A person-centered approach to capture health disparities and multidimensional impact of COVID-related stressors

Abstract

The COVID-19 pandemic has influenced people's lives in diverse ways. The authors utilized latent class analysis (LCA), a person-centered approach, to examine distinct patterns of COVID-related stressors and their associations with alcohol-related, mental health, and quality of life outcomes. Participants were 463 adults who completed the baseline assessment of the National Institute on Alcohol Abuse and Alcoholism COVID-19 Pandemic Impact on Alcohol Study from June 2020 to January 2022. Using cross-sectional data, three analytic methods (continuous sum score, categorical grouping, and LCA) were applied to model 17 COVID-related stressors. Regression analyses indicated higher COVID-related stress and endorsement of four or more COVID-related stressors were generally associated with worse health-related outcomes. LCA revealed four classes: Class 1: Minimal COVID-Related Impact (51.6%); Class 2: Work Interruptions (24.8%); Class 3: Family/Friends Affected by COVID (14.5%); and Class 4: Serious Financial Stress (9.1%). Racial/ethnic minorities were more likely to be in Class 3, whereas individuals with more years of education and higher income were less likely to be in Class 4. Individuals with a history of alcohol use disorder were more likely to be in Classes 2 and 4. Compared with Class 1, Class 4 reported highest levels of perceived stress, problematic alcohol use, anxiety symptoms, depressive symptoms, alcohol craving, loneliness, drinking to cope, and lowest levels of physical, psychological, social, and environment quality of life. COVID-related stressors disproportionately affected minority and vulnerable groups. Individuals who experienced multiple financial stressors had the greatest risk for negative health-related outcomes and may benefit from holistic interventions and community outreach. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Figure 1.

Continuous Sum Score, Categorical Grouping, and Latent Class Analysis of COVID-Related Stressors Note. Panel A shows the frequency distribution of COVID-related stressors and the mean, standard deviation, skewness, and kurtosis of the computed continuous sum score. Panel B shows a three-level categorical grouping of COVID-related stressors into low (30.7%), medium (32.2%), and high (37.2%) levels. Panel C shows the optimal four-class solution empirically derived from latent class analysis. See the online article for the color version of this figure.

Figure 2.

Proportions of Latent Class Membership by Demographic Characteristics, History of AUD, and Enrollment Phase Note. This figure shows the proportions of the four latent classes by age (Panel A), gender (Panel B), race (Panel C), ethnicity (Panel D), years of education (Panel E), household income (Panel F), history of AUD (Panel G), and enrollment phase (Panel H). AUD = alcohol use disorder. See the online article for the color version of this figure.

Figure 3.

Associations Between COVID-Related Stressors and Primary Outcomes From Baseline 1 Survey Note. Two common variable-centered approaches are illustrated for perceived stress (Panels A1 and A2) and problematic alcohol use (Panels B1 and B2). These two variable-centered approaches are contrasted with the latent class analysis approach illustrated in Panels A3 and B3, which showed the highest levels of perceived stress and problematic alcohol use in Class 4 (Serious Financial Stress). Panels C, D, and E illustrate that a similar pattern was found for anxiety symptoms, depressive symptoms, and alcohol cravings, respectively. Error bars indicate 95% confidence intervals. PSS = Perceived Stress Scale; AUDIT = Alcohol Use Disorders Identification Test; GAD-7 = Generalized Anxiety Disorder-7; PHQ-9 = Patient Health Questionnaire-9; PACS = Penn Alcohol Craving Scale. See the online article for the color version of this figure.

Figure 4.

Associations Between COVID-Related Stressors and Secondary Outcomes From Baseline 2 Survey Note. Utilizing the latent class analysis approach, a consistent pattern emerged in which Class 4 (Serious Financial Stress) scored the highest on secondary outcomes of interest, including loneliness (Panel A), drinking to cope (Panel B), and the four domains of QoL (Panels C, D, E, and F). Error bars indicate 95% confidence intervals. UCLA Loneliness = University of California, Los Angeles Loneliness Scale; DMQ-Coping = Drinking Motives Questionnaire-Revised - Coping Subscale; WHOQOL = World Health Organization Quality of Life-BREF; QoL = quality of life. See the online article for the color version of this figure.