The prevalence, incidence and risk factors of mental health problems and mental health services use before and 9 months after the COVID-19 outbreak among the general Dutch population. A 3-wave prospective study

ObjectivesGain insight in the effects of the COVID-19 pandemic on the prevalence, the incidence and risk factors of mental health problems among the Dutch general population and different age groups in November-December 2020, compared to the prevalence, incidence, and risk factors in the same period in 2018 and 2019. More specifically, the prevalence, incidence and risk factors of anxiety and depression symptoms, sleep problems, fatigue, disabilities due to health problems, use of medicines for sleep problems, medicines for anxiety and depression, and mental health services use.MethodsWe extracted data from the LISS (Longitudinal Internet studies for the Social Sciences) panel that is based a probability sample of the Dutch population of 16 years and older by Statistics Netherlands. We used three waves of the longitudinal Health module held in November-December 2018 (T1), November-December 2019 (T2) and November-December 2020 (T3), and selected respondents who were 18 years and older at T1. Data were weighted using 16 demographics profiles of the Dutch adult population (Nstudy sample=4,064). The course of mental health problems was examined with repeated measures multivariate logistic regression analyses, and the differences in incidence with multivariate logistic regression analyses. In both types of analyses, we controlled for sex, age, marital status, employment status, education level and physical disease.ResultsThe repeated measures multivariate logistic regression analyses among the total study sample did not reveal a significant increase in the prevalence of anxiety and depression symptoms, sleep problems, fatigue, disabilities due to health problems, use of medicines for sleep problems, medicines for anxiety and depression, and mental health services use in November- December 2020, compared to November-December 2018 and 2019 (that is, T3 did not differ from T1 and T2). Among the four different age categories (18-34, 35-49, 50-64, and 65 years old and older respondents), 50-64 years respondents had a significantly lower prevalence of anxiety and depression symptoms at T3 than at T1 and T2, while T1 and T2 did not differ. A similar pattern among 65+ respondents was found for mental health services use. We found no indications that the incidence of examined health problems at T2 (no problem at T1, problem at T2) and T3 (no problem at T2, problem at T3) differed. Risk factors for mental health problems at T2 were mostly similar to risk factors at T3; sex and age were less associated with sleep problems at T3, compared to T2 .ConclusionsThe prevalence, incidence and risk factors of examined mental health problems examined nine months after the COVID-19 outbreak appear to be very stable across the end of 2018, 2019 and 2020 among the Dutch adult population and different age categories, suggesting that the Dutch adult population (20 years and older) in general is rather resilient given all disruptions due to this pandemic.

Mental health services use by melanoma patients receiving adjuvant interferon: association of pre-treatment mental health care with early discontinuation

Background Although high-dose interferon (hd-ifn) is the sole approved adjuvant systemic treatment for melanoma in many jurisdictions, it is toxic. We sought to assess the population-level effects of hd-ifn toxicity, particularly neuropsychiatric toxicity, hypothesizing that such toxicity would have the greatest effect on mental health services use in advanced resected melanoma.Methods This retrospective population-based registry study considered all melanoma patients receiving adjuvant hd-ifn in Ontario during 2008–2012. Toxicity was investigated through health services use compatible with hd-ifn toxicity (for example, mental health physician billings). Using stage data reported from cancer centres about a subset of patients (stages iib–iiic), a propensity-matched analysis compared such service use in patients who did and did not receive hd-ifn. Associations between early hd-ifn discontinuation and health services use were examined.Results Of 718 melanoma patients who received hd-ifn, 12% were 65 years of age and older, and 83% had few or no comorbidities. One third of the patients experienced 1 or more toxicity-associated health care utilization events within 1 year of starting hd-ifn. Of 420 utilization events, 364 (87%) were mental health–related, with 54% being family practitioner visits, and 39% being psychiatrist visits. In the propensity-matched analysis, patients receiving hd-ifn were more likely than untreated matched controls to use a mental health service (p = 0.01), with 42% of the control group and 51% of the hd-ifn group using a mental health service in the period spanning the 12 months before to the 24 months after diagnosis. In the multivariable analysis, early drug discontinuation was more likely in the presence of pre-existing mental health issues (odds ratio: 2.0; 95% confidence limits: 1.1, 3.4).Conclusions Stage iib–iiic melanoma patients carry a substantial burden of mental health services use whether or not receiving hd-ifn, highlighting an important survivorship issue for these patients. High-dose interferon is associated with more use of mental health services, and pre-treatment use of mental health services is associated with treatment discontinuation. That association should be kept in mind when hd-ifn is being considered.