On the Nature of Fear and Anxiety Triggered by COVID-19

Mental health and illness of medical students and newly graduated doctors during the pandemic of SARS-Cov-2/COVID-19

Introduction: SARS-Cov-2 virus pandemic causes serious emotional consequences. It has occurred widespread medical courses suspension, and graduations were anticipated. Field hospitals, set up to treat patients with mild to moderate COVID-19, were the main workplaces of newly graduated doctors. Objective: To assess the impact of SARS-Cov-2/COVID-19 pandemic on mental health of medical interns and newly graduated doctors. Method: This is a cross-sectional study performed using a digital platform. Links to forms were sent in two moments: moment 1 (M1), at the beginning of the pandemic, in the first half of April/2020 and moment 2 (M2), after six months of pandemic, in the second half of September/2020. All students from the medical internship and all doctors graduated since 2018 from the three medical schools in Sergipe-NE-Brazil were invited. Results: 335 forms were answered in April and 148 in September. In M1 88.9% considered themselves exposed to excess of information about COVID-19, which was associated with anxiety symptoms (p = 0.04). Long family physical distance was also associated with these symptoms, as increased appetite (p = 0.01), feeling shortness of breath (p = 0.003) and sweating (p = 0.007). Fear of acquire COVID-19 was reported as intense by almost half of participants, and of transmitting by 85.7% in M1. In M2 41.2% reported the death of friends or relatives. Psychiatric illness was described by 38.5% and psychotropic drugs use by 30.1% in M1, especially those who lived alone (p = 0.03) and the single ones (p = 0.01). Alcohol intake was reported by 54.3%, and among doctors graduated in 2020 it increased from 50% in M1 to 85% in M2 (p = 0.04). Conclusion: The pandemic had a negative impact on the mental health of medical students and newly graduated doctors. Exposure to excessive COVID-19 information and family physical distance were associated to anxiety symptoms. Among doctors graduated in 2020, alcohol intake increased during pandemic evolution.

COVID-19: reflections on providing dysphagia care in a Boston hospital

PURPOSE OF REVIEW

Coronavirus Disease-19, (COVID-19) has challenged the customary practice of speech language pathologists (SLPs) in the acute care hospital arena, particularly in patients with swallowing disorders.

RECENT FINDINGS

In this article, we present themes that emerged from qualitative interviews in which 15 SLPs in a tertiary academic medical center in Boston share their clinical experience caring for over 500 patients with COVID-19: triumphs, concerns, and fears.

SUMMARY

The broad themes addressed include adapting to practice laced with fear and uncertainty about safety for themselves and their decision making, coming to terms with disparate and unpredictable clinical presentation, teamwork and collaboration and relationships with their patients despite physical and language barriers.

Predictors of Mental Health after the First Wave of the COVID-19 Pandemic in Poland

The aim of the article is to determine the predictors of mental health among Polish society. Research was conducted after the first wave of the pandemic. Due to such an approach, it was possible to determine whether the secondary effects of the pandemic have impacted on mental health, in addition to socio-demographic and psychological factors. In order to gather the research material, the CAWI on-line survey method was applied and carried out within the framework of the Ariadna Research Panel on a sample of 1079 Poles, aged 15 and over. The FCV-19S scale, which is used to measure the fear of COVID-19 was applied in the measurement. It is a verified diagnostic instrument used to measure mental health across a range of countries. The results of a hierarchical regression analysis have shown that the factors which increase the level of fear of COVID-19 are demographic, social and psychological features, as well as attitudes towards the pandemic. The results of research indicate the significance of social context in the analysis, and contribute to the explanation of the effects of disasters and cataclysms.

Can Psychological Empowerment Prevent Emotional Disorders in Presence of Fear of COVID-19 in Health Workers? A Cross-Sectional Validation Study

The global emergency produced by COVID-19 has been a turning point for health organizations. Healthcare professionals have been exposed to high levels of stress and workload. Close contact with infected patients and the infectious capacity of COVID-19 mean that this group is especially vulnerable to contagion. In various countries, the Fear of COVID-19 Scale has been shown to be a fast and reliable tool. Early detection of fear complements clinical efforts to prevent emotional disorders. Thus, concepts focused on positive occupational health, such as Job Crafting or psychological empowerment (PE), have been examined as a tool to prevent mental health problems at work. In this work, we intended to adapt and validate the 7-item Fear of COVID-19 Scale in health workers (N = 194). The interpretation of the measurement model indicates adequate values of internal consistency reliability, and convergent and discriminant validity. The overall goodness of fit of the model was also adequate. The structural model indicates that the implementation of job crafting measures in health services leads to workers’ greater PE. High levels of anxiety and depression prevent health professionals from psychologically detaching from work. In turn, PE can reduce the emotional disorders caused by the fear of COVID-19.

COVID-19 Protective Behaviors Are Forms of Prosocial and Unselfish Behaviors

The aim of this study was to explore the effects of prosocial and antisocial personality tendencies and context-related state factors on compliance with protective behaviors to prevent the spread of coronavirus infections. Six types of prosocial tendencies (altruism, dire, compliant, emotional, public, and anonymous) and selfishness as the antisocial tendency were included as personality factors, while fear related to the pandemic and empathy toward vulnerable groups (i.e., those in forced isolation) were context-related factors. Furthermore, mediation effect of empathy and moderation effect of fear were explored in relations between personality factors and protective behaviors. The sample included 581 participants (78.3% females). The data were collected from March 28 to April 6, 2020, during the emergency state and curfew in Serbia. The results showed that tendency to help anonymously had a positive effect and selfishness had a negative effect on protective behaviors, over and above demographic characteristics and context-related factors. Among context-related factors, only fear related to the pandemic had a significant unique positive effect on protective behaviors, but it had no moderator effect in the relationship between personality traits and protective behaviors. However, empathy acted as a mediator and partly accounted for the negative effect of selfishness and positive effect of tendency to help anonymously on protective behaviors. The results revealed that compliance with protective measures could be seen as prosocial and unselfish form of behavior. Furthermore, these findings have practical implications for shaping public messages and they can help effectively promote health-responsible behaviors.

The Sum of Fears in Cancer Patients Inside the Context of the COVID-19

The pandemic resulting from COVID-19 has led to the collapse of the health system in dozens of countries. Parallel to clinical risk, the appearance or intensification of psychiatric symptoms has also been documented. The identification of groups at risk is essential for the establishment of preventive and therapeutic strategies. Cancer patients appear to be especially vulnerable both from a clinical and psychiatric perspective. Problems related to contamination and the cancer treatments themselves are intertwined, causing a sum of patients' fears to arise, which can cause mental effects. This study aims to review and investigate the impact of COVID-19 on the mental health of cancer patients and indicate possible support strategies.

Individual and community psychological experiences of the COVID-19 pandemic: The state of emergency in Portugal

Individuals have different ways of coping with crisis. Individual factors, family and contextual features, and community support may influence how individuals feel, think and act during a crisis. COVID-19 was an unexpected pandemic that forced many European countries to take confinement measures and restrict social face to face interactions. This study is an effort to understand how Portuguese residents dealt with the pandemic during the first confinement period, considering different sociodemographic characteristics and trauma exposure perceptions. Five hundred and five adults, between 18 and 79 years old participated in this study via an online self-report assessment protocol. Sociodemographic characteristics such as gender, age, marital status, employment status, and caring responsibilities had an impact on individuals' perceptions regarding their exposure to the pandemic and their quality of life. Perceived exposure to the pandemic was found to predict quality of life in the physical, psychological, and environmental domains. Results have practical implications for European and local policy-making, as well as for targeting psychological interventions for those whose mental health has been negatively affected by the pandemic and for those who may become more affected if confinement measures are implemented again.

A chain mediation model on COVID-19 symptoms and mental health outcomes in Americans, Asians and Europeans

The novel Coronavirus-2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) in March 2020, impacting the lifestyles, economy, physical and mental health of individuals globally. This study aimed to test the model triggered by physical symptoms resembling COVID-19 infection, in which the need for health information and perceived impact of the pandemic mediated the path sequentially, leading to adverse mental health outcomes. A cross-sectional research design with chain mediation model involving 4612 participants from participating 8 countries selected via a respondent-driven sampling strategy was used. Participants completed online questionnaires on physical symptoms, the need for health information, the Impact of Event Scale-Revised (IES-R) questionnaire and Depression, Anxiety and Stress Scale (DASS-21). The results showed that Poland and the Philippines were the two countries with the highest levels of anxiety, depression and stress; conversely, Vietnam had the lowest mean scores in these areas. Chain mediation model showed the need for health information, and the perceived impact of the pandemic were sequential mediators between physical symptoms resembling COVID-19 infection (predictor) and consequent mental health status (outcome). Excessive and contradictory health information might increase the perceived impact of the pandemic. Rapid COVID-19 testing should be implemented to minimize the psychological burden associated with physical symptoms, whilst public mental health interventions could target adverse mental outcomes associated with the pandemic.

Keep Calm and Stay Safe: The Relationship between Anxiety and Other Psychological Factors, Media Exposure and Compliance with COVID-19 Regulations

The COVID-19 pandemic has led many countries to employ public health regulations to achieve behavioral change and stop the transmission of the virus. The factors influencing compliance with these regulations may differ from "classic" predictors for medical compliance. This study attempted to assess the effect of social communication and psychological factors on intention to comply. A cross-sectional online survey was conducted on healthy adults living in Israel (n = 697). The survey assessed the intention to comply with the state COVID-19 regulations and explored possible correlations with demographic and psychosocial factors. Data were collected during May 2020 using a Qualtrics online survey. Data were analyzed to find correlations between anxiety, uncertainty, media exposure and other variables and the level of intention to comply as self-reported. Moderation and mediation effects were studied by an integrative model of influencing factors. We found that media exposure change, trust in responsible agencies and anxiety were positively correlated with compliance, while uncertainty was correlated with noncompliance. The effect of media exposure on compliance had two components. First, media exposure was positively correlated with compliance. On the other hand, media exposure was positively correlated with uncertainty, and uncertainty was negatively correlated with compliance. Interestingly, anxiety, which was positively correlated with media exposure, also moderated the negative correlation between uncertainty and compliance. Our results highlight the important role of uncertainty and anxiety as moderators between media exposure and compliance. To increase public compliance with COVID-19 regulations, efforts should be directed at decreasing uncertainty and anxiety.

The relationship between fear of COVID-19 and mental health problems: A meta-analysis

The coronavirus disease-2019 (COVID-19) pandemic has caused physical and mental health problems among individuals around the world. Recent studies have reported various mental health problems among both health-care workers and the general population. In this meta-analysis, evidence is provided concerning the relationships between the Fear of COVID-19 Scale. The fear of COVID-19 scale: Development and initial validation. International Journal of Mental Health and Addiction] - the most widely used, translated, and validated scale - and mental health problems including, anxiety, stress, depression, distress, post-traumatic stress, and sleep problems among the general population. We searched for relevant studies on Web of Science, Google Scholar, PubMed, and ERIC databases and conducted a meta-analysis with selected studies in accordance with the inclusion criteria. A total of 33 studies met the inclusion criteria. The results demonstrated that fear of COVID-19 was strongly related to anxiety (r = 0.55, n = 19,578), traumatic stress (r = 0.54, n = 8,752), distress (r = 0.53, n = 11,785) as well as being moderately related to stress (r = 0.47, n = 4,340) and depression (r = 0.38, n = 23,835). The correlation with insomnia (r = 0.27, n = 2,114) was modest. These results demonstrate that fear of COVID-19 is associated a wide range of mental health problems among the general population.

A cross-sectional study of infection control measures against COVID-19 and psychological distress among Japanese workers

OBJECTIVES

This study examined the relationship between the status of infection control efforts against COVID-19 in the workplace and workers' mental health using a large-scale Internet-based study.

METHODS

This cross-sectional study was based on an Internet monitoring survey conducted during the third wave of the COVID-19 epidemic in Japan. Of the 33 302 people who participated in the survey, 27 036 were included in the analyses. Participants answered whether or not each of 10 different infection control measures was in place at their workplace (eg, wearing masks at all times during working hours). A Kessler 6 (K6) score of ≥13 was defined as mild psychological distress. The odds ratios (ORs) of psychological distress associated with infection control measures at the workplace were estimated using a multilevel logistic model nested in the prefectures of residence.

RESULTS

The OR of subjects working at facilities with 4 or 5 infection control measures for psychological distress was 1.19 (95% confidence interval [CI]: 1.05-1.34, P = .010), that in facilities with 2 or 3 infection control measures was 1.43 (95% CI: 1.25-1.64, P < .001), and that in facilities with 1 or no infection control measures was 1.87 (95% CI: 1.63-2.14, P < .001) compared to subjects whose workplaces had ≥6 infection control measures.

CONCLUSION

Our findings suggest that proactive COVID-19 infection control measures can influence the mental health of workers.

COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment - A narrative review

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces coronavirus-19 disease (COVID-19) and is a major health concern. Following two SARS-CoV-2 pandemic “waves,” intensive care unit (ICU) specialists are treating a large number of COVID19-associated acute respiratory distress syndrome (ARDS) patients. From a pathophysiological perspective, prominent mechanisms of COVID19-associated ARDS (CARDS) include severe pulmonary infiltration/edema and inflammation leading to impaired alveolar homeostasis, alteration of pulmonary physiology resulting in pulmonary fibrosis, endothelial inflammation (endotheliitis), vascular thrombosis, and immune cell activation.

Although the syndrome ARDS serves as an umbrella term, distinct, i.e., CARDS-specific pathomechanisms and comorbidities can be noted (e.g., virus-induced endotheliitis associated with thromboembolism) and some aspects of CARDS can be considered ARDS “atypical.” Importantly, specific evidence-based medical interventions for CARDS (with the potential exception of corticosteroid use) are currently unavailable, limiting treatment efforts to mostly supportive ICU care.

In this article, we will discuss the underlying pulmonary pathophysiology and the clinical management of CARDS. In addition, we will outline current and potential future treatment approaches.