Health anxiety, cyberchondria, and coping in the current COVID-19 pandemic: Which factors are related to coronavirus anxiety?

Political beliefs and the acceptance of the SARS-CoV-2 pandemic restrictions. The case of Poland

We investigated the relationships between political beliefs regarding two aspects of the right-left distinction (cultural and economic) and the acceptance of the pandemic restrictions using variable-centred and person-centred approaches. The community sample consisted of 305 participants. Four groups of the restrictions were considered. Religious fundamentalism predicted positively the acceptance of the restrictions associated with the limitations of labour rights and those limiting civil rights without a direct impact on safety. Anti-welfare negatively predicted the acceptance of the restrictions regarding social distancing and those limiting civil rights and increasing safety. These associations were discussed in relation to basic needs and values which motivate persons who endorse right-wing or left-wing political views. The latent profile analysis revealed three profiles of political beliefs, which were termed "Conservative Statists," "Liberal Laissez-fairists," and "Conservative Laissez-fairists." The profiles differed in terms of acceptance of the pandemic restrictions, and the patterns of these relationships were different for particular groups of restrictions.

Coping strategies and depression during the COVID-19 pandemic in pregnant women: a cross sectional study

BACKGROUND

Pregnant women are vulnerable to psychological problems depending on the adaptive capacities of their personality and coping strategies. This study aimed to investigate the association between coping strategies of pregnant women during the COVID-19 pandemic and depression.

METHODS

This web-based cross-sectional study was conducted in 2021 on 318 pregnant women in Amol, Iran. Data collection was performed via questionnaires (Brief cope, Edinburgh Postnatal Depression Scale, CDA, and Demographic questionnaire). The questionnaires were completed through the WhatsApp and Telegram applications. Data were analyzed using the hierarchical regression analysis and SPSS software (v. 21) at the significance level of 0.05.

RESULTS

About 40% of participants had depression. The most prevalent coping strategy used by pregnant women was the avoidance strategy. Hierarchical regression revealed that the coping strategy of avoidance was a significant predictor of depression (β = 0.226, p = 0.046) after controlling background characteristics.

CONCLUSIONS

The findings of this study suggest that avoidance style associated with depression in pregnant women. Therefore, obtaining further knowledge about impacts of coping strategies on pregnant women seems to be essential.

Influence of knowledge on Brazilian student's perception of life and clinical classes during COVID-19

BACKGROUND

The current pandemic associated with SARS-CoV-2 has negatively influenced several activities, including teaching in Operative Dentistry. The aim of this study was to evaluate the influence of knowledge in Operative Dentistry on undergraduate students' perception related to personal life and return to clinical practices classes during pandemic.

MATERIALS AND METHODS

The present research was a cross-sectional, observational, and qualitative survey. The 16-item based questionnaire was sent to undergraduate students in 2020, which were divided into two groups, according to the Operative Dentistry knowledge: G1-not started clinical practice; G2-already started or completed clinical practice. Questions were focused on the impact of the pandemic in relation to their personal lives and return to clinical practice classes. Chi-square association test was performed using the SigmaPlot 12.0 software (P ≤ 0.05).

RESULTS

The response rate was 55.5% for G1 and 44.4% for G2. Regarding the questions related to personal life, G1 demonstrated higher percentages of fear of contracting the virus during theoretical classes. Same observations were found when students answered about their fear of contracting coronavirus during the clinical practice classes. However, G2 presented the highest agreement responses for the preparedness feeling to return to theoretical classroom, clinical practice classes, and the possibility of applying online learning.

CONCLUSIONS

In general, students' knowledge had little influence on perception of personal life. However, students who have more knowledge in operative dentistry presented more security about returning to clinical classes.

The Moderating Role of Community Capacity for Age-friendly Communication in Mitigating Anxiety of Older Adults During the COVID-19 Infodemic: Cross-sectional Survey

Background

Older adults were perceived as a vulnerable group during the COVID-19 pandemic due to the health and mental health challenges they faced. The pandemic was accompanied by an “infodemic” of overabundant and questionable information that has affected older adults’ mental health. As the infodemic and ageist narratives were prevalent online, more anxiety symptoms have been induced among older adults who used social media. Age-friendly communication, advocated by the World Health Organization’s Age-friendly City (AFC) guide, could be an antidote by providing tailored information via appropriate channels for older adults.

Objective

This study investigated the role of community capacity for age-friendly communication in mitigating anxiety during the pandemic. We hypothesized that age-friendly communication would moderate the effects of infection risks and social media use on anxiety. A double-moderating effect was hypothesized in the context of diminished trust in traditional media.

Methods

Data were collected from a cross-sectional telephone survey conducted in Hong Kong in 2020. Older adults (N=3421, age≥60 years) were interviewed about their well-being and daily lives. Community capacity for age-friendly communication was measured in a living district–based evaluation. It had 2 components: the reach of appropriate information to older adults (AFC-Information) and the age-friendliness of communication technologies (AFC-Communication Technology) in the community. We tested the hypothesized moderation and double-moderation effects with ordinary least squares regressions.

Results

Perceived COVID-19 infection risk (b=0.002, P=.02) and use of social media for COVID-19 information (b=0.08, P=.04) were associated with more anxiety symptoms. The effect of using social media was moderated by AFC-Information (b=–0.39, P=.002) and AFC-Communication Technology (b=–1.06, P<.001), and the effect of perceived COVID-19 infection risk was moderated by AFC-Information (b=–0.03, P=.002) and AFC-Communication Technology (b=–0.05, P<.001). Lower trust in traditional media exacerbated anxiety symptoms associated with social media use (b=–0.08, P=.02). Higher AFC-Information alleviated this moderation effect (AFC-Information × media trust b=–0.65, P<.001; AFC-Information × social media use b=–2.18, P<.001; 3-way interaction b=0.40, P=.003).

Conclusions

Our findings highlight the role of community age-friendly communication in mitigating anxiety related to the infodemic. Although using social media may have exacerbated the impact of the infodemic on older adults, it has the potential to deliver timely information for an adequate health response. Although the amplifying effects of low media trust was associated with social media use, age-friendly communication determined its strength. Instead of discouraging the use of digital technologies for COVID-19 information, efforts should be made in tailoring information and communication technologies in local communities for older adults.

Health anxiety During COVID-19: Predictive Roles of Health Promoting Behaviors and Sensory Processing Sensitivity

OBJECTIVE

The emergence of the COVID-19 pandemic resulted in major changes in daily life and economic conditions while heightening physical and mental health problems, including health anxiety. Health authorities and elected officials have encouraged individuals to engage in health behaviors. Perceptions of and reactions to these changes could be subject to individual differences. In this line, the current study investigated the predictive roles of health promoting behaviors, sensory processing sensitivity, and their interactions with health anxiety.Design and measures: In this cross-sectional study, 355 participants (73% female, 25.9% male) whose ages range from 19 to 72 (M = 25.91, SD = 9.80) filled out self-reported measures on health promoting behaviors, sensory processing sensitivity, and health anxiety via an online platform between April and May 2020.

RESULTS

It was revealed that caring for a healthy diet, taking responsibility for health and sensory processing sensitivity, but not physical activity and stress management, were associated with health anxiety. Diagnoses and perceptions of physical and mental health problems also contributed to health anxiety during the COVID-19 pandemic.

CONCLUSION

Individuals with higher levels of sensory processing sensitivity and health responsibility were more likely to experience higher levels of health anxiety, while typical physical activities and stress management behaviors were less likely to have an impact during the COVID-19 pandemic. These results highlight the importance of having a healthy diet and the need for pandemic-specific interventions for stress management and sport activities.

Psychological Distancing Usage Uniquely Predicts Reduced Perceived Stress During the COVID-19 Pandemic

Social distancing during the COVID-19 pandemic has presented millions of people with extraordinary challenges that are associated with significant amounts of stress. Emotion regulation is crucial during this crisis as people seek to mitigate the stress and uncertainty of the present moment. In this study, we surveyed a nationally representative sample of 297 adults from the United States on their levels of perceived stress related to the COVID-19 pandemic as well as their level of engagement of different emotion regulation strategies during the pandemic. We performed multiple linear regression analyses to assess which regulation strategies were associated with individual differences in perceived stress. Among all emotion regulation strategies, psychological distancing, which involves thinking about stressful circumstances in an objective, impartial way, was uniquely associated with reductions in perceived stress due to COVID-19 across individuals. This effect was not moderated by age, gender, socioeconomic status, race/ethnicity, or trait-related difficulty in regulating emotion. Conversely, situation modification was associated with significantly greater perceived stress overall. These results suggest the broad applicability and utility of psychological distancing during pandemic-related social distancing as part of an adaptive emotion regulation toolkit and motivate the investigation of interventions involving psychological distancing in this context.

How Long Does Adaption Last for? An Update on the Psychological Impact of the Confinement in Portugal

During the first COVID-19 related confinement in Portugal, there was a decrease in the levels of psychological symptoms measured by the Depression, Anxiety and Stress Scale 21 (March to April 2020). Upon experiencing a new period of restraints in 2021, the psychological impact of this sample was assessed again (N = 322, two more time points). It was expected that the psychological symptoms evidenced in February 2021 would be at similar levels to those found in April 2020, leading to a transfer of adaptation. Contrary to our hypothesis, in the second confinement in Portugal there were higher levels of depression and stress symptoms than at the beginning of the pandemic. On the other hand, the maximum level of anxiety was observed in March 2020. It seems that our perception of the threats in 2021 was not the same as at the onset of COVID-19, or that knowledge was not disseminated to the general population to increase their mental health literacy and help them cope with the imposed challenges.

Stop talking about it already! Co-ruminating and social media focused on COVID-19 was associated with heightened state anxiety, depressive symptoms, and perceived changes in health anxiety during Spring 2020

BACKGROUND

Social distancing presents a significant obstacle for relationships and threatens mental health. Identifying maladaptive, voluntary coping strategies may inform how to maintain interpersonal relationships and mental health during quarantine. Co-ruminating with peers on negative events, moods and fears has adjustment trade-offs of increasing depression and anxiety risk while also enhancing friendship quality. Similarly, social media use is associated with social benefits and risk to mental health. We extend prior research by examining whether co-ruminating on COVID-19, social media use, and social media use focused on COVID-19 during social isolation was associated with heightened depression and anxiety symptoms but also lower loneliness and higher social support during initial lockdown measures in the USA.

METHODS

Adults were recruited through social media (n = 345) to complete self-report surveys on co-rumination, social media use, social distancing, social support from March-May 2020. During this cross-sectional assessment, in addition to completing surveys on current depressive symptoms and state and health anxiety, participants also provided retrospective report of their perceived health anxiety levels six months prior.

RESULTS

Co-ruminating on COVID-19 with peers and greater time on social media focused on COVID-19 predicted perceived increases in health anxiety and were also associated with higher depressive symptoms and state anxiety, even after controlling for significant demographic predictors. Further, in the context of social distancing, both interaction strategies failed to confer social benefits.

CONCLUSIONS

Results have direct implications for maintaining psychosocial health during social distancing restrictions. Adults may modify how they engage with peers by limiting COVID-19 content on social media and COVID-19 discussion.

Does Mental Health Affect the Decision to Vaccinate Against SARS-CoV-2? A Cross-Sectional Nationwide Study Before the Vaccine Campaign

The COVID-19 pandemic generated a sense of threat in the society, leading to social isolation and mental health deterioration. A great deal of hope for the development of herd immunity was placed in preventive vaccinations. The survey, performed before vaccine campaign between September 26-October 27, 2020, during the second wave of the SARS-CoV-2 pandemic in Poland with the Computer Assisted Web Interviews method. The study was partly community based and partly open to the public. Participants were invited to complete the survey using Google forms via social media (Facebook, WhatsApp). The survey was also distributed 54 times at the request of interested persons via e-mail. Total 1,043 questionnaires were assessed for eligibility and 41 were excluded (13 because of the age under 18, and 28 due to refusal to participate: non-response after sending questionnaire via e-mail). Finally 1,001 questionnaires were included to the study and statistical analysis was performed on the basis of the 1,001 responses. The questionnaire consisted of three parts: a sociodemographic survey, a questionnaire assessing the knowledge of the SARS-CoV-2 and the General Health Questionnaire-28. Participants also determined their attitude toward being vaccinated against SARS-CoV-2. The questionnaire was completed by a total of 1,001 participants: 243 people declared that they will not get vaccinated against SARS-CoV-2. Majority of people declaring the willingness to vaccinate were representatives of medical professions, suffering from chronic diseases, with higher values on the total GHQ-28 scale and the subscales: anxiety and insomnia, social dysfunction and somatic dysfunction. Loss of income, difficult access to health care, recognizing the restrictions as excessive and knowledge about COVID-19 were found as significant positive determinants of the reluctance to vaccinate. Greater readiness to vaccinate can be associated with greater certainty about its effectiveness and a hypothetical collectivist attitude. Experiencing anxiety and psychopathological symptoms are risk factors for infection, but can also be conducive to reliance on information about vaccination presented in the media. Reluctance to vaccinate may result from greater awareness of the complexity of the disease, and thus less faith in the effectiveness of vaccines.

The Relationship Among Spirituality, Self-Efficacy, COVID-19 Anxiety, and Hopelessness During the COVID-19 Process in Turkey: A Path Analysis

This study explores the relationship among spirituality, self-efficacy, COVID-19 anxiety, and hopelessness. The participants are comprised of 418 individuals (282 females and 136 males) in Turkey whose ages range between 18 and 61 years old. The participants completed the following surveys: The Coronavirus Anxiety Scale, the General Self-Efficacy Scale, the Beck Hopelessness Scale, and the Spiritual Orientation Inventory. The relationships among the variables have been examined using path analysis. According to the results, spirituality, self-efficacy, and COVID-19 anxiety have direct effects on hopelessness. The analysis also shows self-efficacy to mediate the relationship between spirituality and hopelessness. The proposed model has good fit indices. The findings are discussed in the context of the literature on COVID-19, spirituality, self-efficacy, and hopelessness, with practical implications for mental health professionals being provided.

COVID-19 health misinformation: using design-based research to develop a theoretical framework for intervention

Purpose

Because health misinformation pertaining to COVID-19 is a serious threat to public health, the purpose of this study is to develop a framework to guide an online intervention into some of the drivers of health misinformation online. This framework can be iterated upon through the use of design-based research to continue to develop further interventions as needed.

Design/methodology/approach

Using design-based research methods, in this paper, the authors develop a theoretical framework for addressing COVID-19 misinformation. Using a heuristic analysis of research on vaccine misinformation and hesitancy, the authors propose a framework for education interventions that use the narrative effect of transportation as a means to increase knowledge of the drivers of misinformation online.

Findings

This heuristic analysis determined that a key element of narrative transportation includes orientation towards particular audiences. Research indicates that mothers are the most significant household decision-makers with respect to vaccines and family health in general; the authors suggest narrative interventions should be tailored specifically to meet their interests and tastes, and that this may be different for mothers of different backgrounds and cultural communities.

Originality/value

While there is a significant body of literature on vaccine hesitancy and vaccine misinformation, more research is needed that helps people understand the ways in which misinformation works upon social media users. The framework developed in this research guided the development of an education intervention meant to facilitate this understanding.

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.

Health anxiety is associated with fearful imagery of contracting COVID-19: An experimental study

BACKGROUND

Aversive mental images of contracting or having a severe disease are assumed to contribute to the development and maintenance of health anxiety (HA) via the elicitation of fear, arousal and defensive mobilization. The current COVID-19 pandemic is known to trigger fears of contracting COVID-19.

METHODS

In this study, we used an experimental approach to investigate whether COVID-19-related mental images lead to a fearful response and whether this is associated with levels of HA. 139 participants vividly imagined neutral, standard fear and COVID-19 related narrative scenes.

RESULTS

Standard fear and COVID-19 scripts prompted higher anxiety, arousal, displeasure and avoidance tendencies as compared to neutral scripts. HA was associated with higher anxiety, arousal, displeasure, imagery vividness and stronger avoidance tendencies during imagery of COVID-19 scenes. No associations were found for anxiety sensitivity, trait anxiety as well as depressive and anxiety symptoms. Moreover, there was no association of HA with emotional responses during imagery of standard fear scenes.

LIMITATIONS

Fear responses were assessed via verbal reports. Future studies should also assess behavioral and physiological correlates of fear.

CONCLUSIONS

The present results indicate that individuals with high levels of HA are prone to fearful mental imagery of contracting COVID-19 which might be crucial factor contributing to the exacerbation and chronicity of excessive HA in times of a pandemic.

The Prevalence and Associated Factors of Depressive Symptoms Among Medical Students in Bangladesh During the COVID-19 Pandemic: A Cross-Sectional Pilot Study

Background

Whilst very limited studies have demonstrated a correlation between the COVID-19 pandemic and depressive symptoms amongst Bangladeshi medical students, the prevalence and associated factors of depressive symptoms as measured by the Patient Health Questionnaire (PHQ-9) remains widely unknown.

Objective

The study aimed to investigate the prevalence and factors associated with depression symptoms among Bangladeshi medical students during the COVID-19 pandemic lockdown period.

Method

In this web-based cross-sectional pilot study, medical students' data was collected using the Google Forms web survey platform after obtaining electronic informed consent. A total of 425 medical students were selected using a systematic sampling technique to accumulate depression symptoms and demographic and pandemic-related information. Depression was measured by a self-administered, validated English version of the Patient Health Questionnaire (PHQ-9) tool. The descriptive analysis utilized frequency and percentages, while the stepwise binary logistic regression analysis was performed to investigate the factors associated with depressive symptoms.

Result

Among 425 medical students, 62.3% were female, 97.4% unmarried. Almost 80.2% of medical students had mild to severe levels of depressive symptoms as characterized by PHQ-9. A significantly higher probability of depression was found amongst female students (adjusted OR = 1.8), those who struggled to stay away from social media (adjusted OR = 1.8), those who tried to be optimistic for maintaining better psychology (adjusted OR = 11.1), and those who always had a sleeping difficulty in the last 4 weeks (adjusted OR = 8.9).

Conclusion

A very high prevalence of depression symptoms among Bangladeshi medical students was found across the majority of socio-demographic variables. The alarming prevalence and associated factors of depression suggests the need for follow-intensity psychosocial interventions designed for medical students during the COVID-19 pandemic.

Analysis of Clinical Parameters, Drug Consumption and Use of Health Resources in a Southern European Population with Alcohol Abuse Disorder during COVID-19 Pandemic

The disruption in healthcare attention to people with alcohol dependence, along with psychological decompensation as a consequence of lockdown derived from the COVID-19 pandemic could have a negative impact on people who suffer from alcohol abuse disorder. Observational real world data pre-post study included 9966 men aged >16 years registered as having the diagnosis of alcohol abuse disorder in the electronic medical records (EMR) of the Aragon Regional Health Service (Spain). Clinical (Glutamate-oxaloacetate -GOT-, Glutamate pyruvate -GPT-, creatinine, glomerular filtration, systolic blood pressure -SBP-, diastolic blood pressure -DBP-, total cholesterol, LDL, HDL, triglycerides, and body mass index -BMI-), pharmacological (dose per inhabitant per day, DHD, of drugs used in addictive disorders, benzodiazepines and antidepressants) and health resource use variables (primary and specialized care) were considered. A Student's t-test for matched samples was performed to analyze the changes in clinical variables between alcohol abuse disorder patients with and without COVID-19. Only creatinine and LDL showed a significant but clinically irrelevant change six months after the end of the strict lockdown. The total number of DHDs for all drugs included in the study (except for benzodiazepines), decreased. In the same way, the use of health services by these patients also decreased. The impact of COVID-19 among this group of patients has been moderate. The reorganization of health and social services after the declaration of the state of alarm in our country made possible the maintenance of care for this vulnerable population.

Cross-cultural validation of the new version of the Coronavirus Anxiety Scale in twelve Latin American countries

The Coronavirus Anxiety Scale (CAS) was recently developed to assess dysfunctional anxiety related to COVID-19. Although different studies reported that the CAS is psychometrically sound, it is unclear whether it is invariant across countries. Therefore, the present study aimed to examine the measurement invariance of the CAS in twelve Latin American countries (Argentina, Bolivia, Chile, Colombia, Cuba, Ecuador, El Salvador, Guatemala, Mexico, Paraguay, Peru, and Uruguay). A total of 5196 people participated, with a mean age of 34.06 (SD = 26.54). Multigroup confirmatory factor analysis (CFA) was used to examine the measurement invariance of the CAS across countries and gender. Additionally, the graded response model (GRM) was used to provide a global representation of the representativeness of the scale with respect to the COVID-19 dysfunctional anxiety construct. The unidimensional structure of the five-item CAS was not confirmed in all countries. Therefore, it was suggested that a four-item model of the CAS (CAS-4) provides a better fit across the twelve countries and reliable scores. Multigroup CFA showed that the CAS-4 exhibits scalar invariance across all twelve countries and all genders. In addition, the CAS-4 items are more informative at average and high levels of COVID-19 dysfunctional anxiety than at lower levels. According to the results, the CAS-4 is an instrument with strong cross-cultural validity and is suitable for cross-cultural comparisons of COVID-19 dysfunctional anxiety symptoms in the general population of the twelve Latin American countries evaluated.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-021-02563-0.

Emotion regulation in times of COVID-19: A person-centered approach based on self-determination theory

Although the COVID-19 crisis is a worldwide threat to individuals' physical health and psychological well-being, not all people are equally susceptible to increased ill-being. One potentially important factor in individuals' vulnerability (versus resilience) to ill-being in the face of stress is emotion regulation. On the basis of Self-Determination Theory, this study examined the role of three emotion regulation styles in individuals' mental health during the COVID-19 crisis, that is, integration, suppression, and dysregulation. Participants were 6584 adults (77% female, M age  = 45.16 years) who filled out well-validated measures of emotion regulation, depression, anxiety, life satisfaction, and sleep quality. To examine naturally occurring combinations of emotion regulation strategies, hierarchical k-means clustering was performed, yielding 3 profiles: (a) low scores on all strategies (indicating rather low overall levels of worry; 27%), (b) high scores on integration only (41%), and (c) high scores on suppression and dysregulation (32%). Participants in the profiles scoring high on suppression and dysregulation displayed a less favorable pattern of outcomes (high ill-being, low life satisfaction, and poorer sleep quality) compared to the other two groups. Between-cluster differences remained significant even when taking into account the corona-related worries experienced by people. Overall, the findings underscore the important role of emotion regulation in individuals' mental health during mentally challenging periods such as the COVID-19 crisis. Practical implications and directions for future research are discussed.

Emotional distress and coping strategies in COVID-19 anxiety

The present study aims to identify psychological factors affected by the COVID-19 pandemic given the information we have about reactions during previous pandemics, which documented features of anxiety, depression and post-traumatic stress disorder. We investigated the relationship between health anxiety, symptoms of depression, anxiety and stress, and coping mechanisms in the general population and among students. The study was conducted on Romanian population (n = 759), aged between 18-70 years old (M = 33.24), general population (n = 485), and students (n = 274). The results showed that the general population is more anxious when confronted with the new virus compared to students (t (757) = 1.902, p < .05, p = .029). Following the analysis of the hierarchical regression, the results revealed that when controlling the health anxiety variable, a high level of anxiety symptoms and stress, and a low level of depression symptoms could predict anxiety for COVID-19 (R 2  = .070, F change (3, 754) = 16.759, p ˂ .001). Also, we found that maladaptive strategies are the ones which explain the relationship between health anxiety and COVID-19-related anxiety (95% CI = .011 - .057). The results of this study bring extra knowledge and shed new light on the psychological aspects of the current sanitary crisis and contribute to the understanding of the way people relate to this disease.

COVID-19, Police Violence, and Educational Disruption: The Differential Experience of Anxiety for Racial and Ethnic Households

BACKGROUND

The threat of a deadly pandemic, racial tension, recessionary economic circumstances, and educational disruption likely contributed to the heightened anxiety felt by many Americans in 2020. This study examines the differential anxiety experienced by Black, White, and Hispanic households with and without children during 2020.

METHOD

Data from the Census Bureau's Household Pulse Survey detailing the frequency of anxiety among a nationally representative sample of adults from April 23 to December 21, 2020, was coupled with Centers for Disease Control and Prevention records of COVID-19 diagnoses and state-level police killings. Multinomial logistic regression assessed the relative contribution of COVID-19 deaths, police violence, unemployment, fear of unemployment, change in educational delivery, and geographic location to anxiety among racial/ethnic cohorts with and without children.

RESULTS

Anxiety frequency increased over the sample for all groups. However, White anxiety was highly responsive to state-level COVID-19 fatalities, while Black anxiety was highly correlated with police violence. Households with children showed higher levels of anxiety during nontraditional educational delivery, whereas both households with and without children experienced high levels of fear regarding employment uncertainty and poverty.

CONCLUSIONS

Experiences in 2020 impacted all groups differently, but each showed a high frequency of anxiety.

Cyberchondria, but not preventive behavior, mediates the relationship between fear of COVID-19 and somatic burden: Evidence from Russia

BACKGROUND

There is extensive available research on the relationship between fear of COVID-19 pandemic and physical symptoms. This study was the first to examine the cyberchondria and COVID-19 preventive behavior as mediators of this relationship.

METHODS

A cross-sectional study was conducted from October to December 2021, during the fourth wave of the COVID-19 pandemic in Russia. The participants were 2,011 Russian-speaking volunteers aged 18 years and older. They completed questionnaires on somatic burden, cyberchondria, COVID-19 preventive behavior, and fear of COVID-19 pandemic. Mediation analysis was used to explore the mediating roles of cyberchondria and preventive behavior in the relationship between fear of COVID-19 and somatic burden.

RESULTS

Fear of COVID-19 positively predicted somatic burden, cyberchondria, and COVID-19 preventive behavior. Mediation analysis showed that the relationship between fear of COVID-19 pandemic and somatic burden was mediated by cyberchondria (effect = 0.08, bootstrapping SE = 0.01, bootstrapping 95% CI [0.08, 0.12]), but not COVID-19 preventive behavior (effect = 0.02, bootstrapping SE = 0.01, bootstrapping 95% CI [0.00, 0.05]).

CONCLUSION

The findings suggest that cyberchondria had negative effects on somatic burden during the COVID-19 pandemic. The knowledge of the mediating role of cyberchondria may be used by health care workers when consulting persons with physical health complaints and psychosomatic disorders.

Evaluating the Impact of Verified Government Accounts on the Knowledge, Attitudes, and Intentions of Saudi Residents During the COVID-19 Pandemic

Governments utilize various media channels to disseminate knowledge pertaining to infectious diseases such as COVID-19. When it was declared a pandemic, society began to depend on the media for critical information and countermeasures that would facilitate tackling the virus. The main objective of this research is to examine the impact of verified Saudi government accounts across various media outlets on respondents’ knowledge, attitudes, and intentions regarding COVID-19.A structured online questionnaire was distributed and 315 responses were used for analysis. The results were analyzed using SPSS. The results indicate that the residents of Saudi Arabia have adequate knowledge concerning the symptoms, precautionary measures, and modes of transmission of COVID-19. The respondents have gained this knowledge from verified Saudi government accounts across various media outlets, most prominently via social media..

Cyberchondria During the COVID-19 Pandemic

Many factors govern the behavior pertaining to anxiety regarding health – it may be stressors, triggers, adverse situations faced by people. Since the outbreak of the COVID-19 virus, health-related anxiety has been widespread. December 2019 saw the occurrence of a form of pneumonia, not known at that time, from the Wuhan region of China to rapidly proceed into a worldwide pandemic and lockdown. This disrupted normal life across the globe and affected social and economic functioning. Cyberchondria has been one of the coping strategies seen during this time, pertaining to online health-related searches which offer answers and relief as seen at the surface but also bringing a plethora of mental health challenges. The authors in this chapter try to simplify what exactly cyberchondria is and how has it affected the lives of the worldwide population during the COVID-19 crisis, the biggest pandemic of recent times. The origin, development, and prevalence of the concept, along with coping, treatment, and prevention of the condition are discussed.

The moderating effect of alexithymia on the relationship between stress and cyberchondria

OBJECTIVES

The pandemic has increased the level of perceived stress and provided a fertile soil for Cyberchondria. This study aims to investigate the relationship between stress, cyberchondria, and alexithymia.

METHODS

This cross-sectional study used convenience sampling to carried out on a total 1,117 college students (female/male:536/581; mean age: 19.95 ± 1.32). Cyberchondria Severity Scale (CSS), Toronto Alexithymia Scale (TAS) and Short Depression Anxiety Stress Scales (DASS-21) were used to assessed the present study variables.

RESULTS

Significant differences emerged for CSS scores by gender (t = 3.74, p < 0.01) and had any comorbid disease (t = 2.47, p < 0.05), The Pearson correlation showed Cyberchondria has a significant positive correlation with stress and alexithymia (r = 0.50, p < 0.01, r = 0.36, p < 0.01). Furthermore, the regression analysis described that stress (β = 0.50, p < 0.01) and alexithymia (β = 0.36, p < 0.01) were the significant positive predictors of cyberchondria. Moreover, moderation analysis showed that alexithymia significantly strengthened the association between stress and cyberchondria (F = 107.20, p < 0.01).

CONCLUSION

The study will help medical practitioners to understand how stress and alexithymia can cause an increase in cyberchondria. This will help them to elaborate operational indications for prevention and psychological support.

Negative interpretation of ambiguous bodily symptoms among illness-anxious individuals: Exploring the role of developmental and maintenance constructs

BACKGROUND

Cognitive factors play an essential role in the development and maintenance of anxiety problems. Among individuals with illness anxiety problems, their interpretation of bodily symptoms is a crucial factor in the determination of their ability to regulate their emotions. The catastrophic interpretation of ambiguous bodily symptoms and changes, known as interpretation bias, in line with the failure to reappraise the symptoms in safer ways, is supposed to increase the levels of anxiety in illness-anxious individuals.

METHODS

This study aimed to address the statistical limitations of the direct (self-report) measure of interpretation bias, using an indirect (online interpretation bias task) measure for assessing biased interpretations of bodily symptoms. In addition, we examined the contribution of self-report anxiety sensitivity (AS), intolerance of uncertainty (IU), interpretation bias, and reappraisal to illness anxiety problems in a subclinical population and compared it with controls with low levels of illness anxiety.

FINDINGS

Illness-anxious individuals made more negative interpretations of ambiguous, potentially health-threatening information. They used less reappraisal to regulate their emotion. Among the measures, the physical subscale of AS and the reaction time to the safe resolution of ambiguous information were the best factors that could contribute to the differentiation between the illness-anxious individuals and non-anxious individuals.

CONCLUSION

Our findings provided further support for the biased processing of information related to physical symptoms among individuals with illness anxiety. AS-physical and safe resolutions for ambiguous situations could differentiate the illness-anxious and the control groups better than other factors. These findings suggest that a change of interpretation of ambiguous bodily symptoms among individuals suffering from chronic conditions can be a possible intervention to target anxiety and improve patients' lives.

Verification of the Psychometric Characteristics of the Nijmegen Questionnaire for the Diagnosis of Dysfunctional Breathing During the COVID-19 Pandemic on a Russian Sample

The purpose of the study was to check the psychometric properties of the Nijmegen questionnaire (NQ) (Van Dixhoorn, Duivenvoorden, 1985), aimed at diagnosing the presence of signs of dysfunctional breathing (DВ) according to self–reports of respondents in the conditions of the COVID-19 pandemic in a Russian-speaking sample. The study sample consisted of 1 362 respondents (1 153 women and 209 men) aged 18 to 88 years (mean age 38.3±11.4) who filled out an online questionnaire from April to December 2020 during the COVID-19 pandemic. The following methods were used to test the construct validity of the Russian version of the NQ: 1) Perceived Stress Scale-10 (PSS-10; Ababkov et al., 2016); 2) State-Trait Anxiety Inventory (STAI, Khanin, 1976), the scales of which were modified to measure the level of anxiety during a pandemic (State anxiety) and before the pandemic (Trait anxiety) (Pervichko et al., 2020); 3) The Symptom Check List-32 (SCL-32) (Mitina, Gorbunova, 2011); (4) An abridged version of the Six-Factor Personality Inventory HEXACO-24 (Egorova et al, 2019). The study participants also completed a socio-demographic questionnaire (Pervichko et al., 2020). The results of checking the Russian-language version of the NQ for reliability are presented: the value of the internal consistency coefficient α-Cronbach for the integral indicator = 0.877. Four subscales were identified, the indicators of which improved when the questionnaire was reduced to 10 points. Internal convergent and discriminant validity has been verified for the abridged version. The external constructive validity of the questionnaire is proved. High rates of correlation with stress, situational and personal anxiety, as well as other symptoms of psychological distress were revealed. In addition, a high correlation with emotionality has been established. The problem of the "threshold" value of NQ required to identify the formed symptom complex of DB is discussed. The prevalence of DB symptoms before and during the pandemic was compared. A significant difference in the indicators on the scale for men and women was established. Using the obtained Russian-language version of NQ, it was shown that in the conditions of the COVID-19 pandemic, 27.7% of the study participants who were not sick with COVID-19 showed signs of a formed DB symptom complex, which is more than twice higher than the population indicators in the pre-pandemic period. The frequency of occurrence of the holistic symptom complex of DB in women is three times higher than in men: 31.0% vs 9.1% (p<0.001). The results of the study allow us to conclude that NQ is a reliable and valid tool for diagnosing the severity of DB symptoms, which can be recommended for use as an express diagnostic tool for the presence of psychogenically caused respiratory disorders in persons complaining of "difficulty breathing" in the absence of objective grounds.

Association Between Awareness, Perceived Severity, and Behavioral Control of COVID -19 With Self-Care and Anxiety in Pregnancy: A Cross-Sectional Study

COVID-19 pandemic has caused a tidal wave of anxiety and stress among Iranians, especially pregnant women. This study aimed to assess the association between knowledge, perceived severity, and controllability of COVID-19 with self-care and health anxiety specially in pregnancy. This cross-sectional study was performed on 440 pregnant women. Data were collected using demographic-obstetrics characteristics, as well as the questionnaires of knowledge, perceived severity, and perceived controllability of the COVID-19, health anxiety, and self-care. Self-care was positively correlated with knowledge, perceived severity, and perceived controllability of the COVID-19. Nonetheless, health anxiety had a significant and inverse association with knowledge and perceived controllability, while there was a positive and significant correlation between perceived severity and health anxiety. Based on linear regression, three variables of knowledge, perceived severity, and perceived controllability of the COVID-19 could explain 46.3 and 17.5% of variations in self-care and health anxiety, respectively. It is suggested that due to the critical importance of prenatal care, managers, and health-care providers promote the use of such methods as telehealth and home-based caregivers, especially in areas with inadequate access to health care. So, the pregnant women can be followed up and receive medical care devoid of any stress and anxiety.

The upside: coping and psychological resilience in Australian adolescents during the COVID-19 pandemic

BACKGROUND

Since the COVID-19 outbreak, few studies have investigated the positive psychological consequences on young people. This study examined resilience, positive experiences, and coping strategies reported by Australian adolescents during COVID-19.

METHODS

Self-report surveys were administered online to a sample of 760 Australian adolescents aged 12-18 years. Quantitative and qualitative methods were used to assess resilience, positive experiences, and coping strategies. Exploratory regression analyses were conducted to explore the relationship between resilience and demographics and mental illness history, as well as between resilience and positive experiences.

RESULTS

Overall, adolescents were somewhat resilient (M = 20.93, SD = 8.29). They reported positive experiences during COVID-19, including increased empathy, compassion, gratitude, and connection with others, and reported using a range of active coping strategies. Having a mental illness history and identification as female or non-binary gender were associated with lower resilience (Bs > 2.82, ps < 0.001). Further, resilience was associated with decreased psychological distress (OR = 0.89, p < 0.001) and with increased positive experiences (ORs > 1.03, ps < 0.001).

CONCLUSIONS

Our results indicate that Australian adolescents commonly reported positive experiences and used active coping strategies during COVID-19. Some young people demonstrated higher levels of resilience and were able to make the most out of an unpredictable situation that severely disrupted their daily routine. However, further prospective research using longitudinal methods is necessary to examine causal relationships between variables. An implication of our findings is that resilience-building programs for adolescents may be effective in increasing adaptability after adversity (e.g., climate change, bushfires, pandemics).

Psychological responses of Tunisian general population during COVID-19 pandemic

Introduction

this is the first study assessing the psychological impact on Tunisian general population during the first peak of the COVID-19 pandemic. We aimed to assess the prevalence of anxiety, depressive symptoms and insomnia, as well as associated factors.

Methods

a cross-sectional study was conducted through an online survey of 1615 people during March 23^rd to May 5^th, 2020. We used the hospital anxiety and depression scale for anxiety and depression screening, and the insomnia severity index to assess sleep disturbances.

Results

our study revealed a high prevalence of anxiety and depressive symptoms, and insomnia (70.9%, 71.1% and 60.6% respectively). Multivariable statistics showed that anxiety symptoms were correlated to female gender (adjusted odds ratio [aOR] 1.784, 95% confidence interval (CI 1.252-2.542; p=10^-3), history of mental illness (aOR: 1.680, 95% CI: 1.329-2.125; p<10^-3), frequently social media exposure (aOR: 1.578, 95%CI: 1.250-1.992; p<10^-3), times to focus on COVID-19 ≥ 3hours (aOR: 1.840, 95% CI: 1.433-2.362; p<10^-3), consultation with doctor in the clinic in the past 14 days (aOR: 1.821, 95%CI : 1.220-2.718; p=0.003) and recent traumatic event in the past 14 days (aOR: 1.641,95% CI: 1.331-2.024; p<10^-3). Principal factors associated with depressive symptoms included female gender (aOR: 1.637, 95% CI: 1.150-2.331; p=0.006), history of mental illness (aOR: 1.498, 95% CI: 1.189-1.888; p=10^-3), times to focus on COVID-19 ≥ 3hours (aOR: 1.956, 95% CI: 1.555-2.461; p<10^-3), and recent traumatic event in the past 14 days (aOR: 1.558, 95% CI: 1.265-1.919; p<10^-3). The main factors correlated to insomnia were younger (age <35years) (aOR: 1.592, 95% CI: 1.17 -2.152; p=0.003), female gender (aOR: 1.864, 95% CI: 1.252-2.775; p=0.002), having organic diseases (aOR: 1.527, 95% CI: 1.131-2.061; p=0.006), history of mental illness (aOR: 1.777, 95% CI: 1.396-2.263; p<10^-3), students (aOR: 1.931, 95% CI: 1.495-2.495; p<10^-3), times to focus on COVID-19 ≥3hours (aOR: 1.877, 95% CI: 1.467-2.400; p<10^-3) and recent traumatic event (aOR: 1.431, 95% CI: 1.144-1.789; p=0.002).

Conclusion

our study revealed a major mental health burden in Tunisia during COVID-19 pandemic. Many factors were correlated to anxiety, depressive symptoms and insomnia, suggesting the need for greater psychological support in general and in certain vulnerable groups.

Effects of COVID-19 on maternal anxiety and depressive disease: a literature review

The coronavirus SARS-CoV-2 (COVID-19) infection is a public health emergency of international concern. Pandemics pose a challenge to psychological resilience and can have an adverse impact on mental health. The impact of the ensuing social isolation and loneliness imposed by quarantine along with the worries about the risks of the infection and its economic fallout would appear likely to affect the mental health of the population. It has been reported that women are more likely to experience anxiety and depression symptoms during COVID-19 than men. COVID-19 pandemic had a profound impact on the level of anxiety and depression of pregnant women according to their basal level and pregnancy characteristics. Antenatal mental disorders may be a risk factor for maternal mental health problems such as an increased likelihood of postnatal depression and adverse obstetric and developmental outcomes. Effective coping strategies are associated with better psychological wellbeing during the COVID-19 pandemic, including reduced anxiety and depression. The increased risk of mental disorders due to COVID-19 requires policies to be developed to address prenatal and postpartum care to promote maternal-child wellbeing outcomes.

Levels of uncertainty, fear and satisfaction with health professionals: experiences of parents whose children are hospitalized for COVID-19

This study tried to determine the fear and tolerance of uncertainty levels of the parents of children hospitalized with COVID-19, and their satisfaction with the health care received during this time. Data were collected from 130 literate parents. A significant difference was found between the mean scores on the Intolerance of Uncertainty Scale (IUS-12) and the age of the parents and the presence of COVID-19 in other family members and the IUS-12. Also, a significant correlation was found between parents' fear of COVID-19 and IUS-12 scores. Parents had good levels of satisfaction with health care received and moderate fear of COVID-19 and intolerance of uncertainty levels. As parents' fear of COVID-19 increased, intolerance of uncertainty increased. The demographic characteristics, levels of fear of COVID-19, and intolerance of uncertainty did not affect the satisfaction levels.

Cross-Lagged Analysis of COVID-19-Related Worry and Media Consumption in a Socioeconomically Disadvantaged Sample of Community Adults

The COVID-19 pandemic has led to an increase in an array of mental health problems. Previous research has shown that media exposure to stressful situations is often related to anxiety and stress. However, given that most existing work has used cross-sectional designs, less is known about the interplay of media exposure and worry as they unfold during sustained exposure to a collective stressor. The current study examined bidirectional associations between COVID-related worry and media consumption over a three-month period. Participants were 87 community adults, the majority of whom were recruited from communities heavily impacted by the COVID-19 pandemic. For three consecutive months, participants asked to indicate how much time they spent worrying and consuming news about the COVID-19 pandemic on a scale from 1 ("never") to 5 ("most of the day"). Cross-lagged analyses revealed that Pandemic Worry at Month 1 predicted increases in Pandemic Media Consumption at Month 2, which in turn predicted increases in Pandemic Worry at Month 3. Findings suggest that media consumption may be a maladaptive coping strategy that has the iatrogenic effect of increasing worry. Clarifying the causal associations between anxiety-perpetuating processes and media consumption may have important clinical implications for understanding and treating mental health during health pandemics.

COVID-19 Pandemic, Personality and Geriatric Population: Proposed Pragmatism

The elderly population is a sensitive and delicate cohort of society who is being compelled to bear the significant smoulders of disruptive social behavior of humankind amidst the COVID-19 pandemic. Our aim for this review was (1) to find out the root of disruption of societal integrity and self-centeredness by analyzing the spokes of HEXACO; (2) to delineate their possible relationships with the formation of Neuroticism and eventually Psychopathy, which have endangered human civilization the most in this pandemic; and (3) to search for the potential ways to get rid of these dark times. The constellation of different negative human behaviors probably originate from the negative deflection of components of the HEXACO model of personality towards the genesis of the dark triad. COVID-19 pandemic and upsurge of the dark triad in the form of Neuroticism, Narcissism and Machiavellianism potentially portend major mental health threats. Cultivation and practice of positive emotions and triumph of honesty, humility and humanity are imperative to save the mankind from the savagery of this pandemic.

Predictors of Psychological Distress and Coronavirus Fears in the First Recovery Phase of the Coronavirus Disease 2019 Pandemic in Germany

Objectives: While previous research has mainly focused on the impact of the first acute phase of the COVID-19 pandemic on mental health, little empirical knowledge exists about depression, anxiety, and somatic symptom levels and possible predictors of symptom levels in the pandemic's recovery phase. The present study aimed to analyze the mental burden of a convenience ample of the general German population during the first recovery phase of the pandemic and to identify significant predictors of symptom levels. Methods: Standardized measures of anxiety (GAD-2), depression (PHQ-2), somatic symptoms (PHQ-15), and health anxiety, as well as measures of COVID-19 fears and possible vulnerability factors, were administered through a national, cross-sectional online survey (n = 2160, mean age 42.7 years, 75% female), asking participants for their current symptom levels and their symptom levels prior to the COVID-19 pandemic. Results: Our findings show significantly elevated levels of depression, anxiety, somatic symptoms, and health anxiety in the recovery period compared to before the pandemic. The current prevalence rates based on self-reporting were 26.7% for depression, 24.5% for anxiety, and 29% for somatization. The strongest predictors of these symptom reports included domain-specific pre-existing symptom levels, neuroticism, biological COVID-19 risk factors, avoidance of illness information, and younger age. The most important predictors of COVID-19 fears were subjective COVID-19 risk perception, followed by pre-existing health anxiety, the number of biological COVID-19 risk factors, older age, neuroticism, avoidance of illness information and female gender. Discussion: These findings indicate the need for specific psychological programs to help individuals with enhanced psychological and biological vulnerability to cope better with the mental distress experienced during all phases of the ongoing COVID-19 crisis.

The Status and Influencing Factors of Cyberchondria During the COVID-19 Epidemic. A Cross-Sectional Study in Nanyang City of China

Cyberchondria is considered “the anxiety-amplifying effects of online health-related searches.” During the COVID-19 pandemic, people are likely to search health-related information online for reassurance because of fear and related physical symptoms, while cyberchondria may be triggered due to the escalation of health anxiety, different online seeking behavior preference, information overload, and insufficient e-health literacy. This study aimed to investigate the status and influencing factors of cyberchondria in residents in China during the epidemic period of COVID-19. The participants were 674 community residents of Nanyang city surveyed from February 1 to 15, 2020. We administered online measures, including the Chinese Short Form of the Cyberchondria Severity Scale (C-CSS-12), Short Health Anxiety Inventory (SHAI), eHealth Literacy Scale (eHEALS), Patient Health Questionnaire-15 (PHQ-15), and COVID-19-related online information seeking behavior questionnaire. In our study, the average C-CSS-12 total score of residents was 30.65 ± 11.53 during the virus epidemic; 25% of participants scored 22 or below, 50% scored 23 to 38, and 21.9% scored 39 to 60. The SHAI total score (β = 0.598 > 0, P < 0.001), the use of general search engines (β = 1.867 > 0, P = 0.039), and searching for information on how to diagnose COVID-19 (β = 2.280 > 0, P = 0.020) were independent risk factors for cyberchondria, while searching lasting less than 10 min each (β = −2.992 < 0, P = 0.048), the use of traditional media digital platforms (β = −1.650 < 0, P = 0.024) and professional medical communication platforms (β = −4.189 < 0, P = 0.007) were independent protective factors. Our findings showed that nearly a quarter of the participants scored 39 or higher on the C-CSS-12 in Nanyang city during the pandemic, which should be taken seriously. Health anxiety and COVID-19-related online information seeking behavior including online duration, topics and choice on different information channels were important influencing factors of cyberchondria. These findings have implications for further research and clinical practice on cyberchondria in China.

Trauma exposure and the PTSD symptoms of college teachers during the peak of the COVID-19 outbreak

This study aimed to explore influencing factors for the psychological impact of coronavirus disease 2019 (COVID-19) on Wuhan college teachers, posttraumatic stress symptoms in particular, so as to inform evidence-based strategy development to ameliorate such adverse impacts. An online survey was conducted from 26 to 29 April 2020, and 1650 teachers (47.54% male; M = 40.28 years, SD = 8.3 years) enrolled in Wuhan universities and colleges participated. The results showed that the overall incidence of posttraumatic stress disorder (PTSD) among college teachers was as high as 24.55%, but the average level of PTSD score was low (M = 1.06, SD = 0.72). Logistic regression analysis showed that for those with confirmed COVID-19, the ratio was much higher, up to 2.814 (95% confidence interval [CI]: [1.542, 5.136], p < 0.001); that is, compared with those without symptoms, the ratio of PTSD increased by 181%. For those who had family members or relatives who died of COVID-19, the ratio was 5.592 (95% CI: [2.271, 13.766], p < 0.001), 459% higher than those who had no one who died. But the living places during the pandemic had no significant effect on PTSD. The findings suggest that mental health services reducing PTSD should be provided. Teachers who confirmed COVID-19 or lost loved ones to COVID-19 should be given particular care.

Understanding terror states of online users in the context of COVID-19: An application of Terror Management Theory

The COVID-19 pandemic has provided psych challenges for many in society. One such challenge is the anxiety that is created in many people faced with the risk of death from the disease. Another issue is understanding how individuals cope psychologically with the threat of death from the disease. In this study we examine the manifestation of death anxiety and various coping mechanisms through the lens of terror management theory (TMT) and online platforms. We take a novel approach to testing the theory using big data analytics and machine learning, focusing on the user-generated content of Twitter users. Based on a sample of all tweets in the UK mentioning COVID-19 terms over a 5-month period, we evaluate dictionary mentions of anxiety and death, and various TMT defense mechanisms, and calculate the pattern of latent death anxiety or ‘terror’ states of Twitter users via Hidden Markov Models. The research identifies four online ‘terror’ states, with high death and anxiety mentions during the peak of the pandemic. Further we examine various TMT defense mechanisms that have been proposed in the literature for coping with death anxiety and find that online social connection, achievement and religion all play important roles in improving the model and explaining movement between states. The paper concludes with various implications of the study for future research and practice.

Do patients with pathological health anxiety fear COVID-19? A time-course analysis of 12 single cases during the "first wave" of the COVID-19 pandemic in Germany

OBJECTIVE

Pre-existing health anxiety is associated with an intensified affective response to the novel COVID-19 pandemic in the general population. Still, results on the reaction of people with a diagnosis of pathological health anxiety (i.e., hypochondriasis) are scarce.

METHODS

In the present study, we investigated the course of (health) anxiety related to SARS-CoV-2/COVID-19 in comparison to (health) anxiety related to other severe diseases (e.g., cancer) in a sample of 12 patients with the diagnosis of pathological health anxiety during the "first wave" of the COVID-19 pandemic in Germany. Both SARS-CoV-2 related anxiety and anxiety related to other severe diseases were assessed weekly over 16 measurement points (30.03.-19.07.2020) and primarily analyzed with fixed effects regression analyses.

RESULTS

Unexpectedly, SARS-CoV-2 related anxiety was on average significantly lower than anxiety related to other severe diseases (d = -0.54, p < .001) and not significantly associated with anxiety related to other severe diseases or pre-COVID-19 health anxiety.

CONCLUSION

It therefore appears premature to assume that SARS-CoV-2 related anxiety and other health worries are necessarily strongly interrelated and comparably high in people with pathological health anxiety.

The effect of online solution-focused support program on parents with high level of anxiety in the COVID-19 pandemic: A randomised controlled study

AIM

The aim of this study was to determine the anxiety levels of parents with children aged 3-6 years because of the Coronavirus Disease 2019 (COVID-19) pandemic and to examine the effects of Solution-Focused Support Program (SFSP) applied to parents with a high level of anxiety.

METHODS

The study was conducted as a parallel-group, randomised controlled design. The sample of the study consisted of 77 parents who were randomly assigned to the experimental and control groups (control group n = 40; intervention group n = 37). One session of online SFSP was applied to the intervention group each week and 4 sessions were applied in total. No intervention was applied to the control group. The data were collected using introductory information form and State-Trait Anxiety Inventory (STAI). Statistical Package for the Social Sciences (SPSS) programme and Analysis of Moment Structures (AMOS) 23 application were used in the analysis of the data. Structural Equation Modeling (SEM) was used to examine a hypothesised model that SFSP has both direct and indirect effects on the anxiety levels of parents.

RESULTS

The state and trait anxiety mean scores of the intervention group decreased compared with the pre-intervention mean scores after the implemented programme. While this difference between state anxiety scores was statistically significant (P ≤ .001), the difference between trait anxiety scores was not statistically significant (P > .05). There was no statistically significant difference between the pre-test and post-test STAI total scores of the control group.

CONCLUSIONS

In the study, it has been found that SFSP applied to parents with a high level of anxiety is an effective method in reducing the state anxiety levels of parents.

The uptake and outcomes of Internet-based cognitive behavioural therapy for health anxiety symptoms during the COVID-19 pandemic

BACKGROUND

Internet cognitive behavioural therapy (iCBT) for health anxiety has demonstrated efficacy but has not been evaluated during the COVID-19 pandemic. This study presents the first evaluation of the uptake and outcomes of iCBT for health anxiety during the COVID-19 pandemic.

METHODS

THIS WAY UP is an Australian digital mental health service which delivers iCBT interventions to community members. We compared the uptake of THIS WAY UP's iCBT course for health anxiety in an Australian adult sample who started the course before the pandemic (12th September 2019-11 th March 2020) to during the pandemic (12th March to 11th June 2020). The course was accessible to Australian adults over 18 years old, with no inclusion criteria. Outcomes included course registrations and commencements, lesson and course completion, and self-reported health anxiety (Short Health Anxiety Inventory), depression (Patient Health Questionnaire 9-item) and distress (Kessler-10).

RESULTS

From March to June 2020, we observed significant increases in course registrations (N = 238 vs N = 1057); and course commencements (N = 126 vs. N = 778). Large, significant improvements in health anxiety (g = 0.89), and distress (K10: g = 0.91), and medium improvements in depression (g = 0.55) were found. Course completion during COVID was 30.5%.

CONCLUSIONS

iCBT improved health anxiety during the COVID-19 pandemic, and provides scalable intervention that can address increased demands for mental health services in the community.

Using Ecological Momentary Assessment to Study the Development of COVID-19 Worries in Sweden: Longitudinal Study

Background

The foray of COVID-19 around the globe has certainly instigated worries in many people, and lockdown measures may well have triggered more specific worries. Sweden, more than other countries, relied on voluntary measures to fight the pandemic. This provides a particularly interesting context to assess people’s reactions to the threat of the pandemic.

Objective

The general aim of this study was to better understand the worried reactions to the virus and the associated lockdown measures. As there have been very few longitudinal studies in this area published to date, development of feelings of worry over time was analyzed over a longer range than in previous research. Affective variables, worry in particular, were included because most of the research in this field has focused on cognitive variables. To employ new methodology, ecological momentary assessment was used for data collection and a multilevel modeling approach was adopted for data analysis.

Methods

Results were based on an unbalanced panel sample of 260 Swedish participants filling in 3226 interview questionnaires by smartphone over a 7-week period in 2020 during the rapid rise of cases in the early phase of the pandemic. Causal factors considered in this study included the perceived severity of an infection, susceptibility of a person to the threat posed by the virus, perceived efficacy of safeguarding measures, and assessment of government action against the spread of COVID-19. The effect of these factors on worries was traced in two analytical steps: the effects at the beginning of the study and the effect on the trend during the study.

Results

The level of general worry related to COVID-19 was modest (mean 6.67, SD 2.54 on an 11-point Likert scale); the increase during the study period was small, but the interindividual variation of both the worry level and its increase over time was large. Findings confirmed that the hypothesized causal factors (severity of infection, susceptibility to the threat of the virus, efficacy of safeguarding, and assessment of government preventive action) did indeed affect the level of worry.

Conclusions

The results confirmed earlier research in a very special case and demonstrated the usefulness of a different study design, which takes a longitudinal perspective, and a new type of data analysis borrowed from multilevel study design.

Sustained Effects of Government Response on the COVID-19 Infection Rate in China: A Multiple Mediation Analysis

Many scholars have considered the relationship between the government response to COVID-19, an important social intervention strategy, and the COVID-19 infection rate. However, few have examined the sustained impact of an early government response on the COVID-19 infection rate. The current paper fills this gap by investigating a national survey performed in February 2020 and infection data from Chinese cities surveyed 1.5 years after the outbreak of COVID-19. The results suggest that the Chinese government's early response to COVID-19 significantly and sustainedly reduced China's COVID-19 infection rate, and that this impact worked through risk perception, the adoption of protective action recommendations (PARs), and the chain-mediating effects of risk perception and the adoption of PARs, respectively. These findings have important practical value. In demonstrating how government response and infection rate at the macro level are connected to the behaviour of individuals at the micro level, they suggest feasible directions for curbing the spread of diseases such as COVID-19. When facing such public health emergencies, the focus should be on increasing the public's risk perception and adoption of PARs.

Impact of Anxiety on Readiness for COVID-19 Vaccination among Polish Nursing Undergraduate Students: Nationwide Cross-Sectional Study

The COVID-19 pandemic had a huge impact on the mental health of people around the world, and it increased the level of fear of infection and anxiety about the consequences of the disease caused by the SARS-CoV-2 virus. We examined the relationship between the level of anxiety among nursing students and their knowledge about COVID-19 vaccination. In addition, we explored the correlations among the level of anxiety, knowledge about vaccination, and the willingness to vaccinate against COVID-19. A total of 790 undergraduate nursing students participated in the study. The results demonstrated that the level of anxiety among the surveyed nursing students was low; 40% of the study participants did not report any anxiety at all, 30% reported mild anxiety, 20% reported moderate anxiety, and 9% reported severe anxiety. At the time of the study, 77.2% of the participants were already vaccinated against COVID-19. Student knowledge about vaccination against COVID-19 was high and anxiety levels were low, with no direct correlation between the knowledge of vaccination and the severity of anxiety.

Health Anxiety and Its Correlates in the General Chinese Population During the COVID-19 Epidemic

Background: The novel coronavirus disease 2019 (COVID-19) pandemic has had an adverse impact on the mental health of the general population. This study aimed to investigate the prevalence and correlates of health anxiety (HA) in the general Chinese population to inform psychological interventions in COVID-19-affected areas. Methods: We conducted an online survey of the general population in mainland China between 6 and 17 February 2020 (N = 1,450, 69.79% female; mean age = 37.5 ± 9.1 years). The Whiteley Index-7 (WI-7), COVID-19 knowledge quiz (CKQ), Generalised Anxiety Disorder scale (GAD-7), Patient Health Questionnaire Depression Scale (PHQ-9), and socio-demographic information were surveyed using the Questionnaire-Star program. Results: The prevalence of HA, depression and anxiety were 47.3, 31.3, and 35.7%, respectively. The WI-7 score showed a significant association with age, education level, income, occupation, chronic disease and daily time focused on COVID-19. On binary logistic regression analysis, individuals with masters or higher qualification degree [odds ratio (OR) = 0.632)], older age (OR = 0.981), 2-4 h daily time focused on COVID-19 (OR = 0.684), healthcare workers (OR = 0.749, p = 0.046) and those with more COVID-19 related knowledge (OR = 0.785) showed a significantly negative association with HA. Chronic disease (OR = 1.962), depression (OR = 1.05) and anxiety (OR = 1.228) were significant risk factors for HA. Conclusions: HA was highly prevalent among the general population during the early stages of the COVID-19 outbreak. More than two-fifths of the respondents had obvious HA. Chronic disease, depression and anxiety were risk factors for HA; psychological interventions offered during the pandemic should pay particular attention to these individuals.

COVID-19, Economic Impact, Mental Health, and Coping Behaviors: A Conceptual Framework and Future Research Directions

The COVID-19 pandemic has caused serious economic and social consequences. Recent research shows that the pandemic has not only caused a physical health crisis but also caused many psychological and mental crises. Based on the contemporary cognitive-behavioral models, this article offers a conceptual analysis of how the pandemic affects individual mental health and coping behaviors from the perspective of individual economic status, individual context, and social context. The analysis shows that (1) the pandemic has led to increased economic uncertainty, increased unemployment and underemployment pressure, increased income uncertainty, and different degrees of employment pressure and economic difficulties; (2) these difficulties have stimulated different levels of mental health problems, ranging from perceived insecurity (environmental, food safety, etc.), worry, fear, to stress, anxiety, depression, etc., and the mental health deterioration varies across different groups, with the symptoms of psychological distress are more obvious among disadvantageous groups; and (3) mental health problems have caused behavior changes, and various stress behaviors such as protective behaviors and resistive behaviors. Future research directions are suggested.

Information seeking and health anxiety during the COVID-19 pandemic: The mediating role of catastrophic cognitions

Cognitive–behavioural models of health anxiety propose a positive association between information seeking and health anxiety; however, it is unclear the extent to which cognitive mechanisms may mediate this relationship. Catastrophic cognitions are one type of cognition that may mediate this relationship, and the COVID‐19 pandemic has presented an opportunity to examine these relationships within the context of a global health catastrophe. The current study investigated both cross‐sectional (N = 797) and longitudinal (n = 395) relationships between information seeking, health anxiety and catastrophizing during the pandemic. Data were collected using Amazon Mechanical Turk during April and May 2020. Information seeking and health anxiety were positively associated both cross‐sectionally and longitudinally (rs = .25–.29). Catastrophic cognitions significantly mediated the relationship between information seeking and health anxiety both cross‐sectionally and longitudinally. Developing effective methods of reducing information seeking and catastrophizing may serve to reduce health anxiety during global health crises such as the current pandemic.

Coping with COVID-19 pandemic: reflections of older couples living alone in urban Odisha, India

AIM

We explored the 'coping reflections' of elderly couples living alone (without any other family members) during the COVID-19 pandemic in urban Odisha, India.

BACKGROUND

Evidence worldwide suggests that older people are at increased risk from COVID-19 adverse outcomes and experience greater stress. In our previous community-based study urban dwelling, particularly elderly participants, and living alone reported higher pandemic-associated health care challenges than their rural and residing-with-family counterparts. We intended to explore how the elderly couples living alone coped through this challenging yet stressful situation during the COVID-19 pandemic and what were their key strategies adopted toward this.

METHODS

We conducted telephonic in-depth interviews (IDIs) with 11 urban elderly couples living alone in Bhubaneswar city of Odisha, India using a semi-structured interview guide. All IDIs were digitally recorded, transcribed into the original language, and translated to English. We used a thematic approach for analysis.

FINDINGS

Four themes emerged: (1) Risk appraisal and feeling vulnerable; (2) Safeguarding against COVID-19; (3) Managing routine health care and emergency; and (4) Pursuing mental and psychological well-being. Although fear, anxiety, and loneliness were continuing stressors, many of them learnt to adapt and emerge resilient with the evolving situation. Various elements at the individual, family, community, and organizational levels were conducive to better coping. The companionship and complementary support of spouse, self-health literacy, and digital efficacy, virtual connectedness with family and friends, availability of community pharmacy and diagnostic services in the vicinity, support of neighbors, reengaging with creative leisure time activity, and assurance of a responsive administration at the time of emergency helped them to cruise through the pandemic. Furthermore, watching the re-telecast of prime time serials made these elderly fondly remember their own youth time memories. Self-health monitoring, indoor physical exercise, spiritual practices, continuation of previous prescription, telephonic advice of physicians were add-on strategies that facilitated their physical and psychological well-being during the pandemic.