背景:COVID-19大流行对经济、心理,以及埃塞俄比亚人民的社会福祉。与大流行相关的恐惧会加剧那些先前存在身体和精神健康状况以及先前暴露于创伤事件的人的焦虑和抑郁症状。
方法:我们使用了来自埃塞俄比亚NeuroGAP-精神病研究的数据(分别为898例和941例对照,66%男性,平均年龄=37岁)。数据是在2021年11月至2022年6月COVID-19大流行期间从埃塞俄比亚的四家医院(三家在亚的斯亚贝巴,一家在吉马市)收集的。进行了结构方程模型分析,以检查创伤暴露之间的关联,身体健康状况(如关节炎,神经系统疾病,糖尿病),COVID-19压力,和心理困扰(抑郁和焦虑症状)。我们评估了调解的直接和间接影响,并进行了多组分析,以根据病例控制状况检查适度性。
结果:我们发现证据表明,更大的创伤暴露和身体健康状况对更高的心理困扰的影响是通过更高的COVID-19压力介导的。社会人口统计学特征(年龄较大和被婚姻)与更高的心理困扰相关,这些关联是通过更大的创伤介导的,身体健康状况,和COVID-19压力。病例控制状态也缓和了这些变量之间的关联,调解效果在案例中更强,在控制中更弱。Further,病例报告了更大的创伤和心理困扰,而对照组报告了更多的身体健康状况和COVID-19压力。
结论:我们的研究结果独特地评估了埃塞俄比亚等未研究环境中健康和紧急情况相关因素的相互作用。他们强调了包括日常困难和环境压力因素的重要性,以及之前的创伤暴露,作为评估心理健康症状的危险因素。这项研究对心理健康筛查和干预研究具有重要意义,以应对复杂的紧急情况,如埃塞俄比亚,除了COVID-19大流行外,还有武装冲突史。我们的发现可以帮助开发有针对性的服务,以解决具有先前存在的心理和身体健康状况的风险人群的心理健康问题。
BACKGROUND: The COVID-19 pandemic has profoundly impacted the economic, psychological, and social well-being of people in Ethiopia. Pandemic-related fears can exacerbate anxiety and depression symptoms among those with pre-existing physical and mental health conditions as well as those with prior exposure to traumatic events.
METHODS: We used data from the Ethiopia NeuroGAP-Psychosis study (898 cases and 941 controls with and without a diagnosis of psychosis respectively, 66% male, mean age = 37 years). Data was collected between November 2021 and June 2022 during the COVID-19 pandemic from four hospitals in Ethiopia (three in Addis Ababa and one in Jimma city). Structural equation modeling analysis was conducted to examine the associations between trauma exposure, physical health conditions (like arthristis, neurological disorders, diabetes), COVID-19 stress, and psychological distress (depression and anxiety symptoms). We assessed direct and indirect effects for mediation, and conducted multigroup analysis to examine moderation by
case control status.
RESULTS: We found evidence that the impact of greater trauma exposure and physical health conditions on higher psychological distress was mediated through higher COVID-19 stress. Sociodemographic characteristics (older age and being maried) were associated with higher psychological distress, with these associations mediated through greater trauma, physical health conditions, and COVID-19 stress.
Case-control status also moderated the associations between these variables, with the mediation effects being stronger in cases and weaker in controls. Further, cases reported greater trauma and psychological distress, while controls reported more physical health conditions and COVID-19 stress.
CONCLUSIONS: Our findings uniquely assess the interaction of health and emergency related factors in understudied settings like Ethiopia. They underscore the importance of including daily hardships and environmental stressors, along with prior trauma exposure, as risk factors for the assessment of mental health symptoms. This study has key implications for mental health screening and intervention research in response to complex emergency contexts like Ethiopia with a history of armed conflict in addition to the COVID-19 pandemic. Our findings can aid the development of targeted services that address the mental health of at-risk groups with pre-existing mental and physical health conditions.