.

 

Abstract

Importance  

At the beginning of a public health crisis, such as the coronavirus disease 2019 (COVID-19) pandemic, it is important to collect information about people’s knowledge, worries, and behaviors to examine their influence on quality of life and to understand individual characteristics associated with these reactions. Such information could help to guide health authorities in providing informed interventions and clear communications.

Objectives  

To document the initial knowledge about COVID-19 and recommended health behaviors; to assess worries (ie, one’s perception of the influence of the worries of others on oneself), social appraisal, and preventive behaviors, comparing respondents from areas under different movement restrictions during the first week after the outbreak; and to understand how worries, perceived risk, and preventive behaviors were associated with quality of life and individual characteristics among Italian adults.

Design, Setting, and Participants  

This convenience sample, nonprobablistic survey study recruited adult participants with a snowballing sampling method in any Italian region during the first week of the COVID-19 outbreak in Italy from February 26, 2020, to March 4, 2020. Data were analyzed from March 5 to 12, 2020.

Exposures  

Information was collected from citizens living in the quarantine zone (ie, red zone), area with restricted movements (ie, yellow zone), and COVID-19–free regions (ie, green zone).

Main Outcomes and Measures  

Levels of knowledge on the virus, contagion-related worries, social appraisal, and preventive behaviors were assessed with ratings of quality of life (measured using the Short Form Health Survey). Additionally, some individual characteristics that may be associated with worries and behaviors were assessed, including demographic characteristics, personality traits (measured using Big Five Inventory-10), perceived health control (measured using the internal control measure in the Health Locus of Control scale), optimism (measured using the Revised Life Orientation Test), and the need for cognitive closure (measured using the Need for Closure Scale).

Results  

A total of 3109 individuals accessed the online questionnaire, and 2886 individuals responded to the questionnaire at least partially (mean [SD] age, 30.7 [13.2] years; 2203 [76.3%] women). Most participants were well informed about the virus characteristics and suggested behaviors, with a mean (SD) score of 77.4% (17.3%) correct answers. Quality of life was similar across the 3 zones (effect size = 0.02), but mental health was negatively associated with contagion-related worries (β = –0.066), social appraisal (β = –0.221), and preventive behaviors (β = –0.066) in the yellow zone (R2 = 0.108). Social appraisal was also associated with reduced psychological well-being in the green zone (β = –0.205; R2 = 0.121). In the yellow zone, higher worries were negatively correlated with emotional stability (β = –0.165; R2 = 0.047). Emotional stability was also negatively associated with perceived susceptibility in the yellow (β = –0.108; R2 = 0.040) and green (β = –0.170; R2 = 0.087) zones. Preventative behaviors and social appraisal were also associated with the need for cognitive closure in both yellow (preventive behavior: β = 0.110; R2 = 0.023; social appraisal β = 0.115; R2 = 0.104) and green (preventive behavior: β = 0.174; R2 = 0.022; social appraisal: 0.261; R2 = 0.137) zones.

Conclusions and Relevance  

These findings suggest that during the first week of the COVID-19 outbreak in Italy, people were well informed and had a relatively stable level of worries. Quality of life did not vary across the areas, although mental well-being was challenged by the social appraisal and worries related to the contagion. Increased scores for worries and concerns were associated with more cognitive rigidity and emotional instability.

Keywords: SARS-CoV-2; COVID-19; Society; Psychology; Psychiatry; Italy.

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An #Isolation #Hotel for People Experiencing #Homelessness (N Engl J Med., summary)

[Source: The New England Journal of Medicine, full page: (LINK). Summary, edited.]

An Isolation Hotel for People Experiencing Homelessness

To rapidly communicate short reports of innovative responses to Covid-19 around the world, along with a range of current thinking on policy and strategy relevant to the pandemic, the Journal has initiated the Covid-19 Notes series.

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One April morning during the height of the pandemic in Rhode Island, 43-year-old Mr. H.  picked up the phone in his hotel room and dialed our primary care clinic. “You  wouldn’t believe how awesome they’re treating me here,” he said. “This is actually  great.” Two days earlier, after testing positive for Covid-19, Mr. H. had been transported from the hospital to the Department of Health’s newly established isolation facility, a hybrid boarding home–military base in a former midbudget hotel in Warwick. Mr. H. had been incarcerated for more than half his adult life, but he seemed content inside the hotel, where residents were confined to their rooms. Mr. H. had always found the constraints of hospitalization challenging, frequently leaving against medical advice. It was his contention that the isolation imposed by hospitalization and the hospital’s rules, including prohibition of smoking, made the hospital resemble a prison.

(…)

Keywords: SARS-CoV-2; COVID-19; Society; Psychiatry; USA.

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#Mental #health before and during the #COVID19 pandemic: a longitudinal probability sample #survey of the #UK population (Lancet Psychiatry, abstract)

[Source: Lancet Psychiatry, full page: (LINK). Abstract, edited.]

Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population

Matthias Pierce, PhD, Holly Hope, PhD, Prof Tamsin Ford, PhD, Prof Stephani Hatch, PhD, Prof Matthew Hotopf, PhD, Prof Ann John, PhD, Prof Evangelos Kontopantelis, PhD, Prof Roger Webb, PhD, Prof Simon Wessely, FMedSci, Sally McManus, MSc †, Prof Kathryn M Abel, MD †

Published: July 21, 2020 | DOI: https://doi.org/10.1016/S2215-0366(20)30308-4

 

Summary

Background

The potential impact of the COVID-19 pandemic on population mental health is of increasing global concern. We examine changes in adult mental health in the UK population before and during the lockdown.

Methods

In this secondary analysis of a national, longitudinal cohort study, households that took part in Waves 8 or 9 of the UK Household Longitudinal Study (UKHLS) panel, including all members aged 16 or older in April, 2020, were invited to complete the COVID-19 web survey on April 23–30, 2020. Participants who were unable to make an informed decision as a result of incapacity, or who had unknown postal addresses or addresses abroad were excluded. Mental health was assessed using the 12-item General Health Questionnaire (GHQ-12). Repeated cross-sectional analyses were done to examine temporal trends. Fixed-effects regression models were fitted to identify within-person change compared with preceding trends.

Findings

Waves 6–9 of the UKHLS had 53 351 participants. Eligible participants for the COVID-19 web survey were from households that took part in Waves 8 or 9, and 17 452 (41·2%) of 42 330 eligible people participated in the web survey. Population prevalence of clinically significant levels of mental distress rose from 18·9% (95% CI 17·8–20·0) in 2018–19 to 27·3% (26·3–28·2) in April, 2020, one month into UK lockdown. Mean GHQ-12 score also increased over this time, from 11·5 (95% CI 11·3–11·6) in 2018–19, to 12·6 (12·5–12·8) in April, 2020. This was 0·48 (95% CI 0·07–0·90) points higher than expected when accounting for previous upward trends between 2014 and 2018. Comparing GHQ-12 scores within individuals, adjusting for time trends and significant predictors of change, increases were greatest in 18–24-year-olds (2·69 points, 95% CI 1·89–3·48), 25–34-year-olds (1·57, 0·96–2·18), women (0·92, 0·50–1·35), and people living with young children (1·45, 0·79–2·12). People employed before the pandemic also averaged a notable increase in GHQ-12 score (0·63, 95% CI 0·20–1·06).

Interpretation

By late April, 2020, mental health in the UK had deteriorated compared with pre-COVID-19 trends. Policies emphasising the needs of women, young people, and those with preschool aged children are likely to play an important part in preventing future mental illness.

Funding

None.

Keywords: SARS-CoV-2; COVID-19; Psychiatry; Society; UK.

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Associations Between #Media #Exposure and #Mental #Distress Among #US #Adults at the Beginning of the #COVID19 Pandemic (Am J Prev Med., abstract)

[Source: American Journal of Preventive Medicine, full page: (LINK). Abstract, edited.]

Associations Between Media Exposure and Mental Distress Among U.S. Adults at the Beginning of the COVID-19 Pandemic

Kira E. Riehm, MSc,  Calliope Holingue, PhD, Luther G. Kalb, PhD, Daniel Bennett, PhD, Arie Kapteyn, PhD, Qin Jiang, MA, Cindy Veldhuis, PhD, Renee M. Johnson, PhD, M. Daniele Fallin, PhD, Frauke Kreuter, PhD, Elizabeth A. Stuart, PhD, Johannes Thrul, PhD

Published: July 10, 2020 | DOI: https://doi.org/10.1016/j.amepre.2020.06.008

 

Abstract

Introduction

Exposure to disaster-related media may be a risk factor for mental distress, but this has not been examined in the context of the coronavirus disease 2019 (COVID-19 pandemic. This study assesses if exposure to social and traditional media during the rise of the COVID-19 pandemic was associated with mental distress among U.S. adults.

Methods

Data came from the Understanding America Study, a cross-sectional, nationally representative sample of adults who completed surveys online. Participants included 6,329 adults surveyed between March 10 and March 31, 2020. Regression analyses examined associations of: (1) self-reported average time spent on social media in a day (hours) and (2) number of traditional media sources (radio, TV, and newspaper) consulted to learn about COVID-19 with self-reported mental distress (4-item Patient Health Questionnaire). Data were analyzed in April 2020.

Results

Participants responding at later survey dates reported more time spent on social media (β=0.02, 95% CI=0.01, 0.03), a greater number of traditional media sources consulted to learn about COVID-19 (β=0.01, 95% CI=0.01, 0.02), and greater mental distress (β=0.07, 95% CI=0.04, 0.09). Increased time spent on social media and consulting a greater number of traditional media sources to learn about COVID-19 were independently associated with increased mental distress, even after adjusting for potential confounders (social media: β=0.14, 95% CI=0.05, 0.23; traditional media: β=0.14, 95% CI=0.08, 0.20).

Conclusions

Exposure to a greater number of traditional media sources and more hours of social media was modestly associated with mental distress during the rise of the COVID-19 pandemic in the U.S.

Keywords: SARS-CoV-2; COVID-19; USA; Society; Psychology; Psychiatry.

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#Challenges Estimating Total Lives Lost in #COVID19 #Decisions – Consideration of #Mortality Related to #Unemployment, Social #Isolation, and #Depression (JAMA, summary)

[Source: JAMA, full page: (LINK). Summary, edited.]

Challenges Estimating Total Lives Lost in COVID-19 Decisions – Consideration of Mortality Related to Unemployment, Social Isolation, and Depression

Tyler J. VanderWeele, PhD1

Author Affiliations: 1 Harvard T.H. Chan School of Public Health, Boston, Massachusetts

JAMA. Published online July 8, 2020. doi:10.1001/jama.2020.12187

___

The coronavirus disease 2019 (COVID-19) pandemic has claimed hundreds of thousands of lives, directly and indirectly, and threatens to claim many more. Nations have made different policy decisions that have affected the rate of infection, mortality, the economy, and the life of the country differently. The choices between various alternative policies have led to different trade-offs between what are arguably incommensurable goods, such as survival, mental health, social connection, and economic growth. It can seem difficult or impossible to weigh these numerous factors, yet policy decisions must be made, with countless implications for society. In the early stages of the pandemic, and when information was limited, a cautious approach was arguably most appropriate. As further information becomes available, it becomes possible to make better-informed decisions. However, the inherent challenges involved in the very real, and very difficult, trade-offs remain.

(…)

Keywords: SARS-CoV-2; COVID-19; Society; Poverty.

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Perceived #Discrimination and #Mental #Distress Amid the #COVID19 Pandemic: Evidence From the Understanding #America Study (Am J Prev Med., abstract)

[Source: American Journal of Preventive Medicine, full page: (LINK). Abstract, edited.]

Perceived Discrimination and Mental Distress Amid the COVID-19 Pandemic: Evidence From the Understanding America Study

Ying Liu, PhD,  Brian Karl Finch, PhD, Savannah G. Brenneke, MPH, Kyla Thomas, PhD, PhuongThao D. Le, PhD, MPH

Published: July 06, 2020 | DOI: https://doi.org/10.1016/j.amepre.2020.06.007

 

Abstract

Introduction

This study examines coronavirus disease 2019 (COVID-19) associated discrimination regardless of infection status. It evaluates the contribution of various risk factors (e.g., race/ethnicity, wearing a face mask) and the relationship with mental distress among U.S. adults in March and April 2020, when the pandemic escalated across the country.

Methods

Participants consisted of a probability-based, nationally representative sample of U.S. residents aged ≥18 years who completed COVID-19-related surveys online in March and April (n=3,665). Multivariable logistic regression was used to predict the probability of a person perceiving COVID-19 associated discrimination. Linear regression was used to analyze the association between discrimination and mental distress. Analyses were conducted in May 2020.

Results

Perception of COVID-19 associated discrimination increased from March (4%) to April (10%). Non-Hispanic blacks (absolute risk from 0.09 to 0.15 across months) and Asians (absolute risk from 0.11 to 0.17) were more likely to perceive discrimination than other racial/ethnic groups (absolute risk from 0.03 to 0.11). Individuals who wore face masks (absolute risk from 0.11 to 0.14) also perceived more discrimination compared with those who did not (absolute risk from 0.04 to 0.11). Perceiving discrimination was subsequently associated with increased mental distress (from 0.77 to 1.01 points on the 4-item Patient Health Questionnaire score).

Conclusions

Perception of COVID-19 associated discrimination was relatively low but increased with time. Perceived discrimination was associated with race/ethnicity and wearing face masks, and may contribute to greater mental distress during early stages of the pandemic. The long-term implications of this novel form of discrimination should be monitored.

Keywords: SARS-CoV-2; COVID-19; Society; USA; Racism; Psychology; Psychiatry.

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#Public #behavior #change, #perceptions, #depression, and #anxiety in relation to the #COVID19 outbreak (Open Forum Infect Dis., abstract)

[Source: Open Forum Infectious Diseases, full page: (LINK). Abstract, edited.]

Public behavior change, perceptions, depression, and anxiety in relation to the COVID-19 outbreak

Jing Huang, Fangkun Liu, Ziwei Teng, Jindong Chen, Jingping Zhao, Xiaoping Wang, Ying Wu, Jingmei Xiao, Ying Wang, Renrong Wu

Open Forum Infectious Diseases, ofaa273, https://doi.org/10.1093/ofid/ofaa273

Published: 03 July 2020

 

Abstract

Background

The COVID-19 has spread rapidly and world-widely, which elicits public panic and psychological problems. Public protective behaviors and perception play crucial roles in controlling the spread of illness and psychological status.

Methods

We conducted a cross-sectional online survey in the hardest-hit Hubei province and other areas in China affected by COVID-19 outbreak. Questions about their basic information, the perception of the COVID-19 outbreak, recent preventive or avoidance behaviors, and self-reported mental health scales including the Patient Health Questionnaire (PHQ-9) and Self-Rating Anxiety Scale (SAS) were included. Binary logistic regressions were used to investigate the association between personal variables/perceptions and psychological distress.

Results

6,261 people were included for analysis, with 3,613 (57.7%) in Hubei province (1,743 in Wuhan). A majority of people have adopted preventive and avoidance behaviors. People from Hubei, with contact history, and people who or whose family members were infected had much higher depression or anxiety prevalence. Providing truthful and sufficient information, informing the public about the severity of the disease, and perceptions that the outbreak will be control by protective behaviors were associated with lower depression and anxiety prevalence.

Conclusions

Assessing the public response, perception, and psychological burden during the outbreak may help improve public health recommendations and deliver timely psychological intervention. Further researches can focus on the psychological status of a specialized group to identify ways for better support based on public response and psychological demand.

COVID-19, Public behavior change, Perceptions, Depression, Anxiety

Issue Section: Major Article

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Keywords: SARS-CoV-2; COVID-19; Society; Psychology; Psychiatry; Hubei; China.

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The #psychological #impact of #COVID19 on the #mental #health in the general #population (QJM Int J Med., abstract)

[Source: QJM An International Journal of Medicine, full page: (LINK). Abstract, edited.]

The psychological impact of COVID-19 on the mental health in the general population

G Serafini, B Parmigiani, A Amerio, A Aguglia, L Sher, M Amore

QJM: An International Journal of Medicine,  hcaa201, https://doi.org/10.1093/qjmed/hcaa201

Published: 30 June 2020

 

Abstract

As a result of the emergence of coronavirus disease 2019 (COVID-19) outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the Chinese city of Wuhan, a situation of socio-economic crisis and profound psychological distress rapidly occurred worldwide. Various psychological problems and important consequences in terms of mental health including stress, anxiety, depression, frustration, uncertainty during COVID-19 outbreak emerged progressively. This work aimed to comprehensively review the current literature about the impact of COVID-19 infection on the mental health in the general population. The psychological impact of quarantine related to COVID-19 infection has been additionally documented together with the most relevant psychological reactions in the general population related to COVID-19 outbreak. The role of risk and protective factors against the potential to develop psychiatric disorders in vulnerable individuals has been addressed as well. The main implications of the present findings have been discussed.

Issue Section: Review

Keywords: SARS-CoV-2; COVID-19; Psychology; Psychiatry.

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#Immunological #Implications of #Physical #Inactivity among Older #Adults during the #COVID19 Pandemic (Gerontol., abstract)

[Source: Gerontology, full page: (LINK). Abstract, edited.]

Immunological Implications of Physical Inactivity among Older Adults during the COVID-19 Pandemic

Damiot A.a · Pinto A.J.a · Turner J.E.b · Gualano B.a,c

Author affiliations: a Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil; b Department for Health, University of Bath, Bath, United Kingdom; c Food Research Center, University of São Paulo, São Paulo, Brazil

Gerontology | DOI: https://doi.org/10.1159/000509216

 

Abstract

Social distancing has been adopted worldwide to control severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. Social isolation is likely to lead to a decline in physical activity, which could result in immune system dysfunction, thereby increasing infection susceptibility and exacerbating the pathophysiology of conditions that are common among older adults, including cardiovascular disease, cancer, and inflammatory disorders. Older adults and people living with these comorbidities are at a greater risk for complications during coronavirus disease 2019 (COVID-19). In this review, we discuss the negative impact of physical inactivity on immune function and showcase evidence that regular physical activity may be an effective strategy to counter some of the deleterious effects of social isolation. Furthermore, we briefly highlight key research questions in exercise immunology, with a focus on older adults in the context of COVID-19. Although it is worth emphasizing that there is no direct evidence that physical activity can prevent or treat ­COVID-19, promoting an active lifestyle is a key intervention to counteract the effects of social isolation, especially in older adults and other at-risk individuals, such as those living with chronic diseases associated with ageing and lifestyle.

© 2020 S. Karger AG, Basel

Keywords: SARS-CoV-2; COVID-19; Gerontology.

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#Neurological and #neuropsychiatric #complications of #COVID19 in 153 patients: a #UK-wide surveillance study (Lancet Psychiatry, abstract)

[Source: Lancet Psychiatry, full page: (LINK). Abstract, edited.]

Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study

Aravinthan Varatharaj, MRCP, Naomi Thomas, MRCPCH, Mark A Ellul, MRCP, Nicholas W S Davies, PhD, Thomas A Pollak, MRCP, Elizabeth L Tenorio, PhD, Mustafa Sultan, Ava Easton, PhD, Prof Gerome Breen, PhD, Michael Zandi, PhD, Prof Jonathan P Coles, PhD, Hadi Manji, FRCP, Prof Rustam Al-Shahi Salman, PhD, Prof David K Menon, PhD, Timothy R Nicholson, PhD, Laura A Benjamin, PhD, Prof Alan Carson, PhD, Prof Craig Smith, MD, Prof Martin R Turner, PhD, Prof Tom Solomon, PhD, Rachel Kneen, MRCPCH, Prof Sarah L Pett, PhD, Ian Galea, PhD *, Rhys H Thomas, PhD *, Benedict D Michael, PhD  *, on behalf of the CoroNerve Study Group †

Published: June 25, 2020 | DOI: https://doi.org/10.1016/S2215-0366(20)30287-X

 

Summary

Background

Concerns regarding potential neurological complications of COVID-19 are being increasingly reported, primarily in small series. Larger studies have been limited by both geography and specialty. Comprehensive characterisation of clinical syndromes is crucial to allow rational selection and evaluation of potential therapies. The aim of this study was to investigate the breadth of complications of COVID-19 across the UK that affected the brain.

Methods

During the exponential phase of the pandemic, we developed an online network of secure rapid-response case report notification portals across the spectrum of major UK neuroscience bodies, comprising the Association of British Neurologists (ABN), the British Association of Stroke Physicians (BASP), and the Royal College of Psychiatrists (RCPsych), and representing neurology, stroke, psychiatry, and intensive care. Broad clinical syndromes associated with COVID-19 were classified as a cerebrovascular event (defined as an acute ischaemic, haemorrhagic, or thrombotic vascular event involving the brain parenchyma or subarachnoid space), altered mental status (defined as an acute alteration in personality, behaviour, cognition, or consciousness), peripheral neurology (defined as involving nerve roots, peripheral nerves, neuromuscular junction, or muscle), or other (with free text boxes for those not meeting these syndromic presentations). Physicians were encouraged to report cases prospectively and we permitted recent cases to be notified retrospectively when assigned a confirmed date of admission or initial clinical assessment, allowing identification of cases that occurred before notification portals were available. Data collected were compared with the geographical, demographic, and temporal presentation of overall cases of COVID-19 as reported by UK Government public health bodies.

Findings

The ABN portal was launched on April 2, 2020, the BASP portal on April 3, 2020, and the RCPsych portal on April 21, 2020. Data lock for this report was on April 26, 2020. During this period, the platforms received notification of 153 unique cases that met the clinical case definitions by clinicians in the UK, with an exponential growth in reported cases that was similar to overall COVID-19 data from UK Government public health bodies. Median patient age was 71 years (range 23–94; IQR 58–79). Complete clinical datasets were available for 125 (82%) of 153 patients. 77 (62%) of 125 patients presented with a cerebrovascular event, of whom 57 (74%) had an ischaemic stroke, nine (12%) an intracerebral haemorrhage, and one (1%) CNS vasculitis. 39 (31%) of 125 patients presented with altered mental status, comprising nine (23%) patients with unspecified encephalopathy and seven (18%) patients with encephalitis. The remaining 23 (59%) patients with altered mental status fulfilled the clinical case definitions for psychiatric diagnoses as classified by the notifying psychiatrist or neuropsychiatrist, and 21 (92%) of these were new diagnoses. Ten (43%) of 23 patients with neuropsychiatric disorders had new-onset psychosis, six (26%) had a neurocognitive (dementia-like) syndrome, and four (17%) had an affective disorder. 18 (49%) of 37 patients with altered mental status were younger than 60 years and 19 (51%) were older than 60 years, whereas 13 (18%) of 74 patients with cerebrovascular events were younger than 60 years versus 61 (82%) patients older than 60 years.

Interpretation

To our knowledge, this is the first nationwide, cross-specialty surveillance study of acute neurological and psychiatric complications of COVID-19. Altered mental status was the second most common presentation, comprising encephalopathy or encephalitis and primary psychiatric diagnoses, often occurring in younger patients. This study provides valuable and timely data that are urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy.

Funding

None.

Keywords: SARS-CoV-2; COVID-19; Psychiatry; Neurology; Encephalitis; Encephalopathy.

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