Perceived Impact of Covid-19 Across Different Mental Disorders: A Study on Disorder-Specific Symptoms, Psychosocial Stress and Behavior

COVID-19 Related Traumatic Distress in Psychotherapy Patients during the Pandemic: The Role of Attachment, Working Alliance, and Therapeutic Agency

The early months of the COVID-19 pandemic have been a challenging time for many psychotherapy patients. To understand why certain patients were more resilient, we examined the role of patients' attachment anxiety and attachment avoidance, as well as collaborative therapy experiences (perceived working alliance and therapeutic agency) in their online sessions on their COVID-related traumatic distress over a three-month period. A total of 466 patients in online psychotherapy completed a survey during the first weeks of the pandemic, and 121 of those completed a follow-up survey three months later. Lower distress at follow-up was predicted by patients' lower attachment anxiety and higher therapeutic agency in their online sessions after controlling for baseline distress and time of survey completion. Higher working alliance predicted less distress at follow-up only for patients with high attachment anxiety. For patients with low attachment avoidance (i.e., more securely attached), higher therapeutic agency predicted less distress. These findings suggest that patients' attachment anxiety and therapeutic agency may play significant roles also in online therapy during COVID-19 in patient's experienced traumatic distress, and that working alliance and therapeutic agency may be differentially important for patients with different levels of attachment anxiety and avoidance.

Association between COVID-19 and anxiety during social isolation: A systematic review

BACKGROUND

The uncertainties about coronavirus disease 2019 (COVID-19), the change in routine, lifestyles and the reduction of physical contact can cause stress, anxiety, emotional overload, poor sleep and even physical health complications.

AIM

To evaluate the scientific publications available on the relationship between COVID-19 and anxiety experienced in the general population, during the period of social isolation, adopted by governmental organizations and public health policymakers as a measure to contain the spread of cases.

METHODS

A literature search was performed systematically exploring the PubMed and Medline databases using the following terms classified as MeSH descriptors: (“anxiety” AND “pandemic” AND “COVID-19”). For the search, in the Biblioteca Virtual em Saúde – BVS, Science.gov, Web of Science and National Library platforms, the following keywords were used: ("anxiety" AND "coronavirus" AND "social isolation"). Thirty-seven peer-reviewed articles were found. PRISMA and the Downs & Black checklist were used for qualitative evaluation.

RESULTS

After applying the inclusion criteria, seven (n = 7) original scientific articles were selected. The collated evidence demonstrated increased levels of symptoms of anxiety and depression during the period of social isolation. The population between 21 to 40 years was most affected. The risk of severe depression was twice as high at the epicenter of the pandemic. Sleep quality was significantly impaired. Questions about politics, religion, and consumption of products from China were found to generate fear and anticipate probable changes in the pattern of post-pandemic consumption. Social isolation exacerbated feelings of extreme hopelessness, sadness, loneliness and suicidal ideation.

CONCLUSION

We conclude that there is a potential relationship between social isolation during the COVID-19 pandemic and symptoms of anxiety. It is important to note that the direct and indirect costs of not identifying the detrimental effects of this phenomenon and neglecting strategies for intervention could lead to a significant psychological burden on society in several aspects after social isolation.

Associations Between Depressive Symptoms and Physical Activity Intensity in an Older Adult Population During COVID-19 Lockdown

Introduction

The COVID-19 pandemic led to the implementation of physical–social distancing measures–including self-isolation, home confinement, and quarantine around the world, with psychological consequences such as depression. Older adults are especially likely to develop depressive symptomatology. This study aims to investigate the association between physical activity intensities and sedentary behavior with depression levels among previously active older adults during the COVID-19 lockdown.

Methods

A total of 1,123 physically active older Brazilian adults (67.68 ± 5.91 years, 91.00% female) were interviewed by telephone in regard to sociodemographic, general health status, depression (GDS-15), and physical activity (IPAQ-SV) after being home-confined for 11.59 ± 2.42 weeks. Participants were also asked to self-report changes in their physical activity levels and time spent sitting. Descriptive statistics (mean, frequencies), between-groups comparisons (t-tests and chi-square), and hierarchical regression analysis were used.

Results

About 83.80% of older adults self-reported a decrease in daily physical activity levels and 73.90% increased sitting time. Overall, depressive symptoms were observed in 30.40, and 20.80% met physical activity recommendations. Daily moderate (β = −0.174; 95% CI = −0.026; -0.012) and moderate-to-vigorous (β = −0.183; 95% CI = −0.023; 0.011) physical activity intensities were negatively associated with depression score explaining 2.6 and 2.9% of depression variability, respectively, after adjusting for age, gender, education level, body mass index, and polypharmacy. Daily walking and sitting time were not associated with the depression score (p > 0.05).

Conclusion

The results provide empiric suggestion supporting moderate to vigorous physical activity as a way to reduce depressive levels among older adults during COVID-19 confinement. Supervised home-based exercise programs, specifically designed for older adults, might be an important strategy to maintain and improve older adults’ mental health.

Contamination-related behaviors, obsessions, and compulsions during the COVID-19 pandemic in a United States population sample

BACKGROUND

Contamination-prevention behaviors such as mask wearing and physical distancing are crucial to reduce coronavirus transmission during the COVID-19 pandemic. We hypothesized that engagement in these behaviors could provoke obsessions and phobias in vulnerable individuals in the community.

METHODS

A total of 2117 participants, systematically selected to represent the age, gender, and race distributions of the US population, completed an online survey that assessed demographic characteristics, clinical features, COVID-19 risks, and COVID-19 contamination-prevention behaviors. Logistic regression was used to estimate the magnitude of the relationships between the COVID-19 behavior score and clinically significant contamination obsessions, contamination compulsions, and pre-COVID-19 to current change in obsessive-compulsive symptom scores.

RESULTS

The COVID-19 behavior score was significantly associated with contamination obsessions (odds ratio (OR) = 1.15, 95% CI = 1.12-1.16; p < 0.001) and contamination phobias (OR = 1.14, 95% CI = 1.12-1.16; p < 0.001). The COVID-19 behavior score also was associated with pre-pandemic to current increase in the overall obsessive-compulsive symptom score (OR = 1.16, 95% CI = 1.09-1.23; p < 0.001), as well as increase in obsessive-compulsive symptom score excluding washing items (OR = 1.13, 95% CI = 1.07-1.19; p < 0.001). The magnitude of these relationships did not appreciably change, after adjustment for other variables associated with the outcomes. Moreover, the relationship was significant in those with or without OCD, and in individuals with different levels of doubt and COVID-19 risk.

CONCLUSIONS

Contamination safety measures are critical for reducing the spread of COVID-19 in the community. However, they may be related to the development of contamination-related symptoms and OCD in vulnerable individuals, complicating the diagnosis and treatment of mental disorders during this period.

Could technology enable individuals with schizophrenia to access health care? The case of Ecuador

Purpose

The purpose of this paper is to fill in the gaps in the literature regarding health-care access for individuals with schizophrenia, with a focus on Ecuador, and how technology can enable health-care access during the pandemic.

Design/methodology/approach

To achieve this aim, the author reviewed peer-reviewed articles in English and Spanish (using, among other sources, Medline and ProQuest), the Ecuadorian Constitution, law projects on mental health and suicide and government reports.

Findings

The consensus seems to be that the Ecuadorian health-care system has failed in its constitutional mandate to provide essential care for mentally ill patients, such as those suffering from schizophrenia. The data supporting the use of the internet and smartphone technology for delivering health services during the pandemic are extremely clear, but substantive governmental responses have been lacking.

Research limitations/implications

The major limitation of this study is the lack of data on schizophrenia in Ecuador and the use of technology.

Originality/value

This evaluation of the current literature on the effect of the pandemic on access to health care for patients suffering from mental illness is much-needed and should provide a welcome data source for research, practice and policymaking.

Trustworthiness appraisals of faces wearing a surgical mask during the Covid-19 pandemic in Germany: An experimental study

BACKGROUND

During the Covid-19 pandemic, the negative effects of wearing a mouth-nose cover (MNC) on interpersonal functioning have been discussed in public media but empirical studies on how wearing MNCs affect social judgements are sparse. In the present study, we investigated the effects of MNCs on trustworthiness appraisals, the influence of changes due to MNCs in evaluating joy, and the relationship between a social-cognitive appraisal bias and a participant's characteristics.

METHODS

All participants (N = 165) judged the intensity of happiness and trustworthiness in calm facial stimuli presented with and without a surgical mask covering part of the face. We analysed the relationship of changes in judgements evoked by MNCs to participants' evaluations of MNCs as protective tools and explored their associations with the burden experienced by wearing MNCs, compliance to behaviour recommendations, their risk associated with the pandemic, and their levels of psychological distress.

RESULTS

Overall, calm facial stimuli covered with MNCs were evaluated as less trustworthy and, to an even stronger extent, less happy than uncovered facial stimuli. However, participants varied in whether they showed a negative or positive evaluation of faces with MNCs; the negative bias was stronger in those participants who attributed lower protective potential to MNCs, experienced a higher burden while wearing MNCs, wore MNCs less often, and experienced a higher level of psychological distress.

CONCLUSIONS

A negative bias in trustworthiness appraisals of faces with a positive emotional expression covered by MNCs is linked to a participant's evaluation of MNCs as inefficient and burdening and their experience of high psychological distress.

Schizophrenia during the COVID-19 pandemic

PURPOSE OF REVIEW

The coronavirus disease 19 (COVID-19) pandemic is having a critical impact on healthcare systems across the world, as well as on mental health in the general population; however, evidence regarding the impact of the COVID-19 pandemic on people living with schizophrenia and on the onset of psychotic symptoms is currently emerging.

RECENT FINDINGS

People living with schizophrenia are at an increased risk of COVID-19 and present worse COVID-19-related outcomes, including mortality. They show low levels of information and of concern regarding the possibility of contagion and infection but presented substantially stable levels of psychotic symptoms and even increased subjective well being during the pandemic. SARS-CoV-2, as well as the prolonged social isolation and the spread of misinformation, appear to be responsible in some cases for the onset of psychotic symptoms.

SUMMARY

Clinicians should inform and educate their patients on the risks related to SARS-CoV-2 infection and COVID-19 and on the precautions that they should adopt to avoid contagion. Particular attention should be devoted to maintaining the continuity of care, especially in frail patients. Telemedicine might represent a valid support, but face-to-face visits in some cases remain essential. The hypothesis of a direct role of viral infection on the onset of psychotic disorders is currently debated, as viral involvement of central nervous system appears to be rather infrequent in COVID-19.

Impact of COVID-19 Confinement on Adolescent Patients with Anorexia Nervosa: A Qualitative Interview Study Involving Adolescents and Parents

COVID-19-related restrictions may have a serious impact on patients with eating disorders. We conducted semistructured interviews with female adolescent patients with anorexia nervosa (AN) (n = 13, 13-18 years) currently receiving inpatient or outpatient treatment and their parents (n = 10). We asked for their experiences during COVID-19 confinement regarding everyday life, AN symptoms, and treatment. We used thematic analysis to interpret the data. The main themes identified from the patients' interviews involved restrictions of personal freedom (i.e., leading to tension between patients and family members, reduced motivation to work on recovery), interruption of the treatment routine (emerging risks through self-monitored weight, challenges/opportunities of teletherapy), changes in AN symptoms (more exposure to triggering situations), COVID-19-related fears, and compulsions but also potential opportunities (less stress, better family relationships). The parents discussed changes in daily routines as negative (challenges in maintaining day structures) and positive (more family time, "slowing down"). They expressed reservations about reduced outpatient monitoring and increased teletherapy and discussed challenges in keeping contact with the child and clinicians during inpatient treatment. Moreover, the parents discussed deteriorations and improvements in the patients' psychopathology. Clinical implications from these in-depth insights include the importance of strengthening communication between changing staff cohorts, patients, and parents; motivational work; and joint weight monitoring with the therapist.

Psychopathological Impact and Resilient Scenarios in Inpatient with Schizophrenia Spectrum Disorders Related to Covid Physical Distancing Policies: A Systematic Review

The COVID-19 epidemic posed great challenges to the healthcare community. To contain the epidemiological emergency, confinement measures were instituted, affecting the entire population. The lack of social contact, as well as the disruption of daily life, caused the exacerbation of anxiety and depressive symptoms. The present review of the literature aims to investigate what the effects of the pandemic have been on patients with schizophrenia, hypothesizing, an exacerbation of psychotic symptomatology (positive, negative, disorganized symptoms). Between November 2020 and January 2021, 5353 articles were collected and analyzed from the databases of the ResearchGate, Pubmed, and Psycnet websites, subjected to PRISMA methodology. Of these, 11 were evaluated for eligibility, but only three were included in the study because they met all inclusion criteria. The research did not confirm the expected results, showing that any kind of worsening of schizophrenic symptomatology involved the study samples. However, interesting outcomes were highlighted, such as a significant increase in general well-being during the early period of the pandemic, especially by women, or an increase in CPR (C-reactive Protein) levels in the blood, signaling an inflammatory state. Although the systematic review refuted the initial hypothesis, this must be a starting point: the topic is recent and these findings leave ample room for further investigation, particularly in long-term longitudinal research. It is possible that the true response to this disruption of daily life that occurred only during the past year may manifest itself later in time. On the other hand, interesting outcomes have been brought to light that may provide further interesting research insights.

A Model of Stress Change under the First COVID-19 Pandemic among the General Public in Japanese Major Cities and Rural Areas

Research on stress related to the COVID-19 pandemic has been dominated by the cases of healthcare workers, students, patients, and their stress during the COVID-19 pandemic. This study examined the relationship between the amount of stress change under the COVID-19 pandemic and demographic factors (age, sex, occupation, etc.) in residents of a large city and a rural area of Japan. A total of 1331 valid responses were received in June 2020 from residents of Tokyo, Osaka, and Nagano registered with a private research firm. We were able to identify 15 statistically significant variables out of 36 explanatory variables, which explained the significant increase in stress compared to the pre-pandemic period. Multiple-factor analysis showed that the relationship with people is a more significant explanatory variable for the level of increase in stress than the difference in environment between big cities (Tokyo, Osaka) and rural areas (Nagano), the type of housing, and the decrease in income compared to the pre-pandemic period.

Covid-19 and Families With Parental Mental Illness: Crisis and Opportunity

The COVID-19 emergency has affected us all, but not equally. Families where parents have mental illness (PMI) are potentially at increased risk, but little is known about how they or their support services managed under lockdown/restrictions. We harnessed our existing partnerships with adult and child mental health services in the Republic of Ireland (RoI) and Northern Ireland (NI) to investigate the qualitative experiences of service users and families in coping during the first COVID-19 lockdown (March-May 2020), and how services were supporting them. Semi-structured phone/online interviews were conducted with 22 clinicians/managers (12 from RoI; 10 from NI) who provided information from their caseloads (~155 families with PMI). Sixteen family members (10 from RoI, 6 from NI) were also interviewed. Data were analysed using standard thematic analysis. Sixty percent of families reported improved mental health, primarily due to respite from daily stresses and the "normalisation" of mental distress in the general population. Approximately 30%, typically with more severe/enduring mental illness, reported additional challenges, and mental distress including: unmanageable child behaviours; fear of relapse/hospitalisation; financial difficulties; absence of child care; and a lack of routines. Service provision varied considerably across regions. The experiences within this case study highlight unique opportunities to address the multiple stresses of pre-emergency daily living. We also highlight how mental health services and governments might become more "pandemic ready" to more effectively support vulnerable families, including addressing service overload issues, optimising the use of digital technologies, and providing in-person contact and social supports where required.

Decreasing Psychiatric Emergency Visits, but Stable Addiction Emergency Visits, During COVID-19-A Time Series Analysis 10 Months Into the Pandemic

Background: The COVID-19 pandemic has been suspected to increase mental health problems, but also to possibly lead to a decreased treatment seeking, for example due to fear of attending hospital. Early findings demonstrate decreased treatment seeking for mental health, which may differ across diagnostic groups. This study aimed to examine treatment uptake at a general psychiatry emergency unit and at an addiction psychiatry emergency unit in Malmö, Sweden, separately. In addition, the study aimed to investigate treatment uptake for different diagnostic groups-during and prior to the COVID-19 pandemic. Methods: Monthly data for number of unique patients and number of contacts were extracted for the three-year period of January 2018 through December 2020. Data from each facility were analyzed separately for women, men and patients with psychotic, affective, anxiety and substance use-related disorders. Interrupted time series were used to demonstrate possible effects of COVID-19. Results: COVID-19 was associated with a marked decrease in treatment contacts, both for women and men, in the general psychiatry emergency unit-driven by a significant decrease in anxiety-related disorders (p < 0.001) and affective disorders (p < 0.01)-but not in psychotic or substance use disorders (SUDs). Also, in the addiction psychiatry emergency unit, no significant impact of COVID-19 was seen. Conclusions: COVID-19 may decrease treatment uptake for acute affective and anxiety-related disorders. Given the hypothesized increase in the population regarding these conditions, societal efforts are needed to facilitate adequate treatment for these patients during the COVID-19 pandemic. Society should also remain vigilant with respect to SUDs during the pandemic.

The Intersection Between Childhood Trauma, the COVID-19 Pandemic, and Trauma-related and Psychotic Symptoms in People With Psychotic Disorders

INTRODUCTION

People with psychotic disorders may be disproportionately affected by the traumatic effects of the COVID-19 pandemic. Childhood trauma, which also increases vulnerability to subsequent stressors, is common in individuals with psychosis. In this study, we investigated the intersection of the pandemic, childhood trauma, and psychotic and trauma-related symptoms in individuals with psychotic disorders.

METHODS

We administered a cross-sectional survey to 151 participants [47 schizophrenia (SZ), 53 psychotic bipolar disorder (BP)], 51 healthy control (HC)] during the COVID-19 pandemic. Participants were asked about exposure to the pandemic's impacts, childhood trauma, and post-traumatic stress, dissociative, and psychotic symptoms.

RESULTS

BP reported greater negative impacts to emotional health than SZ and HC and to non-COVID physical health than HC. SZ reported less impact on work and employment during the pandemic. There were no other group differences in pandemic-related adversities. We also found that cumulative exposure to the pandemic's negative impacts was significantly associated with PTSD symptoms but not psychotic or dissociative symptoms. Moreover, the number of adversities an individual experienced during the pandemic was strongly associated with the cumulative number of traumatic experiences they had in childhood.

DISCUSSION

Our results suggest that having a psychotic disorder does not, in and of itself, increase susceptibility to the pandemic's negative impacts. Instead, we provide evidence of a graded relationship between cumulative exposure to the pandemic's negative impacts and PTSD symptom severity, as well as a graded relationship between cumulative childhood traumatic experiences and the number pandemic adversities, across diagnoses.