COVID-19: Psychological flexibility, coping, mental health, and wellbeing in the UK during the pandemic

Peri-Traumatic Distress and Its Relationship to Resilience and Coping Among Medical Students in Malaysia During COVID-19 Lockdown

Background: Medical students are not spared from the challenges related to the Covid-19 lockdown. The fear and uncertainties may lead to traumatic symptoms and test their resilience and sense of coping. Thus, this study aims to determine the prevalence of peri-traumatic distress symptoms and its association with the level of resilience and the coping strategies used during the lockdown among medical students. Materials and Methods: This was a cross-sectional online questionnaire survey involving medical students from a public university in Malaysia. It was conducted during the COVID-19 lockdown or Movement Control Order (MCO) where the students were asked to fill in the COVID-19 Peri-traumatic Distress Index (CPDI), Brief COPE Inventory, and Connor Davidson Resilience Scale (CDRS-25). Results: A total of 282 clinical and 172 pre-clinical medical students were involved. Peri-traumatic distress symptoms were reported by 27% out of the total students. This study found that those who were having peritraumatic distress symptoms were from the pre-clinical years, had poor internet access, as well as lower resilience levels, and used more dysfunctional coping strategies. Pre-clinical medical students with difficult internet access were eight times more likely to have peritraumatic distress symptoms. Conclusions: Given the high level of peri-traumatic distress symptoms reported by medical students during the lockdown, it is vital to identify the vulnerable students, assess their needs and risks to mental health problems during this challenging time as the pandemic is still ongoing with countries going in and out of lockdown depending on the cases at the time. The university administration for each University in Malaysia will need to have a clear academic guideline and policy as well as providing improved infrastructure to minimize the distress faced by medical students.

Exploring the Mental Health Needs of Persons With Autoimmune Diseases During the Coronavirus Disease 2019 Pandemic: A Proposed Framework for Future Research and Clinical Care

Although the coronavirus disease 2019 (COVID-19) pandemic has been associated with increased psychological distress globally, it poses unique challenges to persons who are potentially more vulnerable to its effects, including patients with autoimmune disease. In this article, we review the published literature and media reports to determine factors that may contribute to mental health challenges in persons with autoimmune disease. We then explore existing mental health interventions that have been developed for use in COVID-19 and in patients with autoimmune disorders in general. We identified several potential contributors to psychological distress in patients with autoimmune disease during the pandemic, as follows: feelings of discrimination related to societal response to COVID-19, fear of infection and uncertainty related to immunosuppressive medication, diminished access to usual care and resources, previous health-related trauma, and the exacerbating effect of social isolation. Drawing from existing literature, we synthesize the identified evidence to develop a proposed framework for researching and managing mental health challenges in autoimmune disease during the pandemic and its aftermath.

The Psychological Impact and Associated Factors of COVID-19 on the General Public in Hunan, China

PURPOSE

This study aimed to assess the psychological impact of the COVID-19 pandemic among the general public in Hunan Province, China, which could help develop psychological interventions and mental health programs.

PARTICIPANTS AND METHODS

This online cross-sectional study recruited 571 participants through snowball sampling between February 2 and February 5, 2020. Data were collected through a general information questionnaire, the Public Emergency Psychological State Questionnaire, the Simple Coping Style Questionnaire, and the Public Disease Awareness on COVID-19 Scale.

RESULTS

The total mean score of the public emergency psychological state of the sample was 0.27 (0.31) points, with only 5.78% of participants (n = 33) developing psychological distress. Avoidant coping style and disease awareness were weakly positively correlated (rs = 0.257, p < 0.01) and weakly negatively correlated (rs = -0.124, p <0.01) with psychological responses, respectively. There were significant psychological differences among the following variables: occupation, symptoms of fever or fatigue, discernment of the authenticity of COVID-19 information, and level of concern regarding COVID-19 (p < 0.05).

CONCLUSION

The COVID-19 pandemic appears to have had a minor psychological impact on the general population in Hunan Province. However, psychological health promotion in the general public is still required, especially for employees (such as company employees, migrant workers, and businessmen), individuals with COVID-19-like symptoms, limited discernment competence and unconcerned attitudes.

IMPLICATIONS

The initiatives for improving psychological health among the general public could focus on delivering COVID-19 knowledge and alleviating avoidant coping styles. Our findings could provide important insight for the development of psychological support strategies in China, as well as in other places affected by the epidemic.

Association Between Preventive Behaviour and Anxiety at the Start of the COVID-19 Pandemic in Slovenia

Introduction

The first large outbreak of SARS-CoV-2 in Europe occurred in Northern Italy in February 2020. The relatively fast spread of the infection to Slovenia was expected, and preventive measures for its suppression were widely discussed.

Methods

An online questionnaire was designed to evaluate adherence to preventive measures and the extent to which the taking of preventive measures was associated with people's anxiety level, psychological burden, their perceived vulnerability to disease, germ aversion and a number of demographic characteristics in the early stage of Covid-19 spread. The survey was active for 24 hours (13-14 March 2020). There were 12,307 responses and 7,764 questionnaires were completed in full.

Results

Higher preventive behaviour was found in individuals who experienced greater psychological distress, were more anxious, and expressed greater perceived infectability and germ aversion. Greater compliance with preventive behaviour was found among women, those sharing a household with people aged over 65, the elderly and those who knew somebody who had been infected. These groups also showed higher anxiety levels, which appeared to be significantly increased in general as a result of the specific situation. Quarantine was evaluated as the most efficient preventive measure, and was respected relatively strictly even before it became an officially announced protective measure.

Conclusion

This research reveals a strong association between preventive behaviour and anxiety. Anxiety, together with social distancing, may affect physical and psychological health in the population in the long term. Other aspects of public health might therefore be influenced by the measures currently being enforced to prevent the spread of SARS-CoV-2.

Psychological inflexibility and mental health symptoms during the COVID-19 lockdown in Spain: A longitudinal study

Spain, one of the European countries most affected by the COVID-19 pandemic, underwent a strict lockdown between March and May 2020. This study examines longitudinally the evolution of both psychological inflexibility and mental health symptoms in a sample of college students from the beginning and throughout the end of the mandated lockdown period. We present the results from 197 participants who responded to an online survey at least at two of three data-collection waves scheduled at the beginning (N = 226), halfway (N = 172), and end (N = 188) of the lockdown. The analyses revealed that psychological inflexibility and symptomatology increased over time, and that inflexibility at the beginning of the lockdown indirectly predicted self-reported symptoms at the end of the lockdown via autoregressive parallel paths that also connected cross-sectionally to reveal that changes in inflexibility were predictive of changes in mental health. These results present a dynamic and robust relationship between psychological inflexibility and mental health symptoms throughout a relatively long and presumably stressful period of time.

Examining the Associations between Psychological Flexibility, Mindfulness, Psychosomatic Functioning, and Anxiety during the COVID-19 Pandemic: A Path Analysis

Social distancing plays a leading role in controlling the spread of coronavirus. However, prolonged lockdown can lead to negative consequences in terms of mental health. The goal of the research is to examine the relationship between anxiety and general psychosomatic functioning during the COVID-19 pandemic; the impact of psychological flexibility and mindfulness is also considered. Variables were measured with self-report questionnaires and symptom checklists. The sample included 170 people (M = 27.79, SD = 8.16). Pearson’s correlation, stepwise regression, and path analysis were conducted. The results showed a significant positive relationship between state anxiety and somatic and psychological responses to the pandemic. Path analysis revealed that mindfulness had a direct negative impact on and decreased the level of state anxiety (b = −0.22, p = 0.002), whereas psychological flexibility influenced the variable indirectly (b = 0.23, p = 0.002) by enhancing psychosomatic functioning (b = −0.64, p < 0.001). Psychological flexibility and mindfulness may mediate the development of mental disorders and facilitate achieving overall wellbeing. The study points to the usefulness of mindfulness practice as a form of self-help with anxiety symptoms; this is crucial during the pandemic because contact with clients is restricted.

Leadership in a crisis: doing things differently, doing different things

This article summarises the findings from a review of publications related to healthcare leadership that were published during the first wave of the COVID-19 crisis in 2020. The review discusses a range of strategies for leaders to adopt in challenging situations and identifies three aspects of leadership which are considered essential when leading teams during a crisis: 1) communication, 2) decision making and 3) mental health and wellbeing. This article identifies key principles for each of these three aspects and provides practical tips for how leaders can use the lessons learned from the pandemic in their own contexts.

Impact on Mental Health Due to COVID-19 Pandemic: Cross-Sectional Study in Portugal and Brazil

Mental health effects secondary to the COVID-19 pandemic were till recently considered less important or were neglected. Portugal and Brazil are facing the pandemic in quite different ways. This study aimed to describe the mental health status of the general adult population in Portugal and Brazil during the COVID-19 pandemic and analyze the differences between the two countries. A cross-sectional quantitative study was based on an online questionnaire. Socio-demographic data were collected in addition to four validated scales: CAGE (acronym cut-annoyed-guilty-eye) Questionnaire, Satisfaction with Life Scale, Generalized Anxiety Disorder-7 and Patient Health Questionnaire-2. For each outcome, a multiple linear regression was performed. Five hundred and fifty people answered the questionnaire (435 women). The median age was 38 (Q1, Q3: 30, 47) years, 52.5% resided in Brazil and 47.5% in Portugal. The prevalence of anxiety was 71.3% (mild anxiety was present in 43.1%), the prevalence of depression was 24.7% and 23.8% of the sample had both depression and anxiety. Isolation was a significant factor for depression but not for anxiety. Well-being was below average. Mental illness was considerably higher than pre-COVID-19 levels. Portugal and Brazil will have to be prepared for future consequences of poor mental health and contribute immediate psychological support to their adult populations.