Refugees' mental health affected by COVID-19 stressors

For refugees, the biggest predictor of post-traumatic stress disorder (PTSD), health anxiety, depression, or disability during COVID-19 was if their pandemic experiences triggered memories of past trauma, according to survey results published today in the European Journal of Psychotraumatology.

The researchers surveyed 656 adult refugees in Australia (average age, 42.85 years). Most were from Iraq (58.7%) or Syria (16.9%), and the average time they had lived in Australia was 4.64 years. Most had a secure visa (86.2%), but one in five said their employment declined or was lost because of COVID-19. The survey took place in June 2020, right after the country's first lockdown ended.

The most common stressors were worries about a loved one being infected (72.1%), worries about being infected (66.5%), and worries about infecting others (47.7%), followed by social stressors such as school closures or having to stay at home (41.3% to 46.7%). Worries about infection were associated with worse PTSD and health anxiety, while social stressors were linked to depression. Fears about the future (eg, visa application process) were associated with greater disability and health anxiety.

Although only 41.1% said the pandemic reminded them of a past trauma, those who answered affirmatively were most likely to have worse mental health. "For example, a heightened role of government-mandated restrictions, social isolation strategies, and quarantine measures that are common during COVID-19 might trigger memories of living in situations of political terror or in immigration detention," said senior author Belinda Liddell, PhD, in a University of New South Wales (UNSW) press release.

While Liddell said that pandemic-related difficulties sourcing basic supplies or accessing services could also be reminders, data showed that these issues, along with mistrust of authorities, were reported less frequently and were not connected to mental health symptoms.
Aug 18 Eur J Psychotraumatol study
Aug 17 UNSW
press release


Remdesivir, dexamethasone frequency changed during pandemic

Dexamethasone and remdesivir use for hospitalized COVID-19 patients in the United States has increased since the pandemic started, but the former drug is likely underused for critical cases, according to a study yesterday in the Annals of Internal Medicine.

The study looked at the treatments for 137,879 adults hospitalized at least 1 day for COVID-19 from February 2020 to February 2021 and tracked use of dexamethasone, a widely available and cheap steroid usually used for serious inflammation, and remdesivir, an antiviral originally developed for hepatitis C that was approved by the Food and Drug Administration (FDA) for emergency use in October 2020.

While the use of dexamethasone (or other glucocorticoids) and remdesivir increased overall throughout the study period, both peaked in November 2020. By February 2021, dexamethasone was used in 33% patients while remdesivir was used in 27%, and combined, they were used in 22.7%. The researchers note, however, that frequency varied (intraclass correlation coefficients, 14.2% for dexamethasone and 84.6% for remdesivir). Additionally, dexamethasone may be underused among patients who require mechanical ventilation, with 70% to 77% of mechanically ventilated patients receiving dexamethasone after the RECOVERY trial results were released.

The researchers also looked at the antimalarial hydroxychloroquine and found that usage plummeted 33 percentage points in 1 month after its COVID-19 efficacy was debunked, ending at 0.6% in February 2021.

While the study did not adjust for factors such as drug shortages and oxygen supplementation differences, authors of a related editorial say that the study shows how clinical practices have evolved during the pandemic.

"Clinicians adopted a drug with a mortality benefit (dexamethasone), abandoned a drug with no benefit and the potential for harm (hydroxychloroquine), and recognized the nuances of a third drug (remdesivir) that had FDA approval based on decreased clinical progression but lacked a demonstrated mortality benefit," Marshall J. Glesby, MD, PhD, and Roy M. Gulick, MD, MPH, write. "There have been and will continue to be refinements in the clinical care of COVID-19 based on new evidence that emerges from other carefully conducted trials, including global platform trials."
Aug 17 Ann Intern Med study and editorial

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