Department of Primary and Community Care, Radboud university medical center, Nijmegen, Netherlands.
Academic Collaborative Intellectual Disability and Health - Sterker op Eigen Benen (SOEB), Nijmegen, Netherlands.
JMIR Public Health Surveill. 2024 May 30;10:e44827. doi: 10.2196/44827.
The COVID-19 pandemic and related control measures affected the mental health of all populations. Particular subgroups are underrepresented in mainstream surveys because they are hard to reach, and study measurements are not adapted to their skills. These subgroups include people with lower cognitive and literacy skills, such as people with mild intellectual disability (MID), who were considered vulnerable during the COVID-19 pandemic given their low socioeconomic status, small social networks, increased risks of health problems, and difficulties understanding health-related information.
This study examines the impact of the COVID-19 pandemic on mental health among people with MID or low literacy skills compared with those predominantly represented in national surveys.
A repeated cross-sectional study of people with MID or low literacy skills and a general population sample was conducted in the Netherlands. An easy-read web-based survey was co-designed with, and tested among, people with MID or low literacy skills and conducted in 3 rounds within 1 year of the COVID-19 pandemic (T1: November to December 2020, T2: March to April 2021, and T3: September to October 2021). The survey contained questions about demographics and 6 aspects of mental health: feeling happy, feeling energized, feeling stressed, worry, feeling lonely, and sleeping problems.
Our adapted survey and recruitment procedure enabled 1059 persons with MID or low literacy skills to participate (T1: n=412, 38.9%; T2: n=351, 33.1%; and T3: n=296, 28%). They were significantly younger, had a lower level of education, and more often than not were born outside the Netherlands compared to the general population sample (P<.001). Approximately half of them (604/1059, 57.03%) received professional care. They displayed poorer mental health scores than the general population sample. The percentages of people with MID or low literacy skills who reported more negative feelings in T1 ranged from 20.6% (85/412) reporting feeling lonely often or almost always to 57.8% (238/412) reporting feeling happy almost never or sometimes. The general population sample's percentages were 5.4% (160/2930) and 32.2% (941/2918), respectively. Although scores improved over time in both populations, the disproportional effects remained.
General COVID-19-related restrictions for the entire Dutch population affected people with MID or low literacy skills more negatively than the general population. Our study underscores the relevance of including these subpopulations in public health research because they are often overlooked in regular health data. An accessible web-based survey particularly targeted at this population enabled us to do so, and we reached a group of respondents significantly different from regular survey participants. This survey's results provided insights into the health of people with MID or low literacy skills and gained knowledge to be used by care organizations and policy makers to reduce health disparities during a pandemic and in general.
COVID-19 大流行及相关防控措施影响了所有人群的心理健康。特定亚组在主流调查中代表性不足，因为这些亚组难以接触到，且研究测量方法不适应他们的能力。这些亚组包括认知和读写能力较低的人群，例如轻度智力障碍（MID）患者，他们在 COVID-19 大流行期间被认为是弱势群体，因为他们社会经济地位较低、社交网络较小、健康问题风险增加以及难以理解与健康相关的信息。
本研究旨在调查 COVID-19 大流行对 MID 患者或低读写能力人群心理健康的影响，这些人群与主要出现在全国性调查中的人群相比处于劣势地位。
在荷兰，对 MID 患者或低读写能力人群和一般人群样本进行了一项重复的横断面研究。采用易于阅读的网络调查，与 MID 患者或低读写能力人群共同设计并进行了测试，并在 COVID-19 大流行后的 1 年内进行了 3 轮调查（T1：2020 年 11 月至 12 月；T2：2021 年 3 月至 4 月；T3：2021 年 9 月至 10 月）。调查包含了关于人口统计学和 6 个心理健康方面的问题：感到快乐、感到精力充沛、感到有压力、担忧、感到孤独和睡眠问题。
我们的适应性调查和招募程序使 1059 名 MID 患者或低读写能力人群参与其中（T1：n=412，38.9%；T2：n=351，33.1%；T3：n=296，28%）。与一般人群样本相比，他们的年龄明显更小，受教育程度更低，且多数人（T1：604/1059，57.03%）出生在荷兰以外的国家。他们的心理健康评分明显比一般人群样本差。在 T1 中，有 MID 患者或低读写能力人群报告有较多负面情绪的比例为 20.6%（85/412）报告经常或几乎总是感到孤独，到 57.8%（238/412）报告几乎从未或有时感到快乐。一般人群样本的比例分别为 5.4%（160/2930）和 32.2%（941/2918）。尽管两个群体的分数都随着时间的推移有所提高，但不成比例的影响仍然存在。
针对荷兰全体人口的一般 COVID-19 相关限制对 MID 患者或低读写能力人群的负面影响大于一般人群。我们的研究强调了将这些亚人群纳入公共卫生研究的相关性，因为他们在常规健康数据中经常被忽视。一项针对该人群的可及性网络调查使我们能够做到这一点，我们接触到了一群与常规调查参与者明显不同的受访者。该调查的结果提供了对 MID 患者或低读写能力人群健康状况的深入了解，并为护理组织和政策制定者提供了知识，以减少大流行期间和总体上的健康差距。
