A systematic review and meta-analysis on prevalence of and risk factors associated with depression, anxiety and insomnia in infectious diseases, including COVID-19: a call to action

Risk and Preventive Factors for Depressive Symptoms Among Older Chilean Adults During the SARS-CoV-2 Outbreak: A Longitudinal Study

OBJECTIVE

To specifically examine the multiple factors related to the increase in depressive symptoms during the COVID-19 outbreak in older adults in Chile.

METHOD

A longitudinal study was conducted using a dataset from a nationally representative survey cohort of Chilean older adults followed at three time points during the COVID-19 outbreak. The main outcome was depressive symptoms (Patient Health Questionnaire scale). The independent variables included: age, sex, educational level, geographic area, living alone, self-perceived health, self-reported resilience, loneliness, and social isolation.

RESULTS

A total of 424 older adults were included. Female sex (β = 0.95, 95% CI: 0.22 to 1.68) and loneliness (β = 1.21, 95% CI: 1.05 to 1.37) were the main risk factors for an increase in depressive symptoms in older adults. In contrast, living outside the metropolitan region (β=-0.70, 95% CI: -1.39 to -0.02), living in company (β=-0.34, 95% CI:-1.24 to 0.56), having better self-perceived health (β=-5.04, 95% CI:-6.33 to -3.75) and greater resilience (β=-0.30, 95% CI: -0.38 to -0.23) were preventive factors.

CONCLUSION

These results provide useful evidence to develop mental health prevention or control strategies for older adults.

CLINICAL IMPLICATIONS

The findings highlight the importance of a holistic approach to health care for older adults that integrates strategies to address loneliness, foster resilience, and promote an active social life.

A longitudinal study on the change in sleep across three waves of the COVID-19 outbreaks in Hong Kong

In the year 2020, Hong Kong experienced four COVID-19 epidemic waves. The present study aimed to examine the transition of sleep disturbances and explore its associated factors across the later three epidemic waves. Among the 1138 respondents who participated in an online survey at the second wave (T1, April 2020), 338 and 378 participants also completed a follow-up at the third (T2, August 2020) and fourth waves (T3, December 2020), respectively. Participants completed the Insomnia Severity Index and an investigator-designed questionnaire regarding potential factors associated with sleep change such as perceived risk of being infected, economic stress, and confidence in the government and health care professional. Sample of this study were mainly female (67.7%), married (50.3%), young adults (54.2%) with tertiary education (81.6%). Maintaining normal sleep was the most prevalent trajectory of sleep of all three waves (50.5%), followed by persistent insomnia (17.2%) and remitted insomnia (9.0%). Besides female, older-age and lower education level, the results showed that increment in worry about family being infected (adjusted risk ratio, RR = 1.28), perceived interference of daily lives (adjusted RR = 1.19), and economic distress (adjusted RR = 1.24) were significantly associated with the development of clinical insomnia during the three epidemic waves. These factors were also associated with worsening of other sleep parameters. Insomnia being persistent across the three waves of COVID-19 outbreaks was common. Increasing economic distress, daily interference, and worry about family members being infected were associated with an increasing risk of clinical insomnia across the three COVID-19 outbreaks.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41105-023-00486-w.

Occupational stress and mental health among civil servants during COVID-19 in China: The mediation effect of social support and work-family conflict

Mental health problems of various populations during the COVID-19 pandemic have received high attention, but there is little research on the mental health of Chinese civil servants. The present study investigated occupational stress, mental health problems (i.e., anxiety, depression, and insomnia), social support, and work-family conflict in Chinese civil servants during the COVID-19 pandemic. A total of 327 civil servants in Wenzhou city, China, participated in an online survey, which collected data on socio-demographic characteristics, occupational stress, mental health problems (i.e., anxiety, depression, and insomnia), social support, and work-family conflict. Data were analyzed using non-parametric tests and a multiple mediation model. Self-reported risk at work and support from mental health workers were relatively low. Anxiety, depression, and insomnia prevalence were 49.24 %, 47.1 %, and 20.48 %, respectively. Those who held higher ranks at work had lower levels of anxiety and depression. In addition, those who felt bad about their health status had more mental health problems. Social support and work-family conflict mediated the relationship between occupational stress and mental health problems significantly. Stress management training, organizational-level improvement in work arrangements, and professional mental health services are warranted for Chinese civil servants during the pandemic.

The Risk of Suicide in the Post-COVID-19 Emergency Era: Psychological and Forensic Implications

The emergence of the coronavirus disease 2019 (COVID-19) pandemic brought numerous challenges, including the management of psychological and psychiatric disorders, leading to an increased risk of suicide. At the end of the COVID-19 emergency, we wonder what the impact of the pandemic has been, and still is, on the state of public mental health with respect to the phenomenon of suicide. Therefore, this review aims to explore the psychological and forensic aspects of suicide in the post-COVID-19 emergency era. The paper will delve into the various psychiatric disorders associated in the literature with COVID-19, the risk factors for suicide during the pandemic, and measures that can be taken to prevent suicide in the post-COVID-19 era. Additionally, the paper will look at how forensic experts investigate suicide cases due to COVID-19 and the legal implications of suicide due to the pandemic. The findings of this study will provide insights into the psychological and forensic aspects of suicide in the post-COVID era, and emphasize interventions and policy development to address this growing public health concern.

Sleep disturbance and medical requests among university and college students in Chongqing, China: A cross-sectional study

OBJECTIVES

To investigate the prevalence of sleep disturbance, sleep patterns, sleep-related factors, and medical demands among university and college students in Chongqing, China.

METHODS

Demographic data and responses to the sleep problem questionnaire (SPQ) were collected from 1973 students from 11 universities and 10 colleges between November 2022 and January 2023.

RESULTS

The prevalence of sleep disturbance in university and college students was different in different periods (58.17% during campus lockdown and 40.30% after the lifting of lockdown). The combined prevalence was 49.72%. The prevalence of the 6 types of sleep disturbance showed the same trend. The average sleep latency was 32.79 minutes and the average sleep duration was 7.53 hours. Male, university students, upper-class students, history of depression, academic stress, major life events, bad bedroom environment, and campus lockdown were factors related to sleep disturbance among respondents. Most of the respondents (52.09%) had no medical care requests, and the major reasons were a lack of access to medical care (75.15%), economic pressure (68.49%), concerns regarding curative effects (58.51%), and academic pressure (56.56%).

CONCLUSION

The prevalence of sleep disturbance for university and college students was obviously improved after the lifting of campus lockdown, and the major factors related to sleep disturbance were study, life, mental health, and sleep environment. The students examined herein reported relatively low medical care requests when they experience sleep disturbance.

Long-term post-traumatic stress symptoms in COVID-19 survivors and its risk factors: a two-year longitudinal cohort study

The COVID-19 pandemic has led to widespread mental health problems, necessitating the investigation of longitudinal mental health changes, associated risk factors, and neural mechanisms in survivors. We recorded demographics, mental health, social support, and potential exposures in survivors at 3 months (n = 189), 6 months (n = 47), and 2 years (n = 69) post-discharge and collected brain imaging data at the second timepoint. Control groups included non-COVID-19 locals (3 months: n = 188, 6 months: n = 42, 2 years: n = 71). Results indicated that female survivors exhibited higher post-traumatic stress symptoms (PTSS) and depression levels than female controls for up to 2 years, along with higher anxiety level for up to 6 months. Male survivors had higher PTSS, depression, and anxiety levels than male controls at 2 months. Moreover, COVID-related trauma and low social support were risk factors for PTSS and negative emotions in survivors. Neuroimaging revealed increased amygdala activity in male survivors and correlations between hippocampus activity and depression symptoms as well as between right hippocampus activity and social support. Our study emphasized the importance of monitoring mental wellness in COVID-19 survivors and underscored the crucial role of social support in mitigating mental health problems.

Path Model Analysis of the Effects of Perceived Formalism, and Fear of COVID-19 on Police Officers' PTSD and Insomnia

This study examines whether law enforcement officers' fear of COVID-19, job burnout, and job stress have increased their PTSD and insomnia during the epidemic. This article introduces the perceived formalism of police agencies into the causal model to explore whether perceived formalism increases the job burnout and job stress of police officers. The formalism of administrative agencies is rarely included in epidemic research. This study collected 306 Taiwanese police officers as research subjects. We used confirmatory factor analysis and SEM for hypothesis testing. The study found that perceived formalism positively affects the job burnout and job stress of police officers. Job stress, fear of COVID-19, and job burnout positively affect PTSD and insomnia.

Patient Anxiety and Communication Experience in the Emergency Department: A Mobile, Web-Based, Mixed-Methods Study on Patient Isolation During the COVID-19 Pandemic

BACKGROUND

Anxiety and communication difficulties in the emergency department (ED) may increase for various reasons, including isolation due to coronavirus disease 2019 (COVID-19). However, little research on anxiety and communication in EDs exists. This study explored the isolation-related anxiety and communication experiences of ED patients during the COVID-19 pandemic.

METHODS

A prospective mixed-methods study was conducted from May to August 2021 at the Samsung Medical Center ED, Seoul. There were two patient groups: isolation and control. Patients measured their anxiety using the State-Trait Anxiety Inventory (STAI X1) at two time points, and we surveyed patients at two time points about factors contributing to their anxiety and communication experiences. These were measured through a mobile web-based survey. Researchers interviewed patients after their discharge.

RESULTS

ED patients were not anxious regardless of isolation, and there was no statistical significance between each group at the two time points. STAI X1 was 48.4 (standard deviation [SD], 8.0) and 47.3 (SD, 10.9) for early follow-up and 46.3 (SD, 13.0) and 46.2 (SD, 13.6) for late follow-up for the isolation and control groups, respectively. The clinical process was the greatest factor contributing to anxiety as opposed to the physical environment or communication. Communication was satisfactory in 71.4% of the isolation group and 66.7% of the control group. The most important aspects of communication were information about the clinical process and patient status.

CONCLUSION

ED patients were not anxious and were generally satisfied with medical providers' communication regardless of their isolation status. However, patients need clinical process information for anxiety reduction and better communication.

Challenges in the Management of Children and Adolescents With Epilepsy in China During the COVID-19 Pandemic: An Online Survey-Based Study

INTRODUCTION

To investigate the challenges in the management of children and adolescents with epilepsy in China during the coronavirus disease (COVID-19) pandemic.

METHODS

We conducted a cross-sectional survey among 845 patients with epilepsy using an online-based questionnaire. The questionnaire focused on sociodemographic characteristics, epilepsy-related conditions, health care access, COVID-19 vaccination, and the mental health of caregivers. Depression was assessed using Patient Health Questionnaire-9.

RESULTS

During the pandemic, 24.73% of the patients had increased seizures. The majority of patients (68.89%) experienced difficulty obtaining antiseizure medications. In addition, 94.79% of the patients had difficulty consulting a doctor. A total of 52.78% of the patients selected telemedicine services, and most found these services to be helpful. Moreover, 76.11% of the patients failed to complete the COVID-19 vaccination. More than half of the caregivers had anxiety and depressive symptoms. The risk factors for depression comprised irregularity in taking antiseizure medications, difficulty in obtaining antiseizure medications, and failure to consult a doctor on time.

CONCLUSIONS

The COVID-19 pandemic presented a great challenge in the management of children and adolescents with epilepsy in China. The findings highlight the importance of improving health care systems and medication management and the mental health of their caregivers.

Psychological Health and Risk Factors of College Students within the Context of the COVID-19 Pandemic: A Cross-Sectional Study

BACKGROUND

Students are a priority population in mental health research. This study aimed to explore the risk factors of anxiety and depression symptoms among college students in Chongqing, a megacity under the impact of COVID-19, and to provide a basis for determining the priorities of public health policies and implementing effective educational health care interventions.

METHODS

In this cross-sectional study conducted in Chongqing, China, the data came from web-based stratified random sampling. Anxiety and depression symptoms were measured by the Self-Rating Anxiety Scale (SAS) and the Center for Epidemiological Studies Depression Scale (CES-D), respectively, and risk factors were analyzed by logistic regression.

RESULTS

Data were obtained from 915 college students (34.75% were male, and 65.25% were female) with age (20.29 ± 1.51) in Chongqing, China. The prevalence rates of anxiety and depression were 19.78% and 22.62%, respectively. Logistic regression analysis revealed that the risk factors of anxiety symptoms were associated with junior years, sleep time of less than 6 h a day, influence on career planning, and depression symptoms. Comprehensive, science and engineering, and medicine disciplines, having siblings, poorer mastery of study, and anxiety symptoms were risk factors for developing depression symptoms.

CONCLUSIONS

During the pandemic, college students experienced varying degrees of anxiety and depression. Our research findings highlight the necessity of universities and relevant departments providing precise mental health education for college students under major public health emergencies.

The Influence of Authoritarian-Benevolent Leadership on Subordinates' Work Engagement: A Social Information Processing Perspective

Purpose

The dynamic and complex external environment calls for leaders to be both benevolent and authoritarian to cope with the mutually exclusive demands in the management process. But few research paid attention to the dark side of leaders' inconsistent behaviors on employees' work outcomes. Based on social information processing theory, this study investigated the impact of authoritarian-benevolent leadership on subordinates' work engagement and explored the mediating role of leader-member exchange ambivalence and the moderating role of trait mindfulness.

Methods

A two-wave time-lagged survey approach was employed and data from 309 employees from three Chinese companies were collected. R 4.2.1 and SPSS 26.0 were used to test our hypotheses.

Results

The findings demonstrated how subordinates were influenced in their work engagement by authoritarian-benevolent leadership and leader-member exchange ambivalence and emphasized the value of maintaining a high level of trait mindfulness. This study indicated that (1) authoritarian-benevolent leadership was negatively associated with work engagement, which was mediated by leader-member exchange ambivalence; (2) subordinates' trait mindfulness moderated the relationship between leader-member exchange ambivalence and work engagement; (3) the indirect effect of authoritarian-benevolent leadership on subordinates' work engagement through leader-member exchange ambivalence was moderated by subordinates' trait mindfulness.

Conclusion

This study reveals the dark side of authoritarian-benevolent leadership and deepens our understanding of the mechanism underlying the effect of authoritarian-benevolent leadership on subordinates' work engagement from a new theoretical perspective. Practical implications are provided for managers to effectively develop authoritarian-benevolent leadership skills and improve subordinates' work engagement.

Exploring Astrocyte-Mediated Mechanisms in Sleep Disorders and Comorbidity

Astrocytes, the most abundant cells in the brain, are integral to sleep regulation. In the context of a healthy neural environment, these glial cells exert a profound influence on the sleep-wake cycle, modulating both rapid eye movement (REM) and non-REM sleep phases. However, emerging literature underscores perturbations in astrocytic function as potential etiological factors in sleep disorders, either as protopathy or comorbidity. As known, sleep disorders significantly increase the risk of neurodegenerative, cardiovascular, metabolic, or psychiatric diseases. Meanwhile, sleep disorders are commonly screened as comorbidities in various neurodegenerative diseases, epilepsy, and others. Building on existing research that examines the role of astrocytes in sleep disorders, this review aims to elucidate the potential mechanisms by which astrocytes influence sleep regulation and contribute to sleep disorders in the varied settings of brain diseases. The review emphasizes the significance of astrocyte-mediated mechanisms in sleep disorders and their associated comorbidities, highlighting the need for further research.

Emerging role of the host microbiome in neuropsychiatric disorders: overview and future directions

The human body harbors a diverse ecosystem of microorganisms, including bacteria, viruses, and fungi, collectively known as the microbiota. Current research is increasingly focusing on the potential association between the microbiota and various neuropsychiatric disorders. The microbiota resides in various parts of the body, such as the oral cavity, nasal passages, lungs, gut, skin, bladder, and vagina. The gut microbiota in the gastrointestinal tract has received particular attention due to its high abundance and its potential role in psychiatric and neurodegenerative disorders. However, the microbiota presents in other body tissues, though less abundant, also plays crucial role in immune system and human homeostasis, thus influencing the development and progression of neuropsychiatric disorders. For example, oral microbiota imbalance and associated periodontitis might increase the risk for neuropsychiatric disorders. Additionally, studies using the postmortem brain samples have detected the widespread presence of oral bacteria in the brains of patients with Alzheimer's disease. This article provides an overview of the emerging role of the host microbiota in neuropsychiatric disorders and discusses future directions, such as underlying biological mechanisms, reliable biomarkers associated with the host microbiota, and microbiota-targeted interventions, for research in this field.

Poorer outcomes following COVID-19 infection for patients with depression: A cohort analysis in South Korea

Introduction

It remains unknown whether patients with pre-existing depressive conditions are at high risk of severe COVID-19. Therefore, this study aims to investigate the association between patients with pre-existing depressive conditions and severe COVID-19.

Method

This study is part of the Korea Disease Control and Prevention Agency-COVID19-National Health Insurance Service cohort study of an ongoing large-scale health screening survey of adults 18 years and older residing in South Korea. Pre-existing depression status was measured from 552,860 patients who participated in a biennial health screening from 2019 to 2020. Finally, 29,106 confirmed COVID-19 patients were enrolled and followed up to track any severe clinical events within 1 month of their diagnosis date. Adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated using multivariate-adjusted logistic regression analysis.

Results

We identified 2868 COVID-19 patients with severe clinical events and 26,238 COVID-19 patients without severe clinical events. The moderate-to-severe depressive symptoms group showed an elevated odds of severe outcomes of COVID-19 (aOR, 1.46; 95% CI, 1.25-1.72), including those without vaccination (aOR, 1.32; 95% CI, 1.08-1.61) and those with complete vaccination (aOR, 1.76; 95% CI, 1.18-2.63). In addition, those who were diagnosed with depression along with depressive symptoms at the health screening revealed an increased risk of severe outcomes of COVID-19 (aOR, 2.22; 95% CI, 1.22-4.05).

Conclusion

Moderate-to-severe depressive symptoms were associated with higher odds of severe COVID-19 events in both no and complete vaccination groups. Participants with depressive symptoms may be at higher risk of severe outcomes of COVID-19.

The trends of psychosomatic symptoms and perceived stress among healthcare workers during the COVID-19 pandemic in China: Four cross-sectional nationwide surveys, 2020-2023

An unseen wave of vast infection was detected in China in December 2022, and healthcare workers faced inevitable challenges and heavy stress. We aimed to present a dynamic mental health map and, most importantly, provide a timely report of the current situation in healthcare workers. The current study conducted four national cross-sectional online surveys from February and March 2020, Apr 2022, and Jan 2023. The Psychosomatic Symptom Scale (PSSS) and Perceived Stress Scale-10 (PSS-10) were used to assess psychosomatic symptoms and perceived stress. Fourteen thousand nine hundred forty-five participants (8578 healthcare workers and 6367 others) participated in the surveys. The prevalence of psychosomatic syndrome, reflected by PSSS, was 19.3% (Wave1), 22.9% (Wave2), 36.4% (Wave3), and 60.7% (Wave4) among healthcare workers, compared to 24.0% (Wave1), 35.7% (Wave2), 34.2% (Wave3) and 50.5% (Wave4) among the others. In addition, healthcare workers exhibited lower PSSS total scores at the beginning but higher in later waves. Despite their infection status, they now suffer from more severe psychosomatic symptoms than the rest of society. Our findings suggest that healthcare workers in China have now experienced severe psychosomatic symptoms and tremendous stress. Therefore, there is an urgent need to utilize social support for them.

Prevalence and factors associated with long COVID and mental health status among recovered COVID-19 patients in southern Thailand

Mental health disorders have become a growing public health concern among individuals recovering from COVID-19. Long COVID, a condition where symptoms persist for an extended period, can predict psychological problems among COVID-19 patients. This study aimed to investigate the prevalence of long COVID and mental health status among Thai adults who had recovered from COVID-19, identify the association between the mental health status and long COVID symptoms, and investigate the risk factors associated with the correlation between long COVID and mental health outcomes. A cross-sectional study was conducted among 939 randomly selected participants in Nakhon Si Thammarat province, southern Thailand. The Depression, Anxiety, and Stress Scale-21 was used to investigate mental health symptoms, and a checklist comprised of thirteen common symptoms was used to identify the long COVID among participants. Logistic regression models were used to investigate the risk factors associated with mental health status and long COVID symptoms among participants. Among the 939 participants, 104 (11.1%) had depression, 179 (19.1%) had anxiety, and 42 (4.8%) were stressed. A total of 745 participants (79.3%) reported experiencing at least one symptom of long COVID, with fatigue (72.9%, SE±0.02), cough (66.0%, SE±0.02), and muscle pain (54.1%, SE±0.02) being the most frequently reported symptoms. All long COVID symptoms were significantly associated with mental health status. Shortness of breath, fatigue, and chest tightness were the highest risk factors for mental health status among COVID-19 patients. The final multivariable model indicated that female patients (OR = 1.89), medical history (OR = 1.92), and monthly income lower than 5,000 Thai baht (OR = 2.09) were associated with developing long COVID symptoms and mental health status (all p<0.01). This study provides valuable insights into the potential long-term effects of COVID-19 on mental health and enhances understanding of the mechanisms underlying the condition for predicting the occurrence of mental health issues in Thai COVID-19 patients.

Mental health and cognitive function among medical students after the COVID-19 pandemic in China

Background

Chinese people experienced a nationwide coronavirus disease 2019 (COVID-19) pandemic after the adjustment of epidemic response policies from December 2022 to January 2023. This study aims to explore the prevalence of mental and cognitive symptoms and their associated factors among medical students after the COVID-19 pandemic.

Methods

A cross-sectional study was conducted between February 27th and March 8th, 2023. The symptoms of anxiety, depression, insomnia, post-traumatic stress disorder (PTSD), and cognitive function among medical students were examined using the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Athens Insomnia Scale (AIS), the Impact of Event Scale-6 (IES-6), and the Perceived Deficits Questionnaire-Depression-5 (PDQ-D-5). Data on demographic information was also collected. Statistical analyses were conducted to describe the prevalence and explore the associated factors of mental and cognitive symptoms.

Results

Among 947 participants, the proportion of students experiencing anxiety, depression, insomnia, and PTSD symptoms was 37.8, 39.3, 28.3, and 29.5%, respectively. The self-reported COVID-19 infection rate was 72.2%. Higher grades, childhood, and current rural residence were identified as potential risk factors for mental and cognitive symptoms. Gender, age, average monthly household income, and COVID-19 diagnosis were not associated with mental and cognitive symptoms among medical students.

Conclusion

Our findings revealed a high prevalence of mental and cognitive symptoms among Chinese medical students after the COVID-19 pandemic. Special attention should be paid to the mental health of higher-grade students and those residing in rural areas.

The Relationship Between Social Media Use and Negative Emotions Among Chinese Medical College Students: The Mediating Role of Fear of Missing Out and the Moderating Role of Resilience

Objective

This study aimed to examine the mediating role of fear of missing out (FoMO) and the moderating role of resilience in the association between social media use and negative emotions among medical college students in China during the COVID-19 pandemic.

Participants and Methods

A cross-sectional study design was conducted, medical college students from Qiqihar Medical University, China participated in the study. A total of 470 medical college students were recruited voluntarily to complete questionnaires on social media use, FoMO, resilience, and negative emotions.

Results

Social media use was positively associated with FoMO and negative emotions among medical students (p < 0.01). The total effect of social media use on negative emotions was significant (β = 1.101, SE = 0.079, p < 0.001). Social media use had no significant direct effect on negative emotions (β = 0.168, SE = 0.096, p > 0.05), but it had an indirect effect on negative emotions via mediation of FoMO (β = 0.933, SE = 0.106, 95% CI: 0.731 to 1.149). Moreover, resilience had a significant moderating effect on the relationship between FoMO and negative emotions (β = -0.021, SE = 0.005, 95% CI: -0.032 to -0.012). FoMO had a significant positive predictive effect on negative emotions at both levels of resilience (low resilience individuals: β = 1.079, SE = 0.076, p < 0.001; high resilience individuals: β = 0.212, SE = 0.094, p < 0.05).

Conclusion

Social media use and FoMO may be risk factors for increased negative emotions, and resilience should be considered in prevention and intervention strategies designed to mitigate negative emotions among medical college students.

Life satisfaction, positive affect, depression and anxiety symptoms, and their relationship with sociodemographic, psychosocial, and clinical variables in a general elderly population sample from Chile

Background

This study aims to describe the relationship between life satisfaction, positive affect, depression and anxiety symptoms with sociodemographic, psychosocial and clinical variables, and to identify the relative importance of these predictor groups.

Methods

We evaluated life satisfaction (SWLS), positive affect (PANAS), depressive (PHQ-9), and anxiety (GAI) symptoms and their association with sociodemographic, psychosocial and clinical variables in a multistage, random general population sample of fully functioning individuals aged 60-80 years from the Concepción province and Gran Santiago, Chile (n = 396). We performed weighted multiple regression analysis, considering the complex sample structure with age group, sex, and geographical area, complemented with general and conditional dominance analyses to estimate the relevance of the predictor groups.

Results

We found significant associations with the geographical area, sex, age, education level, household members, having a partner, employment status, caregiver status, economic satisfaction, presence of chronic diseases, medication use, and alcohol use. Satisfaction with health was the most important predictor for positive affect (p < 0.001), depressive (p < 0.001), and anxiety (p < 0.001) symptoms, while alcohol use was the most significant predictor for life satisfaction (p < 0.001).

Conclusion

Simultaneously studying the positive and negative dimensions of wellbeing and mental health in older adults allows for a more comprehensive perspective on the challenges faced during this stage of life. This study accounts for previously unknown associations and contributes to the identification of common and specific predictors in both dimensions.

Family support, anger and aggression in health workers during the first wave of the pandemic

Introduction

Anger is considered as one of the basic human emotions, constituting the affective component of aggression. In the first year of the pandemic, the intense pressure on healthcare workers resulted in the deterioration of their psychosocial problems.

Objective

The aim of this study is to investigate the relationship between family support, anger, and aggression.

Methods

The present study included physicians and nurses who completed an online survey of Dimensions of Anger Reactions-5 (DAR-5), a Brief Aggression Questionnaire (BAQ) and a Family Support Scale (FSS). Before completing the questionnaires, participants were asked to state their gender, years of work, age, and profession.

Results

Fifty-three men and 190 women participated in the study. Almost one-third of the participants had a positive score on the DAR-5 scale. Male participants displayed lower DAR-5 scores compared to women. Female participants displayed lower FSS scores compared to men, but higher scores when compared with earlier measures. Regression showed that 15.2% of the variance in BAQ scores can be explained by DAR-5 scores, with an additional 3.8% explained by FSS scores, while an additional 2.3% is explained by years of working experience. Mediation analysis highlighted the role of family support as a negative mediator in the DAR-5 and BAQ relationship.

Conclusion

During the first year of the pandemic, there was an increase in the sense of family support among female health workers. One-third of the participants displayed increased anger scores. Family support acts as a mediator by preventing anger derailing into aggression. In healthcare worker support programs, it seems necessary to entail a specific section on anger management.

Differences in adoption of COVID-19 pandemic related preventive behaviour by viral load suppression status among people living with HIV during the first wave of the pandemic

BACKGROUND

Adherence to antiretroviral therapy and COVID-19 preventive behaviours among people living with HIV during the pandemic has received little attention in the literature. To address this gap in knowledge, the present study assessed the associations between viral load, adherence to antiretroviral therapy and the use of COVID-19 prevention strategies during the first wave of the COVID-19 pandemic. This was a secondary analysis of data generated through an online survey recruiting participants from 152 countries. Complete data from 680 respondents living with HIV were extracted for this analysis.

RESULTS

The findings suggest that detectable viral load was associated with lower odds of wearing facemasks (AOR: 0.44; 95% CI:0.28-0.69; p < 0.01) and washing hands as often as recommended (AOR: 0.64; 95% CI: 0.42-0.97; p = 0.03). Also, adherence to the use of antiretroviral drugs was associated with lower odds of working remotely (AOR: 0.60; 95% CI: 0.38-0.94; p = 0.02). We found a complex relationship between HIV positive status biological parameters and adherence to COVID-19 preventive measures that may be partly explained by risk-taking behaviours. Further studies are needed to understand the reasons for the study findings.

Food insecurity and sleep health by race/ethnicity in the United States

Food insecurity, poised to increase with burgeoning concerns related to climate change, may influence sleep, yet few studies examined the food security-sleep association among racially/ethnically diverse populations with multiple sleep dimensions. We determined overall and racial/ethnic-specific associations between food security and sleep health. Using National Health Interview Survey data, we categorised food security as very low, low, marginal and high. Sleep duration was categorised as very short, short, recommended and long. Sleep disturbances included trouble falling/staying asleep, insomnia symptoms, waking up feeling unrested and using sleep medication (all ≥3 d/times in the previous week). Adjusting for socio-demographic characteristics and other confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95 % confidence intervals (95 % CIs) for sleep dimensions by food security. Among 177 435 participants, the mean age of 47⋅2 ± 0⋅1 years, 52⋅0 % were women, and 68⋅4 % were non-Hispanic (NH)-White. A higher percent of NH-Black (7⋅9 %) and Hispanic/Latinx (5⋅1 %) lived in very low food security households than NH-White (3⋅1 %) participants. Very low v. high food security was associated with a higher prevalence of very short (PR = 2⋅61 [95 % CI 2⋅44-2⋅80]) sleep duration as well as trouble falling asleep (PR = 2⋅21 [95 % CI 2⋅12-2⋅30]). Very low v. high food security was associated with a higher prevalence of very short sleep duration among Asian (PR = 3⋅64 [95 % CI 2⋅67-4⋅97]) and NH-White (PR = 2⋅73 [95 % CI 2⋅50-2⋅99]) participants compared with NH-Black (PR = 2⋅03 [95 % CI 1⋅80-2⋅31]) and Hispanic/Latinx (PR = 2⋅65 [95 % CI 2⋅30-3⋅07]) participants. Food insecurity was associated with poorer sleep in a racially/ethnically diverse US sample.

The Devastating Effects of Sleep Deprivation on Memory: Lessons from Rodent Models

In this narrative review article, we discuss the role of sleep deprivation (SD) in memory processing in rodent models. Numerous studies have examined the effects of SD on memory, with the majority showing that sleep disorders negatively affect memory. Currently, a consensus has not been established on which damage mechanism is the most appropriate. This critical issue in the neuroscience of sleep remains largely unknown. This review article aims to elucidate the mechanisms that underlie the damaging effects of SD on memory. It also proposes a scientific solution that might explain some findings. We have chosen to summarize literature that is both representative and comprehensive, as well as innovative in its approach. We examined the effects of SD on memory, including synaptic plasticity, neuritis, oxidative stress, and neurotransmitters. Results provide valuable insights into the mechanisms by which SD impairs memory function.

Prevalence and risk factor for long COVID in children and adolescents: A meta-analysis and systematic review

BACKGROUND

Millions of COVID-19 pediatric survivors are facing the risk of long COVID after recovery from acute COVID-19. The primary objective of this study was to systematically review the available literature and determine the pooled prevalence of, and risk factors for long COVID among the pediatric survivors.

METHODS

Studies that assessed the prevalence of, or risk factors associated with long COVID among pediatric COVID-19 survivors were systematically searched in PubMed, Embase, and Cochrane Library up to December 11th, 2022. Random effects model was performed to estimate the pooled prevalence of long COVID among pediatric COVID-19 patients. Subgroup analyses and meta-regression on the estimated prevalence of long COVID were performed by stratification with follow-up duration, mean age, sex ratio, percentage of multisystem inflammatory syndrome, hospitalization rate at baseline, and percentage of severe illness.

RESULTS

Based on 40 studies with 12,424 individuals, the pooled prevalence of any long COVID was 23.36 % ([95 % CI 15.27-32.53]). The generalized symptom (19.57 %, [95 % CI 9.85-31.52]) was reported most commonly, followed by respiratory (14.76 %, [95 % CI 7.22-24.27]), neurologic (13.51 %, [95 % CI 6.52-22.40]), and psychiatric (12.30 %, [95% CI 5.38-21.37]). Dyspnea (22.75 %, [95% CI 9.38-39.54]), fatigue (20.22 %, [95% CI 9.19-34.09]), and headache (15.88 %, [95 % CI 6.85-27.57]) were most widely reported specific symptoms. The prevalence of any symptom during 3-6, 6-12, and> 12 months were 26.41 % ([95 % CI 14.33-40.59]), 20.64 % ([95 % CI 17.06-24.46]), and 14.89 % ([95 % CI 6.09-26.51]), respectively. Individuals with aged over ten years, multisystem inflammatory syndrome, or had severe clinical symptoms exhibited higher prevalence of long COVID in multi-systems. Factors such as older age, female, poor physical or mental health, or had severe infection or more symptoms were more likely to have long COVID in pediatric survivors.

CONCLUSIONS

Nearly one quarter of pediatric survivors suffered multisystem long COVID, even at 1 year after infection. Ongoing monitoring, comprehensive prevention and intervention is warranted for pediatric survivors, especially for individuals with high risk factors.

Depressive Symptoms of Public Health Medical Residents during the COVID-19 Pandemic, a Nation-Wide Survey: The PHRASI Study

Depression is a widespread condition, which increased during the COVID-19 pandemic among healthcare workers as well. The large workload of the pandemic response also affected Public Health Residents (PHRs) who played an important role in infection prevention and control activities. This work aims to assess depression in Italian PHRs, based on data collected through the PHRASI (Public Health Residents' Anonymous Survey in Italy) study. In 2022, 379 PHRs completed the self-administered questionnaire containing Patient Health Questionnaire-9 to evaluate clinically relevant depressive symptoms (PHQ-9 ≥ 10). Multivariate logistic regression shows that the intention (aOR = 3.925, 95% CI = (2.067-7.452)) and the uncertainty (aOR = 4.949, 95% CI = (1.872-13.086)) of repeating the test to enter another postgraduate school/general practitioner course and the simultaneous attendance of two traineeships (aOR = 1.832, 95% CI = (1.010-3.324)) are positively related with depressive symptoms. Conversely, the willingness to work in the current traineeship place (aOR = 0.456, 95% CI = (0.283-0.734)) emerged as a protective factor. Similar results were obtained considering mild-to-severe (PHQ-9 ≥ 5) depressive symptoms and/or stratifying by sex. The findings, suggesting the protective role of job satisfaction toward depression, might entail future interventions to improve the learning experience and promote work-life balance.

Anxiety, insomnia and family support in nurses, two years after the onset of the pandemic crisis

Introduction

The Covid-19 pandemic continues to cause serious physical and mental problems for health professionals, particularly nurses.

Aim

To estimate the prevalence of anxiety and insomnia and to evaluate their possible association with family support received by nurses two years after the onset of the pandemic.

Materials and methods

In total, the study participants were 404 nurses (335 females and 69 males) with a mean age of 42.88 (SD = 10.9) years and a mean of 17.96 (SD = 12) years working as nurses. Nurses from five tertiary hospitals in Athens constituted the study population who completed the questionnaires State-Trait Anxiety Inventory (STAI), Athens Insomnia Scale (AIS) and Family Support Scale (FSS), in the months of November and December 2021. Regarding demographic and occupational characteristics, gender, age and years of experience as nurses were recorded.

Results

60.1% of the nurses showed abnormal scores in state anxiety, with 46.8% in trait anxiety, and 61.4% showed insomnia. Women showed higher scores on the two subscales of anxiety and the insomnia scale compared to men (p < 0.01 and p < 0.05 respectively), while they showed a lower score on the FSS without statistical significance (p > 0.05). Positive correlations (p < 0.01) were found between the State Anxiety Inventory, Trait Anxiety Inventory and AIS, while all of them showed a high negative correlation with FSS (p < 0.01). Age showed a negative correlation with Trait Anxiety Inventory (p < 0.05). As shown by the mediation analysis, the relationship between state anxiety and insomnia was mediated by trait anxiety, whereas state anxiety appeared to be dependent on family support.

Conclusions

Nurses continue to experience high levels of anxiety and insomnia and feel less supported by their families than in the first year of the pandemic. Insomnia appears to be dependent on state anxiety, with a significant indirect effect of trait anxiety, while family support seems to affect state anxiety.

Risk of hospitalization for self-harm among adults hospitalized with SARS-CoV-2 in France: A nationwide retrospective cohort study

While much work has shown a link between the global SARS-CoV-2 pandemic and poor mental health, little is known about a possible association between hospitalization with SARS-CoV-2 infection and subsequent hospitalization for self-harm. Analyses performed on the French national hospital database between March 2020-March 2021 in 10,084,551 inpatients showed that hospitalization with SARS-CoV-2 infection was not associated with hospitalization for self-harm in the following year. However, hospitalization with SARS-Cov-2 was related to an increased risk of self-harm in patients with a suicidal episode at the inclusion (aHR=1.56[1.14-2.15]), suggesting an effect of SARS-CoV-2 in patients with a recent history of self-harm.

Depression and anxiety in peruvian military personnel during the pandemic context: a cross-sectional study

BACKGROUND

During the COVID-19 pandemic, increased workload and stress could have increased mental health problems (anxiety and depression) in military personnel. However, the number of studies in military members is scarce, especially in regard to mental health. The objective of this study was determine the prevalence and factors associated with depression and anxiety in Peruvian military personnel.

METHODS

We undertook an analytical cross-sectional study. The survey was distributed face to face between November 02 and 09, 2021, during the second wave of the COVID-19 pandemic among the military personnel. We used some instruments to measure depression (Patient Health Questionnaire, PHQ-9), anxiety (Generalized Anxiety Disorder, GAD-7), insomnia (Insomnia Severity Index, ISI), food insecurity (Household Food Insecurity Access Scale, HFIAS), physical activity (International Physical Activity Questionnaires, IPAQ-S), resilience (abbreviated CD-RISC), and fear of COVID-19 scale. The exclusion criteria included those who did not completely fill out the evaluation instruments.

RESULTS

We analyzed the data of 615 military personnel that participated in the survey. Of them, 93.7% were male and the median age was 22 years old. There was a prevalence of 29.9% and 22.0% in regard to depression and anxiety symptoms, respectively. In addition, it was found that being married (PR: 0.63; 95% IC: 0.42-0.94), having a relative with mental health problems (PR: 2.16), having experienced food insecurity (PR: 1.48), insomnia (PR: 2.71), fear of COVID-19 (PR: 1.48), and a high level of resilience (PR: 0.65) were factors associated with depression. In regard to anxiety, the factors associated were working for more than 18 months since the beginning of the COVID-19 pandemic (PR: 0.52), a high level of resilience (PR: 0.50; 95% IC: 0.33-0.77), insomnia (PR: 3.32), fear of COVID-19 (PR: 2.43).

CONCLUSION

We found a prevalence of symptoms of depression and anxiety of 29.9% and 22.0%, respectively. In regard to the factors that attenuate depression, we can mention being married and having resilience; and among the aggravating factors, having a relative with mental health problems, food insecurity, insomnia, and fear of COVID-19. Finally, anxiety increased through working time, insomnia, and fear of COVID-19.

Addressing psychosomatic issues after lifting the COVID-19 policy in China: A wake-up call

The Coronavirus has infected up to 900 million people as of 11 Jan 2023 in China Mainland, which is more than 60% of the population. The sudden and unprecedented nature of pandemic has resulted in a range of psychosomatic issues among the population. These issues can manifest in a variety of ways and it is important to address these issues as they can have serious consequences for individuals' mental and physical health. The lifting of lockdown measures in China presents an opportunity to address these issues and provide support to those who have been affected.

Experience of Ethnic Discrimination, Anxiety, Perceived Risk of COVID-19, and Social Support among Polish and International Students during the Pandemic

BACKGROUND

Our research aimed to assess the experiences of ethnic discrimination among students in Poland (Polish and international) during the COVID-19 pandemic. We also tested the prevalence of anxiety symptoms and their relationship with perceived COVID-19 risk, the severity of discrimination, and social support.

METHODS

The data from Polish (n = 481) and international university students (n = 105) were collected online (November-January 2020). Participants completed measures of ethnic discrimination (GEDS), anxiety scale (GAD-7), COVID-19 risk perception index, and perceived social support scale (MSPSS) questionnaires.

RESULTS

The results showed that international students reported being much more discriminated than Polish students during the first year of the COVID-19 pandemic. Contrary to our expectation, a higher risk of anxiety disorders (GAD) was observed in 42% of Polish students compared to 31% of international students. The predictors of higher anxiety symptoms among both groups were the perceived risk of COVID-19 and the greater severity of ethnic discrimination. In both groups, the perceived social support had a protective role in anxiety symptomatology.

CONCLUSIONS

The high prevalence of discrimination, especially among international students, simultaneously with high symptoms of anxiety, requires vigorous action involving preventive measures and psychological support.

Symptoms and risk factors of depression and PTSD in the prolonged COVID-19 pandemic: a longitudinal survey conducted from 2020 to 2022 in Japan

BACKGROUND

The present study aimed to explore changes in depression and posttraumatic stress disorder (PTSD) among the general population during the prolonged COVID-19 pandemic and to investigate risk factors and adaptive/nonadaptive strategies.

METHODS

A web-based longitudinal survey was conducted across five timepoints from 2020 to 2022 in Japan. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), PTSD was measured using Impact of Event Scale-Revised (IESR), and coping strategies were measured using Brief Coping Orientation to Problems Experienced (Brief COPE). Higher scores of PHQ-9 and IESR indicate more symptoms and Higher score of Brief COPE indicate that these means of coping are used very frequently.

RESULTS

A total of 1,366 participants (mean age = 52.76, SD = 15.57) were analyzed. Regarding levels of depression, PHQ-9 scores in 2022 were lower than in 2020 and 2021 (all p < 0.01). Regarding levels of PTSD, IESR scores in 2022 were lower than in 2021 among females (p < 0.001). Being younger (β = -0.08 and - 0.13, both p < 0.01) and engaging in self-blame (β = 0.12 and 0.18, both p < 0.01) increased PHQ-9 scores regardless of sex. For males, not working (β = 0.09, p = 0.004) and having suffered an economic impact (β = 0.07, p = 0.003) were risk factors for depressive symptoms, and active coping (β = -0.10, p = 0.005) was associated with decreased depressive symptoms. For females, substance use (β = 0.07, p = 0.032) and behavioral disengagement (β = 0.10, p = 0.006) increased depressive symptoms, and females did not show strategies that decreased the symptoms.

CONCLUSIONS

Levels of depression might have increased in the early stages of the pandemic and decreased in January 2022. Although males need to improve their economic situation to decrease depressive symptoms, adaptive strategies might be difficult to identify due to the prolonged pandemic among both sexes. In addition, the pandemic might be a depressive event but not a traumatic event among the general population, at least in Japan.

[Challenges of and Responses to Mental Health Problems in the Post-COVID-19 Era]

Since the first outbreak of the coronavirus disease 2019 (COVID-19), prevention and control of the pandemic remains a grim issue because of the continuous emergence of new variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing COVID-19, and the constant emergence of new domestic outbreaks. During the COVID-19 pandemic, mental and psychological problems have increased significantly among different populations, including patients of COVID-19 and their families, health workers, college students, adolescents, children, and even the general population. At present, the COVID-19 epidemic situation in China is rather complicated. The general population is confronted with a variety of challenges, including the threat of infection or reinfection, lower efficiency in study and work, and reduced incomes, and is hence experiencing many mental health problems related to the epidemic situation. Therefore, the relevant governmental departments and health institutions in China have attached high importance to the mental health issue in the process of implementing pandemic control measures of COVID-19. Close collaboration to implement the required epidemic prevention and control measures, improvements in the mental health services for public health emergencies in China, and commitment to the protection of the mental health and well-being of the people in the post-pandemic era have become the top priorities for now. Based on a review of the mental health problems related to COVID-19 pandemic, we suggested strategies to deal with mental health problems in the post-COVID-19 era.

Hope Buffers the Effect of Fear of COVID-19 on Depression among College Students: Insomnia as a Mediator

BACKGROUND

In the period of the global pandemic, psychophysical problems induced by the fear of COVID-19 among college students deserve attention since the dormitory environment in college greatly increases the possibility of COVID-19 infection.

METHODS

A hypothesized mediated moderation model was to be verified using a cross-sectional study among 2453 college students. Fear of COVID-19, insomnia, hope, and depression were assessed by using the relevant scales.

RESULTS

(1) The fear of COVID-19 was positively correlated to depression (β = 0.365, t = 5.553, 95% CI = [0.236, 0.494]); (2) hope moderated the influence of the fear of COVID-19 on depression (β = -0.093, t = -4.066, 95% CI = [-0.137, -0.048]), as well as on insomnia (β = -0.095, t = -4.841, 95% CI = [-0.133, -0.056]); and (3) the mediated moderation model with hope as the moderator and insomnia as the full mediating variable between fear of COVID-19 and depression was verified (β = -0.060, 95% CI = [-0.093, -0.028]).

CONCLUSIONS

The findings suggest that hope is a vital mechanism to explain the relationship between the fear of COVID-19 and depression in early adulthood. In practical application, mental health practitioners should focus on boosting hope and alleviating insomnia when addressing COVID-19-related depression issues among college students.

Risk of insomnia during COVID-19: effects of depression and brain functional connectivity

Normal sleepers may be at risk for insomnia during COVID-19. Identifying psychological factors and neural markers that predict their insomnia risk, as well as investigating possible courses of insomnia development, could lead to more precise targeted interventions for insomnia during similar public health emergencies. Insomnia severity index of 306 participants before and during COVID-19 were employed to determine the development of insomnia, while pre-COVID-19 psychometric and resting-state fMRI data were used to explore corresponding psychological and neural markers of insomnia development. Normal sleepers as a group reported a significant increase in insomnia symptoms after COVID-19 outbreak (F = 4.618, P = 0.0102, df = 2, 609.9). Depression was found to significantly contribute to worse insomnia (β = 0.066, P = 0.024). Subsequent analysis found that functional connectivity between the precentral gyrus and middle/inferior temporal gyrus mediated the association between pre-COVID-19 depression and insomnia symptoms during COVID-19. Cluster analysis identified that postoutbreak insomnia symptoms followed 3 courses (lessened, slightly worsened, and developed into mild insomnia), and pre-COVID-19 depression symptoms and functional connectivities predicted these courses. Timely identification and treatment of at-risk individuals may help avoid the development of insomnia in the face of future health-care emergencies, such as those arising from COVID-19 variants.

Chronic stress in solid tumor development: from mechanisms to interventions

Chronic stress results in disturbances of body hormones through the neuroendocrine system. Cancer patients often experience recurrent anxiety and restlessness during disease progression and treatment, which aggravates disease progression and hinders treatment effects. Recent studies have shown that chronic stress-regulated neuroendocrine systems secret hormones to activate many signaling pathways related to tumor development in tumor cells. The activated neuroendocrine system acts not only on tumor cells but also modulates the survival and metabolic changes of surrounding non-cancerous cells. Current clinical evidences also suggest that chronic stress affects the outcome of cancer treatment. However, in clinic, there is lack of effective treatment for chronic stress in cancer patients. In this review, we discuss the main mechanisms by which chronic stress regulates the tumor microenvironment, including functional regulation of tumor cells by stress hormones (stem cell-like properties, metastasis, angiogenesis, DNA damage accumulation, and apoptotic resistance), metabolic reprogramming and immune escape, and peritumor neuromodulation. Based on the current clinical treatment framework for cancer and chronic stress, we also summarize pharmacological and non-pharmacological therapeutic approaches to provide some directions for cancer therapy.

The phenotype and prediction of long-term physical, mental and cognitive COVID-19 sequelae 20 months after recovery, a community-based cohort study in China

Long-term sequelae clustering phenotypes are important for precise health care management in COVID-19 survivors. We reported findings for 1000 survivors 20 months after diagnosis of COVID-19 in a community-based cohort in China. Sequelae symptoms were collected from a validated questionnaire covering 27 symptoms involved in five organ systems including self-reported physical condition, dyspnea, cognitive function and mental health. The generalized symptoms were reported with the highest rate (60.7%), followed by the mental (48.3%), cardiopulmonary (39.8%), neurological (37.1%; cognitive impairment, 15.6%), and digestive symptoms (19.1%). Four clusters were identified by latent class analysis: 44.9% no or mild group (cluster 1), 29.2% moderate group with mainly physical impairment (cluster 2), 9.6% moderate group with mainly cognitive and mental health impairment (cluster 3), and 16.3% severe group (cluster 4). Physical comorbidities or history of mental disorders, longer hospitalization periods and severe acute illness predicted severe group. For moderate group, adults less than 60 years, with physical comorbidities and severe acute illness were more likely to have physical symptoms, while adult women with longer hospitalization stays had increased risk of cognitive and mental health impairment. Overall, among more than half of community COVID-19 survivors who presented moderate or severe sequelae 20 months after recovery, three-tenth had physical vulnerability that may require physical therapy aiming to improve functioning, one-tenth mental or cognitive vulnerable cases need psychotherapy and cognitive rehabilitation, and one-sixth severe group needs multidisciplinary clinical management. The remaining half is free to clinical intervention. Our findings introduced an important framework to map numerous symptoms to precise classification of the clinical sequelae phenotype and provide information to guide future stratified recovery interventions.

The prevalence and risk factors of mental problems in medical students during COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

This meta-analysis and systematic review aimed to evaluate the global prevalence and risk factors of mental problems (i.e., depression, anxiety, stress, sleep disorder, posttraumatic stress disorder (PTSD), burnout, psychological distress, and suicidal ideation) among medical students during the COVID-19 pandemic.

METHOD

We searched PubMed, Embase, Web of Science, psycARTICLES, PsycINFO, CNKI, and Wan Fang for studies on the prevalence of mental problems among medical students from January 1, 2020, to April 1, 2022. The pooled prevalence was calculated by random-effect models. We performed a narrative review to identify the risk factors.

RESULTS

The meta-analysis included 201 studies (N = 198,000). The prevalence of depression (41 %, 95 % CI, 37-45 %,), anxiety (38 %,95 % CI, 34 %-42 %), stress (34 %, 95 % CI, 27 %-42 %), sleep disorder (52 %, 95 % CI, 44 %-60 %), psychological distress (58 %, 95 % CI, 51 %-65 %), PTSD (34 %, 95 % CI, 22 %-46 %), suicidal ideation (15 %, 95 % CI, 11 %-18 %) and burnout (38 %, 95 % CI, 25 %-50 %) was high. The major risk factors were being female, being junior or preclinical students, exposure to COVID-19, academic stress, psychiatric or physical disorders history, economic trouble, fear of education impairment, online learning trouble, fear of infection, loneliness, low physical activity, low social support, problematic internet or smartphone use, and young age.

LIMITATIONS

Most studies were cross-sectional. Few studies provided a reasonable response rate, suggesting potential selection bias.

CONCLUSIONS

The study demonstrated a high prevalence and risk factors for mental problems during COVID-19, calling for mental health services. Our findings are valuable for college and health authorities to identify high-risk students and provide targeted intervention.

Stigmatization profiles and psychological distress in people at high risk of infection with COVID-19 -A study conducted in Germany from March to August 2021

COVID-19-related stigmatization of affected people or people at risk of infection has been shown to enhance the reluctance of affected individuals to use health services and reduce their mental health. It is thus highly important to gain a thorough understanding of COVID-19-related stigmatization. The present study's first aim was to explore stigmatization profiles of experienced stigmatization (anticipated stigmatization, internalized stigmatization, enacted stigmatization, disclosure concerns) and stigmatization practices in 371 German people at high risk of infection using latent class analyses. The second aim was to investigate the relationship between stigmatization profiles and psychological distress via multiple regression analysis taking into account other possible negative and positive risk factors. Our results showed two stigmatization profiles: "high stigmatization group" and "low stigmatization group". Belonging to the "high stigmatization group" was significantly correlated with higher levels of psychological distress. Other risk factors significantly related to psychological distress were mental health disorders in the past, exposure to COVID-19, fear related to COVID-19, perceived risk of being infected, lower perceived self-efficacy, and lower subjective knowledge about COVID-19.

Factors associated with hopelessness, depression and anxiety in the Honduran-Central America population during the COVID-19 pandemic

Introduction

The mental health of the population has been affected by COVID-19, reporting in many populations higher levels of depressive, anxious and stress symptoms, however, in Honduras there are no studies showing the impact of COVID-19 on the mental health of the population.

Aim

To determine the factors associated with hopelessness, depression and anxiety in times of COVID-19 in the Honduran population.

Methods

Cross-sectional analytical study. Three scales were used, Beck for hopelessness, Hamilton for depression and anxiety, through interviews with the population attending different levels of health care throughout the country. Descriptive and analytical statistics were obtained. For hopelessness, the Beck Hopelessness Scale was used; for depression and anxiety, the Hamilton Scale was used.

Results

Of the 8,125 participants, the population in general showed results of hopelessness 14.9%, depression 12.9% and anxiety 1.2%, there was less hopelessness among women (p = 0.004), university students (p &lt; 0.001), but greater among those who had a family member deceased by COVID-19 (p &lt; 0.001), among those who had diabetes mellitus (DM) (p &lt; 0.001), history of mental illness (p &lt; 0.001) or had consumed drugs in the last 6 months (p &lt; 0.001). There was more depression among those with arterial hypertension (p = 0.002), obesity (p = 0.019), DM (p = 0.004), history of mental illness (p &lt; 0.001) or had consumed drugs in the last 6 months (p &lt; 0.001). There was more anxiety among those infected with COVID-19 (p = 0.023), according to having a family member deceased by COVID-19 (p = 0.045) and in those with a history of mental illness (p &lt; 0.001).

Discussion

The Honduran population presented important differences in the socio-pathological, according to the loss of family members or having previous illnesses, this according to the presentation of problems in the mental sphere.

Conclusion

We found factors associated with hopelessness, we found factors associated with hopelessness, depression and anxiety in times of COVID-19 in the Honduran population.

[Changes in sleep patterns and the doom-scrolling (doom-surfing) phenomenon as modifiable risk factors for anxiety due to continuous stress of the COVID-19 pandemic]

OBJECTIVE

To evaluate the modifiable daily behavior patterns associated with increased anxiety indicators in the general population in response to the COVID-19 pandemic.

MATERIAL AND METHODS

The study examined the characteristics of the Russian population (n=7777) of the international multicenter project COMET-G. In particular, variables were targeted to describe deviations in the behavior of adults during the period of application of measures of social isolation in connection with the pandemic, and revealing a relationship with the total score on the Spielberger State Anxiety Scale (STAI-S). Among these variables, experts selected those that could potentially be subject to change in the short term, that is, act as manageable or modifiable risk factors for the development of anxiety. The selected variables were analyzed in a statistical PLS-model to identify indicators that make the most significant contribution to the increase in the total anxiety score.

RESULTS

Our statistical model explained 48.4% of the variability in the STAI-S anxiety total scores related to changes in daily life habits. In particular, doom-scrolling/doom-surfing about the spread of the virus and the COVID-19 pandemic, changes in sleep patterns and usual daily life activities due to social isolation measures presented as factors significantly contributing to the increase of state anxiety.

CONCLUSION

Given the manageable or modifiable risk factors that we have identified, public awareness and therapeutic recommendations, pointing to the need to (I) control the amount of time spent in the internet and monitor their internet-based content consumption, (II) regulate sleep-wake patterns, (III) maintain daily habits and household activities, may reduce the likelihood of developing anxiety disorders in the context of the impact of a global chronic stress due to the COVID-19 pandemic and associated social isolation measures.

Mental health outcomes following COVID-19 infection: impacts of post-COVID impairments and fatigue on depression, anxiety, and insomnia - a web survey in Sweden

BACKGROUND

The negative impact of the COVID-19 pandemic on the mental health is now clearly established. However, information on the levels of mental ill health of people infected with COVID-19 and potential correlates of poor mental health is still limited. Therefore, the current study aimed to study indicative of potential mental health problems in individuals with a history of probable or confirmed SARS CoV-2 infection/infections and address the impacts of post-COVID impairments and fatigue following COVID-19 infection/infections on depression, anxiety, and insomnia.

METHODS

A web-survey including demographics, questions related to COVID-19 status and post-COVID impairments, and standardized measures of depression, anxiety, insomnia, and fatigue was completed by 507 individuals with a history of probable or confirmed SARS CoV-2 infection/infections.

RESULTS

We found significant rates of significant depression, anxiety, and insomnia in our sample, with more than 70% experiencing levels above the clinical cut offs for at least one psychological health problems. Higher levels of depression, anxiety, and insomnia were associated with the severity of COVID-19 infection in the acute phase, hospitalization because of COVID-19, and higher levels of post-COVID impairments and fatigue. Reduced motivation emerged as the strongest predictor for mental ill health.

CONCLUSIONS

These findings highlight that individuals infected with COVID-19, especially those who still have experienced post-COVID impairments, are more likely to suffer from mental ill-health and may be more vulnerable for poor mental health outcomes. Therefore, more effective actions are needed to take in order to promote and protect mental health of individuals with a history of COVID-19 infection.

Prevalence of Insomnia in the Early Post-COVID-19 Recovery Period

BACKGROUND

Sleep is a complex, reversible process that is responsible for the modulation of various physiological mechanisms. COVID-19-related sleep disorders are affecting different populations with a heterogenous prevalence, yet high rates among infected patients are frequently reported. The aim of the study is to assess the prevalence of insomnia in the early post-COVID-19 recovery period and explore the differences in the results acquired by the Athens Insomnia Scale (AIS) by gender and selected infection severity parameters.

METHODS

The data presented in the paper come from a prospective, observational study on COVID-19 complications (SILCOV-19) consisting of 200 COVID-19 patients. The AIS was used for the quantitative measurement of insomnia symptoms based on ICD-10 criteria.

RESULTS

32% (n = 64) of all patients in the study group obtained results indicating sleep disturbances (>5 points on the scale), while 21.5% (n = 43) obtained results indicating insomnia (>10 points on the scale). The analysis of the results obtained by all patients in the AIS showed a significant correlation with the duration of symptoms (Spearman's rank-order: R = 0.18; p < 0.05), but not with the number of days spent in the hospital or age. Women achieved a higher score in overall AIS, as well as in questions assessing total sleep time, well-being the next day, physical and mental fitness the next day, and sleepiness during the day (p < 0.05).

CONCLUSIONS

the prevalence of insomnia in the early post-COVID-19 recovery period is high.

Planetary sleep medicine: Studying sleep at the individual, population, and planetary level

Circadian rhythms are a series of endogenous autonomous oscillators that are generated by the molecular circadian clock which coordinates and synchronizes internal time with the external environment in a 24-h daily cycle (that can also be shorter or longer than 24 h). Besides daily rhythms, there exist as well other biological rhythms that have different time scales, including seasonal and annual rhythms. Circadian and other biological rhythms deeply permeate human life, at any level, spanning from the molecular, subcellular, cellular, tissue, and organismal level to environmental exposures, and behavioral lifestyles. Humans are immersed in what has been called the "circadian landscape," with circadian rhythms being highly pervasive and ubiquitous, and affecting every ecosystem on the planet, from plants to insects, fishes, birds, mammals, and other animals. Anthropogenic behaviors have been producing a cascading and compounding series of effects, including detrimental impacts on human health. However, the effects of climate change on sleep have been relatively overlooked. In the present narrative review paper, we wanted to offer a way to re-read/re-think sleep medicine from a planetary health perspective. Climate change, through a complex series of either direct or indirect mechanisms, including (i) pollution- and poor air quality-induced oxygen saturation variability/hypoxia, (ii) changes in light conditions and increases in the nighttime, (iii) fluctuating temperatures, warmer values, and heat due to extreme weather, and (iv) psychological distress imposed by disasters (like floods, wildfires, droughts, hurricanes, and infectious outbreaks by emerging and reemerging pathogens) may contribute to inducing mismatches between internal time and external environment, and disrupting sleep, causing poor sleep quantity and quality and sleep disorders, such as insomnia, and sleep-related breathing issues, among others. Climate change will generate relevant costs and impact more vulnerable populations in underserved areas, thus widening already existing global geographic, age-, sex-, and gender-related inequalities.

Association of Acute Headache of COVID-19 and Anxiety/Depression Symptoms in Adults Undergoing Post-COVID-19 Rehabilitation

As a common non-respiratory symptom of COVID-19, headache should not be overlooked, and its characteristics should be recorded with scrutiny. Identifying risk factors associated with post-COVID headache will ensure immediate action and counseling for this population of patients. Therefore, the study aimed to investigate the relationship between headache and psychological state (stress level, depression, and anxiety symptoms) in adults undergoing post-COVID-19 rehabilitation. In addition, we used mediation analysis to evaluate the mediation effect of psychological variables in the relationship between headache and quality of life. This cross-sectional study included 147 patients undergoing post-COVID-19 rehabilitation at the Public Hospital in Poland (64 males, 83 females, with mean age of 56.97 years). Psychological parameters were evaluated using the Hospital Anxiety and Depression Scale (HADS), the Perceived Stress Scale (PSS-10), and the brief World Health Organization Quality of Life Scale (WHOQOL-BRIEF). Additionally, all participants completed a questionnaire related to COVID-19 symptoms and their severity, the place of COVID-19 treatment, and the need for oxygen therapy during hospitalization. Of all participants, 65% experienced headache during COVID-19. Of the participants with headache, there were significantly more females in this group (69% vs. 31%), and they were significantly younger (mean age 55.47 vs. 59.78 years). Participants with headache had a 27% higher HADS-D score, a 21% higher HADS-A score, and a 13% higher PSS-10 score. Moreover, gender and headache were found to be important predictor variables for total HADS and HADS-D, accounting for 11% and 7%, respectively. Mediation analysis has shown that the tested psychological variables mediated 39–68% of the total effect of headache influence on WHOQOL domains. In conclusion, our study demonstrated several relationships between headache that occurred during COVID-19 and symptoms of depression, anxiety, and perceived stress level during post-COVID rehabilitation also in the context of quality of life. Our results show that patients who experienced headaches during COVID-19 are at high risk of developing anxiety-depressive symptoms later. Female gender is associated with a higher prevalence of headache during COVID-19.