Anxiety and Depression Among People Under the Nationwide Partial Lockdown in Vietnam

Examining risk and protective factors for psychological health during the COVID-19 pandemic

BACKGROUND AND OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted people's lives, with significant mental health consequences emerging. In addition to sociodemographic and COVID-19 specific factors, psychological risk and protective mechanisms likely influence individual differences in mental health during the COVID-19 pandemic. We examined associations between a broad set of risk and protective factors with depression, anxiety, alcohol problems, and eating pathology, and investigated interactions between objective stress due to COVID-19 and risk/protective variables in predicting psychopathology.

METHODS

Participants were 877 adults (73.7% female) recruited via internet sources from around the globe, but primarily residing in North America (87.4%).

RESULTS

Structural equation modelling revealed that certain risk and protective factors (e.g., loneliness, mindfulness) were broadly related to psychopathology, whereas others showed unique relations with specific symptoms (e.g., greater repetitive thinking and anxiety; low meaning and purpose and depression). COVID-19 objective stress interacted with risk factors, but not protective factors, to predict greater anxiety symptoms, but not other forms of psychopathology.

CONCLUSIONS

Findings contribute to our understanding of psychological mechanisms underlying individual differences in psychopathology in the context of a global stressor. Strategies that reduce loneliness and increase mindfulness will likely impact the greatest number of mental health symptoms.

Mental Health and COVID-19: Policies, Guidelines, and Initiatives from the Asia-Pacific Region

The COVID-19 outbreak was declared a pandemic by the World Health Organization in March 2020 due to rapid intercontinental spread and high morbidity and mortality. Globally, the disease has had a major impact on human lives, including health, economic, employment, psychological, and overall well-being. The COVID-19, besides causing respiratory, neurological, and cardiovascular diseases, has had significant impact on mental health. Major mental health disorders, including depression, anxiety, and stress, have risen in parallel with increasing prevalence of COVID-19. Many population groups, including children, the elderly, those with chronic illnesses, and health care workers, have been affected. This review gives an overall assessment of the prevalence of COVID-19-associated psychological morbidity. In countries in the Asia-Pacific region, prevalence of depression ranged between 4.9% and 43.1%, anxiety from 7.0 to 43.0%, and stress from 3.4% to 35.7%. As COVID-19 continues to severely affect the psychosocial well-being of the population at large, countries have developed and revised policies, guidelines, and introduced new initiatives to curb mental health issues among their citizens. In the long run, pre-disaster preparedness is important to alleviate long-term post-pandemic psychiatric morbidity and to develop psychological resilience toward disasters and pandemic, alongside investment for better mental health coverage.

Prevalence of depressive symptoms due to COVID-19 and associated factors among healthcare workers in Southern Ethiopia

OBJECTIVES

Globally, novel coronavirus disease 2019 (COVID-19) has spread rapidly since it was first identified and challenging the provision of essential services for low-resource countries. Healthcare workers involved in providing care are at high risk of developing mental health problems. The aim of this was to determine the prevalence of depressive symptoms due to COVID-19 and associated factors among healthcare workers in the West Guji zone in public health facilities, southern Ethiopia.

METHODS

A facility-based cross-sectional study was conducted in public health facilities found in the West Guji zone. A simple random sampling technique was employed to select 283 study subjects. This study was used to assess the prevalence of depression symptoms using Depression, Anxiety and Stress Scale-21, a depression subscale. Descriptive statistics, binary and multiple logistic regressions were used. Adjusted odds ratios (AORs) with 95% confidence interval will be estimated to assess the strength of associations and statistical significance will be declared at a p-value < 0.05.

RESULTS

Out of 283 eligible healthcare workers, 275 respondents had participated in this study with a 97.2% response rate. The prevalence of depressive symptoms was 21.5%. The independent predictors associated with depressive symptoms due to COVID-19 were age (adjusted odds ratio = 2.35, 95% confidence interval = 1.126-3.95), family size (adjusted odds ratio = 3.56, 95% confidence interval = 1.09-11.62), alcohol use (adjusted odds ratio = 4.31, 95% confidence interval = 1.76-10.55), medical illness (adjusted odds ratio = 9.56, 95% confidence interval = 3.71-24.59), having training on COVID-19 (adjusted odds ratio = 0.37, 95% confidence interval = 0.17-0.81), and lack of knowledge on COVID-19 (adjusted odds ratio = 15.34, 95% confidence interval = 6.32-37.21).

CONCLUSION

The prevalence of depressive symptoms among healthcare workers due to COVID-19 was high. Factors associated with depressive symptoms were age, family size, alcohol use, medical illness, having training on COVID-19, and lack of knowledge on COVID-19.

An evaluation of the experiences of academics and practice educators who supported radiography students working on the temporary HCPC register during the COVID-19 pandemic

Introduction

The COVID-19 pandemic has had a profound impact on all those residing in the United Kingdom, resulting in unprecedented changes being made to the education and training of healthcare students. Universities and practice partners had to respond quickly and work in close collaboration with Health Education England, to ensure the changes brought in by the Health and Care Professions Council (HCPC) emergency measures were implemented.

The aim of this study was to explore the experiences of staff supporting final year diagnostic and therapeutic radiography students who joined the HCPC register early during phase one of the COVID-19 pandemic.

Methods

This study was informed by a phenomenological approach, in which a purposeful sample of eight participants comprising of six practice educators (PEs) and two academics. Semi-structured interviews and focus groups were conducted to collect the data via a virtual platform.

Results

The results highlighted three themes, Competence and the transition to registration, Support mechanisms and Communication. Both academics and PEs described how they observed the new registrants gaining confidence and competence during their time on the temporary register and suggested that professional bodies could consider curriculum changes to encompass a final transitional placement similar to their experience. They suggested that having robust support mechanisms and communication in place are essential for the success of this initiative.

Conclusion

The results provide insight into how PEs and academics supported new registrants to meet the necessary requirements of the HCPC register whilst working during the first phase of the COVID-19 pandemic. They highlight the importance of having robust support mechanisms and good communication in place to achieve this.

Implications for practice

Some consideration could be made to changing the curriculum in the future to allow for early temporary registration and paid Band 4 final placements for students working as assistant practitioners.

Teachers' Mental Health and Self-Reported Coping Strategies During the COVID-19 Pandemic in Ecuador: A Mixed-Methods Study

PURPOSE

This study assessed the psychological distress, life satisfaction, and perceived stress of Ecuadorian teachers who adopted online learning in response to the COVID-19 pandemic. It also aimed to qualitatively report the coping strategies used to maintain their mental health and well-being.

METHODS

A web-based cross-sectional survey was conducted from June to mid-August 2020.

RESULTS

In total, 394 teachers completed the questionnaire, and from those, 320 also completed an optional open-ended question included in the survey. More than half of the participants reported taking care of children under 11 years and/or adults over 65 years. At the time of the study, most of the participants were teaching in higher education settings. Age was significantly correlated with all the psychological variables, females presented higher levels of perceived stress, and teachers with home care responsibilities presented higher psychological distress as well as perceived stress. Teachers who had previous training and experience with online teaching presented lower levels of distress, perceived stress as well as higher levels of life satisfaction. The most used coping strategies included seeking social support, exercising, and engaging in leisure activities.

CONCLUSION

The results provide useful information to help develop initiatives that promote teacher well-being. Future studies should consider using a more diverse sample and dedicate attention to work-family conflicts as well as social and structural inequalities that may have a toll on teachers' mental health and performance.

Depression and anxiety during the COVID-19 pandemic in Saudi Arabia: A cross-sectional study

AIMS

The emergence of the COVID-19 global pandemic, with a high transmission and mortality rate, has created an extraordinary crisis worldwide. Such an unusual situation may have an undesirable impact on the mental health of individuals which, in turn, may influence their outcomes. This study aimed to explore the influence of the COVID-19 pandemic on the psychological disposition of residents of the Kingdom of Saudi Arabia.

METHODS

A cross-sectional study using an online survey was conducted in Saudi Arabia between 27 March and 27 April 2020. The Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7) were used to assess depression and anxiety. Logistic regression analysis was used to identify predictors of these.

RESULTS

A total of 2081 individuals participated in the study. The prevalence of depression and anxiety among the study participants was 9.4% and 7.3% respectively. Non-Saudi residents, individuals aged 50 years and above, divorced people, retired people, university students and those with an income between 2000 and 10 000 SR were at higher risk of developing depression. Saudi individuals, married people, the unemployed and those with a high income (>10 000 RS) were at higher risk of developing anxiety.

CONCLUSION

We found that there is a wide range of Saudi residents who are at higher risk of developing mental illness during the current COVID-19 pandemic. Policymakers and mental healthcare providers are advised to provide continuous monitoring of the psychological consequences during this pandemic and provide the required health support.

Age, frequency of volunteering, and Present-Hedonistic time perspective predict donating items to people in need, but not money to combat COVID-19 during lock-down

Restrictions due to COVID-19 necessitated staying at home, but in some cases, encouraged charitable behavior, e.g., donating items to people in need (e.g., clothes, food), or money to support combatting COVID-19. Drawing on the previous findings regarding helping during disastrous situations and roles of time perspective in helping behaviors, the study tested the predictive value of age, gender, previous volunteering, altruistic social value orientation, and time perspectives of donating items to people in need or money to combat COVID-19. The study is pioneering in terms of including time perspectives as individual differences which might contribute to making donations during COVID-19 circumstances. The study was questionnaire-based and conducted online in the eighth week of social distancing in Poland. 150 young adults (age 18-35) took part in the study. Results of multivariable logistic regression analysis indicated that age, frequency of volunteering before the epidemic, and Present-Hedonistic time perspective predict donating items to people in need, but none of the tested variables predicted donating money to combat COVID-19. The findings suggest that charitable behavior, especially in the context of extraordinary social situations, needs to be treated as a multifaceted phenomenon. The study indicates that a Present-Hedonistic time perspective would be a promising individual difference to test in future studies on prosociality.

Impact of Work from Home Policy during the COVID-19 Pandemic on Mental Health and Reproductive Health of Women in Indonesia

Objectives: This study aimed to assess the impact of work from home (WFH) during the COVID-19 pandemic on the mental health and reproductive health of women in Indonesia. To the best of our knowledge, this is the first study evaluating the impact of WFH policy on said health aspects in Indonesia. Methods: We conducted an observational study with a cross-sectional approach using an online survey among premenopausal married women in Indonesia. The survey included the General Health Questionnaire (GHQ-12) for psychological distress, average sexual intercourse frequency (SIF) per week, contraception use, change of menstrual pattern, and desire for having children. To analyze the effect of WFH, the participants were divided into groups based on their WFH compliance: (1) Both couples (her and her spouse) work from home, (2) Only the wife works from home, (3) Only the husband works from home, and (4) Neither works from home. Results: 348 women were included in this study. Psychological distress occurred in 48.0% (n = 167) participants. No significant difference was found between the WFH groups (χ2[3, N = 348] = 2.077, p = .56)). The average weekly SIF was found to be significantly fewer during WFH (T = 5014, z = -5.598, p < .001). However, only 22.7% (n = 79) participants reported the use of contraception and 52.9% (n = 196) participants still wanted to have children. Change of menstrual pattern occurred in 31.6% (n = 110) participants and were significantly correlated to psychological distress (rs= .126, p = .018). Conclusions: WFH does not aggravate the effect of the pandemic on women's mental and reproductive health in Indonesia. A significant number of them still desire to have children and contraceptive prevalence is low.

Psychological impact of mandatory COVID-19 quarantine on small business owners and self-employed in China

A massive home-quarantine took place in China due to the novel coronavirus in the end of 2019. The purpose of the present study was to explore the potential mental health impact of this forced quarantine and widespread shutdown among small business owners and the self-employed. A semi-structured interview was employed among 14 participants from three different cities in China. Grounded Theory was employed to analyze the data using Nvivo11 plus. Based on a qualitative analysis, 9 categories of responses emerged to describe the experience and actions of participants towards the quarantine: enjoyment of life, emotional disturbance, hope, comparisons to others, social support, patriotism, making changes, and obedience. Further analysis suggested that the mental state of participants was either positive or negative depending on enjoyment of life, loss, emotional disturbance, and hope, and that these were impacted by intervening conditions (national measures, social support, patriotism), personal strategies (exercising, studying, comparisons to others), and personal consequences (making change, obedience). Rather than observing a linear pattern of negative outcomes, mental state was found to be variable in that positive outcomes were experienced earlier in the quarantine (making connections with family), negative states were encountered midway through the quarantine (fear of financial loss, anxiety), and more positive mental states (hope) emerged towards the end of the quarantine depending on intervening conditions, personal strategies, and consequences. It can be concluded that the nature of the impact of mandatory quarantine in China among small business owners and the self-employed is complex and depends on a variety of personal and situational factors.

The effect of COVID-19 lockdown on psychiatric admissions: role of gender

BACKGROUND

The UK went into nationwide lockdown on 24 March 2020, in response to COVID-19. The direct psychiatric effects of this are relatively unknown.

AIMS

We examined whether the first UK lockdown changed the demographics of patients admitted to psychiatric hospitals (to include gender, legality, route of admission and diagnoses), independent of seasonal variation..

METHOD

We conducted an anonymous review of psychiatric admissions aged ≥18 years in the 6-month period after the announcement of the first UK lockdown (March to August 2020), and in the previous year (March to August 2019), in Kent and Medway NHS and Social Care Partnership Trust in-patient facilities. The number of admissions were compared, along with factors that may help to explain the psychological effects of national lockdown.

RESULTS

There was no significant increase in total number of admissions or the gender percentage. However, there was a 11.8% increase in formal sectioning under the Mental Health Act 1983. This increase was sustained and statistically significant across all 6 months. A sustained decrease in admissions via the crisis team was also observed as being statistically significant. Separate diagnoses saw changes in percentage of admissions between March and May. The most statistically significant was schizophrenia admissions for men in April (18.7%), and women in March (18.4%).

CONCLUSIONS

Our findings highlight the effect of COVID-19 on the legal status of psychiatric admissions, and emphasise the importance of having a robust, adaptable and open psychiatric service that caters to the ongoing needs of patients, regardless of government restrictions.

Psychological distress experienced by self-quarantined undergraduate university students in Lebanon during the COVID-19 outbreak

INTRODUCTION

Quarantine, although essential during contagious outbreaks, has been correlated with poor psychological outcomes in the general population. Such outcomes include low mood, suicide, and post-traumatic stress symptoms. Studies have mostly looked at the mental health of general citizens, healthcare workers, or infected survivors, with limited research targeting university students. This study aimed to understand the psychological distress experienced by self-quarantined undergraduate university students in Lebanon during the COVID-19 outbreak.

METHODS

Undergraduate students enrolled at the American University of Beirut were invited to participate in a 47-item online questionnaire. 73 participants completed the questionnaire. Demographic data, data about COVID-19 exposure, stressors during quarantine, understanding the rationale, compliance, and difficulties associated with quarantine, and levels of psychological distress were analysed.

RESULTS

75.3% of the participants were considered as having a high risk of developing acute stress. Undergoing quarantine for more than 14 days, having a chronic medical illness, inadequate access to supplies, and fear of infection were all significantly associated with an increased risk of acute stress.

CONCLUSION

Despite being a necessary preventive measure during infectious disease outbreaks, quarantine can be associated with negative psychological effects, particularly in undergraduate students. Providing preventive and effective interventions is of utmost necessity.KEY POINTSDuring COVID-19, three-quarter of students had high risk for acute stress.Females had higher odds of high-risk acute stress compared to males.Having a chronic medical condition was associated with high risk acute stress.Long quarantine and lack of supplies were associated with high risk acute stress.Providing interventions to protect the mental health of students is necessary.

Health Perceptions and Adopted Lifestyle Behaviors During the COVID-19 Pandemic: Cross-National Survey

BACKGROUND

Social isolation measures are requisites to control viral spread during the COVID-19 pandemic. However, if these measures are implemented for a long period of time, they can result in adverse modification of people's health perceptions and lifestyle behaviors.

OBJECTIVE

The aim of this cross-national survey was to address the lack of adequate real-time data on the public response to changes in lifestyle behavior during the crisis of the COVID-19 pandemic.

METHODS

A cross-national web-based survey was administered using Google Forms during the month of April 2020. The settings were China, Japan, Italy, and India. There were two primary outcomes: (1) response to the health scale, defined as perceived health status, a combined score of health-related survey items; and (2) adoption of healthy lifestyle choices, defined as the engagement of the respondent in any two of three healthy lifestyle choices (healthy eating habits, engagement in physical activity or exercise, and reduced substance use). Statistical associations were assessed with linear and logistic regression analyses.

RESULTS

We received 3371 responses; 1342 were from India (39.8%), 983 from China (29.2%), 669 from Italy (19.8%), and 377 (11.2%) from Japan. A differential countrywise response was observed toward perceived health status; the highest scores were obtained for Indian respondents (9.43, SD 2.43), and the lowest were obtained for Japanese respondents (6.81, SD 3.44). Similarly, countrywise differences in the magnitude of the influence of perceptions on health status were observed; perception of interpersonal relationships was most pronounced in the comparatively old Italian and Japanese respondents (β=.68 and .60, respectively), and the fear response was most pronounced in Chinese respondents (β=.71). Overall, 78.4% of the respondents adopted at least two healthy lifestyle choices amid the COVID-19 pandemic. Unlike health status, the influence of perception of interpersonal relationships on the adoption of lifestyle choices was not unanimous, and it was absent in the Italian respondents (odds ratio 1.93, 95% CI 0.65-5.79). The influence of perceived health status was a significant predictor of lifestyle change across all the countries, most prominently by approximately 6-fold in China and Italy.

CONCLUSIONS

The overall consistent positive influence of increased interpersonal relationships on health perceptions and adopted lifestyle behaviors during the pandemic is the key real-time finding of the survey. Favorable behavioral changes should be bolstered through regular virtual interpersonal interactions, particularly in countries with an overall middle-aged or older population. Further, controlling the fear response of the public through counseling could also help improve health perceptions and lifestyle behavior. However, the observed human behavior needs to be viewed within the purview of cultural disparities, self-perceptions, demographic variances, and the influence of countrywise phase variations of the pandemic. The observations derived from a short lockdown period are preliminary, and real insight could only be obtained from a longer follow-up.

Engagement and Effectiveness of a Healthy-Coping Intervention via Chatbot for University Students During the COVID-19 Pandemic: Mixed Methods Proof-of-Concept Study

BACKGROUND

University students are increasingly reporting common mental health problems, such as stress, anxiety, and depression, and they frequently face barriers to seeking psychological support because of stigma, cost, and availability of mental health services. This issue is even more critical in the challenging time of the COVID-19 pandemic. Digital mental health interventions, such as those delivered via chatbots on mobile devices, offer the potential to achieve scalability of healthy-coping interventions by lowering cost and supporting prevention.

OBJECTIVE

The goal of this study was to conduct a proof-of-concept evaluation measuring the engagement and effectiveness of Atena, a psychoeducational chatbot supporting healthy coping with stress and anxiety, among a population of university students.

METHODS

In a proof-of-concept study, 71 university students were recruited during the COVID-19 pandemic; 68% (48/71) were female, they were all in their first year of university, and their mean age was 20.6 years (SD 2.4). Enrolled students were asked to use the Atena psychoeducational chatbot for 4 weeks (eight sessions; two per week), which provided healthy-coping strategies based on cognitive behavioral therapy, positive psychology, and mindfulness techniques. The intervention program consisted of conversations combined with audiovisual clips delivered via the Atena chatbot. Participants were asked to complete web-based versions of the 7-item Generalized Anxiety Disorder scale (GAD-7), the 10-item Perceived Stress Scale (PSS-10), and the Five-Facet Mindfulness Questionnaire (FFMQ) at baseline and postintervention to assess effectiveness. They were also asked to complete the User Engagement Scale-Short Form at week 2 to assess engagement with the chatbot and to provide qualitative comments on their overall experience with Atena postintervention.

RESULTS

Participants engaged with the Atena chatbot an average of 78 (SD 24.8) times over the study period. A total of 61 out of 71 (86%) participants completed the first 2 weeks of the intervention and provided data on engagement (10/71, 14% attrition). A total of 41 participants out of 71 (58%) completed the full intervention and the postintervention questionnaires (30/71, 42% attrition). Results from the completer analysis showed a significant decrease in anxiety symptoms for participants in more extreme GAD-7 score ranges (t39=0.94; P=.009) and a decrease in stress symptoms as measured by the PSS-10 (t39=2.00; P=.05) for all participants postintervention. Participants also improved significantly in the describing and nonjudging facets, based on their FFMQ subscale scores, and asked for some improvements in the user experience with the chatbot.

CONCLUSIONS

This study shows the benefit of deploying a digital healthy-coping intervention via a chatbot to support university students experiencing higher levels of distress. While findings collected during the COVID-19 pandemic show promise, further research is required to confirm conclusions.

Risk of stress/depression and functional impairment in Denmark immediately following a COVID-19 shutdown

Background

Existing estimates of the impact of the COVID-19 burden on mental wellbeing come from countries with high mortality rates. This study therefore aimed to investigate the impact of the first COVID-19 lockdown (March–April 2020) on risk for stress/depression and functional impairment in a representative sample of adult individuals in Denmark, which had lower infection rates, and whether the impact of lockdown was heterogeneous across living situation.

Methods

Using a representative, randomly drawn sample from the complete Danish adult population interviewed in March 2 to April 13, 2020 (n = 2836) and again in July 2020 (n = 1526, 54% retention rate), we study how the imposed lockdown announced March 11 following the onset of the first Danish wave of COVID-19 infections affected mental wellbeing. We use the World Health Organization Five Well-being Index (WHO-5) and the Work and Social Adjustment Scale (WSAS) to capture risk for stress/depression (WHO-5 < 50) and functional impairment (WSAS > 10). Using covariate adjusted ordinary least squares linear probability models and exploiting variation in the timing of responses occurring just before and just after the introduction of lockdown, we compare respondents before lockdown to respondents that answered during lockdown, as well as to answers in re-interviews in July.

Results

In our fully controlled models, we find reduced depressive symptoms among adults immediately after the shutdown, concentrated in adults with children living at home (−.089, p < .01 (from pre lockdown baseline .273)). Measures of functional impairment also declined immediately after the March shutdown among adults with children living at home (−.066, p < .05 (from pre lockdown baseline .150)). Impairment intensified for the entire sample between March and July (+.199, p < .001 (from pre lockdown baseline .248)), but depressive symptoms remained at lower rate in July (−.033, p < .05 (from pre lockdown baseline .332).

Conclusions

Findings in Denmark indicate that living with children at home may have, in the short term, buffered the potential mental health sequelae of the COVID-19 shutdown.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11020-3.

Psychological support in general population during the COVID-19 lockdown in France: Needs and access

INTRODUCTION

With France one of the European countries most strongly affected by COVID-19 in the spring of 2020, French authorities imposed a nationwide lockdown for 8 weeks (March 17-May 10). This study explored the perception of the adult population about the need for-and access to-psychological support from health care professionals (HCP) in response to concerns about the psychological needs during lockdown.

MATERIAL AND METHOD

This online cross-sectional survey of a representative sample of the adult general population of mainland France (N = 2,003) took place during the last four days of the French lockdown (May 7-10, 2020).

RESULTS

One in eight respondents (12.2%) perceived a need for psychological support from an HCP during the lockdown; most had symptoms of depression and/or anxiety of at least moderate intensity. Only a third (29.8%, 3.6% of the entire sample) actually obtained this support. Factors associated with this perceived need included: age under 35, economic difficulties due to lockdown, pre-lockdown use of psychological support, infection with COVID-19, serious worries about becoming infected, and heavy media use to obtain information about the disease. Among those who perceived a need for psychological support, the elderly were the most likely not to consult an HCP. People aged 35-64, those with high income, and those seriously worried about developing COVID-19 were the most likely to forgo seeking access to care because of their fear of infection by the coronavirus-2019.

CONCLUSION

The perceived need for psychological support from an HCP and access to it appeared to be strongly associated with COVID-19 exposure factor. More research about this association is needed to improve the health authorities' understanding of the population's psychological needs in this situation and to enhance HCPs' abilities to meet them. In particular, further research of its specific impact on youth is necessary.

The willingness for dietary and behavioral changes in frontline epidemic prevention workers after experiencing the outbreak of COVID-19 in China: a cross-sectional study

BACKGROUND

The 2019 novel coronavirus disease (COVID-19) has had a massive impact on public health, resulting in sudden dietary and behavioral habit changes. Frontline epidemic prevention workers play a pivotal role against COVID-19. They must face high-risk infection conditions, insufficient anti-epidemic material supplies, mental pressure, and so on. COVID-19 seriously affects their dietary and behavioral habits, and poor habits make them more susceptible to COVID-19. However, their baseline dietary and behavioral habits before COVID-19 and their willingness to change these habits after the outbreak of COVID-19 remain unclear for these workers in China. This study aimed to explore the baseline dietary and behavioral habits of frontline workers and their willingness to change these habits after the outbreak of the epidemic; in addition, susceptible subgroups were identified by stratified analyses as targets of protective measures to keep them from being infected with COVID-19.

METHODS

A cross-sectional study was conducted through an online questionnaire using a sample of 22,459 valid individuals living in China, including 9402 frontline epidemic prevention workers.

RESULTS

Before COVID-19, 23.9% of the frontline epidemic prevention workers reported a high-salt diet, 46.9% of them reported a high frequency of fried foods intake, and 50.9% of them smoked cigarettes. After the outbreak of COVID-19, 34.6% of them expressed a willingness to reduce salt intake, and 43.7% of them wanted to reduce the frequency of pickled vegetables intake. A total of 37.9% of them expressed a willingness to decrease or quit smoking, and 44.5% of them wanted to increase sleep duration. Significant differences in the baseline dietary and behavioral habits and the willingness to change their habits were observed between frontline epidemic prevention workers and other participants. Among the frontline epidemic prevention workers with poor dietary and behavioral habits before COVID-19, frontline epidemic prevention experience was a promoting factor for adopting worse dietary and behavioral habits, including those in the high-salt intake subgroup (OR, 2.824; 95% CI, 2.341-3.405) and the 11-20 cigarettes/day subgroup (OR, 2.067; 95% CI, 1.359-3.143).

CONCLUSIONS

The dietary and behavioral habits of frontline epidemic prevention workers were worse than that those of other participants before COVID-19. They had a greater willingness to adopt healthy dietary and behavioral habits after experiencing the outbreak of COVID-19. However, frontline epidemic prevention workers with poor dietary and behavioral habits before COVID-19 continued in engage in these poor habits. Dietary and behavioral intervention policies should be drafted to protect their health, especially frontline epidemic prevention workers with poor habits at baseline.

Mindfulness-based online intervention on mental health and quality of life among COVID-19 patients in China: an intervention design

BACKGROUND

COVID-19 can lead to increased psychological symptoms such as post-traumatic stress disorder (PTSD), depression, and anxiety among patients with COVID-19. Based on the previous mindfulness-based interventions proved to be effective, this protocol reports a design of a randomized controlled trial aiming to explore the efficacy and possible mechanism of a mindful living with challenge (MLWC) intervention developed for COVID-19 survivors in alleviating their psychological problems caused by both the disease and the pandemic.

METHODS

In April 2021, more than 1600 eligible participants from Hubei Province of China will be assigned 1:1 to an online MLWC intervention group or a waitlist control group. All participants will be asked to complete online questionnaires at baseline, post-program, and 3-month follow-up. The differences of mental health status (e.g. PTSD) and physical symptoms including fatigue and sleeplessness between the COVID-19 survivors who receiving the online MLWC intervention and the control group will be assessed. In addition, the possible mediators and moderators of the link between the MLWC intervention and target outcomes will be evaluated by related verified scales, such as the Five Facets Mindfulness Questionnaire. Data will be analyzed based on an intention-to-treat approach, and SPSS software will be used to perform statistical analysis.

DISCUSSION

The efficacy and potential mechanism of MLWC intervention in improving the quality of life and psychological status of COVID-19 survivors in China are expected to be reported. Findings from this study will shed light on a novel and feasible model in improving the psychological well-being of people during such public health emergencies. Trial registration Chinese Clinical Trial Registry (ChiCTR), ChiCTR2000037524; Registered on August 29, 2020, http://www.chictr.org.cn/showproj.aspx?proj=60034 .

Depression, anxiety and stress among undergraduate students during COVID-19 outbreak and "home-quarantine"

Aim

Many people including students affected physically and psychologically by coronavirus disease (COVID‐19) outbreak and "home‐quarantine." This study aimed at assessing the prevalence and predictors of depression, anxiety and stress among university students in Jordan during "home‐quarantine" due to the outbreak of COVID‐19.

Design

This is a cross‐sectional descriptive study.

Methods

Data were collected from a convenience sample of 1,380 Jordanian university students. A web‐based survey was used to collect data from the participants using the DASS‐21.

Results

The prevalence of depression, anxiety and stress in different levels was 78.7%, 67.9% and 58.7%, respectively, which are higher during “home‐quarantine.” The mean scores of depression, anxiety and stress were at moderate levels. Strong correlations were found between depression, stress and anxiety, with demographic, health‐related, lifestyle variables. Several variables also predicted depression, stress and anxiety.

When COVID-19 enters in a community setting: an exploratory qualitative study of community perspectives on COVID-19 affecting mental well-being

OBJECTIVE

The COVID-19 pandemic has resulted in an increased level of anxiety and fear among the general population related to its management and infection spread. Considering the relevance of present circumstances, we explored perceptions and attitudes of community members towards their mental well-being during the COVID-19 pandemic.

SETTING

We conducted an exploratory qualitative study using a purposive sampling approach, at two communities of Karachi, Pakistan.

PARTICIPANTS

In-depth interviews were conducted with community members including, young adults, middle-aged adults and older adults of both genders. Study data were analysed manually using the thematic analysis technique.

PRIMARY OUTCOME

The primary outcome is assessing community perception towards their mental well-being amidst the COVID-19 pandemic.

RESULTS

A total of 27 in-depth interviews were conducted, between May and June 2020. Three overarching themes were identified: (1) impact of COVID-19 on the mental health of the general communities; (2) current coping mechanisms to adapt to the new reality and (3) recommendations to address the mental health of communities. Generally, community members underwent increased anxiety and fear due to the contagious nature of the virus. Alongside, social, financial and religious repercussions of the pandemic have also heightened psychological distress among community members. However, community members were able to point out some of the coping mechanisms such as getting closer to God, connecting with family, participating in mental health sessions and resetting lives by indulging in diverse activities. Simultaneously, they also recommended the need for remote mental health services for elders and continuous efforts by the government to address the mental health needs of the community.

CONCLUSION

COVID-19-associated mental health consequences have hit every individual in society. The study finding has the potential to guide the development of context-specific innovative mental health programmes to overcome the pandemic repercussions.

COVID-19: The Level of Knowledge, Anxiety and Symptom Presentation

Objective

This study aims to establish whether there is a relationship between the level of knowledge about COVID-19, anxiety scores, and pseudo increases in the symptoms of the patients or not.

Methods

The Beck Anxiety Inventory (BAI) and Republic of Turkey Ministry of Health General Directorate's COVID-19 (SARS-CoV-2 infection) General Information, Epidemiology, and Diagnosis Guide were reviewed to generate the questionnaire's content. The data were obtained through a face-to-face interview method. To test their level of knowledge about COVID-19, they were asked multiple-choice questions that have one or more possible right answers. The Statistical Package for Social Sciences was used for statistical analysis. The results were presented as mean and standard deviations for numerical variables and as frequency and percentage for categorical data.

Results

A total of 402 patients were included in this questionnaire-based study. The average age of the patients was 44.67 ± 4.95 years, and 204 (50.7%) of them were female. The average anxiety score according to the BAI was 7.98 ± 1.29 which classifies as mild anxiety. The overall responses for the knowledge level on COVID-19 section are presented in Table 2. The average score was 9.2 ± 2.7 points out of a possible 14.

Conclusion

The study population showed a moderate level of knowledge, and on average, the patients were not very anxious about the outbreak. The psychosomatic effects of the anxiety caused by the pandemic should be kept in mind by the clinicians since the patients might require a psychiatric consultation in the treatment process.

Psychological impacts of COVID-19 and satisfaction from online classes: disturbance in daily routine and prevalence of depression, stress, and anxiety among students of Pakistan

The present study investigated the (i) socio-demographic predictors of psychological distress, (ii) socio-demographic predictors of satisfaction from online classes, and (iii) the relationship between psychological distress and satisfaction from online classes among university students of Pakistan during the COVID-19 pandemic. An online questionnaire-based survey was conducted. A total of 2220 respondents that was enrolled at the University of the Punjab (PU), University of Management and Technology (UMT), and the University of Central Punjab (UCP) were involved in the current study. Data were collected at a 64% response rate and analyzed with SPSS IBM Version 21.0. Results revealed that approximately 41% of the students were facing severe psychological distress while about 65% were found unsatisfied with online classes. Besides, a linear negative relationship between the independent variable, i.e. psychological distress and the dependent variable, i.e. satisfaction from online classes was found. Therefore, to minimize the level of psychological distress and increase students' satisfaction with online classes it is highly recommended to take precautionary measures by the relevant stakeholders.

Meal and Sleep Timing before and during the COVID-19 Pandemic: A Cross-Sectional Anonymous Survey Study from Sweden

The COVID-19 pandemic and related restrictions, such as stay-at-home-orders, have significantly altered daily routines and lifestyles. Given their importance for metabolic health, we herein compared sleep and meal timing parameters during vs. before the COVID-19 pandemic based on subjective recall, in an anonymous Swedish survey. Among 191 adults (mean age: 47 years; 77.5% females), we show that social jetlag, i.e., the mismatch in sleep midpoint between work and free days, was reduced by about 17 min during the pandemic compared with the pre-pandemic state (p < 0.001). Concomitantly, respondents' sleep midpoint was shifted toward morning hours during workdays (p < 0.001). A later daily eating midpoint accompanied the shift in sleep timing (p = 0.001). This effect was mainly driven by a later scheduled first meal (p < 0.001). No difference in the timing of the day's last meal was found (p = 0.814). Although our survey was limited in terms of sample size and by being cross-sectional, our results suggest that the delay in sleep timing due to the COVID-19 pandemic was accompanied by a corresponding shift in the timing of early but not late meals.

COVID-19 and Mental Health: A Study of Stress, Resilience, and Depression among the Older Population in Pakistan

Extending studies of the adverse effects of SARS-2 coronavirus on general health consequences, this research explores complexities related to the mental health of the elderly as a result of pandemic-related stress. The study addresses this issue by using resilience theory to examine the effects of fear and exposure related to COVID-19 and depression. Besides, our study examines the moderating effects of self-efficacy in order to provide an understanding of how the coping abilities of the elderly may mitigate the effect of stress levels on mental health during pandemics. Our model is tested by analysing the survey data collected from Rawalpindi, a metropolitan city in Pakistan. The main results of the study confirm the positive association of pandemic-related fear and exposure virus with depression. However, self-efficacy shows a negative direct effect on depression, and the findings also confirm the moderation effect of self-efficacy on the fear of COVID-19 and depression, but the moderation effect of self-efficacy on COVID-19 exposure and depression is not supported. Based on the outcomes, some severe geriatric care policies that could weaken the pandemic-related fear, exposure to the virus, and depression are recommended.

Changes in mental health during the COVID-19 crisis in Romania: A repeated cross-section study based on the measurement of subjective perceptions and experiences

The coronavirus 2019 (COVID-19) pandemic has caused dramatic changes in the daily lives of Romanians, affecting their mental health. The COVID-19 pandemic has evolved at three significant peaks, which sequentially occurred on: April 29, 2020; September 18, 2020; and the third wave registered the highest severity on November 27, 2020. Little is known about the mental health changes during this phase of this pandemic. This study evaluated mental health levels in Romania at the end of the first wave of the pandemic and amidst the third and most severe wave. We administered a two-phase internet-based survey among 543 and 583 participants, respectively, recruited through snowball sampling at a 6-month interval. The IPAT Anxiety Scale measured anxiety, the Beck's Depression Inventory measured depression, and the Dissociative Experiences Scale measured dissociation. We observed no statistically significant differences in the number of participants with clinically relevant scores at either time point. In the first survey, 23.8%, 19.2%, and 32.6% reported being clinically anxious, clinically depressed, and showed clinical dissociation, respectively. Binary logistic regressions indicated that age, education level, and previous traumatic events were significantly associated with clinical levels of anxiety and depression. Moreover, multiple linear regression analysis reported a collective significant effect of gender, age, psychological impact, traumatic events, and dissociation on predicting high levels of anxiety and depression. Romanian adults' mental health status was affected during the COVID-19 pandemic, and it did not change 6 months after the first lockdown.

Prevalence of anxiety and depression in South Asia during COVID-19: A systematic review and meta-analysis

INTRODUCTION

The COVID-19 pandemic has impacted biopsychosocial health and wellbeing globally. Pre-pandemic studies suggest a high prevalence of common mental disorders, including anxiety and depression in South Asian countries, which may aggravate during this pandemic. This systematic meta-analytic review was conducted to estimate the pooled prevalence of anxiety and depression in South Asian countries during the COVID-19 pandemic.

METHOD

We systematically searched for cross-sectional studies on eight major bibliographic databases and additional sources up to October 12, 2020, that reported the prevalence of anxiety or depression in any of the eight South Asian countries. A random-effects model was used to calculate the pooled proportion of anxiety and depression.

RESULTS

A total of 35 studies representing 41,402 participants were included in this review. The pooled prevalence of anxiety in 31 studies with a pooled sample of 28,877 was 41.3% (95% confidence interval [CI]: 34.7-48.1, I 2 = 99.18%). Moreover, the pooled prevalence of depression was 34.1% (95% CI: 28.9-39.4, I 2 = 99%) among 37,437 participants in 28 studies. Among the South Asian countries, India had a higher number of studies, whereas Bangladesh and Pakistan had a higher pooled prevalence of anxiety and depression. No studies were identified from Afghanistan, Bhutan, and Maldives. Studies in this review had high heterogeneity, high publication bias confirmed by Egger's test, and varying prevalence rates across sub-groups.

CONCLUSION

South Asian countries have high prevalence rates of anxiety and depression, suggesting a heavy psychosocial burden during this pandemic. Clinical and public mental health interventions should be prioritized alongside improving the social determinants of mental health in these countries. Lastly, a low number of studies with high heterogeneity requires further research exploring the psychosocial epidemiology during COVID-19, which may inform better mental health policymaking and practice in South Asia.

Impact of Covid-19 outbreak on psychological health-The case of Bangladesh

BACKGROUND

The outbreak of COVID-19, a profoundly contagious disease has unnerved the world in a calamitous manner from diverse aspects. The present study ventures to expand the literature by exploring loneliness, social isolation, risk perception, financial distress, and psychological distress amidst the lockdown phase of the general population of Bangladesh.

METHODS

Through an online survey among 474 respondents (between April 17th and April 23rd, 2020), data were collected from the Bangladeshi residents (21 years or above). Descriptive and inferential statistical analyses were conducted using IBM Statistical Package for Social Science (SPSS) and Warp-PLS.

RESULTS

Findings suggest a strong positive correlation among the factors and social isolation, risk perception, financial distress are manifested as the predictors of psychological distress. Besides, females, aged people, and lower-income group are found to be more psychologically distressed.

CONCLUSION

This study yields new insights into the psychological facets of a lower-middle-income earning country, Bangladesh.

Impact of the COVID-19 pandemic on mental health and health-related quality of life among university students in Turkey

The COVID-19 health crisis has reached pandemic scale spreading globally. The present study examines the COVID-19 pandemic’s impact on psychological and physical health-related quality of life (HRQOL) among university students in Turkey. A cross-sectional survey design was used for data collection. From May 11th to May 15th 2020, the study utilized snowball sampling techniques to gather data through an online survey. The pandemic’s psychological effects on participants were measured by the Impact of Event Scale-Revised. Depression, Anxiety and Stress Scale-21 and the 12-Item Short Form Health Survey assess related HRQOL were used to make mental health assessments. 1120 university students were contacted to complete the survey. Of these, a total of 1095 completed the survey, translating to a participation rate of 97.7%. Overall, 64.6%, 48.6% and 45.2%, and 34.5% of all participants self-reported symptomatic signs of depression, anxiety, stress and post-traumatic stress disorder (PTSD), respectively. Female gender and poor family relationships were identified as risk factors for probably PTSD, and symptoms of depression, anxiety, and stress as well. The mean scores of Physical Component Summary (PCS-12) and Mental Component Summary (MCS-12) were 66.99 ± 2.14 and 40.76 ± 2.31, respectively. Students suspected of a history with PTSD had considerably lower total scores for PCS-12 and MCS-12, when cross checked for similarity to those without such a history. The findings of this research suggest that evidence of PTSD, depression, anxiety, and stress is commonly apparent among university students during the period of the COVID-19 crisis. Prevention and intervention approaches to attenuate the psychosocial impact should be an integral component of crisis response during pandemic conditions.

Impact of the COVID-19 outbreak on mental health status and associated factors among general population: a cross-sectional study from Pakistan

The recent outbreak of coronavirus disease (COVID-19) has significantly affected the mental health of people globally. This study aimed to investigate the mental health status and associated factors among residents of Pakistan. An online questionnaire survey was conducted from April 3 to May 7, 2020, using convenience and snowball sampling techniques. Data regarding demographics, physical health status and contact history during the last 2 weeks were collected. Furthermore, the Depression, Anxiety, and Stress scales (DASS-21) were utilized to measure the mental health of the participants. The analyses included descriptive statistics and regression analysis. Of the 1663 participants who completed this survey, 1598 met the inclusion criteria. The results revealed mild to moderate depression among 390 participants (24.4%), mild to moderate anxiety among 490 participants (30.7%) and mild to moderate stress among 52 participants (3.3%). A majority of the participants rated their health as good (n = 751, 47.0%). Moreover, students reported significantly higher scores on depression (B = 1.29, 95% CI = 0.71-1.88; p < 0.05), anxiety (B = 0.56, 95% CI = -0.06 to 1.18; p < 0.05) and stress (B = 0.56, 95% CI = -0.12 to 1.23; p < 0.05). Physical symptoms, including fever, cough and myalgia, and contact history in the last 14 days reported significant associations with depression, anxiety and stress (p < 0.05). The mental health status of the people was noted to be affected during the COVID-19 outbreak. Assessment of several factors with significant associations with depression, anxiety and stress may aid in developing psychological interventions for vulnerable groups.

The effect of anxiety levels of elderly people in quarantine on depression during covid-19 pandemic

This study aims to determine the effect on depression of elderly people's anxiety levels in quarantine during the COVID-19 pandemic. This is a descriptive study, in which data were collected using the online survey method, an introductory information form, a semistructured data form for COVID-19, the Trait Anxiety Inventory, and the Geriatric Depression Scale. Data were collected during the period when a curfew was imposed for the elderly. Data were analyzed using a structural equation model. According to the structural equation model, anxiety was determined as a predictor of depression. The anxiety levels of the elderly who were 65-74 years old, female, single; had insufficient knowledge about the pandemic; and had not encountered a similar outbreak before considered that family relationships were affected negatively so they became lonely and reported that they became bored, exhausted, and distressed during the pandemic, which increased their depression levels. Anxiety affects depression in the elderly. Therefore, it is recommended to provide them with appropriate psychological support interventions and understandable information about the pandemic so that their anxiety and depression levels can be reduced during the pandemic.

Teleconsultation Apps in the COVID-19 Pandemic: The Case of Guayaquil City, Ecuador

The new coronavirus disease (COVID-19) has affected a large part of the worldwide population, causing more than a million deaths between the end of 2019 until now. Technological development and digital tools arise to carry out activities remotely, either for monitoring or diagnosis. Medical teleconsultation activities are not new, but due to the pandemic situation that the COVID-19 originated, it has become a popular option to avoid going to consultations physically due to the risk of contagion. This article presents an analysis of different teleconsultation services implemented during the spread of the COVID-19 in the city of Guayaquil, Ecuador, as a case study. The methodology includes a performance assessment of the teleconsultation apps used during the critical periods of the pandemic. We detailed the fundamental stages deemed to verify that the fulfillment and knowledge about telemedicine in this city are not extensive enough in terms of remote health benefits. Throughout this article, we evidenced that the population is not prepared to manage remote-care systems due to the low use of technology and the lack of support from public or private agencies for providing technological development for medical services that satisfy the needs of the inhabitants.

A Comparative Study on the Psychological Health of Frontline Health Workers in Wuhan Under and After the Lockdown

Background: The coronavirus disease-2019 (COVID-19) outbreak and a 3-month lockdown of Wuhan may have had a long-term impact on the mental health of frontline healthcare workers (HWs). However, there is still a lack of comparative studies on the mental health of front-line HWs in the initial phase of the lockdown and 1 month after the lifting of the lockdown. Methods: We recruited 1717 HWs during the initial phase of the lockdown and 2214 HWs 1 month after the lifting of the lockdown, and their baseline characteristics and psychiatric health in these two phases were compared. Furthermore, Pearson's Chi-square test and multivariate logistic regression analysis were used to determine the possible risk factors associated with depressive symptoms in the front-line HWs. Results: Compared with the initial phase of the lockdown, the proportion of HWs with anxiety symptoms and stress decreased, while the proportion of HWs with depressive symptoms increased a month after the lifting of the lockdown. Male sex, exercise habit, comorbidities, and having family members or relatives with suspected or confirmed COVID-19 infection were significantly related to the increased incidence of depressive symptoms during the initial phase of the lockdown. Comorbidities, negative effect of media coverage, working >4 days a week, lower annual household income, and deteriorating relationships with family members were associated with depressive symptoms a month after the lifting of the lockdown. Conclusion: The increased proportion of HWs with depressive symptoms 1 month after the lifting of the lockdown suggested that mental health of front-line HWs should be a top-priority issue, not only during, but also after the pandemic.

Research on Posttraumatic Stress Disorder in the Context of the COVID-19 Pandemic: A Review of Methods and Implications in General Population Samples

Increasing concern about the mental health sequelae to the COVID-19 pandemic has prompted a surge in research and publications on the prevalence of posttraumatic stress disorder in general population samples in relation to the pandemic. We examined how posttraumatic stress disorder in the context of the COVID-19 pandemic has been studied to date and found three general themes: (1) assessment of posttraumatic stress disorder and posttraumatic stress disorder symptoms relied on self-report measures and often did not determine direct trauma exposure as required by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Criterion A to diagnose posttraumatic stress disorder; (2) inadequate assessment of pre-existing mental disorders and co-occurring stress; and (3) the use of cross-sectional designs in most studies, often relying on snowball sampling strategies to conduct online surveys. Notwithstanding these methodological limitations, these studies have reported moderate to severe posttraumatic symptoms in 25.8% of the general population on average in relation to the pandemic (ranging from 4.6% to 55.3%). Opportunities for advancing future research that will inform public health planning are discussed.