The prevalence of psychological consequences of COVID-19: A systematic review and meta-analysis of observational studies

Quality of life (QoL) among COVID-19 recovered healthcare workers in Bangladesh

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) caused by the SARS-CoV-2 virus has taken the lives of more than 100,000 healthcare workers (HCWs) so far. Those who survived continuously work under immense physical and psychological pressure, and their quality of life (QoL) is impacted. The study aimed to assess the QoL among HCWs in Bangladesh who recovered from COVID-19.

METHODS

This cross-sectional, telephonic interview-based study was conducted among 322 randomly selected HCWs from Bangladesh who were positive for COVID-19 and recovered from the infection before the interview. Data were collected from June to November 2020. We examined the impact of COVID on the QoL of the participants using the validated Bangladesh version of the World Health Organization (WHO) Quality of life questionnaire brief (WHOQOL-BREF). All analyses were done by STATA (Version 16.1).

RESULTS

More than half of the health care professionals were male (56.0%), aged between 26-35 years (51%), and completed graduation (49%). The majority of the study participants in the four domains were married (n = 263, 81%) and living in Dhaka. The average score of the participants was 70.91 ± 13.07, 62.68 ± 14.99, 66.93 ± 15.14, and 63.56 ± 12.11 in physical, psychological, social relationship and environmental domains, respectively. HCWs in urban areas enjoyed 2.4 times better socially stable lives (OR: 2.42, 95% CI: 1.18-4.96) but 72% less psychologically satisfactory lives.

CONCLUSION

HCWs' post-COVID quality of life depended on variable interaction of demographic socioeconomic, including old age, female sex, graduation, and higher monthly income. The findings indicate the issues which should be addressed to improve the quality of life of frontline workers who fight against the pandemic.

The Effect of COVID-19 Diagnosis on the Physical, Social, and Psychological Well-Being of People in the United Arab Emirates: An Explorative Qualitative Study

A positive COVID-19 infection may impact physical, mental, and social health. Different factors may influence these impacts on different levels due to personal circumstances. This study aimed to explore the impact of a positive COVID-19 diagnosis on the physical,mental, social, psychological health, and lifestyle practices of an individual in the United Arab Emirates. A sample of 28 participants was interviewed using online interviews. An interview guide was created based on the coping strategy model and conceptual framework of coping strategies. All interviews were recorded; then transcribed after obtaining written consent from participants. The NVivo software was used for thematic analysis based on both identified coping models. Major themes included the physical effects, social effects, psychological effects, spiritual effects, and lifestyle effects. Emerging themes include coping mechanisms, trust in authorities and the health care system, appreciation of the role of the government, conspiracy theories, and media roles. This study indicates that people diagnosed with COVID-19 have perceived very good support in terms of their physical health from the government and health authorities, but require social, psychological, and educational support during the infection period and post-recovery.

Motivational Profiles in Unemployment: A Self-Determination Perspective

In general, being unemployed has negative implications for the individual and the mental health of the public as a collective. One way to escape this situation is to search for a job. However, following self-determination theory (SDT), unemployed people's different reasons (i.e., their motivation) for engaging in a job search influence their well-being, attitudes, and behaviors for better or worse. Some research has already supported the associations between different types of motivation and these outcomes, but less is known about how these types of motivation simultaneously associate with these outcomes. The current study addressed this issue by studying how different motivational profiles had different implications for the affective experiences, commitment to employment, and job search behavior of the unemployed. Latent profile analysis, among 865 unemployed individuals from previously disadvantaged communities in South Africa, highlighted four distinct motivational profiles: motivated, ambivalent, amotivated, and unmotivated. The motivated reported some good well-being (i.e., positive experiences) and economic outcomes (i.e., employment commitment and job search), but these came at a cost (i.e., more negative experiences). The same went for the ambivalent, but to a lesser extent. Being unmotivated seemed to have the opposite effect in that it came with psychological benefits, but with economic costs, as these individuals might withdraw from the labor market. This also applied to the amotivated, although they experienced less psychological benefit than their unmotivated counterparts. The findings made several contributions to SDT and unemployment research and could help tailor interventions and policies for particular types of unemployed people.

Prevalence of Anxiety and Depression Among the General Population in Africa During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Background

Medical and socio-economic uncertainties surrounding the COVID-19 pandemic have had a substantial impact on mental health. This study aimed to systematically review the existing literature reporting the prevalence of anxiety and depression among the general populace in Africa during the COVID-19 pandemic and examine associated risk factors.

Methods

A systematic search of the following databases African Journal Online, CINAHL, PubMed, Scopus, and Web of Science was conducted from database inception until 30th September 2021. Studies reporting the prevalence of anxiety and/or depression among the general populace in African settings were considered for inclusion. The methodological quality of included studies was assessed using the Agency for Healthcare Research and Quality (AHRQ). Meta-analyses on prevalence rates were conducted using Comprehensive Meta-analysis software.

Results

Seventy-eight primary studies (62,380 participants) were identified from 2,325 studies via electronic and manual searches. Pooled prevalence rates for anxiety (47%, 95% CI: 40-54%, I2 = 99.19%) and depression (48%, 95% CI: 39-57%, I2 = 99.45%) were reported across Africa during the COVID-19 pandemic. Sex (female) and history of existing medical/chronic conditions were identified as major risk factors for anxiety and depression.

Conclusions

The evidence put forth in this synthesis demonstrates the substantial impact of the pandemic on the pervasiveness of these psychological symptoms among the general population. Governments and stakeholders across continental Africa should therefore prioritize the allocation of available resources to institute educational programs and other intervention strategies for preventing and ameliorating universal distress and promoting psychological wellbeing.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021228023, PROSPERO CRD42021228023.

Cognitive Factors Associated With Public Acceptance of COVID-19 Nonpharmaceutical Prevention Measures: Cross-sectional Study

Background

During the COVID-19 crisis, protests against restrictions emerged and rule violations increased, provoking peaks in new positive cases, forcing authorities in France to impose fines to slow down the spread of the disease. Due to these challenges, subsequent implementations of preventive measures in response to COVID-19 recurrences or other pandemics could present difficulties for decision makers. A better understanding of the factors underlying the public acceptance of COVID-19 nonpharmaceutical preventive measures may therefore contribute greatly to the design of more effective public communication during future pandemics.

Objective

The aim of this study was to evaluate the acceptance of COVID-19 nonpharmaceutical prevention measures in France. The specific objectives were (1) to examine the public’s acceptance of COVID-19 nonpharmaceutical prevention measures and (2) to assess the association of the public’s acceptance of these prevention measures and their perception of COVID-19.

Methods

Data were collected from 2004 individuals through an online survey conducted 6-8 weeks after the first lockdown in France. For objective 1, participants were asked the extent to which they supported 8 COVID-19 nonpharmaceutical preventive measures using a 4-point Likert scale. For objective 2, COVID-19–related perceptions were assessed using a 5-point Likert scale from an adapted version of Witte’s Extended Parallel Process Model. Sociodemographic and environmental variables were also collected. The public’s acceptance factors were estimated using an unweighted least squares factorial analysis, and their associations with perceptions of COVID-19, expressed as rate ratios (RR) and 95% CIs, were estimated using generalized linear Poisson regression models. Statistical analyses were performed using the SPSS statistical package.

Results

The acceptance rate reached 86.1% for individual protective measures, such as making masks mandatory in public open spaces, and 70.0% for collective restrictions, such as isolating the most vulnerable people (1604/2004, 80%) or forbidding public gatherings (n=1590, 79.3%). The least popular restrictions were closing all schools/universities and nonessential commerce such as bars and restaurants (n=1146, 57.2%). Acceptance of collective restrictions was positively associated with their perceived efficacy (RR 1.02, 95% CI 1.01-1.03), fear of COVID-19 (RR 1.04, 95% CI 1.03-1.05), and perceived severity of COVID-19 (RR 1.04, 95% CI 1.03-1.06), and negatively with age >60 years (RR 0.89, 95% CI 0.81-0.98). Acceptance of individual protective measures was associated with their perceived efficacy (RR 1.03, 95% CI 1.03-1.04), fear of COVID-19 (RR 1.02, 1.01-1.03), and perceived severity of COVID-19 (RR 1.03, 1.01-1.05).

Conclusions

Acceptance rates of COVID-19 nonpharmaceutical measures were rather high, but varied according to their perceived social cost, and were more related to collective than personal protection. Nonpharmaceutical measures that minimize social costs while controlling the spread of the disease are more likely to be accepted during pandemics.

COVID-19 Pandemic, Risk, and Blame Attributions: A Scoping Review

BACKGROUND

The COVID-19 pandemic and its associated psychological distress led people to engage in attributing several health-related behaviors and consequences at the community and international levels. A scoping review was conducted to explore the existing literature on the use of attribution theory in understanding the psychological phenomena underlying health-related behavior and consequences during the pandemic.

METHODS

We conducted the literature review using Arksey and O'Malley's methodological framework for scoping review. Studies were identified through a comprehensive search of the following six databases: MEDLINE through PubMed, ProQuest, JSTOR, Scopus, ScienceDirect, and Google Scholar. All databases were searched for entries in English from September 2019 to September 2021 to correspond to the advent of the pandemic.

RESULTS

Several elements influence attributions and the influences of the attributions on people's responses to information and the consequences of attributions in influencing people's responses to information and behavior changes in the context of the COVID-19 pandemic. The importance of attribution errors leading to stigmatization and responsibility framing, both crucial for implementing pandemic control measures and enhancing psychological well-being, were also highlighted.

CONCLUSION

More research is needed in this field to inform people-centered policies and pandemic preparedness plans to mitigate the potentially devastating psychosocial consequence of the pandemic or other public health emergencies.

Association between work situation and life satisfaction during the COVID-19 pandemic: prospective cohort study in Norway

OBJECTIVES

To estimate the impact of being laid off from work, having to work from home or having been diagnosed with COVID-19 on self-reported satisfaction with life.

DESIGN

Nationwide population-based cohort study.

SETTING

Norway.

PARTICIPANTS

We followed more than 80 000 participants in an ongoing cohort study, the Norwegian Mother, Father and Child Cohort Study (MoBa), during the COVID-19 pandemic. We analysed current life satisfaction in April and again in September/October 2020 for subjects whose work situation and infection status had changed.

MAIN OUTCOME MEASURES

Self-reported satisfaction with life, using a scale from 0 (worst) to 10 (best). We analysed the scale both continuously and as a binary variable (

RESULTS

Temporary and permanent layoffs, working from a home-based office, and getting a COVID-19 diagnosis were all associated with modestly, but significantly lower concurrent life satisfaction, both in the total on a population level and for subjects experiencing a change in job status between spring and autumn. The associations with change in work situation were stronger for men. For men with permanent job loss, the adjusted odds ratio (OR) for low life satisfaction (<6) was 3.2 (95% CI 2.4 to 4.2) in April and 4.9 (95% CI 3.5 to 6.9) in autumn. Among all, a suspected or confirmed COVID-19 diagnosis was associated with an adjusted OR for low life satisfaction of 1.9 (95% CI 1.6 to 2.3) in spring. The strength of associations between work situation and life satisfaction did not vary much across socio-economic strata, but layoffs were more common among those with low education.

CONCLUSION

Layoffs, home office and infection status had clear impact on the quality of life as measured with a global life satisfaction scale. These findings suggest that social differentials in quality of life, are increasing during the pandemic.

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Key Words

• COVID-19
• epidemiology
• mental health

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MESH Headings

• Adult
• COVID-19/epidemiology
• COVID-19 Testing
• Cohort Studies
• Female
• Humans
• Male
• Norway/epidemiology
• Pandemics
• Personal Satisfaction
• Prospective Studies
• Quality of Life

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Grants

• Norges Forskningsråd
• Norwegian Institute of Public Health (NIPH)

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Affiliation(s)

Ellen Øen Carlsen Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
Ida H Caspersen Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
Helga Ask Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
Ragnhild Eek Brandlistuen Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
Lill Trogstad Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
Per Magnus Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway

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Meaningfulness protects from and crisis of meaning exacerbates general mental distress longitudinally

BACKGROUND

Reactions to the COVID-19 pandemic are diverse, and both mental distress and existential crises can arise. The identification of protective and exacerbating factors and their progress over time is therefore highly relevant. The current study examined longitudinal protective effects of meaningfulness and exacerbating effects of crisis of meaning on general mental distress.

METHODS

N = 431 participants from Germany and Austria (mean age: 42 years) completed an online survey in both April/May (T1) and July/August 2020 (T2). After determining temporal stability or changes in meaningfulness, crisis of meaning, and general mental distress (PHQ-4), we examined whether (i) meaningfulness and (ii) crisis of meaning, measured at T1, incrementally predicted PHQ-4 at T2, beyond baseline levels of PHQ-4. We further tested (iii) a within-subject mediation of temporal changes in PHQ-4 by changes in crisis of meaning.

RESULTS

Meaningfulness prospectively predicted lower PHQ-4, and crisis of meaning predicted higher PHQ-4. From the first wave of the pandemic until a slowdown three months later, meaningfulness was stable, and crisis of meaning and PHQ-4 decreased. Changes in crisis of meaning mediated the changes in PHQ-4.

CONCLUSIONS

Meaningfulness appears to have a protective, and crisis of meaning an exacerbating effect on psychological distress, as shown here for the time of the first pandemic wave until three months later. Attention to existential experiences of meaningfulness and loss of meaning thus proves relevant to the clinical and public health context. Measures that support meaningfulness will help coping with crises of meaning, which in turn supports overcoming general mental distress.

Psychological homeostasis and protective behaviours in the Covid-19 pandemic

Since the first case of human SARS-CoV-2 infection late in 2019 workers across multiple disciplines have been strenuously engaged in attempting to prevent the spread of the virus and to provide care to patients. Never in history has so much human effort been concentrated on a single health trauma. Much of the new research is empirical in nature with relatively few strands of theory. This article focuses on two recent theories relevant to COVID-19 protective behaviours, the COM-B and the General Theory of Behaviour. New empirical findings on the means, motives and opportunities for COVID-19 protective behaviours improve our knowledge and capacity to cope with pandemics using psychological homeostasis.

COVID-19 Pandemic in Portugal: Psychosocial and Health-Related Factors Associated with Psychological Discomfort

The COVID-19 pandemic is a stressful long-lasting event with an increasingly negative impact upon individuals. This study aimed at assessing the magnitude of depression, anxiety, and stress among adults living in Portugal during the first mandatory lockdown of 2020, and the psychosocial and health-related factors associated with these symptoms. A sample of 484 adults (73% women) with an average age of 40 years old (Standard Deviation, SD = 14.03) responded to an online survey. The survey included measures of depression, anxiety, stress, social support, COVID-19 interference in daily life, attitudes towards COVID-19, and health perception. The impact of the lockdown on psychological well-being was large, with up to 36% of the participants showing signs of at least mild psychological discomfort (i.e., depression, anxiety, and stress). Social support, COVID-19 interference on daily life, health perception, and age, explained all the dependent variables. Education level, income, attitudes towards COVID-19, and gender explained some of the dependent variables. These results suggest that the COVID-19 pandemic has a serious impact on the psychological health of Portuguese adults. The role of the procedures to control the pandemic on the mental health of Portuguese adults should not be underestimated.

The Moderating Effect of Resilience on Mental Health Deterioration among COVID-19 Survivors in a Mexican Sample

Resilience has been reported to be a protective psychological variable of mental health; however, little is known about its role in COVID-19 survivors. Thus, in this study, we aimed to evaluate the levels of depression, anxiety, stress, traumatic impact, and resilience associated with COVID-19, as well as to investigate the role of resilience as a moderating variable. A sample of 253 participants responded to an online survey; all were previously diagnosed with COVID-19 by a nasopharyngeal swab RT-PCR test, were older than 18 years, and signed an informed consent form. Significant negative correlations were found between resilience and the mental health variables. Higher resilience was significantly related to a lower impact of the event, stress, anxiety, and depression when the number of symptoms was low. Only when the duration of COVID-19 was short and resilience levels were medium or high was psychological distress reduced. Moreover, resilience moderated the effects of COVID-19 on mental health, even if a relapse occurred. The results emphasize the need for interdisciplinary interventions aimed at providing COVID-19 patients with psychological and social resources to cope with the disease, as well as with probable relapses.

Global prevalence and associated risk factors of posttraumatic stress disorder during COVID-19 pandemic: A meta-analysis

BACKGROUND

The COVID-19 pandemic has negatively impacted the psychological well-being of individuals and society. Previous studies conducted on coronavirus outbreaks including Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome pandemic found that posttraumatic stress disorder (PTSD), depression, and anxiety were the most common mental health problems and long-term consequences of these outbreaks. Currently, comprehensive and integrated information on the global prevalence of PTSD due to the COVID-19 pandemic is lacking.

OBJECTIVE

In the present meta-analysis, we examined the global prevalence and associated risk factors of PTSD in patients/survivors of COVID-19, health professionals, and the population at large.

DESIGN

Meta-analysis.

DATA SOURCE

Cochrane, CINAHL, Embase, MEDLINE, PubMed, Scopus, Web of Science, and manual search up to June 2021.

METHODS

We included studies evaluating the prevalence of PTSD during the COVID-19 pandemic in either patients/survivors, health professionals, and the population at large. The data were analyzed using logit transformation with the random-effects model. Risk of bias assessment was conducted using Hoy and colleagues.

RESULTS

A total of 63 studies (n = 124,952) from 24 different countries were involved. The overall pooled estimate of PTSD prevalence was 17.52% (95% CI 13.89 to 21.86), with no evidence of publication bias (t=-0.22, p-value=0.83). This study found a high prevalence of PTSD among patients with COVID-19 (15.45%; 95% CI 10.59 to 21.99), health professionals (17.23%; 95% CI 11.78 to 24.50), and the population at large (17.34%; 95% CI 12.21 to 24.03). Subgroup analyses showed that those working in COVID-19 units (30.98%; 95% CI, 16.85 to 49.86), nurses (28.22%; 95% CI, 15.83 to 45.10), those living in European countries (25.05%; 95% CI 19.14 to 32.06), and studies that used Clinician-Administered PTSD Scale for DSM-5 (30.18%, 95% CI 25.78 to 34.98) demonstrated to have the highest PTSD prevalence compared to other subgroups. Meta-regression analyses revealed that the elderly (above age 65) had lower PTSD prevalence (-1.75, 95% CI -3.16 to -0.34) than the adult population.

CONCLUSION AND IMPLICATIONS

Substantial PTSD prevalence was found in patients with COVID-19, health professionals, and the population at large. Moderator analysis revealed that age, unit of work, health profession, continent, and assessment tools as significant moderators. Mental health services are needed for everyone, especially adults under the age of 65, those who work in COVID-19 units, nurses, and people in the European continent.

REGISTRATION

The study protocol was registered with the International database of prospective registered systematic reviews (PROSPERO): CRD42020218762. Tweetable abstract: The pooled PTSD prevalence during COVID-19 pandemic for patients with COVID-19, health professionals, and the population at large was 17.52%.

The Mental Health and Social Media Use of Young Australians during the COVID-19 Pandemic

Young people may be particularly vulnerable to the mental health impacts of the COVID-19 pandemic and may also be more likely to use social media at this time. This study aimed to explore young people’s mental health and social media use during the COVID-19 pandemic and examined their use of social media to seek and provide support for suicidal thoughts and self-harm during this period. Young people aged 16–25 (n = 371, M = 21.1) from the general population in Australia completed an anonymous, cross-sectional online survey advertised on social media from June to October 2020. Participants reported high levels of psychological distress, with over 40% reporting severe levels of anxiety and depression, and those with a mental health diagnosis were more likely to perceive the pandemic to have had a negative impact on their mental health. Gender-diverse participants appeared the most negatively impacted. Social media use was high, with 96% reporting use at least once a day, and two-thirds reporting an increase in social media use since the start of the pandemic. One-third had used social media to seek support for suicidal thoughts or self-harm, and half had used it to support another person. This study adds to a growing literature suggesting social media can provide an opportunity to support young people experiencing psychological distress and suicide risk. Uniquely, this study points to the utility of using social media for this purpose during high-risk periods such as pandemics, where access to face-to-face support may be limited. To promote the quality and safety of support provided on social media, resources for help-seekers and help-givers should be developed and disseminated. Social media companies must consider the vulnerability of some users during pandemics and do what they can to promote wellbeing and safety.

Kuala Lumpur train collision during the COVID-19 pandemic

BACKGROUND

Two city trains collided in an underground tunnel on 24 May 2021 at the height of COVID-19 pandemic near the Petronas Towers, Kuala Lumpur, Malaysia, immediately after the evening rush hours. We aim to evaluate the management of this mass casualty incident highlighting the lessons learned to be used in preparedness for similar incidents that may occur in other major cities worldwide.

METHODS

Information regarding incident site and hospital management response were analysed. Data on demography, triaging, injuries and hospital management of patients were collected according to a designed protocol. Challenges, difficulties and their solutions were reported.

RESULTS

The train's emergency response team (ERT) has shut down train movements towards the incident site. Red zone (in the tunnel), yellow zone (the station platform) and green zone (outside the station entrance) were established. The fire and rescue team arrived and assisted the ERT in the red zone. Incident command system was established at the site. Medical base station was established at the yellow zone. Two hundred and fourteen passengers were in the trains. Sixty-four of them were injured. They had a median (range) ISS of 2 (1-43), and all were sent to Hospital Kuala Lumpur (HKL). Six (9.4%) patients were clinically triaged as red (critical), 19 (29.7%) as yellow (semi-critical) and 39 (60.9%) as green (non-critical). HKL's disaster plan was activated. All patients underwent temperature and epidemiology link assessment. Seven (10.9%) patients were admitted to the hospital (3 to the ICU, 3 to the ward and 1 to a private hospital as requested by the patient), while the rest 56 (87.5%) were discharged home. Six (9.4%) needed surgery. The COVID-19 tests were conducted on seven patients (10.9%) and were negative. There were no deaths.

CONCLUSIONS

The mass casualty incident was handled properly because of a clear standard operating procedure, smooth coordination between multi-agencies and the hospitals, presence of a 'binary' system for 'COVID-risk' and 'non-COVID-risk' areas, and the modifications of the existing disaster plan. Preparedness for MCIs is essential during pandemics.

Exploring the Heterogeneity and Trajectories of Positive Functioning Variables, Emotional Distress, and Post-traumatic Growth During Strict Confinement Due to COVID-19

COVID-19 pandemic-related confinement may be a fruitful opportunity to use individual resources to deal with it or experience psychological functioning changes. This study aimed to analyze the evolution of different psychological variables during the first coronavirus wave to identify the different psychological response clusters, as well as to keep a follow-up on the changes among these clusters. The sample included 459 Spanish residents (77.8% female, M_age = 35.21 years, SD_age = 13.00). Participants completed several online self-reported questionnaires to assess positive functioning variables (MLQ, Steger et al. in J Loss Trauma 13(6):511-527, 2006. 10.1080/15325020802173660; GQ-6, McCullough et al. in J Person Soc Psychol 82:112-127, 2002. 10.1037/0022-3514.82.1.112; CD-RISC, Campbell-Sills and Stein in J Traum Stress 20(6):1019-1028, 2007. 10.1002/jts.20271; CLS-H, Chiesi et al. in BMC Psychol 8(1):1-9, 2020. 10.1186/s40359-020-0386-9; SWLS; Diener et al. in J Person Assess, 49(1), 71-75, 1985), emotional distress (PHQ-2, Kroenke et al. in Med Care 41(11):1284-1292, 2003. 10.1097/01.MLR.0000093487.78664.3C; GAD-2, Kroenke et al. in Ann Internal Med 146(5):317-325, 2007. 10.7326/0003-4819-146-5-200703060-00004; PANAS, Watson et al. in J Person Soc Psychol 47:1063-1070, 1988; Perceived Stress, ad hoc), and post-traumatic growth (PTGI-SF; Cann et al. in Anxiety Stress Coping 23(2):127-137, 2010. 10.1080/10615800903094273), four times throughout the 3 months of the confinement. Linear mixed models showed that the scores on positive functioning variables worsened from the beginning of the confinement, while emotional distress and personal strength improved by the end of the state of alarm. Clustering analyses revealed four different patterns of psychological response: "Survival", "Resurgent", "Resilient", and "Thriving" individuals. Four different profiles were identified during mandatory confinement and most participants remained in the same cluster. The "Resilient" cluster gathered the largest number of individuals (30-37%). We conclude that both the heterogeneity of psychological profiles and analysis of positive functioning variables, emotional distress, and post-traumatic growth must be considered to better understand the response to prolonged adverse situations.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10902-021-00469-z.

Quality of life among patients with chronic non-communicable diseases during COVID-19 pandemic in Southern Ethiopia: A cross-sectional analytical study

BACKGROUND

The COVID-19 outbreak became a continuing global health agenda. It has a significant impact on individuals' quality of life (QOL). Patients with preexisting medical conditions may have severely reduced QOL. The aim of this study was to assess QOL and its associated factors among patients with chronic non-communicable diseases (NCDs) during COVID-19 pandemic at Sidama Regional State, southern Ethiopia.

METHODS

We conducted a multicenter, cross-sectional study from 1 June to 1 September 2021. A total of 633 participants took part in the study, using an interviewer-administered structured questionnaire. The QOL was measured using the World Health Organization Quality of Life (WHOQOL-BREF) Scale, which has 12 items. To describe different variables, descriptive statistics were employed. To find independent factors associated with QOL, we used multivariable linear regression analysis. P-value of < 0.05 was declared statistically significant at 95% confidence interval (CI).

RESULTS

The majority (56.4%) of participants were male and about half (53.1%) had a diagnosis of diabetes mellitus. The multivariable linear regression model showed statistically significant negative association between different independent variables such as age (β = -0.188, 95% CI = -0.238 to -0.139), being female (β = -1.942, 95% CI = -3.237 to -0.647), duration of illness ≤ 5 years (β = -4.222, 95% CI = -6.358 to -2.087), alcohol use in the past 3 months (β = -4.574, 95% CI = -6.905 to -2.243), common mental disorder (CMD) (β = -1.512, 95% CI = -2.924 to -0.100), insomnia (β = -0.274, 95% CI = -0.380 to -0.168), and QOL. Also, there is a statistically significant positive association between QOL and being illiterate (β = 3.919, 95% CI = 1.998-5.841) and living in the rural area (β = 2.616, 95% CI = 1.242-3.990).

CONCLUSION

In general, the findings confirmed that the COVID-19 pandemic had a negative impact on patients with chronic NCDs QOL. The QOL was significantly influenced by age, gender, educational status, residence area, duration of illness, alcohol use, CMD, and insomnia during COVID-19 pandemic. Thus, this study suggests that addressing insomnia, co-morbidities of mental disorders, and alcohol use has the potential effect to improve the QOL of patients with chronic medical illnesses.

A systematic review and meta-analysis of longitudinal cohort studies comparing mental health before versus during the COVID-19 pandemic in 2020

BACKGROUND

Increases in mental health problems have been observed during the COVID-19 pandemic. The objectives were to examine the extent to which mental health symptoms changed during the pandemic in 2020, whether changes were persistent or short lived, and if changes were symptom specific.

METHODS

Systematic review and meta-analysis of longitudinal cohort studies examining changes in mental health among the same group of participants before vs. during the pandemic in 2020.

RESULTS

Sixty-five studies were included. Compared to pre-pandemic outbreak, there was an overall increase in mental health symptoms observed during March-April 2020 (SMC = .102 [95% CI: .026 to .192]) that significantly declined over time and became non-significant (May-July SMC = .067 [95% CI: -.022 to .157]. Compared to measures of anxiety (SMC = 0.13, p = 0.02) and general mental health (SMC = -.03, p = 0.65), increases in depression and mood disorder symptoms tended to be larger and remained significantly elevated in May-July [0.20, 95% CI: .099 to .302]. In primary analyses increases were most pronounced among samples with physical health conditions and there was no evidence of any change in symptoms among samples with a pre-existing mental health condition.

LIMITATIONS

There was a high degree of unexplained heterogeneity observed (I2s > 90%), indicating that change in mental health was highly variable across samples.

CONCLUSIONS

There was a small increase in mental health symptoms soon after the outbreak of the COVID-19 pandemic that decreased and was comparable to pre-pandemic levels by mid-2020 among most population sub-groups and symptom types.

A large scale meta-analytic atlas of mental health problems prevalence during the COVID-19 early pandemic

The COVID‐19 pandemic and related restrictions can impact mental health. To quantify the mental health burden of COVID‐19 pandemic, we conducted a systematic review and meta‐analysis, searching World Health Organization COVID‐19/PsycInfo/PubMed databases (09/29/2020), including observational studies reporting on mental health outcomes in any population affected by COVID‐19. Primary outcomes were the prevalence of anxiety, depression, stress, sleep problems, posttraumatic symptoms. Sensitivity analyses were conducted on severe mental health problems, in high‐quality studies, and in representative samples. Subgroup analyses were conducted stratified by age, sex, country income level, and COVID‐19 infection status. One‐hundred‐seventy‐three studies from February to July 2020 were included (n = 502,261, median sample = 948, age = 34.4 years, females = 63%). Ninety‐one percent were cross‐sectional studies, and 18.5%/57.2% were of high/moderate quality. The highest prevalence emerged for posttraumatic symptoms in COVID‐19 infected people (94%), followed by behavioral problems in those with prior mental disorders (77%), fear in healthcare workers (71%), anxiety in caregivers/family members of people with COVID‐19 (42%), general health/social contact/passive coping style in the general population (38%), depression in those with prior somatic disorders (37%), and fear in other‐than‐healthcare workers (29%). Females and people with COVID‐19 infection had higher rates of almost all outcomes; college students/young adults of anxiety, depression, sleep problems, suicidal ideation; adults of fear and posttraumatic symptoms. Anxiety, depression, and posttraumatic symptoms were more prevalent in low‐/middle‐income countries, sleep problems in high‐income countries. The COVID‐19 pandemic adversely impacts mental health in a unique manner across population subgroups. Our results inform tailored preventive strategies and interventions to mitigate current, future, and transgenerational adverse mental health of the COVID‐19 pandemic.

A systematic review and meta‐analysis to quantify the impact of mental health burden of COVID‐19 pandemic and related restrictions.

The highest prevalence emerged for posttraumatic symptoms in COVID‐19 infected people (94%).

Females and people with COVID‐19 infection had higher rates of almost all outcomes.

In low‐/middle‐income nations, the prevalence of anxiety, depression, and posttraumatic symptoms is high.

How Is the History of Early Traumatic Exposure Associated With the Psychopathological Outcomes of COVID-19 Related Lockdown and Subsequent Re-opening in People With Eating Disorders?

The negative impact of COVID-19 pandemic on people with Eating Disorders (EDs) has been documented. The aim of this study was to evaluate whether a history of traumatic experiences during childhood or adolescence was associated with a higher degree of psychopathological worsening during COVID-19 related lockdown and in the following re-opening period in this group of people. People with EDs undergoing a specialist ED treatment in different Italian services before the spreading of COVID-19 pandemic (n = 312) filled in an online survey to retrospectively evaluate ED specific and general psychopathology changes after COVID-19 quarantine. Based on the presence of self-reported traumatic experiences, the participants were split into three groups: patients with EDs and no traumatic experiences, patients with EDs and childhood traumatic experiences, patients with EDs and adolescent traumatic experiences. Both people with or without early traumatic experiences reported retrospectively a worsening of general and ED-specific psychopathology during the COVID 19-induced lockdown and in the following re-opening period. Compared to ED participants without early traumatic experiences, those with a self-reported history of early traumatic experiences reported heightened anxious and post-traumatic stress symptoms, ineffectiveness, body dissatisfaction, and purging behaviors. These differences were seen before COVID-19 related restrictions as well as during the lockdown period and after the easing of COVID-19 related restrictions. In line with the "maltreated ecophenotype" theory, these results may suggest a clinical vulnerability of maltreated people with EDs leading to a greater severity in both general and ED-specific symptomatology experienced during the exposure to the COVID-19 pandemic.

Trajectories of change in internalizing symptoms during the COVID-19 pandemic: A longitudinal population-based study

BACKGROUND

Longitudinal data indicates that the mental health of the general population may not have been as badly affected by the COVID-19 pandemic as some had feared. Most studies examining change in mental health during the pandemic have assumed population homogeneity which may conceal evidence of worsening mental health for some. In this study, we applied a heterogeneous perspective to determine if there were distinct groups in the population characterised by different patterns of change in internalizing symptoms during the pandemic.

METHODS

Self-report data were collected from a nationally representative sample of Irish adults (N = 1041) at four time-points between April and December 2020.

RESULTS

In the entire sample, mean levels of internalizing symptoms significantly declined from March to December 2020. However, we identified four distinct groups with different patterns of change. The most common response was 'Resilience' (66.7%), followed by 'Improving' (17.9%), 'Worsening' (11.3%), and 'Sustained' (4.1%). Belonging to the 'Worsening' class was associated with younger age, city dwelling, current and past treatment for a mental health problem, higher levels of empathy, and higher levels of loneliness.

LIMITATIONS

Sample attrition was relatively high and although this was managed using robust statistical methods, bias associated with non-responses cannot be entirely ruled out.

CONCLUSION

The majority of adults experienced no change, or an improvement in internalizing symptoms during the pandemic, and a relatively small proportion of adults experienced a worsening of internalizing symptoms. Limited public mental health resources should be targeted toward helping these at-risk individuals.

Feelings of fear, sadness, and loneliness during the COVID-19 pandemic: Findings from two studies in the UK

During the COVID-19 pandemic, exposure to COVID-related stimuli, has been enormous. Exposure to threat-related stimuli, can have a significant impact on people's wellbeing particularly in relation to COVID-related anxiety. The present research comprises two empirical studies. In Study 1, a newly developed Emotional Stroop Task (EST) and an Image Rating Task (IRT) were used to assess, automatic and non-automatic affective responses to COVID-related words and images during the first wave of the pandemic in the UK general population. In Study 2, the same tasks were used to evaluate the affective responses of University students during the second wave of the pandemic. Additionally, loneliness and pro-social behaviours were explored in relation COVID-related anxiety in the same population. Overall, the results showed that automatic affective responses as measured by interference effects on the EST, remained unaffected during the pandemic. However, non-automatic affective responses to COVID-related images measured by the IRT, indicated that participants rated these images as more fearful sadder and higher in anger, compared to non-COVID negative images matched for arousal and negativity and this was more evident in people with high COVID-anxiety. Trait anxiety was related to higher levels of loneliness, more prosocial behaviour and higher intentions to help others, while COVID-related anxiety mediated these effects, suggesting that for high levels of trait anxiety, participants were more likely to have helped someone in need during the pandemic when their COVID-anxiety levels were low.

First Manic Attack During COVID-19 Treatment: A Case Report

On March 11, 2020, the World Health Organization declared that the infection of novel coronavirus identified in Wuhan, China, is a pandemic. Various studies have shown that SARS-CoV-2 infection can trigger psychiatric effects such as anxiety, depression, and bipolar disorder. Here, we reported a case with no significant psychiatric history who experienced first-episode mania during the COVID-19 treatment. On the third day of hospitalization, the patient’s mood was elevated, she thought she can treat other patients with her special power, she was talkative and irritable. Olanzapine 20 mg was started and the patient’s score on the Young Mania Rating Scale decreased on the 17th day. Psychiatric outcomes associated with covid 19 are just emerging and it seems likely to be a potential engagement for psychiatric professionals in the future. More studies are required in terms of the treatment, course, and follow-up of psychiatric sequelae in these patients.

Mental Health Inequalities During COVID-19 Outbreak: The Role of Financial Insecurity and Attentional Control

The COVID-19 pandemic and subsequent lockdowns negatively impacted the mental health of populations. This impact is not equally distributed and increases existing mental health inequalities. Indeed, government restrictions and the economic consequences of the pandemic affect more the less educated and less wealthy people. However, psychological processes implicated in this increase of mental health inequalities during the COVID-19 pandemic remain unexplored. The present study (N=591) tested the role of financial insecurity and attentional control in the relation between socioeconomic status and mental health, along with the influence of trait anxiety. Based on Structural Equation Modelling, findings showed a mediation effect of financial insecurity, but not of attentional control, in the relationship between socioeconomic status and mental health. In addition, exploratory analyses suggested that financial insecurity also mediated the effect of attentional control on mental health. Results of the present research point at the importance of understanding psychological processes implicated in the effect of economic crises on mental health inequalities.

The COVID-19 disaster and mental health-assessing, responding and recovering

The coronavirus disease 19 (COVID-19) pandemic is a disaster that has impacted lives globally. The purpose of this paper is to understand the linkage between COVID-19 and its impact on mental health. To reach this aim, we reviewed the literature on COVID-19 and mental conditions. Based on the literature, we identified COVID-19 as an unexpected, large-scale event that disrupted communities and caused death, destruction and trauma which upended normal existence. For mental conditions, effects of the pandemic are likely to manifest in different ways: development of symptoms in previously healthy individuals, new episodes in those with predisposition to mental disorders and development of symptoms that do not meet diagnostic criteria. The level of mental health problems varies depending on the stage of the pandemic, country, population groups and types of conditions. This also applies to the level of suicide, although suicides do not seem to have increased during the pandemic. Yet, we identified a net of factors contributing to mental conditions, in general. These factors include demographic factors (e.g. female gender, younger and older age), social factors (e.g. economically disadvantaged), mental factors (e.g. pre-existing mental conditions) and relationship factors (e.g. stressful relationship, lack of relationships). Additionally, we identified COVID-19-specific factors such as threat to own life and threat to life of loved ones, containment measures and interruption of services and social life. We further explored potentially additional suicide-related risk factors. Regardless of differences, health care and psychosocial systems were in many countries not prepared to respond to a viral disaster. Viral disaster requires that responses not only include direct care but also responses to populations that may need support due to known determinants of mental health.

Occupational Health of Frontline Healthcare Workers in the United Arab Emirates during the COVID-19 Pandemic: A Snapshot of Summer 2020

The study aim was to understand the availability of personal protective equipment (PPE) and the levels of anxiety, depression, and burnout of healthcare workers (HCWs) in the United Arab Emirates (UAE). This study was an online-based, cross-sectional survey during July and August 2020. Participants were eligible from the entire country, and 1290 agreed to participate. The majority of HCWs were females aged 30-39 years old, working as nurses, and 80% considered PPE to be available. Twelve percent of respondents tested positive for SARS-CoV-2. Half of HCWs considered themselves physically tired (52.2%), reported musculoskeletal pain or discomfort (54.2%), and perceived moderate-to-high levels of burnout on at least one of three burnout domains (52.8%). A quarter of HCWs reported anxiety (26.3%) or depression (28.1%). HCWs reporting not having musculoskeletal pain, having performed physical activity, and higher scores of available PPE reported lower scores of anxiety, depression, and burnout. UAE HCWs experienced more access to PPE and less anxiety, depression, and burnout compared with HCWs in other countries. Study findings can be used by healthcare organizations and policymakers to ensure adequate measures are implemented to maximize the health and wellbeing of HCWs during the current COVID-19 and future pandemics.

Psychiatric sequelae in COVID-19 survivors: A narrative review

In December 2019, a novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was initially reported in Wuhan, China. Previous epidemics including SARS and middle east respiratory syndrome raises concern that COVID-19 infection may pose a significant threat to the mental health of affected individuals. Studies and reviews have shown the acute psychiatric manifestations in COVID-19 patients, although long term psychiatric sequelae are predicted, there are only few review studies about the long term psychiatry outcome in COVID-19 survivors. Clinically significant post-traumatic stress disorder, anxiety, and/or depression among COVID-19 survivors during 14-90 d were observed following the diagnosis. Risk of anxiety or depression were higher in patients with more severe illness at 6 mo follow-up, early convalescence, and at 1 mo follow-up. Diagnosis of COVID-19 Led to more first diagnoses and relapses of psychiatric illness during the first 14-90 d after COVID-19 diagnosis. The possible underlying mechanisms of psychiatric sequelae in COVID-19 infection are neurotropism, immune response to SARS-CoV-2, hypothalamo-pituitary-adrenal axis hyperactivity, disrupted neuronal circuits in several brain regions, increased stress levels, neuroinflammation, and neuronal death. This study will review the psychiatric sequelae in previous coronavirus pandemics, current studies, risk factors, and thorough explanation on pathophysiology of the psychiatric sequalae in COVID-19 survivors.

Quality of life of COVID-19 recovered patients in Bangladesh

Coronavirus Disease-2019 (COVID-19) quickly surged the whole world and affected people's physical, mental, and social health thereby upsetting their quality of life. Therefore, we aimed to investigate the quality of life (QoL) of COVID-19 positive patients after recovery in Bangladesh. This was a study of adult (aged ≥18 years) COVID-19 individuals from eight divisions of Bangladesh diagnosed and confirmed by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) from June 2020 to November 2020. Given a response rate of 60% in a pilot study, a random list of 6400 COVID-19 patients was generated to recruit approximately 3200 patients from eight divisions of Bangladesh and finally a total of 3244 participants could be recruited for the current study. The validated Bangla version of the World Health Organization Quality of Life Brief (WHOQOL-BREF) questionnaire was used to assess the QoL. Data were analyzed by STATA (Version 16.1) and R (Version 4.0.0). All the procedures were conducted following ethical approval and in accordance with the Declaration of Helsinki. The mean scores of QoL were highest for the physical domain (68.25±14.45) followed by social (65.10±15.78), psychological (63.28±15.48), and environmental domain (62.77±13.07). Psychological and physical domain scores among females were significantly lower than the males (p<0.001). The overall quality of life was lower in persons having a chronic disease. Participants over 45 years of age were 52% less likely to enjoy good physical health than the participants aged below 26 years (AOR: 0.48, CI: 0.28-0.82). The quality of life of employed participants was found 1.8 times higher than the unemployed (AOR: 1.80, CI: 1.11-2.91). Those who were admitted to hospitals during infection had a low QoL score in physical, psychological, and socials domains. However, QoL improved in all aspect except the psychological domain for each day passed after the diagnosis. These findings call for a focus on the quality of life of the COVID-19 affected population, with special emphasis given to females, older adults, unemployed, and people with comorbidities.

PTSD Symptoms and Sleep Quality of COVID-19 Patients During Hospitalization: An Observational Study from Two Centers

BACKGROUND

The outbreak of COVID-19 has developed into a pandemic. Data are required that specifically address the psychological consequences in COVID-19 confirmed patients. This study mainly aimed to examine posttraumatic stress disorder (PTSD) symptoms and sleep quality among COVID-19 confirmed patients during hospitalization.

METHODS

An observational study was conducted in two designated hospitals in Wuhan, China. Data were collected from 190 patients hospitalized with laboratory-confirmed COVID-19 infection between February 10, 2020 and March 13, 2020.

RESULTS

The mean age of the 190 confirmed patients was 55.7 years (SD = 13.7), of which 96 (50.5%) were female and 88 (46.3%) had family members or acquaintances infected with COVID-19. Lymphocytopenia was presented in 62 (32.6%) patients and 25 (13.2%) patients showed oxygen desaturation. The prevalence of high PTSD symptoms was 22.6% among the 190 patients. The median time from symptom onset to first medical visit and hospitalization was 2 days (IQR, 1-5) and 16 days (IQR, 10-27), respectively. Patients' PTSD symptoms were positively related to the time from symptom onset to first medical visit (r = 0.156, p < 0.05) and hospitalization (r = 0.181, p < 0.01). There were significant correlations between sleep quality and PTSD symptoms (r = 0.312-0.547, p < 0.01).

CONCLUSION

The prevalence of high PTSD symptoms was 22.6% among hospitalized COVID-19 patients. Early diagnosis and treatment of COVID-19 symptoms are beneficial to infected patients both physically and psychologically. With the recovery of physical symptoms, psychological intervention is desired to promote the trauma recovery in COVID-19 patients.

Locus of control moderates the association of COVID-19 stress and general mental distress: results of a Norwegian and a German-speaking cross-sectional survey

BACKGROUND

An internal locus of control (LoC I) refers to the belief that the outcome of events in one's life is contingent upon one's actions, whereas an external locus of control (LoC E) describes the belief that chance and powerful others control one's life. This study investigated whether LoC I and LoC E moderated the relationship between COVID-19 stress and general mental distress in the general population during the early months of the COVID-19 pandemic.

METHODS

This cross-sectional survey study analysed data from a Norwegian (n = 1225) and a German-speaking sample (n = 1527). We measured LoC with the Locus of Control-4 Scale (IE-4), COVID-19 stress with a scale developed for this purpose, and mental distress with the Patient Health Questionnaire 4 (PHQ-4). Moderation analyses were conducted using the PROCESS macro for SPSS.

RESULTS

The association between COVID-19 stress and general mental distress was strong (r = .61 and r = .55 for the Norwegian and the German-speaking sample, respectively). In both samples, LoC showed substantial moderation effects. LoC I served as a buffer (p < .001), and LoC E exacerbated (p < .001) the relation between COVID-19 stress and general mental distress.

CONCLUSIONS

The data suggest that the COVID-19 pandemic is easier to bear for people who, despite pandemic-related strains, feel that they generally have influence over their own lives. An external locus of control, conversely, is associated with symptoms of depression and anxiety. The prevention of mental distress may be supported by enabling a sense of control through citizen participation in policy decisions and transparent explanation in their implementation.

Changes in Stress, Coping Styles, and Life Satisfaction between the First and Second Waves of the COVID-19 Pandemic: A Longitudinal Cross-Lagged Study in a Sample of University Students

In this study, we aimed to explain the interplay mechanism between stress, life satisfaction, and coping styles among university students. A cohort study was performed during the first (wave 1; W1) and second (wave 2; W2) waves of the Coronavirus disease 2019 (COVID-19) pandemic. The total sample included 231 university students, of which 59.31% were women. The Satisfaction with Life Scale (SWLS), Perceived Stress Scale (PSS), and Coping Inventory for Stressful Situations (CISS) were included in one online survey. Stress, emotion-oriented, and avoidance-oriented coping styles increased from W1 to W2 of the COVID-19 pandemic, while life satisfaction and task-oriented coping decreased. The partial mediation effect of all three coping styles during W1 and W2 (in a cross-sectional approach) on the relationship between perceived stress and life satisfaction was confirmed in this study. The task-oriented and avoidance-oriented coping styles can play a mediating role in the reciprocal relationship between life satisfaction and perceived stress during W1 and W2 of the pandemic. There were no mutual interactions between stress and life satisfaction from a longitudinal approach. Coping styles changed subsequently due to stressful environmental changes related to lockdown during the COVID-19 pandemic. Having a wide range of coping strategies from which to choose during an unstable situation should help manage stress and well-being.

Mental health of older people in social isolation: the role of physical activity at home during the COVID-19 pandemic

The COVID-19 pandemic involves a new coronavirus characterized by a respiratory disease resulting from an infection with severe acute respiratory syndrome by coronavirus 2 (SARS-CoV-2). The severity and fatality of COVID-19 are directly related to age and immunocompromised states, with older adults making up the vast majority of cases. The elderly with a higher risk of serious complications due to COVID-19 and deaths are also the group most susceptible to the damage of social isolation, impacting on mental health, resulting in a more sedentary lifestyle, and health problems due to several causes, implying need for greater attention, care and protection. Physical activity has shown excellent results for mental health, being used in different treatments and populations, when considering the elderly, one of the ways to mitigate this impact on mental health is the practice of physical activity. Here, we discuss the impacts of social isolation on mental health and the role of physical activity and exercise in the homes of the elderly as a way to protect the spread of other diseases from all causes during the COVID-19 pandemic period. To this end, we discuss some possibilities that can be used by the elderly in the period of social isolation, to the point of remaining active within their homes.

Sense of Coherence and Burnout in Healthcare Professionals in the COVID-19 Era

Emotional exhaustion in the context of vulnerability to burnout is a part of the universal narrative of high stress and systematically reported in healthcare professionals. The sense of coherence (SOC) is a salutogenic construct, operationalized by A. Antonovsky as a generalized resistance resource (GRR) to stress in three dimensions: meaningfulness (Me), the desire of a person to be motivated to cope; comprehensibility (C), the belief that the challenge is understood; and manageability (Ma), the belief that coping resources are available. The relation between SOC and the dimensions of burnout-Emotional Exhaustion (EE), Depersonalization (D), and Personal Accomplishment (PA)-is a part of salutogenic functioning, which reveals the inner motivation and self-organization of the psycho-emotional energetic resource. This study traces the salutogenic functioning of Bulgarian healthcare professionals during the pandemic. A general psychological background of coherence and exhaustion has been identified. All components of the SOC were positively correlated to Personal Accomplishment. Emotional Exhaustion and Depersonalization correlated negatively with coherence. SOC was validated as a possible determinant to predict the reduction of exhaustion and depersonalization as well as high levels of professional performance. The dimension of Meaningfulness in the coherence phenomenon was demonstrated to have the highest predictive value for professional burnout.

Depression Symptoms Mediate Mismatch Between Perceived Severity of the COVID-19 Pandemic and Preventive Motives

The present study monitored changes in beliefs about the coronavirus disease 2019 (COVID-19) pandemic, depressive symptoms, and preventive motives between the first and second waves in South Korea using an online survey administered to 1,144 individuals nationally representative for age, gender, and areas of residence. While participants correctly updated their beliefs about the worsening pandemic situations, the perceived importance of social distancing did not change, and their motives to follow prevention measures shifted toward compulsory rather than voluntary motives. This inconsistency appeared to be mediated by depressive symptoms, such that negative belief changes followed by increased depressive symptoms were associated with the decreased perceived importance of social distancing and decreased voluntary motives. Our data highlights the importance of psychological responses to the dynamically evolving pandemic situations in promoting preventive behaviors.

Beyond the physical risk: Psychosocial impact and coping in healthcare professionals during the COVID-19 pandemic

AIMS AND OBJECTIVES

This study aimed to examine the psychosocial impact and identify risk factors for poor psychosocial outcomes in healthcare professionals during the Coronavirus disease 2019 (COVID-19) pandemic in Cyprus.

BACKGROUND

Healthcare professionals are in the forefront of the COVID-19 pandemic facing an unprecedented global health crisis, which can have consequences on their psychosocial health. There is a need to identify risk factors for poor psychosocial outcomes to inform the design of tailored psychological interventions.

DESIGN

Cross-sectional online study.

METHODS

A total of 1071 healthcare professionals completed self-report questionnaires. Measures included sociodemographic information, COVID-19-related characteristics, quality of life (Brief World Health Organization Quality of Life; WHOQOL-Bref), anxiety (Generalized Anxiety Disorder-7; GAD-7), depression (Patient Health Questionnaire-8; PHQ-8), occupational burnout (Copenhagen Burnout Inventory; CBI), and coping (Brief Coping Orientation to Problems Experienced; Brief COPE). This article follows the STROBE reporting guidelines.

RESULTS

The prevalence of moderate to severe anxiety and clinically significant depression was 27.6% and 26.8%, respectively. Significant risk factors for poor psychological outcomes included being female, being a nurse or doctor (vs non-medical professional), working in frontline units (inpatient, intensive care), perceptions of inadequate workplace preparation to deal with the pandemic, and using avoidance coping. Depression and occupational burnout were significant risk factors for poor quality of life.

CONCLUSION

The findings suggest several individual, psychosocial, and organisational risk factors for the adverse psychological outcomes observed in healthcare professionals during the COVID-19 pandemic.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the urgent need for screening for anxiety and depression and psychological interventions to combat an imminent mental health crisis in healthcare professionals during the COVID-19 pandemic. Pandemic response protocols and public health initiatives aiming to improve and prevent mental health problems in healthcare professionals during the current and future health crises, need to account for the various factors at play.

The roles of life stress and preventive health behaviors on parent mental health during the COVID-19 pandemic

The COVID-19 pandemic has disrupted millions of lives, with life stress and daily hassles having a potential impact on parent mental health. This study examined whether preventive health behaviors (e.g. social distancing, mask wearing) and social support relate to parent mental health. In a cross-sectional analysis of parents (N = 176, May-September 2020), life events and daily hassles were positively associated with depressive and anxiety symptoms. Preventive health behaviors moderated the association between daily hassles and depressive symptoms. Preventive health behaviors may protect those with high levels of daily hassles from moderate levels of depression.

Psychological consequences of hospital isolation during the COVID-19 pandemic - research on the sample of polish firefighting academy students

Currently, a very important thread of research on COVID-19 is to determine the dimension of the psychopathological emotional reactions induced by the COVID-19 pandemic. A non-experimental online research project was designed to determine the predictors of the severity of psychopathological symptoms, such as depression and PTSD symptoms, and the nature of the feedback mechanism between them in groups of men, remaining in hospital isolation due to infection and at-home isolation during the COVID-19 epidemic. The presence of symptoms of depression, post-traumatic stress disorder (PTSD) and a sense of threat due to the pandemic were assessed using the following screening tests: IES-R by Weiss and Marmar, PHQ-9 by Spitzer et al., and a self-constructed sliding scale for assessing COVID-19 anxiety. The study was carried out on a group of 57 firefighting cadets, hospitalized in a COVID-19 isolation room (M_age = 23.01), staying in isolation due to SARS-CoV-2 virus infection and a control group of 57 healthy men (M_age = 41.38) staying at home during quarantine and national lockdown. COVID-19 pandemic causes many psychopathological reactions. The predictive models revealed that the predictors of symptoms of PTSD in isolated patients included depression and the experienced sense of COVID-19 threat resulting from the disease, while in the control group the symptoms of depression were the only predictor of PTSD. PTSD experiences are usually associated with depression. It may also be a form of the re-experiencing process or the effect of high affectivity, indirectly confirmed by the participation of hyperarousal in the feedback loop. Our findings highlight the importance of mental health aspects in patients treated during the COVID-19 pandemic. The COVID-19 pandemic requires social distancing, quarantine and isolation, which may cause psychopathological symptoms not only in affected people, but also in the general population. Moreover, the need for greater psychological support can be emphasized for both: the sick and the general population.

The Psychological Impacts During the Initial Phase of the COVID-19 Outbreak, and its Associated Factors Among Pastoral Community in West Omo Zone, South-West Ethiopia, 2020: A Community-Based Study

BACKGROUND

COVID-19 is a global pandemic and a major health crisis affecting several nations. Such outbreaks are associated with adverse mental health consequences to any group of the population. Despite its negative effects, no study has addressed the potential psychological impacts of the COVID-19 outbreak among the pastoral community. This study aims to assess psychological experiences during the early stages of the COVID-19 outbreak and the factors that contributed to it among pastoral community residents in West Omo, South-West Ethiopia.

METHODS

A community-based cross-sectional study was carried out from May to June 2020. The study subjects were selected through a multistage sampling technique. Data were collected through face-to-face interviews, and entered into EpiData 3.1, then exported to SPSS version 24 for statistical analysis. The psychological impact was assessed by the Depression, Anxiety and Stress Scale (DASS-21). P-value < 0.20 during bi-variable analysis was considered as a candidate for multivariable logistic regression. Independent factors of depression, anxiety, and stress were assessed using adjusted odds ratio with 95% confidence level s at P-value < 0.05 cut-off point.

RESULTS

A total of 845 eligible pastoral residents were interviewed, with a 94.4% response rate. The prevalence of a positive response for anxiety, depression and stress was 30.8%, 26.3% and 24.4%, respectively. Being female was highly associated with developing anxiety and depression. Anxiety was found to be three times more prevalent among the respondents with ≥ 3 family members. Furthermore, participants with a history of mental illness, poor social support, and a high perceived life threat were also at a higher risk of experiencing anxiety, depression, and stress.

CONCLUSION

The prevalence of positive depression, anxiety and stress results were high. As a result, special attention should be paid, by governmental and non-governmental health organizations, to psychosocial and mental health programs for pastoral residentsduring the COVID-19 pandemic.

Patterns of Psychological Responses among the Public during the Early Phase of COVID-19: A Cross-Regional Analysis

This study aimed to compare the mediation of psychological flexibility, prosociality and coping in the impacts of illness perceptions toward COVID-19 on mental health among seven regions. Convenience sampled online survey was conducted between April and June 2020 from 9130 citizens in 21 countries. Illness perceptions toward COVID-19, psychological flexibility, prosociality, coping and mental health, socio-demographics, lockdown-related variables and COVID-19 status were assessed. Results showed that psychological flexibility was the only significant mediator in the relationship between illness perceptions toward COVID-19 and mental health across all regions (all ps = 0.001-0.021). Seeking social support was the significant mediator across subgroups (all ps range = <0.001-0.005) except from the Hong Kong sample (p = 0.06) and the North and South American sample (p = 0.53). No mediation was found for problem-solving (except from the Northern European sample, p = 0.009). Prosociality was the significant mediator in the Hong Kong sample (p = 0.016) and the Eastern European sample (p = 0.008). These findings indicate that fostering psychological flexibility may help to mitigate the adverse mental impacts of COVID-19 across regions. Roles of seeking social support, problem-solving and prosociality vary across regions.

Suffering and Salutogenesis: A Conceptual Analysis of Lessons for Psychiatry From Existential Positive Psychology (PP2.0) in the Setting of the COVID-19 Pandemic

The COVID-19 pandemic has had a widespread effect on the thoughts, emotions and behavior of millions of people all around the world. In this context, a large body of scientific literature examining the mental health impact of this global crisis has emerged. The majority of these studies have framed this impact in terms of pre-defined categories derived from psychiatric nosology, such as anxiety disorders, depression or post-traumatic stress disorder. These constructs often fail to capture the complexity of the actual experiences of the individuals being studied; more specifically, they describe these experiences exclusively in terms of disease, while neglecting their potentially adaptive or “salutogenic” aspects. Similarly, discussion of psychological assistance for these individuals has largely been confined to a reiteration of “evidence-based” psychological or pharmacological techniques which can be delivered using remote access technology. In the context of the COVID-19 pandemic, these approaches are likely to be of mixed efficacy. Conversely, “negative emotions” or distressing psychological experiences may actually be functional in the setting of a disaster or crisis, serving to minimize harm, maximize social coherence and compliance, and facilitate adherence to safety measures. The limitations of the “conventional” approach are, to a certain degree, inherent to the prevailing medical model of mental health. Beyond these considerations lies the concept of “salutogenesis,” a term which refers to the innate capacity of individuals to create and maintain health and well-being in the face of adversity. Using principles derived from the second wave of positive psychology (PP2.0), particularly its emphasis on the totality of human experience and the possibility of deriving meaning and character growth from suffering, this paper conceptually analyses the relevant aspects of salutogenesis and PP2.0, and proposes an alternate approach for addressing mental health concerns during the COVID-19 pandemic. Such an approach, while acknowledging the utility of the conventional medical-psychotherapeutic model in specific cases, reduces the risk of medicalizing human experience, and provides individuals and communities with opportunities for growth and adaptation. The benefits of this proposal could potentially extend far beyond the current crisis, offering an opportunity for the field of psychiatry and mental health research to move away from a purely “disease-centered” model.

Disaster management of the psychological impact of the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has exposed a suboptimal response to this threatening global disaster, including the response to the psychological impact. Both the economic hardship and the continuous media coverage of alarming news have exacerbated this effect which also includes increased domestic violence.

AIM

To address this important aspect of disaster management and provide recommendations on how to mitigate these effects.

METHODS

This is a narrative review written by three experts in community medicine, disaster medicine and psychiatry reflecting the interdisciplinary approach in managing disasters. Selected important papers, personal published papers, PUBMED articles and media news related to the disaster management of the psychological effects of COVID-19 pandemic were collected over the last year, critically appraised and used in writing this manuscript.

RESULTS

The COVID-19 pandemic causes major emotional distress. Lack of effective treatments and availability of the current vaccines for this virus increases the fear of being infected and infecting others. Negative emotions are common and are related to adjustment but may progress in the long term to anxiety, depression, and post-traumatic stress syndrome. The COVID-19 pandemic has a major impact on mental health. The most common distress reactions include anxiety, insomnia, perception of insecurity, anger, fear of illness, and risky behaviors. Patients having mental disorders are vulnerable during the pandemic because of (1) somatic vulnerability, (2) cognitive and behavioral vulnerability, (3) psychosocial vulnerability, and (4) disruption to psychiatric care. Psychiatric wards, which are commonly separate from main hospitals, should be included in the disaster management plans. Acute care physicians carry the psychological and ethical impact of difficult triage decisions when ending the support of some patients to save others. A combination of fear and guilt may overcome normal human tolerance levels in vulnerable health workers. The moral injuries can be carried for a long time.

CONCLUSIONS

Addressing the psychological effects is an essential component of disaster management of infectious pandemics. This should be implemented through the whole spectrum of disaster management including preparedness, mitigation, response, and recovery.

Pediatric admissions to emergency departments of North-Western Italy during COVID-19 pandemic: A retrospective observational study

Background

COVID-19 pandemic caused huge decrease of pediatric admissions to Emergency Department (ED), arising concerns about possible delays in diagnosis and treatment of severe disorders.

Methods

Impact of COVID-19 on Pediatric Emergency Room (ICOPER) was a retrospective multicentre observational study including 23 Italian EDs.

All the children <18 years admitted, between March 9th and May 3rd 2020 stratified by age, priority code, cause of admission and outcome have been included and compared to those admitted in the same period of 2019.

Our objectives were to assess the characteristics of pediatric admissions to EDs since COVID-19 outbreak until the end of lockdown, and to describe the features of critical children.

Findings

16,426 children were admitted in 2020, compared to 55,643 in 2019 (-70·48%). Higher reduction was reported in hospitals without Pediatric Intensive Care Unit (PICU) (-73·38%) than in those with PICU (-64·08%) (P<0·0001). Admissions with low priority decreased more than critical ones (-82·77% vs. 44·17% respectively; P<0·0001). Reduction of discharged patients was observed both in hospitals with (-66·50%) and without PICU (-74·65%) (P<0·0001). No difference in the duration of symptoms before admission was reported between 2019 and 2020, with the majority of children accessing within 24 h (55·08% vs. 57·28% respectively; P = 0·2344).

Interpretation

Admissions with low priority decreased significantly more than those with high priority; we suppose that the fear of being infected in hospital maybe overcame the concerns of caregivers. Compared to 2019, no significant referral delay by caregivers was reported. Our data suggest the need of adaptation of EDs and primary care services to different needs of children during COVID-9 pandemic.

COVID-19 Pandemic and Overall Mental Health of Healthcare Professionals Globally: A Meta-Review of Systematic Reviews

OBJECTIVE

This meta-review aimed to provide a comprehensive overview of overall mental health of healthcare professionals during the COVID-19 pandemic.

METHOD

We conducted a comprehensive literature search on Academic Search Premier, CINAHL, Cochrane Library, and MEDLINE. A predefined eligibility criterion was used to screen the articles. The methodology quality of eligible studies was assessed using Joanna Briggs Institute checklist for systematic reviews. The data were narratively synthesised in line with the meta-review aim.

RESULT

Forty systematic reviews (represented as K = 40), which reported data from 1,828 primary studies (N) and 3,245,768 participants, met the inclusion criteria. The findings from a pooled prevalence indicate that anxiety (16-41%, K = 30, N = 701), depression (14-37%, K = 28, N = 584), and stress/post-traumatic stress disorder (18.6-56.5%, K = 24, N = 327) were the most prevailing COVID-19 pandemic-related mental health conditions affecting healthcare workers. Other reported concerns included insomnia, burnout, fear, obsessive-compulsive disorder, somatization symptoms, phobia, substance abuse, and suicidal thoughts. Considering regions/countries, the highest anxiety was reported in the United-Kingdom [22.3, 95% Confidence Interval (CI):7-38, N = 4] compared to other countries, while the highest depression was in the Middle-East, (41, 95% CI:16-60, N = 5) and stress in the Eastern Mediterranean region (61.6, 95% CI:56.4-66.8, N = 2) compared to other regions. The most significant risk factors include female gender, younger age, being a nurse, and frontline professional. The most-reported coping strategies include individual/group psychological support, family/relative support, training/orientation, and the adequacy of personal protective equipment.

CONCLUSION

It was concluded that healthcare professionals (nurses, doctors, allied health) have experienced various mental health issues during COVID-19 pandemic. The meta-review, therefore, recommends targeted interventions and health policies that address specific mental health issues to support health professionals worldwide during the duration of the COVID-19 pandemic and similar future health crises.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4202126200, identifier: CRD42021262001.

Research on Posttraumatic Stress Disorder in the Context of the COVID-19 Pandemic: A Review of Methods and Implications in General Population Samples

Increasing concern about the mental health sequelae to the COVID-19 pandemic has prompted a surge in research and publications on the prevalence of posttraumatic stress disorder in general population samples in relation to the pandemic. We examined how posttraumatic stress disorder in the context of the COVID-19 pandemic has been studied to date and found three general themes: (1) assessment of posttraumatic stress disorder and posttraumatic stress disorder symptoms relied on self-report measures and often did not determine direct trauma exposure as required by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Criterion A to diagnose posttraumatic stress disorder; (2) inadequate assessment of pre-existing mental disorders and co-occurring stress; and (3) the use of cross-sectional designs in most studies, often relying on snowball sampling strategies to conduct online surveys. Notwithstanding these methodological limitations, these studies have reported moderate to severe posttraumatic symptoms in 25.8% of the general population on average in relation to the pandemic (ranging from 4.6% to 55.3%). Opportunities for advancing future research that will inform public health planning are discussed.