Fear of the coronavirus (COVID-19): Predictors in an online study conducted in March 2020

Mental health and illness of medical students and newly graduated doctors during the pandemic of SARS-Cov-2/COVID-19

Introduction: SARS-Cov-2 virus pandemic causes serious emotional consequences. It has occurred widespread medical courses suspension, and graduations were anticipated. Field hospitals, set up to treat patients with mild to moderate COVID-19, were the main workplaces of newly graduated doctors. Objective: To assess the impact of SARS-Cov-2/COVID-19 pandemic on mental health of medical interns and newly graduated doctors. Method: This is a cross-sectional study performed using a digital platform. Links to forms were sent in two moments: moment 1 (M1), at the beginning of the pandemic, in the first half of April/2020 and moment 2 (M2), after six months of pandemic, in the second half of September/2020. All students from the medical internship and all doctors graduated since 2018 from the three medical schools in Sergipe-NE-Brazil were invited. Results: 335 forms were answered in April and 148 in September. In M1 88.9% considered themselves exposed to excess of information about COVID-19, which was associated with anxiety symptoms (p = 0.04). Long family physical distance was also associated with these symptoms, as increased appetite (p = 0.01), feeling shortness of breath (p = 0.003) and sweating (p = 0.007). Fear of acquire COVID-19 was reported as intense by almost half of participants, and of transmitting by 85.7% in M1. In M2 41.2% reported the death of friends or relatives. Psychiatric illness was described by 38.5% and psychotropic drugs use by 30.1% in M1, especially those who lived alone (p = 0.03) and the single ones (p = 0.01). Alcohol intake was reported by 54.3%, and among doctors graduated in 2020 it increased from 50% in M1 to 85% in M2 (p = 0.04). Conclusion: The pandemic had a negative impact on the mental health of medical students and newly graduated doctors. Exposure to excessive COVID-19 information and family physical distance were associated to anxiety symptoms. Among doctors graduated in 2020, alcohol intake increased during pandemic evolution.

Intolerance of uncertainty and reactions to the COVID-19 pandemic

The COVID-19 pandemic has presented a threat to mental health worldwide. The current study aims to investigate the role of intolerance of uncertainty in cognitive, emotional and behavioral reactions to this pandemic and propose a path model of these reactions. In the first two months of the COVID-19 pandemic in Slovakia, participants in a general sample (n = 1,011) as well as an older adult sample (n = 655) completed measures regarding intolerance of uncertainty, mental health (anxiety, well-being, perceived stress) and adherence to preventive measures. Two rounds of data collection were carried out in the first sample. Intolerance of uncertainty was found to be related to mental health indicators and the structural equation model showed a direct and indirect effect on them as well as on the adherence to preventive measures. However, the comparison of data from different time points has brought inconsistent results. The findings highlight the role of intolerance of uncertainty in reaction to threat and indicate the potential of uncertainty reduction e.g., getting clear messages from authorities, as a way of decreasing mental health problems.

Factors explaining the fear of being infected with COVID-19

Background

The prevalence of COVID‐19 has a social and economic impact on people, leaving them distressed and fearful of getting infected.

Objective

To determine the variables attributable to the fear of contracting COVID‐19.

Design

This is a quantitative study based on an online cross‐sectional self‐administered survey in Chile between 10 July 2020 and 10 August 2020.

Setting and participants

A sample of 531, comprising over 18‐year‐old participants from middle‐ and high‐income levels, was selected.

Outcome measures

Estimations were obtained using a probit regression model with marginal effects.

Results

Fear prevailed mainly in women. It has a positive relationship with variables such as chronic illnesses, infectious family or relatives, reduction in economic activity and perception of bad government response to a pandemic. Fear has a negative relationship with knowledge about COVID‐19, education level and ageing. Moreover, those who consider socioeconomic impact less important than health care do not fear a COVID‐19 infection.

Discussionand conclusion

The socioeconomic and health aspects help predict fears. Thus, the government should prioritize these variables in implementing policies. The government's credibility and communication systems can also reduce fears of contracting COVID‐19.

Patient or public contribution

A pilot focus group of COVID‐19–recuperated individuals and some members of our interest groups were consulted in the design stage of the study; this helped in constructing the survey questions. Additionally, three independent individuals volunteered to read and comment on the draft manuscript.

Quality of life under the COVID-19 quarantine

BACKGROUND

COVID-19 has spread rapidly throughout the world, causing thousands of illnesses and deaths. To fight this pandemic, almost all governments and health authorities have focused on prevention. In March or April, most countries' officials imposed home quarantine and lockdown measures nationwide.

PURPOSE

This study sought to assess health-related quality of life (HRQoL) and anxiety levels among people in Portugal under mandatory home quarantine due to the COVID-19 pandemic. The results were compared to the general Portuguese population's HRQoL before the COVID-19 outbreak. This research also aimed to understand the factors that can influence the respondents' HRQoL.

METHODS

A sample of Portugal's population quarantined at home (n = 904) filled in an online survey comprising the Generalized Anxiety Disorder 7-item and the EQ-5D-5L and other questions about sociodemographic characteristics, feelings, duties and activities during the quarantine. The sample was weighted to mirror the general population's gender, age and education. Descriptive analyses and correlation coefficients were used to evaluation the respondents' anxiety and HRQoL. Generalised linear models were estimated to identify determinants of HRQoL during the COVID-19 quarantine.

RESULTS

The results show that individuals quarantined at home reported higher anxiety and lower HRQoL levels and that people with more anxiety tended to have a lower HRQoL. Females and elderly individuals experienced the highest levels of anxiety and poorest HRQoL. In addition, HRQoL during the quarantine can be explained by various occupational and attitudinal variables, as well as sociodemographic variables.

CONCLUSION

Individuals' mental health should be taken into consideration during pandemics or other emergency situations. Anxiety and other factors can decrease people's HRQoL, in conjunction with the pandemic's social and economic consequences.

COVID-19 information overload and generation Z's social media discontinuance intention during the pandemic lockdown

While previous research highlights the benefits of social media in times of a pandemic, this research focuses on the potential dark side of social media use among Generation Z (Gen Z) in the UK during the COVID-19 pandemic lockdown between March and May 2020. The study reveals that COVID-19 information overload through social media had a negative impact on Gen Z social media users' psychological well-being. Moreover, perceived information overload heightened both social media fatigue and fear of COVID-19, which, in turn, increased users' social media discontinuance intention. In addition, considering that social media is the predominant method of maintaining connectivity with others for Gen Z users during the lockdown, the fear of missing out (FoMO) buffered the impact of social media fatigue and fear of COVID-19 on Gen Z users' social media discontinuance intention. Our research adds a hitherto underexplored perspective to the impact of the COVID-19 pandemic on young people's mental health. We offer a series of practical suggestions for social media users, social media platform providers, and health officials, institutions, and organizations in the effective and sustainable use of social media during the global COVID-19 pandemic and in the post-pandemic time.

[Evidence of the validity of a Brazilian version of the Fear of COVID-19 Scale]

This study sought to analyze the evidence of the validity of a Brazilian version of the Fear of COVID-19 Scale (FCV-19S), based on indicators relating to: (1) the internal structure; (2) the internal consistency; (3) the relation with external variables; and (4) the content. The instrument was culturally adapted, focusing on semantic and specifically Brazilian linguistic aspects. The Brazilian version of the FCV-19S was then applied, in a virtual environment, to 211 participants (72.98% female) with an average age of 37.07 years (SD=13.03), together with the Self-Perception Questionnaire on Mental Health in Pandemics and the Sociodemographic and Functional Questionnaire. The confirmatory factor analysis revealed one-dimensionality. The internal consistency indices obtained (Cronbach's alpha =0.921; McDonald's omega =0.926) can be considered high. The correlation between fear and obsessive thinking of the disease, generalized anxiety, generalized stress, phobic-avoidant behavior and bereavement due to the pandemic was found to be statistically significant. Evidence of the validity related to content, derived from a qualitative approach, were satisfactory. The conclusion drawn is that the Brazilian version of the FCV-19S proved to be adequate regarding the evidence of the expected validity.

Predictors of Mental Health after the First Wave of the COVID-19 Pandemic in Poland

The aim of the article is to determine the predictors of mental health among Polish society. Research was conducted after the first wave of the pandemic. Due to such an approach, it was possible to determine whether the secondary effects of the pandemic have impacted on mental health, in addition to socio-demographic and psychological factors. In order to gather the research material, the CAWI on-line survey method was applied and carried out within the framework of the Ariadna Research Panel on a sample of 1079 Poles, aged 15 and over. The FCV-19S scale, which is used to measure the fear of COVID-19 was applied in the measurement. It is a verified diagnostic instrument used to measure mental health across a range of countries. The results of a hierarchical regression analysis have shown that the factors which increase the level of fear of COVID-19 are demographic, social and psychological features, as well as attitudes towards the pandemic. The results of research indicate the significance of social context in the analysis, and contribute to the explanation of the effects of disasters and cataclysms.

Levels and predictors of fear and health anxiety during the current outbreak of COVID-19 in immunocompromised and chronic disease patients in Saudi Arabia: A cross-sectional correlational study

Coronavirus disease 2019 (COVID-19) infection has become a clinical threat to healthy people as well as immunocompromised patients and those with pre-existing chronic diseases around the world. This study, which used a cross-sectional correlational design, aimed to assess the levels of fear and health anxiety and to investigate their predictors during the current outbreak of COVID-19 in immunocompromised and chronic disease patients in Saudi Arabia. Sociodemographic and clinical data, fear of COVID-19, and health anxiety measurements were collected by online surveys from June 15 to July 15, 2020. Univariate and multiple linear regression analysis was used to identify predictors. A total of 1,030 patients in 13 provinces in Saudi Arabia completed the questionnaire. A significant number of patients with chronic diseases experienced considerable levels of fear and anxiety during the COVID-19 outbreak. It was found that 21.44% of participants met the criteria for anxiety cases, and 19.4% were considered borderline anxiety cases. In regression analysis, significant predictors of fear and health anxiety were female gender, lower education, middle-aged, divorced or widowed, receiving immunosuppressants, type of chronic disease (Crohn’s disease, hypertension, and cardiovascular diseases), and media use as a source of knowledge about COVID-19. Immunocompromised and chronic disease patients are vulnerable to fear and anxiety during epidemic infectious diseases such as COVID-19. Optimizing this population’s compliance with appropriate infection prevention and control strategies is crucial during the infectious outbreaks to ensure their safety, to decrease the risk of infection and serious complications, and reduce their fear and health anxiety. Effective positive psychological interventions and support strategies also need to be immediately implemented to increase psychological resilience and improve the mental health of these patients. Due to the COVID-19 outbreak, chronic disease patients in Saudi Arabia need special attention from health authorities, policymakers, and healthcare professionals to manage maladaptive forms of health anxiety and fear.

Acceptance and attitudes toward COVID-19 vaccines: A cross-sectional study from Jordan

Vaccines are effective interventions that can reduce the high burden of diseases globally. However, public vaccine hesitancy is a pressing problem for public health authorities. With the availability of COVID-19 vaccines, little information is available on the public acceptability and attitudes towards the COVID-19 vaccines in Jordan. This study aimed to investigate the acceptability of COVID-19 vaccines and its predictors in addition to the attitudes towards these vaccines among public in Jordan. An online, cross-sectional, and self-administered questionnaire was instrumentalized to survey adult participants from Jordan on the acceptability of COVID-19 vaccines. Logistic regression analysis was used to find the predictors of COVID-19 vaccines' acceptability. A total of 3,100 participants completed the survey. The public acceptability of COVID-19 vaccines was fairly low (37.4%) in Jordan. Males (OR = 2.488, 95CI% = 1.834-3.375, p < .001) and those who took the seasonal influenza vaccine (OR = 2.036, 95CI% = 1.306-3.174, p = .002) were more likely to accept COVID-19 vaccines. Similarly, participants who believed that vaccines are generally safe (OR = 9.258, 95CI% = 6.020-14.237, p < .001) and those who were willing to pay for vaccines (OR = 19.223, 95CI% = 13.665-27.042, p < .001), once available, were more likely to accept the COVID-19 vaccines. However, those above 35 years old (OR = 0.376, 95CI% = 0.233-0.607, p < .001) and employed participants (OR = 0.542, 95CI% = 0.405-0.725, p < .001) were less likely to accept the COVID-19 vaccines. Moreover, participants who believed that there was a conspiracy behind COVID-19 (OR = 0.502, 95CI% = 0.356-0.709, p < .001) and those who do not trust any source of information on COVID-19 vaccines (OR = 0.271, 95CI% = 0.183-0.400, p < .001), were less likely to have acceptance towards them. The most trusted sources of information on COVID-19 vaccines were healthcare providers. Systematic interventions are required by public health authorities to reduce the levels of vaccines' hesitancy and improve their acceptance. We believe these results and specifically the low rate of acceptability is alarming to Jordanian health authorities and should stir further studies on the root causes and the need of awareness campaigns. These interventions should take the form of reviving the trust in national health authorities and structured awareness campaigns that offer transparent information about the safety and efficacy of the vaccines and the technology that was utilized in their production.

COVID-19 Fear Level of Surgical Nurses Working in Pandemic and Surgical Units

Purpose

Nurses who care for COVID-19 patients are more likely to be affected psychologically than nurses who do not, and reactions such as increased fear may lead to psychological problems among nurses. The aim of this study was to determine the COVID-19 fear level of surgical nurses by using the Fear of COVID-19 Scale.

Design

A descriptive and cross-sectional study.

Methods

Totally, 202 surgical nurses who take care of suspected or infected COVID-19 patients working in pandemic and surgical units of a university hospital were included in the study. For data collection, “Nurse Characteristics Form” and “Fear of COVID-19 Scale” were used. Study data was analyzed with the descriptive statistics, Mann-Whitney U test, Spearman Correlation test.

Findings

The mean total COVID-19 fear score of the nurses was 25.09 ± 7.29 (min: 7, max: 35) and nurses who received training related to COVID-19 had statistically lower fear than those who did not (U = 3773.500; P= .027). Losing a patient because of COVID-19, being older and experienced in nursing significantly affected the total fear score of nurses (respectively, U = 3899.000; P= .004; r_s = 0.152; P = .031, r_s = 0.205; P = .003).

Conclusions

Surgical nurses have a moderate level of COVID-19 fear and it is recommended to conduct appropriate on-line training programs to develop psychological support strategies.

Health anxiety, coping mechanisms and COVID 19: An Indian community sample at week 1 of lockdown

It is critical to gain an understanding of the impact of the COVID 19 pandemic and the associated lockdown restrictions on the psychological, social and behavioural functioning of the general public, in order to inform public health promotion and future health service resource allocation. This cross-sectional study, completed during week 1 of lockdown in India, reports on data from 234 participants using an online survey. Data regarding health anxiety, coping mechanisms and locus of control was collected. Structural equation modelling was used to assess the relationship between locus of control, coping mechanisms, health anxiety and age. Age related differences in both locus of control and coping strategies were found. Younger people experienced more health-related anxiety and were more likely to engage with social media as a coping mechanism. Mindfulness-based strategies may reduce health anxiety by increasing tolerance of uncertainty experienced during the COVID 19 pandemic.

Exploring fear of COVID-19 and its correlates among older adults in Bangladesh

OBJECTIVE

This study was aimed to assess the perceived fear of COVID-19 and its associated factors among older adults in Bangladesh.

METHODS

This cross-sectional study was conducted in October 2020 among 1032 older Bangladeshi adults aged ≥60 years. A semi-structured questionnaire was used to collect information on participants' characteristics and COVID-19 related information. Perceived fear of COVID-19 was measured using the seven-item Fear of COVID-19 Scale (FCV-19S), where the cumulative score ranged from 7 to 35. Multiple linear regression was performed to identify factors associated with perceived fear of COVID-19.

RESULTS

The mean fear score was 19.4. Participants who were concerned about COVID-19 (β: 2.75, 95% CI: 1.71 to 3.78) and overwhelmed by COVID-19 (β: 3.31, 95% CI: 2.33 to 4.29) were significantly more likely to be fearful of COVID-19. Moreover, older adults who felt themselves isolated from others and whose close friends and family members were diagnosed with COVID-19 were more fearful. However, the participants who received COVID-19 related information from the health workers had a lower level of fear (β: -1.90, 95% CI: - 3.06 to - 0.73).

CONCLUSIONS

The presence of overwhelming fear of COVID-19 among the older adults of Bangladesh underlines the psychological needs of these vulnerable groups. Health workers have a key role in addressing these needs and further research is needed to identify the effective strategies for them to use.

Experiences of Patients With COVID-19 Admitted to the Intensive Care Units: A Qualitative Study

This study aimed to describe the experiences of patients with COVID-19 admitted to the intensive care units (ICU). The data were analyzed by content analysis on 16 ICU patients with COVID-19. Data were collected by semi-structured interviews. Three categories were identified: (a) captured by a challenging incident with subcategories: perceived sudden and challenging death, fear of carelessness in overcrowding, worry about the family, and frustration with stigmatizing; (b) the flourishing of life with subcategories: spiritual-awakening, resilience in the face of life challenges, promoting health behaviors, and striving for recovery; and (c) honoring the blessings with subcategories: understanding the importance of nurses, realizing the value of family, and realizing the value of altruism. COVID-19 survivors experienced both positive and negative experiences. The results of this study could help health care providers identify the needs of ICU patients with COVID-19, including psychological, social, and spiritual support and design care models.

The Persian Version of the COVID-19 Phobia Scale (Persian-C19P-S) and the Differences in COVID-19-Related Phobic Reactions in Patients with Anxiety Disorders

Coronavirus disease 2019 (COVID-19) is a pandemic outbreak increasing several psychological distress, such as anxiety and phobia, and may affect patients with anxiety disorders. A scale has been recently designed to assess COVID-19-related phobic reactions named the COVID-19 Phobia Scale (C19P-S). The present study aimed to evaluate factor structure, reliability, and validity of the Persian version of the C19P-S (Persian-C19P-S) in patients with anxiety disorders and to compare COVID-19-related phobia among these patients. Three hundred patients with anxiety disorders completed the Persian-C19P-S and other scales assessing anxiety traits (e.g., the Short Health Anxiety Inventory (SHAI), the Health Concerns Questionnaire-54 (HCQ-54), and the Patient Health Questionnaire-4 (PHQ-4)) and COVID-19-related distress (e.g., the COVID Stress Scales (CSS) and the Fear of COVID-19 Scale (FCV-19)). The results showed that the Persian-C19P-S replicated the four-factor structure of the original C19P-S. Internal consistency and test-retest reliability coefficients evidenced the reliability of the scale. The validity of the scale (convergent and discriminant validity) was confirmed. Patients who had generalized anxiety and panic disorders showed higher phobic reactions related to COVID-19 than those with social anxiety disorder and specific phobia. This study indicates that the Persian version of the C19P-S is a valid scale to be used in Iranian patients with anxiety disorders to evaluate COVID-19-related phobia. Moreover, COVID-19-related phobic reactions are higher in some specific types of anxiety disorders.

COVID-19 Lockdown and the Behavior Change on Physical Exercise, Pain and Psychological Well-Being: An International Multicentric Study

Objective: To evaluate the impact of the COVID-19 pandemic and the following lockdown on physical exercise (PEx) practice, pain, and psychological well-being. Methods: A cross-sectional multicentric study was performed using a nonrandom convenience sampling from the general population (≥18 years-old) of 6 countries (Brazil, Italy, France, Portugal, Germany, and Spain) adopting social isolation (SI). The validated self-administered online survey (PEF-COVID19) was used. The tests T-test and Chi-square with Bonferroni correction were used for statistical analysis and a multivariate logistic regression model (p ˂ 0.05). Results: We included 3194 replies and ~80% of the respondents were in SI. Brazilian sample was highly influenced by the pandemic considering PEx practice and habits, pain, anxiety, and stress (p ˂ 0.05). Among the European countries, Italy presented the major changes. The model to predict the non-practice of PEx during SI showed that the variables countries, smoking, SI, and PEx level were significant predictors (p ˂ 0.001). Conclusion: The pandemic changed the PEx practice and habits, and the psychological well-being of populations in different manners. Countries, smoking, SI, and PEx level were predictors for the non-practice of PEx. Public health strategies are suggested to avoid sedentary lifestyles and quality of life decrease.

The Development and Adoption of Online Learning in Pre- and Post-COVID-19: Combination of Technological System Evolution Theory and Unified Theory of Acceptance and Use of Technology

After the outbreak of COVID-19, schools heavily depend on e-learning technologies and tools to shift from in-person class to online. This review article analyzes the changes of technology evolution and technology adoption of e-learning in pre- and post-COVID-19 based on the Technology System Evaluation Theory (TSET) and technology adoption of e-learning based on the Unified Theory of Acceptance and Use of Technology (UTAUT). We intend to explore the interaction of technology evolution and technology adoption in the different focus of e-learning technology in the two stages and the particularity and heterogeneity of the UTAUT model. The results indicate that (1) The moderating results of technology evolution are proposed and evaluated under the UTAUT model before the COVID-19 outbreak. Studies after the COVID-19 pandemic paid more attention to technology efficiency rather than effectiveness; (2) Research on e-learning focuses on the infrastructure to reach more users after the outbreak of COVID-19 because e-learning is the only way to continue education; (3) COVID-19 fear moderates the relationship between the external factors and the behavior intention of e-learning users. The lack of financial support on technology evolution will directly weaken the implementation of new technology. Social Isolation offers more opportunities for students to engage in e-learning. Meanwhile, it slows down the implementation of e-learning because of out-to-date hardware and software. This article offers an enhanced understanding of the interaction of technology evolution and technology adoption under unexpected environments and provides practical insights into how to promote new technology in a way that users will accept and use easily. This study can be tested and extended by empirical research in the future.

Psychological Distress, Fear of COVID-19, and Resilient Coping Abilities among Healthcare Workers in a Tertiary First-Line Hospital during the Coronavirus Pandemic

The COVID-19 pandemic is causing a heavy burden in hospital healthcare workers (HCW) in terms of increased work, organizational changes, risk exposure, and social stigma. The present study aims at evaluating the psychological outcome among HCWs at the final stages of the first wave of the COVID-19 pandemic. This cross-sectional and survey-based study was conducted during June 2020 among 996 HCWs of the University Hospital of Padova. All the subjects completed questionnaires investigating the perception of risk of infecting or being infected by COVID-19, psychopathological variables, and coping abilities. Compared to physicians and healthcare assistants, nurses showed higher levels of depression (p = 0.002), insomnia (p < 0.001), and generalized anxiety (p = 0.001). Females reported increased concerns about the possibility of infecting others (p = 0.046), greater anxiety (p < 0.001), COVID-19 related fears (p < 0.001), depression (p < 0.001), and post-traumatic distress (p < 0.001) than males. Being employed in a COVID-19 unit, being transferred to other units, and living with children and the elderly were factors associated with higher levels of psychological distress. Greater coping abilities were detected in physicians, and in those HCWs employed in COVID units. Our findings evidenced that the psychological consequences of the pandemic were non-homogeneously distributed across HCWs categories and pointed out the presence of specific in-hospital and out-of-hospital risk factors.

Sentimental Analysis of COVID-19 Tweets Using Deep Learning Models

The novel coronavirus disease (COVID-19) is an ongoing pandemic with large global attention. However, spreading false news on social media sites like Twitter is creating unnecessary anxiety towards this disease. The motto behind this study is to analyses tweets by Indian netizens during the COVID-19 lockdown. The data included tweets collected on the dates between 23 March 2020 and 15 July 2020 and the text has been labelled as fear, sad, anger, and joy. Data analysis was conducted by Bidirectional Encoder Representations from Transformers (BERT) model, which is a new deep-learning model for text analysis and performance and was compared with three other models such as logistic regression (LR), support vector machines (SVM), and long-short term memory (LSTM). Accuracy for every sentiment was separately calculated. The BERT model produced 89% accuracy and the other three models produced 75%, 74.75%, and 65%, respectively. Each sentiment classification has accuracy ranging from 75.88-87.33% with a median accuracy of 79.34%, which is a relatively considerable value in text mining algorithms. Our findings present the high prevalence of keywords and associated terms among Indian tweets during COVID-19. Further, this work clarifies public opinion on pandemics and lead public health authorities for a better society.

Psychological distress associated with the COVID-19 lockdown: A two-wave network analysis

BACKGROUND

Although preliminary research has evidenced negative psychological consequences of the COVID-19 pandemic among the general population, little research has been carried out examining the interplay among the broader dimensions and correlates of individual distress. Via network analysis, the current study investigated the pathways that underlie some components of psychological distress and their changes over time (during and post COVID-19-related lockdown).

METHODS

1,129 adult participants (79.1% women) completed a two-wave online survey during and after the lockdown, and reported on variables such as depression, anxiety, stress, fear of COVID, intolerance of uncertainty, emotion regulation and social support. The networks were estimated via Gaussian Graphical Models and their temporal changes were compared through the centrality measures.

RESULTS

Depression, stress, anxiety and fear of COVID formed a spatially contiguous pattern, which remained unchanged in both the two waves. After the lockdown, the fear of COVID node reduced its strength in the network, whereas inhibitory intolerance of uncertainty and emotion suppression were associated with depression. Emotion regulation was connected to depression, but not to stress and anxiety during both waves. Perceived emotional support had few connections to the other nodes.

LIMITATIONS

Only 32.7% of participants provided complete responses for both waves.

CONCLUSION

The COVID-19 outbreak has had a significant psychosocial impact on adults. In the context of the network approach, depressive symptoms had the highest strength and their associations to other dimensions of individual distress may be key factors in understanding the influence of exposure to the COVID-19 outbreak on mental health.

How has COVID-19 affected mental health nurses and the delivery of mental health nursing care in the UK? Results of a mixed-methods study

WHAT IS KNOWN ON THE SUBJECT?: During the COVID-19 pandemic, there has been research considering the impact on medical healthcare professionals and the mental health needs of the general population. However, limited focus has been placed on mental health services or mental health staff providing care in the community and in hospitals. While nurses make up the largest section of the mental health workforce in the UK, the impact that this pandemic has had on their work has been largely ignored. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides a unique insight into the experiences and impact that the COVID-19 pandemic has had on mental health nurses across a range of community and inpatient settings to understand what has changed in their work and the care they can and do provide during this crisis. This includes exploring how services have changed, the move to remote working, the impact of the protective equipment crisis on nurses and the difficult working conditions facing those in inpatient settings where there is minimal guidance provided. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: By understanding the impact the pandemic has had on mental health nursing care, we can understand the gaps in guidance that exist, the challenges being faced and the impact the crisis has had on care for mental health service users. By doing so, we can plan for the ongoing nature of this pandemic and the aftermath that the crisis may leave for our service users and workforce alike. ABSTRACT: Introduction While evidence has emerged concerning the impact of COVID-19 on the general population and the challenges facing health services, much less is known regarding how the pandemic has directly affected the delivery of mental health nursing care. Aim This paper aimed to explore how COVID-19 has affected the ability of mental health nurses to deliver care in community and inpatient mental health services in the UK. Method We investigated staff reports regarding the impact of the COVID-19 pandemic on mental healthcare and mental health service users in the UK, using a mixed-methods online survey. A total of 897 nurses across a range of inpatient and community settings participated. Discussion Key themes within the data explore the following: new ways of working; remote working; risks of infection/infection control challenges; and the impact on service users. Targeted guidelines are required to support mental health nurses providing care and support during a pandemic to people in severe mental distress, often in unsuitable environments. Implications for Practice Service developments need to occur alongside tailored guidance and support for staff welfare supported by clear leadership. These findings identify areas requiring attention and investment to prepare for future crises and the consequences of the pandemic.

The impact of the coronavirus pandemic on specific symptom dimensions and severity in OCD: A comparison before and during COVID-19 in the context of stress responses

The present study aimed to compare a group of patients with obsessive-compulsive disorder (OCD; N = 270) before and during COVID-19 on specific obsessive-compulsive (OC) symptom dimensions and symptom severity. In addition, the study aimed to evaluate the associations of COVID-19-related stress responses with change in OC symptom dimensions and severity of symptoms as the result of the pandemic. Results showed that patients with OCD had higher scores on all OC symptom dimensions and symptom severity during the pandemic as compared to their scores from before the pandemic. Thus, the effect of COVID-19 is not limited to an increase in fears of contamination alone, but occurs across other symptom dimensions, including responsibility for harm, unacceptable thoughts, and symmetry. In addition, regression analyses indicated that COVID-19-related stress responses significantly predicted the observed increase in specific OC symptom dimensions and general severity, after controlling for pre-COVID-19 scores of symptoms and severity. The increase of symptoms as the result of COVID-19 might be best understood in the context of a non-specific stress-related response similar to the effects observed in non-clinical and other clinical populations.

Social Isolation and Acceptance of the Learning Management System (LMS) in the time of COVID-19 Pandemic: An Expansion of the UTAUT Model

The COVID-19 Pandemic has led to social isolation; however, with the help of technology, education can continue through this tough time. Therefore, this research attempts to explore the Unified Theory of Acceptance and Use of Technology (UTAUT) through the expansion of the model. Also, make it relevant to investigate the influence of social isolation, and the moderating role of Corona fear on Behavioral Intention of the Learning Management System and its Use Behavior of Learning Management System among students. The data was analyzed using Partial Least Square (PLS) and Structural Equation Modelling (SEM). The findings show a positive link of Performance Expectancy (PE), Effort Expectancy (EE), Social Influence (SI), and Social Isolation on Behavioral Intention of LMS and, also between Behavioral Intention of LMS and its Use behavior. Moreover, the results of the moderation analysis show that Corona fears only moderates the link of Performance Expectancy and Social influence with Behavioral Intention of LMS. The findings imply the need for improving the LMS experience to increase its Behavioral Intention among students. Finally, the author's recommendation for future researchers is to examine the extended model in other countries and territories to analyze Coronavirus's influence on e-learning acceptance.

Uncertainty in the Time of Corona: Precautionary Adherence, Fear, and Anxiety in New York City During the COVID-19 Pandemic

ABSTRACT

The recent COVID-19 pandemic is having profound impacts on every sector of society, and New York City (NYC) emerged as an early epicenter of the disease. Given the novelty and scale of the disease, information surrounding COVID-19 has been marked by considerable uncertainty and confusion. Although various factors have been associated with COVID-19 distress, little is known about the relations between levels of intolerance of uncertainty (IU) and anxiety symptoms and behaviors. This cross-sectional study sought to examine potential correlates and pathways between anxiety and precautionary behaviors with the two levels of IU: prospective and inhibitory. Individuals from NYC (N = 99) completed an online survey through Amazon Mechanical Turk. Findings revealed that fear of COVID-19 accounts for associations between prospective IU and greater anxiety symptoms and behaviors, whereas precaution adherence accounts for associations between prospective IU and reduced anxiety symptoms and behaviors. In addition, precaution adherence accounts for associations between inhibitory IU and greater anxiety symptoms and behaviors. The results shed light on ways in which variations in IU may be associated with anxiety symptoms and behaviors in the context of COVID-19 and future pandemic scenarios.

Latent profile analysis of COVID-19 fear, depression, anxiety, stress, mindfulness, and resilience

The purpose of the current study was to identify latent profiles of COVID-19 fear, depression, anxiety, stress, mindfulness, and resilience among university students. A total of 506 university undergraduate and graduate students from various universities were recruited through online platforms in Turkey. Data were collected utilizing self-report scales and were analyzed utilizing latent profile analysis. Results indicated significant relationships among COVID-19 fear, depression, anxiety, stress, resilience, and mindfulness. A three-class solution was adapted to fit the current data. Findings revealed that 46% of the participants were classified into the high COVID-19 fear and medium psychological symptoms profile. Also, 38% of the participants were identified as low psychological symptoms and high mindfulness and resilience. Additionally, 16% of the participants were classified as high COVID-19 fear, psychological symptoms and low mindfulness and resilience. Female gender was positively associated with COVID-19 fear, depression, anxiety, and stress. Life satisfaction and social support were positively associated with the mindfulness and resilience, and were negatively related to COVID-19 fear, depression, anxiety, and stress.

Information and Communications Technology (ICT) Usage during COVID-19: Motivating Factors and Implications

This study was designed to investigate the roles information and communications technology (ICT) played during the current COVID-19 pandemic. Specifically, we focused on the relationships between ICT use and perceived importance of social connectedness and future anxiety, while considering relevant personality and psychosocial factors. A U.S. sample of 394 adults answered questions about ICT use, pandemic-related reactions and actions, demographics, and psychosocial factors via an online survey. Using logistic regression, findings indicated that personality (extraversion and conscientiousness) and psychosocial (need to belong and perceived attachment to phone) factors, types of ICT as news source, and gender were associated with perceived importance of social connectedness. Neuroticism, time spent on ICT for social purposes, and perceived threat of COVID-19 were associated with future anxiety. In addition, using Mann-Whitney U test, people who rated higher on importance of social connectedness had higher ICT use, both in terms of types and time spent on ICT. Overall, results are consistent with the idea that technology is a coping tool during the pandemic and balanced use can lead to feelings of social connectedness and less future anxiety. Therefore, it is important for authorities to align their messaging and outreach with people's psychosocial, personality, and health considerations through ICT channels while empowering ICT users to be responsible for their interactions with the technology.

Anxiety, Health Self-Perception, and Worry About the Resurgence of COVID-19 Predict Fear Reactions Among Genders in the Cuban Population

The resurgence of COVID-19 could deepen the psychological impacts of the pandemic which poses new challenges for mental health professionals. Among the actions that should be prioritized is the monitoring of the groups that have shown greater psychological vulnerability during the first stage of the pandemic. The first aim of our study is to explore the fear reactions to COVID-19 between genders during the second wave of the outbreak in Cuba. Second, establish possible predictors of fear of COVID-19 in relation to gender. Specifically, we will evaluate how anxiety related to COVID-19, health self-perception, and worry about the resurgence of COVID-19 predict fear reactions among women and men in the Cuban population. A cross-sectional online study was designed. The research was conducted between August 16 and October 18, 2020. A total of 373 people completed the online survey. A socio-demographic questionnaire, the Fear of COVID-19 Scale and the Coronavirus Anxiety Scale were used. An independent-samples t-test was conducted to compare the fear, worry, anxiety and self-perceived health scores, between genders. The relationship between those variables and fear of COVID-19, was investigated using Pearson correlation coefficient. Finally, multiple linear regression was used to evaluate the possible associations (predictors) related to fear of COVID-19. In our study, women, compared to men, presented greater fear reactions, greater concern about resurgence of COVID-19 and poorer self-perceived health. Anxiety reactions in our sample showed no differences between genders. In women, anxiety of COVID-19, worry about resurgence of COVID-19, and self-perceived health are associated with fear reactions to COVID-19. In the case of men, the self-perceived health showed no associations with fear reactions. Our results confirm the results of several related investigations during the first wave of the pandemic where women have shown greater psychological vulnerability compared to men. However, we cannot rule out that the real impact of the pandemic on mental health in men is much greater than that described by the studies conducted to date. Additional studies are needed on the psychological impact of COVID-19 on men.

Familial Experiences of Caring for Schizophrenia Patients during the Covid-19 Pandemic: A Qualitative Study

Introduction: Due to the Covid-19 pandemic, families are facing problems caring for and implementing Covid-19 health protocols when caring for schizophrenia patients. A lack of knowledge and behavior changes make it difficult for the families to care for the schizophrenia patients. This study aims to explore the familial experiences of caring schizophrenia patients during the Covid-19 pandemic.Methods: A phenomenological qualitative design was undertaken as of November 2020. A total of 10 participants via the purposive sampling technique were recruited. The study was conducted in Semarang, Indonesia. We used semi-structured interviews to obtain the data and we used thematic content analysis to examine it.Results: From the 10 participants, we got 3 themes, namely family fears, financial problems, and health treatment access. The themes were obtained from the families of the patients who care for them on a daily basis. During the Covid-19 pandemic, caring for schizophrenia patients has become more difficult and the cause of a lot of worry.Conclusion: The families experienced several problems when caring for schizophrenia patients. The families experienced fear of the schizophrenia patients being infected by Covid-19, the families worried about whether or not the schizophrenia patients would experience a relapse and they felt stressed due to the news circulating. The families also had to spend more money to cover the cost of the patient’s care and transportation, and the schizophrenia patients were rarely controlled because of the family’s fears. This problem can be an issue for nurses who should strive to provide proper education and plan interventions for schizophrenia patients at the family level.

A Fear of COVID-19 and PTSD Symptoms in Pathological Personality: The Mediating Effect of Dissociation and Emotion Dysregulation

Background: The 2019 coronavirus disease (COVID-19) outbreak is currently putting a strain on the mental health resilience of the world's population. Specifically, it is likely to elicit an intense response to fear and to act as a risk factor for the onset of posttraumatic stress disorder (PTSD). Some individuals may be more at risk than others, with pathological personality variables being a potential candidate as a central vulnerability factor. In addition, the pathways that lead the pathological personality to PTSD and intense fear responses to COVID-19 are likely to be explained by poor emotion regulation capacities, as well as by dissociative mechanisms. Aims: This study aimed to shed light on vulnerability factors that may account for the onset of PTSD and intense responses of fear in response to COVID-19 outbreak and to test the mediating role of emotion dysregulation and dissociation proneness in these pathways. Methods: We used a longitudinal design of research administered to a sample of community individuals (N = 308; meanage = 35.31, SD = 13.91; 22.7% were male). Moreover, we used self-report questionnaires to measure pathological personality, emotion regulation capacities, dissociative proneness at the beginning of the lockdown, and PTSD symptoms and fear of COVID-19 at the end of the Italian lockdown (from March 9 to May 18, 2020). Structural equation modeling was used to test the hypotheses. Results: We found that pathological personality levels longitudinally predicted PTSD and fear of COVID-19 levels. Moreover, the associations between emotion dysregulation and dissociation were shown to significantly and totally mediate the relationship between pathological personality and PTSD, whereas no significant mediation effects were observed in relation to fear of COVID-19. Conclusions: Individuals with pathological personality traits may be more vulnerable to the onset of negative psychological consequences related to COVID-19 outbreak, such as PTSD symptomatology and fear levels. Emotion regulation capacities appear to be relevant targets of interventions for PTSD symptomatology. Future research should explore the mediating variables linking pathological personality to intense fear responses to COVID-19.

Fear of COVID-19 for Individuals and Family Members: Indications from the National Cross-Sectional Study of the EPICOVID19 Web-Based Survey

The study analyzed the association of the fear of contagion for oneself and for family members (FMs) during the first wave of the COVID-19 pandemic, with demographic and socioeconomic status (SES) and health factors. The study was performed within the EPICOVID19 web-based Italian survey, involving adults from April-June 2020. Out of 207,341 respondents, 95.9% completed the questionnaire (60% women with an average age of 47.3 vs. 48.9 years among men). The association between fear and demographic and SES characteristics, contacts with COVID-19 cases, nasopharyngeal swab, self-perceived health, flu vaccination, chronic diseases and specific symptoms was analyzed by logistic regression model; odds ratios adjusted for sex, age, education and occupation were calculated (aORs). Fear for FMs prevailed over fear for oneself and was higher among women than men. Fear for oneself decreased with higher levels of education and in those who perceived good health. Among those vaccinated for the flu, 40.8% responded they had feelings of fear for themselves vs. 34.2% of the not vaccinated. Fear increased when diseases were declared and it was higher when associated with symptoms such as chest pain, olfactory/taste disorders, heart palpitations (aORs > 1.5), lung or kidney diseases, hypertension, depression and/or anxiety. Trends in fear by region showed the highest percentage of positive responses in the southern regions. The knowledge gained from these results should be used to produce tailored messages and shared public health decisions.

"Staying Home - Feeling Positive": Effectiveness of an on-line positive psychology group intervention during the COVID-19 pandemic

The current study investigated the effectiveness of a group on-line positive psychology intervention (OPPI) designed to mitigate the psychological impact of the COVID-19 pandemic and the subsequent measures to control it. Study participants (N = 82, M age  = 33.07, SD = 9.55) were all Greek adults divided into an intervention (n = 44) and a control group (n = 38). The intervention group attended a voluntary, online, two-week, six-session (each 50 min), group intervention. The intervention aimed at enhancing participants' personal strengths and resilience in order to cope more effectively with the psychological impact of social distancing (e.g., feelings of anxiety, sadness, fear, and/or loneliness). All participants completed an online questionnaire one week before the intervention's implementation, which included scales measuring their: demographic characteristics, empathy, resilience, affectivity, feelings of loneliness, depression and anxiety levels, and feelings of fear regarding the outbreak. Participants in both the intervention and control group completed the same measures the week following the intervention's termination to examine its effects, and two weeks later to examine its long-term effectiveness. The intervention was found to be effective in alleviating the impact of the pandemic and in strengthening participants' resilience. More specifically, the results showed significant decreases for the intervention group in all measures of psychosocial distress (anxiety, depression, loneliness and fear) and significant increases in empathy, resilience, and experience of positive emotions. The study's implications for the development and implementation of online psychological interventions during a crisis are discussed.

Assessing the Psychological Impacts of COVID-19 in Undergraduate Medical Students

Medical education has been uniquely affected by the Novel Coronavirus Disease 2019 (COVID-19). As the pandemic's psychological impacts on medical students remain unclear, this study assessed COVID-19's impacts on undergraduate medical students' stress and anxiety. A nationwide, online survey was administered via email chains between June-August 2020 to first-fourth year medical students in the United States. Demographics, 4-point Perceived Stress Scale that measures stress, 7-point Generalized Anxiety Disorder Scale that measures anxiety, and the impacts of social, health, and academic stressors due to COVID-19 were collected. Of the 852 students who participated, 66.1% experienced mild, moderate, or severe anxiety. Mean PSS-4 score was 7.25/16. Stress was highest in second- through fourth-year students. Students with preexisting mental health conditions had significantly higher stress and anxiety scores, and higher percentage of stress attributed to COVID-19. Trust in government institutions during COVID-19 was the highest stressor in first- and second-year students. Delay/availability of standardized exams was the highest stressor for third-year students. Impact on rotations/residencies was the highest stressor for fourth-year students. Understanding how students' anxiety and stress have changed due to COVID-19 will allow educators to identify students in need and guide recommendations on the implementation of psychological interventions and support strategies.

Keep Calm and Stay Safe: The Relationship between Anxiety and Other Psychological Factors, Media Exposure and Compliance with COVID-19 Regulations

The COVID-19 pandemic has led many countries to employ public health regulations to achieve behavioral change and stop the transmission of the virus. The factors influencing compliance with these regulations may differ from "classic" predictors for medical compliance. This study attempted to assess the effect of social communication and psychological factors on intention to comply. A cross-sectional online survey was conducted on healthy adults living in Israel (n = 697). The survey assessed the intention to comply with the state COVID-19 regulations and explored possible correlations with demographic and psychosocial factors. Data were collected during May 2020 using a Qualtrics online survey. Data were analyzed to find correlations between anxiety, uncertainty, media exposure and other variables and the level of intention to comply as self-reported. Moderation and mediation effects were studied by an integrative model of influencing factors. We found that media exposure change, trust in responsible agencies and anxiety were positively correlated with compliance, while uncertainty was correlated with noncompliance. The effect of media exposure on compliance had two components. First, media exposure was positively correlated with compliance. On the other hand, media exposure was positively correlated with uncertainty, and uncertainty was negatively correlated with compliance. Interestingly, anxiety, which was positively correlated with media exposure, also moderated the negative correlation between uncertainty and compliance. Our results highlight the important role of uncertainty and anxiety as moderators between media exposure and compliance. To increase public compliance with COVID-19 regulations, efforts should be directed at decreasing uncertainty and anxiety.

Relationships Between the Life Satisfaction, Meaning in Life, Hope and COVID-19 Fear for Turkish Adults During the COVID-19 Outbreak

The current study investigated whether there are significant relationships between life satisfaction and meaning in life, hope and COVID-19 fear and the extent to which life satisfaction is predicted by these variables. The study group of this research consists of 1,186 adults with the mean age of 41.04. Study group participants are consists of different cities of different regions of Turkey. As the data collection tools, the life satisfaction scale, the meaning in life scale, the dispositional hope scale and the COVID-19 fear scale were used. The results of the analyses have revealed that meaning in life, hope (actuating thinking and alternative ways thinking) are significant predictors of life satisfaction as positively. Besides, it is seen COVID-19 fear, age, gender and the presence of people infected with COVID-19 around aren't significant predictors of life satisfaction in adults.

Intolerance of COVID-19-Related Uncertainty and Negative Emotions among Chinese Adolescents: A Moderated Mediation Model of Risk Perception, Social Exclusion and Perceived Efficacy

The uncertainty caused by the COVID-19 pandemic has exacerbated negative emotions, especially among adolescents, who feel unable to tolerate the uncertainty of the epidemic. However, the mechanism by which the intolerance of COVID-19-related uncertainty (COVID-19 IU) affects negative emotions in adolescents remains unclear. This study explored the underlying mechanism from COVID-19 IU to negative emotions using a moderated mediation model in adolescents. In total, 3037 teenagers completed a cross-sectional survey including measures of COVID-19 IU, risk perception, social exclusion, perceived efficacy, and negative emotions. The results showed that COVID-19 IU positively predicted negative emotions and that risk perception and social exclusion mediated this relationship. In addition, both the direct effect of COVID-19 IU on negative emotions and the mediating effect of risk perception on this relationship were moderated by perceived efficacy; in particular, COVID-19 IU had a greater impact on negative emotions among adolescents with lower levels of perceived efficacy. These findings suggest that COVID-19 IU is closely associated with negative emotions among adolescents and that effective measures should be taken to enable adolescents to improve their perceived efficacy and develop a reasonable perception of risk, help them eliminate the stigma of the disease, and strengthen their connections with society.

Social Study Resources and Social Wellbeing Before and During the Intelligent COVID-19 Lockdown in The Netherlands

The first intelligent COVID-19 lockdown resulted in radical changes within the tertiary educational system within the Netherlands. These changes posed new challenges for university students and many social welfare agencies have warned that it could have adverse effects on the social wellbeing (SWB) of university students. Students may lack the necessary social study-related resources (peer- and lecturer support) (SSR) necessary to aid them in coping with the new demands that the lockdown may bring. As such, the present study aimed to investigate the trajectory patterns, rate of change and longitudinal associations between SSR and SWB of 175 Dutch students before and during the COVID-19 lockdown. A piecewise latent growth modelling approach was employed to sample students' experiences over three months. Participants to complete a battery of psychometric assessments for five weeks before the COVID-19 lockdown was implemented, followed by two directly after and a month follow-up. The results were paradoxical and contradicting to initial expectations. Where SSR showed a linear rate of decline before- and significant growth trajectory during the lockdown, SWB remained moderate and stable. Further, initial levels and growth trajectories between SSR and SWB were only associated before the lockdown.

Perceived Impact of Quarantine on Loneliness, Death Obsession, and Preoccupation With God: Predictors of Increased Fear of COVID-19

Most countries are facing the societal challenging need for a new quarantine period due to the increasing number of COVID-19 infections, indicating a second or even third wave of disease. The COVID-19 pandemic has brought to the surface existential issues that are typically less present in people's focal attention. The first aim of this study was to identify some of these existential struggles such as increased feelings of loneliness, death obsession, and preoccupation with God. Secondly, we explored the association of these factors with the increased fear of coronavirus during the quarantine. Data was collected from 1,340 Romanian adults using a cross-sectional web-based survey design in the midst of the national lockdown period of COVID-19. Participants completed measures of COVID-19 related loneliness, death obsession, and preoccupation with God twice; first, thinking about the period before the pandemic, and second, for the current situation during the quarantine. Then, they completed a fear of COVID-19 measure. Participants perceived an increase in the feelings of loneliness, death obsession, and preoccupation with God during the confinement. Furthermore, gender, knowing someone diagnosed with COVID-19, loneliness, death obsession, and preoccupation with God predicted fear of COVID-19. Interestingly, days in isolation did not predict fear of COVID-19 nor were associated with feelings of loneliness. In line with existential positive psychology, these results highlight the importance of policies and interventions targeting the experience of loneliness, spiritual beliefs, and particularly those aimed to promote death acceptance, in order to alleviate intense fear of COVID-19.

Longitudinal Trajectories of Study Characteristics and Mental Health Before and During the COVID-19 Lockdown

The COVID-19 lockdown has significantly disrupted the higher education environment within the Netherlands and led to changes in available study-related resources and study demands of students. These changes in study resources and study demands, the uncertainty and confusion about educational activities, the developing fear and anxiety about the disease, and the implementation of the COVID-19 lockdown measures may have a significant impact on the mental health of students. As such, this study aimed to investigate the trajectory patterns, rate of change, and longitudinal associations between study resources-demands and mental health of 141 university students from the Netherlands before and during the COVID-19 lockdown. The present study employed a longitudinal design and a piecewise latent growth modeling strategy to investigate the changes in study resources and mental health over a 3 month period. The results showed that moderate levels of student resources significantly decreased before, followed by a substantial rate of increase during, lockdown. In contrast, study demands and mental health were reported to be moderate and stable throughout the study. Finally, the growth trajectories of study resources-demands and mental health were only associated before the lockdown procedures were implemented. Despite growing concerns relating to the negative psychological impact of COVID-19 on students, our study shows that the mental health during the initial COVID-19 lockdown remained relatively unchanged.

A Cross-Country Examination on the Fear of COVID-19 and the Sense of Loneliness during the First Wave of COVID-19 Outbreak

The aim of the current study is to examine gender, age. and cross-country differences in fear of COVID-19 and sense of loneliness during the lockdown, by comparing people from those countries with a high rate of infections and deaths (e.g., Spain and Italy) and from countries with a mild spread of infection (e.g., Croatia, Serbia, Slovakia, Slovenia, and Bosnia and Herzegovina). A total of 3876 participants (63% female) completed an online survey on "Everyday life practices in COVID-19 time" in April 2020, including measures of fear of COVID-19 and loneliness. Males and females of all age groups in countries suffering from the powerful impact of the COVID-19 pandemic reported greater fear of COVID-19 and sense of loneliness. In less endangered countries, females and the elderly reported more symptoms than males and the young; in Spanish and Italian samples, the pattern of differences is considerably more complex. Future research should thoroughly examine different age and gender groups. The analysis of emotional well-being in groups at risk of mental health issues may help to lessen the long term social and economic costs due to the COVID-19 outbreak.

The psychological impact of the COVID-19 pandemic on adults with autism: a survey study across three countries

Background

Previous studies have reported a negative psychological and mental health impact of the COVID-19 pandemic. This impact is likely to be stronger for people with autism as they are at heightened risk of mental health problems and because the pandemic directly affects social functioning and everyday routines. We therefore examined COVID-19 pandemic-related changes in mental health, the impact of the pandemic on their social life and routines, satisfaction with pandemic-related information and tips, and participants’ wishes for guidance.

Methods

We used a mixed-method approach, collecting quantitative and qualitative survey data from adults with and without autism across three European countries: Belgium, the Netherlands, and the UK (N = 1044).

Results

We found an increase in depression and anxiety symptoms in response to the pandemic for both the non-autism and the autism group, which was greater for adults with autism. Furthermore, adults with autism showed a greater increase in worries about their pets, work, getting medication and food, and their own safety/security. They felt more relieved from social stress, yet experienced the loss of social contact as difficult. Adults with autism also felt more stressed about the loss of routines. Pleasant changes noted by adults with autism were the increase in solidarity and reduced sensory and social overload. Adults with autism frequently reported problems with cancellation of guidance due to the pandemic and expressed their wish for (more) autism-specific information and advice.

Limitations

Our sample is likely to reflect some degree of selection bias, and longitudinal studies are needed to determine long-term effects.

Conclusions

Results highlight the psychological burden of the pandemic on adults with autism and shed light on how to support them during this COVID-19 pandemic, which is especially important now that the pandemic is likely to have a prolonged course. There is a need for accessible, affordable (continued) support from health services. Guidance may focus on the maintenance of a social network, and adjusting routines to the rapid ongoing changes. Finally, we may learn from the COVID-19 pandemic-related changes experienced as pleasant by adults with autism to build a more autism-friendly society post-pandemic.

An Analysis of the Psychosocial Challenges Faced by the University Students During COVID-19 Pandemic, and the Students' Knowledge, Attitudes, and Practices Toward the Disease

INTRODUCTION

The aims of the present study were 1) to identify the major psychosocial challenges faced by students of a university in Istanbul, during the initial period of the COVID-19 outbreak, 2) to assess how these interacted with their level of knowledge, attitudes, and practices toward COVID-19 and the related health measures in place.

METHODS

As part of an international research, a total of 2583 university students from Istanbul participated in an online survey, which included questions in several domains including their studies and daily life before and after the outbreak, their concerns and worries about the pandemic, their level of knowledge on COVID-19, their views on the policies implemented by the government and their institution, their attitude and practices toward the protective measures.

RESULTS

Majority of the students reported to suffer from financial adversities due to the outbreak. The closure of residential facilities and the cancellation of face-to-face lectures resulted in the vast majority of the students moving back to their family home. Their daily routines were largely replaced by individual home activities, and social interactions shifted almost totally to digital platforms. They also reported high levels of anxiety and worries concerning a wide range of the possible detrimental outcomes of COVID-19, which were in close association with their knowledge, attitudes, and practices towards the disease, as well as their adherence to the policy measures and their satisfaction with the policies of the government.

CONCLUSION

These results may help policymakers in better understanding the psychosocial impacts of COVID-19 on the life of university students, and to develop more comprehensive strategies to address their multifaceted struggles, as well as to improve their compliance with the health measures in the future.

Impact of COVID-19 on health services utilization in Province-2 of Nepal: a qualitative study among community members and stakeholders

BACKGROUND

The COVID-19 pandemic has posed unprecedented challenges and threats to the health care system, particularly affecting the effective delivery of essential health services in resource-poor countries such as Nepal. This study aimed to explore community perceptions of COVID-19 and their experiences towards health services utilization during the pandemic in Province-2 of Nepal.

METHODS

The semi-structured qualitative interviews were conducted among purposively selected participants (n = 41) from a mix of rural and urban settings in all districts (n = 8) of the Province 2 of Nepal. Virtual interviews were conducted between July and August 2020 in local languages. The data were analyzed using thematic network analysis in NVivo 12 Pro.

RESULTS

The findings of this research are categorized into four global themes: i) Community and stakeholders' perceptions towards COVID-19; ii) Impact of COVID-19 and lockdown on health services delivery; iii) Community perceptions and experiences of health services during COVID-19; and iv) COVID-19: testing, isolation, and quarantine services. Most participants shared their experience of being worried and anxious about COVID-19 and reported a lack of awareness, misinformation, and stigma as major factors contributing to the spread of COVID-19. Maternity services, immunization, and supply of essential medicine were found to be the most affected areas of health care delivery during the lockdown. Participants reported that the interruptions in health services were mostly due to the closure of health services at local health care facilities, limited affordability, and involvement of private health sectors during the pandemic, fears of COVID-19 transmission among health care workers and within health centers, and disruption of transportation services. In addition, the participants expressed frustrations on poor testing, isolation, and quarantine services related to COVID-19, and poor accountability from the government at all levels towards health services continuation/management during the COVID-19 pandemic.

CONCLUSIONS

This study found that essential health services were severely affected during the COVID-19 pandemic in all districts of Province-2. It is critical to expand and continue the service coverage, and its quality (even more during pandemics), as well as increase public-private sector engagement to ensure the essential health services are available for the population.

Sociodemographic, Cognitive, and Emotional Determinants of Two Health Behaviors during SARS-CoV-2 Outbreak: An Online Study among French-Speaking Belgian Responders during the Spring Lockdown

To contain the SARS-CoV-2 infection rate, health authorities have encouraged the population to enhance protective behaviors such as physical distancing and handwashing. Behavioral sciences emphasize the role of sociocognitive determinants to explain health behaviors, while largely ignoring emotional factors. In a large online study (N > 4000), we investigated the role of sociodemographic, cognitive, emotional, and social factors that can facilitate or hinder handwashing and limitation of social contacts. Data were collected from March 18 until April 19, 2020, which corresponds to the spring lockdown and the first peak of the pandemic in Belgium. Logistic regressions showed that sociodemographic factors (gender, age, level of education) and the dimensions of the Theory of Planned Behavior (intentions, attitudes, perceived behavioral control and subjective norms) had a strong impact on health behaviors, but that emotional factors explained an additional part of the variance. Being more attentive/determined and frightened/anxious, along with scoring higher on health anxiety were related to a higher frequency of handwashing. In contrast, being enthusiastic/happy was related to lower adherence to limiting social contacts. Our results suggest that the type of predictors and the direction of associations depend on the type of health behavior considered. The role of specific emotional factors in addition to more classical predictors is discussed. The study offers new perspectives regarding the factors that are associated with the adherence to behaviors recommended to adopt when faced with a pandemic.

Psychometric properties of the Brazilian version of the fear of COVID-19 scale (FCV-19S)

COVID-19 can bring several psychological problems to patients and non-patients, which highlights the need for a better understanding of outcomes that can emerge due the occurrence of the virus. One of these variables is fear, present in situations of continuous uncertainty. Fear is a key variable for mental health and tracking it and its correlates might help to develop proper education and prevention programs. Currently, Brazil is one of the epicentres of the COVID-19 pandemic, with its public health system scrapped and not being able to contain the amount of infected people. Therefore, a proper measure to screen the fear of COVID-19 will help to provide improvements in mental health in such contexts. For that, two studies were performed. In Study 1 (N = 230) we assessed the factorial structure of the measure through exploratory factor analysis, and item parameters using item response theory. In Study 2 (N = 302), we assessed whether the structure would replicate in an independent sample and through confirmatory factor analysis, besides assessing convergent validity using Structural Equation Modelling and proposing a shorter version of the measure. Both long and short versions presented a reliable unidimensional structure and similar patterns of correlations with depression, anxiety, and stress. Overall, our results showed that the FCV-19S and its short version are useful measures to the assessment of fear of COVID-19 in Brazil.

Psychosocial predictors of virus and social distancing fears in undergraduate students living in a US COVID-19 "hotspot"

The COVID-19 pandemic is positioned to exact a substantial mental health toll on the global population. Heightened fears of viral contamination and fears of the negative consequences of social distancing (e.g., fears related to home confinement, fears of loneliness and isolation) might contribute to the distress caused by the pandemic. Cross-sectional data were collected from undergraduates (N = 608) residing in a U.S. pandemic "hotspot" at the time of data collection (between 7 April to 9 May, 2020). Outcome variables included viral contamination fears and social distancing fears. Predictor variables included biological sex, underlying medical vulnerability, number of recent viral symptoms, presence of positive COVID-19 test in social network, anxiety, depression, stress, emotion dysregulation, intolerance of uncertainty, body vigilance, and health anxiety. Female sex, anxiety severity, intolerance of uncertainty, and health anxiety uniquely predicted fears of viral contamination. Female sex and depression severity uniquely predicted fears of social distancing. Multiple anxiety-related vulnerabilities are potential intervention targets for reducing viral contamination fears. Depression is a potential intervention target for social distancing fears. Females might be at greater risk for both types of fears.

Experiences of women with ovarian cancer during the COVID-19 pandemic: Examining intolerance of uncertainty and fear of COVID-19 in relation to psychological distress

PURPOSE

Our research aimed to examine the role of intolerance of uncertainty (IU) in psychological distress (PD) among women with ovarian cancer. Fear of COVID-19 (FCOV) was examined as a mediator, and participant health status and the reopening status of their geographic region were examined as moderators.

DESIGN

A cross-sectional quantitative design was employed.

PARTICIPANTS

Participants (n = 100) were recruited through various online sources and completed the study via Qualtrics.

METHODS

Moderated mediation models and post-hoc linear regression analyses were used to determine the role of predictor variables in PD.

RESULTS

No significant moderators or mediators were found. Despite a strong correlation between FCOV and IU, both variables explained unique variance in the anxiety and stress models, while FCOV was not significant in the depressive symptoms model.

IMPLICATIONS FOR PROVIDERS

Both IU and FCOV should be considered in helping women with ovarian cancer manage their PD during the COVID-19 pandemic.

Cross-cultural measurement invariance of the fear of COVID-19 scale in seven Latin American countries

The objective was to evaluate the cross-cultural measurement invariance of the Fear of COVID-19 Scale (FCV-19S) in 7 Latin American countries (Colombia, Ecuador, El Salvador, Mexico, Paraguay, Argentina, and Uruguay). The participants were 2944 people, selected through non-probability sampling for convenience, where the majority were women. Data collection occurred between 12 June and 14 September 2020. The results indicated that the model with two related factors presents a better fit to the data and has partial scalar invariance among the 7 countries. Differences in emotional and physiological reactions were observed between the countries.

Impact of Fear of Contracting COVID-19 and Complying with the Rules of Isolation on Nutritional Behaviors of Polish Adults

The aim of the study was to examine whether, and to what extent, fear of contracting Covid-19 and compliance with the mandatory rules of isolation affected Polish adults' nutritional behaviors. The online study was carried out during the first wave of the pandemic on a sample of 926 adults. Through cluster analysis, three groups of respondents were isolated: 1. People who fear a Covid-19 infection and follow the isolation rules (FFR), 2. People moderately afraid of the disease and following the rules loosely (MFFR), 3. People who are not afraid of the infection and do not follow the rules of isolation. (NFFR). The clusters were profiled with consideration of different aspects of eating behaviors as well as socio-demographic and economic features. The results of the study show a close relationship between the level of fear of contracting Covid-19 and the degree to which isolation rules are followed. These two factors were found to have a significant impact on eating behaviors, such as food purchases, eating patterns, and levels of consumption. It was stated that the FFR group changed their eating behaviors the most in terms of food purchasing, eating habits (excluding diversity and quality of diet), and food product consumption. The greatest stability in the majority of the analyzed areas of nutritional behaviors was observed in the MFFR cluster. The NFFR group shown the greatest decrease both in regularity and quality of their meals. This group also exhibited a significant increase in the consumption of alcoholic beverages. The results of the study can be useful in the decision making process when introducing restrictions or managing information. They also point to the need for extensive nutritional education focused on explaining the relationship between nutrition and health during a pandemic.

The Mediating Effects of Fear of COVID-19 and Depression on the Association Between Intolerance of Uncertainty and Emotional Eating During the COVID-19 Pandemic in Turkey

The COVID-19 pandemic has greatly affected the mental health of individuals due to severe changes in their normal life routines. These changes might give rise to stress-induced factors and result in developing maladaptive behaviors. Therefore, the present study tested an explorative sequential mediation model regarding the COVID-19 pandemic as a global natural experiment and hypothesized that fear and depression would be serial mediators of the relationship between intolerance of uncertainty and emotional eating. An online cross-sectional survey with convenience sampling was adopted. A total of 362 participants were recruited from Turkey, and each completed a battery of demographic questions and psychometric scales. The standardized instruments used to test the model’s constructs were the Intolerance of Uncertainty Scale, Fear of COVID-19 Scale, Hospital Anxiety and Depression Scale, and Three-Factor Eating Questionnaire-R21. The model was tested using a bootstrapping method utilizing IBM AMOS 24 software. Results showed that emotional eating was positively associated with intolerance of uncertainty, fear of COVID-19, and depression. Moreover, fear of COVID-19 had positive correlation with intolerance of uncertainty and depression. Significant negative association was also found between age and intolerance of uncertainty. In addition, females significantly reported higher levels of emotional eating and fear of COVID-19 than males. The study’s hypothesized sequential mediation model was further supported. It is concluded that depression most likely developed by fear was triggered by intolerance of uncertainty during the COVID-19 pandemic and leading to emotional eating. The study is significant because it advances theories of emotional eating with an investigation examining some of its underlying mechanisms. Also, it is one of a few research studies highlighting to what extent the COVID-19 pandemic-related cognitions and emotions are associated with maladaptive behaviors in the case of emotional eating.