Treatment, Persistent Symptoms, and Depression in People Infected with COVID-19 in Bangladesh

Long-term health sequelae and quality of life at least 6 months after infection with SARS-CoV-2: design and rationale of the COVIDOM-study as part of the NAPKON population-based cohort platform (POP)

Purpose

Over the course of COVID-19 pandemic, evidence has accumulated that SARS-CoV-2 infections may affect multiple organs and have serious clinical sequelae, but on-site clinical examinations with non-hospitalized samples are rare. We, therefore, aimed to systematically assess the long-term health status of samples of hospitalized and non-hospitalized SARS-CoV-2 infected individuals from three regions in Germany.

Methods

The present paper describes the COVIDOM-study within the population-based cohort platform (POP) which has been established under the auspices of the NAPKON infrastructure (German National Pandemic Cohort Network) of the national Network University Medicine (NUM). Comprehensive health assessments among SARS-CoV-2 infected individuals are conducted at least 6 months after the acute infection at the study sites Kiel, Würzburg and Berlin. Potential participants were identified and contacted via the local public health authorities, irrespective of the severity of the initial infection. A harmonized examination protocol has been implemented, consisting of detailed assessments of medical history, physical examinations, and the collection of multiple biosamples (e.g., serum, plasma, saliva, urine) for future analyses. In addition, patient-reported perception of the impact of local pandemic-related measures and infection on quality-of-life are obtained.

Results

As of July 2021, in total 6813 individuals infected in 2020 have been invited into the COVIDOM-study. Of these, about 36% wished to participate and 1295 have already been examined at least once.

Conclusion

NAPKON-POP COVIDOM-study complements other Long COVID studies assessing the long-term consequences of an infection with SARS-CoV-2 by providing detailed health data of population-based samples, including individuals with various degrees of disease severity.

Trial registration

Registered at the German registry for clinical studies (DRKS00023742).

Knowledge, attitudes and perceptions towards COVID-19 vaccinations: a cross-sectional community survey in Bangladesh

BACKGROUND

Several vaccines have been approved for use against coronavirus disease (COVID-19) and distributed globally in different regions. However, general community knowledge, attitudes and perceptions towards COVID-19 vaccinations are poorly understood. Thus, the study aimed to investigate community knowledge, attitudes and perceptions towards COVID-19 vaccinations in Bangladesh.

METHODS

An exploratory and anonymous population-based e-survey was conducted among 1658 general individuals (55.6% male; mean age = 23.17 ± 6.05 years; age range = 18-65 years). The survey was conducted using a semi-structured and self-reported questionnaire containing informed consent along with four sections (i.e., socio-demographics, knowledge, attitudes, and perceptions). Multiple linear regression was performed to determine the variables predicting knowledge, and attitudes towards COVID-19 vaccinations.

RESULTS

The mean scores of knowledge and attitudes were 2.83 ± 1.48 (out of 5) and 9.34 ± 2.39 (out of 12) respectively. About a quarter of participants thought that the COVID-19 vaccination available in Bangladesh is safe, only 60% will have the vaccination and about two-thirds will recommend it to family and friends. In the multiple regression model, higher SES, having university/ higher levels of education, having nuclear families and having previous history of essential vaccines uptake were associated with knowledge; whilst attitudes were significantly associated with being female and having previous history of essential vaccines uptake. Just over half of the participants thought that everyone should be vaccinated and 61% responded that health workers should be vaccinated first on priority basis. 95% of respondents believed the vaccine should be administered free of charge in Bangladesh and almost 90% believed that the COVID-19 vaccine used in Bangladesh may have side effects.

CONCLUSIONS

The findings reflect inadequate knowledge but more positive attitudes towards COVID-19 vaccine among the general population in Bangladesh. In order to improve knowledge, immediate health education programs need to be initiated before mass vaccination are scheduled.

COVID-19-specific diabetes worries amongst diabetic patients: The role of social support and other co-variates

BACKGROUND

The COVID-19 pandemic has impacted every individual's life. It has been shown that mortality in people with underlying diseases including diabetes has been very high. The present study aimed to measure diabetes related worries (outcome) and their associations with social support and lifestyle (exposures) amongst people with diabetes during the COVID-19 pandemic.

METHODS

An online cross-sectional survey was completed by 928 respondents (>18 years) between 15-11-2020 and 12-12-2020. The questionnaire comprised four sections: socio-demographic details, diabetic-related worries, social support, and behavioral changes due to COVID-19. Descriptive statistics, correlations and hierarchical regression analysis were performed in the study.

RESULTS

Data from 928 respondents (51.61% male; mean age = 52.48 [SD = 11.76]; age range = 18-86 years) were analyzed. The mean score for COVID-19 specific diabetes worries was 3.13 out of 8. Hierarchical regression analysis showed that the mean COVID-19-specific diabetes worries score was significantly associated with lower age, cigarette smoking, perceived poor health status, presence of other diabetic complications. Lack of social support from family, friends, work colleagues and diabetes care team and also eating more than usual were also significantly associated with COVID-19 specific diabetes worry.

CONCLUSIONS

Diabetes related worries were strongly associated with a lack of social support during the COVID-19 pandemic. The findings suggest the need of social support as well as improving knowledge and guidelines is important for people with diabetes during the COVID-19 pandemic.

Depression and anxiety among individuals with medical conditions during the COVID-19 pandemic: Findings from a nationwide survey in Bangladesh

BACKGROUND

Coronavirus disease 2019 (COVID-19) disproportionately impacts individuals with medical conditions, including with respect to their mental health. The present study investigated depression and anxiety and their correlates among individuals with medical conditions in Bangladesh.

METHODS

Subjects were recruited to participate in an internet-based survey. Data were collected from November 2020 to January 2021 using convenience sampling by a semi-structured questionnaire through online platforms. Multiple regression analyses were performed to determine associations applying Bonferroni correction (p < 0.004). The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) measured depression and anxiety, respectively.

RESULTS

Nine-hundred-and-seventy-one participants (50.1% male; mean age = 42.29 ± 15.86 years; age range = 18-80 years) with medical conditions were included in final analyses. The most frequently reported conditions were diabetes, hypertension, obesity, heart disease, asthma, and anemia. Estimates of moderate to severe depression and anxiety were 38.9% and 35.2%, respectively. The mean depression and anxiety scores were significantly higher among participants who reported having hypertension, obesity, heart disease, asthma, anemia, cancer and chronic obstructive pulmonary disease (COPD). Using Bonferroni correction (p < 0.004), depression was associated with being female and a student, having poorer quality of life, poorer health status and greater numbers of co-morbidities, not engaging in physical exercise and tobacco smoking. Anxiety was associated with being female and a student, having lower socioeconomic status, poorer quality of life, poorer health status and greater numbers of co-morbidities, less sleep and tobacco smoking.

CONCLUSIONS

Depression and anxiety are prevalent among individuals with medical conditions and correlate with sociodemographic, quality-of-life and smoking measures. Interventions targeting vulnerable groups should be employed and investigated.

Insufficient Physical Activity and Sedentary Behaviors among Medical Students during the COVID-19 Lockdown: Findings from a Cross-Sectional Study in Pakistan

Background: The unprecedented COVID-19 pandemic has resulted in social distancing and isolation which leads to insufficient physical activity and thereby increases sedentary behaviors. Hence, this study aimed to assess the prevalence of insufficient physical activity and sedentary behaviors among medical students during the COVID-19 lockdown in Pakistan, and to determine their associated factors. Methods: A cross-sectional online survey was carried out among 407 medical students from the Punjab and Sindh provinces between May and June 2020. To collect data, an e-questionnaire was sent to obtain informed consent along with questions concerning socio-demographics as well as an International Physical Activity Questionnaires–Short Form (IPAQ–SF). Results: As per the IPAQ, almost five in ten participants were physically inactive (48.2%), and 45.2% reported sedentary behaviors. Participants with insufficient physical activity were more likely to report sedentary behaviors than their counterparts (AOR = 2.53; 95% CI = 1.66–3.85, p < 0.001). The odds of insufficient physical activity were higher among the participants who did not strictly follow the COVID-19 preventive measures (AOR = 2.51; 95% CI = 1.35–4.69, p = 0.004); similarly, there were increased odds of sedentary behaviors observed among participants within a normal weight range compared to those who were underweight (AOR = 2.69; 95% CI = 1.76–4.11, p < 0.001). Conclusions: Insufficient physical activity and sedentary behavior are prevalent among medical students in Pakistan during the COVID-19 pandemic. These findings indicate the importance of establishing tailored policies and programs to encourage young adults to engage in physical activity.

Post-COVID syndrome. A case series and comprehensive review

The existence of a variety of symptoms with a duration beyond the acute phase of COVID-19, is referred to as post-COVID syndrome (PCS). We aimed to report a series of patients with PCS attending a Post-COVID Unit and offer a comprehensive review on the topic. Adult patients with previously confirmed SARS-CoV-2 infection and PCS were systematically assessed through a semi-structured and validated survey. Total IgG, IgA and IgM serum antibodies to SARS-CoV-2 were evaluated by an electrochemiluminescence immunoassay. A systematic review of the literature and meta-analysis were conducted, following PRISMA guidelines. Univariate and multivariate methods were used to analyze data. Out of a total of 100 consecutive patients, 53 were women, the median of age was 49 years (IQR: 37.8–55.3), the median of post-COVID time after the first symptoms was 219 days (IQR: 143–258), and 65 patients were hospitalized during acute COVID-19. Musculoskeletal, digestive (i.e., diarrhea) and neurological symptoms including depression (by Zung scale) were the most frequent observed in PCS patients. A previous hospitalization was not associated with PCS manifestation. Arthralgia and diarrhea persisted in more than 40% of PCS patients. The median of anti-SARS-CoV-2 antibodies was 866.2 U/mL (IQR: 238.2–1681). Despite this variability, 98 patients were seropositive. Based on autonomic symptoms (by COMPASS 31) two clusters were obtained with different clinical characteristics. Levels of anti-SARS-CoV-2 antibodies were not different between clusters. A total of 40 articles (11,196 patients) were included in the meta-analysis. Fatigue/muscle weakness, dyspnea, pain and discomfort, anxiety/depression and impaired concentration were presented in more than 20% of patients reported. In conclusion, PCS is mainly characterized by musculoskeletal, pulmonary, digestive and neurological involvement including depression. PCS is independent of severity of acute illness and humoral response. Long-term antibody responses to SARS-CoV-2 infection and a high inter-individual variability were confirmed. Future studies should evaluate the mechanisms by which SARS-CoV-2 may cause PCS and the best therapeutic options.

["Coronasomnia"-promoting resilience through insomnia treatment]

Hintergrund

Der Begriff „Coronasomnia“ beschreibt populärwissenschaftlich Schlafstörungen, die im Zusammenhang mit der COVID-19-Pandemie in Erscheinung treten. Diese können auch im Anschluss der Pandemie einen Teil der Bevölkerung betreffen. Erste wissenschaftliche Hinweise deuten darauf hin, dass durch die Pandemie entstandene Insomniebeschwerden sich nach dem Ende der Pandemie chronifizieren und somit die schlafmedizinische Gemeinschaft weiterhin beschäftigen werden.

Methoden

Es wurde eine orientierende Literaturrecherche in Medline und Google Scholar mit folgender Kombination an Keywords durchgeführt: „Insomnia and COVID-19“; „Insomnia and Long-COVID“; „Insomnia, PTSD and COVID-19“; „Fatigue and Insomnia in Long-COVID“. Darüber hinaus lagen den Autoren mehrere kürzlich erschienene Artikel vor, welche durch Mitglieder des „European Insomnia Network“ veröffentlicht wurden.

Ergebnisse

Studien zu dem Thema Insomnie und COVID-19 zeigen signifikante Assoziationen zwischen akuter Infektion und Insomnie bei betroffenen Personen. Die Prävalenz von Insomniesymptomen bei Personen mit COVID-19 lag bei 36–88 % und somit deutlich über die Prävalenz in der Bevölkerung mit 10–40 %.

Fazit

Digitale Therapieangebote als aktuelle Behandlungsmöglichkeit von Insomnie können Patienten unabhängig von der räumlichen Entfernung angeboten werden. Demnach wäre nicht nur eine baldige Zulassung von mobilen Therapieapplikationen, sondern auch von personengeleiteten, digitale Therapieangeboten für Insomnie zu empfehlen. Die Aufnahme personalisierter und schlafedukativer Maßnahmen im Bereich des betrieblichen Gesundheitsmanagements wird nahegelegt.

Financial and Mental Health Concerns of Impoverished Urban-Dwelling Bangladeshi People During COVID-19

Background: The COVID-19 pandemic has impacted the physical, mental and financial health of many individuals. Individuals living in impoverished crowded settings may be particularly vulnerable to COVID-19-related stressors. How substantially marginalized groups like impoverished urban-dwelling individuals have been impacted during this pandemic is poorly understood. The present study aimed to investigate the associated factors of financial concerns and symptoms of depression and posttraumatic stress disorder (PTSD) during the COVID-19 pandemic among impoverished urban-dwelling individuals residing in Dhaka, Bangladesh. Methods: A cross-sectional survey was conducted between August and September 2020 using face-to-face interviews in six disadvantaged neighborhoods ("slums") in Dhaka. Individuals were interviewed using a semi-structured questionnaire consisting of questions assessing socio-demographics, lifestyle, financial well-being relating to the COVID-19 pandemic, depression, and PTSD. Results: Four-hundred-and-thirty-five individuals (male = 54.7%; mean age = 45.0 ± 12.0 years; age range = 18-85 years) participated. Most (96.3%) reported that their household income decreased due to the COVID-19 pandemic. Factors associated with decreased household incomes included female gender, primary education, joblessness, food scarcity and depression. Depression symptoms were linked to female gender, joblessness, divorce, living in a joint family, excessive sleep and smoking. Low incomes, excessive sleep, joblessness and food scarcity were positively associated with PTSD symptoms. In contrast, less sleep appeared protective against PTSD. Conclusions: Public health initiatives, in particular mental health services that target stress and biocentric approaches that consider how humans interact with multiple facets of nature, should be introduced to mitigate against potential financial and psychological effects of the pandemic on impoverished urban-dwelling individuals in Bangladesh.

A systematic review of neuropsychological and psychiatric sequalae of COVID-19: implications for treatment

PURPOSE OF REVIEW

COVID-19 impacts multiple organ systems and is associated with high rates of morbidity and mortality. Pathogenesis of viral infection, co-morbidities, medical treatments, and psychosocial factors may contribute to COVID-19 related neuropsychological and psychiatric sequelae. This systematic review aims to synthesize available literature on psychiatric and cognitive characteristics of community-dwelling survivors of COVID-19 infection.

RECENT FINDINGS

Thirty-three studies met inclusion/exclusion criteria for review. Emerging findings link COVID-19 to cognitive deficits, particularly attention, executive function, and memory. Psychiatric symptoms occur at high rates in COVID-19 survivors, including anxiety, depression, fatigue, sleep disruption, and to a lesser extent posttraumatic stress. Symptoms appear to endure, and severity of acute illness is not directly predictive of severity of cognitive or mental health issues. The course of cognitive and psychiatric sequelae is limited by lack of longitudinal data at this time. Although heterogeneity of study design and sociocultural differences limit definitive conclusions, emerging risk factors for psychiatric symptoms include female sex, perceived stigma related to COVID-19, infection of a family member, social isolation, and prior psychiatry history.

SUMMARY

The extant literature elucidates treatment targets for cognitive and psychosocial interventions. Research using longitudinal, prospective study designs is needed to characterize cognitive and psychiatric functioning of COVID-19 survivors over the course of illness and across illness severity. Emphasis on delineating the unique contributions of premorbid functioning, viral infection, co-morbidities, treatments, and psychosocial factors to cognitive and psychiatric sequelae of COVID-19 is warranted.

Characteristics and predictors of acute and chronic post-COVID syndrome: A systematic review and meta-analysis

BACKGROUND

A significant proportion of individuals experience lingering and debilitating symptoms following acute COVID-19 infection. The National Institute for Health and Care Excellence (NICE) have coined the persistent cluster of symptoms as post-COVID syndrome. This has been further sub-categorised into acute post-COVID syndrome for symptoms persisting three weeks beyond initial infection and chronic post-COVID syndrome for symptoms persisting beyond twelve weeks. The aim of this review was to detail the prevalence of clinical features and identify potential predictors for acute and chronic post-COVID syndrome.

METHODS

A systematic literature search, with no language restrictions, was performed to identify studies detailing characteristics and outcomes related to survivorship of post-COVID syndrome. The last search was performed on 6 March 2021 and all pre-dating published articles included. A means of proportion meta-analysis was performed to quantify characteristics of acute and chronic post-COVID syndrome. Study quality was assessed with a specific risk of bias tool. PROSPERO Registration: CRD42020222855.

FINDINGS

A total of 43 studies met the eligibility criteria; of which, 38 allowed for meta-analysis. Fatigue and dyspnoea were the most prevalent symptoms in acute post-COVID (0·37 and 0·35) and fatigue and sleep disturbance in chronic post-COVID syndrome (0·48 and 0·44), respectively. The available evidence is generally of poor quality, with considerable risk of bias, and are of observational design.

INTERPRETATION

In conclusion, this review highlights that flaws in data capture and interpretation, noted in the uncertainty within our meta-analysis, affect the applicability of current knowledge. Policy makers and researchers must focus on understanding the impact of this condition on individuals and society with appropriate funding initiatives and global collaborative research.

Depressive symptoms associated with COVID-19 preventive practice measures, daily activities in home quarantine and suicidal behaviors: Findings from a large-scale online survey in Bangladesh

BACKGROUND

The world is facing a public health emergency situation caused by the COVID-19 pandemic. Psychological wellbeing among individuals worldwide has been negatively affected by the pandemic especially in low- and middle-income countries such as Bangladesh. The present study aimed to assess the estimate of depressive symptoms and investigated its associations with COVID-19 preventive practice measures, daily activities in home quarantine, and suicidal behaviors in a large-scale Bangladeshi online survey.

METHODS

An online-based cross-sectional survey was widely distributed to Bangladeshi citizens. A total of 13,654 participants (61.0% male; mean age = 24.0 years [SD = 6.0]; age range 18-65 years) completed the survey between May and June (2020). The survey included socio-demographics and COVID-19-related questions, along with lifestyle, suicidal, and psychometric measures. Hierarchical regression was performed to determine significant associations between depression and examined variables.

RESULTS

The estimate of depressive symptoms during the COVID-19 pandemic was 43.5%. Based on hierarchical regression analysis, depression was significantly associated with not engaging in COVID-19 preventive measures, daily activities in home quarantine (e.g., playing videogames), and suicidal behaviors.

CONCLUSIONS

Depressive symptoms appeared to be high during the COVID-19 pandemic in Bangladesh. To fight against the pandemic, mental health issues as well as physical health issues need to be taken into consideration.

Prevalence and correlates of anxiety and depression in frontline healthcare workers treating people with COVID-19 in Bangladesh

BACKGROUND

Healthcare workers (HCWs) who are in the frontline during the COVID-19 pandemic are often under significant pressures that may predispose them to symptoms of poor mental health. This study aimed to investigate the prevalence of anxiety and depression among HCWs and factors correlated with mental health concerns during the COVID-19 pandemic in Bangladesh. And, it also aimed to evaluate the psychometric properties of the Bangla version of the Hospital Anxiety and Depression Scale (HADS).

METHODS

A cross-sectional survey was conducted between July and August, 2020. A self-reported online questionnaire was utilized to collect data. The survey included questions concerning socio-demographic, lifestyle, and work setting, as well as the HADS. A confirmatory factor analysis (CFA) and multiple linear regression analysis were performed.

RESULTS

Data from 803 HCWs (50.7% male; mean age: 27.3 [SD = 6.9]; age range: 18-58 years) were included in the final analysis. The Bangla HADS was psychometrically sound, and demonstrated good internal consistency and reliability (α = 0.83), and excellent construct validity. Prevalence estimates of anxiety and depression were 69.5%, and 39.5%, respectively, for less severe symptomology (at least borderline abnormal), and 41.2% and 15.7% for more severe (at least abnormal) symptomology. Regression analyses with the total HADS score as a dependent variable revealed significant (p < 0.05) associations with female gender, moderate and poor health status, infrequent physical exercising, smoking, having had regrets about one's profession because of the pandemic and associated experiences, not updating on the latest COVID-19-related research, experiencing discrimination in the workplace, and facing social problems due to working in a lab or hospital during the COVID-19 pandemic.

CONCLUSIONS

Symptoms of anxiety and depression are prevalent among HCWs during the COVID-19 pandemic in Bangladesh. The findings suggest a need for screening for mental health concerns, and employing early intervention to help these individuals.

Long-COVID Syndrome? A Study on the Persistence of Neurological, Psychological and Physiological Symptoms

BACKGROUND

Emerging aspects of the Covid-19 clinical presentation are its long-term effects, which are characteristic of the so-called "long COVID". The aim of the present study was to investigate the prevalence of physical, psychological, and sleep disturbances and the quality of life in the general population during the ongoing pandemic.

METHODS

This study, based on an online survey, collected demographic data, information related to COVID-19, sleep disturbances, and quality of life data from 507 individuals. The level of sleep disturbances and quality of life was assessed through the Insomnia Severity Index (ISI) and the EuroQol-5D (EQ-5D), respectively.

RESULTS

In total, 507 individuals (M = 91 and F = 416 women) completed the online survey. The main symptoms associated with "long COVID" were headache, fatigue, muscle aches/myalgia, articular pains, cognitive impairment, loss of concentration, and loss of smell. Additionally, the subjects showed significant levels of insomnia (p < 0.05) and an overall reduced quality of life (p < 0.05).

CONCLUSIONS

The results of the study appear in line with recent publications, but uncertainty regarding the definition and specific features of "long COVID" remains. Further studies are needed in order to better define the clinical presentation of the "long COVID" condition and related targeted treatments.

Post-COVID-19 Syndrome: The Persistent Symptoms at the Post-viral Stage of the Disease. A Systematic Review of the Current Data

Whilst the entire world is battling the second wave of COVID-19, a substantial proportion of patients who have suffered from the condition in the past months are reporting symptoms that last for months after recovery, i. e., long-term COVID-19 symptoms. We aimed to assess the current evidence on the long-term symptoms in COVID-19 patients. We did a systematic review on PubMed, Web of Science, EMBASE, and Google Scholar from database inception to February 15, 2021, for studies on long-term COVID-19 symptoms. We included all type of papers that reported at least one long-term COVID-19 symptom. We screened studies using a standardized data collection form and pooled data from published studies. Cohort cross-sectional, case-report, cases-series, case-control studies, and review were graded using specific quality assessment tools. Of 11,361 publications found following our initial search we assessed 218 full-text articles, of which 145 met all selection criteria. We found that 20.70% of reports on long-term COVID-19 symptoms were on abnormal lung functions, 24.13% on neurologic complaints and olfactory dysfunctions, and 55.17% on specific widespread symptoms, mainly chronic fatigue, and pain. Despite the relatively high heterogeneity of the reviewed studies, our findings highlighted that a noteworthy proportion of patients who have suffered from SARS-CoV-2 infection present a "post-COVID syndrome." The multifaceted understanding of all aspects of the COVID-19 pandemic, including these long-term symptoms, will allow us to respond to all the global health challenges, thus paving the way to a stronger public health.

Problematic Smartphone and Social Media Use Among Bangladeshi College and University Students Amid COVID-19: The Role of Psychological Well-Being and Pandemic Related Factors

Background: Smartphone and social media use are an integral part of our daily life. Currently, the impact of excessive smartphone and social media use during the COVID-19 pandemic is poorly understood. The present study aimed to investigate problematic smartphone use (PSPU) and problematic social media use (PSMU) among Bangladeshi college and university students during the COVID-19 pandemic. Methods: A cross-sectional study was carried out involving 5,511 Bangladeshi college and university students (male: 58.9%; mean age: 21.2 years [SD = 1.7]; age range: 18-25) during the social-distancing in the COVID-19 pandemic (July 2020). A self-reported survey containing questions regarding socio-demographic, lifestyle, and home quarantine activities along with four psychometric scales was completed by participants. Results: The mean scores of PSPU and PSMU were 20.8 ± 6.8 (out of 36) and 14.7 ± 4.8 (out of 30). Based on a hierarchical regression analysis, PSPU and PSMU were positively associated with lower age, poor sleep, social media use, watching television, anxiety, and depression. Additionally, PSMU was linked to being female, living with nuclear family, having urban residence, irregular physical exercise, poor engagement with academic studies, and avoiding earning activities, whilst being male, being married, living with lower-income family, and alcohol consumption were linked to PSMU. Conclusions: The findings indicate that PSPU and PSMU were linked to poor psychological well-being (i.e., anxiety and depression) and other factors (especially lower age, poor sleep) during the pandemic, further suggesting the need for interventions including virtual awareness programs among college and university students.

The Effect of Self-Disclosure on Loneliness in Adolescents During COVID-19: The Mediating Role of Peer Relationships

Long-term home isolation has had a certain impact on adolescents' enthusiasm for interpersonal communication and desire for self-disclosure during COVID-19. The purpose of this study was to explore the relationship between adolescents' self-disclosure and loneliness during COVID-19, and to analyze the mediating role of peer relationship in it. We conducted a cross-sectional study involving 830 Chinese adolescents (males: 47.5%, Mage14.25 years; females: 52.05%, Mage 14.19 years; Age range 12-15). Participants completed a self-reported survey that included sociodemographic, Jourard Self-Disclosure Scale, UCLA, and Peer Relationship Scale. The results showed that in the period of COVID-19, adolescents' self-disclosure affects loneliness through peer relationship, that is, the level of self-disclosure can significantly predict loneliness through peer relationship, and peer relationship plays a complete mediating role.

Exploring the Neuropsychiatric Sequalae of Perceived COVID-19 Exposure in College Students: A Pilot Digital Phenotyping Study

The urgency to understand the long-term neuropsychiatric sequala of COVID-19, a part of the Post-Acute COVID-19 Syndrome (PACS), is expanding as millions of infected individuals experience new unexplained symptoms related to mood, anxiety, insomnia, headache, pain, and more. Much research on PACS involves cross sectional surveys which limits ability to understand the dynamic trajectory of this emerging phenomenon. In this secondary analysis, we analyzed data from a 4-week observational digital phenotyping study using the mindLAMP app for 695 college students with elevated stress who specified if they were exposed to COVID-19. Students also completed a biweekly survey of clinical assessments to obtain active data. Additionally, passive data streams like GPS, accelerometer, and screen state were extracted from phone sensors and through features the group built. Three hundred and eighty-second number participants successfully specified their COVID-19 exposure and completed the biweekly survey. From active smartphone data, we found significantly higher scores for the Prodromal Questionnaire (PQ) and the Pittsburgh Sleep Quality Index (PSQI) for students reporting exposure to COVID-19 compared to those who were not (ps < 0.05). Additionally, we found significantly decreased sleep duration as captured from the smartphone via passive data for the COVID-19 exposed group (p < 0.05). No significant differences were detected for other surveys or passive sensors. Smartphones can capture both self-reported symptoms and behavioral changes related to PACS. Our results around changes in sleep highlight how digital phenotyping methods can be used in a scalable and accessible manner toward better capturing the evolving phenomena of PACS. The present study further provides a foundation for future research to implement improving digital phenotyping methods.

Psychological states of Bangladeshi people and associated factors during the outbreak of COVID-19: A cross-sectional survey

COVID-19 is imposing an extremely serious challenge to individuals' physical and mental health. The enforcement of lockdown, restriction on public gathering, social distancing strategy, and unprecedented quarantine measures has affected many aspects of peoples' lives in Bangladesh with potential consequences on their mental and physical health. This study aimed to assess the psychological states and their related factors among general people in Bangladesh during the COVID-19 outbreak. An e-questionnaire-based cross-sectional survey was conducted among 565 Bangladeshi general people between April and May, 2020. Measures included socio-demographics, chronic disease-related variables, the Self-Rating Depression Scale (SDS), and the Self-Rating Anxiety Scale (SAS). Descriptive analysis and bivariate linear regression with "depression" and "anxiety" as the dependent variables were carried out to identify the factors associated with these. Results showed that 30.1% and 32.6% of participants had mild to extremely severe levels of anxiety and depression, respectively. Females were 2.3 (OR = 2.26; 95% CI = 1.58-3.25, p < 0.001) and 2.2 (OR = 2.19; 95% CI = 1.51-3.16, p < 0.001) times more likely to have depression and anxiety, respectively compared to males. In contrast, the odds of depression and anxiety were 2.9 (OR = 2.85; 95% CI = 1.66-4.90, p < 0.001) and 2.0 (OR = 2.00; 95% CI = 1.20-3.36, p = 0.008) times higher, respectively among individuals aged above 40 years than those aged between 18-40 years. The healthcare authority should take necessary steps considering the psychological problems of the general people during the health emergency.