Comparison of the severity of psychological distress among four groups of an Iranian population regarding COVID-19 pandemic

Dynamic monitor on psychological problems of medical aid teams in the context of corona virus disease 2019: a multi-stage and multi-factor quantitative study

Background

To explore the psychological status and vulnerability characteristics of medical staff with the progress of the epidemic.

Methods

This study investigated the prevalence of mental problems of 2748 medical staff in four stages. The PHQ-9 (Patient Health Questionnaire), GAD-7 (Generalized Anxiety Disorder questionnaire), SSS (Somatization Symptom Checklist), Pittsburgh sleep quality index, and PCL-C (Self-rating scale for post-traumatic stress disorder) were used for the psychological evaluation, and univariate logistic standardised analysis, and multivariate logistic regression for data analysis.

Results

The prevalence of mental problems showed a statistically significant difference. In Stage 1, mild anxiety and mild depression reached the highest value of 41.4 and 40.72% respectively. Between 4 and 17 March that of mild depression rose from 16.07 to 26.7%, and between 17 and 26 March the prevalence of mild anxiety increased from 17.28 to 20.02%. Female, unmarried, and working in Wuhan are the risk factors of mental health of medical staff (P < 0.05).

Conclusion

The psychological status of the medical staff has changed dynamically. Stage 1 and the latter period of Stages 2 and 3 are the high-risk stages. Female and unmarried are the dangerous characteristics of psychological vulnerability.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11479-0.

Psychometric Properties of the Impact of Events Scale-Revised (IES-R) Among General Iranian Population During the COVID-19 Pandemic

Objective: The aim of this study was to translate and evaluate the validity and reliability of the Impact of Events Scale-Revised (IES-R) among the Iranian general population during the coronavirus disease 2019 (COVID-19) pandemic. Method: This study was methodological cross-sectional. It was conducted on an Iranian public population from April to July 2020 which was during the COVID-19 pandemic. Construct validity was determined through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) with a total of 500 adults recruited via online data gathering. Reliability was checked through the average inter-item correlation (AIC), Cronbach's alpha, and McDonald's omega. Convergent and divergent validity was determined using Fornell and Larcker's approach. Results: The results showed that the Persian version of IES-R had three factors, including intrusion (six items), avoidance (seven items), and hyperarousal (five items), that explained 59.22% of the total variance of the IES-R. The CFA findings indicated that all goodness-of-fit indices confirmed the model fit. The Cronbach's alpha, McDonald's omega, composite reliability (CR), and maximal reliability were excellent, and the three factors have good convergent validity. Conclusion: The findings of this study indicated that the Persian version of the IES-R scale is efficient and useful to assess post-traumatic stress disorder among Iran general population in the COVID-19 outbreak.

Effects of the COVID-19 pandemic on characteristics of functional (psychogenic) seizures

OBJECTIVE

We investigated whether the COVID-19 pandemic has affected the clinical characteristics of patients with functional seizure (FS) (at the time of diagnosis).

METHODS

In a retrospective study of a prospectively developed and maintained database, all patients diagnosed with FS before and during the COVID-19 pandemic were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from December 2008 until February 2021.

RESULTS

Three hundred and eighty-eight patients were studied. Three hundred and sixty-four patients (94%) were diagnosed before and 24 persons (6%) during the pandemic. Patients diagnosed during the COVID-19 pandemic less frequently had generalized motor seizures [odds ratio (OR): 0.30, 95% confidence interval (CI): 0.12-0.77; p = 0.012] and had higher seizure frequencies (OR: 1.00, 95% CI: 1.00-1.01; p = 0.044). Functional seizures were inversely associated with the education level as a trend during the COVID-19 pandemic (OR: 0.36, 95% CI: 0.13-1.01; p = 0.052).

CONCLUSION

The COVID-19 pandemic has affected the characteristics of patients with FS (at the time of diagnosis). Larger and multi-center studies are needed to investigate the links and associations between the COVID-19 pandemic and characteristics of FS.

Dental Nurses' Mental Health in Germany: A Nationwide Survey during the COVID-19 Pandemic

Several studies have found a rise in the rate of psychological discomfort among healthcare personnel since the COVID-19 pandemic outbreak. In this study, we analyzed the relationship between psychological variables of anxiety, depression, stress, avoidance, intrusion and hyperarousal and several factors among German dental nurses. For this poll, dental nurses were asked nationwide to take part via an online-based survey from July 2020 to January 2021. This survey gathered data on demographics, as well as psychological assessments through the Impact of Events Scale-Revised (IES-R) instrument, and the Depression Anxiety Stress Scales (DASS-21). The correlations between DASS-21/IES-R ratings and sociodemographic data were investigated using univariate analyses (Kruskal-Wallis and Mann-Whitney U tests). Single comparisons were performed using the Dunn-Bonferroni post hoc test if a relevant test result was significant followed by multiple linear regressions. Furthermore, 252 dental nurses took part in the study and showed overall normal or mild results of all psychological variables. Having immune-deficiency or chronic diseases, employment at a dental practice, being married, having no children and seeing the pandemic as a financial threat were presented as significant risk factors (p ≤ 0.05) with higher DASS-21 and IES-R scores. These results emphasize the aspects that must be considered to safeguard German dental nurses' mental wellbeing during the crisis.

Prevalence and correlates of psychological distress amongst healthcare workers during the COVID-19 pandemic: An online survey

Background

Understanding the mental health needs of healthcare workers during coronavirus disease 2019 (COVID-19) pandemic with a view of mitigating its impact on occupational functioning is vital.

Aim

To determine the prevalence and correlates of psychological distress amongst healthcare workers.

Setting

The study was carried out in Nigeria during COVID-19 pandemic.

Methods

A cross-sectional quantitative study using a convenience sample was conducted amongst healthcare workers. The survey comprised of two Google formatted self-report questionnaires, a 12-item General Health Questionnaire and a questionnaire containing socio-demographic, work related and knowledge of COVID-19 variables. Questionnaires were distributed via closed professional WhatsApp platforms. Data were analysed using descriptive statistics, chi-square test and logistic regression.

Results

There were 313 respondents and prevalence of psychological distress was 47.0%. Females were almost twice as likely to have psychological distress as males (OR = 1.92, 95% CI: 1.21-3.04, p = 0.006). Healthcare workers who had no contact with COVID-19 positive patients had an 87% reduced risk of psychological distress (OR = 0.13, 95%CI: 0.23-0.25, p = 0.018) compared with those who had contact with COVID-19 positive patients. Healthcare workers with poor knowledge of COVID-19 had a 44% reduced risk of psychological distress compared with those with good knowledge (OR = 0.56, 95% CI: 0.34-0.93, p = 0.025).

Conclusion

Findings revealed that healthcare workers in Nigeria reported psychological distress during COVID-19 pandemic. Greater risk was amongst females and those who had contact with COVID-19 positive patients whilst poor knowledge was protective.

Suicide attempt risks among hotline callers with and without the coronavirus disease 2019 related psychological distress: a case-control study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic profoundly impacts on mental health, yet it is still unclear whether COVID-19 distress makes people more vulnerable to suicidal behavior. The present study aims to examine the association between COVID-19 related psychological distress and risk for suicide attempt, and moderators of this association, among hotline callers.

METHODS

This case-control study was conducted at the largest psychological support hotline in China. Hotline callers who sought help for psychological distress and reported whether or not they attempted suicide in the last 2 weeks (recent suicide attempt) were analyzed. The primary predictor of recent suicide attempt was the presence or absence of COVID-19 related psychological distress. Demographic variables and common risk and protective factors for suicidal behavior were also studied. Callers with COVID-19 related distress (COVID-19 callers) and those without such distress (non-COVID-19 callers) were compared on these variables. Recent suicide attempt was regressed on COVID-19 related distress and the other variables, and significant interaction terms of aforementioned predictors by COVID-19 related distress, to identify variables that moderate the association of COVID-19 related distress and recent suicide attempt.

RESULTS

Among 7337 included callers, there were 1252 COVID-19 callers (17.1%) and 6085 non-COVID-19 callers (82.9%). The COVID-19 callers were less likely to report recent suicide attempt (n = 73, 5.8%) than the non-COVID-19 callers (n = 498, 8.2%, P = 0.005). The COVID-19 callers were also less likely to have high scores on depressive symptoms (22.6% vs 26.3%, P < 0.001) and psychological distress (19.5% vs 27.3%, P < 0.001), and were more likely to have high hopefulness scores (46.5% vs 38.0%, P < 0.001). Tests of moderating effects showed that acute life events were associated with one-half lower risk (P = 0.021), and a trend that suicide attempt history was associated with two-thirds greater risk (P = 0.063) for recent suicide attempt, among COVID-19 callers than non-COVID-19 callers.

CONCLUSIONS

The COVID-19 calls are from individuals with lower suicide-related risk compared to more typical callers. Acute stressful life events provided a key context for suicide attempt in non-COVID-19 callers, i.e., more typical calls.

Depression among healthcare workers in the Eastern Mediterranean Region: a systematic review and meta-analysis

BACKGROUND

Depression is a major population health challenge globally. This systematic review and meta-analysis aims to (i) determine depression prevalence and (ii) identify the risk and protective factors of depression among healthcare workers (HCWs) in the Eastern Mediterranean Region (EMR).

METHODS

The protocol was registered on Open Science Framework (registration ID: https://osf.io/rdv27 ). We searched five databases (PubMed, Embase, PsycINFO, Al Manhal, Google Scholar) till July 22, 2020 without language restrictions. We included studies from the EMR using a depression screening or diagnostic instrument to measure the depression prevalence among HCWs. Studies were assessed and data were pooled using random-effects meta-analysis based on the Cochrane handbook.

RESULTS

The systematic review identified 108 studies from 12 EMR countries with varying quality. Working long hours, poor sleep quality and being female were risk factors for depression in EMR HCWs. The meta-analysis comprised 77 studies providing 122 prevalence measures across 7 EMR countries. The pooled prevalence of depression among EMR HCWs was 33.03% (95% CI = 27.40-39.19%). Emergency HCWs had markedly higher rates of depression [53.14% (95% CI = 26.63-77.99%)] compared to HCWs of other specialties. Most studies had an appropriate sample size.

CONCLUSIONS

Depression among EMR HCWs is a major concern. Steps must be taken to prevent, identify, and manage depression among HCWs. Fostering a compassionate and empathetic environment is critically important to building a resilient healthcare system. Generating high-quality regional data from longitudinal studies on mental health will further contribute to a better understanding and management of depression among EMR HCWs.

Perceived Stress and Coping Strategies During the COVID-19 Pandemic Among Public Health and Preventive Medicine Students in Vietnam

PURPOSE

Little is known about the effect of COVID-19 pandemic on public health and preventive medicine students, particularly in resource-limited countries. This study evaluated stress level in this population in Vietnam and their coping strategies during the COVID-19 pandemic.

PATIENTS AND METHODS

A cross-sectional study was conducted in April 2020 among 563 public health and preventive medicine students. A structured questionnaire included background information, the level of stress measured by the Perceived Stress Scale (PSS) and coping strategies evaluated by the Brief COPE. To compare the PSS score and Brief COPE score among participants with different characteristics, two-sided t tests or ANOVA tests were used when appropriate.

RESULTS

Most participants were females (71.4%), and the mean age was 21.6 years old (SD = 2.1). Almost all had moderate to high levels of knowledge, attitude and skill toward COVID-19 prevention and protection. The mean PSS score was 17.02 (SD 4.06), and more than 80% had a certain level of stress. The mean score of approach coping strategies was higher than avoidant coping strategies (2.74 and 1.84). Students with a high level of stress had a higher preference for avoidance coping strategies.

CONCLUSION

Although students reported relatively good knowledge, attitude and skill as well as the preference for adaptive coping strategies, they experienced a high level of stress during the COVID-19 pandemic.

Emotional effect of the Covid-19 pandemic on oral surgery procedures: a social media analysis

BACKGROUND

This study aimed to analyze Twitter users' emotional tendencies regarding oral surgery procedures before and after the coronavirus disease 2019 (COVID-19) pandemic worldwide.

METHODS

Tweets posted in English before and after the COVID-19 pandemic were included in the study. Popular tweets in 2019 were searched using the keywords "tooth removal", "tooth extraction", "dental pain", "wisdom tooth", "wisdom teeth", "oral surgery", "oral surgeon", and "OMFS". In 2020, another search was conducted by adding the words "COVID" and "corona" to the abovementioned keywords. Emotions underlying the tweets were analyzed using CrystalFeel - Multidimensional Emotion Analysis. In this analysis, we focused on four emotions: fear, anger, sadness, and joy.

RESULTS

A total of 1240 tweets, which were posted before and after the COVID-19 pandemic, were analyzed. There was a statistically significant difference between the emotions' distribution before and after the pandemic (p < 0.001). While the sense of joy decreased after the pandemic, anger and fear increased. There was a statistically significant difference between the emotional valence distributions before and after the pandemic (p < 0.001). While a negative emotion intensity was noted in 52.9% of the messages before the pandemic, it was observed in 74.3% of the messages after the pandemic. A positive emotional intensity was observed in 29.8% of the messages before the pandemic, but was seen in 10.7% of the messages after the pandemic.

CONCLUSION

Infectious diseases, such as COVID-19, may lead to mental, emotional, and behavioral changes in people. Unpredictability, uncertainty, disease severity, misinformation, and social isolation may further increase dental anxiety and fear among people.

Is COVID-19 Immune to Misinformation? A Brief Overview

During the current COVID-19 pandemic, misinformation is a major challenge, raising several social and psychological concerns. This article highlights the prevailing misinformation as an outbreak containing hoaxes, myths, and rumours. In comparison to traditional media, online media platforms facilitate misinformation even more widely. To further affirm this ethical concern, the researchers cite relevant studies demonstrating the role of new media in misinformation and its potential consequences. Besides other significant psychosocial impacts, such as xenophobia, psychological distress, LGBT rights violation, gender-based violence, misinformation is undermining healthcare workers' psychological health and their efforts to mitigate the impact of COVID-19. In view of the adverse consequences of misinformation, this article addresses it as a massive ethical challenge during the current outbreak. Thus, the researchers make relevant suggestions to evaluate misinformation sources and mitigate the psychosocial impacts attributed to misinformation during crises. They include forming mental health teams comprising of psychologists, psychiatrists, and trained paramedical staff; rapid dissemination of authentic and updated COVID-19 situation reports regularly; establishing helpline services; and recognizing a broader range of personal needs. All health authorities should make clear that they are listening and responding to public concerns. Much effort is needed to counteract COVID-19 misinformation.

Meaning-Centered Coping in the Era of COVID-19: Direct and Moderating Effects on Depression, Anxiety, and Stress

The COVID-19 pandemic has subjected most of the world’s population to unprecedented situations, like national lockdowns, health hazards, social isolation and economic harm. Such a scenario calls for urgent measures not only to palliate it but also, to better cope with it. According to existential positive psychology, well-being does not simply represent a lack of stress and negative emotions but highlights their importance by incorporating an adaptive relationship with them. Thus, suffering can be mitigated (and transformed into growth) by, among other factors, adopting an attitude of positive reframing, maintaining hope, existential courage, life appreciation, engagement in meaningful activities, and prosociality. The conglomerate of these elements has been recently denominated as meaning-centered coping. In this study, we evaluated the protective role of this type of coping on mental health. A sample of 12,243 participants from 30 countries across all continents completed measures of Meaning-Centered Coping Scale (MCCS), depression, stress, anxiety and stressful COVID-19 related conditions they experienced. Results indicated that meaning-centered coping was strongly associated with diminished symptoms of stress, anxiety, and depression. Moreover, it moderated various relationships between vulnerability factors and markers of psychological distress, especially in the case of depression. These findings call for attention to meaning-centered coping approaches in the context of hardship, such as the current COVID-19 health crisis. In these difficult times, decision-makers and health organizations may integrate these approaches into their guidelines.

The Psychological Impact of the COVID-19 Pandemic on Dentists in Germany

Since the announcement of the coronavirus 2019 (COVID-19) outbreak as a pandemic, several studies reported increased psychological distress among healthcare workers. In this investigation, we examined the association between psychological outcomes and various factors among German dentists. Dentists from all German federal states were invited to participate in this study through a self-administered online questionnaire between July and November 2020. This questionnaire collected information on demographics, Depression Anxiety Stress Scales (DASS-21), and the Impact of Events Scale-Revised (IES-R) instrument. The associations displayed between demographic and psychological outcomes of depression, anxiety, stress, intrusion, avoidance, and hyperarousal were evaluated. Seven-hundred-and-thirty-two dentists participated in the survey and reported overall scores of (4.88 ± 4.85), (2.88 ± 3.57), (7.08 ± 5.04), (9.12 ± 8.44), (10.68 ± 8.88) and (10.35 ± 8.68) for depression, anxiety, stress, intrusion, avoidance, and hyperarousal, respectively. For females, being between 50-59 years of age, being immune deficient or chronically ill, working at a dental practice, and considering the COVID-19 pandemic a financial hazard were reported as significant associated factors (p < 0.05) with higher DASS-21 and IES-R scores. These findings underline the aspects which need to be taken into attention to protect the mental wellbeing of dentists in Germany during the crisis.

Online-Learning due to COVID-19 Improved Mental Health Among Medical Students

In reference to the announcement of the pandemic of the new coronavirus 2019-(nCoV), all educational institutions in the Republic of Kazakhstan have switched to online learning (OL). The purpose of this study was to investigate the mental state of the medical students switching to OL in comparison with the mental state of the students who had traditional learning (TL). A repeated questionnaire-based cross-sectional study was conducted among medical students ranging from 1st year to 5th year at Astana Medical University in the 2019-2020 academic year. The first study was conducted during the TL (October-November 2019, N = 619), and the second study was conducted during the OL period (April 2020, N = 798). Burnout syndrome, depression, anxiety, somatic symptoms, and satisfaction with academic performance have been studied. The findings revealed that prevalence of the burnout syndrome, depression, anxiety, and somatic symptoms decreased after transitioning from TL to OL. However, during the OL period, the prevalence of colleague-related burnout increased, which tells us about the negative impact of OL on students' communication and interpersonal relationships. The most common depression and anxiety symptoms, dissatisfaction with academic performance were among students who indicated a decrease in academic performance during OL. Students who lived alone during the quarantine were more prone to depression during OL. In conclusion, during the quarantine period after the transition from TL to OL, the mental health state of medical students improved, despite the severe conditions of the pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-020-01165-y.

What We Have Learned from Two Decades of Epidemics and Pandemics: A Systematic Review and Meta-Analysis of the Psychological Burden of Frontline Healthcare Workers

In light of the current coronavirus disease 2019 (COVID-19) pandemic and potential future infectious disease outbreaks, a comprehensive understanding of the negative effects of epidemics and pandemics on healthcare workers' mental health could inform appropriate support interventions. Thus, we aimed to synthesize and quantify the psychological and psychosomatic symptoms among frontline medical staff. We searched four databases up to March 19, 2020 and additional literature, with daily search alerts set up until October 26, 2020. Studies reporting psychological and/or psychosomatic symptoms of healthcare workers caring for patients with severe acute respiratory syndrome, H1N1, Ebola, Middle East respiratory syndrome, or COVID-19 were eligible for inclusion. Two reviewers independently conducted the search, study selection, quality appraisal, data extraction, and synthesis and involved a third reviewer in case of disagreement. We used random effects modeling to estimate the overall prevalence rates of psychological/psychosomatic symptoms and the I2 statistic. We included 86 studies, reporting data from 75,991 participants. Frontline staff showed a wide range of symptoms, including concern about transmitting the virus to the family (60.39%, 95% CI 42.53-76.96), perceived stress (56.77%, 95% CI 34.21-77.95), concerns about own health (45.97%, 95% CI 31.08-61.23), sleeping difficulties (39.88%, 95% CI 27.70-52.72), burnout (31.81%, 95% CI 13.32-53.89), symptoms of depression (25.72%, 95% CI 18.34-33.86), symptoms of anxiety (25.36%, 95% CI 17.90-33.64), symptoms of posttraumatic stress disorder (24.51%, 95% CI 18.16-31.46), mental health issues (23.11%, 95% CI 15.98-31.10), and symptoms of somatization (14.68%, 95% CI 10.67-19.18). We found consistent evidence for the pervasive and profound impact of large-scale outbreaks on the mental health of frontline healthcare workers. As the CO-VID-19 crisis continues to unfold, guaranteeing easy access to support structures for the entire healthcare workforce is vitally important.

The role of social media in spreading panic among primary and secondary school students during the COVID-19 pandemic: An online questionnaire study from the Gaza Strip, Palestine

BACKGROUND

The rapid outbreak of the COVID-19 pandemic has opened up various issues on social media platforms among school students. The dangerous issue is that misinformation, fake news, and rumours spread on social media faster than reliable information, and also faster than the virus itself, damaging the health systems and affecting the mental health of social media users.

OBJECTIVE

The current study aims at determining how social media affects the spread of panic about COVID-19 among primary and secondary school students in the Gaza Strip, Palestine.

METHODS

The data were collected through an online questionnaire. By utilizing convenience sampling, we have reached a total of 1067 school students, aged between 6 and 18 years, from 56 schools located in the Gaza Strip, Palestine. Independent Samples T-test, ANOVA, and chi-square tests were used to compare the data.

RESULTS

The results showed that social media has a significant impact on spreading panic about COVID-19 among school students, with a potential negative impact on their mental health and psychological well-being. Facebook was the most common social media platform among students (81.8%), where female students had a higher likelihood than male students to use it to get news about COVID-19 (p < 0.001). Health news was the most frequently topic seen, read, or heard (n = 529, 56.2%) during the COVID-19 pandemic, where males were more likely to follow health news than females (p < 0.001). The majority of the students (n = 736, 78.1%) were psychologically affected, whereas those physically affected were the lowest (n = 12, 1.3%). Female students were psychologically affected and experienced greater fear significantly more than male students (p < 0.001). The effect of social media panic depending on a student's age and gender. (p < 0.001). This study showed a significant positive correlation between social media and spreading panic about COVID-19 (R = 0.891).

CONCLUSIONS

During the closure of schools, students are using social media to continue their learning as well as to know more information about the COVID-19 outbreak. Social media has a main role in rapidly spreading of panic about the COVID-19 pandemic among students in the Gaza Strip.