Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter

Moderation Effect of Physical Activity on the Relationship Between Fear of COVID-19 and General Distress: A Pilot Case Study in Arabic Countries

Aims

This study aimed to investigate the effects of the fear of COVID-19, level of physical activity, and gender on negative stress (distress) in an Arab population by means of structural equations based on partial least squares.

Materials and Methods

The sample population comprised of 459 participants from four Arab countries (age M = 33.02, SD = 8.46; n = 237 women and n = 222 men). The level of education was basic (<9 years of study; n = 144), secondary/vocational (between 9 and 12; n = 178), and university (n = 137). The “Fear of COVID-19” Scale, the short form of the “International Physical Activity Questionnaire,” and the “Perceived Stress Scale” questionnaires were disseminated by emails and social networks via Google Forms. SMARTPLS software version 3.2.9 was used to model the relationships between the variables under study.

Results

Results confirmed the links between level of physical activity, fear of COVID-19, and gender, showing a significant mediating effect of the fear of COVID-19 on the relationship between gender and general distress. The level of physical activity was also found to influence the fear of COVID-19, varying depending on gender. In addition, the model highlighted the presence of a moderation effect of the level of physical activity.

Conclusion

Based on the model presented in the present study, we can conclude that the COVID-19 pandemic has a profound impact on psychological distress in the target populations. The impact of the level of physical activity on psychological distress is shown to be very important during the pandemic phase.

L. Yuen K, Tüscher O, Thrul J, Kreuter F, Sprengholz P, Betsch C, Dieter Stieglitz R, Lieb K. Psychomorbidity, Resilience, and Exacerbating and Protective Factors During the SARS-CoV-2 Pandemic

BACKGROUND

The SARS-CoV-2 pandemic has caused mental stress in a number of ways: overstrain of the health care system, lockdown of the economy, restricted opportunities for interpersonal contact and excursions outside the home and workplace, and quarantine measures where necessary. In this article, we provide an overview of psychological distress in the current pandemic, identifying protective factors and risk factors.

METHODS

The PubMed, PsycINFO, and Web of Science databases were systematically searched for relevant publications (1 January 2019 - 16 April 2020). This study was registered in OSF Registries (osf.io/34j8g). Data on mental stress and resilience in Germany were obtained from three surveys carried out on more than 1000 participants each in the framework of the COSMO study (24 March, 31 March, and 21 April 2020).

RESULTS

18 studies from China and India, with a total of 79 664 participants, revealed increased stress in the general population, with manifestations of depression and anxiety, post-traumatic stress, and sleep disturbances. Stress was more marked among persons working in the health care sector. Risk factors for stress included patient contact, female sex, impaired health status, worry about family members and significant others, and poor sleep quality. Protective factors included being informed about the increasing number of persons who have recovered from COVID, social support, and a lower perceived infectious risk. The COSMO study, though based on an insufficiently representative population sample because of a low questionnaire return rate (<20%), revealed increased rates of despondency, loneliness, and hopelessness in the German population as compared to norm data, with no change in estimated resilience.

CONCLUSION

Stress factors associated with the current pandemic probably increase stress by causing anxiety and depression. Once the protective factors and risk factors have been identified, these can be used to develop psychosocial interventions. The informativeness of the results reported here is limited by the wide variety of instruments used to acquire data and by the insufficiently representative nature of the population samples.

Risk Perceptions and Psychological Effects During the Italian COVID-19 Emergency

The current study provides data about the immediate risk perceptions and psychological effects of the COVID-19 pandemic among Italian participants. A sample of 980 volunteers answered a web-based survey which aimed to investigate the many facets of risk perceptions connected to COVID-19 (health, work, institutional-economy, interpersonal and psychological), and risk-related variables such as perceived knowledge, news seeking, perceived control, perceived efficacy of containment measures, and affective states. Socio-demographic characteristics were also collected. Results showed that although levels of general concern are relatively high among Italians, risk perceptions are highest with regards to the institutional-economy and work, and lowest concerning health. COVID-19 has been also estimated to be the least likely cause of death. Cognitive and affective risk-related variables contributed to explain the several risk perception domains differently. COVID-19 perceived knowledge did not affect any risk perception while the perceived control decreased health risk likelihood. The other risk-related variables amplified risk perceptions: News seeking increased work and institutional-economy risk; perceived efficacy of containment measures increased almost all perceived risks; negative affective states of fear, anger and sadness increased health risk; anxiety increased health, interpersonal and psychological risks, and uncertainty increased work, institutional-economy, interpersonal and psychological risk perceptions. Finally, positive affective states increased health risk perception. Socio-psychological implications are discussed.

General Mental Health State Indicators in Argentinean Women During Quarantine of up to 80-Day Duration for COVID-19 Pandemic

Introduction: Argentinean quarantine during the COVID-19 pandemic is one of the most long-lasting worldwide. We focused on the first 80-days of this quarantine on Argentinean women. Our aims were to analyze differences in general mental health state (MHS) indicators, by the (1) sites of residence with different prevalence of COVID-19 cases, and (2) quarantine duration; (3) to assess multiple relationships between each general MHS indicator and potentially affecting factors. Methods: We used a cross-sectional design with convenience successive sampling (N = 5,013). The online survey included a socio-demographic questionnaire (elaborated ad hoc) with standardized and validated self-reported questionnaires (General Health Questionnaire, Kessler Psychological Distress Scale) measuring the MHS indicators: self-perceived health, psychological discomfort, social functioning and coping, and psychological distress. Results: Worse self-perceived health and higher psychological discomfort affected significantly more women residing in sites with high prevalence of COVID-19 cases, compared to those residing in sites with intermediate prevalence, but effect sizes were small. Mean scores of all general MHS indicators were significantly worse for longer quarantine sub-periods (up to 53, 68, and 80-day duration) than for shorter sub-periods (up to seven, 13, and 25-day duration). Being a younger age, having mental disorder history, and longer quarantine durations were associated to worsening MHS, while the lack of previous suicide attempt has a protective effect. Discussion: Our findings show that a worse MHS during quarantine may not be attributed to the objective risk of contagion (measured greater or less), and under quarantine, women MHS-as indicated by group central tendency measures-got worse as time went by. This strongly suggests that special attention needs to be paid to younger women and to women with history of mental disorder. Along with physical health, mental health must be a priority for the Government during and after quarantine and the COVID-19 pandemic.

Social and electronic media exposure and generalized anxiety disorder among people during COVID-19 outbreak in Bangladesh: A preliminary observation

Classified as a pandemic by the World Health Organization, the novel Coronavirus Disease (COVID-19) has spread to Bangladesh since early March of 2020, and people are getting daily updates from the social and electronic media. We aimed at assessing the prevalence of anxiety among Bangladeshi people during the pandemic in connection with social media exposure (SME) and electronic media exposure (EME). For this cross-sectional study, data were collected from 880 participants by a self-administered online-based questionnaire relating personal characteristics, self-rate health (SRH), SME, and EME with anxiety. Findings show that around half of the surveyed population experienced a spike of anxiety (49.1%) during the pandemic, ten times higher than the national anxiety rate in 2019. The participants with an increased SME of over four hours per day experienced a higher level of anxiety than individuals with < = 2 hours exposure to social media. Similarly, the anxiety was higher among people with fair/bad SRH compared to individuals with excellent SRH. It is highly recommended to develop active surveillance and effective monitoring systems to reduce the spread of misinformation from both social and electronic media to improve the state of mental health conditions during the pandemic.

Psychological Impact of COVID-19 Confinement and Its Relationship with Meditation

The objective of this study was to evaluate the psychological impact of confinement due to the COVID-19 pandemic, considering any protective factors, such as the practice of meditation or self-compassion, and their relationship with different lifestyles and circumstances of adults residing in Spain. A cross-sectional study was done using an anonymous online survey in which 412 participants filled out the Depression, Anxiety and Stress Scale-2; the Impact of Events Scale; and the Self-Compassion Scale-Short Form, reporting severe symptomatology of posttraumatic stress and mild anxiety and depression. Quality of cohabitation and age were found to be key variables in the psychological impact of confinement. The impact of confinement was more negative for those who reported very poor cohabitation as opposed to very good (F (3, 405) = 30.75, p ≤ 0.001, d = 2.44, r = 0.054) or for those under 35 years of age compared to those over 46 (F (2, 409) = 5.14, p = 0.006, d = 0.36). Practicing meditation was not revealed as a protective factor, but self-compassion was related to better cohabitation during confinement (F (3, 403) = 11.83, p ≤ 0.001, d = 1.05). These results could be relevant in designing psychological interventions to improve coping and mental health in other situations similar to confinement.

The effect of COVID-19 lockdown on lifestyle and mood in Croatian general population: a cross-sectional study

Aim

To investigate the effect of the coronavirus 2019 (COVID-19) lockdown on lifestyle behaviors and mood changes in the Croatian general population.

Methods

During ten days of the COVID-19 lockdown in Croatia, 3027 respondents (70.3% female) from the general population completed an online, self-report questionnaire. Demographic data and data on lifestyle habits and mood changes before and during the COVID-19 lockdown were collected.

Results

A total of 95.64% of respondents reported to follow most or all restrictions, with female sex (P < 0.001) and higher education level (P < 0.001) being associated with higher restriction compliance. Women smoked an increased number of cigarettes (P < 0.001). The proportion of respondents of both sexes who did not drink or drank 7 drinks per week or more increased (P < 0.001). Women also reported lower frequency (P = 0.001) and duration of physical exercise (P < 0.001). In total, 30.7% of respondents gained weight, with female sex (OR, 2.726) and higher BMI (OR, 1.116; both P < 0.001) being associated with an increased likelihood of gaining weight. Both men and women felt more frequently afraid (P < 0.001), discouraged (P < 0.001), and sad (P < 0.001).

Conclusion

Public health authorities should promote the adoption of healthy lifestyles in order to reduce long-term negative effects of the lockdown.

Gender medicine: Lessons from COVID-19 and other medical conditions for designing health policy

Gender-specific differences in the prevalence, incidence, comorbidities, prognosis, severity, risk factors, drug-related aspects and outcomes of various medical conditions are well documented. We present a literature review on the extent to which research in this field has developed over the years, and reveal gaps in gender-sensitive awareness between the clinical portrayal and the translation into gender-specific treatment regimens, guidelines and into gender-oriented preventive strategies and health policies. Subsequently, through the lens of gender, we describe these domains in detail for four selected medical conditions: Asthma, obesity and overweight, chronic kidney disease and coronavirus disease 2019. As some of the key gender differences become more apparent during adolescence, we focus on this developmental stage. Finally, we propose a model which is based on three influential issues: (1) Investigating gender-specific medical profiles of related health conditions, rather than a single disease; (2) The dynamics of gender disparities across developmental stages; and (3) An integrative approach which takes into account additional risk factors (ethnicity, socio-demographic variables, minorities, lifestyle habits etc.). Increasing the awareness of gender-specific medicine in daily practice and in tailored guidelines, already among adolescents, may reduce inequities, facilitate the prediction of future trends and properly address the characteristics and needs of certain subpopulations within each gender.

Positive Impact of Mindfulness Meditation on Mental Health of Female Teachers during the COVID-19 Outbreak in Italy

The Covid-19 pandemic and subsequent public health measures were shown to impact negatively on people's mental health. In particular, women were reported to be at higher risk than men of developing symptoms of stress/anxiety/depression, and resilience was considered a key factor for positive mental health outcomes. In the present study, a sample of Italian female teachers (n = 66, age: 51.5 ± 7.9 years) was assessed with self-report instruments one month before and one month after the start of the Covid-19 lockdown: mindfulness skills, empathy, personality profiles, interoceptive awareness, psychological well-being, emotional distress and burnout levels were measured. Meanwhile, they received an 8-week Mindfulness-Oriented Meditation (MOM) course, through two group meetings and six individual video-lessons. Based on baseline personality profiles, analyses of variance were performed in a low-resilience (LR, n = 32) and a high-resilience (HR, n = 26) group. The LR and HR groups differed at baseline in most of the self-report measures. Pre-post MOM significant improvements were found in both groups in anxiety, depression, affective empathy, emotional exhaustion, psychological well-being, interoceptive awareness, character traits and mindfulness levels. Improvements in depression and psychological well-being were higher in the LR vs. HR group. We conclude that mindfulness-based training can effectively mitigate the psychological negative consequences of the Covid-19 outbreak, helping in particular to restore well-being in the most vulnerable individuals.

Listening to Hospital Personnel's Narratives during the COVID-19 Outbreak

Healthcare workers (HCWs) facing the COVID-19 pandemic are required to deal with unexpectedly traumatic situations, concern about contamination, and mounting patient deaths. As a means to address the changing needs of our hospital’s HCWs, we conducted a narrative analysis study in the early stages of the covid-19 outbreak. A focus group of medical experts, conducted as the initial step, recommended that a bottom-up research tool be used for exploring HCWs’ traumatic experiences and needs. We therefore conducted 450 semi-structured in-depth interviews with hospital personnel. The interviews were based on Maslow’s Pyramid of Needs model, and the narratives were analyzed by applying the Listening Guide methodology. The interviewees expressed a need for physical and psychological security in the battle against Covid-19, in addition to the need for attachment and meaning. Importantly, we also found that the interview itself may serve as a therapeutic tool. In light of our findings, we recommended changes in hospital practices, which were subsequently implemented. Further research on HCWs’ traumatic experiences and needs will provide evidence-based knowledge and may enable novel approaches in the battle against Covid-19. To conclude, the knowledge generated by listening to HCWs’ narratives may provide suitable support programs for professionals.

Factors contributing to healthcare professional burnout during the COVID-19 pandemic: A rapid turnaround global survey

Background

Healthcare professionals (HCPs) on the front lines against COVID-19 may face increased workload and stress. Understanding HCPs’ risk for burnout is critical to supporting HCPs and maintaining the quality of healthcare during the pandemic.

Methods

To assess exposure, perceptions, workload, and possible burnout of HCPs during the COVID-19 pandemic we conducted a cross-sectional survey. The main outcomes and measures were HCPs’ self-assessment of burnout, indicated by a single item measure of emotional exhaustion, and other experiences and attitudes associated with working during the COVID-19 pandemic.

Findings

A total of 2,707 HCPs from 60 countries participated in this study. Fifty-one percent of HCPs reported burnout. Burnout was associated with work impacting household activities (RR = 1·57, 95% CI = 1·39–1·78, P<0·001), feeling pushed beyond training (RR = 1·32, 95% CI = 1·20–1·47, P<0·001), exposure to COVID-19 patients (RR = 1·18, 95% CI = 1·05–1·32, P = 0·005), and making life prioritizing decisions (RR = 1·16, 95% CI = 1·02–1·31, P = 0·03). Adequate personal protective equipment (PPE) was protective against burnout (RR = 0·88, 95% CI = 0·79–0·97, P = 0·01). Burnout was higher in high-income countries (HICs) compared to low- and middle-income countries (LMICs) (RR = 1·18; 95% CI = 1·02–1·36, P = 0·018).

Interpretation

Burnout is present at higher than previously reported rates among HCPs working during the COVID-19 pandemic and is related to high workload, job stress, and time pressure, and limited organizational support. Current and future burnout among HCPs could be mitigated by actions from healthcare institutions and other governmental and non-governmental stakeholders aimed at potentially modifiable factors, including providing additional training, organizational support, and support for family, PPE, and mental health resources.

Mental distress in dermatologists during COVID-19 pandemic: Assessment and risk factors in a global, cross-sectional study

There is a sparsity of data regarding the mental health status of dermatologists during COVID-19 pandemic. Evaluate the effects of pandemic on mental health of dermatologists on a large scale and identify risk factors for mental distress. 733 dermatologists were included in this cross-sectional, web-based survey. Mental distress was reported by 77.2% of responders. Considerable percentages of participants experienced stress (73.9%), irritation (33.7%), insomnia (30%), or depression (27.6%), and 78.6% were overwhelmed with the amount of pandemic information they were receiving. Mental distress was significantly associated with practice years, volume of patients seen per week before pandemic, personal protective equipment availability at hospital (P = .001 for each), practice location (continent; P < .001), and participant's assessment that the healthcare system was not equipped for the pandemic (P = .003). Stress was associated with hospital service (P = .003), and depression with being overwhelmed with the amount of pandemic information received (P = .004). In a logistic model, teledermatology use was the most powerful predictor of mental distress (OR, 1.57 [95% CI, 1.07-2.32]). Mental distress was common among dermatologists during this pandemic. Teledermatology use was the most powerful predictor of mental distress. Preventative strategies and psychosocial interventions should be implemented.

Evaluating the Psychological Impacts Related to COVID-19 of Vietnamese People Under the First Nationwide Partial Lockdown in Vietnam

This is the first time in Vietnam that people have undergone "social distancing" to minimize the spreading of infectious disease, COVID-19. These deliberate preemptive strategies may have profound impacts on the mental health of the population. Therefore, this study aimed to identify the psychological impacts of COVID-19 on Vietnamese people and associated factors. We conducted a cross-sectional study during a one-week social distancing and isolation from April 7 to 14, 2020, in Vietnam. A snowball sampling technique was carried out to recruit participants. Impact of Event Scale-Revised (IES-R) was utilized to assess the psychological impacts of the COVID-19. Of all participants, 233 (16.4%) reported low level of PTSS; 76 (5.3%) rated as moderate, and 77 (5.4%) reported extreme psychological conditions. Being female, above 44 years old, or having a higher number of children in the family were positively associated with a higher level of psychological distress. Being self-employed/unemployed/retired was associated with a higher score of intrusion and hyperarousal subscale. Individuals who have a history of touching objects with the possibility of spreading coronavirus (utensils) were related to a higher level of avoidance. There were relatively high rates of participants suffering from PTSS during the first national lockdown related to COVID-19. Comprehensive strategies for the screen of psychological problems and to support high-risk groups are critical, especially females, middle-aged adults and the elderly, affected laborers, and health care professionals.

Prevalence and predictors of general psychiatric disorders and loneliness during COVID-19 in the United Kingdom

Despite ample research on the prevalence of specific psychiatric disorders during COVID-19, we know little about the broader psychological impact of the pandemic on a wider population. The study investigates the prevalence and predictors of general psychiatric disorders measured by the 12-item General Health Questionnaire (GHQ-12) and frequency of loneliness during COVID-19 in the United Kingdom, a country heavily hit by the pandemic. We analyzed 15,530 respondents of the first large-scale, nationally representative survey of COVID-19 in a developed country, the first wave of Understanding Society COVID-19 Study. Results show that 29.2% of the respondents score 4 or more, the caseness threshold, on the general psychiatric disorder measure, and 35.86% of the respondents sometimes or often feel lonely. Regression analyses show that those who have or had COVID-19-related symptoms are more likely to develop general psychiatric disorders and are lonelier. Women and young people have higher risks of general psychiatric disorders and loneliness, while having a job and living with a partner are protective factors. This study showcases the psychological impact, including general psychiatric disorders and loneliness, of broader members of the society during COVID-19 and the underlying social inequalities.

Person-Centered Approach to the Diverse Mental Healthcare Needs During COVID 19 Pandemic

In this COVID-19 pandemic, many mental health problems arose. The mental health difficulties are sufficiently significant to disturb the peace and wellbeing of the people involved. A poor population’s mental health needs are complex (elderly individuals, those with chronic co-morbidity, youth and disadvantaged population, emergency care professionals, police officers, and patients with pre-existing mental health issues). In resource-scarce environments, in the light of the person-centered treatment paradigm, there is an immediate need to plan to meet the emerging challenge.

Stress and Stigmatization in Health-Care Workers during the COVID-19 Pandemic

BACKGROUND

The health-care workers showed the highest risks of the adverse psychological reactions from the COVID-19 pandemic.

AIM

This study aimed to evaluate the structure and severity of psychological distress and stigmatization in different categories of health-care workers during the COVID-19 pandemic.

MATERIALS AND METHODS

This study included two phases of online survey in 1800 Russian-speaking health-care workers (March 30 - April 5 and May 4 - May 10, 2020). The Psychological Stress Scale (PSM-25) and modified Perceived Devaluation-Discrimination scale (Cronbach's α = 0.74) were used. Dispersion analysis was performed with P = 0.05, Cohen's d, and Cramer's V calculated (effect size [ES]).

RESULTS

The psychological stress levels decreased in the second phase (ES = 0.13), while the stigma levels (ES = 0.33) increased. Physicians experienced more stress compared with nurses and paramedical personnel (ES = 0.34; 0.64), but were less likely to stigmatize SARS-CoV-2-infected individuals (ES = 0.43; 0.41). The increasing probability of contact with infected individuals was associated with higher levels of psychological stress (probable contact ES = 0.48; definite contact ES=0.97). The highest rates of contacts with COVID-19 patients were reported by physicians (χ2 = 123.0; P = 0.00, Cramer's V = 0.2), the youngest (ES = 0.5), and less experienced medical workers (ES = 0.33).

CONCLUSION

Direct contact with coronavirus infection is associated with a significant increase in stress among medical personnel. The pandemic compromises the psychological well-being of the youngest and highly qualified specialists. However, the stigmatizing reactions are not directly associated with the risks of infection and are most prevalent among nurses and paramedical personnel.

Impact of restrictions on parental presence in neonatal intensive care units related to coronavirus disease 2019

OBJECTIVES

To determine the relationship between the emergence of COVID-19 and neonatal intensive care unit (NICU) family presence as well as how NICU design affects these changes.

STUDY DESIGN

A cross-sectional survey from April 21 to 30, 2020. We queried sites regarding NICU demographics, NICU restrictions on parental presence, and changes in ancillary staff availability.

RESULTS

Globally, 277 facilities responded to the survey. NICU policies preserving 24/7 parental presence decreased (83-53%, p < 0.001) and of preserving full parental participation in rounds fell (71-32%, p < 0.001). Single-family room design NICUs best preserved 24/7 parental presence after the emergence of COVID-19 (single-family room 65%, hybrid-design 57%, open bay design 45%, p = 0.018). In all, 120 (43%) NICUs reported reductions in therapy services, lactation medicine, and/or social work support.

CONCLUSIONS

Hospital restrictions have significantly limited parental presence for NICU admitted infants, although single-family room design may attenuate this effect.

Latent profiles of the comorbidity of the symptoms for posttraumatic stress disorder and generalized anxiety disorder among children and adolescents who are susceptible to COVID-19

The present study aims to examine the comorbidity patterns of the symptoms (intrusion and avoidance) for posttraumatic stress disorder (PTSD) and generalized anxiety disorder (GAD) and the role of perceived threat and courtesy stigma in distinguishing specific patterns of the symptoms for PTSD and GAD among children and adolescents who are susceptible to coronavirus disease 2019 (COVID-19) in Hubei, China. A total of 1172 (683 female and 489 male) children and adolescents aged 8-18 years were involved in completing the measurements of PTSD, GAD, perceived threat of COVID-19, and COVID-19-related courtesy stigma. The Latent Profile Analysis identified the three profiles of the symptoms for PTSD and GAD which were labeled as Moderate PTSD, Mild Comorbidity, and Severe Comorbidity. The scores of the symptoms for PTSD, GAD, perceived threat, and stigma were different among the three profiles. The risk factors (i.e., perceived threat and stigma) that are related to comorbidity patterns were examined through a three-step method. The possibility of entry into the Severe Comorbidity Profile increased with increasing perceived threat and stigma. The mental health care interventions for children and adolescents who are susceptible to COVID-19 can be developed to reduce perceived threat and stigma.

Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown

The aim of this paper was to review the literature on adolescent psychiatric disorders related to the COVID-19 pandemic and lockdown. Stressful life events, extended home confinement, brutal grief, intrafamilial violence, overuse of the Internet and social media are factors that could influence the mental health of adolescents during this period. The COVID-19 pandemic could result in increased psychiatric disorders such as Post-Traumatic Stress, Depressive, and Anxiety Disorders, as well as grief-related symptoms. Adolescents with psychiatric disorders are at risk of a break or change in their care and management; they may experience increased symptoms. The COVID-19 pandemic and lockdown may have a negative impact on the mental health of adolescents, although there is still no data on the long term impact of this crisis. Adolescents' individual, familial, and social vulnerability, as well as individual and familial coping abilities, are factors related to adolescent mental health in times of crisis. Adolescents are often vulnerable and require careful consideration by caregivers and healthcare system adaptations to allow for mental health support despite the lockdown. Research on adolescent psychiatric disorders in times of pandemics is necessary, as such a global situation could be prolonged or repeated.

The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public - A systematic review and meta-analysis

The coronavirus disease 2019 (COVID-19) pandemic has caused enormous psychological impact worldwide. We conducted a systematic review and meta-analysis on the psychological and mental impact of COVID-19 among healthcare workers, the general population, and patients with higher COVID-19 risk published between 1 Nov 2019 to 25 May 2020. We conducted literature research using Embase, PubMed, Google scholar and WHO COVID-19 databases. Among the initial search of 9207 studies, 62 studies with 162,639 participants from 17 countries were included in the review. The pooled prevalence of anxiety and depression was 33% (95% confidence interval: 28%-38%) and 28% (23%-32%), respectively. The prevalence of anxiety and depression was the highest among patients with pre-existing conditions and COVID-19 infection (56% [39%-73%] and 55% [48%-62%]), and it was similar between healthcare workers and the general public. Studies from China, Italy, Turkey, Spain and Iran reported higher-than-pooled prevalence among healthcare workers and the general public. Common risk factors included being women, being nurses, having lower socioeconomic status, having high risks of contracting COVID-19, and social isolation. Protective factors included having sufficient medical resources, up-to-date and accurate information, and taking precautionary measures. In conclusion, psychological interventions targeting high-risk populations with heavy psychological distress are in urgent need.

[PSYCOVID-19, psychological support device in the fields of mental health, somatic and medico-social]

In December 2019 the World Health Organization (WHO) recorded the first cases of an infectious disease that appeared in China in November of the same year. Generated by the new coronavirus SARS-CoV2, it is quickly named COVID-19 for COronaVirus Infectious Disease 2019. The spread of this unknown disease will soon have worldwide consequences: the contagiousness of the virus is extremely high and potentially lethal. In France, the population initially reacted with disbelief until the disease reached Europe and the first cases appeared on French territory, at the end of January. A few weeks later, on 16 March 2020, President Macron declared the country "at war" against COVID-19. The next day the population was placed in lockdown. At the present time, the country's activity is at a standstill. Schools, businesses and shops are closed. The French citizens are astounded. They suddenly have to face fear: fear of falling ill or that a close relative may fall ill, fear of being locked up and experiencing restrictions of liberties, fear of economic precariousness. And, above all, fear of uncertainty. In order to prevent the mental consequences of this crisis, psychological support units have been created with urgency at national scale. These units are intended to support the healthcare professionals as well as the patients and more broadly, the general population. The unit responsible for the department of Gironde has been set up quickly, over the weekend of March 21, 2020. The COVIDPSY33 listening unit has thus been created in Bordeaux by the Charles Perrens Hospital with support from the Agence Régionale de Santé Nouvelle-Aquitaine (ARS). Simultaneously, the PSYCOVID-19 unit was created. This additional unit works in collaboration with the COVIDPSY33 platform and offers psychological assistance to the general population and caregivers in the sectors of Bordeaux Rive Droite, Bordeaux Gare, Rives de Garonne, Rives d'Arcins and Sud Gironde. It thus covers an area equivalent to approximately half of Gironde, the largest department in metropolitan France. In the present interview, Samantha Al Joboory and Florence Monello, psychiatrist and psychologist coordinating PSYCOD-19, present this psychological support unit.

How mental health care should change as a consequence of the COVID-19 pandemic

The unpredictability and uncertainty of the COVID-19 pandemic; the associated lockdowns, physical distancing, and other containment strategies; and the resulting economic breakdown could increase the risk of mental health problems and exacerbate health inequalities. Preliminary findings suggest adverse mental health effects in previously healthy people and especially in people with pre-existing mental health disorders. Despite the heterogeneity of worldwide health systems, efforts have been made to adapt the delivery of mental health care to the demands of COVID-19. Mental health concerns have been addressed via the public mental health response and by adapting mental health services, mostly focusing on infection control, modifying access to diagnosis and treatment, ensuring continuity of care for mental health service users, and paying attention to new cases of mental ill health and populations at high risk of mental health problems. Sustainable adaptations of delivery systems for mental health care should be developed by experts, clinicians, and service users, and should be specifically designed to mitigate disparities in health-care provision. Thorough and continuous assessment of health and service-use outcomes in mental health clinical practice will be crucial for defining which practices should be further developed and which discontinued. For this Position Paper, an international group of clinicians, mental health experts, and users of mental health services has come together to reflect on the challenges for mental health that COVID-19 poses. The interconnectedness of the world made society vulnerable to this infection, but it also provides the infrastructure to address previous system failings by disseminating good practices that can result in sustained, efficient, and equitable delivery of mental health-care delivery. Thus, the COVID-19 pandemic could be an opportunity to improve mental health services.

Sex and Gender Differences in Health: What the COVID-19 Pandemic Can Teach Us

The authors of this commentary call for sex- and gender-specific and differentiating factors to be urgently included in the research, prevention, and therapeutics implementation response to the coronavirus disease 2019 pandemic.

Coronavirus disease 2019: What could be the effects on Road safety?

In March 2020, the World Health Organization declared COVID-19 a world-wide pandemic. Countries introduced public health measures to contain and reduce its spread. These measures included closures of educational institutions, non-essential businesses, events and activities, as well as working from and staying at home requirements. These measures have led to an economic downturn of unprecedented proportions. Generally, as economic activity declines, travel decreases and drivers are exposed to a lower risk of collisions. However, research on previous economic downturns suggests economic downturns differentially affect driver behaviours and situations. COVID-19 pandemic effects on road safety are currently unknown. However, preliminary information on factors such as the increased stress and anxiety brought about by the COVID-19 pandemic, more "free" (idle) time, increased consumption of alcohol and drugs, and greater opportunities for speeding and stunt driving, might well have the opposite effect on road safety. Using an interactionist model we identify research questions for researchers to consider on potential person and situation factors associated with COVID-19 that could affect road safety during and after the pandemic. Collaborative efforts by researchers, and public and private sectors will be needed to gather data and develop road safety strategies in relation to the new reality of COVID-19.

Psychological states of Bangladeshi people four months after the COVID-19 pandemic: An online survey

BACKGROUND

The COVID-19 pandemic essentially imposes psychological effects on people. As the pandemic progresses, people experience psychological trauma gradually, which can change over time. The present study aimed to assess the prevalence of depression, anxiety, and stress among Bangladeshi people four months after the COVID-19 outbreak.

METHODS

An online cross-sectional survey was conducted among Bangladeshi citizens aged ≥18 years from June 1 to June 10, 2020. The participants completed an online questionnaire examining socio-demographic variables and COVID-19 related factors, along with the Depression Anxiety and Stress Scale 21. A total of 1146 respondents have been included in the study. Data were analyzed using the Statistical Package for Social Sciences, IBM Statistics version 22.0.

RESULTS

The prevalence of moderate to the extremely severe levels of depression, anxiety, and stress was 47.2%, 46.0%, and 32.5%, respectively, with no significant gender differences. The prevalence of anxiety and stress was significantly higher in participants aged >30 than in participants aged 18-30 years. Daily follow up COVID-19 related news, having COVID-19 symptoms so far, having contact (direct or indirect) with COVID-19 infected person, and fear of infection were significantly associated with depression, anxiety, and stress.

CONCLUSIONS

Sizable proportions of participants had depression, anxiety and stress four months after the COVID-19 outbreak in Bangladesh. The findings of this study underscores the need for strategies aimed at reducing these psychological sufferings in Bangladeshi people in the context of COVID-19.

Translation and psychometrical properties of Coronavirus Anxiety Scale (CAS) in Peruvian young people and adults

Background: The overall aim of the study was to translate into Spanish and evaluate the psychometric properties of the Coronavirus Anxiety Scale (CAS). Method: The sample was composed of 622 Peruvian young people and adults who answered CAS. The structural evaluation was conducted with confirmatory factor analysis. Factorial invariance was used to verify the equivalence by sex and age, Results: The unifactorial model revealed good fit indexes χ²(5) = 12.40,CFI = .998, TLI = .996, RMSEA = .049, SRMR = .033. Also, the internal consistency using McDonald´s Omega coefficient was high (ω > .80). The factorial invariance indicated that the unifactorial structure is stable according to age. Conclusion: The Peruvian version of the CAS has evidence to be considered an accurate, valid, and invariant measure and the results support the unifactorial model.

Psychological distress experiences of Nigerians during Covid-19 pandemic; the gender difference

This study examine the psychological distress experience of Nigerians during the COVID-19 pandemic, across gender. From March 20, 2020, to April 12, 2020, this descriptive survey used a snowballing sampling technique to select 502-Nigerians with an online semi-structured questionnaire detailing the impact of Event Scale-Revised, Generalized Anxiety Disorder – 7 item scale, Patient Health Questionnaire and Insomnia Severity Index. Gender had an insignificant difference in the level of insomnia (χ2 ​= ​04.93; df ​= ​3; p ​> ​0.05), however, 20.8% of males had sub-threshold of insomnia, 8.2% experienced moderate insomnia and 5.9% had severe insomnia; 32% females reported sub-threshold of insomnia, 12.4% had moderate insomnia while 3.6% had severe insomnia. Also, gender had an insignificant difference in the measures of depression (χ2 ​= ​01.94; df ​= ​4; p ​> ​0.05); 55.4% males reported minimal depression, 22.3% had mild depression, 11.9% had moderate depression; 6.7%–3.7% males had moderate to severe depression while, 49.3% of the females had minimal depression, 26.7% reported mild depression, 14.29% had moderate depression, 4.4%–5.3% had moderate to severe depressive symptoms. Posttraumatic Stress Symptoms (PTSS) has no gender difference among respondents (χ2 ​= ​02.51; df ​= ​3; p ​> ​0.05); 23% of males reported partial PTSS, 17.5% presented clinical PTSS, and 21.6% males had severe PTSS; while 29.3% of females had severe PTSS, 24% reported partial PTSS and 18.7% had clinical PTSS. Respondents reported insignificant gender differences on anxiety (χ2 ​= ​0.08; df ​= ​1; p ​> ​0.05), while 51% reported moderate anxiety and 49% exhibited severe anxiety during the COVID-19 pandemic in Nigeria. Findings revealed that Nigerians experienced psychological distress during COVID-19 pandemic. The government and stakeholders should initiate tele-mental health services to serve as alternative to traditional treatment to manage present and future pandemic psychological implications among Nigerians.

Daily Monitoring of Emotional Responses to the Coronavirus Pandemic in Serbia: A Citizen Science Approach

The COVID-19 pandemic, a health emergency with international consequences, has brought serious impact on all aspects of society and affects not only health and economy, but psychological functioning and mental health as well. This research was conducted in order to examine and further our understanding of emotional reactions to the ongoing pandemic. Change in emotional reactions during the pandemic and relations with specific pandemic related behaviors and personality traits from the revised Reinforcement sensitivity theory were explored. The research was conducted in Serbia for 35 days while the country was in a state of emergency, as a citizen science project. Out of the 1526 participants that joined the study, 444 (67% female) had measures for all five weeks. Longitudinal changes in four emotional states during the pandemic were examined: worry, fear, boredom, and anger/annoyance. Results indicate a decrease in all four emotional states over time. The biggest decrease was present in case of worry, followed by fear and boredom. Regression analysis showed that personality dimensions, as well as behavioral responses in this situation significantly predicted emotional reactions. Findings revealed the Behavioral activation system was significantly related to worry, fear and boredom, Fight with boredom and anger, and the Behavioral inhibition system with anger. Adherence to protection measures, as well as increased exposure to the media, had significant positive relations with worry and fear. These results indicate that both stable characteristics and specific pandemic-related behaviors are significantly related to emotional response during the pandemic.

Impact of COVID-19 on Public Mental Health and the Buffering Effect of a Sense of Coherence

INTRODUCTION

It is claimed that the coronavirus disease 2019 (COVID-19) pandemic has had a negative impact on mental health. However, to date, prospective studies are lacking. Moreover, it is important to identify which factors modulate the stress response to the pandemic. Previously, sense of coherence (SOC) has emerged as a particularly important resistance factor.

OBJECTIVE

This prospective study aimed to assess the impact of the COVID-19 outbreak on mental health and to investigate the ability of pre-outbreak SOC levels to predict changes in psychopathological symptoms.

METHODS

This study assessed psychopathological symptoms and SOC before and after the COVID-19 outbreak as well as post-outbreak COVID-19-related traumatic distress in a German-speaking sample (n =1,591). Bivariate latent change score (BLCS) modeling was used to analyze pre- to post-outbreak changes in psychopathological symptoms and the ability of SOC to predict symptom changes.

RESULTS

Overall, there was no change in psychopathological symptoms. However, on an individual-respondent level, 10% experienced a clinically significant increase in psychopathological symptoms and 15% met cut-off criteria for COVID-19-related traumatic distress. Using BLCS modeling, we identified a high-stress group experiencing an increase in psychopathological symptoms and a decrease in SOC and a low-stress group showing the reversed pattern. Changes in SOC and psychopathological symptoms were predicted by pre-outbreak SOC and psychopathological symptom levels.

CONCLUSIONS

Although mental health was stable in most respondents, a small group of respondents characterized by low levels of SOC experienced increased psychopathological symptoms from pre- to post-outbreak. Thus, SOC training might be a promising approach to enhance the resistance to stressors.

COVID-19 in Portugal: exploring the immediate psychological impact on the general population

Like previous pandemics, the coronavirus disease 2019 (COVID-19) has direct and indirect effects, including in mental health. To evaluate the immediate psychological impact of COVID-19, we conducted an online survey in Portugal (24-27 March 2020), using the Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety and Stress Scale (DASS-21). From the 10,529 participants (M = 31.33; SD = 9.73), 83.4% were women, had a mean age of 31.2 years, and 70.9% were active workers. Depression, anxiety, and stress were rated as moderate to severe in 11.7%, 16.9%, and 5.6% of the sample, respectively. Moreover, 49.2% of participants reported a moderate or severe psychological impact of the outbreak. Women, the unemployed, those with lower education, living in rural areas, and with flu-like symptoms or chronic disorders were risk factors. Further research is needed to identify vulnerable groups to better inform and adapt mental health policies and interventions.

Resumption of Endodontic Practices in COVID-19 Hardest-Hit Area of China: A Web-based Survey

INTRODUCTION

The purpose of this study was to investigate the resumption of endodontic practices in Hubei Province, China 1 month after the end of the lockdown.

METHODS

A Web-based survey was sent to 1069 active endodontic specialists and general dentists who provided endodontic care in Hubei Province from May 7 to May 9, 2020. The survey consisted of 18 questions on demographics, the current situation of endodontic practice for the participants, and concerns regarding contracting or spreading the virus in newly opened endodontic practices.

RESULTS

A total of 322 participants completed the survey. Most respondents (62%) were from Wuhan. Almost 83% of the respondents have resumed their endodontic practice partially or fully. Most respondents in practice (99%) would take measures to screen patients before treatment including paid screening measures. More than 93% of the respondents reported having taken special measures for routine endodontic treatment at this stage, with the most common measure taken being wearing an N95 mask. The rubber dam was recognized as efficient in preventing infection by most respondents. Many respondents were concerned about contracting coronavirus disease 2019 (COVID-19) as a result of routine endodontic practice at this stage, and respondents with more than 11 years of endodontic experience were significantly less concerned about infection compared with those with fewer than 5 years of experience (P < .05).

CONCLUSIONS

There is a fear of contracting/spreading COVID-19 among endodontic clinicians, the fear is negatively associated with years of practice, and most clinicians believe that rubber dam isolation can protect them and their patients from COVID-19.

Anxiety About the Risk of Death of Their Patients in Health Professionals in Spain: Analysis at the Peak of the COVID-19 Pandemic

The COVID-19 health crisis has had a global effect, but the consequences in the different countries affected have been very different. In Spain, in a short period of time, health professionals went from a situation of stability to living with a working environment characterized by overcrowded hospitals, lack of individual protection equipment, non-existent or contradictory work protocols, as well as an unknown increase in mortality. Although in their professional activity health workers are closely linked to death processes, in recent months, working conditions and health emergencies have drawn an unheard of working scenario, with the stress and anxiety they may suffer when faced with the death of their patients. The present quantitative research was carried out in different hospitals in Spain on health professionals during the month of April 2020. Through the subscale of anxiety in the face of the death of others, developed by Collett-Lester, it has been verified that health professionals have had to develop their work in a context of precariousness, putting at risk both their individual and collective health, notably increasing anxiety in the face of the death of their patients. The predictive variables of this anxiety have been the absence of individual protection equipment, as well as high levels in the burnout subscales of emotional exhaustion and depersonalization.

An automated Residual Exemplar Local Binary Pattern and iterative ReliefF based COVID-19 detection method using chest X-ray image

Coronavirus is normally transmitted from animal to person, but nowadays it is transmitted from person to person by changing its form. Covid-19 appeared as a very dangerous virus and unfortunately caused a worldwide pandemic disease. Radiology doctors use X-ray or CT images for the diagnosis of Covid-19. It has become crucial to help diagnose such images using image processing methods. Therefore, a novel intelligent computer vision method to automatically detect the Covid-19 virus was proposed. The proposed automatic Covid-19 detection method consists of preprocessing, feature extraction, and feature selection stages. Image resizing and grayscale conversion are used in the preprocessing phase. The proposed feature generation method is called Residual Exemplar Local Binary Pattern (ResExLBP). In the feature selection phase, a novel iterative ReliefF (IRF) based feature selection is used. Decision tree (DT), linear discriminant (LD), support vector machine (SVM), k nearest neighborhood (kNN), and subspace discriminant (SD) methods are chosen as classifiers in the classification phase. Leave one out cross-validation (LOOCV), 10-fold cross-validation, and holdout validation are used for training and testing. In this work, SVM classifier achieved 100.0% classification accuracy by using 10-fold cross-validation. This result clearly has shown that the perfect classification rate by using X-ray image for Covid-19 detection. The proposed ResExLBP and IRF based method is also cognitive, lightweight, and highly accurate.

The status and high risk factors of severe psychological distress in migraine patients during nCOV-2019 outbreak in Southwest China: a cross-sectional study

Background

Psychological distress is highly prevalent among migraineurs during public health emergencies. The coronavirus disease 2019 (nCOV-2019) has created mass panic in China due to its highly contagious by contact and aerosols and lack of effective treatment. However, the emotion status of migraineurs stayed unclear during the nCOV-2019 outbreak.

Objective

To understand psychological distress of migraineurs by comparing with common population and identify potential high-risk factors of severe psychological distress among migraine patients.

Method

We enrolled the migraineurs treated at the department of Neurology of West China Hospital and healthy controls with age- and sex-matched to migraineurs. Data on clinicodemographics and psychological distress in the month of February 2020 (during in the nCOV-2019 outbreak in China) were collected. We used the Kessler 6-item (K-6) scale to assess psychological distress. Potential risk factors of severe psychological distress were identified using univariate and multivariate logistic regression.

Results

The 144 migraineurs and 150 controls were included in the study. Migraineurs showed significantly higher K-6 scores than controls (P < 0.001). Migraine attack frequency in previous 30 days and time spent paying attention to outbreak showed significant in multivariate logistic regression with respective odds ratios of 2.225 (95%CI 1.361–3.628, P = 0.001) and 1.589 (95% 1.117–2.26, P = 0.01).

Conclusion

During public health outbreaks, healthcare professionals should focus not only on controlling and reducing migraine attack but also on mental health of migraineurs, especially those with high frequency migraine attack.

Changes in Sex Life among People in Taiwan during the COVID-19 Pandemic: The Roles of Risk Perception, General Anxiety, and Demographic Characteristics

This study used data collected from an online survey study on coronavirus disease 2019 (COVID-19) in Taiwan to examine changes in sex life during the pandemic and the factors affecting such changes. In total, 1954 respondents were recruited from a Facebook advertisement. The survey inquired changes in sex life during the pandemic, including satisfaction with the individual's sex life, frequency of sexual activity, frequency of sex-seeking activity, and frequency of using protection for sex. The associations of change in sex life with risk perception of COVID-19, general anxiety, gender, age, and sexual orientation were also examined. For each aspect of their sex life, 1.4%-13.5% of respondents reported a decrease in frequency or satisfaction, and 1.6%-2.9% reported an increase in frequency or satisfaction. Risk perception of COVID-19 was significantly and negatively associated with frequencies of sexual and sex-seeking activities. Higher general anxiety was significantly and negatively associated with satisfaction of sex life and frequencies of sexual and sex-seeking activities. Sexual minority respondents were more likely to report decreased satisfaction with sex life and frequencies of sexual activity and sex-seeking activities during COVID-19. Health care providers should consider these factors when developing strategies for sexual wellness amid respiratory infection epidemics.

COVID-19 Related Experience, Knowledge, Attitude, and Behaviors Among 2,669 Orthodontists, Orthodontic Residents, and Nurses in China: A Cross-Sectional Survey

Objectives: To assess the current COVID-19 related experiences, knowledge, attitudes, and behaviors among orthodontists, orthodontic residents, and orthodontic nurses in China, and to identify factors associated with their self-perceived and actual level of knowledge, as well as their willingness to treat/care for COVID-19 patients.

Materials and Methods: A cross-sectional online survey was conducted in China using a 37-item questionnaire developed based on previous research. A professional online survey tool (www.wjx.cn) and a social media platform (WeChat) were used to display and distribute the questionnaire. Data were collected during April 11 to 13, 2020, when most regions of China had resumed dental practice except for high-risk regions such as Wuhan. Then the data were analyzed with multivariable generalized estimating equations.

Results: A total of 2,669 valid questionnaires were collected. Orthodontic services were suspended for nearly all respondents (97.8%) during the epidemic, and 68.0% had resumed work by the time they completed the questionnaire. The majority of respondents (80.2%) were confident that they understood COVID-19 related knowledge, but most of them only correctly answered less than half of the questions testing their actual level of knowledge. About two-thirds (64.1%) were willing to treat/care for patients with confirmed or suspected COVID-19. The completion of relevant training programs was significantly associated with more confidence in knowledge mastery (P < 0.001) and a higher actual level of knowledge (P < 0.001), but did not increase their willingness to treat/care for patients with COVID-19 (P = 0.235).

Conclusions: Before work resumption, COVID-19-related training programs are essential for the improvement of knowledge, confidence, and preparedness of orthodontic professionals. Sufficient and proper protection should also be provided to ensure safety and reduce the psychological burden on them.

Clinical Relevance: The findings can provide evidence for policy-making related to the resumption of elective dental services.

Challenges and management of neurological and psychiatric manifestations in SARS-CoV-2 (COVID-19) patients

COVID-19 is a pandemic caused by human coronavirus (HCoV) SARS-CoV-2, which originated in Wuhan, China, at the end of 2019 and spread globally during 2020. Due to the difficulty of clinical decision-making during this period, our study group reviewed current literature focusing on the neurological and psychiatric aspects of COVID-19. Despite the knowledge on this newly discovered virus which is constantly evolving, different pieces of evidence reported an association between COVID-19 and neurological symptoms like headache, dizziness, taste and smell disorders and complications involving the nervous system eventually triggered by the pathologic processes elicited by SARS-CoV-2. It seems that younger patients are less prone to develop severe forms of COVID-19. However, neurological signs have been reported in paediatric patients as well, and in some cases, the infection presented neurological sequelae. Furthermore, children with particular neurological diseases or treated with specific drugs (e.g. immune-suppressant therapies) must be carefully monitored during this pandemic. Neurologists should be aware of the main drug–drug interactions and the neurological side effects of COVID-19 treatments. Notably, adverse mental health impact has been reported in patients with SARS-CoV-2, which could be related either to the social strain or to the eventual neurotropic effects of the virus, which in other infections have been proven to promote the onset of psychiatric symptoms. Further, psychiatric population may be more vulnerable to the infection and at higher risk for adverse outcomes.

Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: A mixed-method study

Since the end of 2019, Corona Virus Disease 2019 (COVID-19) has been the cause of a worldwide pandemic. The mental status of patients with COVID-19 who have been quarantined and the interactions between their psychological distress and physiological levels of inflammation have yet to be analyzed. Using a mixed-method triangulation design (QUAN + QUAL), this study investigated and compared the mental status and inflammatory markers of 103 patients who, while hospitalized with mild symptoms, tested positive with COVID-19 and 103 matched controls that were COVID-19 negative. The severity of depression, anxiety, and post-traumatic stress symptoms (PTSS) was measured via an on-line survey. Using a convenience sampling technique, qualitative data were collected until the point of data saturation. In addition, a semi-structured interview was conducted among five patients with COVID-19. Peripheral inflammatory markers were also collected in patients, both at baseline and within ± three days of completing the on-line survey. Results revealed that COVID-19 patients, when compared to non-COVID controls, manifested higher levels of depression (P < 0.001), anxiety (P < 0.001), and post-traumatic stress symptoms (P < 0.001). A gender effect was observed in the score of "Perceived Helplessness", the subscale of PSS-10, with female patients showing higher scores compared to male patients (Z = 2.56, P = 0.010), female (Z = 2.37, P = 0.018) and male controls (Z = 2.87, P = 0.004). Levels of CRP, a peripheral inflammatory indicator, correlated positively with the PHQ-9 total score (R = 0.37, P = 0.003, Spearman's correlation) of patients who presented symptoms of depression. Moreover, the change of CRP level from baseline inversely correlated with the PHQ-9 total score (R = -0.31, P = 0.002), indicative of improvement of depression symptoms. Qualitative analysis revealed similar results with respect to patient reports of negative feelings, including fear, guilt, and helplessness. Stigma and uncertainty of viral disease progression were two main concerns expressed by COVID-19 patients. Our results indicate that significant psychological distress was experienced by hospitalized COVID-19 patients and that levels of depressive features may be related to the inflammation markers in these patients. Thus, we recommend that necessary measures should be provided to address depression and other psychiatric symptoms for COVID-19 patients and attention should be paid to patient perceived stigma and coping strategies when delivering psychological interventions.

Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender

BACKGROUND

The COVID-19 pandemic is having negative effects on societies' mental health. Both the pandemic and the measures taken to combat it can affect individuals' mental health.

AIMS

The purpose of this study was to evaluate the levels of depression, anxiety and health anxiety in Turkish society during the COVID-19 pandemic, and to examine the factors affecting these.

METHOD

The study was performed using an online questionnaire. Participants were asked to complete a sociodemographic data form, the Hospital Anxiety and Depression Scale (HADS) and the Health Anxiety Inventory (HAI). The effects on depression, anxiety and health anxiety levels of factors such as age, sex, marital status, living with an individual aged above 60, the presence of a new Coronavirus+ patient among friends or relatives, previous and current psychiatric illness and presence of accompanying chronic disease were then investigated.

RESULTS

In terms of HADS cut-off points, 23.6% (n = 81) of the population scored above the depression cut-off point, and 45.1% (n = 155) scored above the cut-off point for anxiety. In regression analysis, female gender, living in urban areas and previous psychiatric illness history were found as risk factors for anxiety; living in urban areas was found as risk factor for depression; and female gender, accompanying chronic disease and previous psychiatric history were found as risk factors for health anxiety.

CONCLUSION

The results of this cross-sectional study suggest that the groups most psychologically affected by the COVID-19 pandemic are women, individuals with previous psychiatric illness, individuals living in urban areas and those with an accompanying chronic disease. Priority might therefore be attached to these in future psychiatric planning.

COVID-19 Impact on Well-Being and Education in Radiology Residencies: A Survey of the Association of Program Directors in Radiology

RATIONALE AND OBJECTIVES

The COVID-19 pandemic has forced rapid evolution of the healthcare environment. Efforts to mitigate the spread of the virus through social distancing and shelter-at-home edicts have unintended consequences upon clinical and educational missions and mental well-being of radiology departments. We sought to understand the impact of the COVID-19 pandemic on radiology residencies with respect to the educational mission and perceptions of impact on well-being.

MATERIALS AND METHODS

This study was IRB exempt. An anonymous 22 question survey regarding the impact of COVID-19 pandemic on educational and clinical missions of residencies, its perceived impact upon morale of radiologists and trainees and a query of innovative solutions devised in response, was emailed to the Association of Program Directors in Radiology membership. Survey data were collected using SurveyMonkey (San Mateo, California).

RESULTS

Respondents felt the COVID-19 pandemic has negatively impacted their residency programs. Regarding the educational mission impact, 70.1% (75/107) report moderate/marked negative impact and 2.8% (3/107) that educational activities have ceased. Regarding the pandemic's impact on resident morale, 44.8% (48/107) perceive moderate/marked negative effect; perceived resident morale in programs with redeployment is significantly worse with 57.1% (12/21) reporting moderate/marked decrease. Respondents overwhelmingly report adequate resident access to mental health resources during the acute phase of the pandemic (88.8%, 95/107). Regarding morale of program directors, 61% (65/106) report either mild or marked decreased morale. Program innovations reported by program directors were catalogued and shared.

CONCLUSION

The COVID-19 pandemic has markedly impacted the perceived well-being and educational missions of radiology residency programs across the United States.

[Not Available]

Covid-19: psychological support programmes. The spread of Covid-19 in France, the confinement of the population and the changes to our way of life as a result of the health crisis have caused psychological distress to many people of all ages and conditions. In response to these problems, numerous remote psychological support programmes have been set up through teleconsultations. PsyCovid-19, created at Cadillac psychiatric hospital, is one such example.

An Insight into the Sex Differences in COVID-19 Patients: What are the Possible Causes?

Studies have reported a sex bias in case fatalities of COVID-19 patients. Moreover, it is observed that men have a higher risk of developing a severe form of the disease compared to women, highlighting the importance of disaggregated data of male and female COVID-19 patients. On the other hand, other factors (eg, hormonal levels and immune functions) also need to be addressed due to the effects of sex differences on the outcomes of COVID-19 patients. An insight into the underlying causes of sex differences in COVID-19 patients may provide an opportunity for better care of the patients or prevention of the disease. The current study reviews the reports concerning with the sex differences in COVID-19 patients. It is explained how sex can affect angiotensin converting enzyme-2 (ACE2), that is a key component for the pathogenesis of COVID-19, and summarized the gender differences in immune responses and how sex hormones are involved in immune processes. Furthermore, the available data about the impact of sex hormones on the immune functions of COVID-19 cases are looked into.

Influence of coronavirus disease 2019 pandemic state of emergency in orthopaedic fracture surgical treatment

Purpose

After the appearance of first COVID-19 cases in Serbia, state of emergency was declared on 15 March 2020 and lasted for 54 days. The aim of this report is to compare orthopaedic fracture frequencies in this period, when the walk was limited at the home mostly, with those during the same part in the previous year with regular state, thus to examine staying at home as a factor influencing the frequency of different fracture types.

Methods

There were 86 patients during the state of emergency in year 2020 and 106 patients during the same part of year 2019 with a regular state, having orthopaedic trauma surgery. Number of fractures, gender distribution, and age of patients have been compared between these periods.

Results

Total number of fractures decreased for about 19% during the state of emergency. There was nonsignificant difference in fracture frequency for all skeletal areas (p > 0.05), except for distal femoral fractures which occurred more often during the state of emergency (p < 0.05). Female ratio was higher during state of emergency than in regular state for femoral neck fractures.

Conclusion

Restricted going outside the home for 54 days has the influence in total number of fractures and gender distribution in femoral neck fractures. The method of external fixation used could be assumed as a reducing factor of intraoperative virus pandemic propagation among medical staff.

Global Prevalence of Posttraumatic Stress Disorder (PTSD) during and after Coronavirus Pandemic: A Study Protocol for a Systematic Review and Meta-Analysis

Objective: Studies conducted on severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19 epidemics have shown PTSD can occur during and after infectious diseases. However, more studies are needed to explore PTSD during and after COVID-19 outbreak. The objective of this study is to provide a protocol of systematic review and meta-analysis to report the global prevalence of PTSD during and after coronavirus pandemics among general population, health care workers, survivors, or patients with coronaviruses.

Method: We include all studies that reported the prevalence of PTSD during and after coronavirus pandemics and search databases, including Web of Science, PubMed, Scopus, Embase, and Google Scholar from first of November 2002 to May 18, 2020. Two authors independently use relevant checklists to quality assessment of the included studies and extract data. We use the graphical methods and fixed or random effect models to aggregate prevalence estimates. Also, we will assess heterogeneity between the included studies using the I2 heterogeneity statistic and use subgroup and sensitivity analysis to assess the sources of heterogeneity.

Discussion: We infer that PTSD is a common experience during and after infectious disease pandemics, especially COVID-19. The findings of this study can be used by health policymakers and other stakeholders and will provide a path to future studies.

Racial and Gender-Based Differences in COVID-19

The novel coronavirus disease (COVID-19) has become a global health crisis since its first appearance in Wuhan, China. Current epidemiological studies suggest that COVID-19 affects older patients with multiple comorbidities, such as hypertension, obesity, and chronic lung diseases. The differences in the incidence and severity of COVID-19 are likely to be multifaceted, depending on various biological, social, and economical factors. Specifically, the socioeconomic differences and psychological impact of COVID-19 affecting males and females are essential in pandemic mitigation and preparedness. Previous clinical studies have shown that females are less susceptible to acquire viral infections and reduced cytokine production. Female patients have a higher macrophage and neutrophil activity as well as antibody production and response. Furthermore, in-vivo studies of the angiotensin-converting enzyme 2 (ACE2) showed higher expression in the kidneys of male than female patients, which may explain the differences in susceptibility and progression of COVID-19 between male and female patients. However, it remains unknown whether the expression of ACE2 differs in the lungs of male or female patients. Disparities in healthcare access and socioeconomic status between ethnic groups may influence COVID-19 rates. Ethnic groups often have higher levels of medical comorbidities and lower socioeconomic status, which may increase their risk of contracting COVID-19 through weak cell-mediated immunity. In this article, we examine the current literature on the gender and racial differences among COVID-19 patients and further examine the possible biological mechanisms underlying these differences.

Post-COVID-19 follow-up clinic: depicting chronicity of a new disease

BACKGROUND AND AIM OF THE WORK

The coronavirus disease-19 (COVID-19) outbreak is posing considerable challenges to healthcare systems and societies worldwide. While the knowledge on the acute phase of the disease has rapidly expanded, little is known on the consequences of COVID-19 following clinical remission. We set up a multidisciplinary COVID-19 follow-up outpatient clinic to identify and address the clinical needs of COVID-19 survivors. Here we describe the features of our follow-up programme.

METHODS

The multidisciplinary assessment comprises a complete physical examination, respiratory evaluation (peripheral oxygen saturation, respiratory rate, dyspnoea assessment, lung ultrasound and pulmonary function), cardiovascular assessment (electrocardiography, echocardiography), nutritional assessment (anthropometrics, mini Nutritional Assessment screening tool), neurological examination including cognitive tests, and mental health assessment. All data are prospectively collected, and blood is sampled for biobanking.

RESULTS

Since 7 April to 5 June, 2020, 453 out of the 1388 COVID-19 survivors managed at our University Hospital have been evaluated at the Outpatient COVID-19 Follow-up Clinic. The characteristics of the follow-up cohort are similar to those of the whole cohort of COVID-19 in terms of demographics, comorbidities, and COVID-19 severity upon ED presentation, indicating that the follow-up cohort is representative of the whole cohort.

CONCLUSIONS

Continuous patient monitoring might give an answer to the numerous unsolved questions about what comes next in this pandemic and beyond. This will help physicians and researchers establish strategies to face future pandemics and develop preventative and therapeutic strategies for similar hyperinflammatory conditions.