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

The Prevalence and Predictors of Depressive, Anxiety, and Stress Symptoms Among Tepi Town Residents During the COVID-19 Pandemic Lockdown in Ethiopia

BACKGROUND

As a result of the coronavirus disease 2019 (COVID-19) outbreak, many countries have imposed movement restrictions and implemented lockdowns. However, evidence from a variety of nations showed that the COVID-19 outbreak and its associated quarantine measures triggered a wide range of psychological problems, such as anxiety, depression, and stress in the general population. As a result, the purpose of this study was to determine the prevalence and predictors of depression, anxiety, and stress symptoms among Tepi town residents during the pandemic lockdown.

METHODOLOGY

A community-based cross-sectional survey was conducted among residents of Tepi town from September 15 through September 25, 2020, and residents who have lived in Tepi town for at least 6 months were included. We have employed the depression, anxiety, and stress scale 21 (DASS-21) to evaluate depression, anxiety, and stress. The Chi-squared test of association and logistic regression were used to identify factors associated with depression, anxiety, and stress among residents of Tepi town. For all statistical analysis, we used (IBM) SPSS version 25.

RESULTS

According to the current study, the prevalence of depression, anxiety, and stress symptoms were 37.7%, 39.0%, and 44.2%, respectively, among residents of Tepi town. Estimated odds of having depression, anxiety, and stress were as follows: for being female 6.315, 4.591, and 3.155; smoking 1.787, 1.883, and 1.787; sleep problem 2.613, 2.254, and 1.721; chewing Khat 2.156, 2.053, and 2.110; quarantine for 14 days 2.251, 1.902, and 1.960; and frequent use of social media 3.126, 1.849, and 3.126 times more likely as compared to their corresponding reference group respectively. The odds of developing depression and anxiety respectively were as follows: for alcohol consumption 2.438 and 1.797 times higher than their corresponding reference group respectively. Those exposed to COVID-19 were 3.870 times more likely to develop depression symptoms. Estimated odds of having anxiety and stress symptoms for fear of COVID-19 were 1.776 and 1.835; social interactions altered were 3.197 and 2.069, moderate levels of hope were 2.687 and 2.849 respectively. The odds ratio for those taking traditional preventive medicine, and having family members infected with COVID-19 were 2.475 and 1.837 times more likely to experience anxiety symptoms respectively.

CONCLUSION

In this study, the prevalence of depression, anxiety, and stress symptoms was found to be high among residences in Tepi town. Being female, chewing Khat, smoking, being quarantined for 14 days, frequently using social media, and having sleeping problems were all found to be significantly associated with an increased risk of developing depression, anxiety, and stress symptoms, whereas alcohol consumption and family members infected by COVID-19 were considerably linked to depression and anxiety symptoms. Fear of COVID-19, influence on social interaction and having a moderate level of hope were substantially related to stress and anxiety symptoms, while taking preventive medicine was found to be a significant factor in anxiety symptoms among Tepi town residences. Interventions should be made to improve the mental health of Tepi residents.

Prediction and comparison of psychological health during COVID-19 among Indian population and Rajyoga meditators using machine learning algorithms

Issues of providing mental health support to people with emerging or current mental health disorders are becoming a significant concern throughout the world. One of the biggest effects of digital psychiatry during COVID-19 is its capacity for early identification and forecasting of a person's mental health decline resulting in chronic mental health issues. Therefore, through this study aims at addressing the hological problems by identifying people who are more likely to acquire mental health issues induced by COVID-19 epidemic. To achieve this goal, this study includes 1) Rajyoga practitioners' perceptions of psychological effects, levels of anxiety, stress, and depression are compared to those of the non practitioners 2) Predictions of mental health disorders such as stress, anxiety and depression using machine learning algorithms using the online survey data collected from Rajyoga meditators and general the population. Decision tree, random forest, naive bayeBayespport vector machine and K nearest neighbor algorithms were used for the prediction as they have been shown to be more accurate for predicting psychological disorders. The support vector machine showed the highest accuracy among all other algorithms. The f1 score was also the highest for support vector machine.

Association between COVID-19 pandemic declaration and depression/anxiety among U.S. adults

BACKGROUND

Although studies have investigated the impact of the COVID-19 on mental health, few studies have attempted to compare the prevalence of depression/anxiety symptoms among U.S. adults before and after the COVID-19 pandemic declaration. We examined the prevalence and association between depression/anxiety symptoms and COVID-19 pandemic declaration among U.S. adult population and subgroups.

METHODS

A nationally representative cross-sectional study of the Health Information National Trends Survey (HINTS 5, Cycle 4) assessing health-related information and behaviors in U.S. adults aged ≥18 years from February through June 2020. The primary dependent variable was current depression/anxiety derived from Patient Health Questionnaire-4. The main independent variable was responses before and after the COVID-19 pandemic declaration in addition to sexual identity heterosexual identity, /race/ethnicity and rural-urban commuting areas. Covariates were sociodemographic factors, and health risk behaviors. Weighted percentages, multivariable logistic regression, and Chi-square tests were used to establish the prevalence and association between current depression/anxiety and the independent variables and covariates.

RESULTS

A total of 3,865 participants completed the survey and included 35.3% of the participants before the COVID-19 pandemic declaration. Most of the sample were aged 50-64 years [33.0%]; males [51.0%]; and non-Hispanic Whites [70.1%]). The post-pandemic declaration included participants, aged 35-49 years [27.0%]; females [52.6%]; and non-Hispanic Whites [59.6%]). The prevalence of depression/anxiety was higher after the COVID-19 pandemic declaration (32.2%) than before the declaration (29.9%). Higher risks of depression/anxiety symptoms after the declaration were associated with being a sexual minority ([adjusted odds ratio] AOR, 2.91 [95% confidence interval (CI), 1.38-6.14]) and having fair/poor general health (AOR, 2.91 [95% CI, 1.76-4.83]). The probability of experiencing depression/anxiety symptoms after the declaration was highest among homosexuals/lesbians/gays (65.6%) compared to bisexuals (39.6%), and heterosexuals (30.1%).

CONCLUSIONS

In this study, young adults, non-Hispanic Whites, and those with fair/poor general health had a higher burden of depression/anxiety symptoms after the pandemic declaration. The development of psychological support strategies to promote wellbeing during the pandemic may reduce psychological distress in the population, especially among at-risk populations.

Are psychological status and trust in information related to vaccine hesitancy during COVID-19 pandemic? A latent class and mediation analyses in Italy

Despite the recognized benefits of the COVID-19 vaccination, vaccine hesitancy (VH) remains one of the biggest challenges of the mass vaccination campaign. Most studies investigating VH determinants focused on socio-demographics and direct relationships. In this study, we aimed at: 1) identifying subgroups of people differently affected by the pandemic, in terms of psychological status; 2) investigating the role of psychological status and trust in information as possible mediators of the relationship between individual characteristics and VH. To this purpose, a latent class analysis (LCA) followed by a mediation analysis were carried out on data from a survey conducted in January 2021 on 1011 Italian citizens. LCA identified four different subgroups characterized by a differential psychological impact of the pandemic: the extremely affected (21.1%), the highly affected (49.1%), the moderately affected (21.8%) and the slightly affected (8%). We found that VH decreased with the increase of psychological impact (from 59.3% to 23.9%). In the mediation analysis, past vaccination refusal, age 45-54 years and lower-than-average income, were all indirectly related to higher VH through mistrust in COVID-19 information. Differently, the psychological impact counteracted the greater VH in females, the negative effect of social media among youngest (<35 years) and the negative effect of mistrust in the lower-than-average-income subgroup. Knowledge of psychological profile of hesitant individuals, their level of trust and the sources of information they access, together with their sociodemographic characteristics provides a more comprehensive picture of VH determinants that can be used by public health stakeholders to effectively design and adapt communication campaigns.

Prevalence and Predictors of Anxiety among Stable Hospitalized COVID-19 Patients in Malaysia

The COVID-19 pandemic has created anxiety among hospitalized SARS-CoV-2 patients. Therefore, this study aimed to determine the prevalence of anxiety and its associated factors among stable inpatient COVID-19 patients in Malaysia. Method: A cross-sectional study was conducted using a web-based online survey involving 401 patients from Malaysia’s leading COVID-19 hospitals from 15th April until 30th June 2020, who were chosen using quota sampling. The General Anxiety Disorders 7 items (GAD-7) scale, the Coping Orientation to Problems Experienced Inventory (Brief-COPE) and a socio-demographic profile questionnaire were used. Descriptive analysis and multiple logistic regression were performed using SPSS v23 to determine the prevalence of anxiety and its associated factors. Result: The results showed that the prevalence of anxiety was 7.0%. Multiple logistic regression analysis revealed that female gender (p < 0.05), a fear of infection (p < 0.05), a lack of information (p < 0.05), a maladaptive coping mechanism of behavioral disengagement (p < 0.001) and self-blame (p < 0.001) were significantly associated with anxiety. Meanwhile, adaptive coping mechanisms via instrumental support (p < 0.001) were a significant protective predictor of anxiety. Conclusions: COVID-19 infection has had a significant influence on the mental health of patients. Findings in our study provide baseline data on the prevalence of anxiety among stabilized COVID-19 inpatients in Malaysia. Despite the relatively low prevalence, the data have the potential to improve the present mental health monitoring system and the deployment of suitable treatments in dealing with similar circumstances.

Anyone but Me: Unrealistic Optimism, Emotions and Anxiety in the Face of COVID-19 Pandemic

The worldwide COVID-19 pandemic (and its consequences, such as lockdown and public health regimes) was a novel and stressful situation for most of people, and, as such, it significantly affected both cognitive and emotional functioning of individuals. In our study, we explored unrealistic optimism bias (the cognitive error giving people a feeling of invulnerability) and any declared preventive behaviours undertaken in order to minimise the risk of contagion. We also measured twelve specific emotions (differing in valence and origin) and the feeling of the anxiety caused by the coronavirus. The results allowed us to confirm the occurrence of unrealistic optimism bias (being significantly stronger for men than women), which correlated negatively with the declared number of preventive behaviours. Unrealistic optimism was also positively correlated with negative automatic emotions and negatively correlated with positive reflective emotions. We created models accounting for the variance of general anxiety, finding significant predictors for both separate groups of younger and older adults (negative emotions, both automatic and reflective; and preventive behaviours). However, there was an effect of positive emotions (both automatic and reflective) having a protective role from the feeling of general anxiety, which was significant for the older group only. Our findings may be a valuable cue for coping with crisis situations.

Understanding the impact of the COVID-19-related lockdown in university workers. Identifying groups through cluster analysis

Objective

To analyse the COVID-19-related lockdown impact on University workers, to identify groups based on this information, and to study the factors associated with each group.

Study design

Cross-sectional study.

Methods

A survey was conducted 3.5 weeks after COVID-19-related lockdown in University workers in Spain. Sociodemographic variables, housing, work, health conditions, levels of anxiety, stress and depression (DASS-21), and social support (MSPSS) were collected. A cluster analysis was performed to identify groups depending on the impact of the lockdown. Differences between groups were tested using Chi-square and Mann-Whitney-U tests, and associated factors with binary logistic regression.

Results

We identified two groups of workers. "G1: Consequences in the daily life routine" was mainly composed of men, Research and Teaching Personnel (RTP) with more stable professional categories, higher income level, and bigger houses than people in G2. Participants in "G2: Concerns for the current and future well-being" presented worse intensity of pain than before the lockdown, more anxiety, depression, stress and less social support than people in G1. ASP (Administration and Services Personnel) had more risk of belonging to G2 than RTP (OR = 5.863). A higher number of people living at home decreased the risk of being in G2 (OR = 0.439). People with lower pain intensity had less risk of being in G2 (OR = 0.014), and this risk decreased as friends support increased (OR = 0.833).

Conclusions

In G1, the consequences were immediately reflected in the stress resulting from changes in their daily work routine. In G2, the concerns were related to their professional future, with worse mental health, greater intensity of pain and less social support.

Impact of COVID-19 pandemic on the mental health of university students in the United Arab Emirates: a cross-sectional study

BACKGROUND

The COVID-19 pandemic had a significant impact on the mental well-being of students worldwide. There is a scarcity of information on the mental health impact of the COVID-19 pandemic on university students in the United Arab Emirates (UAE). This study aimed to investigate the mental health impact of the COVID-19, including depression, anxiety and resilience among a sample of university students in the UAE.

METHODS

A cross-sectional study using an online survey was conducted from September to November 2021. The patient health questionnaire (PHQ-9), generalized anxiety disorder-7 (GAD-7) and Connor-Davidson Resilience Scale (CD-RISC-10) were used to assess depression, anxiety, and resilience. The COVID-19 impact was assessed using a list of questions.

RESULTS

Only, 798 students completed the survey and were analyzed for this study. Overall, 74.8% of the students were females, 91.2% were never married, and 66.3% were UAE-nationals. Based on PHQ-9 and GAD-7 cut-off scores (≥ 10), four out of ten of the students self-reported moderate to severe depression (40.9%) and anxiety (39.1%). Significantly higher mean PHQ-9 and GAD-7 scores were found among students who were impacted by COVID-19 than those non-impacted (mean PHQ-9 = 9.51 ± 6.39 and 6.80 ± 6.34; p = 0.001, respectively) and (mean GAD-7 = 9.03 ± 6.00 and 8.54 ± 6.02; respectively, p < 0.001). Female students who were impacted by COVID-19 had statistically significant higher depression and anxiety scores (mean PHQ-9 of 9.14 ± 5.86 vs. 6.83 ± 6.25, respectively; p < 0.001) than the non-impacted females (mean GAD-7 of 9.57 ± 6.32 vs. 5.15 ± 3.88, respectively; p = 0.005). Never married students had significantly higher PHQ-9 and GAD-7 scores than ever-married (9.31 ± 6.37 vs. 6.93 ± 5.47, P = 0.003) and (8.89 ± 6.11 vs. 7.13 ± 5.49, respectively; p = 0.017).

CONCLUSIONS

The results of this study demonstrate that the COVID-19 pandemic has negatively impacted the mental health of this sample of university students in terms of depression and anxiety. The results highlight the need to adopt culturally appropriate interventions for university students and focus on vulnerable groups.

The evolution of research on depression during COVID-19: A visual analysis using Co-Occurrence and VOSviewer

Background

The COVID-19 pandemic has led to public health problems, including depression. There has been a significant increase in research on depression during the COVID-19 pandemic. However, little attention has been paid to the overall trend in this field based on bibliometric analyses.

Methods

Co-Occurrence (COOC) and VOSviewer bibliometric methods were utilized to analyze depression in COVID-19 literature in the core collection of the Web of Science (WOS). The overall characteristics of depression during COVID-19 were summarized by analyzing the number of published studies, keywords, institutions, and countries.

Results

A total of 9,694 English original research articles and reviews on depression during COVID-19 were included in this study. The United States, China, and the United Kingdom were the countries with the largest number of publications and had close cooperation with each other. Research institutions in each country were dominated by universities, with the University of Toronto being the most productive institution in the world. The most frequently published author was Ligang Zhang. Visualization analysis showed that influencing factors, adverse effects, and coping strategies were hotspots for research.

Conclusion

The results shed light on the burgeoning research on depression during COVID-19, particularly the relationship between depression and public health. In addition, future research on depression during COVID-19 should focus more on special groups and those at potential risk of depression in the general population, use more quantitative and qualitative studies combined with more attention to scale updates, and conduct longitudinal follow-ups of the outcomes of interventions. In conclusion, this study contributes to a more comprehensive view of the development of depression during COVID-19 and suggests a theoretical basis for future research on public health.

Fear of COVID-19, stress and depression: A meta-analytic test of the mediating role of anxiety

OBJECTIVES

The COVID-19 pandemic has negatively affected the lives of millions of individuals physiologically, behaviorally, socially, and/or psychologically. Moreover, there is now much empirical evidence that mental health problems have increased during the pandemic period and these problems have various consequences. The changes in the mood states of individuals due to the pandemic underpins the rationale of the present study. The aim of the study was to identify the cross-sectional associations between fear of COVID-19, stress, anxiety, and depression by using two stage-meta-analytic structural equation modeling (TS-MASEM).

DESIGN

This is a meta-analytic structural equation modelling study.

METHOD

A systematic literature review initially identified 4840 studies. As a result of applying inclusion and exclusion criteria, 25 studies comprising 28 samples (reporting 120 effect sizes) were eligible for inclusion in the current TS-MASEM (N = 16,452).

RESULTS

The results showed significant associations between fear of COVID-19, stress, anxiety, and depression. Additionally, the mediation role of anxiety in the association between depression and fear of COVID-19 and stress was explored.

CONCLUSIONS

Although the results did not allow for causal inferences regarding depression, they provide insight into the possible consequences of fear of COVID-19 and comorbid problems for clinicians and researchers.

Perceived Impact of the COVID-19 Pandemic on Physical Activity Among Adult Patients With Rheumatologic Disease

OBJECTIVE

The objective of this cross-sectional study was to investigate the impact of the COVID-19 pandemic on physical activity (PA) levels of patients with rheumatic and musculoskeletal diseases (RMDs) and to examine factors associated with decreased PA.

METHODS

A sample of adult patients with RMDs (n = 7,776) was identified through electronic medical records from an academic health care system in North Carolina. Invitations to participate in an online survey were sent between July 2020 and September 2020 to assess self-reported changes in PA during the COVID-19 pandemic. Descriptive statistics, age-adjusted prevalence odds ratios (PORs), and 95% confidence intervals (CIs) were computed to examine patient characteristics associated with decreased PA.

RESULTS

A total of 893 eligible participants completed the survey (mean age 57.8 ± 14.9 years, 75.8% female). The most common primary diagnoses reported among participants included rheumatoid arthritis (27.3%), osteoarthritis (16.0%), and systemic lupus erythematosus (SLE) (13.0%). More than half of participants (56.8%) reported engaging in less PA since the pandemic began. Factors associated with engaging in less PA included lower self-reported general health (POR, 2.21; CI, 1.64-2.97) and a diagnosis of SLE (POR, 1.57; CI, 1.03-2.38). Comorbidities associated with decreased PA included chronic pain (POR, 1.38; CI, 1.04-1.82), depression (POR, 1.48; CI, 1.09-2.01), and hypertension (POR, 1.44; CI, 1.10-1.90).

CONCLUSION

The COVID-19 pandemic has exacerbated barriers to PA in patients with RMDs. There is a critical need to provide resources, support, and multifaceted programs to encourage PA in patients with RMDs during the COVID-19 pandemic.

A cross-sectional study of the psychological impact of the COVID-19 pandemic on camped refugees in Ghana

Vulnerable populations such as camped refugees are often exposed to spread of infectious diseases because of their living conditions, limited resources available to them and exclusion from social services. This study examined the psychological state of camped refugees in Ghana during the COVID-19 pandemic and how their background characteristics predict the severity of the pandemic's psychological impact. It covered 763 refugees aged 15 years and above resident in two (Krisan = 316 and Ampain = 447) camps. Nine COVID-19 Anxiety Scale indicators were used to examine the psychological state of camped refugees. A composite indicator was derived to examine the overall psychological impact. Logistic regression was used to examine the factors that were associated with severe psychological impact. The multivariate analysis revealed that sex of the respondent, marital status and age of head of household were the only socio-demographic factors associated with having a severe psychological impact of the pandemic. There was very strong evidence that respondents who had moderate (OR = 1.74, 95% CI = 1.12, 2.7) and high (OR = 1.66, 95% CI = 1.05, 2.63) knowledge of the disease had increased odds of severe psychological impact. Also, those with moderate (OR = 2.97, 95% CI = 1.78, 4.97) and high (OR = 12.98, 95% CI = 7.86, 21.42) adherence had increased odds of severe psychological impact. None of the pre-existing health conditions and challenges were not significantly associated with severe psychological impact. The limited number of significant socio-demographic covariates suggests that severe psychological impact of the pandemic was a problem in the general population, and thus interventions should target the general population of camped refugees. Also, health education should not only focus on enhancing knowledge and promoting preventive measures but also on managing psychological distress.

Attachment and Sexuality: Impact of Confinement by COVID-19

This study examined attachment style and its relationship with sexual self-esteem during COVID-19 confinement. COVID-19 has caused changes in the way couples interact intimately and sexually around the world; some have found improvements and others an increase in difficulties. This article uses a retrospective pre post approach to evaluate 120 men and 89 women who were part of a couple at the time of confinement in Spain and completed an online survey. The sample was obtained during the de-escalation months, from May 9th until July 1st, 2020. Through an online survey we collected the data using the Spanish version of the Experiences in Close Relationships (ECR-S) to measure attachment and the Brief Sexuality Scale (SS) to measure aspects related to the participants sexuality (sexual self-esteem, sexual depression, and sexual preoccupation), as well as a scale designed post hoc on other aspects related to sexuality. Overall, the t-test results suggest that confinement had a negative effect on sexuality because sexual depression (SD) had a small increased in our sample. Multiple regression analysis showed that FSI, and ANXS attachment style were able to predict sexual depression during confinement. The results also showed a decrease in the strength of the relationship between sexual self-esteem (SSE) and attachment styles during confinement. However, sexual preoccupation (SP) and sexual self-esteem (SSE) remained relatively stable. Based on the results obtained, we conclude that there is an association between an increase in participants' sexual depression and being confined due to COVID-19.

Using patient-reported outcome measures to assess psychological well-being in a non-representative US general population during the COVID-19 pandemic

PURPOSE

The impact of the COVID-19 pandemic on psychological well-being will likely be long-lasting. Efforts directed towards monitoring the onset and progression of distress and mental health disorders are needed to identify and prioritize at-risk populations. This study assesses the psychological well-being of the United States (US) general population during the early phase of the COVID-19 COVID-19 pandemic using validated patient-reported outcome measures (PROMs).

METHODS

A cross-sectional study design was used. Adults (18 years or older) who could read and write in English were recruited through Prolific in May 2020. Participants completed a REDCap survey including demographic and health-related questions and three PROMs measuring global health (PROMIS-10 Global Health), anxiety [Generalized Anxiety Disorder Scale-7 (GAD-7)], and depression [Patient Health Questionnaire-9 (PHQ-9)]. A multivariable linear regression was used to identify key factors associated with worse psychological well-being.

RESULTS

Mean age of the 2023 participants was 31.92 ± 11.57 years (range, 18-82). Participants were mainly White (64.7%, n = 1309), female (52.2%, n = 1057), working full-time before the pandemic (43.5%, n = 879), and completed a college, trade, or university degree (40.7%, n = 823). Most participants reported mild to severe anxiety (57.3%, n = 1158) and depression (60%, n = 1276) on the GAD-7 and PHQ-9, respectively. Patient characteristics associated with worse psychological well-being included: age ≤ 39 years, non-White, female or gender diverse, BMI ≥ 30, uninsured, annual income ≤ $49,999 (USD), lower educational attainment, and belief that COVID-19 is deadlier than flu.

CONCLUSION

PROMs can be used to assess and monitor psychological well-being during the COVID-19 pandemic and to inform the planning and delivery of targeted public health interventions to support at-risk populations.

Psychological impact of COVID-19 after hospital discharge: A follow-up study on Italian recovered patients

BACKGROUND

Since COVID-19 outbreak, clinical experience on its management during the acute phase has rapidly grown, including potential effects on the psychopathological dimension. However, still few data are available regarding the impact on survivors' mental health over the long-term.

METHODS

A sample of 1457 COVID-19 patients underwent a multidisciplinary follow-up protocol, approximately 3 months after hospital discharge, including a psychological evaluation. The primary outcomes were anxiety, depression, resilience, post-traumatic symptoms, and health-related quality of life. Furthermore, we examined the potential role of hospitalization and delay in the follow-up assessment on the increased burden of illness.

RESULTS

Although a general high level of resilience emerged, suggesting most patients relied on their individual and interpersonal resources to face difficulties related to the pandemic, almost one third of the sample reported signs of psychological distress over time, especially post-traumatic symptoms, with anxiety being more represented than depression. Furthermore, hospitalization - regardless of the setting of care - and promptness in follow-up evaluation were found to play a protective role on patients' recovery and mental wellbeing.

LIMITATIONS

Selection bias of patients exclusively admitted to the hospital; absence of a control group; psychological assessment relying on self-reported instruments.

CONCLUSIONS

The current crisis demands resilience and adjustment resources, either in the acute and post-acute phase. Thus, the clinical effort should aim at relieving the traumatic impact of such condition through timely interventions. Further investigation may address potential predictors of developing a traumatic stress response, in order to identify and promptly treat at-risk subpopulations.

Mental health inequalities in times of crisis: evolution between 2005 and 2021 among the Spanish salaried population

BACKGROUND

Studying the working population's mental health in times of crisis (such as the 2008 recession or the COVID-19 pandemic) is very relevant. This study aims to assess the prevalence of poor mental health among the Spanish salaried population, according to the labour market inequality axes (2005-2021).

METHODS

Repeated cross-sectional study by comparing different surveys from 2005, 2010, 2016 and 2021 on workers residing in Spain who had been working in a salaried job during the week preceding the survey. n=7197 (2005), n=4985 (2010), n=1807 (2016) and n=18 870 (2021).

OUTCOME VARIABLE

poor mental health (Mental Health Inventory of the 36-item Short Form Health Survey scale). Explanatory variables: gender, age, occupational class and type of contract. Prevalence of poor mental health was estimated for each year by means of logistic regression models with robust clustered SEs, stratifying by the explanatory variables. Additionally, prevalence ratios (PR) were estimated by means of robust Poisson regression models to assess differences between the explanatory variables' categories. All analyses were weighted to address unrepresentativeness.

RESULTS

Poor mental health significantly increased in 2021 (55.92%), compared with the previous years of study (15%-17.72%). Additionally, pattern changes were identified on inequality axes in 2021, with better mental health status among older workers (oldest group PR: 0.76; 95% CI 0.71 to 0.8) and permanent workers (PR: 0.9; 95% CI 0.85 to 0.94).

CONCLUSION

This study shows a steep worsening of mental health among the salaried population in 2021 compared with previous periods. In 2021, health inequalities have apparently narrowed, although not by improving the disadvantaged groups' mental health but by worsening the typically advantaged groups' mental health.

Perceived stress and associated factors among university students in Ethiopia during the late stage of the COVID-19 pandemic: A cross-sectional study

Background

During extensive outbreaks of infectious diseases, people who are impacted, particularly the subgroups of the community who are at an increased risk of mental health problems, may experience increased stress and mental health difficulties. University students are one such susceptible population and are prone to experiencing high levels of stress as compared with the general population. Therefore, this study aimed at assessing perceived stress and identifying its associated factors among university students in Ethiopia during the late stage of the COVID-19 pandemic.

Methods

A cross-sectional study was conducted among university students in Ethiopia from 30 May to 30 June 2021. Students were asked to fill out an online survey on Google Forms that included consent, sociodemographic information, the UCLA-8 Loneliness Scale, the standard validated stress scale (PSS-10) questionnaire, and the three-item Oslo Social Support Scale (OSSS-3) to assess social support. The collected data were exported to SPSS 26. Descriptive and analytical statistics were carried out. Binary and multiple logistic regression analyses were performed to find associated factors, and variables with a p-value of 0.05 were considered statistically significant variables.

Results

A total of 426 university students were included in the survey, among whom 268 (62.9%) were male participants. The age of the participants ranged from 18 to 37 years. Health-related departments accounted for 37.1% of the participants, while non-health-related departments accounted for 62.9%. The prevalence of stress was 18.3% in the study population. In this study, extreme susceptibility to COVID-19, sleeping problems, poor self-efficacy to prevent COVID-19, and loneliness were significantly associated with perceived stress.

Conclusion

Stress was prevalent among university students in Ethiopia during the late stage of the COVID-19 pandemic. Extreme susceptibility to COVID-19, sleeping problems, poor self-efficacy, and loneliness were identified as factors for stress. Therefore, we suggest that universities should provide opportunities for safe social connection, counseling, and guidance for students.

Stress and coping strategies in the general population of Greece and Cyprus in response to the COVID-19 pandemic: a cross-sectional study

The COVID-19 pandemic and the lockdown policy had a profound psychological impact on the general population worldwide. The aim of this study was to assess the level of stress and coping strategies used during the initial stage of the COVID-19 outbreak and their association. Secondary aims were to a) identify the most important coping strategies and b) investigate predictors of stress. A cross-sectional study was conducted by using an anonymous online questionnaire. The study was carried out from April 23 to May 4 2020. A snowball sampling method was conducted to recruit potential participants from the general population of Greece and Cyprus. Participants over 18 years old who were familiar with the Greek language were included. The psychological impact was assessed by the Impact of Event Scale-Revised (IES-R). Coping strategies were assessed using 15 statements detected from a review of the literature. Participants were asked to rate each one of the coping strategies according to how important it was to them, on a four-point likert scale. The sample consisted of 3941 participants (74.2% women, N=2926), with a mean age of 36.9 years old. The most important coping strategies adopted were 1) "Dealing the situation with a positive attitude" (96.5%), 2) "Follow strict personal protective measures" (95,9%), 3) "Acquiring knowledge about coronavirus" (94.6%), 4) "Engaging in health-promoting behaviors" (89.6%), 5) "Limiting the time spent on media" (75.5%). The highest and positive coefficients were recorded for the association of IES-R scales with 1) "Talking with family and friends to reduce stress", 2) "Seeking help from a mental health professional", 3) "Limiting the time spent on media", 4) "Relieving and managing emotions", 5) "Practicing relaxation techniques". 26.5% showed severe psychological impact. Conclusion: Addressing stress levels with the use of functional coping strategies can be beneficial to protect the general population from adverse psychological outcomes.

The Effects of the COVID-19 Pandemic on Mental Health: A Web-Based Study Among Romanian Adults

Background In Romania, as in other parts of the world, the family doctor is the first to make contact with a healthy patient and is also the first to notice even the smallest pathological changes. In the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the patient's communication with the family doctor became even closer and some behavioral changes could be easily noticed. Objective To assess the symptoms of anxiety and depression in the Romanian population using social media platforms in the context of the COVID-19 pandemic. Methods We conducted an anonymous, web-based cross-sectional survey consisting of 31 questions related to general characteristics (age, gender, education, inhabitancy, residence, smoking status, and alcohol consumption) and adapted GAD-7 (7-item General Anxiety Disorders questionnaire) and PHQ-9 (9-item Patient Health Questionnaire). This questionnaire was sent to volunteers in an electronic format through a social network (Facebook, Twitter). The data collected were statistically processed using IBM SPSS v25.0 (IBM Corp., Armonk, NY). The inclusion criteria were age over 18 years and no history of chronic disease. The exclusion criteria consisted of the absence of a mental illness diagnosis. Results From the 1254 respondents, 1232 cases were selected for statistical analysis after applying the exclusion criteria. The mean age was 35.94 (SD = 11.4, 95%CI=10.9-11.9) with a minimum of 18 years and a maximum of 97 years. Eighty-four point nine percent (84.9%; N=1046) of all study participants are female and 79.13% (N= 975) live in the urban area. A total of 188 (15.25%) were diagnosed with COVID-19 of which 31 (16.66%) were male and 157 (15%) were female. N=170 (13.8%) reported moderate symptoms of anxiety during the last two weeks before the survey while N=96 (7.8%) had severe anxiety. Twenty-two point two percent (22.2%; N=274) of the participants reported moderate symptoms of depression while 10.1% (N=125) had moderately severe symptoms and 6.6% (N=81) could be diagnosed with severe depression. A greater likelihood of screening for depression diagnosis was associated with ages between 25 and 34 years (OR=0.90, 95%CI=0.86-0.94, P<.001), 35 and 44 years (OR=0.88, 95%CI=0.84-0.93, P<.001), and 45 and 54 years (OR=0.87, 95%CI=0.82-0.92, P<.001). Also, a tendency was observed for women to be more prone to high levels of anxiety (OR=1.21, 95%CI=1.08-1.35, P< .001) and depression (OR=2.16, 95%CI=1.51-308, P< .005). Conclusions Regarding the high prevalence of depression and anxiety, especially in women, appropriate measures for the risk categories should be applied. In the new social context created by the COVID-19 pandemic, screening for psychiatric and psychological disorders should be performed by telemedicine.

Remote Interventions to Support Students' Psychological Well-Being during the COVID-19 Pandemic: A Narrative Review of Recent Approaches

The COVID-19 pandemic has negatively affected students' mental health, and it is important to implement mental health management strategies. The purpose of this study was to present current findings on the implementation of remote mental health interventions in students during the pandemic. The PubMed and Web of Science electronic databases were searched and, from a total of 174 articles, 106 records were excluded according to the inclusion criteria and 23 were assessed as full texts. After the full-text screening, 12 studies were included in the review. The included publications were randomized clinical trials focused on remote mental support interventions among students from 10 countries, representing both genders, and were in the average age range of 17-55 years with an overall number of 892 participants. The included studies covered the effectiveness of strictly psychotherapeutic programs, such as cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT), as well as other techniques such as mindfulness, laughter therapy, the brain wave modulation technique (BWM-T), and physical activity-based interventions. This narrative review provides an overview of studies with a wide range of types of remote mental health support interventions. Each of the forms of intervention analyzed in this review resulted in positive changes in students' mental health, which indicates hope for widespread help via various forms of intervention implemented remotely.

Mental and physical health correlates of the psychological impact of the first wave of COVID-19 among general population of Pakistan

The primary aim was to assess the role of mental and physical health of COVID-19 and its psychological impact in the general population of Pakistan during the first wave of COVID-19. It was hypothesized that there would be a significant predictive association among socio-demographic variables, psychological impact and mental health status resulting from COVID-19, and poor self-reported physical health would be significantly associated with adverse psychological impact and poor mental health status because of COVID-19. A cross-sectional survey research design was used in which 1,361 respondents were sampled online during lockdown imposed in the country. The Impact of Events Scale-Revised (IES-R) was used to assess the psychological impact of COVID-19, and the Depression Anxiety Stress Scales (DASS-21) was used to assess participants’ mental health status. 18% of the respondents reported moderate to severe event-specific distress, 22.6% reported moderate to severely extreme depression, 29% reported moderate to extreme anxiety, and 12.1% reported moderate to extreme stress. Female gender, having graduate-level education, currently studying, and self-reported physical symptoms (persistent fever, chills, headache, cough, breathing difficulty, dizziness, and sore throat) were significantly associated with higher levels of psychological impact exhibited through higher scores on the IES-R and poorer mental health status exhibited through higher scores on the DASS-21 (Depression, Anxiety, and Stress Subscales).

Affective Attitudes in the Face of the COVID-19 Pandemic: The Dynamics of Negative Emotions and a Sense of Threat in Poles in the First Wave of the Pandemic

For millions of people, the COVID-19 pandemic situation and its accompanying restrictions have been a source of threat and confrontation with negative emotions. The pandemic's universal and long-term character, as well as the ensuing drastic limitation of control over one's life, have made it necessary to work out adaptive strategies that would reduce negative experiences and eventually lead to the restoration of well-being. The aim of this research was to identify strategies that people use in response to a long-term threat that restore affective balance and a subjective sense of security. We registered selected manifestations of affective reactions to the pandemic situation. The researchers focused on the dynamics of changes in the areas of (1) experienced negative emotions (asked in an indirect way) and (2) a subjective feeling of threat regarding the pandemic (in three different contexts: Poland, Europe, and worldwide) during the first phase of the pandemic in Poland. It was expected that both the negative emotions and the sense of threat would decrease with time. In addition, it was anticipated that the physical distance would modify the assessment of the situation as threatening depending on the geographical proximity: in Poland, Europe, and worldwide. We used the mixed quasi-experimental design in the series of four studies conducted by Internet in March, May, June, and July 2020. The intensity of negative emotions and the sense of threat caused by the pandemic situation in Poland, Europe, and worldwide were measured. Despite the objective number of confirmed COVID-19 cases during each of the stages of the study, both the intensity of emotions attributed by participants as well as the feeling of threat were found to have decreased. In addition, surprisingly, a reversed effect of the distance was revealed: namely, a sense of threat experienced towards distant locations (Europe and the world) was found to be more acute when compared with the threat experienced in Poland. The obtained results are interpreted as a manifestation of adaptive perception of the threat that lies beyond one's control, which takes the form of unconscious, biased distortions: unrealistic optimism. The decrease in the intensity of negative emotions explains unrealistic absolute optimism, while the perception of the situation in Poland as less threatening than in Europe and around the world is predicted by unrealistic comparative optimism.

Validation of the Brief Perceived Positive Lockdown Impact Scale PPLIS-4

BACKGROUND

Although research showed that positive aspects of the lockdown were perceived during the pandemic, there are no tools to test the positive impact of mandatory social isolation on life. The present study aims to validate a newly developed, brief, four-item perceived positive lockdown impact scale (PPLIS-4).

METHODS

A cross-sectional online survey study was formed among 4370 adults in three samples: Sample 1 consisted of university students from Poland and Ukraine, Sample 2 consisted of Polish university students under 26 (emerging adults), and Sample 3 consisted of Polish and Ukrainian adults above 25 (non-emerging adults). The standardized questionnaire was used for criterion validity to measure life satisfaction (SWLS), perceived stress (PSS-10), anxiety (GAD-7), and depression (PHQ-9).

RESULTS

The exploratory factor analysis (EFA) showed a one-factor solution in Sample 1 in Polish and Ukrainian university students. The confirmatory factor analysis (CFA) and confirmatory composite analysis (CCA) showed the one-factor structure appropriate for the PPLIS-4 among emerging and non-emerging adults. Criterion validity was also confirmed since the PPLIS-4 was positively related to the SWLS and negatively related to stress, anxiety, and depression.

CONCLUSIONS

The PPLIS-4 is a short but valid questionnaire to assess the positive aspects of lockdown. The PPLIS-4 can be used during the COVID-19 pandemic to measure some positive effects of changes in lifestyle as an aspect of resilience.

Effects of the COVID-19 Pandemic on the Success of Traditional Small and Medium Enterprises (SMEs): An Investigation of the Footprints of Economic Crisis Attributable to COVID-19

The COVID-19 pandemic created a significant economic decline and altered market behavior, forcing buyers and dealers online. The traditional local market merchants are not fully equipped with e-commerce business techniques and strategies, which is a barrier to their e-commerce behavior and success. The study aims to help small-medium firms adapt to an uncertain economic environment instead of reducing or shutting down business-like in Pakistan. From health to education, economy to domestic and social protection, various researches have been done since 2020. The researcher used primary data sources and did a Quantitative study after collecting the 240 samples size of data from the successful e-commerce players of Pakistan. The results confirm that customer satisfaction is essential for entrepreneurs to succeed, as customers were not satisfied with online shopping during COVID-19. Customer knowledge management (CKM) and job satisfaction (JS) are studied as potential and realized capacity variables. CKM act as a strategic asset to collect and assimilate the external customer knowledge. In contrast, satisfied employees act as a valuable asset that dynamically responds to changing customer needs and business environment by efficiently utilizing their knowledge and skills and reaching business success which is mirrored in customer satisfaction. Conclusive results enable practitioners to perceive the business success during economic crises in the organization's absorptive capacity.

COVID-19 associated fear & anxiety among students: Findings from a large-scale online survey in Bangladesh

Objective: The study aimed to assess anxiety and fear of COVID-19 among home-staying Bangladeshi students. Participants: A total of 3997 university students across Bangladesh participated in the study. Methods: A cross-sectional study was conducted using the generalized anxiety disorder scale and the fear of COVID-19 scale to measure anxiety and fear, respectively. Results: 40.11% of participants had anxiety. Fear of death by COVID-19 (β1'=4.45; 95% CI: 3.99-4.90) and perceiving COVID-19-like symptoms as having COVID-19 (β1'=2.47; 95% CI: 1.76-3.18) were associated with higher fear. Exposure to COVID-19 news on social media was a predictor of fear and anxiety. Furthermore, the severe educational loss was associated with fear (β1'=2.88; 95% CI: 2.25-3.50) and anxiety (β2'=1.91; 95% CI: 1.41 to 2.41). Physical exercise and recreational activities were protective factors for fear and anxiety. Conclusion: The study reports a higher level of psychological difficulties among students during the COVID-19 pandemic which needs further longitudinal exploration to design appropriate interventions.

Food insecurity and level of depression among patients with chronic diseases, and associated factors during the COVID-19 lockdown: a cross-sectional study in rural Rwanda

OBJECTIVES

We aimed to describe access to food and symptoms of depression among patients with chronic diseases or their caregivers, and assess associated factors during the COVID-19 lockdown in rural Rwanda.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

A stratified random sampling technique was used to recruit 220 patients enrolled in the HIV, non-communicable diseases, mental health, paediatric development clinic and oncology programmes in three rural districts of Rwanda.

OUTCOME MEASURES

Telephone-based interviews were conducted to collect data on the number of daily meals before and during the COVID-19, and depression was assessed using the Patient Health Questionnaire-9. We used logistic regression analysis to investigate factors associated with households reporting a reduction in daily meals and with the survey respondent reporting symptoms of depression.

RESULTS

Of the participants, 19.1% reported a reduction in daily number of meals for either adults or children in their households during lockdown and 24.6% had depression. Reporting a reduction in daily meals was associated with the district of residence and estimated household's monthly income. Self-reported depression was significantly associated with negative experiences during lockdown, including reporting feeling depressed or fear (AOR 4.82; 95% CI 2.08 to 11.21), loneliness (AOR 4.33; 95% CI 1.32 to 14.13), reduction in daily meals (AOR 4.15; 95% CI 1.56 to 11.00) and lack of access to healthcare (OR 3.29; 95% CI 1.32 to 8.23).

CONCLUSIONS

Our findings suggest that significant reduction in access to food affected rural Rwandans with chronic diseases during COVID-19 lockdown, and the lockdown effect varied by household's pre-pandemic level of vulnerability to food insecurity. Reduction in household meals, as well as other self-reported effects of the lockdown, were associated with worse psychological status of survey respondents. Economic and food support should be considered by governments and non-governmental organisations to protect those most vulnerable including patients with chronic diseases against the effects of pandemics and their associated containment measures.

Social isolation and the brain in the pandemic era

Intense sociality has been a catalyst for human culture and civilization, and our social relationships at a personal level play a pivotal role in our health and well-being. These relationships are, however, sensitive to the time we invest in them. To understand how and why this should be, we first outline the evolutionary background in primate sociality from which our human social world has emerged. We then review defining features of that human sociality, putting forward a framework within which one can understand the consequences of mass social isolation during the COVID-19 pandemic, including mental health deterioration, stress, sleep disturbance and substance misuse. We outline recent research on the neural basis of prolonged social isolation, highlighting especially higher-order neural circuits such as the default mode network. Our survey of studies covers the negative effects of prolonged social deprivation and the multifaceted drivers of day-to-day pandemic experiences.

Testing positive, losing a loved one, and financial hardship: Real-world impacts of COVID-19 on US college student distress

BACKGROUND

The COVID-19 pandemic has taken a particularly heavy toll on U.S. college students. In addition to facing academic-related stress and social pressures, these individuals are now increasingly susceptible to experiences such as contracting the virus, losing loved ones to COVID-19, or facing financial hardship due to the pandemic. The effects of such personal, pandemic-related experiences on young adult mental health - and the inherent racial disparities within these outcomes - remain largely understudied.

METHODS

We analyzed 65,568 undergraduate students from the Spring 2021 American College Health Association-National College Health Assessment (ACHA-NCHA).

RESULTS

The rates of the aforementioned COVID-19-related stressors were unevenly distributed across racial groups. A logistic regression analysis to identify predictors of moderate and serious psychological distress revealed that participants who had experienced the death of a loved one had 1.14 times greater odds of developing psychological distress (p < 0.0001). Those who experienced financial hardship had an odds ratio of 1.78 (p < 0.0001). Surprisingly, testing positive for COVID-19 was associated with an odds ratio of 0.82 of psychological distress (p < 0.0001).

LIMITATIONS

Self-reported measures are susceptible to recall bias and misinterpretation. Exposure and outcome variables were measured simultaneously in this cross-sectional study which limits inference on causality.

CONCLUSIONS

Financial burdens and bereavement are especially impactful stressors among college students during the pandemic, whereas contracting COVID-19 seemingly exhibits less impact on distress levels. When addressing student wellbeing, institutions should consider prioritizing the implementation of resources to support individuals affected by pandemic-related financial and familial losses.

Challenges faced by university students during the COVID-19: An international study in five countries during the early phase of the pandemic

This study focused on the specific challenges of university students in the face of the COVID-19 pandemic and examined similarities and differences in COVID-related concerns and difficulties in functioning in samples of undergraduate students in five countries. A sample of 4306 undergraduate university students (43.8% males, 56.2% females) from Israel, Kosovo, Ukraine, Cyprus and Germany participated in an anonymous online survey during the first wave of the pandemic, between March and June 2020. Study variables included the assessment of the exposure to COVID-19, perceived health status, specific COVID-related concerns and functional difficulties, social support, and the perceived level of coping. Similar concerns about the uncertainty regarding the termination of the health crisis and worry for the health of family members were identified as the most common concerns in the five countries. Challenges in online learning and financial difficulties were rated as the most central difficulties. Both COVID-related concerns and COVID-related difficulties predicted lower levels of perceived coping. Greater social support was associated with better perceived coping. Policymakers should be informed by the accumulating research showing the substantive relationships between academic difficulties and perceived COVID-related distress and coping.

Symptoms of depression and anxiety increased marginally from before to during the COVID-19 pandemic among young adults in Canada

We documented changes in depressive and anxiety symptoms from before to during the COVID-19 pandemic among young adults and investigated whether changes differed across participant characteristics. Data were available in an investigation of 1294 grade 7 students recruited in 1999–2000. For this analysis, we used data collected pre-pandemically in 2017–20 (mean (SD) age = 30.6 (1.0)) and during the pandemic in 2020–21 (mean (SD) age = 33.6 (0.6)). 673 participants with data in both cycles were retained for analysis. Symptoms were measured using the Major Depression Inventory (MDI) and the Generalized Anxiety Disorder-7 (GAD-7) scale. Standardized mean differences (SMD) of changes in MDI and GAD-7 values between cycles were calculated across participant characteristics. On average, MDI scores increased by 2.1 (95%CI 1.4, 2.8) points during the pandemic from mean 10.5; GAD-7 scores increased by 1.2 (0.8, 1.5) points from mean 4.7. The SMD was 0.24 (0.14, 0.33) for MDI, and 0.24 (0.13, 0.34) for GAD-7. No differences in MDI change scores were observed across participant characteristics. Differences in GAD-7 change scores were observed by mood/anxiety disorder (SMD − 0.31 (− 0.58, − 0.05)), household income (0.24 (0.02, 48)), living with young children (− 0.56 (− 1.23,− 0.05)), and adherence to public health recommendations 0.58 (0.19, 1.03)). Increases in depressive and anxiety symptoms were observed 10–16 months into the COVID-19 pandemic among adults age 32–36.

A systematic review of the international evolution of online mental health strategies and recommendations during the COVID-19 pandemic

INTRODUCTION

The global health crisis caused by the COVID-19 pandemic has had a negative impact on mental health (MH). As a response to the pandemic, international agencies and governmental institutions provided an initial response to the population's needs. As the pandemic evolved, the population circumstances changed, and some of these international agencies updated their strategies, recommendations, and guidelines for the populations. However, there is currently a lack of information on the attention given to response strategies by the different countries throughout the beginning of the pandemic.

OBJECTIVES

1) To evaluate the evolution of online MH strategies and recommendations of selected countries to cope with the MH impact of COVID-19 from the early stages of the pandemic (15 April 2020) to the vaccination period (9 June 2021) and 2) to review and analyse the current structures of these online MH strategies and recommendations.

METHODOLOGY

An adaptation of the PRISMA guidelines to review online documents was developed with a questionnaire for MH strategies and recommendations assessment. The search was conducted on Google, including documents from April 2020 to June 2021. Basic statistics and Student's t test were used to assess the evolution of the documents, while a two-step cluster analysis was performed to assess the organisation and characteristics of the most recent documents.

RESULTS

Statistically significant differences were found both in the number of symptoms and mental disorders and MH strategies and recommendations included in the initial documents and the updated versions generated after vaccines became available. The most recent versions are more complete in all cases. Regarding the forty-six total documents included in the review, the cluster analysis showed a broad distribution from wide-spectrum documents to documents focusing on a specific topic.

CONCLUSIONS

Selected governments and related institutions have worked actively on updating their MH online documents, highlighting actions related to bereavement, telehealth and domestic violence. The study supports the use of the adaptation, including the tailor-made questionnaire, of the PRISMA protocol as a potential standard to conduct longitudinal assessments of online documents used to support MH strategies and recommendations.

The relationship between health worry, work distress, and affective symptoms during the COVID-19 pandemic: The mediating role of hopelessness and helplessness

OBJECTIVES

The COVID-19 pandemic presented both serious health threats and economic hardships, which were reflected in increased rates of mood and anxiety symptoms. We examined two separate distress domains, health worries and work distress, as predictors of mood and anxiety symptoms. Additionally, we considered whether these two domains might be uniquely associated with the development of dysfunctional beliefs, as a proposed mechanism to account for increased symptoms during the pandemic. Two separate models were considered to examine if associations remained stable through the first year of the pandemic.

METHODS

Participants (N = 2152) were a representative sample of Florida adults. They completed online surveys at three waves: Wave 1 (April-May 2020), Wave 2 (May-June 2020), and Wave 3 (December-February 2021). Participants completed measures of COVID-19 health worry and work distress, anxiety, and depression. They also reported their level of hopelessness and helplessness (indices of dysfunctional beliefs).

RESULTS

In an early pandemic model (Wave 1-Wave 2), health worry directly and indirectly predicted anxiety and depression via dysfunctional beliefs. In contrast, work distress only indirectly predicted both outcomes. In a longer-term model (Wave 2-Wave 3), health worry had direct and indirect effects on downstream anxiety but not depression. Pandemic work distress had no effect on depression or dysfunctional beliefs; however, it was associated with less anxiety.

CONCLUSIONS

Although health worry and work distress predicted later symptoms of anxiety and depression, they appeared to operate through different pathways. These findings provide guidance for the development of more effective interventions to reduce the impact of pandemics.

Quality of work life, fear of COVID-19, job satisfaction, and commitment: a moderated mediation model

Purpose

Principally, this study aims to test a conceptual framework of the moderating influence of fear of COVID-19 on the following hypothesized relationships (1) quality of work life and bankers' commitment, (2) the mediating spillover effect of job satisfaction in the quality of work life (QWL) and affective commitment relationship.

Design/methodology/approach

A quantitative cross-sectional research design is adopted on 318 bankers chosen from four prominent Indian cities. The mediation model is tested through SPSS, PROCESS macro, and AMOS. Conditional process modeling is also administered to test the moderating effect of fear of COVID-19.

Findings

The results suggest that the positive effect of QWL on commitment is completely mediated through job satisfaction. Further, the fear induced by COVID-19 negatively moderated the positive direct relation of QWL with commitment and the positive mediating spillover effect of job satisfaction.

Originality/value

The present research is virtually the first to introduce fear of COVID-19 as a psychological construct, to test a moderated mediation model for implications to organizational behavior and human psychology theory and practice. In coalescence of the need satisfaction, spillover, and COR theories, the authors postulate that as spillover between the domains of an individual's life (work, social, financial, personal, and overall life satisfaction) occurs, such effect is calibrated (augmented or attenuated) by the degree of risk/threat/depletion of their resources in the quest for attaining higher valued resources (overall life satisfaction). The moderated mediation mechanism is suggested for replication in other avenues for greater generalizability.

[Assessing psychological, anxiety, depression and stress levels of Senegalese general population during COVID-19 pandemic]

OBJECTIVES

- Assessing of Impact of Event, depression, anxiety and stress levels in the Senegalese general population during the COVID19 pandemic and identifying associated factors.

METHODS

- Socio-demographic data, psychological impact of the pandemic, and mental health status of participants were collected using an online questionnaire administered to the general population of Senegal between April 1st and April 30th 2021. Psychological impact and mental health status were assessed, respectively, by the Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety, and Stress Scale 21 (DASS21). The data were analyzed by Jamovi software, version 1.6.23. Logistic regression in univariate and multivariate analyses were used to determine statistically significant associations with a significance level of p<0.05.

RESULTS

- We enrolled 447 respondents with 19% reporting a moderate to severe psychological impact of the outbreak. Respectively 13.4%, 5.1% and 15.2% had moderate to extremely severe symptoms of depression, anxiety and stress. Statistically significant associations with higher odds of severe levels of psychological impact of the event, depression, anxiety, and stress were represented by five characteristics: Living in Dakar, no formal education, a personal medical chronic disease, a close family member with a chronic medical disease and poor to very poor self-reported health status.

CONCLUSION

- This study determined the prevalence of post-traumatic stress disorder, depression, anxiety, and stress in the Senegalese general population during the COVID19 pandemic. Our study assessed the prevalence of post-traumatic stress disorder, depression, anxiety, and stress in the general population of Senegal during the COVID pandemic19. It confirms that the pandemic has truly an impact on the mental health of the Senegalese population. This impact is strongly influenced by geographic area and level of education.

Impact of the restrictions on community activities policy during the COVID-19 on psychological health in Indonesia's urban and rural residents: A cross-sectional study

Background and Aims

Although extensive research has been conducted on the psychological impact after exposure to the COVID-19 pandemic, very few studies simultaneously investigated the negative and positive impacts on urban and rural residents. This study aims to compare the extent of psychological impact on Indonesian living in urban and rural areas a year after the first case of COVID-19 was reported.

Design Methodology and Approach

We employed a cross-sectional study design. A total of 428 participants completed a set of web-based questionnaires from February to March 2021, consisting of the Impact of Event Scale-Revised (IES-R), the Perceived Social-Support (PSS), the mental health-related lifestyle (MHLS), and 6-item negative impacts, and the Jenkins' Sleep Scale (JSS).

Findings

Over 40% of the participants reported moderate to severe trauma-related distress; 30%-40% increased stress at work, home, and financial stress, and 50% more social support gained from their family and friends. Although 62.1% of participants paid more attention to their mental health, only 30% engaged in a healthier lifestyle, and 36.7% had sleep problems. No significant differences were found between urban and rural residents on psychological impact, changes in mental health and related lifestyles, and sleep quality. Urban residents perceived more negative impacts, in parallel with increased social support, compared to rural residents. We also found a significant correlation between psychological impact, sleep disturbance, and increased social support. However, there was no significant association between mental health-related lifestyles and other scales.

Originality and Value

This is among the first studies that examine the urban-rural disparity on the positive and negative impact of the COVID-19 in the later stage of the pandemic. Our findings offer insights to provide equal effort to mitigate the negative impacts of the COVID-19 crisis as well as promote healthy lifestyle behaviors in both urban and rural residencies.

Psychometric properties and clinical utility of COVID-19-related distress scale among children and adolescents with Disabilities

Background

The aim was to estimate the psychometric properties of the COVID-19-related distress scale in our society, as well as verifying the global structure of the COVID-19-related distress scale through exploratory factor analysis and the confirmatory factor analysis model for the dimensions prepared in the light of previous studies and the general factor model.

Methods

The study follows the design of the exploratory cross-sectional studies by applying a scale electronically using the Google Forms tool. Construct validity was evaluated using confirmatory factor analysis, exploratory factor analysis, and content validity. Pearson product-moment correlation, Cronbach's alpha reliability coefficient, and test-retest methods were used to evaluate reliability.

Results

In the analysis made for internal consistency in the reliability study of the scale, the Cronbach's alpha reliability coefficients were determined as α = 0.93 for the physical dimension subscale, 0.90 for the psychological and emotional dimension, 0.92 for cognitive dimension, 0.91 for the social dimension, 0.92 for behavioral dimension, 0.87 for living Dimension and 0.94 for the whole scale. The total number of items on the scale is 62. It is clear that the items of the scale explained 55.49 % of the variance of the correlation matrix between the items, which indicates that the scale has an appropriate degree to extract the variance that explains COVID-19-related distress. The fit indices were found to be Chi square = 862.30 (p < .001), degree of freedom = 210 (χ2 = 862.30; df = 210, χ2/df = 4.10), root mean square error of approximation (RMSEA) = 0.07 (p < .05) standardized root mean- square residual (SRMR) = 0.05, comparative fit index (CFI) = 0.92, non-normed fit index (NNFI) = 0.95, goodness of fit index (GFI) = 0.95, and adjusted goodness of fit index (AGFI) = 0.94.

Conclusions

The COVID-19-related distress scale is an easy to administer, valid, and reliable instrument to assess COVID-19-related distress. This instrument can be a helpful tool informing us about distress related to COVID-19 and hence may prevent adverse long-term consequences arising due to pandemic.

Pseudoscience and fraudulent products for COVID-19 management

As of now, the COVID-19 pandemic has become uncontrolled and is spreading widely throughout the world. Additionally, new variants of the mutated viral variants have been found in some countries that are more dangerous than the original strain. Even vaccines cannot produce complete protective immunity against the newer strains of SARS-CoV-2. Due to such a dreadful situation, lots of fear and depression have been created among the public. People are looking for the treatment of the disease at any cost and there is a race in the market to provide treatment and make money, whether it is effective or not! In such a condition, many fraud products, remedies, and myths have come into the market, which is falsely claimed to be effective for the disease and can harm the patients. Hence, FDA has banned such products and remedies. In this review, we have compiled all such fraudulent and pseudosciences identified for COVID-19. Currently, in the pandemic time, health agencies are approving the repurposed medicines based on the small-scale clinical data for emergency uses that become ineffective (most of the cases) after large randomized clinical studies. Proper vigilance strategies need to be defined by the regulatory agencies of the nation and routine awareness programs shall be arranged for educating the people and healthcare workers on routine updates.

Analysis of changes in geographical factors affecting sales in commercial alleys after COVID-19 using machine learning techniques

Social restrictions, such as social distancing and self-isolation, imposed owing to the coronavirus disease-19 (COVID-19) pandemic have resulted in a decreased demand of commodities and manufactured products. However, the factors influencing sales in commercial districts in the pre- and post-COVID-19 periods have not yet been fully understood. Thus, this study uses machine learning techniques to identify the changes in important geographical factors among both periods that have affected sales in commercial alleys. It was discovered that, in the post-COVID-19 period, the number of pharmacies, age groups of the working population, average monthly income, and number of families living in apartments priced higher than $600k in the catchment areas had relatively high importance after COVID-19 in the prediction of a high level of sales. Moreover, the percentage of deciduous forests appeared to be a important factor in the post-COVID-19 period. As the average monthly income and worker population in their 60s and numbers of pharmacies and banks increased after the pandemic, sales in commercial alleys also increased. The survival of commercial alleys has become a critical social problem in the post-COVID-19 era; therefore, this study is meaningful in that it suggests a policy direction that could contribute to the revitalization of commercial alley sales in the future and boost the local economy.

The corona blues according to daily life changes by COVID-19: A partial least squares regression model

This study identifies determinants of the variation in depression resulting from COVID-19, specifies in detail the changes to daily life, and then compares the determinants' magnitude. The determinants were combined into three groups: first, the unpredictability of the disease and side effects by its response measures (specifically, restrictions on the freedom of movement and strain on social relationships); second, (mis)information through social media, public authorities, and mass media; and third, income reductions and other sociodemographic factors. Daily life changes were divided into four categories: travel/mobility, time at home (alone and with family), domestic activities (remote work, online shopping, food deliveries, reading, and online networking), and conflicts (with family and neighbors). We measured the total 29 predictors using data from the 2020 Seoul Survey, which is based on face-to-face interviews with a probability sample of adult residents. We made our estimations using partial least squares regression, which can analyze all original variables regardless of collinearity. The regression model found that major stressors include declines in out-of-home offline networking and the rise of domestic activities-and subsequent conflicts with family-restrictions on mobility (specifically, those of leisure travel), and income reductions. In contrast, changes to working and shopping (to remote work and online shopping) rather than leisure increased uses of private transportation modes. Moreover, we found influences of all forms of communications and media to be insignificant. We shall also provide a discussion on policy and academic implications of the findings.

Psychotherapy and Follow-Up in Health Care Workers After the COVID-19 Epidemic: A Single Center's Experience

Objective

The present study aims to analysis the mental health of high-risk health care workers (HHCWs) and low-risk HCWs (LHCWs) who were respectively exposed to COVID-19 wards and non-COVID-19 wards by following up on mental disorders in HCWs in China for 6 months.

Methods

A multi-psychological assessment questionnaire was used to follow up on the psychological status of HCWs in the Affiliated Hospital of Xuzhou Medical University in Xuzhou City (a non-core epidemic area) at 6 months after the first evaluation conducted during the COVID-19 epidemic. Based on the risk of exposure to COVID-19 patients, the HCWs were divided into two groups: high-risk HCWs, who worked in COVID-19 wards, and low-risk HCWs, who worked in non-COVID-19 wards.

Results

A total of 198 HCWs participated in the study, and 168 questionnaires were selected for evaluation. Among them, 93 (55.4%) were in the HHCW group and 75 (44.5%) were in the LHCW group. Significant differences were observed in salary, profession, and altruistic behavior between the two groups (P < 0.05). There were no significant differences in the anxiety, depression, insomnia, or posttraumatic stress disorder (PTSD) scores between the two groups. Logistic regression revealed that work stress was a major joint risk factor for mental disorders in HCWs. Among all the HCWs, a total of 58 voluntarily participated in psychotherapy; the analysis showed a significant decrease in anxiety, depression, PTSD, work stress, and work risk after attending psychotherapy. There were also significant differences in positive and negative coping styles before and after psychotherapy.

Conclusion

In the present follow-up, work stress was the major contributing factor to mental disorders in HCWs. Psychotherapy is helpful in terms of stress management and should be provided to first-line COVID-19 HCWs.

Acute Effects of Facial Coverings on Anaerobic Exercise Performance in College-Aged Adults

The use of facial coverings has been amplified during the COVID-19 pandemic as a means to minimize the spread of disease. However, facial coverings may impede ventilation during high-intensity activity, leading to a reduction in cardiopulmonary exercise capacity. Thus, the purpose of this study was to determine the acute impact of different facial coverings on exercise performance in college-aged individuals during a 300-yard shuttle. It was hypothesized that the lowest heart rate (HR), completion time (CT), and rate of perceived exertion (RPE) would occur with no mask. Furthermore, it was hypothesized the SHEMA97 mask would have lower HR, CT, and RPE compared to surgical and fabric masks. Results showed the use of the fabric mask resulted in significantly higher HR compared to no mask (p = 0.006). The SHEMA97 mask resulted in faster CT and lower RPE compared to both the fabric and surgical masks (p < 0.001). All mask conditions yielded significantly higher levels of perceived discomfort than wearing no mask (p < 0.05). While the use of facial coverings can help prevent the spread of disease, their use during exercise may pose limitations to performance; however, the ability of the SHEMA97 to provide minimal changes to CT and RPE provides a promising option.

Social connectedness, emotional regulation, and health behaviors as correlates of distress during lockdown for COVID‐19: A diary study

Mass lockdowns are a powerful infection‐reduction strategy but are a significant stressor. This study aimed to explore whether various factors known to predict distress in normal contexts (e.g. social connectedness, emotional‐regulation strategies, and health‐related behaviors) are associated with daily distress under lockdown conditions. A time‐based diary study evaluated how perceived social connectedness, health‐promoting, and risk behaviors predicted within‐person and between‐person psychological distress. One hundred and nine adults completed surveys on these variables daily for 15 days while under stringent COVID‐19 lockdown in Colombia. Emotional suppression and reappraisal were measured at the start of the study to explore whether they predicted distress. Distress was lower on the days that people experienced greater social connectedness (within‐person analyses) but was not significantly predicted by between‐participant differences in emotional regulation. Health‐promoting behaviors such as exercising and meaningful activity were associated with lower distress, while watching COVID‐19 news and eating high‐calorie food were associated with higher distress. Looking at individual dynamics provides meaningful insights on daily behaviors associated with distress that might improve people's wellbeing during lockdown, such as social connectedness, meaningful activity, nutrition, exercise, and minimizing news exposure. Future research with alternative designs will enable causal conclusions to be drawn.

A Path Model for Subjective Well-Being during the Second Wave of the COVID-19 Pandemic: A Comparative Study among Polish and Ukrainian University Students

Background: Previous studies showed several associations between physical and mental health dimensions and well-being. This study aims to examine a complex path model explaining the life satisfaction of university students from Poland and Ukraine during the second wave of the COVID-19 pandemic. Methods: The cross-sectional web-based study was performed in November 2020 using Google Forms. The conventional sample of 3230 university students from Poland (n = 1581) and Ukraine (n = 1649), aged 18–59 (M = 21.40, SD = 3.46), with 59% women, participated in the study. We used standardized questionnaires to measure life satisfaction (SWLS), self-reported physical health (GSRH), perceived stress (PSS-10), coronavirus-related PTSD (PCL-S), anxiety (GAD-7), and depression (PHQ-9). We also developed some questions to assess the exposure to the COVID-19 pandemic, positive effects of the pandemic, religiosity, and physical activity (PA). Results: We found a high prevalence of stress, coronavirus-related PTSD, anxiety, and depression and a low level of life satisfaction and physical health. Polish students, women, and those with insufficient PA levels reported worse physical and mental health than Ukrainians, men, and those who exercised sufficiently during the pandemic. Low perceived stress can directly predict life satisfaction, anxiety, and depression. Low stress also leads to better physical health, sufficient PA levels, high religiosity, and more perceived positive effects of the pandemic. Several indirect effects between particular variables and life satisfaction were also found in the path model. Conclusions: The target group for campus prevention programs is Polish university students, women, and people with insufficient PA levels. Intervention and prevention programs should focus on coping strategies and techniques for improving mental and physical health.

Prediction of post-traumatic growth in the face of the COVID-19 crisis based on resilience, post-traumatic stress and social participation: A longitudinal study

The COVID-19 crisis has generated a severe and negative psychological impact worldwide. Despite this, it is also possible to experience post-traumatic growth (PTG). This study aimed to longitudinally explore the prevalence of PTG in the Spanish population and test a predictive model for PTG from resilience, post-traumatic stress symptoms (PTSS), and participation in social activities. Data were collected longitudinally in March, July, and November 2020 via an online survey. About 20% of the sample showed moderate-high levels of PTG, with no significant differences over time. The predictive model explained 19% of the variance in PTG, showing that the inverse relation between resilience and PTG was mediated by PTSS. Additionally, participation in social activities acted as a predictor of PTG. Women, young people, those who had lost their job and people who had experienced COVID-19 symptoms or the loss of a loved one presented higher PTG. Thus, people have experienced positive changes (PTG), but these did not protect them from adverse symptomatology (PTSS).

Stressors, manifestations and course of COVID-19 related distress among public sector nurses and midwives during the COVID-19 pandemic first year in Tasmania, Australia

Impacts of the COVID-19 pandemic on the mental health of healthcare workers has been established, linking workplace factors with high levels of stress, anxiety, depression, insomnia and burnout. Less established is how COVID-19 affects both work, home and social life of nurses and midwives concurrently. This study describes the prevalence and severity of anxiety, depression, post-traumatic stress disorder (PTSD) and insomnia and examines their associations with stressors within the work, home and social environment, among nurses and midwives. A longitudinal, mixed-methods, online survey explored the psychological health of public sector nurses and midwives during the COVID-19 pandemic first year. Surveys were conducted in April (initial) and June 2020 (3-month), and April 2021 (12-month) and consisted of psychological tests including the Patient Health Questionnaire, General Anxiety Disorder, Insomnia Severity Index, and the Impact of Events Scale-Revised; workplace and lifestyle questions, together with free-text comments. The relative strengths of the associations between predictor and outcome variables were estimated using repeated measures ordered logistic regression, and free text responses were themed. Data show diagnostic levels of anxiety (23%, 18%, 21%) at surveys one, two and three respectively, depression (26%, 23% and 28%), PTSD (16%, 12% and 10%) and insomnia (19%, 19% and 21%). The strongest predictors of psychological distress were current home and family stress and poor clinical team support. Factors which will help preserve the mental health of nurses and midwives include strong workplace culture, reducing occupational risk, clear communication processes, and supporting stable and functional relationships at home. The COVID-19 pandemic has increased the visibility of mental distress on nurses and midwives and established they are pivotal to healthcare. The health service has a duty-of-care for the welfare of nurses and midwives who have entered this psychologically taxing profession to future proof service delivery and safeguard its service-response capacity.

Psychological Impact and Risk of Suicide in Hospitalized COVID-19 Patients, During the Initial Stage of the Pandemic: A Cross-Sectional Study

OBJECTIVES

This study aimed to assess the psychological impact and risk of suicide in patients hospitalized for COVID-19.

METHODS

A cross-sectional study was conducted on a representative sample of patients hospitalized for COVID-19 at the "San Cecilio" University Hospital (Granada, Spain) between March and May 2020. Sociodemographic and clinical variables were collected. All participants were evaluated using the Gijon's Social-Familial Evaluation Scale to assess social problems, the Impact of Event Scale-6 and the Hospital Anxiety-Depression Scale to assess psychological impact, the Columbia Suicide Severity and Beck Hopelessness scales to assess risk of suicide, and the List of Threatening Experiences questionnaire to control for confounding bias.

RESULTS

Thirty-six COVID-19 patients were evaluated. Of them, 33.3% had a significant psychological impact; 13.9% showed symptoms of anxiety, 13.9% showed symptoms of depression, and 47.2% showed symptoms of anxiety-depression. Moderate and severe risk of suicide were found in 75% and 2.8% of the patients, respectively. Suicidal ideation was observed in 16.7% and suicide behaviors in 5.6% of the patients. Psychological impact was associated with previous psychological treatment, a greater degree of functional dependency, and increased social-familial risk. In addition, the risk of suicide was mainly associated with active treatment of a psychiatric illness and active smoking. No significant correlation was found between psychological impact and risk of suicide.

CONCLUSIONS

Psychological impact and risk of suicide were significant in patients admitted for COVID-19. Although the risk of suicide was not associated with increased psychological impact, both should be assessed, especially in patients at higher risk based on significantly associated factors.

Concern about COVID-19 among the Spanish population: Validation of a scale and associated symptoms

BACKGROUND

The health crisis caused by the COVID-19 pandemic has led to a considerable increase in the psychopathology of COVID-19 patients and among the general population. This study aims to conduct the psychometric analysis of the scale of concern about COVID-19 in the Spanish population and to estimate the level of concern and dysfunctional anxiety present one year after the lockdown measures in Spain aimed at resisting the spread of the viral disease among the population.

METHODS

The factorial structure of the instrument, its reliability for the general population and for COVID patients, and its construct validity have been analyzed, and measurements of dysfunctional concern have been obtained from a sample of 502 adults.

RESULTS

The scale of concern about COVID-19 showed optimal results of reliability and validity for the Spanish population, confirming that it is an ideal instrument for estimating the concern regarding coronavirus contagion.

LIMITATIONS

This study used a cross-sectional design and thus, could not compare the changes in the incidence of anxiety symptoms before and after the COVID-19 outbreak. Furthermore, the use of mental health services prior to the COVID-19 restrictions was not assessed in this study, and therefore, no comparisons between the two time points could be made.

CONCLUSIONS

After a year of the confinement measures that was instilled to avoid further spread of the disease, the Spanish population presented levels of concern and anxiety that may require clinical attention, with a significant percentage of participants meeting the requirements to be diagnosed with generalized anxiety disorders.

Impact of Confinement on Coping Strategies and Psychosocial Factors among University Students

The pandemic has had psychological effects on the university population. Factors such as emotional intelligence, coping strategies and levels of anxiety, depression and stress have been affected by the situation generated by COVID-19. This study aims to analyze how EI, coping strategies and levels of anxiety, depression and stress have been affected by the situation generated by the pandemic in a population of 567 students from the University of Jaén (Spain). For this purpose, we administered three instruments: the Wong and Law emotional intelligence scale (WLEIS), the Spanish version of the coping strategies inventory (CSI) and the depression anxiety stress scales (DASS-21). At the same time, we asked students to describe their personal circumstances during confinement and their tendency to follow the measures and recommendations promoted by the Ministry of Health. The results obtained showed a positive relationship between EI and coping strategies and a negative relationship with levels of depression, anxiety and stress. A positive relationship was also found between coping and levels of anxiety, depression and stress. It was also found that the circumstances in which students experienced the period of confinement also modulated their levels of EI, coping strategies and their levels of depression, anxiety and stress.

Meta-Analysis of Psychological Interventions for Reducing Stress, Anxiety, and Depression among University Students during the COVID-19 Pandemic

(1) Background: The aim of this study is to investigate the effects of internet-based intervention programs for reducing stress, anxiety, and depression among university students during the COVID-19 pandemic by conducting a meta-analysis. (2) Methods: Searches were conducted in the following databases: MEDLINE, EbscoHost Academic Search Ultimate, and PsycArticles, using a combination of "Covid-19 AND 'Randomized Controlled Trial' AND students", as well as a combination of the following search terms: "internet", "online", "treat_", "psycholog_", "intervention", "program_", "stress_", "depress_", "anxiety", "university", "college", "freshm_", "sophomore_", and "undergraduat_". The population, intervention, control, outcomes, and study design (PICOS) framework was used (P (population): university students during the COVID-19 pandemic; I (intervention): internet-based intervention programs for reducing stress, anxiety, and depression; C (control): no intervention, usual care, or on a waiting list; O (outcomes): stress, anxiety, and depression indicators; S (study design): meta-analysis including only randomized controlled trials (RCTs)). A meta-analysis was performed on the 10 retrieved studies published between 2021 and 2022. Only RCTs were analyzed. (3) Results: All 10 analyzed papers revealed a trend in the effectiveness of internet-based intervention for reducing stress, anxiety, and depression in university students during COVID-19. Significant effects from the included RCTs with interventions for reducing stress and depression were established. (4) Conclusions: Psychological internet-based interventions may help to reduce depression and stress among university students; however, more research is needed to determine their effectiveness in reducing anxiety.