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1. Suicidal behaviour amid first wave of COVID-19 pandemic in Malaysia: Data from the COVID-19 mental health international (COMET-G) study

Author

Salmi Razali, Jo Anne Saw, Nurul Azreen Hashim, Nor Jannah Nasution Raduan, Dina Tukhvatullina, Daria Smirnova, and Konstantinos N. Fountoulakis

Subjects
suicidal behaviour, COVID-19, Malaysia, mental health, pandemic, Psychiatry, RC435-571
Abstract

During the COVID-19 pandemic, numerous social and life changes were implemented to curb the spread of the disease. The effect of lockdown and isolation predisposes the general population to various psychological health concerns. The existing determinants of suicidal behaviour were further added with social isolation, financial stress, depression, and other pandemic-related stressors. Hence, our study aimed to investigate suicidal behaviour and the associated factors among Malaysians during the COVID-19 pandemic. It is a cross-sectional online questionnaire survey that used convenient sampling, where the survey was disseminated to the public via Google Forms through social media during the first wave of the COVID-19 pandemic in Malaysia. This study is also part of a large international COVID-19 mental health international study for the general population (COMET-G). This research revealed concerns about issues related to suicidal behaviours during the beginning of the COVID-19 pandemic. Suicidal behaviours were associated with depression, sex, marital status, educational level, employment type, residential area, number of people living together, number of children, and family dynamics. The pandemic effects from psychological, social, and economic perspectives will definitely take more time for recovery. Future prevention and protection are needed especially for the highly at-risk group on top of the general population in any future unforeseen circumstances of the pandemic.

Published
2022
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2. Results of the COVID-19 mental health international for the health professionals (COMET-HP) study: depression, suicidal tendencies and conspiracism

Author

Konstantinos N. Fountoulakis, Grigorios N. Karakatsoulis, Seri Abraham, Kristina Adorjan, Helal Uddin Ahmed, Renato D. Alarcón, Kiyomi Arai, Sani Salihu Auwal, Julio Bobes, Teresa Bobes-Bascaran, Julie Bourgin-Duchesnay, Cristina Ana Bredicean, Laurynas Bukelskis, Akaki Burkadze, Indira Indiana Cabrera Abud, Ruby Castilla-Puentes, Marcelo Cetkovich, Hector Colon-Rivera, Ricardo Corral, Carla Cortez-Vergara, Piirika Crepin, Domenico de Berardis, Sergio Zamora Delgado, David de Lucena, Avinash de Sousa, Ramona di Stefano, Seetal Dodd, Livia Priyanka Elek, Anna Elissa, Berta Erdelyi-Hamza, Gamze Erzin, Martin J. Etchevers, Peter Falkai, Adriana Farcas, Ilya Fedotov, Viktoriia Filatova, Nikolaos K. Fountoulakis, Iryna Frankova, Francesco Franza, Pedro Frias, Tatiana Galako, Cristian J. Garay, Leticia Garcia-Álvarez, Paz García-Portilla, Xenia Gonda, Tomasz M. Gondek, Daniela Morera González, Hilary Gould, Paolo Grandinetti, Arturo Grau, Violeta Groudeva, Michal Hagin, Takayuki Harada, Tasdik M. Hasan, Nurul Azreen Hashim, Jan Hilbig, Sahadat Hossain, Rossitza Iakimova, Mona Ibrahim, Felicia Iftene, Yulia Ignatenko, Matias Irarrazaval, Zaliha Ismail, Jamila Ismayilova, Asaf Jacobs, Miro Jakovljević, Nenad Jakšić, Afzal Javed, Helin Yilmaz Kafali, Sagar Karia, Olga Kazakova, Doaa Khalifa, Olena Khaustova, Steve Koh, Svetlana Kopishinskaia, Korneliia Kosenko, Sotirios A. Koupidis, Illes Kovacs, Barbara Kulig, Alisha Lalljee, Justine Liewig, Abdul Majid, Evgeniia Malashonkova, Khamelia Malik, Najma Iqbal Malik, Gulay Mammadzada, Bilvesh Mandalia, Donatella Marazziti, Darko Marčinko, Stephanie Martinez, Eimantas Matiekus, Gabriela Mejia, Roha Saeed Memon, Xarah Elenne Meza Martínez, Dalia Mickevičiūtė, Roumen Milev, Muftau Mohammed, Alejandro Molina-López, Petr Morozov, Nuru Suleiman Muhammad, Filip Mustač, Mika S. Naor, Amira Nassieb, Alvydas Navickas, Tarek Okasha, Milena Pandova, Anca-Livia Panfil, Liliya Panteleeva, Ion Papava, Mikaella E. Patsali, Alexey Pavlichenko, Bojana Pejuskovic, Mariana Pinto da Costa, Mikhail Popkov, Dina Popovic, Nor Jannah Nasution Raduan, Francisca Vargas Ramírez, Elmars Rancans, Salmi Razali, Federico Rebok, Anna Rewekant, Elena Ninoska Reyes Flores, María Teresa Rivera-Encinas, Pilar A. Saiz, Manuel Sánchez de Carmona, David Saucedo Martínez, Jo Anne Saw, Görkem Saygili, Patricia Schneidereit, Bhumika Shah, Tomohiro Shirasaka, Ketevan Silagadze, Satti Sitanggang, Oleg Skugarevsky, Anna Spikina, Sridevi Sira Mahalingappa, Maria Stoyanova, Anna Szczegielniak, Simona Claudia Tamasan, Giuseppe Tavormina, Maurilio Giuseppe Maria Tavormina, Pavlos N. Theodorakis, Mauricio Tohen, Eva-Maria Tsapakis, Dina Tukhvatullina, Irfan Ullah, Ratnaraj Vaidya, Johann M. Vega-Dienstmaier, Jelena Vrublevska, Olivera Vukovic, Olga Vysotska, Natalia Widiasih, Anna Yashikhina, Panagiotis E. Prezerakos, Michael Berk, Sarah Levaj, Daria Smirnova, Fountoulakis, Konstantinos N [0000-0001-5503-0811], N. Karakatsoulis, Grigorios [0000-0002-4786-1217], Castilla-Puentes, Ruby [0000-0002-0597-6155], Fountoulakis, Nikolaos K [0000-0002-5965-707X], Smirnova, Daria [0000-0002-9591-4918], and Apollo - University of Cambridge Repository

Subjects
Psychiatry, Health (social science), Social Psychology, Depression, Epidemiology, Conspiracy theories, COVID-19, Anxiety, Health professionals, Mental disorders, Mental health, Suicidality, Psychiatry and Mental health
Abstract

Introduction: The current study aimed to investigate the rates of anxiety, clinical depression, and suicidality and their changes in health professionals during the COVID-19 outbreak. Materials and methods: The data came from the larger COMET-G study. The study sample includes 12,792 health professionals from 40 countries (62.40% women aged 39.76 ± 11.70; 36.81% men aged 35.91 ± 11.00 and 0.78% non-binary gender aged 35.15 ± 13.03). Distress and clinical depression were identified with the use of a previously developed cut-off and algorithm, respectively. Statistical analysis: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses, and Factorial Analysis of Variance (ANOVA) tested relations among variables. Results: Clinical depression was detected in 13.16% with male doctors and ‘non-binary genders’ having the lowest rates (7.89 and 5.88% respectively) and ‘non-binary gender’ nurses and administrative staff had the highest (37.50%); distress was present in 15.19%. A significant percentage reported a deterioration in mental state, family dynamics, and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (24.64% vs. 9.62%; p < 0.0001). Suicidal tendencies were at least doubled in terms of RASS scores. Approximately one-third of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop clinical depression was associated with a history of Bipolar disorder (RR = 4.23). Conclusions: The current study reported findings in health care professionals similar in magnitude and quality to those reported earlier in the general population although rates of clinical depression, suicidal tendencies, and adherence to conspiracy theories were much lower. However, the general model of factors interplay seems to be the same and this could be of practical utility since many of these factors are modifiable. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

Published
2023

3. Sociodemographic Factors of Depression During the COVID-19 Pandemic in Malaysia: the COVID-19 Mental Health International Study

Author

Salmi Razali, Dina Tukhvatullina, Nurul Azreen Hashim, Nor Jannah Nasution Raduan, Saw Jo Anne, Zaliha Ismail, Mikaella E Patsali, Daria Smirnova, and Konstantinos N Fountoulakis

Abstract

To determine the prevalence of depression and the sociodemographic factors associated with depression in Malaysia during the COVID-19 pandemic METHODS. This study is part of the COVID-19 Mental Health International Study to collect data on the impact of the pandemic on mental health through an online survey. People who were aged ≥18 years, able to read Malay or English, had access to the internet, and consented to participate were asked to complete a pro forma questionnaire to collect their sociodemographic data. The presence of distress and depression was assessed using the English or Malay version of the Center for Epidemiologic Studies Depression Scale.Of 963 participants, 451 (46.8%) had depression and 512 (53.2%) had no depression who were either normal (n = 169, 17.5%) or had distress (n = 343, 35.6%). Participants had higher odds of having depression when living with two people (adjusted odds ratio [AOR] = 3.896, p = 0.001), three people (AOR = 2.622, p0.001) or four people (AOR = 3.135, p0.001). Participants with three children had higher odds of having depression (AOR = 2.084, p = 0.008), whereas having only one child was a protective factor for depression (AOR = 0.481, p = 0.01). Participants had higher odds of having depression when self-employed (AOR = 3.825, p = 0.003), retired (AOR = 4.526, p = 0.001), being housekeeper (AOR = 7.478, p = 0.004), not working by choice (AOR = 5.511, p0.001), or unemployed (AOR = 3.883, p = 0.009). Participants had higher odds of depression when living in a small town (AOR = 3.193, p0.001) or rural area (AOR = 3.467, p0.001). Participants with no chronic medical illness had lower odds of having depression (AOR = 0.589, p = 0.008).In Malaysia during the COVID-19 pandemic, people who are living with two, three, or four people, having three children, living in a small town or rural areas, and having unstable income have higher odds of having depression. Urgent intervention for those at risk of depression is recommended.

Published
2022

6. The effect of different degrees of lockdown and self-identified gender on anxiety, depression and suicidality during the COVID-19 pandemic: Data from the international COMET-G study

Author

Konstantinos N. Fountoulakis, Grigorios N. Karakatsoulis, Seri Abraham, Kristina Adorjan, Helal Uddin Ahmed, Renato D. Alarcón, Kiyomi Arai, Sani Salihu Auwal, Michael Berk, Sarah Bjedov, Julio Bobes, Teresa Bobes-Bascaran, Julie Bourgin-Duchesnay, Cristina Ana Bredicean, Laurynas Bukelskis, Akaki Burkadze, Indira Indiana Cabrera Abud, Ruby Castilla-Puentes, Marcelo Cetkovich, Hector Colon-Rivera, Ricardo Corral, Carla Cortez-Vergara, Piirika Crepin, Domenico De Berardis, Sergio Zamora Delgado, David De Lucena, Avinash De Sousa, Ramona Di Stefano, Seetal Dodd, Livia Priyanka Elek, Anna Elissa, Berta Erdelyi-Hamza, Gamze Erzin, Martin J. Etchevers, Peter Falkai, Adriana Farcas, Ilya Fedotov, Viktoriia Filatova, Nikolaos K. Fountoulakis, Iryna Frankova, Francesco Franza, Pedro Frias, Tatiana Galako, Cristian J. Garay, Leticia Garcia-Álvarez, Maria Paz García-Portilla, Xenia Gonda, Tomasz M. Gondek, Daniela Morera González, Hilary Gould, Paolo Grandinetti, Arturo Grau, Violeta Groudeva, Michal Hagin, Takayuki Harada, Tasdik M. Hasan, Nurul Azreen Hashim, Jan Hilbig, Sahadat Hossain, Rossitza Iakimova, Mona Ibrahim, Felicia Iftene, Yulia Ignatenko, Matias Irarrazaval, Zaliha Ismail, Jamila Ismayilova, Asaf Jacobs, Miro Jakovljević, Nenad Jakšić, Afzal Javed, Helin Yilmaz Kafali, Sagar Karia, Olga Kazakova, Doaa Khalifa, Olena Khaustova, Steve Koh, Svetlana Kopishinskaia, Korneliia Kosenko, Sotirios A. Koupidis, Illes Kovacs, Barbara Kulig, Alisha Lalljee, Justine Liewig, Abdul Majid, Evgeniia Malashonkova, Khamelia Malik, Najma Iqbal Malik, Gulay Mammadzada, Bilvesh Mandalia, Donatella Marazziti, Darko Marčinko, Stephanie Martinez, Eimantas Matiekus, Gabriela Mejia, Roha Saeed Memon, Xarah Elenne Meza Martínez, Dalia Mickevičiūtė, Roumen Milev, Muftau Mohammed, Alejandro Molina-López, Petr Morozov, Nuru Suleiman Muhammad, Filip Mustač, Mika S. Naor, Amira Nassieb, Alvydas Navickas, Tarek Okasha, Milena Pandova, Anca-Livia Panfil, Liliya Panteleeva, Ion Papava, Mikaella E. Patsali, Alexey Pavlichenko, Bojana Pejuskovic, Mariana Pinto Da Costa, Mikhail Popkov, Dina Popovic, Nor Jannah Nasution Raduan, Francisca Vargas Ramírez, Elmars Rancans, Salmi Razali, Federico Rebok, Anna Rewekant, Elena Ninoska Reyes Flores, María Teresa Rivera-Encinas, Pilar Saiz, Manuel Sánchez de Carmona, David Saucedo Martínez, Jo Anne Saw, Görkem Saygili, Patricia Schneidereit, Bhumika Shah, Tomohiro Shirasaka, Ketevan Silagadze, Satti Sitanggang, Oleg Skugarevsky, Anna Spikina, Sridevi Sira Mahalingappa, Maria Stoyanova, Anna Szczegielniak, Simona Claudia Tamasan, Giuseppe Tavormina, Maurilio Giuseppe Maria Tavormina, Pavlos N. Theodorakis, Mauricio Tohen, Eva Maria Tsapakis, Dina Tukhvatullina, Irfan Ullah, Ratnaraj Vaidya, Johann M. Vega-Dienstmaier, Jelena Vrublevska, Olivera Vukovic, Olga Vysotska, Natalia Widiasih, Anna Yashikhina, Panagiotis E. Prezerakos, Daria Smirnova, Karakatsoulis, Grigorios N [0000-0002-4786-1217], Alarcón, Renato D [0000-0002-7316-1185], Berk, Michael [0000-0002-5554-6946], Apollo - University of Cambridge Repository, Psychiatry 1, RS: MHeNs - R2 - Mental Health, and Psychiatrie & Neuropsychologie

Subjects
Male, Mental health, lockdown, anxiety, mental health history, Depression, Depression/epidemiology, COVID-19, Suicidality, Anxiety, Psychiatry and Mental health, Suicide, Communicable Disease Control, Humans, Female, Pandemics, Biological Psychiatry, Anxiety/epidemiology
Abstract

Fountoulakis K.N., Karakatsoulis G.N., Abraham S., Adorjan K., Ahmed H.U., Alarcón R.D., Arai K., Auwal S.S., Berk M., Bjedov S., Bobes J., Bobes-Bascaran T., Bourgin-Duchesnay J., Bredicean C.A., Bukelskis L., Burkadze A., Abud I.I.C., Castilla-Puentes R., Cetkovich M., Colon-Rivera H., Corral R., Cortez-Vergara C., Crepin P., De Berardis D., Delgado S.Z., De Lucena D., De Sousa A., Stefano R.D., Dodd S., Elek L.P., Elissa A., Erdelyi-Hamza B., Erzin G., Etchevers M.J., Falkai P., Farcas A., Fedotov I., Filatova V., Fountoulakis N.K., Frankova I., Franza F., Frias P., Galako T., Garay C.J., Garcia-Álvarez L., García-Portilla M.P., Gonda X., Gondek T.M., González D.M., Gould H., Grandinetti P., Grau A., Groudeva V., Hagin M., Harada T., Hasan T.M., Hashim N.A., Hilbig J., Hossain S., Iakimova R., Ibrahim M., Iftene F., Ignatenko Y., Irarrazaval M., Ismail Z., Ismayilova J., Jacobs A., Jakovljević M., Jakšić N., Javed A., Kafali H.Y., Karia S., Kazakova O., Khalifa D., Khaustova O., Koh S., Kopishinskaia S., Kosenko K., Koupidis S.A., Kovacs I., Kulig B., Lalljee A., Liewig J., Majid A., Malashonkova E., Malik K., Malik N.I., Mammadzada G., Mandalia B., Marazziti D., Marčinko D., Martinez S., Matiekus E., Mejia G., Memon R.S., Martínez X.E.M., Mickevičiūtė D., Milev R., Mohammed M., Molina-López A., Morozov P., Muhammad N.S., Mustač F., Naor M.S., Nassieb A., Navickas A., Okasha T., Pandova M., Panfil A.-L., Panteleeva L., Papava I., Patsali M.E., Pavlichenko A., Pejuskovic B., Da Costa M.P., Popkov M., Popovic D., Raduan N.J.N., Ramírez F.V., Rancans E., Razali S., Rebok F., Rewekant A., Flores E.N.R., Rivera-Encinas M.T., Saiz P., de Carmona M.S., Martínez D.S., Saw J.A., Saygili G., Schneidereit P., Shah B., Shirasaka T., Silagadze K., Sitanggang S., Skugarevsky O., Spikina A., Mahalingappa S.S., Stoyanova M., Szczegielniak A., Tamasan S.C., Tavormina G., Tavormina M.G.M., Theodorakis P.N., Tohen M., Tsapakis E.M., Tukhvatullina D., Ullah I., Vaidya R., Vega-Dienstmaier J.M., Vrublevska J., Vukovic O., Vysotska O., Widiasih N., Yashikhina A., Prezerakos P.E., Smirnova D.

Published
2022
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7. Results of the COVID-19 mental health international for the general population (COMET-G) study

Author

Kiyomi Arai, Anca Livia Panfil, Darko Marčinko, J. Vrublevska, Muftau Mohammed, Dalia Mickevičiūtė, Piirika Crepin, Görkem Saygili, Nor Jannah Nasution Raduan, Seetal Dodd, Anna Yashikhina, Daniela Morera González, Elmars Rancans, Cristian Javier Garay, Helal Uddin Ahmed, Khamelia Malik, Eimantas Matiekus, Tomohiro Shirasaka, Paolo Grandinetti, Tasdik M. Hasan, Sotirios A. Koupidis, Nurul Azreen Hashim, Pilar A. Saiz, David Saucedo Martínez, Arturo Grau, Alejandro Molina-López, Jo Anne Saw, Dina Tukhvatullina, Felicia Iftene, Renato D. Alarcón, Svetlana Kopishinskaia, Sahadat Hossain, Olivera Vuković, Mika S. Naor, Satti Sitanggang, Sridevi Sira Mahalingappa, Leticia García-Álvarez, Manuel Sanchez de Carmona, Liliya Panteleeva, Olga Kazakova, Jan Hilbig, Johann M. Vega-Dienstmaier, Francesco Franza, Matias Irarrazaval, Pavlos N. Theodorakis, Sani Salihu Auwal, Alvydas Navickas, Domenico De Berardis, Viktoriia Filatova, David Freitas de Lucena, Miro Jakovljevic, Afzal Javed, Gulay Mammadzada, Olena Khaustova, Adriana Farcas, Steve Koh, Ruby C. Castilla-Puentes, Panagiotis E. Prezerakos, Gamze Erzin, Takayuki Harada, Pedro Frias, Tatiana Galako, Kristina Adorjan, Hector Colon-Rivera, Justine Liewig, Oleg Skugarevsky, Indira Indiana Cabrera Abud, Sarah Bjedov, Berta Erdelyi-Hamza, Korneliia Kosenko, Barbara Kulig, Xarah Elenne Meza Martínez, Bojana Pejuskovic, Ratnaraj Vaidya, Elena Ninoska Reyes Flores, Sergio Zamora Delgado, Marcelo Cetkovich, Avinash De Sousa, Eva Maria Tsapakis, Iryna Frankova, Federico Rebok, Petr Morozov, Amira Nassieb, Bilvesh Mandalia, Alexey Pavlichenko, Mariana Pinto da Costa, Anna Rewekant, Patricia Schneidereit, Olga Vysotska, Roumen Milev, Maria Stoyanova, Laurynas Bukelskis, Roha Saeed Memon, Ricardo Corral, Nuru Suleiman Muhammad, Donatella Marazziti, Michal Hagin, María Teresa Rivera-Encinas, Julie Bourgin-Duchesnay, Giuseppe Tavormina, Jamila Ismayilova, Mauricio Tohen, Helin Yilmaz Kafali, María Paz García-Portilla, Violeta Groudeva, Daria Smirnova, Mikaella E. Patsali, Ramona Di Stefano, Filip Mustač, Nikolaos K. Fountoulakis, Dina Popovic, Abdul Majid, Michael Berk, Anna Spikina, Alisha Lalljee, Zaliha Ismail, Mikhail Popkov, Xenia Gonda, Julio Bobes, Sagar Karia, Salmi Razali, Carla Cortez-Vergara, Konstantinos N. Fountoulakis, Rossitza Iakimova, Francisca Vargas Ramírez, Maurilio Giuseppe Maria Tavormina, Asaf Jakobs, Najma Iqbal Malik, Teresa Bobes-Bascarán, Illés Kovács, Hilary Gould, Tarek Okasha, Anna Szczegielniak, Peter Falkai, Nenad Jakšić, Livia Priyanka Elek, Evgeniia Malashonkova, C. Bredicean, Yulia Ignatenko, Bhumika Shah, Akaki Burkadze, Seri Abraham, Anna Elissa, Ion Papava, Mona Ibrahim, Doaa Ahmed Khalifa, Milena Pandova, Gabriela Mejia, Tomasz M. Gondek, Simona Claudia Tamasan, Grigorios N Karakatsoulis, Ketevan Silagadze, Stephanie Martinez, Ilya Fedotov, Martin J. Etchevers, Irfan Ullah, Natalia Widiasih, Berk, Michael [0000-0002-5554-6946], Bobes-Bascaran, Teresa [0000-0002-5279-504X], and Apollo - University of Cambridge Repository

Subjects
Male, Psychological intervention, Anxiety, Mental disorders, Suicidality, Global Burden of Disease, COVID-19 / epidemiology, 0302 clinical medicine, Anxiety / epidemiology, COVID-19, depression, suicidality, mental health, conspiracy theories, mental disorders, psychiatry, anxiety, Pharmacology (medical), 030212 general & internal medicine, Depression (differential diagnoses), Psychiatry, education.field_of_study, Depression, Anxiety / etiology, Conspiracy theories, Mental Health, Middle Aged, Depression / etiology, 3. Good health, Psychiatry and Mental health, Distress, COVID-19 / complications, Neurology, Female, Mental health, medicine.symptom, Clinical psychology, Adult, COVID-19 / psychology, Population, Article, Suicidal Ideation, 03 medical and health sciences, medicine, Humans, Bipolar disorder, education, Pandemics, Biological Psychiatry, Depression / epidemiology, Pharmacology, business.industry, SARS-CoV-2, Stress, Psychological / etiology, medicine.disease, Relative risk, Neurology (clinical), business, 030217 neurology & neurosurgery, Stress, Psychological
Abstract

Introduction: There are few published empirical data on the effects of COVID-19 on mental health, and until now, there is no large international study. ----- Material and methods: During the COVID-19 pandemic, an online questionnaire gathered data from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively. ----- Statistical analysis: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables. ----- Results: Probable depression was detected in 17.80% and distress in 16.71%. A significant percentage reported a deterioration in mental state, family dynamics and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (31.82% vs. 13.07%). At least half of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop depression was associated with history of Bipolar disorder and self-harm/attempts (RR = 5.88). Suicidality was not increased in persons without a history of any mental disorder. Based on these results a model was developed. ----- Conclusions: The final model revealed multiple vulnerabilities and an interplay leading from simple anxiety to probable depression and suicidality through distress. This could be of practical utility since many of these factors are modifiable. Future research and interventions should specifically focus on them.

Published
2021

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