Factors associated with psychological distress during the coronavirus disease 2019 (COVID-19) pandemic on the predominantly general population: A systematic review and meta-analysis

Psychological distress of patients with end-stage kidney disease undergoing dialysis during the 2019 coronavirus disease pandemic: A cross-sectional study in a University Hospital

INTRODUCTION

Previous studies have revealed that the COVID-19 pandemic can cause psychological distress such as depression and anxiety. Patients with chronic kidney disease (CKD) might be more vulnerable to psychological distress due to the COVID-19 pandemic. Its impact could be different according to dialysis modality. The aim of this study was to investigate COVID-19-related psychological stress experienced by end-stage kidney disease (ESKD) patients and identify differences in concerns about COVID-19 between hemodialysis (HD) and peritoneal dialysis (PD) patients.

METHODS

This cross-sectional study included 148 dialysis patients at Soonchunhyang University Cheonan Hospital from August 2020 to September 2020. These patients responded to a questionnaire covering mental health status and COVID-19 related concerns. Symptoms of depression, anxiety, stress, and insomnia were measured using a 9-item Patient Health Questionnaire (PHQ-9), a 7-item Generalized Anxiety Disorder (GAD-7) scale, a 22-item Impact of Event Scale-Revised (IES-R), and a 7-item Insomnia severity Index (ISI), respectively. Outcomes of HD and PD patients were compared by propensity score matching analysis.

RESULTS

Dialysis patients reported psychological distress including symptoms of depression, anxiety, stress, and insomnia. HD patients showed higher scores for depression (p = 0.018), anxiety(p = 0.005), stress(p<0.001), and insomnia(p = 0.006) than the PD patients. After propensity score matching, HD was associated with depression(p = 0.0131), anxiety(p = 0.0143), and stress(p = 0.000415).

CONCLUSION

Dialysis patients showed psychological distress during the COVID-19 pandemic period, with HD patients having more severe symptoms than PD patients.

Impact of Longitudinal Social Support and Loneliness Trajectories on Mental Health during the COVID-19 Pandemic in France

(1) Background: Little is known about how the COVID-19 pandemic has impacted social support and loneliness over time and how this may predict subsequent mental health problems. This study aims to determine longitudinal trajectories of social support and loneliness in the French general population during the first year of the COVID-19 pandemic and study whether variations in these trajectories are associated with symptoms of depression and anxiety; (2) Methods: Analyses were based on data from 681 French participants in the international COVID-19 Mental Health Study (COMET) study, collected at four periods of time between May 2020 and April 2021. Group-based trajectory modelling (GBTM) was used to determine social support and loneliness trajectories. Associations between the identified trajectories and symptoms of depression and anxiety, measured with the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7), were tested through multivariate linear regression models; (3) Results: Social support trajectories revealed four stable groups: 'poor' (17.0%), 'moderate' (42.4%), 'strong' (35.4%) and 'very strong' (5.1%). Loneliness trajectories also identified four groups: 'low stable' (17.8%), 'low rising' (40.2%), 'moderate stable' (37.6%) and 'high rising' (5.0%). Elevated symptoms of depression were associated with poor social support as well as all identified loneliness trajectories, while high levels of anxiety were associated with moderate stable and high rising loneliness trajectories; (4) Conclusions: High and increasing levels of loneliness are associated with increased symptoms of depression and anxiety during the pandemic. Interventions to address loneliness are essential to prevent common mental health problems during the pandemic and afterwards.

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.

Age- and gender-related differences in the evolution of psychological and cognitive status after the lockdown for the COVID-19 outbreak: a follow-up study

OBJECTIVE

Individuals experienced psychological symptoms in response to quarantine for the COVID-19 pandemic. Therefore, we aimed to investigate the possible effect of age and gender on the evolution of mental health status after the quarantine in the Italian population and the baseline predictors of post-traumatic stress symptoms.

METHODS

An online follow-up questionnaire including an assessment of depression, anxiety, anger, post-traumatic stress, subjective cognitive failures, resilience, and coping style was completed by participants 2 months after the end of the quarantine (n = 758).

RESULTS

Individuals experienced psychological symptoms also 2 months after the end of the quarantine. No decrease in depression and anxiety scores emerged, but younger individuals and females experienced more severe symptoms. Anger symptoms decreased in young adults, whereas they increased in older adults. Moreover, individuals reported more cognitive failures at follow-up. No changes were observed in resilience, whereas participants reported adopting fewer coping strategies at follow-up. Finally, post-traumatic stress symptoms 2 months after the end of the lockdown were associated with more severe psychological symptoms and more fear of getting infected at baseline.

CONCLUSIONS

Our findings demonstrate that the long-term psychological impact and the cognitive consequences of quarantine differ according to age and gender. The identification of more vulnerable groups allows the implementation of interventions to reduce psychological symptoms and the risk for cognitive impairment.

The influence of sex, gender, age, and ethnicity on psychosocial factors and substance use throughout phases of the COVID-19 pandemic

OBJECTIVES

The SARS-CoV-2 (COVID-19) pandemic has had profound physical and mental health effects on populations around the world. Limited empirical research has used a gender-based lens to evaluate the mental health impacts of the pandemic, overlooking the impact of public health measures on marginalized groups, such as women, and the gender diverse community. This study used a gender-based analysis to determine the prevalence of psychosocial symptoms and substance use (alcohol and cannabis use in particular) by age, ethnicity, income, rurality, education level, Indigenous status, and sexual orientation.

METHODS

Participants in the study were recruited from previously established cohorts as a part of the COVID-19 Rapid Evidence Study of a Provincial Population-Based Cohort for Gender and Sex (RESPPONSE) study. Those who agreed to participate were asked to self-report symptoms of depression, anxiety, pandemic stress, loneliness, alcohol use, and cannabis use across five phases of the pandemic as well as retrospectively before the pandemic.

RESULTS

For all psychosocial outcomes, there was a significant effect of time with all five phases of the pandemic being associated with more symptoms of depression, anxiety, stress, and loneliness relative to pre-COVID levels (p < .0001). Gender was significantly associated with all outcomes (p < .0001) with men exhibiting lower scores (i.e., fewer symptoms) than women and gender diverse participants, and women exhibiting lower scores than the gender diverse group. Other significant predictors were age (younger populations experiencing more symptoms, p < .0001), ethnicity (Chinese/Taiwanese individuals experiencing fewer symptoms, p = .005), and Indigenous status (Indigenous individuals experiencing more symptoms, p < .0001). Alcohol use and cannabis use increased relative to pre-pandemic levels, and women reported a greater increase in cannabis use than men (p < .0001).

CONCLUSIONS

Our findings highlight the need for policy makers and leaders to prioritize women, gender-diverse individuals, and young people when tailoring public health measures for future pandemics.

Community psychological and behavioural responses to coronavirus disease 2019 over one year of the pandemic in 2020 in Hong Kong

Monitoring community psychological and behavioural responses to coronavirus disease 2019 (COVID-19) is important for informing policy making and risk communication to sustain public compliance with challenging precautionary behaviours and mitigating the psychological impacts. Monthly telephone-based cross-sectional surveys in January-April 2020 and then weekly surveys from May through December 2020 were conducted to monitor changes in public risk perception of COVID-19, personal efficacy in self-protection, confidence in government's ability to control the pandemic, precautionary behaviours, perceived impact of precautionary behaviours, psychological fatigue and distress in Hong Kong, and examine their inter-relationships. While worry about contracting COVID-19 increased, personal efficacy and confidence in government declined as the community incidence of COVID-19 increased. The public maintained high compliance with most precautionary behaviours throughout but relaxed behaviours that were more challenging when disease incidence declined. Public confidence in government was persistently low throughout, of which, a lower level was associated with more psychological fatigue, lower compliance with precautionary behaviours and greater psychological distress. Perceived greater negative impact of precautionary behaviours was also associated with more psychological fatigue which in turn was associated with relaxation of precautionary behaviours. Female, younger and unemployed individuals reported greater psychological distress throughout different stages of the pandemic. Risk communication should focus on promoting confidence in self-protection and pandemic control to avoid helplessness to act when the pandemic resurges. Policy making should prioritize building public trust, enhancing support for sustaining precautionary behaviours, and helping vulnerable groups to adapt to the stress during the pandemic.

Factors Associated with Depression and Anxiety in Adults ≥60 Years Old during the COVID-19 Pandemic: A Systematic Review

COVID-19 represents a threat to public health and the mental health of the aged population. Prevalence and risk factors of depression and anxiety have been reported in previous reviews in other populations; however, a systematic review on the factors associated with depression and anxiety in older adults is not currently present in the literature. We searched PubMed, Embase, Scopus, ProQuest Psychology Database, Science Direct, Cochrane Library and SciELO databases (23 February 2021). The results were obtained by entering a combination of MeSH or Emtree terms with keywords related to COVID-19, elderly, depression and anxiety in the databases. A total of 11 studies were included in the systematic review. Female gender, loneliness, poor sleep quality and poor motor function were identified as factors associated with both depression and anxiety. Aspects related to having a stable and high monthly income represent protective factors for both depression and anxiety, and exercising was described as protective for depression. This study synthesised information and analysed the main factors associated with depression and anxiety in the older population during the COVID-19 pandemic. However, the cross-sectional design of most of the included studies does not allow a causal relationship between the factors analysed and depression or anxiety.

Crohn's and Colitis Canada's 2021 Impact of COVID-19 and Inflammatory Bowel Disease in Canada: Mental Health and Quality of Life

There has been a dramatic rise in mental health difficulties during the coronavirus disease 2019 (COVID-19) pandemic. While young adults have the lowest risk of hospitalization and mortality due to COVID-19, they have been identified as being at highest risk of detrimental mental health outcomes during the pandemic, along with women, those with lower socioeconomic status and those with pre-existing mental health conditions. Somewhat of a crisis in mental health has emerged across the general population through the evolution of the pandemic. A national Canadian survey identified a quadrupling of those experiencing pervasive elevated anxiety symptoms early in the pandemic compared to pre-pandemic levels, and a doubling of those with pervasive elevated depressive symptoms. Independent of the pandemic, persons with inflammatory bowel disease (IBD) can face multiple challenges related to their disease, which can result in a significant psychosocial burden and psychologic distress. Anxiety and depression have been found to be more prevalent in persons with IBD. Many potential factors contribute to the increased psychologic distress and negative impacts on mental health of the COVID-19 pandemic on persons with IBD. These include the fears of contracting COVID-19 or infecting other people. Many believe that IBD or its treatments predispose them to an increased risk of COVID-19 or a worse outcome if acquired. Concerns about access to health care add to mental distress. People with IBD generally report lower quality of life (QOL) compared to community controls. Psychologic interventions, in addition to adequate disease control, have been shown to improve health-related QOL. Uncertainty is another factor associated with reduced health-related QOL. Most studies suggest that persons with IBD have suffered QOL impairment during the pandemic in comparison to the pre-pandemic period. Uncertainties brought on by the pandemic are important contributors for some of the reduction in QOL.

Sympathetic nerve-adipocyte interactions in response to acute stress

Psychological stress predisposes our body to several disorders. Understanding the cellular and molecular mechanisms involved in the physiological responses to psychological stress is essential for the success of therapeutic applications. New studies show, by using in vivo inducible Cre/loxP-mediated approaches in combination with pharmacological blockage, that sympathetic nerves, activated by psychological stress, induce brown adipocytes to produce IL-6. Strikingly, this cytokine promotes gluconeogenesis in hepatocytes, that results in the decline of tolerance to inflammatory organ damage. The comprehension arising from this research will be crucial for the handling of many inflammatory diseases. Here, we review recent advances in our comprehension of the sympathetic nerve-adipocyte axis in the tissue microenvironment.

Mental and sexual well-being in non-binary and genderqueer individuals

BACKGROUND

Non-binary and genderqueer (NBGQ) individuals do not identify with a binary gender identity. Some but not all NBGQ individuals identify as transgender, and it is currently unclear on which aspects of mental and sexual well-being NBGQ and binary transgender individuals may differ.

AIM

To compare NBGQ, binary transgender and cisgender individuals on variables related to mental well-being, sexual well-being, and sexual self-concept discrepancies.

METHODS

We conducted an online questionnaire study in 125 transgender men, 72 transgender women, 78 NBGQ individuals, 98 cisgender men, and 107 cisgender women.

RESULTS

For most variables, NBGQ individuals did not differ from binary transgender individuals. These two groups differed only on gender dysphoria and transgender specific body image worries, which were both lower in the NBGQ group. Compared to the cisgender group, NBGQ individuals scored higher on gender dysphoria, actual/ought sexual self-concept discrepancies, and actual/ideal sexual self-concept discrepancies, and lower on general life satisfaction and sexual esteem related to body perception.

DISCUSSION

These results offer a first quantitative analysis of sexual well-being in NBGQ individuals, and highlight that - while both groups face unique challenges - NBGQ individuals encounter similar difficulties concerning mental and sexual well-being as binary transgender individuals.

Factors related to depression, distress, and self-reported changes in anxiety, depression, and suicidal thoughts during the COVID-19 state of emergency in Latvia

PURPOSE

Evidence suggests that the 2020 COVID-19 pandemic might have deleterious effects on the population's mental health and psychiatric outcomes. We examined the prevalence of depression, distress, and suicidal thoughts and their association with social and economic factors during the state of emergency in a nationwide representative sample of the general population in Latvia.

MATERIALS AND METHOD

An online survey was conducted using a randomized stratified sample of the general adult population in July 2020 for 3 weeks. Distress, depression, suicidal thoughts, and self-reported changes in mental health were identified using a structured questionnaire. The statistical analysis included chi-square tests, analyses of variance, and multivariate forward-stepwise linear regressions.

RESULTS

The study sample included 2608 respondents. Clinical depression was present in 5.75% and distress in 7.82%. Suicidal thoughts increased in 13.30% of those with a history of clinical depression, and 27.05% of those with a history of suicidal attempts. The variables that were associated with increases in self-reported anxiety, depressive thoughts, suicidal ideation, and being currently depressed/distressed included lower general health, increased fears of contracting COVID-19 or having family members contract it and die, history of suicidality, increased family conflicts, decreased religiosity, caring for a vulnerable person. Protective factors included positive changes in family relationships and economic situation, maintaining one's basic routine, and having more people living in the household.

CONCLUSIONS

Further research and interventions should focus specifically on these factors. The study's findings can help to develop future strategies for management of psychological support for different groups in general population.

Understanding the emotional response to Covid-19 information in news and social media: A mental health perspective

The impact of the COVID‐19 pandemic and ensuing social restrictions has been profound, affecting the health, livelihoods, and wellbeing of populations worldwide. Studies have shown widespread effects on mental health, with an increase in stress, loneliness, and depression symptoms related to the pandemic. Media plays a critical role in containing and managing crises, by informing society and fostering positive behavior change. Social restrictions have led to a large increase in reliance on online media channels, and this can influence mental health and wellbeing. Anxiety levels, for instance, may be exacerbated by exposure to COVID‐related content, contagion of negative sentiment among social networks, and “fake news.” In some cases, this may trigger abstinence, leading to isolation and limited access to vital information. To be able to communicate distressing news during crises while protecting the wellbeing of individuals is not trivial; it requires a deeper understanding of people's emotional response to online and social media content. This paper selectively reviews research into consequences of social media usage and online news consumption for wellbeing and mental health, focusing on and discussing their effects in the context of the pandemic. Advances in Artificial Intelligence and Data Science, for example, Natural Language Processing, Sentiment Analysis, and Emotion Recognition, are discussed as useful methods for investigating effects on population mental health as the pandemic situation evolves. We present suggestions for future research, and for using these advances to assess large data sets of users' online content, to potentially inform strategies that enhance the mental health of social media users going forward.

A Meta-Analysis for Simultaneously Estimating Individual Means with Shrinkage, Isotonic Regression and Pretests

Meta-analyses combine the estimators of individual means to estimate the common mean of a population. However, the common mean could be undefined or uninformative in some scenarios where individual means are “ordered” or “sparse”. Hence, assessments of individual means become relevant, rather than the common mean. In this article, we propose simultaneous estimation of individual means using the James–Stein shrinkage estimators, which improve upon individual studies’ estimators. We also propose isotonic regression estimators for ordered means, and pretest estimators for sparse means. We provide theoretical explanations and simulation results demonstrating the superiority of the proposed estimators over the individual studies’ estimators. The proposed methods are illustrated by two datasets: one comes from gastric cancer patients and the other from COVID-19 patients.

Prevalence of Anxiety in Dental Students during the COVID-19 Outbreak: A Meta-Analysis

Background: Since the onset of the COVID-19 pandemic, the psychological state of university students has been a cause for concern. In particular, odontology students have experienced symptoms of anxiety due to the closure of universities and the suspension of clinical training. Methods: Medline via PubMed was searched for studies on the prevalence of anxiety in dental undergraduates, published from 1 December 2019 to 1 August 2021. Results: A total of fifteen studies were included in this review. Our results show a prevalence of anxiety of 35% reported by dental students, which was independent of gender, response rate or methodological quality. The only significant finding was a lower prevalence of anxiety in studies located in Europe compared to those located in other continents. Conclusions: The results suggest dental students are experiencing significant levels of anxiety during this COVID-19 pandemic and that there seem to be differences between students from different regions of the world. Therefore, it is important to help dental students psychologically as the pandemic situation continues.

Current Status and Associated Factors of Depression and Anxiety Among the Chinese Residents During the Period of Low Transmission of COVID-19

Background: The outbreak of coronavirus disease 2019 (COVID-19) has contributed to depression and anxiety among the general population in China. The purpose of this study is to investigate the prevalence and associated factors of these psychological problems among Chinese adults during the period of low transmission, which could reflect the long-term depression and anxiety of the COVID-19 outbreak. Methods: A cross-sectional survey was conducted in China from 4 to 26 February 2021. Convenient sampling strategy was adopted to recruit participators. Participants were asked to filled out the questions that assessed questionnaire on the residents' depression and anxiety. Results: A total of 2,361 residents filled out the questionnaire. The mean age was 29.72 years (SD = 6.94) and majority of respondents were female (60.10%). Among the respondents, 421 (17.83%), 1470 (62.26%), and 470 (19.91%) were from eastern, central, and western China, respectively. 1704 (72.17%) consented COVID-19 information has been disclosed timely. 142 (6.01%) and 130 (5.51%) patients suffered from depression and anxiety symptoms. Furthermore, some influencing factors were found, including marital status, place of residence, employment status. Conclusion: This study revealed that anxiety and depression still are potential depression and anxiety for some residents, which suggested early recognition and initiation of interventions during the period of low transmission is still indispensable.

Risk and protective factors, stressors, and symptoms of adjustment disorder during the COVID-19 pandemic - First results of the ESTSS COVID-19 pan-European ADJUST study

Background

The COVID-19 pandemic exposes individuals to multiple stressors, such as quarantine, physical distancing, job loss, risk of infection, and loss of loved ones. Such a complex array of stressors potentially lead to symptoms of adjustment disorder.

Objective

This cross-sectional exploratory study examined relationships between risk and protective factors, stressors, and symptoms of adjustment disorder during the first year of the COVID-19 pandemic.

Methods

Data from the first wave of the European Society of Traumatic Stress Studies (ESTSS) longitudinal ADJUST Study were used. N = 15,563 participants aged 18 years and above were recruited in eleven countries (Austria, Croatia, Georgia, Germany, Greece, Italy, Lithuania, the Netherlands, Poland, Portugal, and Sweden) from June to November 2020. Associations between risk and protective factors (e.g. gender, diagnosis of a mental health disorder), stressors (e.g. fear of infection, restricted face-to-face contact), and symptoms of adjustment disorder (ADNM-8) were examined using multivariate linear regression.

Results

The prevalence of self-reported probable adjustment disorder was 18.2%. Risk factors associated with higher levels of symptoms of adjustment disorder were female gender, older age, being at risk for severe COVID-19 illness, poorer general health status, current or previous trauma exposure, a current or previous mental health disorder, and longer exposure to COVID-19 news. Protective factors related to lower levels of symptoms of adjustment disorder were higher income, being retired, and having more face-to-face contact with loved ones or friends. Pandemic-related stressors associated with higher levels of symptoms of adjustment disorder included fear of infection, governmental crisis management, restricted social contact, work-related problems, restricted activity, and difficult housing conditions.

Conclusions

We identified stressors, risk, and protective factors that may help identify individuals at higher risk for adjustment disorder.

Prevalence of Psychological Distress and Associated Factors in Nursing Students during the COVID-19 Pandemic: A Cross-Sectional Study

Little is known about psychological distress and its associated factors during the COVID-19 pandemic among nursing students, especially during the initial spread. The present study aimed to investigate the prevalence of psychological distress among Japanese nursing students after the first semester of 2020 with shifted classes and practice online. Furthermore, we examined whether factors such as health issues and resilience were associated with psychological distress. The data were obtained from a cross-sectional, self-administered questionnaire survey at a Japanese nursing college from September to November 2020 (n = 289). We collected data such as sociodemographic variables, medical history, insomnia, and resilience (Bidimensional Resilience Scale). Psychological distress was measured using the K6 scale (scores ≥ 5). The prevalence of psychological distress was 58.5%. The multivariate Poisson regression analysis found a negative association between innate resilience factors, and positive associations between medical history, insomnia, and psychological distress. The present study showed that more than half of the study participants experienced high levels of psychological distress. Our results suggest the importance of monitoring mental health among nursing students, focusing not only on health issues, but also personality components such as innate resilience during the prolonged COVID-19 pandemic.

A Brief, Mobile Intervention to Decrease Depression and Loneliness and Improve Relationship Quality During the Covid-19 Pandemic

Introduction: Effective, scalable interventions to address depression and loneliness and improve the quality of social relationships are needed for public health in pandemic and non-pandemic contexts. Towards this end, a randomized, controlled trial tested a mobile-based intervention, derived from social psychological and relationship science, for improving relational well-being and decreasing depression and loneliness. Methods: Participants were randomly assigned to either intervention (n = 719) or assessment only (n = 701) conditions and completed daily diary surveys for 28 days in the midst of the first wave of the Covid-19 pandemic. In the middle 14 days of the study, intervention participants received daily text-message suggestions for improving relational and mental well-being. Results: Results indicated that the intervention decreased depression and loneliness and improved relationships during the intervention period but these changes were not sustained when the intervention ceased. Discussion: Results are encouraging in that evidence-based suggestions can be scaled effectively but additional efforts are required to sustain improvements over time.

High Sitting Time Is a Behavioral Risk Factor for Blunted Improvement in Depression Across 8 Weeks of the COVID-19 Pandemic in April-May 2020

The COVID-19 pandemic has elicited increased sedentary behaviors, decreased moderate-to-vigorous physical activity (MVPA), and worsened mental health, yet the longitudinal impact of these changes and their inter-relations remains unknown. Our purpose was to examine associations between changes in self-reported activity behaviors and mental health over an 8-week period following the COVID-19 outbreak. Participants from all 50 states and the District of Colombia were recruited through convenience and snowball sampling at baseline April 3-10, 2020. Prospective data from 2,327 US adults with ≥2 responses (63.8% female; 74.3% response rate) were collected weekly via online survey for eight consecutive weeks (April 3-June 3, 2020). Primary exposures were self-reported time spent sitting, viewing screens and in MVPA, with primary outcomes being depressive symptoms, anxiety symptoms, and positive mental health (PMH). A significant sitting-by-time interaction (p < 0.05) showed slightly higher marginal effects for depressive symptoms for the 90th-percentile of sitting time than the 10th-percentile at baseline (5.8 [95% confidence interval = 5.5-6.2] vs. 5.7 [5.4-6.1]), with the difference magnifying over time (week 8: 3.5 [3.2-3.9] vs. 2.7 [2.4-2.9]). No other interactions over time were significant. Screen time was negatively associated with PMH and positively associated with depressive and anxiety symptoms (p < 0.05). Sitting time was negatively associated with PMH (p < 0.05). Rapid changes in sitting patterns (e.g., due to a pandemic) may have lasting effects on depressive symptoms. Strategies targeting those most affected (i.e., young adults, females) and/or focused on reducing sitting time may be critical for preventing long-term mental health effects resulting from COVID-19 or other large-scale behavior changes in the general population.

Psychological distress, fear and coping among Malaysians during the COVID-19 pandemic

Introduction

The COVID-19 pandemic has enormously affected the psychological well-being, social and working life of millions of people across the world. This study aimed to investigate the psychological distress, fear and coping strategies as a result of the COVID-19 pandemic and its associated factors among Malaysian residents.

Methods

Participants were invited to an online cross-sectional survey from Aug-Sep 2020. The study assessed psychological distress using the Kessler Psychological Distress Scale, level of fear using the Fear of COVID-19 Scale, and coping strategies using the Brief Resilient Coping Scale. Univariate and multivariate logistic regression analyses were conducted to adjust for potential confounders.

Results

The mean age (±SD) of the participants (N = 720) was 31.7 (±11.5) years, and most of them were females (67.1%). Half of the participants had an income source, while 216 (30%) identified themselves as frontline health or essential service workers. People whose financial situation was impacted due to COVID-19 (AOR 2.16, 95% CIs 1.54–3.03), people who drank alcohol in the last four weeks (3.43, 1.45–8.10), people who were a patient (2.02, 1.39–2.93), and had higher levels of fear of COVID-19 (2.55, 1.70–3.80) were more likely to have higher levels of psychological distress. Participants who self-isolated due to exposure to COVID-19 (3.12, 1.04–9.32) and who had moderate to very high levels of psychological distress (2.56, 1.71–3.83) had higher levels of fear. Participants who provided care to a family member/patient with a suspected case of COVID-19 were more likely to be moderately to highly resilient compared to those who did not.

Conclusion

Vulnerable groups of individuals such as patients and those impacted financially during COVID-19 should be supported for their mental wellbeing. Behavioural interventions should be targeted to reduce the impact of alcohol drinking during such crisis period.

Locus of control moderates the association of COVID-19 stress and general mental distress: results of a Norwegian and a German-speaking cross-sectional survey

BACKGROUND

An internal locus of control (LoC I) refers to the belief that the outcome of events in one's life is contingent upon one's actions, whereas an external locus of control (LoC E) describes the belief that chance and powerful others control one's life. This study investigated whether LoC I and LoC E moderated the relationship between COVID-19 stress and general mental distress in the general population during the early months of the COVID-19 pandemic.

METHODS

This cross-sectional survey study analysed data from a Norwegian (n = 1225) and a German-speaking sample (n = 1527). We measured LoC with the Locus of Control-4 Scale (IE-4), COVID-19 stress with a scale developed for this purpose, and mental distress with the Patient Health Questionnaire 4 (PHQ-4). Moderation analyses were conducted using the PROCESS macro for SPSS.

RESULTS

The association between COVID-19 stress and general mental distress was strong (r = .61 and r = .55 for the Norwegian and the German-speaking sample, respectively). In both samples, LoC showed substantial moderation effects. LoC I served as a buffer (p < .001), and LoC E exacerbated (p < .001) the relation between COVID-19 stress and general mental distress.

CONCLUSIONS

The data suggest that the COVID-19 pandemic is easier to bear for people who, despite pandemic-related strains, feel that they generally have influence over their own lives. An external locus of control, conversely, is associated with symptoms of depression and anxiety. The prevention of mental distress may be supported by enabling a sense of control through citizen participation in policy decisions and transparent explanation in their implementation.

Risk factors for depression during the COVID-19 pandemic: a longitudinal study in middle-aged and older adults

BACKGROUND

The COVID-19 pandemic and resultant social restrictions have had widespread psychological ramifications, including a rise in depression prevalence. However, longitudinal studies on sociodemographic risk factors are lacking.

AIMS

To quantify longitudinal changes in depression symptoms during the pandemic compared with a pre-pandemic baseline, in middle-aged and older adults, and identify the risk factors contributing to this.

METHOD

A total of 5331 participants aged ≥50 years were drawn from the English Longitudinal Study of Ageing. Self-reported depression symptoms in June/July 2020 were compared with baseline data from 2-3 years prior. Regression models investigated sociodemographic and lifestyle variables that could explain variance in change in depression.

RESULTS

Within-participant depression scores increased significantly from pre-pandemic levels: 14% met the criteria for clinical depression at baseline, compared with 26% during the pandemic. Younger age, female gender, higher depression scores at baseline, living alone and having a long-standing illness were significant risk factors. Gender-stratified regression models indicated that older age was protective for women only, whereas urban living increased risk among women only. Being an alcohol consumer was a protective factor among men only.

CONCLUSIONS

Depression in UK adults aged ≥50 years increased significantly during the pandemic. Being female, living alone and having a long-standing illness were prominent risk factors. Younger women living in urban areas were at particularly high risk, suggesting such individuals should be prioritised for support. Findings are also informative for future risk stratification and intervention strategies, particularly if social restrictions are reimposed as the COVID-19 crisis continues to unfold.

Health and social behaviour through pandemic phases in Switzerland: Regional time-trends of the COVID-19 Social Monitor panel study

Background

Switzerland has a liberal implementation of Coronavirus mitigation measures compared to other European countries. Since March 2020, measures have been evolving and include a mixture of central and federalistic mitigation strategies across three culturally diverse language regions. The present study investigates a hypothesised heterogeneity in health, social behavior and adherence to mitigation measures across the language regions by studying pre-specified interaction effects. Our findings aim to support the communication of regionally targeted mitigation strategies and to provide evidence to address longterm population-health consequences of the pandemic by accounting for different pandemic contexts and cultural aspects.

Methods

We use data from from the COVID-19 Social Monitor, a longitudinal population-based online survey. We define five mitigation periods between March 2020 and May 2021. We use unadjusted and adjusted logistic regression models to investigate a hypothesized interaction effect between mitigation periods and language regions on selected study outcomes covering the domains of general health and quality of life, mental health, loneliness/isolation, physical activity, health care use and adherence to mitigation measures.

Results

We analyze 2,163 (64%) participants from the German/Romansh-speaking part of Switzerland, 713 (21%) from the French-speaking part and 505 (15%) from the Italian-speaking part. We found evidence for an interaction effect between mitigation periods and language regions for adherence to mitigation measures, but not for other study outcomes (social behavior, health). The presence of poor quality of life, lack of energy, no physical activity, health care use, and the adherence to mitigation measures changed similarly over mitigation periods in all language regions.

Discussion

As the pandemic unfolded in Switzerland, also health and social behavior changed between March 2020 to May 2021. Changes in adherence to mitigation measures differ between language regions and reflect the COVID-19 incidence patterns in the investigated mitigation periods, with higher adherence in regions with previously higher incidence. Targeted communcation of mitigation measures and policy making should include cultural, geographical and socioeconomic aspects to address yet unknown long-term population health consequences caused by the pandemic.

Effects of biopsychosocial factors on the association between loneliness and mental health risks during the COVID-19 lockdown

Previous data suggest that loneliness is a hallmark of the mental health issues triggered by the SARS-CoV-2 pandemic. The purpose of the present study was to examine the impact of loneliness on mental health and behavioural outcomes, as well as the moderating and mediating effects of biopsychosocial variables on these relationships. The data were collected during France’s first national COVID-19 lockdown and included 556 participants (M_age = 30.06 years, range = 18–87) who completed well-known validated measures assessing symptom-levels of anxiety, depression, and insomnia. They also indicated their level of worry about the COVID-19 crisis, and provided sociodemographic and health status data. Responses were submitted to hierarchical linear regression and mediation analyses. In terms of prevalence of loneliness, 18.9% of participants reported severe loneliness. High levels of loneliness were significantly associated with the three mental health and behavioural outcomes. The loneliness – anxiety relationship was moderated by employment and working arrangements. The loneliness – insomnia relationship was moderated by living conditions, history of medical or psychological problems, and COVID-19-related worry. Further findings supported the indirect effects of COVID-related worry on pathways from loneliness to the three mental health and behavioural health outcomes. The mediation models accounted for 28.9%, 33.7%, and 15.0% of the variance in anxiety, depression, and insomnia. The present evidence-based findings revealed that loneliness and worry were major contributing factors of mental health and behavioural concerns during the COVID-19 lockdown. They could inform treatment recommendations for tackling prolonged-self isolation and loneliness in specific vulnerable groups.

Feelings of worthlessness links depressive symptoms and parental stress: A network analysis during the COVID-19 pandemic

BACKGROUND

The prevalent co-occurrence between parental stress and depression has been established prior to and during the COVID-19 pandemic outbreak. However, no studies to date have identified the connections through which these symptom domains interact with each other to emerge into a complex and detrimental mental health state, along with the plausible mechanistic variables that may play key roles in maintaining parental stress and depression. The aim of this research is to uncover these interactions in a period where parents experience heightened demands and stress because of the strict social distancing protocols.

METHODS

Network analysis is utilized to examine parental stress and depressive symptoms during the COVID-19 pandemic in a large cross-sectional study (N = 2,868) of parents. Two graphical Gaussian graphical network models were estimated, one in which only parental stress and depression symptoms were included, and another in which several mechanistic variables were added.

RESULTS

Expected influence and bridge expected influence revealed that feeling worthless was the most influential node in the symptoms network and bridged the two psychological states. Among the mechanistic variables, worry and rumination was specifically relevant in the depressive cluster of symptoms, and self-criticism was connected to both constructs.

CONCLUSION

The study displays that the co-occurrence of parental stress and depression has specific pathways, was manifested through feelings of worthlessness, and has specific patterns of connection to important mechanisms of psychopathology. The results are of utility when aiming to avoid the constellation of co-occurring parental stress and depressive symptoms during the pandemic.

How does the COVID-19 affect mental health and sleep among Chinese adolescents: a longitudinal follow-up study

OBJECTIVE

The Corona Virus Disease-19 (COVID-19) pandemic has evolved into the largest public health event in the world. Earlier COVID-19 studies have reported that the pandemic caused widespread impacts on mental health and sleep in the general population. However, it remains largely unknown how the prevalence of mental health problems and sleep disturbance developed and interacted in adolescents at different times in the epidemic.

METHODS

831 teenagers (aged 14-19) underwent a longitudinal follow-up study to evaluate the prevalence of mental health problems and sleep disturbance among adolescents before, during, and after the COVID-19 breakout in China and to explore the interaction between mental health and sleep across the three measurements. The chronotype, anxiety and depression level, sleep quality, and insomnia were investigated during each measurement.

RESULTS

The adolescents had delayed sleep onset and sleep offset time, longer sleep duration during the quarantine than before and after the epidemic, whereas their chronotype tended to morning type during the epidemic. Yet, the highest prevalence of anxiety, depression, poor sleeper, and insomnia symptoms were observed before but not during the COVID-19 breakout. The females and adolescents who were eveningness type showed significantly higher anxiety and depression levels, poorer sleep quality, and severe insomnia status than the males and the intermediate and morning types. Sleep disturbance was positively associated with mental problems among three measurements. Pre-measured depression level significantly predicted sleep disturbance level at follow-ups.

CONCLUSION

These findings suggested that adolescents' high prevalence of mental health and sleep problems occurred before the COVID breakout and decreased during and after the epidemic. Gender and chronotype were significant risk factors associated with affective and sleep disturbances. Depression positively predicted later sleep problems, but not vice versa.

The Psychological Impact of Coronavirus Pandemic Restrictions in Italy. The Mediating Role of the Fear of COVID-19 in the Relationship between Positive and Negative Affect with Positive and Negative Outcomes

Italy was quickly hit hard by the coronavirus. 'Lockdown' has significantly impacted the psychological health, personal wellbeing and quality of life of the people. The study aims to explore the relationship between positive and negative affect, as well as positive (spiritual well-being and flourishing) and negative outcomes (psychological distress caused by a traumatic life event in terms of perception of PTSD symptoms) on Italian adults during the lockdown period. Data was collected between April and May 2020. The participants were 281 Italian adults aged between 18 and 73 years. The survey was composed of the following measures: Flourishing Scale, Jarel Spiritual Well-Being scale, Positive and Negative Affect Schedule, Impact of Event Scale-Revised, Fear of COVID-19. The mediational analysis shows that fear of COVID-19 fully mediates the relationship between negative affect and spiritual well-being and flourishing; fear of COVID-19 partially mediates the relationship between negative affect and PTSD symptoms; the positive affect shows only direct effects on positive outcomes. Therefore, fear of COVID-19 does not play any mediation role. Implications for psychological interventions and future research will be discussed.

Factors associated with serious psychological distress during the COVID-19 pandemic in Japan: a nationwide cross-sectional internet-based study

OBJECTIVE

To investigate the factors associated with serious psychological distress (SPD) during the COVID-19 pandemic in Japan.

DESIGN

Nationwide cross-sectional study using survey data.

SETTING

Internet survey using sampling weights for national estimates conducted between 25 August and 30 September 2020 in Japan.

EXPOSURES

Demographics (age, gender), socioeconomic status (income level, employment type, educational attainment, marital status, family composition and caregiving burden); the experience of domestic violence (DV), the state of emergency and fear of and stigma related to COVID-19.

MAIN OUTCOME MEASURES

Prevalence of SPD, defined as Kessler 6 Scale score ≥13.

RESULTS

Among 25 482 respondents, 10.0% met the criteria of SPD. Overall, women (adjusted OR (aOR) 1.59; 95% CI 1.17 to 2.16; p=0.003), ages 15-29 (aOR 2.35 compared with ages 45-59 years; 95% CI 1.64 to 3.38; p<0.001), low-income level (aOR 1.70 compared with intermediate income; 95% CI 1.16 to 2.49; p=0.007), providing caregiving to family members (aOR 5.48; 95% CI 3.51 to 8.56; p<0.001), experiencing DV (aOR 5.72; 95% CI 3.81 to 8.59; p<0.001) and fear of COVID-19 (aOR 1.96; 95% CI 1.55 to 2.48; p<0.001) were associated with SPD. Among women aged 15-29 years, who have a higher risk of suicide during the COVID-19 pandemic in Japan, caregiving, DV, fear of COVID-19 and COVID-19-related stigma were associated with SPD.

CONCLUSIONS

Economic situation, caregiving burden, DV and fear of COVID-19 were independently associated with SPD during the COVID-19 pandemic. Among young women, similar factors, except economic situation, were associated with SPD. Targeted interventions based on age and gender may be more effective in mitigating the negative impact of the COVID-19 pandemic on the population's mental health.

Impact of the coronavirus disease 2019 pandemic on healthcare workers: systematic comparison between nurses and medical doctors

PURPOSE OF REVIEW

The COVID-19 outbreak has had major impact on individual's psychological health and overall well being worldwide. Evidence shows that these psychological challenges are especially prominent in healthcare workers (HCW); especially in nurses. Indeed, several studies report that nurses suffer more psychologically because of the consequences of the pandemic compared with medical doctors. To further look into this, we systematically review the recent literature to see whether the psychological impact of the COVID-19 pandemic differs between medical doctors and nurses across studies and which aspects of mental health are especially affected in nurses.

RECENT FINDINGS

Across studies, there is solid evidence that nurses show poorer mental health outcomes compared with medical doctors during the COVID-19 pandemic. This is especially true for symptoms of depression, anxiety and posttraumatic stress disorder (PTSD). Here, prevalence rates in nurses are often higher than 50%. In contrast, general stress levels and burnout seem to be comparable between nurses and medical doctors.

SUMMARY

Given that nurses suffer more from depression, anxiety and PTSD symptoms during the COVID-19 pandemic, special programs addressing their needs are required.

Psychosocial Factors Associated with Depression and Anxiety During COVID-19 Pandemic Among Outpatients with Depression

OBJECTIVE

Long-term social distancing, isolation, and economic fallout may be significant psychological triggers during pandemic, such as COVID-19, especially for those with underlying psychiatric illness. This study was conducted to address the psychological impact of COVID-19 pandemic among patients with depression based at a teaching hospital in Malaysia.

METHODS

This is a cross-sectional online study among patients with depression from University Malaya Medical Centre, using Generalized Anxiety Disorder-7 (GAD-7), Montgomery-Åsberg Depression Rating Scale-Self Assessment (MADRS-S), Insomnia Severity Index (ISI), Multidimensional Scale of Perceived Social Support (MSPSS), Knowledge, Attitudes, and Practices (KAP), and Social Media Addiction during COVID-19 Pandemic (SMACOP).

RESULTS

One hundred seventy-eight patients participated in this study. The mean total of the KAP score is 12.65 (SD = 2.65), with knowledge section (mean = 7.34 [SD = 2.13]), attitudes section (mean = 2.63 [SD = 0.58]), and practices section (mean = 2.69 [SD = 1.00]). They scored moderately on the MADRS-S (mean = 21.03 [SD = 4.62]) and ISI (mean = 20.25 [SD = 4.62]) but had high GAD-7 scores (mean = 16.8 (SD = 6.27]). From the multiple logistic regression analyses, depressive symptoms of greater severity (MADRS-S 18-34) are significantly associated with more severe insomnia (P < .001, adjusted OR = 9.101, 95% CI: 3.613-22.924). Furthermore, the high anxiety level is associated with the younger age group (P = .029, Adjusted OR = 2.274, 95% CI: 1.090-4.746), greater severity of insomnia (P < .001, Adjusted OR = 22.9, 95% CI: 6.145-85.343), and higher risk of COVID-19 related social media addiction (P = .011, adjusted OR = 2.637, 95% CI: 1.253-5.550).

CONCLUSION

This study demonstrates the high levels of sleep disturbances and anxiety symptoms experienced by outpatients with depression during the COVID-19 pandemic. These are closely linked to the younger age group and at-risk social media addiction related to COVID-19.

Suicidal Ideation and Predictors of Psychological Distress during the COVID-19 Pandemic in Eswatini: A Population-Based Household Telephone Survey

The unpredictability of the COVID-19 pandemic can induce psychological distress in individuals. We investigated perceived stressors, prevalence of psychological distress and suicidal ideation, and predictors of psychological distress among adults during the COVID-19 pandemic in Eswatini. This study was a cross-sectional, population-based household telephone survey of 993 conveniently sampled adults (18+ years) from all the four administrative regions of Eswatini. Data were collected between 9 June and 18 July 2020 during the first wave of the COVID-19 pandemic, when the country was under a partial lockdown. COVID-19-related psychological distress was assessed using the Kessler 6-item Psychological Distress Scale (K6). We performed weighted modified Poisson regression analyses to identify significant predictors of moderate/severe psychological distress (K6 scores: ≥5). The weighted prevalences of moderate (K6 scores: 5–12) and severe psychological distress (K6 scores: ≥13) were 41.7% and 5.4%, respectively. Participants reported several perceived COVID-19-related stressors, including worries and fears of the contagion-specific death, serious need for food and money, and concerns about loss of income or business. The weighted prevalence of suicidal ideation was 1.5%. Statistically significant predictors of increased risk for moderate/severe psychological distress included living in the Hhohho and Manzini regions; feeling not well informed about COVID-19; feeling lonely; having received COVID-19 food or financial relief from the government; feeling burdened by the lockdown; being married; and being youth (18–24 years). The results call for the government to urgently augment the provision of mental health services during the pandemic. Mental health practitioners and programs may use several stressors and risk factors identified in this study to inform interventions and government policies aimed at reducing psychological distress induced by the pandemic.

Subjective wellbeing in parents during the COVID-19 pandemic in Australia

OBJECTIVES

To examine (1) the subjective wellbeing of Australian parents raising children and adolescents (0-18 years) during April 2020 'stage three' COVID-19 restrictions, in comparison with parents assessed over 18-years prior to the pandemic; and (2) socio-demographic and COVID-19 predictors of subjective wellbeing during the pandemic.

METHODS

Cross-sectional data were from the COVID-19 Pandemic Adjustment Survey (CPAS, N = 2365 parents of a child 0-18 years, 8-28th April 2020); and a pre-pandemic national database containing 18 years of annual surveys collected in 2002-2019 (N = 17,529 parents).

RESULTS

Levels of subjective wellbeing during the pandemic were considerably lower than ratings prior to the pandemic (Personal Wellbeing Index, mean[SD] = 65.3 [17.0]; compared to [SD] = 75.8 [11.9], p < 0.001). During the pandemic, lower subjective wellbeing was associated with low education (adjusted regression coefficient, 95% confidence interval [95% CI] = -5.19, -0.93), language other-than-English (95% CI = -7.22, -1.30), government benefit (95% CI = -6.99, -0.96), single parents (95% CI = -8.84, -4.59), child neurodevelopmental condition (95% CI = -3.44, -0.76), parent physical/mental health problems (95% CI = -3.23, -0.67), COVID-environmental stressors (95% CI = -3.48, -2.44), and fear/worry about COVID-19 (95% CI = -8.13, -5.96). Unexpectedly, parent engagement with news media about the pandemic was associated with higher subjective wellbeing (95% CI = 0.35, 1.61).

CONCLUSION

Subjective wellbeing in parents raising children aged 0-18 years appears to be disproportionately impacted by the COVID-19 pandemic and restrictions in Australia. Specific at-risk groups, for which government intervention may be warranted, include parents in socially disadvantaged contexts, parents with pre-existing mental health difficulties, and parents facing significant COVID-19-related work changes.

Influence of Resilience and Optimism on Distress and Intention to Self-Isolate: Contrasting Lower and Higher COVID-19 Illness Risk Samples From an Extended Health Belief Model

The study investigated the influence of resilience and dispositional optimism on, first, emotional distress and, second, the intention to self-isolate, experienced by people with a lower and higher illness risk, during the lockdown imposed in Spain during the first COVID-19 wave. These effects were investigated against the background of the Health Belief Model (HBM). A convenience sample of N = 325 participants completed an online survey including an ad-hoc questionnaire measuring the HBM core factors: Perceived health threat (susceptibility and severity of getting infected), and perceived quarantine benefits and costs. Self-efficacy and perceived social pressure were also measured. Based on reviews regarding pandemic outbreaks, quarantine benefits were conceptualized as the perceived effectiveness and solidary contribution of self-isolating in line with the quarantine protocols. Quarantine “psychosocial” costs were conceptualized as a composite of perceived boredom, loneliness, and economic concerns. Findings revealed an asymmetrical pattern of results so that (i) people at higher risk were more distressed by the perceived severity of getting infected whereas people at lower risk were more distressed by the psychosocial costs. Moreover, (ii) resilience and optimism were more “protective” against distress within the lower and higher risk groups, respectively. In addition, (iii) quarantine benefits and self-efficacy promoted the intention to self-isolate within both groups. However, (iv) optimism hindered such intention. This finding is discussed in the light of links between dispositional optimism and optimistic bias; the underestimation of experiencing negative events, which can relax the perceived health risk. Based on these findings, communication campaigns should prioritize information about the effectiveness of the implemented preventive behaviors rather than the costs of not implementing them, and be cautionary in encouraging excessive optimism.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Positive and Negative Impacts of the COVID-19 Pandemic on Relationship Satisfaction in Male Couples

Little is known about the impact of the coronavirus pandemic and control measures on gay, bisexual, and other men who have sex with men (GBMSM) couples. The goal of this study was to investigate individual-level relationship satisfaction during the COVID-19 pandemic in a sample of 209 coupled GBMSM in the United States. We analyzed reported happiness and feelings about a relationship's future and assessed the odds of changing relationship happiness and investment associated with pandemic-related life changes (pandemic-related employment change; COVID-19 illness; high-risk of severe illness), using logistic and multinomial logit models. Fifty-five percent of participants (N = 114) reported that their relationship happiness had not changed during the pandemic, but 30% (N = 62) reported increased relationship happiness. 25% (N = 53) reported they had become more invested in their relationship's future during the pandemic, and only one participant reported decreased investment. The odds of increased relationship investment was significantly associated with pandemic-related employment change (adjusted odds ratio (aOR), 95% confidence interval (CI): 2.19 [1.04, 4.61]) and increased sex during the pandemic (aOR: 4.38 [1.55, 12.41]). Those with a pandemic-related employment change also had significantly higher odds of increased relationship happiness than those without a change (aOR: 2.10 [1.01, 4.35]). COVID-19 cases that reported being at higher risk of serious COVID-19 disease had higher odds of decreased relationship happiness than high-risk non-cases (aOR: 6.58 [1.10, 39.39]). Additional research in this area is warranted to minimize the long-term impacts of the pandemic on coupled GBMSM.

COVID-19-Related Anxiety and Its Association with Dietary Diversity Score Among Health Care Professionals in Ethiopia: A Web-Based Survey

Background

The outbreak of coronavirus disease 2019 (COVID-19) is a stressful and overwhelming situation for health care professionals (HCP), especially, who are caring for patients in the resource-limited health care settings of low-income countries. Due to the increasing number of COVID-19 cases in Ethiopia, HCPs are at risk for COVID-19-related anxiety and associated inadequate nutrition. However, the magnitude of COVID-19-related anxiety and its association with dietary diversity among HCPs is not well studied.

Objective

To assess the magnitude of COVID-19-related anxiety and its association with dietary diversity score among health care professionals in Ethiopia.

Methods

A web-based cross-sectional survey was conducted among HCPs working in university hospitals, primary hospitals, and health centers in south and southwest Ethiopia. A structured online survey questionnaire was designed on Google forms and carried out from May 15 to June 14, 2020. COVID-19-related anxiety was assessed using the coronavirus anxiety scale. Dietary diversity was measured using 9 items individual dietary diversity score. Data analysis was done using the Statistical Package for Social Sciences version 24. Multiple logistic regression was computed to identify independent factors associated with COVID-19-related anxiety. Statistical significance was set at p<0.05.

Results

The prevalence of COVID-19-related anxiety among health care professionals was found to be 20.2%. COVID-19-related anxiety is significantly associated with a low dietary diversity score [AOR=5.93 (1.67, 21.07)]. The other factors which are independently associated with COVID-19-related anxiety are the presence of depression [AOR=6.98 (2.91–16.73)] and diploma educational status [AOR=0.16 (0.04–0.55)].

Conclusion

One-fifth of the study participants were found to have probable COVID-19-related anxiety. Designing a screening and intervention strategy for COVID-19-related anxiety among HCPs, particularly to those with low dietary diversity scores and depression, is recommended.

Stress and Mental Health among Children/Adolescents, Their Parents, and Young Adults during the First COVID-19 Lockdown in Switzerland

The present study aimed to assess various stressful situations and the psychological impact of the first COVID-19 pandemic lockdown among youths in Switzerland. We included samples of 1627 young adults aged 19–24 from the Swiss Youth Epidemiological Study on Mental Health and 1146 children and adolescents aged 12–17 years and their parents. We assessed symptoms of various mental health problems, internet use, and perceived stress during the first COVID-19 lockdown. In the analyses, data were weighted to be representative of the Swiss population. During the first lockdown in Switzerland, the most common sources of perceived stress were the disruption of social life and important activities, uncertainty about how long the state of affairs would last, and the pandemic itself. In addition, around one-fifth of the young adults met the criteria for at least one of the mental health problems (attention deficit hyperactivity disorder, depression, generalized anxiety disorder), while one-third of children/adolescents screened positive for at least one of the mental health problems (attention deficit hyperactivity disorder, oppositional defiant disorder, depression, anxiety). Moreover, 30.1% of children and 21.3% of young adults met the criteria for problematic internet use. The study showed considerable stress perceived by young adults and symptoms of mental health problems, especially among females, during the first COVID-19 lockdown in Switzerland.

Prolonged COVID 19 Outbreak and Psychological Response of Nurses in Italian Healthcare System: Cross-Sectional Study

Aim of the study was to analyze the posttraumatic stress disorder risk nurses, detecting the relationship between distress experience and personality dimensions in Italian COVID-19 outbreak. A cross-sectional study was conducted based on 2 data detection (March 2020 and September 2020). Mental evaluation was carried out in Laboratory of Clinical Psychology on n.69 nurses in range age 22-64 years old (mean age 37.3; sd ± 10.3; 55% working in nursing care with confirmed COVID-19 patients (named frontline; secondline nurses have been identified by nursing care working with infectious patients but no confirmed COVID-19). Measurement was focused on symptoms anxiety, personality traits, peritraumatic dissociation and post-traumatic stress for all participants. No online screening was applied. Comparisons (ANOVA test) within the various demographic characteristics demonstrated few significant differences between groups on DASS-21, PDEQ, and ISE-R scores. Correlation analysis (Spearman test) was performed among PDEQ, DASS-21, BFI-10 and IES-R and confirmed between anxiety (DASS-21) and peritraumatic dissociation and post-traumatic stress; then anxiety is positively correlated to agreeableness variable of BFI-10 test. The emotional distress was protracted overtime (after 6 months) but in long-term personality traits resulted mediator facing subjective stress. Our finding drew details for protective and predictive risk factors as well as mental health issues of nurses dealing with pandemic: healthcare workers faced the protracted challenge caring COVID-19 patients over and over again: in short time the impact was relevant, and the prolonged exposition to the stressor was tackled by personal resources such as personality traits.

Brief videoconferencing psychological intervention for reducing COVID-19 related distress: study protocol for a randomized controlled trial

Background

Globally COVID-19 has had a profound impact on the psychological wellbeing of millions of people, and there is an urgent imperative to address elevated levels of distress during the COVID-19 pandemic. The World Health Organization (WHO) has developed Problem Management Plus (PM+), a low intensity psychological intervention for adults experiencing psychological distress. This paper outlines the study protocol for a trial that tests the effectiveness of an adapted version of PM+ to reduce distress associated with COVID-19.

Methods

A single-blind, parallel, randomized controlled trial will be carried out for distressed people across Australia. via video conferencing on a small group basis. Following informed consent, adults that screen positive for levels of psychological distress (General Health Questionnaire-12 (GHQ-12 score ≥ 3) and have access to videoconferencing platform will be randomised to an adapted version of gPM+ (n = 120) or enhanced treatment as usual (ETAU) (n = 120). The primary outcome will be reduction in psychological distress including anxiety and depression at 2-months post treatment. Secondary outcomes include worry, sleep problems, anhedonia, social support, and stress in relation to COVID-19.

Discussion

The trial aims assess whether an adapted version of videoconferencing PM+ that is specifically designed to target COVI-19 related distress will result in reduced distress relative to enhanced usual care.

Trial registration

This trial was prospectively registered on the ANZCTR on 14/4/20 (ACTRN12620000468921).

Factors Associated with Serious Psychological Distress during the COVID-19 Pandemic in Japan

Importance:

The coronavirus disease 2019 (COVID-19) pandemic may have a negative impact on mental health of the population, leading to higher suicide rates, in many countries. However, little is known about risk factors associated with worsened mental health during the COVID-19 pandemic.

Objective:

To investigate the factors associated with serious psychological distress (SPD) during the COVID-19 pandemic in Japan.

Design, Setting, and Participants:

A cross-sectional study using a large-scale internet survey conducted between August 25 and September 30, 2020, in Japan.

Exposures:

Demographics (age, gender, marital status, family composition, and caregiving burden), socio-economic status (income level, employment type, educational attainment), the experience of domestic violence (DV), the state of emergency, fear of COVID-19, and stigma related to COVID-19.

Main Outcomes and Measures:

Prevalence of SPD, defined as Kessler 6 scale score ≥13.

Results:

Among 25,482 individuals included in this study, 2,556 (10%) met the criteria of SPD. Overall, women (adjusted odds ratio [aOR] 1.59; 95%CI, 1.17–2.16; P=0.003), ages 15–29 (aOR compared with ages 45–59, 2.35; 95%CI, 1.64–3.38; P<0.001), low income (aOR compared with intermediate income, 1.70; 95%CI, 1.16–2.49; P=0.007), providing caregiving to family members (aOR, 5.48; 95%CI, 3.51–8.56; P<0.001), experiencing DV (aOR, 5.72; 95%CI, 3.81–8.59; P<0.001), and fear of COVID-19 (aOR, 1.96; 95%CI, 1.55–2.48; P<0.001) were associated with a higher rate of SPD. Among women aged 15–29 years, who experienced the highest rate of SPD, caregiving, DV, fear of COVID-19, and COVID-19-related stigma were associated with a higher rate of SPD; whereas economic situation (income level and employment type) and social isolation (marital status) were not associated with the prevalence of SPD.

Conclusions and Relevance:

Economic situation, caregiving burden, DV, and fear of COVID-19 were independently associated with SPD during the COVID-19 pandemic. Among young women—who have a higher risk of suicide during the COVID-19 pandemic in Japan—similar factors, except economic situation, were associated with a higher rate of SPD. Targeted interventions based on age and gender may be more effective in mitigating the negative impact of the COVID-19 pandemic on the population’s mental health.

The Relationship Between COVID-19 Related Stress and Medication Adherence Among High-Risk Adults During the Acceleration Phase of the US Outbreak

PURPOSE

To assess the relationship between stress regarding COVID-19 and medication adherence.

PATIENTS AND METHODS

Older adults with ≥1 chronic condition(s) were recruited from 4 active, federally funded studies in Chicago to participate in a longitudinal telephone survey. Participants self-reported stress regarding COVID-19 in the last week. Adherence was measured via the ASK-12 survey.

RESULTS

Most participants reported feeling stressed "some of the time" (54.0%), while 18.2% felt stressed "most" or "all of the time" and 27.8% "never" felt stressed. In bivariate analyses, participants who reported being stressed "most" or "all of the time" had worse medication adherence than participants who reported being stressed "some of the time" or "never" (p < 0.001). In multivariable analyses, participants who reported feeling stressed "most" or "all of the time" had worse adherence than those who "never" felt stressed (Adjusted Least Square Mean (Standard Error): 21.3 (0.6) vs 19.7 (0.6), p=0.01).

CONCLUSION

Stress due to COVID-19 has significantly impacted medication adherence, which has negative implications for the course of both COVID-19 and comorbid conditions. Healthcare providers should be aware of the potential impact of COVID-19 on patients' mental and physical well-being and consider ways to routinely assess patient experiences.

Physical and Psychosocial Well-Being of Hospitalized and Non-Hospitalized Patients With COVID-19 Compared to the General Population in Qatar

Background: Many studies have shown a high prevalence of depression, anxiety, and stress symptoms in COVID-19 patients and the general population. However, very few studies directly examined the potential impact on the health-related quality of life (HRQoL), and none compared HRQoL in COVID-19 patients to the general population amid the pandemic. Methods: We carried out a cross-sectional study comparing HRQoL (as measured using the RAND Short Form 36 or SF-36 Health Survey) in randomly selected individuals from three different groups: hospitalized COVID-19 patients, quarantined COVID-19 patients, and controls from the general population in Qatar. We constructed a multivariate analysis of covariance (MANCOVA) to compare the SF-36 scores between the three groups and control for various covariates. Results: Our sample consisted of 141 COVID-19 inpatients, 99 COVID-19 quarantined patients, and 285 healthy controls. Surprisingly, we found that HRQoL was higher in COVID-19 hospitalized than in COVID-19 non-hospitalized patients than in controls. The main components where COVID-patients scored higher than controls were physical functioning and role limitations due to emotional problems. In COVID-19 patients, the female gender, older age, and past psychiatric history were associated with lower HRQoL. Conclusions: It seems that COVID-19 patient's HRQoL might be better than expected. Our results can be explained by social support from family and friends, easy access to mental health screening and care, and a possible change of perspectives after recovery from COVID-19, resulting in psychological growth and enhanced resilience.

Common Mental Disorders Among Informal Primary Caregivers of Adults With Mental Illness During the Coronavirus Disease 2019 Epidemic in Eastern Ethiopia: A Cross-Sectional Study

Background: Coronaviruses (CoVs) are emerging respiratory viruses and cause illnesses ranging from the common cold to severe acute respiratory syndrome (SARS). Informal primary caregivers of individuals with mental illness were special populations suffering from both the burden of caring for mentally ill individuals and the danger of the Coronavirus disease 2019 (Covid-19) epidemic. Objective: The objective of the study was to assess the prevalence and associated factors of common mental disorders (CMDs) among the informal primary caregivers of adults with mental illness during the Covid-19 epidemic. Methods: A hospital-based cross-sectional study design was conducted from July 1 to 30, 2020. A systematic random sampling technique was used to get samples of informal primary caregivers. Data were analyzed by bivariable and multivariable logistic regression analysis. In the final model, variables having a p-value < 0.05 were declared as associated with CMDs. Result: Out of a total of 218 informal primary caregivers, 215 responded to this study. The prevalence of CMDs was 40.5% [95% confidence interval (CI) = 36.66, 44.3%] among informal primary caregivers. Being female informal primary caregivers [adjusted odds ratios (AOR) 1.98, 95% CI = 1.05, 3.76], being student informal primary caregivers (AOR 5.8, 95% CI: 1.2, 28.4), caring patients with psychosis (AOR 3.33, 95% CI: 1.12, 9.92) and caring patients with bipolar disorder (AOR 3.12, 95% CI: 1.35, 7.23) were significantly associated with CMDs. Conclusion: Our study cannot show the causal relationship due to its cross-sectional study design nature. However, this study showed relatively higher prevalence of CMDs among informal primary caregivers of adults with any mental illness during the Covid-19 epidemics relative to pre-Covid-19 times. Being a female caregiver, being a student caregiver, and caring for adults with psychosis and bipolar disorder were factors associated with CMDs. Attention should be given, and essential psychosocial care should be provided, to maintain the mental health of informal primary caregivers of individuals with mental illness especially during the Covid-19 pandemic.

COVID-19 Related Psychological Distress, Fear and Coping: Identification of High-Risk Groups in Bangladesh

Background: The COVID-19 pandemic has imposed psychological distress and fear across the globe; however, factors associated with those issues or the ways people cope may vary by country or context. This study aimed to investigate the factors associated with psychological distress, fear, and coping strategies for people living in Bangladesh during the COVID-19 pandemic. Methods: A cross-sectional study conducted in August-September 2020 using online platforms in Bangladesh. People residing in Bangladesh, aged ≥18 years, who were proficient in English and able to respond to online questionnaire. The Kessler Psychological Distress Scale was used to assess the psychological stress. Level of fear was assessed using the Fear of COVID-19 Scale, and strategies to cope were assessed using the Brief Resilient Coping Scale. Results: Of the 962 participants, half of them were aged between 30 and 59 years. Being born in Bangladesh, having graduate education, perceived distress due to employment change, effect of COVID-19 on financial situation, having multiple comorbidities, and visiting a healthcare provider in the last 4 weeks were associated with higher levels of both psychological distress and fear of COVID-19. Furthermore, higher psychological distress was associated with being a female (AOR 1.81, 95% CI 1.33-2.47, p < 0.001), being a frontline worker (AOR 1.50, 95% CI 1.04-2.15, p < 0.05), having pre-existing psychiatric problems (AOR 4.03, 95% CI 1.19-13.7, p < 0.05), being a smoker (AOR 2.02, 95% CI 1.32-3.09, p < 0.01), providing care to a known/suspected COVID-19 patient (AOR 1.96, 95% CI 1.40-2.72, p < 0.001), having a recent overseas travel history and being in self-quarantine (AOR 4.59, 95% CI 1.23-17.2, p < 0.05), self-isolation without COVID-19 (AOR 2.63, 95% CI 1.68-4.13, p < 0.001) or being COVID-19 positive (AOR 2.53, 95% CI 1.19-5.34, p < 0.05), and having high levels of fear of COVID-19 (AOR 3.27, 95% CI 2.29-4.66, p < 0.001). A higher level of fear was associated with moderate to high levels of psychological distress (AOR 3.29, 95% CI 2.31-4.69, p < 0.001). People with pre-existing mental health problems were less likely to be resilient (AOR 0.25, 95% CI 0.11-0.54, p < 0.01), whereas those with having an income were more likely to be resilient (AOR 1.46, 95% CI 1.02-2.11, p < 0.05). Conclusion: Effective interventions to support the vulnerable groups including improved access to mental health services are of utmost importance during the pandemic.

Mental Health During the First Weeks of the COVID-19 Pandemic in the United States

Background: By March 2020, the World Health Organization declared the COVID-19 crisis as a worldwide pandemic and many local governments instituted stay-at-home orders and closed non-essential businesses. Within the United States, tens of millions of workers lost their jobs and financial security during the first few weeks of the national response, in an attempt to slow the global pandemic. Because of the enormity of the pandemic and its potential impact on mental health, the objective of the present study was to document the prevalence of mental health problems and their association with pandemic-related job loss during the third week of the nationwide shutdown. Methods: Mental health was assessed via online questionnaires among a representative sample of 1,013 U.S. adults on April 9-10, 2020. Rates of clinically significant mental health outcomes were compared between participants who lost their job as a result of COVID-19 restrictions (17.4%) vs. those who did not (82.6%). Bivariate multiple logistic regression identified factors that were predictive of, and protective against, mental health problems. Results: The prevalence of clinically significant symptoms was significantly higher than prior population estimates, ranging from 27 to 32% for depression, 30 to 46% for anxiety disorders, 15 to 18% for acute/post-traumatic stress, 25% for insomnia, and 18% for suicidal ideation. Prevalence estimates were 1.5-1.7 times higher for those who reported job loss due to COVID-19 restrictions than those who did not. Mental health problems were predicted by worry over financial instability, insomnia, social isolation, and alcohol consumption, while getting outside more often, perceived social support, and older age were protective against these problems. Conclusions: During the first 3 weeks of lockdowns/stay-at-home restrictions, mental health problems, including depression, anxiety, insomnia, and acute stress reactions were notably elevated relative to prior population estimates. Job loss related to the nationwide shutdown was particularly associated with poorer mental health. These findings provide a baseline of mental health functioning during the first weeks of the national emergency and lockdown orders in response to COVID-19.

The Influences of COVID-19 on Patients With Chronic Kidney Disease: A Multicenter Cross-Sectional Study

Background: The outbreak of coronavirus disease 2019 (COVID-19) has attracted global attention. During the lockdown period of COVID-19, follow-up of many patients with chronic disease had been interrupted, which brought severe challenges to better management of their disease. This study aimed at exploring the change of illness, daily life, and psychological responses during the COVID-19 pandemic among chronic kidney disease (CKD) patients. Methods: A total of 612 patients were enrolled in this study; 282 patients were categorized into the CKD stage 1-2 group and 330 patients were categorized into the CKD stage 3-5 group. Among two groups, 168 (27.5%) and 177 (28.9%) patients were female with a median age of 42 and 45, respectively. The study was conducted by collecting the questionnaires in five nephrology centers. The questionnaire consisted of assessment of anxiety by using the Self-Rating Anxiety Scale and the influences of COVID-19, which included basic demographic data, the influences of COVID-19 on illness and daily life, as well as the patients' psychological responses during the epidemic. Results: A total of 612 patients were included and divided into two groups according to eGFR. Ninety-six patients (34%) in the CKD stage 1-2 group and 141 patients (42.7%) in the CKD stage 3-5 group had reduced their follow-up frequency (p = 0.031). More patients with CKD stages 1-2 consulted online (25.9%), p = 0.005. Besides, patients in the CKD stage 3-5 group tended to be more anxious about follow-up (p = 0.002), fearful of being infected with COVID-19 (p = 0.009), and more likely to feel symptoms getting worse (p = 0.006). The standard scores of SAS were 48.58 ± 7.082 and 51.19 ± 5.944 in the CKD stage 1-2 group and the CKD stage 3-5 group, respectively (p < 0.001). There were significant differences in the severity of anxiety (p = 0.004). Conclusion: COVID-19 had a greater impact on patients with CKD stages 3-5 than those with stages 1-2 in terms of illness, daily life, and psychological disorder. Patients with CKD stages 3-5 were more anxious during the COVID-19 pandemic.