Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control

Fostering Resilient Health Systems in India: Providing Care for PLHIV Under the Shadow of COVID-19

Introduction

The novel coronavirus or COVID-19 has resulted in major human casualties, and extreme socio-economic crises causing catastrophic disturbances to health systems and communities alike. This study qualitatively explores the challenges experienced by healthcare providers while providing services to people living with HIV (PLHIV) during the pandemic outbreak and subsequent lockdown in India. The paper also explores strategies developed and adopted to provide continued care for PLHIV.

Methods

Using an empirical phenomenological approach, qualitative in-depth telephonic interviews were conducted with 19 HIV care providers from five states in India. The recorded interviews were transcribed and analyzed using inductive thematic analysis with the help of Dedoose software.

Results

From the analysis of participants' narratives, three main themes emerged: (1) Challenges of working during a pandemic; (2) Remodeling care delivery to ensure continuity of services; (3) Resilience.

Discussion

Our findings highlight the challenges that providers faced, despite which, adaptive efforts were made to continue providing quality care for PLHIV through ingenious and innovative strategies. To foster resilient health systems, health workers are the primary stakeholders. We recommend formal social protection, comprehensive primary healthcare support, and sufficient capacity building for health workers for their self-care and pandemic preparedness.

Psychological wellbeing and associated factors among nurses exposed to COVID 19: Findings from a cross sectional study

Background

The coronavirus pandemic known as COVID-2019 poses a global concern. The psychological well-being of front-line nurses and other healthcare providers is a major concern.

Aims

This study evaluated the psychological well-being and the associated factors among nurses in Dr. Soliman Fakeeh Hospital during the COVID-19 pandemic.

Methods

The cross-sectional survey was conducted during the peak period of COVID 19 among 367 nurses recruited from Dr. Soliman Fakeeh Hospital. The online survey was used with the snowballing sampling technique to collect the participants' socio-demographic data and assess their psychological status using DASS-21; in addition, the major traumatic event was assessed by Impact of Event Scale-Revised, and self-efficacy was evaluated.

Results

67.7% of the 367 respondents experienced moderate or severe psychological problem; 46.1% reported moderate to severe depressive symptoms; 48.0% moderate to severe anxiety symptoms; and 48.4% moderate to severe stress levels. The psychological status and influence of a major traumatic event and self-efficacy were statistically significant different among nurses according to age, gender, working experience, marital status, working in a COVID 19 unit or with suspected cases.

Conclusions

Nurses had a significantly increased risk of developing psychological problems, negatively impacted by the major traumatic event and poor self-efficacy.

Contribution of nursing research to fighting against COVID-19 pandemic. A systematic review

Introduction: The 2019 coronavirus disease (COVID-19) pandemic, should be an opportunity to ensure greater visibility of nursing in health systems and society worldwide. Objective: Review and synthesize the patterns on COVID-19 and nursing research, identifying the main journals, country of origin, language, topics, designs, and area of applicability of the results. Materials and Methods: Systematic review. Searches in PubMed, CINAHL, LILACS, and EMBASE databases (from the inception of the pandemic to May 15, 2020) were performed. Articles of any language related were related to SARS-CoV-2 infection or COVID-19 disease and nursing in any of its roles (care, management, education, among others) and using any epidemiological design or a scientific report were included. Two reviewers independently selected the studies and extracted the data. The main findings from the included studies were summarized through narrative synthesis and descriptive tables. The characteristics of the studies were presented as absolute values and proportions. Results: Three hundred and sixty-five articles were assessed for eligibility. Thirty-eight were included, published in 28 journals. Of those, 53.57% (n=15) were nursing specific. Most articles were “narrative reviews”, accounting for 23.68% (n=9). Most studies were conducted in China (n=18, 47.37%), followed by the United Kingdom and the United States. Thirty-four (89.47%) articles were published in English, followed by Portuguese and Chinese. We identified five areas of application of the results, and the most frequent was the “clinical” setting with 47.00% (n=18). Discussion: These findings are crucial to give visibility to nursing work during the emergency of the COVID-19 pandemic. Mental health was the main research topic, while the clinical setting concentrates the major number of articles. This pattern was aligned with the challenges of the initial phase of the pandemic. Conclusion: Future research should explore the current state of evidence in the main topics identified in this review and continue to give visibility to work carried out by nursing in the emergency of the COVID-19 pandemic.

Trait Empathy Modulates Patterns of Personal and Social Emotions During the COVID-19 Pandemic

The COVID-19 pandemic has caused profound consequences on people's personal and social feelings worldwide. However, little is known about whether individual differences in empathy, a prosocial trait, may affect the emotional feelings under such threat. To address this, we measured 345 Chinese participants' personal emotions (e.g., active, nervous), social emotions (i.e., fearful and empathetic feelings about various social groups), and their empathy traits during the COVID-19 pandemic. Using the representational similarity analysis (RSA), we calculated the pattern similarity of personal emotions and found the similarity between the positive and negative emotions was less in the high vs. low empathy groups. In addition, people with high (vs. low) empathy traits were more likely to have fearful and sympathetic feelings about the disease-related people (i.e., depression patients, suspected COVID-19 patients, COVID-19 patients, flu patients, SARS patients, AIDS patients, schizophrenic patients) and showed more pattern dissimilarity in the two social feelings toward the disease-related people. These findings suggest a prominent role of trait empathy in modulating emotions across different domains, strengthening the polarization of personal emotions as well as enlarging social feelings toward a set of stigmatized groups when facing a pandemic threat.

Psychological distress reported by healthcare workers in Saudi Arabia during the COVID-19 pandemic: A cross-sectional study

INTRODUCTION

Few studies have considered the impact of COVID-19 on the mental health of healthcare workers (HCWs) in the Kingdom of Saudi Arabia (KSA). We estimated the prevalence and severity of psychological distress and characterized predisposing risk factors among HCWs in KSA during the COVID-19 pandemic.

METHODS

We conducted a cross-sectional online survey of 1,985 HCWs from 6 hospitals across the country designated with caring for COVID-19 patients between April 16 and June 21, 2020. Our data analysis was performed using logistic regressions. Ordered logistic regressions were also performed using forward stepwise model selection to explore the effects of risk factors on psychological distress.

RESULTS

The prevalence of psychological distress reported by HCWs in KSA was high, ranging from mild-moderate to severe in severity. Younger HCWs, women, those in contact with COVID-19 patients, and those who either had loved ones affected or who were themselves affected by COVID-19 were the most at-risk of psychological distress. Risk factors such as insomnia, loneliness, fear of transmission, and separation from loved ones most significantly predicted elevated levels of distress among HCWs.

CONCLUSIONS

Increasing psychological distress was commonly reported by HCWs during the early months of COVID-19 pandemic in KSA. Public health policy makers and mental health professionals must give special attention to risk factors that predispose HCWs in KSA to psychological distress.

Prevalence and associated factors of depressive symptoms among the young adults during the post-epidemic period - Evidence from the first wave of COVID-19 in Hubei Province, China

Introduction

China emerged from the first wave of COVID-19 in a short period of time and returned to normal economic and living order nationwide, making China's entry into the post-COVID-19 epidemic period since April 2020. However, the COVID-19 epidemic had a great impact on young adults' psychological status and may continue into the post-epidemic period. The enormous economic, employment and entrepreneurship pressures of this period may exacerbate this negative impact. This study investigated the depression status of the young adults and put forward the suggestions on how to strengthen the psychological crisis intervention and social security to cultivate the resilience of the young adults after major public health emergencies.

Methods

This study conducted a questionnaire survey to identify the prevalence of depressive symptoms and explore the associated factors of depressive symptoms among 1069 young adults in X City, Hubei province in September 2020. And the multistage stratified random sampling method was used for sampling. Depressive symptoms were measured using the 10-item version of the Center for Epidemiological Studies Depression Scale (CES-D-10). Descriptive statistics and logistic regression analysis were adopted for statistical analysis.

Results

1069 respondents (67.68% male; mean age = 28.87 ± 4.18 years; age range = 18–35 years) were included in final analyses. About 25.9% of the respondents reported depressive symptoms (CES-D-10 score = 7.28 ± 3.85). Age, marital status, employment status, monthly disposable income, the cognition, experience and social relationship of the COVID-19 epidemic, and regional discrimination were significantly associated with depressive symptoms. Being male (P = 0.025), age of 25–29 years (P = 0.011), having a household size with 4–5 (P = 0.01) and more than 8 (P = 0.012) family members, a little pessimism about the prospect of COVID-19 epidemic prevention and control (P = 0.044), often (P = 0.018) or always (P = 0.009) participation in anti-epidemic volunteer work were likely to lead to depressive symptoms.

Conclusions

In the post-COVID-19 epidemic period, the psychological status of young people is generally stable, but some of them are depressed. Life, work and mental stress affect the generation of depressive symptoms among the young adults.

Working with patients and the mental health of health care workers during the COVID-19 pandemic

BACKGROUND: Anxiety and concern are among the most common problems facing healthcare workers (HCWs) during epidemic diseases. OBJECTIVE: To identify the predictive factors of anxiety, fears, and psychological distress among healthcare workers during the COVID-19 pandemic. METHODS: An online survey method was used on a sample of 153 of HCWs; (110) frontline and (43) non-frontline HCWs. They answered on the Hamilton anxiety rating scale, the Kessler psychological distress scale (K10), and the COVID-19 Concerns Questionnaire. RESULTS: The results demonstrated that 47.05% of HCWs have a severe level of fear related to COVID-19, 43.13% have very severe anxiety, and 30.71% experience severe psychological distress. The differences between frontline and non-frontline HCWs, female and male HCWs, and HCWs working in medical clinics, on quarantine, or in another place were significant in the three scales. Predictive factors of anxiety, fear, and psychological distress include working on the front lines, being female, and being over 50 years old. Meanwhile, working in a workplace with COVID-19 patients predicted anxiety and psychological distress, but not fears associated with COVID-19. CONCLUSION: HCWs have a high prevalence of symptoms of mental disorders that may interfere with their work. These results may have therapeutic applications during pandemics.

Assessment of Acceptability and Initial Effectiveness of a Unified Protocol Prevention Program to Train Emotional Regulation Skills in Female Nursing Professionals during the COVID-19 Pandemic

Healthcare professionals, especially women, have shown increases in anxious-depressive symptoms as a consequence of the COVID-19 pandemic. The aim of this pilot study was to evaluate the acceptability and preliminary effectiveness of a Unified Protocol (UP) prevention program to provide emotional regulation skills to cope with stressful situations. The sample consisted of 27 nursing professionals (100% women; mean age: 45.67; SD = 7.71) working in a Spanish public hospital during COVID-19, who were randomized to an immediate treatment group (ITG, n = 13) or to a delayed treatment group (DTG, n = 14, which served as the waiting list control group and received the program 5 weeks after the ITG had received it). The program consisted of five-weekly, two-hour, UP-based group sessions. Variables related to emotional symptomatology, emotional regulation, personality, burnout, and perceived quality of life were evaluated at the following time points: pre- and post-intervention and at 1-, 3-, and 6-month follow-ups. Statistically significant between-group differences showed lower emotional exhaustion and personal accomplishment in favor of the ITG after the intervention. Regarding the effect over time for all participants who received the UP (n = 27), statistically significant reductions were observed in neuroticism, personal accomplishment, and subjective distress caused by traumatic events (-0.23 ≤ d ≤ -0.73). A statistically significant interaction "Time*Condition" was found in anxiety, with increases in the DTG. Participants showed high satisfaction with the UP. These findings show good acceptability and preliminary effectiveness of the UP to reduce the emotional impact of the pandemic in female nursing workers.

Perceived stress and resilience levels during the COVID-19 pandemic among critical care nurses in Saudi Arabia: a correlational cross-sectional study

Background

The continuous spreading of the respiratory coronavirus disease, COVID-19, has been a threat to global health, especially among those fighting directly against it. Nurses who work in critical care have reported very high levels of stress during these extreme circumstances. It is very important to measure the level of stress and resilience among these nurses in order to diminish further psychological distress. This study aims to assess the levels of perceived stress and resilience among critical care nurses.

Methodology

In this correlational cross-sectional study, critical care nurses (n = 139) were recruited by gatekeepers in a governmental university hospital in Riyadh City between 12 March and 8 April 2021 to complete an online questionnaire. The measurement tools used in this study were the Connor-Davidson Resilience Scale 10 (CD-RISC-10) and the Perceived Stress Scale of COVID-19 (PSS-10 items). Data were analyzed using a descriptive and inferential analysis to calculate frequencies to determine the distribution of stress and resilience, and multiple regression was applied to assess the relationship between them.

Results

One hundred and thirty-nine critical care nurse (64%) responded. The perceived levels of stress reported were: no stress (8%; n = 12), mild stress (14%; n = 21), moderate stress (38%; n = 55), high stress (22%; n = 32), and severe stress (18%; n = 26). The levels of resilience reported were: very low (8%; n = 11), low (18%; n = 26), moderate (42%; n = 62), and high (32%; n = 47). The level of stress and resilience reported by the majority of critical care nurses was moderate; there was no significant correlation between COVID-19-related stress and resilience among the critical care nurses. Severe levels of stress were mostly reported among critical care nurses working in the NICU and high levels of stress were reported among those working in the emergency department. The nurses reported being highly confident that they were able to handle personal epidemic related problems with a mean score of 2.36. This reflects having a high level of resilience (42%; n = 62) and was significantly associated with years of experience as a nurse (p < 0.0027).

Conclusion

Although COVID-19 cases had declined significantly during the study period in Saudi Arabia, the majority of nurses were still experiencing moderate to high levels of stress about the epidemic, but were, at the same time, moderately resilient. Continued monitoring of the stress levels of this high-risk group is highly essential. Conducting more research is needed to measure the effectiveness of psychosocial support interventions.

Psychological distress experienced by physicians and nurses at a tertiary care center in Lebanon during the COVID-19 outbreak

The COVID-19 outbreak has had a significant mental health toll on healthcare workers in Lebanon. We examined pandemic-related psychological distress among healthcare workers in a tertiary care medical center. One hundred and fifty participants completed an online questionnaire. About half showed a high risk of acute distress (58.7%) on the GHQ-28, while most (89.3%) scored low/moderate stress on the PSS-10. The IES-R revealed concern for post-traumatic stress in one-third of participants, significantly in nurses (p = 0.008) and those living with vulnerable individuals (p = 0.030). Mental health history did not increase the risk. Our findings highlight the need for early targeted interventions during the pandemic.

The mental health benefits of community helping during crisis: Coordinated helping, community identification and sense of unity during the COVID-19 pandemic

Communities are vital sources of support during crisis, providing collective contexts for shared identity and solidarity that predict supportive, prosocial responses. The COVID-19 pandemic has presented a global health crisis capable of exerting a heavy toll on the mental health of community members while inducing unwelcome levels of social disconnection. Simultaneously, lockdown restrictions have forced vulnerable community members to depend upon the support of fellow residents. Fortunately, voluntary helping can be beneficial to the well-being of the helper as well as the recipient, offering beneficial collective solutions. Using insights from social identity approaches to volunteering and disaster responses, this study explored whether the opportunity to engage in helping fellow community members may be both unifying and beneficial for those engaging in coordinated community helping. Survey data collected in the UK during June 2020 showed that coordinated community helping predicted the psychological bonding of community members by building a sense of community identification and unity during the pandemic, which predicted increased well-being and reduced depression and anxiety. Implications for the promotion and support of voluntary helping initiatives in the context of longer-term responses to the COVID-19 pandemic are provided. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

The lived experience of bereaved Iranian families with COVID-19 grief

The present study investigated the lived experience of bereaved family members from grief due to COVID-19 using descriptive phenomenological method via in-depth interviews. The participants (N = 30) were spouses, children, parents, and siblings of the deceased. The obtained data from interviewing were analyzed using Colaizzi's method. Eight main themes were obtained. Findings suggest that society is confronted with the prolonged grief on a large scale and has put people in an existential experience situation. Different experiences, which have led to creation of new meaning in loss and life, has been able to help some post-traumatic growth in the bereaved.

Association Between Clinical Competencies and Mental Health Symptoms Among Frontline Medical Staff During the COVID-19 Outbreak: A Cross-Sectional Study

Background

In China, mental health of frontline medical staff might be influenced by clinicians' ability to handle the outbreak of coronavirus disease 2019 (COVID-19). Few studies to-date have addressed the association between clinicians' competencies and mental health in this context. This cross-sectional study was to examine the prevalence of mental health symptoms among frontline medical staff that fought against the COVID-19 outbreak, and explore the associations between their competencies, and separate and concurrent depressive and anxiety symptoms.

Methods

A total of 623 frontline medical staff was included in this study. Competencies, depressive symptoms, and anxiety symptoms were assessed using a self-reported short form of the Chinese clinical physicians' competency model, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 questionnaire, respectively. Logistic regression models were used to evaluate the associations between one SD increase in competency scores and the prevalence of mental health problems.

Results

The prevalence of depressive, anxiety, and comorbid depressive and anxiety symptoms was 40.93, 31.78, and 26.00%, respectively. Among the medical staff with higher total competency scores, the prevalence of depressive [odds ratios (ORs) = 0.67, 95% confidence intervals (CIs): 0.55-0.81], anxiety (OR = 0.68, 95% CI: 0.56-0.83), and comorbid anxiety and depressive symptoms (OR = 0.69, 95% CI: 0.55-0.83) was lower than among their lower-scoring counterparts. Subgroup analyses stratified by core competency scores revealed similar associations as the main analyses.

Conclusion

The present findings highlight the association between high core competency scores and lower prevalence of depressive, anxiety, and comorbid anxiety and depressive symptoms.

The Arabic Version of the Impact of Event Scale-Revised: Psychometric Evaluation among Psychiatric Patients and the General Public within the Context of COVID-19 Outbreak and Quarantine as Collective Traumatic Events

The Coronavirus Disease-19 (COVID-19) pandemic has provoked the development of negative emotions in almost all societies since it first broke out in late 2019. The Impact of Event Scale-Revised (IES-R) is widely used to capture emotions, thoughts, and behaviors evoked by traumatic events, including COVID-19 as a collective and persistent traumatic event. However, there is less agreement on the structure of the IES-R, signifying a need for further investigation. This study aimed to evaluate the psychometric properties of the Arabic version of the IES-R among individuals in Saudi quarantine settings, psychiatric patients, and the general public during the COVID-19 outbreak. Exploratory factor analysis revealed that the items of the IES-R present five factors with eigenvalues > 1. Examination of several competing models through confirmatory factor analysis resulted in a best fit for a six-factor structure, which comprises avoidance, intrusion, numbing, hyperarousal, sleep problems, and irritability/dysphoria. Multigroup analysis supported the configural, metric, and scalar invariance of this model across groups of gender, age, and marital status. The IES-R significantly correlated with the Depression Anxiety Stress Scale-8, perceived health status, and perceived vulnerability to COVID-19, denoting good criterion validity. HTMT ratios of all the subscales were below 0.85, denoting good discriminant validity. The values of coefficient alpha in the three samples ranged between 0.90 and 0.93. In path analysis, correlated intrusion and hyperarousal had direct positive effects on avoidance, numbing, sleep, and irritability. Numbing and irritability mediated the indirect effects of intrusion and hyperarousal on sleep and avoidance. This result signifies that cognitive activation is the main factor driving the dynamics underlying the behavioral, emotional, and sleep symptoms of collective COVID-19 trauma. The findings support the robust validity of the Arabic IES-R, indicating it as a sound measure that can be applied to a wide range of traumatic experiences.

The Psychological Impact of COVID-19 among a Sample of Italian Adults with High-Functioning Autism Spectrum Disorder: A Follow-Up Study

The strict lockdowns imposed to contain the COVID-19 pandemic brought an increase in levels of stress, anxiety, and depression in the general population. However, in a previous study, our group found that individuals with High-Functioning Autism Spectrum Disorders (HF-ASD) reported an increase in their psychological wellbeing and a decrease in their daily tiredness, in relation to the social distancing measures imposed during the first Italian lockdown (between March and May 2020). In this follow-up study, conducted during the "second wave" of COVID-19, we included the same group of individuals with HF-ASD and evaluated their levels of stress, anxiety, depression, PTSD-related symptoms, tiredness, and perceived wellbeing; moreover, we compared our results to the ones we obtained during the first lockdown on the same population. We found that individuals with HF-ASD experienced higher levels of the aforementioned psychiatric symptoms during the second lockdown, with respect to the first one. These levels positively correlated with their scores at the Autism Quotient subscale Attention Switching: hence, we speculated that these symptoms might be due not only to the prolonging of the social distancing measures, but also to the uncertainty that HF-ASD participants started experiencing at the end of the first lockdown.

Emotional State of Chinese Healthcare Workers During COVID-19 Pandemic

Objective

Anti-epidemic work against coronavirus disease (COVID) has become routine work in China. Our study was intended to investigate the emotional and psychological state of healthcare workers and look for the association between sociodemographic factors/profession-related condition and emotional state.

Methods

A cross-sectional survey was conducted online among healthcare workers from various backgrounds. Symptoms of anxiety and depression were assessed by the Chinese versions of the seven-item Generalized Anxiety Disorder (GAD-7) and the nine-item Patient Health Questionnaire (PHQ-9), respectively. Supplementary questions (Supplementary Material) were recorded to describe the participants’ information about workplace violence, profession, and attitude related to the COVID pandemic. Wherever suitable, independent t-test, and one-way ANOVA were performed to detect group differences of GAD-7 and PHQ-9 total scores after grouping by sociodemographic variables, respectively, such as age, gender, marital status, educational level, after-tax income, department category, job title, experience of workplace violence, and anti-epidemic participation. Multiple linear regression analyses (stepwise method) were utilized in order to look for the potential associated factors of GAD-7 and PHQ-9 total scores.

Results

A total of 2,139 questionnaires with valid response were completed. Approximately 86.44% of participants had minimal symptoms of anxiety, 11.08% mild, 1.59% moderate, and 0.89% severe. Meanwhile, 81.34% had minimal symptoms of depression, 14.07% mild, 2.90% moderate, 1.17% moderately severe, and 0.51% severe. Student’s t-test showed that participants with female gender, with experience of workplace violence scored higher on both GAD-7 and PHQ-9, and participants with experience of anti-epidemic front-line work during pandemic scored lower on both GAD-7 and PHQ-9. ANOVA showed that participants aging from 31 to 40, with higher educational level, with middle level of annual after-tax income, with department of internal medicine or surgery, or with middle level of job title scored higher on both GAD-7 and PHQ-9. Regression analyses showed that female gender, high job title, and the experience of workplace violence positively were associated with anxiety or depression. Doctoral education, department (other vs. psychiatry), job enthusiasm, and professional self-identity were negatively associated with anxiety or depression. Additionally, psychological support was negatively associated with depression.

Conclusion

As the epidemic prevention and control against COVID-19 become normalized in China, emotional state of healthcare workers deserves extensive attention. Our study revealed that gender, educational level, department category, job title, the experience of workplace violence, job enthusiasm, and professional self-identity are the most important influencing factors of physician’s anxiety and depression. Self-tailored psychological intervention should be based on the predisposing factors above to mentally prepare healthcare workers for this long-lasting battle against COVID-19.

The impact of the COVID-19 pandemic on pediatric developmental services: a cross-sectional study on overall burden and mental health status

BACKGROUND

The COVID-19 outbreak has taken a heavy toll on the mental well-being of healthcare workers, even those who have not been directly involved in the care of acutely ill patients. The aims of this study were to identify the overall burden and mental health status of healthcare workers in pediatric developmental services under the influence of the COVID-19 pandemic, and to identify the risk and protective factors associated with mental health.

METHODS

This cross-sectional web-based study was part of a large multicenter VOICE study conducted among employees ((neuro-)pediatricians, psychologists, speech therapists, occupational therapists, etc.) from various pediatric developmental services between June and July 2020. A total of 1291 questionnaires regarding overall burden, mental health status (depression, generalized anxiety disorder and emotional exhaustion) and risk and protective factors for mental health (working conditions, potential problems during the COVID-19 pandemic and psychological resources) were analyzed. Descriptive statistics and multiple linear regression were used for data analysis.

RESULTS

A total of 44.5% (574/1291) participants felt a high or very high overall burden during the COVID-19 pandemic. Of all the participants, 14.6% (171/1173) reported clinically significant levels of depressive symptoms, 17.0% (199/1173) reported generalized anxiety disorder symptoms and 44.6% (532/1192) reported emotional exhaustion. Multiple linear regression analyses identified several common risk and protective factors for mental health status variables. The burden of an increase in the quantity of work, fear of work and fear of becoming infected showed the strongest negative associations, whereas psychological resources and sufficient relaxation in leisure time exhibited the strongest positive associations.

CONCLUSION

Employees who were not directly involved in the care of acutely ill patients were also exposed to considerable stress, some of which was not different from that experienced by professionals who were directly affected. These employees should not be lost sight of and must be offered appropriate support.

Caring for Psychological Distress of Patients With COVID-19: A Mixed-Method Cross-Sectional Study

Introduction

The 2019-2020 pandemic COVID-19 has become a global health crisis. While many recent studies on COVID-19 pandemic have focused on disease epidemiology and psychological status of patients, few have explored the multi-facet influential factors or combined perspectives from both the patients and healthcare workers. The purposes of this study were to: analyze the influencing factors of psychological distress of COVID-19 patients; and describe the experience of healthcare workers relieving psychological distress.

Materials and Methods

This study uses a mixed-method cross-sectional design, including a quantitative study and a qualitative study, targeting two populations: COVID-19 patient and health workers, respectively. In the quantitative part, we recruited a convenience sample of patients with COVID-19 from five hospitals in Wuhan, Hubei Province from 10 to 15 April, 2020. Besides, we collected data by using participants' socio-demographic information sheet, the Connor-Davidson Resilience Scale-10, the Herth Hope Index, the Distress Thermometer, the Revised Chinese Version of Mishel Uncertainty in Illness Scale, and the Chinese Version of Wake Forest Physician Trust Scale. In the qualitative part, the participants were healthcare workers involved in medical aid missions in Hubei Province, China. Meanwhile, we used sampling with convenient and purposive, data collection with a semi-structured online video interview, and text transcription with Colaizzi's phenomenological method.

Results

The results reveal that 25.7% of patients reported higher level of psychological distress (n = 31, scoring ≥4). After controlling the sociodemographic variables, only severity of COVID-19 (β = 0.282, P = 0.025) and uncertainty in illness (β = 0.345, P = 0.007) shown significant effect on psychological distress in the regression model (F = 10.862, R 2 = 0.222, P < 0.001). The experience of healthcare workers emerged five themes: Particularly needed psychological care, Manifestation of negative emotion, Manifestation of proactive adaptation, Strategies relieving psychological distress, and gains of healthcare workers after delivering effective psychological care.

Conclusion

The 25.7% of patients with COVID-19 still suffered from psychological distress, which should receive timely attention from healthcare workers. And the severity of the disease and disease uncertainty have a significant impact on distress. It is critical to train the healthcare workers on detecting the different manifestation of psychological distress, offering timely disease related information, and applying communication strategies.

Professionalism: COVID-19 made me do it!

PURPOSE OF REVIEW

COVID-19 pandemic has created profound ethical challenges, not only for clinical decision-making but also for defining physician professional conduct.

RECENT FINDINGS

Multiple ethical questions arose as the COVID-19 pandemic ravaged globally, including physician obligations in a pandemic, allotment of personal protective equipment, care of unvaccinated patients, discern between evidence-based and unreliable information, addressing end-of-life wishes, implications of involving medical students in a public health crisis, and finally physician burnout aggravated by a pandemic.

SUMMARY

There is a need to redefine existing medical professionalism standards so that future healthcare professionals are well prepared to deal with similar public health crisis.

Impact of COVID-19 on psychological distress among SME owners in Ghana: Partial least square-structural equation modeling (PLS-SEM) approach

A critical part of the national economy is small and medium enterprises (SMEs). SME owners are vital contributors to the overall economy. Due to their limited capital and assets, they are more vulnerable. In comparison to their contribution, the value of assessing SME owner's depression, anxiety, and mental stress has been very minimal during the COVID-19 outbreak. Firms were forced to close due to lockdown, and they faced substantial business losses. Thus, this study aims to investigate SME owners' psychological distress due to business losses during this pandemic. The study used psychological parameters: Depression, Anxiety, Stress Scale-21 (DASS-21) to examine SME owners' psychological distress. A total number of 217 owners were surveyed through a judgmental sampling technique using a structured questionnaire. Data were analyzed employing partial least square-based structural equation modeling (PLS-SEM). The findings showed that DASS-21 parameters and fear of business loss affected psychological distress. Besides, fear of business loss increases psychological distress, whereas government support lessens the distress. Theoretically, this study extended the scope of DASS-21 scale and contributed to the literature of psychology. In terms of policy implications, this study provides useful information for government, policymakers, and SME owners about the effects mentioned above.

The Courage to Continue: Healthcare Social Worker's Resilience During COVID-19

The COVID-19 pandemic has exacerbated disparities in access to healthcare and mental health, often forcing healthcare social workers into ethical and moral dilemmas as they endeavor to provide equitable, humanistic care to their patients and caregivers. The purpose of this mixed method study was to explore how COVID-19-related personal and professional grief and losses impacted healthcare social worker's distress and resilience. Participants were recruited through healthcare social work professional organizations from September-November 2020. Participants (N = 246) completed an online survey capturing sociodemographic variables, as well as mental distress, pandemic-related meaning-making, and resilience. Data analysis included correlations and regressions pertaining to meaning-making, emotional distress, and resilience, as well as thematic analysis of participants' open-ended survey responses. Approximately one-third of participants reported emotional distress and difficulty in finding meaning from their pandemic-related losses. Participants reported a lower level of resilience when compared with the United States general population. Three themes emerged from social workers' qualitative responses: the hardest year of my career; the collective loss of our normal; and we were built for this. Pandemic-related grief permeates social workers' daily lives; yet their training and resilience foster hope to positively impact their clients, communities, and families.

Mechanisms of action of fluvoxamine for COVID-19: a historical review

The ongoing coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) accelerates the discovery of prophylactic and therapeutic drugs for persons infected with the virus. Drug repurposing for the COVID-19 pandemic has received particular attention. Increasing clinical data suggest that antidepressant use in early-stage subjects with COVID-19 might be associated with a reduced risk of intubation or death. Among the antidepressants, fluvoxamine is the most attractive drug for mild to moderate subjects with COVID-19. In this article, we review the mechanisms of action (i.e., serotonin transporter, sigma-1 receptor, and acid sphingomyelinase) of fluvoxamine for COVID-19. Furthermore, we discuss a possible link between maternal COVID-19 infection and a risk for neuropsychiatric disorders (i.e., autism spectrum disorder and schizophrenia) in offspring.

Vicarious trauma and nursing: An integrative review

Nursing requires empathic engagement, within therapeutic relationships, to ensure the delivery of compassionate care. Empathic engagement with people who have experienced trauma is known to potentially lead to experiences of vicarious trauma occurring in the caregiver. However, relatively little is known about the implications of vicarious trauma for nurses. This integrative review aimed to explore what is known about vicarious trauma and consider its implications for nursing. Twenty-two articles were included in the review, with findings considering how vicarious trauma is conceptualized and applied to nursing in the literature, what implications of vicarious trauma, specific to nursing, are identified in the literature, and what vicarious trauma interventions are identified to apply to nursing. The findings highlight clear articulation of the concept of vicarious trauma and its relevance to nursing, including its pervasive and significant personal and professional effects. Vicarious trauma was identified to be a workplace hazard for nurses working across settings, which also impacts upon organizations. The review highlighted that at individual, team, organizational, and social levels, awareness and preventative approaches are recommended. These approaches require systemic supports that foster individual coping mechanisms, self-care and support networks for nurses, education about vicarious trauma, screening for vicarious trauma, and formalized access to clinical supervision and peer support for all nurses. With increasing awareness of trauma across health care settings, and a move towards the delivery of 'trauma informed care', recognition of vicarious trauma amongst nurses as a likely 'cost' of the delivery of compassionate care to trauma survivors, is essential.

Sleep disorders and mental health in hospital workers during the COVID-19 pandemic: a cross-sectional multicenter study in Northern Italy

INTRODUCTION

From the beginning of the COVID-19 pandemic, healthcare workers had to face unprecedented emergency needs associated with an extraordinary amount of psychological distress. In this cross-sectional multicenter study, we investigated sleep disturbances, and the level of anxiety and depression among the healthcare and non-healthcare staff of three hospitals in Milan (Italy) during the COVID-19 outbreak. Moreover, we explored potential predisposing factors for affective symptoms and poor sleep.

METHODS

Between June and July 2020, we administered an online questionnaire to evaluate the presence of sleep disorders (Pittsburgh Sleep Quality Index), insomnia (Sleep Condition Indicator), anxiety (State Trait Anxiety Inventory), and depression (Beck Depression Inventory-II). We used univariate and multivariate analysis to evaluate the association between the personal conditions and sleep and affective disorders.

RESULTS

The 964 participants reported high rates of sleep disorders (80.3%)-mainly insomnia (30.5%)-anxiety (69.7%), and depression (32.8%). The multivariate analysis showed a strong association of sleep disorders, especially insomnia, with female gender (p = 0.004), divorced marital status (p = 0.015), self-isolation (p = 0.037), and chronic diseases (p = 0.003). Anxiety was significantly associated with teleworking (p = 0.001), while depressive symptoms were associated with self-isolation (p = 0.028), modified work schedules (p = 0.03), and chronic diseases (p = 0.027).

CONCLUSION

In hospital workers, the high prevalence of sleep and psychiatric symptoms during the COVID-19 outbreak appears to be determined mainly by modifications of personal or work habits. Teleworking was associated with increased anxiety. An accurate planning of hospital activities and a psychological support are needed to prevent and manage sleep and mental disorders.

Stressors associated with the COVID‐19 pandemic, disability, and mental health: Considerations from the Intermountain West

The deleterious mental health effects associated with the COVID-19 pandemic are increasingly apparent, however, questions remain about the extent to which pandemic-related stressor exposure has contributed to increased psychological distress among an already disadvantaged group, individuals with disabilities. The first aim of the study was to examine the distribution of pandemic-related stressors across multiple dimensions-employment, personal and family finances, personal relationships, and quality of social life-among individuals with and without disabilities. The second aim of the study was to examine the association between a composite COVID-19 stressor score and two mental health outcomes-depressive and anxiety symptoms-among the two subsamples. The study used quota-based online survey data (N = 2043) collected in the summer of 2020 from adults (18 and older) residing in the Intermountain West, half of whom had a self-reported disability. Study results demonstrated that individuals with disabilities experienced pandemic-related stressors at significantly higher rates relative to their non-disabled counterparts. Further, pandemic stressor exposure was associated with greater negative effects on their psychological well-being. We argue that the COVID-19 pandemic is generating a secondary mental illness pandemic, and that individuals with disabilities are affected by it at significantly higher proportions.

Sentiment and emotion trends in nurses' tweets about the COVID-19 pandemic

PURPOSE

Twitter is being increasingly used by nursing professionals to share ideas, information, and opinions about the global pandemic, yet there continues to be a lack of research on how nurse sentiment is associated with major events happening on the frontline. The purpose of the study was to quantitatively identify sentiments, emotions, and trends in nurses' tweets and to explore the variations in sentiments and emotions over a period in 2020 with respect to the number of cases and deaths of COVID-19 worldwide.

DESIGN

A cross-sectional data mining study was held from March 3, 2020 through December 3, 2020. The tweets related to COVID-19 were downloaded using the tweet IDs available from a public website. Data were processed and filtered by searching for keywords related to nursing in the profile description field using the R software and JMP Pro Version 16 and the sentiment analysis of each tweet was done using AFINN, Bing, and NRC lexicon.

FINDINGS

A total of 13,868 tweets from the Twitter accounts of self-identified nurses were included in the final analysis. The sentiment scores of nurses' tweets fluctuated over time and some clear patterns emerged related to the number of COVID-19 cases and deaths. Joy decreased and sadness increased over time as the pandemic impacts increased.

CONCLUSIONS

Our study shows that Twitter data can be leveraged to study the emotions and sentiments of nurses, and the findings suggest that the emotional realm of nurses was affected during the COVID-19 pandemic according to the emotional trends observed in tweets.

CLINICAL RELEVANCE

The study provides insight into what nurses are feeling, and findings from this study highlight the importance of developing and implementing interventions targeted at nurses at the workplace to prevent mental health consequences.

Factors Associated With Psychological Outcomes Among Vaccinated and Unvaccinated Health Care Workers Against COVID-19 Infection in Bangladesh

Background

Vaccination of healthcare workers (HCWs) is recommended during the COVID-19 pandemic to reduce the risk of infection for themselves and their patients, as well as to encourage their patients to get immunized. The present study aimed to investigate the psychological outcomes and associated factors among vaccinated and unvaccinated HCWs against COVID-19 infection in Bangladesh.

Methods

From March to August 2021, an online nationwide survey was conducted with a total of 2,038 Bangladeshi HCWs. The frequency of symptoms of general health problems, depression, anxiety, stress, post-traumatic stress disorder, insomnia, and loneliness was assessed using the Bangla versions of the GHQ-12, PHQ-2, GAD-2, PSS-4, PC-PTSD-5, ISI, and UCLA-LS scales, respectively.

Results

Compared with unvaccinated HCWs (n = 1,058), vaccinated HCWs (n = 980) had a statistically significant lower prevalence of general health problems (16.7 vs. 59.1%), depression (15.6 vs. 31.9%), post-traumatic stress disorder (22.3 vs. 30.8%), insomnia (23.8 vs. 64.9%), and loneliness symptoms (13.9 vs. 21.8%). Among vaccinated HCWs, females were significantly associated with a higher risk of symptoms of general health problems (AOR, 2.71; 95% CI, 0.97-7.60), anxiety (AOR, 2.17; 95% CI, 1.14-4.13), and loneliness (AOR, 2.52; 95% CI, 1.11-5.73). Except for anxiety and post-traumatic stress disorder symptoms, participants living in urban areas had a significantly lower risk of all psychological outcomes (e.g., depression: AOR, 0.43; 95% CI, 0.27-0.67; stress: AOR, 0.64; 95% CI, 0.47-0.88). Respondents who were married were significantly less likely to experience symptoms of general health problems (AOR, 0.10; 95% CI, 0.02-0.39), depression (AOR, 0.31; 95% CI, 0.22-0.82), insomnia (AOR, 0.46; 95% CI, 0.20-1.03), and loneliness (AOR, 0.31; 95% CI, 0.10-0.92). Participants who worked as doctors were significantly less chance of experiencing symptoms of general health problems (AOR, 0.18; 95% CI, 0.08-0.37), depression (AOR, 0.51; 95% CI, 0.30-0.87), and anxiety (AOR, 0.54; 95% CI, 0.37-0.78). On the other hand, unvaccinated HCWs who were 18-29 years old and had <5 years of work experience were significantly associated with a higher risk of all psychological outcomes except anxiety and insomnia symptoms (e.g., depression among 18-29 years old: AOR, 1.83; 95% CI, 0.27-2.60; stress among those with <5 years of work experience: AOR, 2.37; 95% CI, 0.93-6.07). Participants who worked as nurses were significantly more likely to suffer from depression (AOR, 1.44; 95% CI, 0.84-2.46), anxiety (AOR, 1.42; 95% CI, 0.24-1.73), and stress (AOR, 1.55; 95% CI, 0.31-0.89) symptoms. Except for anxiety and stress symptoms, respondents who worked as frontline workers and provided direct care to infected patients were the significantly higher chance of experiencing all psychological outcomes (e.g., depression among who worked as frontline workers: AOR, 2.41; 95% CI, 0.23-3.73; insomnia among those who provide direct care to infected patients: AOR, 2.60; 95% CI, 0.34-3.06). Participants who were infected with COVID-19 had a significantly less chance of experiencing symptoms of general health problems (AOR, 0.89; 95% CI, 0.65-1.22), depression (AOR, 0.66; 95% CI, 0.48-0.92), and anxiety (AOR, 0.63; 95% CI, 0.46-0.87).

Conclusions

To control the infection and improve psychological outcomes, this study suggests emphasizing the vaccinated to unvaccinated HCWs as soon as possible. They also required special attention, health-related education, and psychological support.

Factors Associated with Distress Among Medical Staff During the Initial Phase of the COVID-19 Pandemic in Peru

The current COVID-19 pandemic affects the mental health of medical staff. Our objective was to evaluate the factors that are associated with the distress of physicians in two general hospitals in Lima, Peru. A cross-sectional correlational survey study was carried out. Physicians completed The Impact of Event Scale-Revised-22 (IES-R), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). A total of 310 physicians completed the survey, 36.5% of whom reported distress symptoms. Higher levels of distress were reached by women, by those with a prior psychiatric diagnosis, by those who considered that the hospital does not provide adequate personal protective equipment, and by those who perceived stigma from family members. Multiple regression analysis showed that there is a correlation between distress symptoms and anxiety symptoms, (B = 0.509), depressive symptoms (B = 0.305), the total hours/week worked in the Emergency Department (B=-0.142), and the stigma perception (B = 0.096). Early intervention programs must be developed to support medical staff members exposed to severe distress situations such as the current viral pandemic.

Work-Family Interaction, Self-Perceived Mental Health and Burnout in Specialized Physicians of Huelva (Spain): A Study Conducted during the SARS-CoV-2 Pandemic

BACKGROUND

The medical staff who work in specialized healthcare are among the professionals with a greater risk of presenting negative indicators of mental health. These professionals are exposed to numerous sources of stress that can have a negative influence on their personal life. Currently, SARS-CoV-2 poses an additional and relevant source of stress. The aim of this study was to identify the interactions between the work and family environments, as well as to analyze self-perceived mental health and burnout in physicians who, during the COVID-19 pandemic, carried out their jobs in public health in Huelva (Spain), also considering a series of sociodemographic variables.

METHODS

This is a descriptive, cross-sectional study. Information from 128 participants was collected using the SWING, MBI-HSS and GHQ-12 questionnaires, along with sociodemographic data and possible situations of contact with SARS-CoV-2. The data were analyzed, and correlations were established.

RESULTS

Most of the sample obtained a positive interaction result of work over family. Those who had been in contact with SARS-CoV-2 represented higher percentages of a positive result in GHQ-12, negative work-family interaction, burnout, emotional exhaustion and depersonalization. In general, the men showed a worse mental health state than women.

CONCLUSIONS

The medical staff of Huelva who had been in contact with situations of SARS-CoV-2 in their work environment presented worse indicators of mental health and greater negative interaction of work over family than those who had not been in contact with these situations.

Help Seeking of Highly Specialized Mental Health Treatment before and during the COVID-19 Pandemic among Health Professionals

(1) Background: Ongoing specialized programs for health professionals (HPs) adapted their treatment services during the COVID-19 pandemic. (2) Methods: We conducted a retrospective observational study of medical e-records of HPs with mental disorders working in Catalonia that were consecutively admitted to the Galatea Care Program Clinical Unit. The sample (N = 1461) was divided into two periods: 21.5 months before (n = 637) and after (n = 824) 14 March 2020. (3) Results: There was a significant increase (29.4%) in the number of referrals to the specialized Clinical Unit during the pandemic, especially with respect to physicians compared to nurses. The percentage of HP women at admission and the clinical severity of the first treatment episode remained without changes before and after the COVID-19 pandemic. The most prevalent main diagnoses also remained similar: adjustment disorders (41.5%), mood disorders (24.9%), anxiety disorders (14.4%), and substance use disorders (11.8%). (4) Conclusions: HPs, particularly physicians, more frequently sought voluntary help from specialized mental health programs during the COVID-19 pandemic. Future studies are needed to analyze the reasons behind this finding and the evolution of referrals to these types of programs after the COVID-19 outbreak.

Burden and Growth during COVID-19: Comparing Parents of Children with and without Disabilities

The COVID-19 pandemic and the measures taken to contain it have had a disproportionate impact on families with young children, especially with disabilities. This study examined factors associated with burden and growth among parents of young children in Israel, while comparing parents of children with and without disabilities. We hypothesized that the association between family functioning, informal social support, and perceived adequacy of educational services and burden and growth would be moderated by disabilities. An online questionnaire was completed by 675 parents of young children, 95 of them with disability. The moderating effect of disability on burden and growth was examined using PROCESS. Compared to parents of children without disabilities, greater burden was found among parents of children with disabilities, but levels of growth were similar. External support was lacking for both parent groups. Educational services were perceived as severely inadequate. Lower perceived adequate educational services were associated with greater burden. On the other hand, higher levels of family functioning (i.e., family cohesion and adaptability) and greater adequacy of educational services were associated with growth. The results show that while burden was greater for parents of children with disabilities, growth during the COVID-19 period was possible for parents of both groups. The findings also pointed to the importance of the family system for sustaining the wellbeing of its members in lockdown situations. Put together, the findings highlight the importance of planning for such national and global emergencies.

The fear of COVID-19 and job insecurity impact on depression and anxiety: An empirical study in China in the COVID-19 pandemic aftermath

The employees' psychological health and resilience in times of emergency and general uncertainty was chosen due to the immense implications for economics, entrepreneurs, psychologists and psychiatrists, and policymakers. This study aims to provide an insight into uncertainty-induced anxiety and depression among Chinese employees in the aftermath of the COVID-19 outbreak. Analysis performed in the context of China in the COVID-19 pandemic aftermath is significant due to the universal nature of external shock impact on psychological welfare, applicable across nations and business sectors and in similar contexts. The statistical analysis was performed with SEM software AMOS version 23. The research model consisting of fear of COVID-19, job insecurity, anxiety, depression, was empirically tested. A purposive sampling technique was applied with the online questionnaire shared with employees in companies located in China. Respondents were working in educational services, information technology, engineering, electronics, and other sectors on white-collar jobs. The data collection was conducted from May to August 2020, in the aftermath of the COVID-19 pandemic in China. The research sample consisting of 283 respondents was used for analysis. Path analysis was performed, and standardized parameter estimates, standard errors, and p-values were calculated. The results indicate a positive and significant impact of job insecurity on depression and anxiety. Furthermore, results indicate that the fear of COVID-19 significantly impacts anxiety and depression but does not impact job insecurity. The findings can be used in a multidisciplinary effort to mitigate the psychological damage. Furthermore, they complement the ongoing epidemiological and scientific discourse on people's personal health and choice of coping.

Prevalence and correlates of COVID-19-related traumatic stress symptoms among older adults: A national survey

Coronavirus pandemics increase the incidence of posttraumatic stress disorder (PTSD), which requires intensive treatment and is related to several long-term psychiatric disorders. Older adults are particularly vulnerable to COVID-19 and hence trauma symptoms. It is not known what is the prevalence of trauma symptoms relating to COVID-19 specifically among older adults nor what may be the markers for the emergence of trauma symptoms. The aim of the present research was to estimate the prevalence, and identify correlates of, traumatic stress symptoms attributable to COVID-19 among older adults in the UK. A cross-sectional survey that assessed COVID-19-related trauma symptoms and demographics was conducted with a sample of 3012 adults aged 60 years and older who were representative of the UK population. Data were analysed descriptively and using multiple/logistic regression. 36.5% of the sample (n = 1100) reported experiencing clinically meaningful traumatic stress symptoms that could lead to as many as 27.4% of the sample going on to develop PTSD. Women and younger older adults were particularly likely to experience clinically meaningful symptoms of traumatic stress. Work is urgently required to prepare services to address what may be substantial numbers of older people presenting with PTSD in the future.

Prevalence of psychological outcomes and its associated factors in healthcare personnel working during COVID-19 outbreak in India

BACKGROUND

Care of COVID-19 patients has been shown to affect the mental health of healthcare personnel (HCP), however, there is little data reflecting psychological health of HCP in India.

AIMS

The present study was undertaken to assess the prevalence of psychological outcomes and its association with various sociodemographic and occupational factors among the HCP in India.

METHODOLOGY

A cross-sectional, online survey, using snowball sampling method was conducted between June 1, 2020, and June 22, 2020. The HCP working in COVID-19 designated hospitals across India were invited to participate. Patient Health Questionnaire-4 and 19-item stress-related questionnaire were used to evaluate symptoms of overall anxiety, depression, COVID-19 infection specific anxiety, exhaustion, and workload.

RESULTS

In this cross-sectional study with 2334 HCP from 27 states and 7 union territories of India; 17.9% of participants had depression, 18.7% had overall anxiety, 26.5% had exhaustion, 30.3% reported heavy workload, and 25.4% had COVID-19 infection-specific anxiety, respectively. The HCP working in states with higher caseload was a common risk factor for overall anxiety (odds ratio [OR], 1.7; P < 0.001), depression (OR, 1.6; P < 0.001), COVID-19 infection-specific anxiety (OR, 2.5; P < 0.001), exhaustion (OR, 3.1; P < 0.001), and heavy workload (OR, 2.6; P < 0.001). Nurses were more at risk for depression (OR, 2.2; P < 0.001), anxiety specific to COVID-19 infection (OR, 1.3; P = 0.034), and heavy workload (OR, 2.9; P < 0.001); while doctors were more at risk for overall anxiety (OR, 2.0; P = 0.001) and exhaustion (OR, 3.1; P < 0.001).

CONCLUSIONS

Frontline workers, specifically nurses and doctors, and those working in states with high COVID-19 caseload are more at risk for adverse psychological outcomes. The relatively less prevalence compared with other countries, is perhaps a reflection of measures undertaken, including early lockdown, ensuring better all-round preparedness and social norms.

Forward-focused coping predicts better mental health outcomes in mid- to late-life during the COVID-19 pandemic

Objectives: Psychosocial stressors associated with the COVID-19 pandemic may increase the risk of depression and anxiety in the general population. Individuals approaching or within older adulthood may be especially vulnerable to these psychosocial stressors and their impact on mental health outcomes. Consequently, there is an urgent need to identify protective factors for older adults. The purpose of the present study was to determine the relative contribution of coping flexibility (CF) and two distinct coping strategies, forward-focused and trauma-focused, on negative affect in persons 50 years of age and older during the COVID-19 pandemic. Method: Data were collected using an online survey, including questions about demographic information, coping, depression, and anxiety. Participants aged 50 and over were included in our analyses of depression (N = 800) and anxiety (N = 638). Results: Both higher CF and higher forward-focused coping predicted lower depression and lower anxiety. In contrast, higher trauma-focused coping predicted slightly higher depressive symptoms but was not a significant predictor of anxiety. Conclusion: Our findings suggest that higher forward-focused coping may serve as a protective factor in older adults during the pandemic and, therefore, may be an effective treatment target for mental health interventions.

Associations of household structure and presence of children in the household with mental distress during the early stages of the U.S. COVID-19 pandemic

PURPOSE

The objectives of the current study were to (1) assess associations between household structure (i.e., living with spouse compared to living alone, with children, or with a spouse and children), presence of children, and mental distress in April 2020 and change in mental distress (between April and August 2020); and (2) determine whether these associations are moderated by income or sex.

PARTICIPANTS

A total of 2,214 adults aged 25-55 from the April and August 2020 waves of the Understanding America study were included in the analytic sample.

STUDY METHOD

Multivariable, survey-weighted linear regression models were used to examine associations between explanatory variables (i.e., household structure and number of children) and outcome variables (mental distress in April and change in mental distress), measured via the Patient Health Questionnaire (PHQ)-4.

RESULTS

In adjusted models, each additional child under the age of 12 was associated with lower mental distress in April 2020 (β = -.30, p = .002). Having children aged 13 to 18 and household structure were not significantly associated with mental distress. In interaction models, living with children only was associated with decreased mental distress among individuals reporting low income (interaction β = -1.28, p = .016) but not high income. Similarly, living with children only was associated with decreased mental distress in females (interaction β = -1.09, p = .025) but not males.

CONCLUSION

This study supports prior literature that demonstrates the positive association of child rearing with psychological well-being and suggests that these benefits may be present even under stay-at-home orders in the early stages of the U.S. COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A narrative review into the impact of COVID-19 pandemic on senior high school adolescent mental health

Problem

High school teenagers are facing significant challenges during the COVID‐19 pandemic. Teenagers are at risk of experiencing physical, mental, and social health problems due to the COVID‐19 pandemic. This narrative review aims to explore the impact of COVID‐19 on the emergence of mental health problems in high school adolescents.

Methods

This study employed a narrative review method. We conducted a systematic search using PRISMA on three databases: Medline, PubMed, and ScienceDirect. A total of 40 articles met the inclusion and exclusion criteria set based on the research objectives.

Findings

The study uncovered that high school adolescents had an increased risk of experiencing mental health problems, namely psychological distress, worry, loneliness, anxiety, depression, traumatic symptoms, other psychological disorders, suicide risk, sleep disorders, and psychosocial functioning. Anxiety, depression, and psychological stress were the most discussed mental health problems among high school adolescents during the COVID‐19 pandemic.

Conclusions

There is a need for efforts to identify health problems and intervene in mental health problems early in high school adolescents. Schools, mental health workers, and the government (e.g., policy stakeholders) need to implement the recommendations given as a follow‐up effort for mental health services for high school youth.

Investigation of the Perceived Coronavirus Threat, E-Health Literacy, and Psychological Well-Being in Turkey

This study aims to examine the relationship between e-health literacy, psychological well-being, and perceived coronavirus disease threat in people aged 18 and over living in Turkey. Another aim of the study is to reveal whether the participants' perceptions about the threat of coronavirus disease, e-health literacy, and psychological well-being differ according to various socio-demographic characteristics. Data was collected from 5153 people through a questionnaire created via Google Form on the Internet. The data collection process was carried out on April 22-27, 2020. According to the result of the regression analysis made in line with the data obtained; it was determined that the perceived coronavirus threat explained 4.6% of the total variance on psychological well-being and 2.7% of the total variance on e-health literacy; and finally, e-health literacy explained 18.6% of the total variance on psychological well-being. The study also revealed that the participants' scores regarding the perceived coronavirus threat show statistically significant differences depending on age, gender, marital status, education level, place of residence, income level, having a chronic disease, regular drug use, smoking use, the degree of information about the coronavirus disease and watching TV programs about the current coronavirus news. As a result of this research, it is thought that individuals should minimize their perception of coronavirus threats by increasing their e-health literacy levels, and thus, their psychological well-being levels should be increased.

The Impact of the COVID-19 Pandemic on Burnout, Compassion Fatigue, and Compassion Satisfaction in Healthcare Personnel: A Systematic Review of the Literature Published during the First Year of the Pandemic

This literature review aimed to determine the level of burnout, compassion fatigue, and compassion satisfaction, as well as their associated risks and protective factors, in healthcare professionals during the first year of the COVID-19 pandemic. We reviewed 2858 records obtained from the CINAHL, Cochrane Library, Embase, PsycINFO, PubMed, and Web of Science databases, and finally included 76 in this review. The main results we found showed an increase in the rate of burnout, dimensions of emotional exhaustion, depersonalization, and compassion fatigue; a reduction in personal accomplishment; and levels of compassion satisfaction similar to those before the pandemic. The main risk factors associated with burnout were anxiety, depression, and insomnia, along with some sociodemographic variables such as being a woman or a nurse or working directly with COVID-19 patients. Comparable results were found for compassion fatigue, but information regarding compassion satisfaction was lacking. The main protective factors were resilience and social support.

The experience of European hospital-based health care workers on following infection prevention and control procedures and their wellbeing during the first wave of the COVID-19 pandemic

Background

Working under pandemic conditions exposes health care workers (HCWs) to infection risk and psychological strain. A better understanding of HCWs’ experiences of following local infection prevention and control (IPC) procedures during COVID-19 is urgently needed to inform strategies for protecting the psychical and psychological health of HCWs. The objective of this study was therefore to capture the perceptions of hospital HCWs on local IPC procedures and the impact on their emotional wellbeing during the first wave of the COVID-19 pandemic in Europe.

Methods

Participants were recruited in two sampling rounds of an international cross-sectional survey. Sampling took place between 31 March and 17 April 2020 via existing research networks and between 14 May and 31 August 2020 via online convenience sampling. Main outcome measures were behavioural determinants of HCWs’ adherence to IPC guidelines and the WHO-5 Well-Being Index, a validated scale of 0–100 reflecting emotional wellbeing. The WHO-5 was interpreted as a score below or above 50 points, a cut-off score used in previous literature to screen for depression.

Results

2289 HCWs from 40 countries in Europe participated. Mean age was 42 (±11) years, 66% were female, 47% and 39% were medical doctors and nurses, respectively. 74% (n = 1699) of HCWs were directly treating patients with COVID-19, of which 32% (n = 527) reported they were fearful of caring for these patients. HCWs reported high levels of concern about COVID-19 infection risk to themselves (71%) and their family (82%) as a result of their job. 40% of HCWs considered that getting infected with COVID-19 was not within their control. This feeling was more common among junior than senior HCWs (46% versus 38%, P value < .01). Sufficient COVID-19-specific IPC training, confidence in PPE use and institutional trust were positively associated with the feeling that becoming infected with COVID-19 was within their control. Female HCWs were more likely than males to report a WHO-5 score below 50 points (aOR 1.5 (95% confidence interval (CI) 1.2–1.8).

Conclusions

In Europe, the COVID-19 pandemic has had a differential impact on those providing direct COVID-19 patient care, junior staff and women. Health facilities must be aware of these differential impacts, build trust and provide tailored support for this vital workforce during the current COVID-19 pandemic.

Measuring mental well-being among frontline nurses during the COVID-19 crisis: Evidence from Saudi Arabia

In the days of the COVID-19 pandemic, frontline nurses providing care to different communities face are particularly vulnerable to the mental health threats of the crisis. The objective of this study was to examine the structural validity, convergent validity, and reliability of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) in professional nurses amidst the COVID-19 crisis in Saudi Arabia. Data were collected from 413 nurses in Saudi Arabia using a cross-sectional online survey. Consistent with the original version, results of the confirmatory factor analysis revealed a unidimensional structure of the WEMWBS. Support for convergent validity was found as the WEMWBS significantly correlated with measures of burnout and compassion satisfaction. In terms of reliability, all WEMWBS items yielded high internal consistencies suggesting that the 14 items were robust indicators of mental well-being. In response to the challenges of the COVID-19 crisis, the current study offers a psychometrically sound instrument that can be utilized in screening the mental well-being of nurses in the days of a public health crisis. Preserving the positive aspect of mental health among frontline healthcare workers and promoting quality of care for communities requires a contextualized measurement tool that efficiently assesses mental well-being.

Compassion Fatigue and Satisfaction in Nurses and Midwives during the COVID-19 Pandemic in Turkey

Objective: To examine the levels of compassion fatigue and compassion satisfaction of nurses and midwives during the COVID-19 pandemic and the influencing factors. Methods: This descriptive study was carried out with the participation of Turkish midwives and nurses. In the study using the convenience sampling method, data were collected online using an online questionnaire. The questionnaire, created through the Google form, was shared between May and June 2021 in the midwife and nurse groups (Facebook, Instagram, WhatsApp) on electronic platforms. Compassion fatigue (CF) and compassion satisfaction (CS) consisting of the burnout (BO) and secondary traumatic stress (STS) subcomponents were assessed by the Professional Quality of Life scale. The study was completed with 402 nurses and midwives from various units. Descriptive statistics, and the Mann-Whitney U and Kruskal-Wallis tests were used in the analysis of the data. Results: Among the participants, the rate of dissatisfaction with the clinic worked was 24.6% and the turnover intention rate was 70.6%. During the pandemic period, 75.6% of the participants reported that they were exposed to verbal violence, 7.7% to physical violence, and 74.4% to mobbing behaviors. Low CS was found in 24.9% of the participants, a high level of BO in 27.1%, and high STS in 32.8%. Conclusion: Violence and mobbing against nurses and midwives should be prevented in order to increase the professional quality of life.

＜Editors' Choice＞ Developing online lectures using text mining reduces health workers' anxiety in non-epicenter areas of COVID-19

COVID-19 is indirectly associated with various mental disorders such as anxiety, insomnia, and depression, and healthcare professionals who treat COVID-19 patients are particularly prone to severe anxiety. However, neither the anxiety of healthcare workers in non-epicenter areas nor the effects of knowledge support have been examined thus far. Participants were 458 staff working at the Toyota Regional Medical Center who completed a preliminary questionnaire of their knowledge and anxiety regarding COVID-19. Based on text mining of the questionnaire responses, participants were offered an online lecture. The effect of the lecture was analyzed using a pre- and post-lecture rating of anxiety and knowledge confidence, and quantitative text mining. The response rates were 45.6% pre- and 62.9% post-lecture. Open-ended responses regarding anxiety and knowledge were classified into seven clusters using a co-occurrence network. Before the lecture, 28.2%, 27.2%, and 20.3% of participants were interested in and anxious about "infection prevention and our hospital's response," "infection and impact on myself, family, and neighbors," and "general knowledge of COVID-19," respectively. As a result of the lecture, Likert-scale ratings for anxiety of COVID-19 decreased significantly and knowledge confidence increased significantly. These changes were confirmed by analyses of open-ended responses about anxiety, lifestyle changes, and knowledge. Positive changes were strongly linked to the topics focused on in the lecture, especially infection prevention. The anxieties about COVID-19 of healthcare workers in non-epicenter areas can be effectively reduced through questionnaire surveys and online lectures using text mining.

The COVID-19 pandemic and its potential enduring impact on children

PURPOSE OF REVIEW

The COVID-19 pandemic has ushered in great and rapid change in our society. Although children are somewhat less likely to get infected or have severe symptoms from COVID-19, they are being adversely affected by this global public health emergency in many direct and indirect ways. This review focuses on the major areas in which children and adolescents are suffering, and how pediatricians can anticipate and optimize child healthcare and support as the COVID-19 pandemic and its aftermath continues.

RECENT FINDINGS

This review provides preliminary insights into the physical, psychological, educational, developmental, behavioral, and social health implications of the pandemic on the pediatric population, highlighting both the pandemic's current and potential future impact on children.

SUMMARY

The COVID-19 pandemic has and will likely continue to adversely affect many different aspects of children's health and well-being. It is important for pediatricians to be aware of these consequences of COVID-19 and take steps to help their patients now and in the future. Because the virus continues to ravage many parts of the world, continued research is needed to identify and evaluate any additional COVID-related challenges and concerns that adversely impact the growth and development of children.

Relationship between stress and alexithymia, emotional processing and negative/positive affect in medical staff working amid the COVID-19 pandemic

The psychological burden of the COVID-19 pandemic may have a lasting effect on emotional well-being of healthcare workers. Medical personnel working at the time of the pandemic may experience elevated occupational stress due to the uncontrollability of the virus, high perceived risk of infection, poor understanding of the novel virus transmission routes and unavailability of effective antiviral agents. This study used path analysis to analyze the relationship between stress and alexithymia, emotional processing and negative/positive affect in healthcare workers. The sample included 167 nurses, 65 physicians and 53 paramedics. Sixty-two (21.75 %) respondents worked in COVID-19-designated hospitals. Respondents were administered the Toronto Alexithymia Scale-20, Cohen's Perceived Stress Scale, Emotional Processing Scale, and the Positive and Negative Affect Schedule. The model showed excellent fit indices (χ2 (2)=2.642, p=0.267; CFI=0.999, RMSEA=0.034, SRMR=0.015). Multiple group path analysis demonstrated physicians differed from nurses and paramedics at the model level (X2diff (7)=14.155, p<0.05 and X2diff (7)=18.642, p<0.01, respectively). The relationship between alexithymia and emotional processing was stronger in nurses than in physicians (difference in beta=0.27; p<0.05). Individual path χ2 tests also revealed significantly different paths across these groups. The results of the study may be used to develop evidence-based intervention programs promoting healthcare workers' mental health and well-being.

Two-stage mental health survey of first-line medical staff after ending COVID-19 epidemic assistance and isolation

Facing with COVID-19 epidemic such a catastrophic health emergency, the mental health status of medical staff deserves attention. We conducted a two-stage of psychological status monitoring after the end of the assistance and 14 days of isolation, further targeted the vulnerable groups in need of intervention. The study is a cross-sectional survey on 1156 Yunnan medical staff aid to Hubei. Used Cluster sampling method to collect data at 2 time points (at the end of returning from Wuhan and the 14th day of isolation), from March 18, 2020 to April 6, 2020. Female and nurse had higher rates of depressive symptoms than male and doctors and other occupations. The proportion of female with mild and above moderate anxiety levels (22.91%, 2.61%) was higher than male (17.35%, 1.03%) (p < 0.05). Female had a better impaired sleep quality (45.06%, 17.49%) more than male (28.57%, 7.94%). Medical staff supported in Wuhan and with junior professional titles reported a higher proportion of sleep quality impairment. At the 14th isolation day stage, the proportion of nurses changed from depression to health (9.15%) and from health to depression (6.1%) better than doctors. The front-line medical staffs had suffered greater psychological pressure in the treatment process of major public health emergency. Researches on the dynamic monitor for the change of psychological status after aiding epidemic areas were still in relatively blank stage. Targeting the vulnerable characteristics of aiding medical staff is significant for effective psychological intervention and sustainable operation of health system.