Psychological interventions during COVID-19: Challenges for low and middle income countries

Critical issues in treating COVID-19-positive psychiatric patients in low- and middle-income countries

This paper considers certain specific issues that will be faced by low- and middle-income countries when treating psychiatric patients who test positive for COVID-19. The need for both medical and psychiatric units to do the same and challenges in the treatment and management of positive-testing patients are discussed.

Economic evaluations of psychological treatments for common mental disorders in low- and middle-income countries: protocol for a systematic review

BACKGROUND

Common mental disorders (CMDs) are highly prevalent conditions that constitute a major public health and economic burden on society in low- and middle-income countries (LMICs). Despite the increased demand for economic evidence to support resource allocation for scaled-up implementation of mental health services in these contexts, economic evaluations of psychological treatments for CMDs remain scarce.

OBJECTIVE

The proposed systematic review aims to synthesize findings on methods and outcomes of economic evaluations of psychological treatments for CMDs in LMICs and appraise quality.

METHODS

We will identify, select, and extract data from published economic evaluations of psychological interventions for CMDs conducted in LMICs. We will search bibliographic databases (PubMed, EMBASE, CINAHL, Web of Science, EconLit, PsycINFO, Africa-Wide Information, Cochrane library, Centre for Reviews and Dissemination (CRD), Cost Effectiveness Analysis (CEA) Registry), and the African Journals Online (AJOL) and Google Scholar platforms. Only full economic evaluations (Cost-Effectiveness Analysis (CEA), Cost-Utility Analysis (CUA), Cost-Consequence Analysis (CCA), or Cost-Benefit Analysis (CBA)) of psychological treatments for CMDs (defined as depressive, anxiety, and substance use disorders) conducted in LMICs will be included. There will be no restrictions based on date of publication, perspective, follow-up duration or sample size. Data extraction will be guided by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

RESULTS

The results presented will be examined using a narrative synthesis approach. The quality of included studies will be assessed using the Drummond & Jefferson checklist.

CONCLUSION

The fledgling evidence base in this area provides an opportunity to promote improved economic evaluation methods in line with repeated calls for economic evidence alongside effectiveness evidence in these settings. A rigorously developed economic evaluation evidence base will support resource allocation decisions for scaled up implementation of psychological interventions in LMIC settings.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020185277.

Evidence of the psychological effects of pseudoscientific information about COVID-19 on rural and urban populations

This research aims to analyze the effects of pseudoscientific information (PI) about COVID-19 on the mental well-being of the general population. A total of 782 participants were classified according to the type of municipality in which they lived (rural municipalities and urban municipalities). The participants answered psychometric questionnaires that assessed psychological well-being, pseudoscientific beliefs and the ability to discriminate between scientific and pseudoscientific information about COVID-19. The results indicated the following: the greater the ability to discriminate between false information and true information, the greater the levels of psychological well-being perceived by the participant. The ability to discriminate predicts up to 32% of psychological well-being only for subjects living in rural municipalities. Residents in urban municipalities showed lower levels of well-being than residents in rural municipalities. It is concluded that new social resources are needed to help the general population of urban municipalities discriminate between pseudoscientific and scientific information.

Brief Research Report: The Association Between Educational Experiences and Covid-19 Pandemic-Related Variables, and Mental Health Among Children and Adolescents

Introduction: Mental health problems among children and adolescents are frequent. Today, the world is facing a pandemic with a novel coronavirus, which is related to the higher rates of mental problems reported worldwide. The objective of this study was to determine the impact of the Covid-19 related experiences, educational experiences, and family functioning on mental health and wellbeing among children and adolescents in Chile during the Pandemic and lockdown health measures. Methods: This is a cross-sectional analysis of the first wave of an ongoing longitudinal study among girls and boys of Pre-Kindergarten to 12th grade (4-18 years old) in Santiago, Chile. The sample consisted of 979 students from eight different schools. The method of data collection was online surveys administered to parents and adolescents. The dependent variables were mental health problems and wellbeing. Several independent variables were assessed (sociodemographic variables, Covid-19 related experiences, related educational experiences, and family functioning). A descriptive analysis and univariable and multivariable regression models were performed to study the association between variables. Results: Positive educational experiences, primarily academic self-concept, reduced the probability of mental health problems and increased wellbeing. Among covid-19 related variables, practicing meditation or praying reduced emotional problems, while having family or health problems increased emotional problems among adolescents. No clear association between Covid-19 related experiences variables among children was found. Conclusions: Our findings may help educational and public health authorities to plan future school preventive interventions to improve mental health and wellbeing in this population.

Frequency and correlates of anxiety symptoms during the COVID-19 pandemic in low- and middle-income countries: A multinational study

OBJECTIVE

Studies have documented the significant direct and indirect psychological, social, and economic consequences of the Coronavirus disease 2019 (COVID-19) in many countries but little is known on its impact in low- and middle-income countries (LMICs) already facing difficult living conditions and having vulnerable health systems that create anxiety among the affected populations. Using a multinational convenience sample from four LMICs (DR Congo, Haiti, Rwanda, and Togo), this study aims to explore the prevalence of anxiety symptoms and associated risk and protective factors during the COVID-19 pandemic.

METHODS

A total of 1267 individuals (40.8% of women) completed a questionnaire assessing exposure and stigmatization related to COVID-19, anxiety, and resilience. Analyses were performed to examine the prevalence and predictors of anxiety.

RESULTS

Findings showed a pooled prevalence of 24.3% (9.4%, 29.2%, 28.5%, and 16.5% respectively for Togo, Haiti, RDC, and Rwanda, x² = 32.6, p < .0001). For the pooled data, exposure to COVID-19 (β = 0.06, p = .005), stigmatization related to COVID-19 (β = 0.03, p < .001), and resilience (β = -0.06, p < .001) contributed to the prediction of anxiety scores. Stigmatization related to COVID-19 was significantly associated to anxiety symptoms in all countries (β = 0.02, p < .00; β = 0.05, p = .013; β = 0.03, p = .021; β = 0.04, p < .001, respectively for the RDC, Rwanda, Haiti, and Togo).

CONCLUSIONS

The findings highlight the need for health education programs in LMICs to decrease stigmatization and the related fears and anxieties, and increase observance of health instructions. Strength-based mental health programs based on cultural and contextual factors need to be developed to reinforce both individual and community resilience and to address the complexities of local eco-systems.

A child's right to protection during the COVID-19 crisis: An exploratory study of the child protective services of Estonia

In 2019 the novel Coronavirus COVID-19 was discovered, and the following year the World Health Organization declared a pandemic. This pandemic is unprecedented in human history and affects all aspects of life. In this article, we explore the pandemic's impact on child protective services in Estonia and survey a representative sample of child protection workers (n = 81), asking three open-ended questions designed to explore child protection practice. These questions concern the impact on organisational design, the workers' ability to conduct a diagnosis of a child's care context, and what knowledge they could draw upon, as well as the decision itself. The overall findings indicate that the organisational design left practice unprepared; there was a general lack of ability to act upon referrals and also to conduct investigations to evaluate care contexts. Furthermore, there is a general lack of knowledge of how to deal with protective practices and conduct decision-making during crisis situations.

Psychological Distress among Adults in Home Confinement in the Midst of COVID-19 Outbreak

Objectives  The aim of this study was to evaluate psychological distress caused by the novel coronavirus disease 2019 (COVID-19) pandemic among the adult population residing in Pakistan.

Materials and Methods  This cross-sectional survey-based study comprised 1,000 adults residing in Pakistan. A questionnaire was formulated and circulated among adult population of Pakistan, the depression and anxiety symptoms using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales were assessed.

Statistical Analysis  Independent t -test, cross tabulation, and regression analysis were used to identify variables having impact on PHQ-9 and GAD-7 scores. A p -value of ≤ 0.05 was considered statistically significant.

Results  Among 1,000 participants, 573 were males and 427 were females who completed the survey. Majority were restricted to home for more than 40 days. Considerable number of participants reported depressive (540, 54%) and anxiety (480, 48%) symptoms. Gender, age, earnings, and occupation have significant relation with psychological distress, although similar was not found with education levels.

Conclusion  Psychological distress, a concerning yet addressable issue was found among adults arising amid COVID-19 outbreak. Currently, physical health effects of COVID-19 are being looked, while mental health effects being under-addressed. This issue should be addressed to avoid any psychological impact in future.

Measuring Psychosocial Reactions to COVID-19: The COVID Reaction Scales (COVID-RS) as a New Assessment Tool

Knowing and measuring the psychosocial reactions of people to the coronavirus crisis could be useful for predicting citizen responsibility and psychological well-being in the general population. In this research, we present the COVID Reaction Scales (COVID-RS), a new tool that can measure and quantify the psychopathological reactions of the population to the COVID-19 crisis. The sample consisted of 667 subjects. Explorative and confirmative factor analyses were applied to examine the validity and reliability of the COVID-RS. Five dimensions were extracted that predicted 35.08% of the variance of the psychopathological reactions: (1) disorganized behaviors, (2) avoidant behaviors, (3) maladaptive information consumption, (4) herd behaviors and (5) loneliness. The results indicated that social quarantine induces and increases psychopathological reactions. However, emotional loneliness is reduced for each person with whom the respective subject lives during the quarantine. Finally, we can conclude that the COVID-RS has satisfactory validity and reliability. Measuring dysfunctional reactions to COVID-19 can enable the prediction of citizen responsibility.

Immediate impact of stay-at-home orders to control COVID-19 transmission on socioeconomic conditions, food insecurity, mental health, and intimate partner violence in Bangladeshi women and their families: an interrupted time series

BACKGROUND

Stay-at-home orders (lockdowns) have been deployed globally to control COVID-19 transmission, and might impair economic conditions and mental health, and exacerbate risk of food insecurity and intimate partner violence. The effect of lockdowns in low-income and middle-income countries must be understood to ensure safe deployment of these interventions in less affluent settings. We aimed to determine the immediate impact of COVID-19 lockdown orders on women and their families in rural Bangladesh.

METHODS

An interrupted time series was used to compare data collected from families in Rupganj upazila, rural Bangladesh (randomly selected from participants in a randomised controlled trial), on income, food security, and mental health a median of 1 year and 2 years before the COVID-19 pandemic to data collected during the lockdown. We also assessed women's experiences of intimate partner violence during the pandemic.

RESULTS

Between May 19 and June 18, 2020, we randomly selected and invited the mothers of 3016 children to participate in the study, 2424 of whom provided consent. 2414 (99·9%, 95% CI 99·6-99·9) of 2417 mothers were aware of, and adhering to, the stay-at-home advice. 2321 (96·0%, 95·2-96·7) of 2417 mothers reported a reduction in paid work for the family. Median monthly family income fell from US$212 at baseline to $59 during lockdown, and the proportion of families earning less than $1·90 per day rose from five (0·2%, 0·0-0·5) of 2422 to 992 (47·3%, 45·2-49·5) of 2096 (p<0·0001 comparing baseline with lockdown period). Before the pandemic, 136 (5·6%, 4·7-6·6) of 2420 and 65 (2·7%, 2·1-3·4) of 2420 families experienced moderate and severe food insecurity, respectively. This increased to 881 (36·5%, 34·5-38·4) of 2417 and 371 (15·3%, 13·9-16·8) of 2417 during the lockdown; the number of families experiencing any level of food insecurity increased by 51·7% (48·1-55·4; p<0·0001). Mothers' depression and anxiety symptoms increased during the lockdown. Among women experiencing emotional or moderate physical violence, over half reported it had increased since the lockdown.

INTERPRETATION

COVID-19 lockdowns present significant economic, psychosocial, and physical risks to the wellbeing of women and their families across economic strata in rural Bangladesh. Beyond supporting only the most socioeconomically deprived, support is needed for all affected families.

FUNDING

National Health and Medical Research Council, Australia.

Research in Mental Health During the COVID-19 Pandemic: Quality versus quantity

NONE

Status and influential factors of anxiety depression and insomnia symptoms in the work resumption period of COVID-19 epidemic: A multicenter cross-sectional study

OBJECTIVE

In this study, the authors analyzed the status of anxiety depression and insomnia symptoms and influential factors in the work resumption period of Coronavirus disease 2019 (COVID-19).

METHODS

A multicenter cross-sectional survey was conducted from March 2, 2020 to March 8, 2020 in Shandong Province, China, using quota sampling combined with snowball sampling. The Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Insomnia Severity Index (ISI) were used to assess the anxiety, depression, and insomnia symptoms. The multivariate logistic regression analysis was used to explore the influential factors.

RESULTS

A total of 4000 invitations were sent from three centers, 3237 valid questionnaires were received. Based on GAD-7, PHQ-9, and ISI scales, 19.5%-21.7% of the participants had anxiety, depression, or insomnia symptoms; 2.9%-5.6% had severe symptoms. Besides, 2.4%, 4.8%, and 4.5% of the participants had anxiety-depression, anxiety-insomnia, or depression-insomnia combined symptoms. The scores of anxiety and insomnia symptoms, along with scores of depression and insomnia symptoms were positively correlated in these samples. Aged 50-64 years and outside activities once in ≥30 days were risk factors of anxiety, depression, and insomnia symptoms in common. During the epidemic, 17.4% of the participants had received psychological interventions, and only 5.2% had received individual interventions.

CONCLUSIONS

The incidence of psychological distress increased during the outbreak of COVID-19 in the work resumption period than the normal period. Current psychological interventions were insufficient; target psychological interventions should be conducted in time.

In the middle of the COVID-19 outbreak: Early practical guidelines for psychosocial aspects of COVID-19 in East Java, Indonesia

It is generally recognized that psychosocial interventions are an essential component in dealing with the COVID-19 outbreak. Research focusing on the handling of psychosocial conditions in the COVID-19 outbreak seems sparse. After reviewing several scholarly articles, we recommend several things that can be used as a basis for developing practical guidelines for handling psychosocial problems, especially in East Java Province, Indonesia. Development of practical guidelines for first-hand response and early treatment of psychosocial aspects of COVID-19 in East Java Province, Indonesia, based on the recommendations of 14 articles related to COVID-19 psychosocial handling was carried out. Some evidence strongly supports the need for knowledge about the stages of COVID-19, understanding of psychosocial responses, understanding of psychosocial interventions, and availability of hotline services in psychosocial interventions at each stage of the COVID-19 outbreak. It is important to provide practical guidance for the early management of psychosocial aspects of the innovative COVID-19 in providing more comprehensive care. There is strong evidence of the need for practical guidance on initial handling of the psychosocial aspects of COVID-19 for the community, especially in Indonesia's East Java Province.

Anxiety levels and obsessive compulsion symptoms of pregnant women during the COVID-19 pandemic

Objective

Reliable data regarding maternal mental well-being during the Severe Acute Respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic are scarce. This study aimed to assess the state/trait anxiety and obsessive-compulsive symptoms of pregnant women and compare those with the non-pregnant population using patient-reported validated outcome measures.

Materials and Methods

This prospective case-control study was conducted at a tertiary 'Coronavirus Pandemic Hospital' in İstanbul, Turkey in April, 2020. Pregnant and non-pregnant women were consecutively allocated to two groups regardless of gestational age. The primary outcome was to identify the anxiety levels and obsessive-compulsive symptoms of pregnant women during the SARS-CoV-2 pandemic using the State-Trait Anxiety inventory (STAI) and Maudsley Obsessive-Compulsive inventory (MOCI), respectively.

Results

Two hundred three pregnant women and 101 non-pregnant women were included. The mean STAI-S questionnaire score of pregnant and nonpregnant women was 41.96±9.15 and 46.62±12, respectively (p=0.001). The overall incidence of STAI >40 in pregnant and non-pregnant women was 62.6% and 73.3%, respectively. The mean total score of MOCI was 17.9±6.7 and 15±6.6 in pregnant and non-pregnant women, respectively. The overall incidence of 30-item-MOCI ≥13.1 in pregnant and non-pregnant women was 61.6% (125/203) and 30.7% (31/103), respectively (p<0.001).

Conclusion

State anxiety and obsessive-compulsive symptoms in pregnant women were found increased during the current SARS-CoV-2 pandemic. Pregnant women showed more favourable anxiety levels compared with non-pregnant women. These findings can be used to improve the coping skills of pregnant women during the pandemic, to prepare for the post-pandemic period, and to deal with the long-term mental health impact of COVID-19.

The mediating effect of the cyberchondria and anxiety sensitivity in the association between problematic internet use, metacognition beliefs, and fear of COVID-19 among Iranian online population

With the rapid growth of the novel coronavirus disease 2019 (COVID-19), individuals may try to find related medical information using the internet to overcome their fears. Under such circumstances, individuals with the features of cyberchondria, anxiety sensitivity, and metacognitive beliefs in negative thoughts may suffer more fears than those without these features. Therefore, the present study proposed a model to understand the associations between problematic internet use (PIU), cyberchondria, anxiety sensitivity, metacognition beliefs, and fear of COVID-19. Utilizing a cross-sectional online survey, 651 Iranians completed the following psychometric scales: Metacognition Questionnaire-30 (MCQ-30), Anxiety Sensitivity Questionnaire (ASI), Cyberchondria Severity Scale-Short Form (CSS-12), Fear of COVID-19 Scale (FCV-19S), and Generalized Problematic Internet Use Scale (GPIUS). Structural equation modeling (SEM) was used to assess the proposed model via several fit indices. The indices include Tucker-Lewis index (TLI), comparative fit index (CFI), standardized root mean square residual (SRMR), and root mean square error of approximation (RMSEA). The fit indices (CFI = 0.948, TLI = 0.938, RMSEA = 0.053, and SRMR = 0.001) indicated the good fit between the data and the proposed model. Moreover, fear of COVID-19 was significantly and directly predicted by cyberchondria (β = 0.479, p < .001) and anxiety sensitivity (β = 0.286, p < .001). The relationship between PIU and cyberchondria with fear of COVID-19 was mediated significantly by anxiety sensitivity and metacognitive beliefs. Because fear of COVID-19 was found to be significantly associated with cyberchondria and anxiety sensitivity, healthcare providers may want to provide additional support for those with cyberchondria and anxiety sensitivity tendencies.

Impact of COVID-19 on the Mental Health of Children and Adolescents

The coronavirus disease 2019 (COVID-19) outbreak was first reported in Wuhan, China, and was later reported to have spread throughout the world to create a global pandemic. As of August 18th, 2020, the coronavirus had spread to more than 216 countries with at least 21,756,357 confirmed cases, resulting in 771,635 deaths globally. Several countries declared this pandemic as a national emergency, forcing millions of people to go into lockdown. This unexpected imposed social isolation has caused enormous disruption of daily routines for the global community, especially children. Among the measures intended to reduce the spread of the virus, most schools closed, canceled classes, and moved it to home-based or online learning to encourage and adhere to social distancing guidelines. Education and learnings of 67.6% of students are impacted globally due to coronavirus in 143 countries. The transition away from physical classes has significantly disrupted the lives of students and their families, posing a potential risk to the mental well-being of children. An abrupt change in the learning environment and limited social interactions and activities posed an unusual situation for children's developing brains. It is essential and obligatory for the scientific community and healthcare workers to assess and analyze the psychological impact caused by the coronavirus pandemic on children and adolescents, as several mental health disorders begin during childhood. Countries across the globe, including the United States, are in the dilemma of determining appropriate strategies for children to minimize the psychological impact of coronavirus. The design of this review is to investigate and identify the risk factors to mental health and propose possible solutions to avoid the detrimental consequence of this crisis on the psychology of our future adult generations.

Is 2020 the year when primatologists should cancel fieldwork? A reply

The aim of this article is to explore the impact of coronavirus disease (COVID-19) pandemic on primate-related conservation work. The withdrawal of primatologists and conservation staff from field research can lead to a number of detrimental effects not just on conservation but also on local communities in low- and middle-income countries. Inequalities in access to health and financial insecurities may be drivers for the illegal wildlife trade and the lack of tourism and research activity may allow poachers to work with greater ease. The paper also looks at how conservation organizations and research bodies should modify their field protocols by developing robust occupational health policies that will not only make field work safer but also support local staff as they are likely to face the greatest threats to their physical health, psychological health, and economic loss from COVID-19. By adopting a One Health approach that considers the complex interactions between human and primate health, researchers will be able to find new ways of working not only to protect primates but understand how they adapt to the COVID-19 pandemic.

Pseudoscientific beliefs and psychopathological risks increase after COVID-19 social quarantine

BACKGROUND

The health crisis caused by COVID-19 has led many countries to opt for social quarantine of the population. During this quarantine, communication systems have been characterized by disintermediation, the acceleration of digitization and an infodemic (excess and saturation of information). The following debate arises: Do the levels related to the psychotic phenotype and pseudoscientific beliefs related to the interpretation of information vary before and after social quarantine?

OBJECTIVES

This research aims to examine the psychological effects of social quarantine on the psychotic phenotype and pseudoscientific beliefs-experiences of the general nonclinical population. The following hypothesis was posed: social quarantine alters the levels of magical thinking, pseudoscientific beliefs and anomalous perceptions due to quarantine.

METHODS

A pre- and posttest analysis design was applied based on the difference in means, and complementary Bayesian estimation was performed. A total of 174 Spanish subjects responded to different questionnaires that evaluated psychopathological risks based on psychotic phenotypes, pseudoscientific beliefs and experiences before and after quarantine.

RESULTS

Significant differences were obtained for the variables positive psychotic symptoms, depressive symptoms, and certain perceptual alterations (e.g., cenesthetic perceptions), and a significant increase in pseudoscientific beliefs was also observed. The perceptual disturbances that increased the most after quarantine were those related to derealization and depersonalization. However, paranoid perceptions showed the highest increase, doubling the initial standard deviation. These high increases could be related to the delimitation of physical space during social quarantine and distrust towards information communicated by the government to the population. Is it possible that social alarmism generated by the excess of information and pseudoscientific information has increased paranoid perceptual alterations?

CONCLUSIONS

Measures taken after quarantine indicate that perceptual disturbances, subclinical psychotic symptoms and beliefs in the pseudoscience have increased. We discuss which elements of quarantine coincide with the social marginality theory and its clinical repercussions.

The interface of psychiatry and COVID-19: Challenges for management of psychiatric patients

COVID-19 is a viral infection that has multisystemic physical and psychological complications. The following paper looks at the various challenges seen while treating psychiatric patients during the COVID pandemic. There is a need for physician to be aware of the drug interactions between psychiatric medications and the medications used routinely in the management of COVID. There is also the concern of psychiatric side effects of medications used to manage COVID and medical complications caused by some side effects of psychiatric drugs. The telepsychiatry and telemedicine paradigm has made it mandatory for physicians to be vigilant of the same.

Psychological burden of quarantine in children and adolescents: A rapid systematic review and proposed solutions

As COVID-19 grips the world, many people are quarantined or isolated resulting in adverse consequences for the mental health of youth. This rapid review takes into account the impact of quarantine on mental health of children and adolescents, and proposes measures to improve psychological outcomes of isolation. Three electronic databases including PubMed, Scopus, and ISI Web of Science were searched. Two independent reviewers performed title and abstract screening followed by full-text screening. This review article included 10 studies. The seven studies before onset of COVID 19 about psychological impact of quarantine in children have reported isolation, social exclusion stigma and fear among the children. The most common diagnoses were acute stress disorder, adjustment disorder, grief, and post-traumatic stress disorder. Three studies during the COVID-19 pandemic reported restlessness, irritability, anxiety, clinginess and inattention with increased screen time in children during quarantine. These adverse consequences can be tackled through carefully formulated multilevel interventions.

COVID-19 and Psychological Disaster Preparedness - An Unmet Need

OBJECTIVE

The coronavirus disease (COVID-19) pandemic is a disaster of unprecedented proportions with global repercussions. Psychological preparedness, the primed cognitive awareness and anticipation of dealing with emotional responses in an adverse situation, has assumed a compelling relevance during a health disaster of this magnitude.

METHODS

An anonymized eSurvey was conducted in India to assess psychological preparedness toward the ongoing pandemic with a focus on knowledge, management of own and others' emotional response, and anticipatory coping mechanisms among the survey population. An adapted version of the qualitative Psychological Preparedness for Natural Disaster Scale validated by the World Health Organization was widely circulated over the Internet and various social media platforms for assessment. Results are expressed as median ± standard deviation. Descriptive statistics were used and figures downloaded from surveymonkey.com.

RESULTS

Of the 1120 respondents (M:F 1.7:1, age 35 years ±14.1), most expressed a high level of perceived knowledge and confidence of managing COVID-19, such as awareness of the symptoms of the illness (95.1%), actions needed (94.4%), hospital to report to (88.9%), and emergency contact number (89.1%). A majority (95%) monitored regularly the news bulletins and scientific journals regarding COVID-19. However, nearly one-third (29.2%) could not assess their likelihood of developing COVID-19, and 17.5% were unaware of the difference between a mild and severe infection. Twenty-three percent (23.3%) were unfamiliar with the materials needed in an acute illness situation.

CONCLUSION

Psychological disaster preparedness is reasonable, although lacking in specific domains. Timely but focused interventions can be a cost-efficient administrative exercise, which federal agencies may prioritize working on.