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

Psychological Distress in Outpatients With Lymphoma During the COVID-19 Pandemic

Cancer patients are a population at high risk of contracting COVID-19 and, also of developing severe complications due to the infection, which is especially true when they are undergoing immunosuppressive treatment. Despite this, they had still to go to hospital to receive chemotherapy during lockdown. In this context, we have evaluated the psychological status of onco-hematological outpatients receiving infusion and not deferrable anti-neoplastic treatment for lymphoproliferative neoplasms, with the aim of both measuring the levels of post-traumatic symptoms, depression, and anxiety during the pandemic and also of investigating the perception of risk of potential nosocomial infection. The Impact of Event Scale-Revised (IES-R) and the Hospital Anxiety and Depression Scale (HADS) were administered to all patients. Moreover, patients were investigated about their worries regarding the impact of COVID-19 on their lives as onco-hematologic patients. Since the 2nd to the 29th April 2020 (during the first phase of the lockdown period in Italy), 77 outpatients were prospectively evaluated. They were diagnosed with non-Hodgkin's lymphoma, classical Hodgkin lymphoma, and Chronic lymphocytic leukemia/Small lymphocytic lymphoma. The mean age was 56.6 (range 22-85). We found that 36% of patients had anxiety (HADS-A), 31% depression (HADS-D), and 43% were above the cut-off for the HADS-General Scale; 36% fulfilled the diagnostic criteria for post-traumatic stress disorder (PTSD). Women and younger patients were found to be more vulnerable to anxiety and PTSD. The study firstly analyzes the psychological impact of the COVID-19 pandemic on the frail population of patients affected by lymphoproliferative neoplasms, to underly the importance of screening patients for emotional and distress conditions and then offering them psychological support.

[Problems of mental health in the situation of COVID-19 pandemic]

The WHO declared COVID-19 pandemic, the deterioration of the epidemic situation in Russia, the lockdown and the growing fear in society caused by panic rumors and misinformation spread on social networks and the media pose urgent organizational and medical tasks for our psychiatric service. Based on the experience of other countries that have already encountered the massive spread of COVID-19, the author presents a review of the proposed urgent and preventive organizational and treatment measures and suggests practical recommendations on urgent temporary reorganization of the psychiatric service, and the provision of psychological and psychotherapeutic support to the most vulnerable groups of the population, including medical personnel working with patients with COVID-19, and the management of mentally ill patients with severe acute respiratory syndrome. As the primary goals, it is proposed to separate the flows of people in need of psychological support and psychiatric care, and organize the remote provision of these services (hotline phones and telemedicine consultations). Particular attention is paid to the management of mentally ill patients with coronavirus respiratory syndrome and the characteristics of psychopharmacological therapy with an overview of the potential risks of side-effects and complications related primarily to respiratory function, including those due to adverse drug interactions.

Provision of Psychotherapy during the COVID-19 Pandemic among Czech, German and Slovak Psychotherapists

Psychotherapists around the world are facing an unprecedented situation with the outbreak of the novel coronavirus disease (COVID-19). To combat the rapid spread of the virus, direct contact with others has to be avoided when possible. Therefore, remote psychotherapy provides a valuable option to continue mental health care during the COVID-19 pandemic. The present study investigated the fear of psychotherapists to become infected with COVID-19 during psychotherapy in personal contact and assessed how the provision of psychotherapy changed due to the COVID-19 situation and whether there were differences with regard to country and gender. Psychotherapists from three European countries: Czech Republic (CZ, n = 112), Germany (DE, n = 130) and Slovakia (SK, n = 96), with on average 77.8% female participants, completed an online survey. Participants rated the fear of COVID-19 infection during face-to-face psychotherapy and reported the number of patients treated on average per week (in personal contact, via telephone, via internet) during the COVID-19 situation as well as (retrospectively) in the months before. Fear of COVID-19 infection was highest in SK and lowest in DE (p < 0.001) and was higher in female compared to male psychotherapists (p = 0.021). In all countries, the number of patients treated on average per week in personal contact decreased (p < 0.001) and remote psychotherapies increased (p < 0.001), with more patients being treated via internet than via telephone during the COVID-19 situation (p < 0.001). Furthermore, female psychotherapists treated less patients in personal contact (p = 0.036), while they treated more patients via telephone than their male colleagues (p = 0.015). Overall, the total number of patients treated did not differ during COVID-19 from the months before (p = 0.133) and psychotherapy in personal contact remained the most common treatment modality. Results imply that the supply of mental health care could be maintained during COVID-19 and that changes in the provision of psychotherapy vary among countries and gender.

Anxiety, Self-Compassion, Gender Differences and COVID-19: Predicting Self-Care Behaviors and Fear of COVID-19 Based on Anxiety and Self-Compassion with an Emphasis on Gender Differences

Objective: The outbreak of COVID-19 has different effects on people's psychological and social aspects. This study aimed to investigate the relationship between anxiety, self-compassion, and gender differences with self-care behaviors and fear of COVID-19 in Kermanshah. Method : In the cross-sectional study, 403 people answered online questions on the Generalized Anxiety Disorder 7-Item (GAD-7) Scale, Self-Compassion Scale (SCS), Fear of COVID-19 Scale (FCV-19S), and a questionnaire focusing on COVID-19-related behavior. Pearson correlation coefficient and regression analysis were used for data analysis. Results: There was a significant relationship between social distance and gender, and people who observed social distancing reported higher levels of fear of COVID-19 (p < 0.001). No significant relationship was found between handwashing behaviour and gender variables, marital status, and education (p > 0.05). There was a significant difference between those who answered yes to self-care behaviours related to washing and those who answered no in terms of variables of fear of COVID-19, the overall score of compassion, and subscales of compassion, including self-kindness and isolation (p < 0.05). In relation to fear of COVID-19, married status, anxiety, and common humanity had a positive relationship with fear of COVID-19. However, self-judgment was negatively related to fear of COVID-19 (p < 0.05). Conclusion: According to the findings of the present study, men and people who are less afraid of COVID-19 are more likely not to observe self-care behaviors. Therefore, providing training about treatment protocols is necessary for these people. To reduce the fear of this disease in people with high levels of fear, psychologists, psychiatrists, and other medical staff can implement protocols to increase compassion.

Mental health circumstances among health care workers and general public under the pandemic situation of COVID-19 (HOME-COVID-19)

BACKGROUND

After the spread of the coronavirus disease 2019 (COVID-19) globally, upgraded quarantine and physical distancing strategy, strict infection measures, and government's strict lockdown have been abided to confront the spread of the COVID-19 in Thailand. During the COVID-19 pandemic, concerns about the mental health and psychosocial problems among health care workers and the general population are now arising. Yet, information on mental health and psychosocial problems among health care workers and the general population have not been comprehensively reported in Thailand. As such, we conduct a cross-sectional study, a national online survey to describe the short- and long-term consequences of the COVID-19 pandemic on mental health and psychosocial problems among health care workers and the general population in Thailand.

METHODS

This study is a repeated cross-sectional study, an open online voluntary national-based survey during the wave I (April 21-May 4, 2020) follow-up in the wave II (August 3-16, 2020), wave III (November 15-28, 2020), and a 1-year follow-up survey (wave IV: April 21-May 4, 2021) in Thailand. Health care workers at the hospitals and the adult general population will be invited to participate in the online survey via the SurveyMonkey that limits one-time participation per unique internet protocol address. The target sample size of at least 1182 health care workers and 1310 general populations will be required to complete the online survey for each wave of the survey. Sociodemographic characteristics and a set of measurement tools for mental and psychosocial problems for each subcohort including depression, anxiety, stress, resilient copings, neuroticism, perceived social support, wellbeing, somatic symptoms, insomnia, burnout (for healthcare workers), and public stigma toward COVID-19 infection (for the general population) will be collected. For all estimates of prevalence, we will weigh data for all wave analyses under the complex design of the survey. Subgroup analyses stratified by key characteristics will also be done to analyze the proportion differences. For the repeated cross-sectional survey, we will combine the data from the wave I to wave IV survey to analyze changes in the mental health status. We will perform multilevel logistic regression models with random intercepts to explore associations with individual-level and region-level/hospital-level predictors. We also plan to perform an ancillary systematic review and meta-analysis by incorporating data from our findings to all available evidence.

RESULTS

Our findings will provide information on the short- and long-term mental health status as well as the psychosocial responses to the COVID-19 outbreak in a national sample of health care workers and the general population in Thailand.

CONCLUSION

This prospective, nationally based, a repeated cross-sectional study will describe the mental health status and psychosocial problems among health care workers and the general population in Thailand during the COVID-19 pandemic.

ETHICS AND DISSEMINATION

Ethical approval for the study was obtained from the Faculty of Public Health and Faculty of Pharmacy, Chiang Mai University. The findings will be disseminated through public, scientific, and professional meetings, and publications in peer-reviewed journals.

THAI CLINICAL TRIALS REGISTRY (TCTR) REGISTRATION NUMBER

TCTR20200425001.

Cancer Care During COVID-19 Era: The Quality of Life of Patients With Thyroid Malignancies

Background: The Covid-19 pandemic's potential psychological impact has been widely discussed on the basis of expert opinion and previous experience with emergencies of this type. We conducted a survey of cancer patients to explore more objectively the outbreak's impact on their emotional well-being and quality of life.

Methods: Between March 18 and April 4, 2020, at an endocrine cancer center in Rome, Italy, 137 patients were asked to complete an online 6-item questionnaire developed by our staff to explore the emotional effects of the Covid-19 outbreak in Italy (Covid-19 Emotional Impact Survey, C-19EIS). For validation purposes, we also asked participants to complete an online version of the validated Italian translation of the EORTC QLQ-C30 questionnaire. Responses were analyzed in relation to responders' age, sex, and clinical status (advanced/metastatic disease undergoing systemic treatment vs. stable metastatic thyroid cancer in active surveillance vs. low-risk thyroid cancers with no evidence of structural disease during standard follow-up).

Results: Response rates were high (51% for the C-19EIS, 44.5% for the EORTC QLQ-C30). Overall C-19EIS scores indicated high concern over the outbreak (median 8/12). Scores were higher in women (8 [IQR 5–9] vs. 6 [IQR 5–8] in men; p = 0.048) and in patients <65 years (8 [IQR 5–9] vs. 6 [IQR 4–8] in older patients; p = 0.013). No differences emerged across clinical status groups. C-19EIS scores were inversely correlated with the EORTC QLQ-C30 Emotional function subscale (rho −0.69; p < 0.001).

Conclusions: There is objective evidence that the Covid-19 outbreak is causing substantial emotional distress among cancer patients, regardless of their disease severity or current health-care needs.

Psychological Impact and Associated Factors During the Initial Stage of the Coronavirus (COVID-19) Pandemic Among the General Population in Spain

The outbreak of COVID-19 in Spain started at the end of February. By 9th April 2020 Spain was the second country in confirmed cases and in deaths. On March 14, 2020, the Spanish Government declared the state of alarm to limit viral transmission. During such state, citizens must stay confined at home with few justified exceptions. This whole situation drastically changed the life of the population, which can cause a wide range of psychosocial impacts. This study explored the psychological impact of the COVID-19 pandemic in the general adult population (N = 3055) during the first stages of the outbreak in Spain, as well as their anxiety, stress and depression levels. We also examined the extent to which the following variables were associated to participants' mental health: (1) demographics; (2) degree of concern about the pandemic; (3) environmental conditions during the home confinement, (4) changes in daily life as a consequence of the pandemic; (5) contact with the COVID-19 disease; (6) actual and perceived severity of the crisis; (7) information about the COVID-19, (8) perceived health status and (9) leisure activities conducted within the last 24 h. Our results show that Spanish consider the current COVID-19 health crisis as fairly severe, and the majority felt that the COVID-19 crisis had greatly impacted on their daily life, including changes in their daily routines and cancelation of important activities. About 36% of the participants reported moderate to severe psychological impact, 25% showed mild to severe levels of anxiety, 41% reported depressive symptoms, and 41% felt stressed. Women, young, and those who that lost their job during the health crisis showed the strongest negative psychological symptoms. What worried Spaniards the most was the likelihood of suffering an economic crisis derived from the pandemic. We found factors associated with better mental health, such as being satisfied with the information received about the health crisis, conducting leisure activities, and the perception of being in good health. These findings can be used to design psychological interventions to help coping with COVID-19 pandemic, both in Spain and other countries.

Evaluation of Depression and Anxiety Levels and Related Factors Among Operating Theater Workers During the Novel Coronavirus (COVID-19) Pandemic

Purpose

Tremendous physical and psychological pressure has been placed on health care workers because of the outbreak of novel coronavirus disease 2019. This study aimed to examine the anxiety and depression levels and related factors among health care professionals working in operating theaters (anesthetic technicians and nurses) during the coronavirus disease 2019 pandemic.

Design

The universe of this descriptive study consisted of health care professionals working in operating theaters in various health care institutions in Turkey.

Methods

Data were collected online between April 9, 2020 and April 12, 2020 using a SurveyMonkey Questionnaire (SurveyMonkey, San Mateo, CA) and health care workers who volunteered to participate in the study were contacted via the social media platforms Twitter, LinkedIn, and WhatsApp and asked to answer the questionnaire. Statistical analysis was performed using the SPSS version 22.0 software.

Findings

A total of 702 health care professionals working in operating theaters participated in the study. The mean depression and anxiety scores of the participants were found to be 9.4 ± 4.6 (min 0 to max 21) and 10.0 ± 4.5 (min 0 to max 21), respectively. Depression scores were statistically significantly higher among females, single individuals, those who had children, those living with a person aged 60 years or older (P < .05). Meanwhile, anxiety scores were statistically significantly higher among females, single individuals (including widowed and divorced), university graduates, those with at least one chronic disease, and those whose workload increased (P < .05).

Conclusions

The present study showed that anxiety and depression symptoms were high among health care professionals working in operating theaters. To reduce these symptoms, psychological conditions of health care professionals can be followed continuously and regularly via standard procedures, and necessary interventions can be provided in the early period.

Psychological Symptoms During the Two Stages of Lockdown in Response to the COVID-19 Outbreak: An Investigation in a Sample of Citizens in Northern Spain

Spain has been in a state of emergency since 14th March due to the COVID-19 crisis. This state of emergency means that the population must comply with strict rules such as lockdown (confinement to their homes except for essential trips) and social distancing. The aim of this study was to examine the psychological state of the general population in a sample recruited in Northern Spain. Sociodemographic and psychological data were gathered, assessing variables such as stress, anxiety, and depression. A questionnaire was administered at the beginning of the lockdown and three weeks later. The sample was recruited using an online questionnaire by means of a non-probabilistic snowball sampling methodology. A total of 1,933 people participated in this study. The results reveal that more than a quarter of the participants have reported symptoms of depression (27.5%), anxiety (26.9%) and stress (26.5%) and as the time spent in lockdown has progressed, psychological symptoms have risen. In relation to gender, data indicate that men have higher levels of depression than women, and similar levels of anxiety and stress. Greater symptomatology has also been found among the younger population and in people with chronic diseases. We discuss the need to continue carrying out these types of studies to prevent and treat psychological problems that could emerge amidst this pandemic.

Caring for the carers: Advice for dealing with sleep problems of hospital staff during the COVID-19 outbreak

Hospital staff are at the frontline in the COVID‐19 outbreak. The stressors they experience may induce sleep problems in a population already at risk. Sleep deprivation, long shifts and insomnia in hospital staff have been associated with individual, organizational and public health hazards. These include increased risk of mental and somatic disorders, altered immune responses, medical errors, misunderstandings, drowsy driving and burnout. In March 2020, the World Health Organization called for providing access to mental health and counselling for health professionals involved in the COVID‐19 outbreak. To answer this call, we propose practical advice for the management of sleep problems (sleep deprivation, insomnia and shift work) that can be included in supportive interventions. The advice is based on psychobiological principles of sleep regulation and on guidelines for the treatment of insomnia and was implemented within an initiative offering psychological support to the staff of three university hospitals in Rome.

Early Impact of COVID-19 on Individuals with Eating Disorders: A survey of ~1000 Individuals in the United States and the Netherlands

We received rapid ethical permission to evaluate the early impact of COVID-19 on people with eating disorders. Participants in the United States (US, N=511) and the Netherlands (NL, N=510), recruited through ongoing studies and social media, completed an online baseline survey that included both quantitative measures and free-text responses assessing the impact of COVID-19 on situational circumstances, eating disorder symptoms, eating disorder treatment, and general well-being. Results revealed strong and wide-ranging effects on eating disorder concerns and illness behaviors that were consistent with diagnoses. Participants with anorexia nervosa (US 62% of sample; NL 69%) reported increased restriction and fears about being able to find foods consistent with their meal plan. Individuals with bulimia nervosa and binge-eating disorder (US 30% of sample; NL 15%) reported increases in their binge-eating episodes and urges to binge. Respondents noted marked increases in anxiety since 2019 and reported greater concerns about the impact of COVID-19 on their mental health than physical health. Although many participants acknowledged and appreciated the transition to telehealth, limitations of this treatment modality for this population were raised. Individuals with past histories of eating disorders noted concerns about relapse related to COVID-19 circumstances. Encouragingly, respondents also noted positive effects including greater connection with family, more time for self-care, and motivation to recover.

[How do children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) experience lockdown during the COVID-19 outbreak?]

Objectifs

Le confinement général de la population française dans le contexte de la pandémie de COVID-19, liée au nouveau Coronavirus SARS-COV-2, est une situation potentiellement à risque pour les enfants avec un développement atypique. L’objectif de notre étude est de mieux comprendre l’état de santé mentale des enfants et adolescents avec le trouble déficit d’attention hyperactivité (TDAH) en période de confinement.

Méthodes

Cinq cent trente-huit patients ont répondu à un sondage anonyme en ligne, proposé via les réseaux sociaux et relayé ou posté sur le site des associations de personnes concernées par le TDAH durant la période de confinement.

Résultats

Une majorité des enfants et adolescents de notre enquête a connu soit un mieux-être soit un état général psychologique stable d’après leurs parents. Une diminution de l’anxiété est mise en lien avec l’interruption de la scolarité présentielle et un rythme « sur-mesure ». Pour certains, l’abandon des aménagements et le volume de tâches ont posé problème avec des attitudes d’opposition et d’évitement. Les parents décrivent également une prise de conscience des difficultés de leurs enfants, ce qui ressort comme un élément constructif. Les enfants dont l’état se dégrade ont à la fois des difficultés comportementales et émotionnelles. En ce qui concerne le recours aux soins, la téléconsultation comme outil de continuité de soins a été largement appréciée.

Conclusions

Avant les contraintes liées à la crise sanitaire, les aspects scolaires sont cités comme principaux facteurs influençant l’état émotionnel de l’enfant et de l’adolescent avec TDAH dans le contexte de confinement.

Mental Health Effects of COVID-19 Pandemia: A Review of Clinical and Psychological Traits

OBJECTIVE

As the coronavirus (COVID-19) pandemic sweeps across the world, it is causing widespread concern, fear and stress, all of which are natural and normal reactions to the changing and uncertain situation that everyone finds themselves in.

METHODS

In this general review, we examined the literature about the psychological effects of COVID-19 pandemia. In total 65 papers were reviewed using the Medline computer database. Only publications in English were selected.

RESULTS

Children are likely to be experiencing worry, anxiety and fear and older people are also those with underlying health conditions, having been identified as more vulnerable to COVID-19, can be extremely frightening and very fear-inducing. China and several other countries took strict isolation measures. Medical staff and affiliated healthcare workers (staff) are under both physical and psychological pressure.

CONCLUSION

The COVID-19 pandemic is exceptional. Its effect will likely be imprinted on each individual involved. Extensive stressors will emerge or become worsened. Many medical staff workers will be harmfully psychologically affected.

[Panic and pandemic: Review of the literature on the links between panic disorder and the SARS-CoV-2 epidemic]

Although the "panic" word has been abundantly linked to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic in the press, in the scientific literature very few studies have considered whether the current epidemic could predispose to the onset or the aggravation of panic attacks or panic disorder. Indeed, most studies thus far have focused on the risk of increase and aggravation of other psychiatric disorders as a consequence of the SARS-CoV-2 epidemic, such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). Yet, risk of onset or aggravation of panic disorder, especially the subtype with prominent respiratory symptoms, which is characterized by a fear response conditioning to interoceptive sensations (e.g., respiratory), and hypervigilance to these interoceptive signals, could be expected in the current situation. Indeed, respiratory symptoms, such as coughs and dyspnea, are among the most commonly associated with the SARS-CoV-2 (59-82% and 31-55%, respectively), and respiratory symptoms are associated with a poor illness prognosis. Hence given that some etiological and maintenance factors associated with panic disorder - i.e., fear conditioning to abnormal breathing patterns attributable or not to the COVID-19 (coronavirus disease 2019), as well as hypervigilance towards breathing abnormalities - are supposedly more prevalent, one could expect an increased risk of panic disorder onset or aggravation following the COVID-19 epidemic in people who were affected by the virus, but also those who were not. In people with the comorbidity (i.e., panic disorder or panic attacks and the COVID-19), it is particularly important to be aware of the risk of hypokalemia in specific at-risk situations or prescriptions. For instance, in the case of salbutamol prescription, which might be overly used in patients with anxiety disorders and COVID-19, or in patients presenting with diarrhea and vomiting. Hypokalemia is associated with an increased risk of torsade de pointe, thus caution is required when prescribing specific psychotropic drugs, such as the antidepressants citalopram and escitalopram, which are first-line treatments for panic disorder, but also hydroxyzine, aiming at anxiety reduction. The results reviewed here highlight the importance of considering and further investigating the impact of the current pandemic on the diagnosis and treatment of panic disorder (alone or comorbid with the COVID-19).

[Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review]

OBJECTIVE

The lack of ressources and coordination to face the epidemic of coronavirus raises concerns for the health of patients with mental disorders in a country where we keep in memory the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims at proposing guidance to ensure mental health care during the SARS-CoV epidemy in France.

METHODS

Authors performed a narrative review identifying relevant results in the scientific and medical literature and local initiatives in France.

RESULTS

We identified four types of major vulnerabilities in patients suffering from mental disorders during this pandemic: (1) medical comorbidities that are more frequently found in patients suffering from mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which represent risk factors for severe infections with Covid-19; (2) age (the elderly constituting the population most vulnerable to coronavirus); (3) cognitive and behavioral troubles which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability due to stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly adapted to psychiatric establishments in a context of major shortage of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds are closed, wards have a high density of patients, mental health community facilities are closed, medical teams are understaffed and poorly trained to face infectious diseases. We could also face major issues in referring patients with acute mental disorders to intensive care units. To maintain continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of Covid+ units. These units are under the dual supervision of a psychiatrist and of an internist/infectious disease specialist; all new entrants should be placed in quarantine for 14 days; the nurse staff should benefit from specific training, from daily medical check-ups and from close psychological support. Family visits would be prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management should be organized with the possibility of home visits, in order to support them when they get back home and to help them to cope with the experience of confinement, which is at risk to induce recurrences of mental disorders. The total or partial closure of mental health community facilities is particularly disturbing for patients but a regular follow-up is possible with telemedicine and should include the monitoring of the suicide risk and psychoeducation strategies; developing support platforms could also be very helpful in this context. Private psychiatrists have also a crucial role of information with their patients on confinement and barrier measures, but also on measures to prevent the psychological risks inherent to confinement: maintenance of sleep regularity, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic.

DISCUSSION

French mental healthcare is now in a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the containment of the general population.

Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review

OBJECTIVE

The lack of resources and coordination to face the coronavirus epidemic raises concerns for the health of patients with mental disorders in a country where we still have memories of the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims to propose guidance to ensure mental health care during the SARS-CoV epidemic in France.

METHODS

The authors performed a narrative review identifying relevant results in the scientific and medical literature and in local initiatives in France.

RESULTS

We identified four types of major vulnerabilities among patients with mental disorders during this pandemic: (1) medical comorbidities that are more frequently found among patients with mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which are risk factors for severe covid-19 infection; (2) age (the elderly form the population most vulnerable to the coronavirus); (3) cognitive and behavioural disorders, which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability as a result of stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly suited to psychiatric establishments in a context of major shortages of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds have been closed, wards have high densities of patients, mental health community facilities are closed, and medical teams are understaffed and poorly trained to face infectious diseases. There are also major issues when referring patients with acute mental disorders to intensive care units. To maintain the continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of "COVID+ units". These units are under the dual supervision of a psychiatrist and an internist/infectious disease specialist; all new entrants are placed in quarantine for 14 days; the nursing staff receives specific training, daily medical check-ups and close psychological support. Family visits are prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management are organized with the possibility of home visits, in order to support patients when they get back home and to help them cope with the experience of confinement, which is liable to induce recurrences of mental disorders. The total or partial closure of community mental health facilities is particularly disturbing for patients, but a regular follow-up is possible with telemedicine and should include the monitoring of suicide risk and psycho-education strategies; developing support platforms could also be very helpful in this context. Private practice psychiatrists also have a crucial role of information towards their patients on confinement and barrier measures, and also on measures to prevent the psychological risks inherent in confinement: maintenance of regular sleep r, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic.

DISCUSSION

French mental healthcare is now facing a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the confinement of the general population.

Role of neutrophil-lymphocyte-ratio in the mortality of males diagnosed with COVID-19

BACKGROUND AND OBJECTIVES

With this study, for the first time among patients diagnosed with COVID-19, the neutrophil-lymphocyte-ratios of men and women were compared.

MATERIALS AND METHODS

The study was conducted with 80 patients and the data was gained retrospectively on the electronic documents of the hospital.

RESULTS

The neutrophil-lymphocyte-ratio was statistically significant and higher in the male than the women for all ages and geriatric patients (p<0.05).

CONCLUSION

The higher neutrophil-lymphocyte-ratio in older males diagnosed with COVID-19 could be a causative reason for the higher mortality rates in men. We hope that these findings would be helpful for further studies.

Addressing collegiate mental health amid COVID-19 pandemic

College students encounter unique challenges leading to poor mental health in the wake of the COVID-19 outbreak. Before the pandemic started, one in five college students experienced one or more diagnosable mental disorders worldwide. The fact that the COVID-19 pandemic affects collegiate mental health underscores the urgent need to understand these challenges and concerns in order to inform the development of courses of action and public health messaging that can better support college students in this crisis. This article provides recommendations that prepare higher education institutions and health professionals for addressing collegiate mental health needs and challenges posed by COVID-19.

Mental Health Problems during the COVID-19 Pandemics and the Mitigation Effects of Exercise: A Longitudinal Study of College Students in China

(1) Background: The novel coronavirus disease 2019 (COVID-19) is a global public health emergency that has caused worldwide concern. Vast resources have been allocated to control the pandemic and treat patients. However, little attention has been paid to the adverse impact on mental health or effective mitigation strategies to improve mental health. (2) Purpose: The aim of this study was to assess the adverse impact of the COVID-19 outbreak on Chinese college students’ mental health, understand the underlying mechanisms, and explore feasible mitigation strategies. (3) Methods: During the peak time of the COVID-19 outbreak in China, we conducted longitudinal surveys of sixty-six college students. Structured questionnaires collected information on demographics, physical activity, negative emotions, sleep quality, and aggressiveness level. A mixed-effect model was used to evaluate associations between variables, and the mediating effect of sleep quality was further explored. A generalized additive model was used to determine the dose-response relationships between the COVID-19 death count, physical activity, and negative emotions. (4) Results: The COVID-19 death count showed a direct negative impact on general sleep quality (β = 1.37, 95% confidence interval [95% CI]: 0.55, 2.19) and reduced aggressiveness (β = −6.57, 95% CI: −12.78, −0.36). In contrast, the COVID-19 death count imposed not a direct but an indirect impact on general negative emotions (indirect effect (IE) = 0.81, p = 0.012), stress (IE = 0.40, p < 0.001), and anxiety (IE = 0.27, p = 0.004) with sleep quality as a mediator. Moreover, physical activity directly alleviated general negative emotions (β = −0.12, 95% CI: −0.22, −0.01), and the maximal mitigation effect occurred when weekly physical activity was about 2500 METs. (5) Conclusions: (a) The severity of the COVID-19 outbreak has an indirect effect on negative emotions by affecting sleep quality. (b) A possible mitigation strategy for improving mental health includes taking suitable amounts of daily physical activity and sleeping well. (c) The COVID-19 outbreak has reduced people’s aggressiveness, probably by making people realize the fragility and preciousness of life.

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 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), 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 prevalent 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, support for family, PPE, and mental health resources.

FUNDING

N/A.

What about heart and mind in the COVID-19 era?

From the time of Hippocratic medicine, heart-brain interactions have been recognized and contributed to both mental and physical health. Heart-brain interactions are complex and multifaceted and appear to be bidirectional. Exposure to chronic and daily stressors such as quarantine, or severe psychological trauma like a significant person in danger of life can affect the cardiovascular system and the emotional experience of the individual, leading to an increased risk of developing a cardiovascular disease or mental illness. Subjects with comorbidities between mental disorders and heart diseases are obviously more susceptible to be influenced by emotional burden due to the spread of COVID-19, with emotional responses characterized by fear, panic, anger, frustration. Psychological services and crisis interventions are needed at an early stage to reduce anxiety, depression and post-traumatic stress disorder in such a stressful period, with a special attention to special groups of patients, such as women, children, or the elderly.

Dealing with sleep problems during home confinement due to the COVID-19 outbreak: Practical recommendations from a task force of the European CBT-I Academy

In the current global home confinement situation due to the COVID-19 outbreak, most individuals are exposed to an unprecedented stressful situation of unknown duration. This may not only increase daytime stress, anxiety and depression levels, but also disrupt sleep. Importantly, because of the fundamental role that sleep plays in emotion regulation, sleep disturbance can have direct consequences upon next day emotional functioning. In this paper, we summarize what is known about the stress-sleep link and confinement as well as effective insomnia treatment. We discuss those effects of the current home confinement situation that can disrupt sleep but also those that could benefit sleep quality. We suggest adaptions of cognitive behavioural therapy elements that are feasible to implement for those facing changed work schedules and requirements, those with health anxiety and those handling childcare and home-schooling, whilst also recognizing the general limitations imposed on physical exercise and social interaction. Managing sleep problems as best as possible during home confinement can limit stress and possibly prevent disruptions of social relationships.

Posttraumatic stress symptoms of health care workers during the corona virus disease 2019

Corona virus disease 2019 (COVID-19) outbreak has attracted worldwide attention. The COVID-19 outbreak is unique in its rapid transmission and results in heavy stress for the front-line health care workers (HCWs). The current study aimed to exam posttraumatic stress symptoms (PTSSs) of HCWs fighting for the COVID-19 and to evaluate their sleep quality after 1-month stressful suffering. Three hundred seventy-seven HCWs working in different provinces of China participated in the survey between February 1 and 5. The demographic information was collected first. Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) and the Pittsburgh Sleep Quality Index (PSQI) were selected to measure PTSSs and sleep quality. Results showed that 1 month after the outbreak, the prevalence of PTSSs was 3.8% in HCWs. Female HCWs were more vulnerable to PTSSs with hazard ratio of 2.136 (95% CI = 1.388-3.286). HCWs with higher exposure level also significantly rated more hyperarousal symptoms (hazard ratio = 4.026, 95% CI = 1.233-13.140). There was a significant difference of sleep quality between participants with and without PTSSs (z value = 6.014, p < .001) and among different groups with various contact frequencies (chi-square = 7.307, p = .026). Path analysis showed that there was a significant indirect effect from exposure level to PTSSs through sleep quality (coefficient = 1.750, 95% CI of Boostroop test = 0.543-2.998). In summary, targeted interventions on sleep contribute to the mental recovery during the outbreak of COVID-19. Understanding the mental health response after a public health emergency might help HCWs and communities prepare for a population's response to disaster.

A comprehensive hospital agile preparedness (CHAPs) tool for pandemic preparedness, based on the COVID-19 experience

COVID-19 presents an unprecedented challenge to hospitals and the systems in which they operate. The primary exponential surge of COVID-19 cases is arguably the most devastating event a hospital will face. In some countries, these surges during the initial outbreak of the disease have resulted in hospitals suffering from significant resource strain, leading to excess patient mortality and negatively impacting staff wellbeing. As experience builds in managing these surges, it has become evident that agile, tailored planning tools are required. The comprehensive hospital agile preparedness (CHAPs) tool provides clinical planners with six key domains to consider that frequently create resource strain during COVID-19; it also allows local planners to identify issues unique to their hospital, system or region. Although this tool has been developed from COVID-19 experiences, it has potential to be modified for a variety of pandemic scenarios according to transmission modes, rates and critical care resource requirements.

Problemas de salud mental en la sociedad: un acercamiento desde el impacto del COVID 19 y de la cuarentena

La sociedad mundial vive una experiencia sin precedente, que moviliza todas las estructuras gubernamentales, sanitarias y sociales. Desde diciembre de 2019 a 15 de abril de 2020, la pandemia de coronavirus (COVID-19) se ha propagado a 213 países, con 1.848.439 casos confirmados en el contexto mundial y 676.162 en América Latina. En lo transcurrido del 6 de marzo hasta 15 de abril, en Colombia se informaron 3.105 casos y 131 muertes1.

Tele-Psychiatry Assessment of Post-traumatic Stress Symptoms in 100 Patients With Bipolar Disorder During the COVID-19 Pandemic Social-Distancing Measures in Italy

The acute phase of the COrona VIrus Disease-19 (COVID-19) emergency determined relevant stressful burdens in psychiatric patients, particularly those with chronic mental disorders such as bipolar disorder (BD), not only for the threat of being infected but also for the strict lock-down and social-distancing measures adopted, the economic uncertainty, and the limited possibilities to access psychiatric services. In this regard, telepsychiatry services represented a new important instrument that clinicians could adopt to monitor and support their patients. The aim of the present study was to investigate acute post-traumatic stress symptoms (PTSS) reported by patients with BD followed in the framework of a telepsychiatry service, set up in the acute phase of the COVID-19 outbreak at the psychiatric clinic of the University of Pisa (Italy). A sample of 100 patients were consecutively enrolled and assessed by the IES-r, GAD-7, HAM-D, and YMRS. Patients reported a mean (±SD) IES-r total score of 18.15 ± 13.67. Further, 17% of the sample reported PTSS (IES-r > 32), 17% depressive symptoms (HAM-D > 17), and 26% anxiety symptoms (GAD-7 > 10). Work and financial difficulties related to the COVID-19 pandemic and anxiety symptoms appeared to be positively associated with the development of acute PTSS. Acute manic symptoms appeared to be protective. The data of the present study suggest the relevance of monitoring patients with BD exposed to the burden related to the COVID-19 outbreak for prompt assessment and treatment of PTSS.

Policies to Improve the Mental Health of People Influenced by COVID-19 in China: A Scoping Review

Background: In response to the potentially concurrent mental health crisis due to the COVID-19 outbreak, there have been ongoing mental health policies put in place in China. This review aims to systematically synthesize the implemented national-level mental health policies released by the Chinese government during the COVID-19 outbreak, and summarize the implementation of those mental health policies. Methods: Six databases and two websites were systematically searched, including published studies and gray literature published between December 1, 2019 and October 29, 2020. Results: A total of 40 studies were included. Among them, 19 were national-level policies on mental health released by the Chinese government, and 21 studies reported data on the implementation of those mental health policies. Mental health policies were issued for COVID-19 patients, suspected cases, medical staff, the general population, patients with mental illness, and mental institutions. In the early stage of the COVID-19 epidemic, attention was paid to psychological crisis intervention. In the later stage of the epidemic, the government focused mainly on psychological rehabilitation. During the COVID-19 outbreak, more than 500 psychiatrists from all over China were sent to Wuhan, about 625 hotlines were notified in 31 provinces, several online psychological consultation platforms were established, social software such as TikTok, Weibo, and WeChat were used for psychological education, and many books on mental health were published. Responding quickly, maximizing the use of resources, and emphasizing the importance of policy evaluation and implementation quality were characteristics of the mental health policies developed during the COVID-19 outbreak. Challenges facing China include a low rate of mental health service utilization, a lack of evaluation data on policy effects, and no existing national-level emergency response system and designated workforce to provide psychological crisis interventions during a national emergency or disaster. Conclusions: This review suggests that China has responded quickly and comprehensively to a possible mental health crisis during the COVID-19 outbreak, appropriate mental health policies were released for different members of the population. As the epidemic situation continues to change, the focus of mental health policies has been adjusted accordingly. However, we should note that there has been a lack of separate policies for specific mental health issues during the COVID-19 outbreak.

Mental Health Impacts of the COVID-19 Pandemic on International University Students, Related Stressors, and Coping Strategies

Background: The coronavirus disease 2019 (COVID-19) pandemic has disrupted university teaching globally. The mental health impacts on international university students have been overlooked. Aims: This study examined the differences in COVID-19-related stressors and mental health impacts between international university students studying in the UK or USA who returned to their home country or region (returnees) and those who stayed in their institution country (stayers), and identified COVID-19-related stressors and coping strategies that were predictors of mental health. Method: An online questionnaire survey was conducted from April 28 through May 12, 2020 using an exponential, non-discriminative snowball sampling strategy (registered at the National Institutes of Health: NCT04365361). Results: A total of 124 full-time international university students (36.3% male) were included: 75.8% had returned to their home country or region for reasons related to COVID-19; 77.4% were pursuing a bachelor's program, and 53.2% were in programs with practicum component. 84.7% of all students had moderate-to-high perceived stress, 12.1% had moderate-to-severe symptoms of anxiety and depression, and 17.7% had moderate-to-severe symptoms of insomnia. Compared with returnees, stayers had significantly higher stress from COVID-19-related stressors such as personal health and lack of social support (Cohen's d: 0.57-1.11), higher perceived stress [10-item Perceived Stress Scale (PSS-10)] {22.6 ± 6.2 vs. 19.1 ± 6.1, β [95% confidence interval (CI)]: 4.039 (0.816, 7.261), Cohen's d: 0.52}, and more severe insomnia symptoms [Insomnia Severity Index (ISI)] [11.8 ± 6.1 vs. 7.6 ± 5.2, β (95% CI): 3.087 (0.262, 5.912), Cohen's d: 0.45], with moderate-to-large effect sizes. Compared with males, females reported significantly higher stress from uncertainties about academic program (Cohen's d: 0.45) with a small effect size. In the total sample, stress related to academics (e.g., personal attainment, uncertainties about academic program, and changes in teaching/learning format), health (including personal health and health of family and friends), availability of reliable COVID-19-related information, and lack of social support predicted more negative mental health impacts. Resilience, positive thinking, and exercise were predictors of less severe mental health impacts. Conclusions: Stayers experienced more adverse mental health impacts than returnees. We call on educators and mental health professionals to provide appropriate support for international students, particularly the stayers, during the pandemic.

Palestinian Health Care Workers' Stress and Stressors During COVID-19 Pandemic: A Cross-Sectional Study

BACKGROUND

COVID-19 is thought to be the most significant public health threat the modern world has encountered. Health care workers (HCWs) face enormous pressure due to work overload, negative emotions, exhaustion, lack of contact with their families, and risk of catching the infection and death.

AIM

This study aims to assess the level of stress perceived by HCWs and possible associated factors during the COVID-19 outbreak in Palestine.

METHODS

A cross-sectional sample of 430 frontlines HCWs was conducted using an online self-reported questionnaire. HCWs' stress from the COVID-19 outbreak, factors that increase stress, and the activities that reduced stress were assessed. Chi-square test was used to compare between a categorical variable and the study outcome; associations are presented as odds ratios (OR) and confidence intervals (95% CI) with 0.05 significance level. Al-Najah National University institutional review board granted ethics approval.

RESULTS

Most respondents (74.0%) reported high-stress levels during the outbreak. Fear of transmitting the virus to family was the most stressful factor (91.6%). HCWs who did not have training on the outbreak response were more likely to have high-stress levels (OR = 2.7 [95% CI = 1.7-4.4], P < .001). Those with high stress reported being disappointed (OR = 2.4 [95% CI = 1.5-3.6], P < .001), and strongly considered taking sick leave (OR = 3.9 [95% CI = 1.9-7.9], P < .001).

CONCLUSION

HCWs are under tremendous stress, given the ongoing COVID-19 pandemic. Understanding the psychological impact of the outbreak on HCWs and the activities that mitigate the stress is crucial to guide policies and interventions that can maintain psychological well-being.

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.

A Systematic Review of the Impact of Viral Respiratory Epidemics on Mental Health: An Implication on the Coronavirus Disease 2019 Pandemic

Background: The twenty-first century viral respiratory epidemics have taught us valuable lessons. Our systematic review examined the impact of these epidemics, including coronavirus disease 2019 (COVID-19), on mental health among different population groups, drawing on their insights for recommendations for the current COVID-19 pandemic. Methods: Searches were performed on PubMed, Embase, PsycINFO, Web of Science, Scopus, CINAHL, and Cochrane on April 4, 2020. Studies that had undefined mental health outcomes or did not use a validated scale for measure were excluded. Quality assessment was carried out via the Newcastle-Ottawa Scale. Results: We included 95 studies, most of which were conducted in Hong Kong (31.6%) and China (21.4%). A total of 30 (30.9%) studies are on the general public, 41 (42.2%) on healthcare workers, and 26 (26.6%) on patients and quarantined individuals. Furthermore, 36 (37.1%) of the studies are of high quality, 48 (49.5%) are of moderate quality, and 13 (13.4%) are of low quality. The most significant mental health outcomes reported include anxiety, depression, and post-traumatic stress disorder symptoms. The subgroups identified to have a higher risk of psychiatric symptoms among the general public include females, the elderly, individuals with chronic illness, migrant workers, and students. Long-term mental health impact was reported in some healthcare workers and epidemic patients, even up to 3 years in the former. Interestingly, when compared to non-quarantined groups, quarantine was not significantly associated with worse mental health outcomes. Conclusion: Important implications for the COVID-19 pandemic were highlighted. Respiratory epidemics pose a significant psychological morbidity onto many population groups. Psychological support for vulnerable groups, including healthcare workers and patients, should be implemented to prevent them from spiraling into clinical psychiatric conditions.

Psychological Distress After Covid-19 Recovery: Reciprocal Effects With Temperament and Emotional Dysregulation. An Exploratory Study of Patients Over 60 Years of Age Assessed in a Post-acute Care Service

To study the long-term psychological effects of Covid-19 disease, we recruited 61 patients older than 60 years of age and administered the Kessler questionnaire K10 to assess psychological distress and classify them according to mental health risk groups. Patients' affective temperaments were assessed with the 39-item form of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A-39) and emotional dysregulation with the Difficulties in Emotion Regulation Scale (DERS). Patients were divided in two samples according to their scores on the K10, i.e., a high likelihood of psychological distress group (N = 18) and a low likelihood of psychological distress group (N = 43). The two groups differed on their gender composition, in that more women (N = 11) were in the former and more men in the latter (N = 29) (χ² = 4.28; p = 0.039). The high likelihood of psychological distress group scored higher on the Cyclothymic (3.39 ± 3.45 vs. 0.93 ± 1.08, p < 0.001) and the Depressive (2.28 ± 2.82 vs. 0.65 ± 1.09, p = 0.01) affective temperaments of the TEMPS and on the lack of Impulse control (12.67 ± 4.04 vs. 9.63 ± 3.14, p = 0.003) and lack of Clarity (15.00 ± 5.56 vs. 9.85 ± 4.67, p = 0.004) scales of the DERS. Our results show that having had Covid-19 may be related with high likelihood for psychological distress in advanced-age people and this may in turn be associated with impaired emotional regulation and higher scores on depressive and cyclothymic temperaments.

A Network Analysis of Post-traumatic Stress Disorder Symptoms and Correlates During the COVID-19 Pandemic

Background and Objective: The coronavirus disease 2019 (COVID-19) outbreak has been suggested as a collective trauma, which presents a continuing crisis. However, the specific post-traumatic implication of this crisis has not been adequately studied yet. The current study was aimed to ascertain the most central symptom and the strong connections between symptoms of post-traumatic stress disorder (PTSD). At the same time, exploring the relationship between covariates and the network of PTSD symptoms, by taking sex, anxiety, depression, suicidal ideation, quality of life, and social support as covariates, may help us to know the arise and maintenance of PTSD symptoms and give specified suggestions to people under the shadow of COVID-19. Method: The Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), was used to assess the PTSD symptoms extent of 338 healthy participants over the past month. Networks were analyzed using state-of-the-art regularized partial correlation models. In addition, the centrality of the symptoms and the robustness of the results were analyzed. Results: The network analysis revealed that the especially strong connections emerged between avoidance of thoughts and avoidance of reminders, hypervigilance and exaggerated startle response, intrusive thoughts and nightmares, flashbacks and emotional cue reactivity, and detachment and restricted affect. The most central symptoms were self-destructive/reckless behavior. Incorporation of covariates into the network revealed the strong connections path between self-destructive/reckless behavior and loss of interest and depression. Conclusion: Self-destructive/reckless behavior was the most central symptom in the network of PTSD symptoms related to the COVID-19 pandemic, which as an important target of interfere may have great benefits.

Mental health in the era of COVID-19: prevalence of psychiatric disorders in a cohort of patients with type 1 and type 2 diabetes during the social distancing

BACKGROUND

In patients with diabetes, the prevalence of depression and anxiety symptoms is about two to four times greater than in the general population. The association between diabetes and mental health disorders could be exacerbated in a stressful environment, and psychological distress could increase depressive symptoms and cause adverse diabetes outcomes.

OBJECTIVES

To assess the prevalence of mental health disorders in patients with diabetes during the social distancing period due to COVID-19 pandemic.

METHODS

This is a cross-sectional study developed to assess the impact of social distancing on a cohort of adults with type 1 (n = 52) and type 2 diabetes (n = 68) in Brazil. Inclusion criteria involved having an HbA1c test collected in the past 3 months and having a valid telephone number in electronic medical records. The primary outcome was the prevalence of minor psychiatric disorders, assessed by survey (SRQ-20). Secondary outcomes included the prevalence of diabetes related emotional distress, eating and sleeping disorders, all assessed by validated surveys at the moment of the study. Statistical analyses included unpaired t-test for continuous variables and χ ² test for categorical variables.

RESULTS

Overall (n = 120), participants had a mean age of 54.8 ± 14.4 years-old, and HbA1c of 9.0 ± 1.6% (75 ± 17.5 mmol/mol); 93% of patients showed signs of current mental suffering based on the surveys measured. Almost 43% of patients showed evidence of significant psychological distress, with a significant greater tendency in patients with type 2 diabetes. The presence of diabetes related emotional distress was found in 29.2% of patients; eating disorders in 75.8%; and moderate/severe sleeping disorders in 77.5%.

CONCLUSIONS

We found a high prevalence of evidence of psychological distress among patients with diabetes during the COVID-19 pandemic and this highlights the need for mental health access and support for patients with type 1 and type 2 diabetes.

COVID-19 Pandemic and Lockdown Measures Impact on Mental Health Among the General Population in Italy

BACKGROUND

The psychological impact of the COronaVIrus Disease 2019 (COVID-19) outbreak and lockdown measures on the Italian population are unknown. The current study assesses rates of mental health outcomes in the Italian general population three to 4 weeks into lockdown measures and explores the impact of COVID-19 related potential risk factors.

METHODS

A web-based survey spread throughout the internet between March 27^th and April 6^th 2020. Eighteen thousand one hundred forty-seven individuals completed the questionnaire, 79.6% women. Selected outcomes were post-traumatic stress symptoms (PTSS), depression, anxiety, insomnia, perceived stress, and adjustment disorder symptoms (ADS). Seemingly unrelated logistic regression analysis was performed to identify COVID-19 related risk factors.

RESULTS

Endorsement rates for PTSS were 6,604 (37%), 3,084 (17.3%) for depression, 3,700 (20.8%) for anxiety, 1,301 (7.3%) for insomnia, 3,895 (21.8%) for high perceived stress and 4,092 (22.9%) for adjustment disorder. Being woman and younger age were associated with all of the selected outcomes. Quarantine was associated with PTSS, anxiety and ADS. Any recent COVID-related stressful life event was associated with all the selected outcomes. Discontinued working activity due to the COVID-19 was associated with all the selected outcomes, except for ADS; working more than usual was associated with PTSS, Perceived stress and ADS. Having a loved one deceased by COVID-19 was associated with PTSS, depression, perceived stress, and insomnia.

CONCLUSION

We found high rates of negative mental health outcomes in the Italian general population 3 weeks into the COVID-19 lockdown measures and different COVID-19 related risk factors. These findings warrant further monitoring on the Italian population's mental health.