Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter

The Fear of COVID-19: Gender Differences among Italian Health Volunteers

Background: During the COVID-19 pandemic, the fear of being infected was a major concern, resulting in both physical and psychological effects. Despite several studies on fear of COVID-19 in the general population, the effects on healthy volunteers who face COVID-19 on the frontlines have not yet been investigated. Methods: An online survey on specific psychological variables related to COVID-19 was administered to 720 healthy volunteers, and gender differences were investigated. Results: The primary finding was that females showed higher scores in all dimensions assessed. A multiple linear regression conducted on both genders exhibited a similar pattern of predictors, highlighting the pivotal role of negative affect in the male group. Conclusions: The findings suggest that COVID-19 had significant effects on healthy volunteers, especially in the female group. Although the previous literature did not report the crucial role played by the negative affect in the male sample, these results highlight the need to deepen how both genders use different emotional strategies to cope with stressful situations. This study may be useful in the development of specific psychological support and ad hoc training for healthy volunteers.

The Influence of Parents’ Attachment on Young People’s Stress during the COVID-19 Pandemic in Indonesia

Background: Novel Coronavirus Diseases 19 (COVID-19) pandemic brings significant effects on the life of peoplse, for example various educational activities which have been conducted in the school before the outbreak are now conducted in the family. This arises some problems which then become newly-emerging sources of stress. Objective: This research aims at revealing the correlation between parent’s attachment and adolescent’s stress during the COVID-19 pandemic. Method: This research uses quantitative methods with online surveys. The research population is adolescents in Indonesia, and the research samples consist of 10-21 years-old adolescents who live with their parents and are willing to be the respondents of this research with 392 respondents. The sampling method utilizes accidental sampling during four weeks. The data was quantitatively analyzed by involving univariate and bivariate analysis as well as linear regression. Results: The results of the research showed that the normality test used the Kolmogorov-Smirnov Test on parental attachment and stress was normally distributed so that the linearity test was valid using the Test for Linearity. The test showed that adolescent's stress level depends on parental attachment with a negative correlation. The higher parent's attachment, the lower the adolescent's stress. Conclusion: The novel coronavirus disease (COVID-19) pandemic could effect to increased psychiatric disorders such as post-traumatic stress, anxiety disorders, and depressive

Quality of life during COVID-19 pandemic: a community-based study in Dakahlia governorate, Egypt

BACKGROUND

The sudden transmission of the novel coronavirus along with instant measures taken in response to the Coronavirus Disease 2019 (COVID-19) pandemic caused many new challenges adversely disturbing quality of life (QoL). The objective of this study is to measure quality of life of the public during the COVID-19 pandemic and factors affecting it among adults.

METHODS

This is a community-based cross-sectional household study with analytic component conducted in an agricultural area in Dakahlia governorate, Egypt and included 500 individuals. Data were collected through a structured interview, and the collected data included socio-demographic characteristics as well as some data related to their habits and comorbidities, their experience with COVID-19 and data about QoL using the COV19-Impact on Quality of Life (COV19-QoL) scale Arabic version, after assessing Content validity and reliability.

RESULTS

The total QoL score (mean ± standard deviation) is 2.3 ± 0.6 and the score for QoL in general and perception of danger on personal safety show the highest mean with 2.6 ± 0.7. The lowest mean score is related to the perception of mental health deterioration (1.9 ± 0.8). Independent predictors of the total QoL scale are sex (regression coefficient (95% CI) = 0.1 (0.02 to 0.2), p value = 0.02), monthly income (regression coefficient (95% CI) = 0.1 (0.004 to 0.2), p value = 0.04), knowing someone infected with COVID-19 (regression coefficient (95% CI) = 0.15 (0.08 to 0.3), p value = 0.001), and data collection time (regression coefficient (95% CI) = 0.1 (0.006 to 0.2), p value = 0.04).

CONCLUSIONS

COVID-19 pandemic has impacted the public quality of life, particularly in terms of general quality of life and personal safety. People with substantial predictors of lower quality of life should be given more attention.

The Changes in the Daily Lives and Life Satisfaction of Female Academicians during the Pandemic Process

Objective: The new type of coronavirus (COVID-19) disease has more serious consequences and risks by gender and plays a role in biological, socio-cultural and behavioral differences. This process is particularly severe in terms of the problems faced by women and some disadvantaged groups. The aim of this study is to determine the effect of changes in the daily lives of female academicians on life satisfaction during the COVID-19 pandemic process. Methods: The sample of this descriptive study consists of 178 female academicians who have been actively working at a public university in the northeast of Turkey between Oct 1, 2020 and Feb 1, 2021. The data of the research were collected by "Personal Information Form" and "Contentment with Life Scale". Descriptive statistics (percentage, frequency, average), Pearson product-moment correlation analysis, t-test, and ANOVA test were used to evaluate the data. Results: It was found that 83.1% of the female academicians preferred to stay at their own homes and 52.8% of them did not receive support while fulfilling their daily responsibilities during the pandemic process in which female academicians had to work and learn at home. The total score of the Contentment with Life Scale of female academicians was found to be 20.15 ± 6.95. Female academicians who participated in the study had moderate level of contentment with life. It was determined in the study that the increase in the time spent on academic development, academic studies, and themselves increased female academicians’ life contentment and was statistically significant (p˂0.05). It was found that increased time spent for housework decreased life satisfaction. Conclusions: It was determined that professional and individual development is quite significant in increasing life satisfaction in female academicians. That strategies that can increase female academicians life contentment should be developed and women who are sensitive and need to be protected should be supported more in this situation.

Role-play Games (RPGs) for Mental Health (Why Not?): Roll for Initiative

COVID-19 has impacted the mental health of the general public negatively, associated with preventative measures, restricting life activities. These restrictions, such as the stay-at-home strategy, resulted in heightened stress, depression, loneliness, substance abuse, and domestic violence, violating people's occupational and personal lives. During the pandemic, the demands for role-play games (RPGs) have increased: for example, the sales of "Dungeons & Dragons" tripled, underscoring the potential mental health benefits of such games. However, research into the mental health benefits of such games remains under-developed, needing more scientific attention. Accordingly, this commentary paper reviews the existing literature, and suggests areas for application and research about RPGs and mental health including psychotherapy, career guidance, education, and people with disabilities. Insights offered can help practitioners and researchers in RPGs and mental health conduct empirical research and develop alternative approaches for mental health in stressful times.

The perceptions of nursing students regarding coronavirus and occupation according to gender: A qualitative study

Outbreaks are experienced differently based on gender. In the context of the Covid-19 epidemic, students' perceptions of the nursing profession, their feelings related to themselves, their social circle, nursing, and the appropriateness of nursing practices are important. This study aimed to determine the perceptions of nursing students of the Coronavirus and their occupation according to gender. Twenty nursing students were interviewed using the semi-structured interview method. Content analysis and MAXQDA were performed. Five categories were identified: Visual perceptions regarding the nursing occupation and Covid-19, future nurses' occupational perceptions according to gender of pandemics such as the Coronavirus, the effect of the pandemic on occupational perception, perceptions of the people around them of their profession in relation to the pandemic, and the approach toward any pandemic in the future in terms of their profession as a nurse. Pandemics such as Covid-19 can affect the occupational perceptions of nursing students.

Mental health outcomes and risk factors among female physicians during the COVID-19 pandemic

The fast spread of the COVID-19 pandemic brought a huge workload burden. Health care workers have become a particular risk group for developing mental health symptoms, with women being the most affected group according to preliminary data. The aim of this study was to provide information about the prevalence of depression, anxiety, sleep disturbances, and post-traumatic stress disorder symptoms in female physicians during the COVID-19 pandemic and describe risk factors associated with them. Using a cross-sectional design, we applied an online questionnaire to 303 female physicians inquiring about COVID-19 changes in their social and professional dynamics. To assess the presence of depression, anxiety, sleep disturbances, and post-traumatic stress disorder symptoms, the participants responded the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder scale (GAD-7), the Pittsburgh Sleep Quality Index (PSQI), and the PTSD Checklist for DSM-5 (PCL-5). The prevalence for depression, anxiety, sleep quality disturbances and PTSD symptoms was 72.6%, 64.3%, 77.8%, and 19.4% respectively. The main risk factor associated with every outcome was having a previous history of any mental health disorder. Younger age and being at the frontline for COVID-19 attention were relevant to depression symptoms. Our results were in agreement with previous studies, confirming the need for specific age-tailored mental health interventions in female physicians, especially those with previous diagnoses of mental health disorders.

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Prevalence for female physician depression, anxiety and sleep disturbances was 72.6%, 64.3% and 77.8% respectively.

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Previous history of mental health disorders was associated with current depression, anxiety, PTSD, and sleep quality disturbances.

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Younger age was related to depression and PTSD symptoms development.

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Being at COVID-19 frontline of attention was related to depression symptoms.

How Much Burnout and Coping Influence Quality of Life among Young Oncology Providers in Romania during the COVID-19 Pandemic

This study aims to investigate the correlations between burnout, coping strategies, and quality of life among young oncology healthcare workers in Romania during the COVID-19 pandemic. We collected the data using an online questionnaire consisting of sociodemographic questions, the Maslach Burnout Inventory, the COPE questionnaire, and the 15D instrument. A total of 122 healthcare providers responded to our survey. We evaluated the differences in the scores among the three groups of healthcare workers in oncology under 40 years old: medical oncologists (n = 87), radiation oncologists (n = 11), and oncology nurses (n = 24). Finally, we conducted a correlation analysis between the dimensions of burnout, coping, and quality of life. Overall, the medical oncologists exhibited much higher burnout levels than nurses in the COVID-19 pandemic outbreak, having statistically significant higher levels of emotional exhaustion, depersonalization, and lack of personal achievement. Some factors were inversely associated with burnout: active approach, planning, positive interpretation and growth, and acceptance. Our findings illustrated a very good level of health-related quality of life (average = 0.93, SD = 0.06), and no statistically significant differences were found in the quality of life between the three groups. This study was the first to identify the profile of young oncology providers in Romania. Our findings may be relevant in creating preventive strategies for burnout and increasing the quality of life in Romanian young oncology providers in future crises.

Generalized anxiety disorder symptoms during COVID-19 pandemic in Jazan, Saudi Arabia

The aim of this study was to measure anxiety levels and many co-factors that might influence the levels of anxiety during the COVID-19 outbreak in southern Saudi Arabia (KSA). A cross-sectional self-reporting survey was conducted to determine the level of generalized anxiety disorder (GAD) symptoms related to COVID-19 and quarantining. We selected a convenience sample of eligible participants who had been invited online through social media apps. The survey instrument was distributed, and 981 participants responded. Of the total sample, almost 90% were under the age of 40, 75% were women, and 77% had an educational level beyond high school. Just over half were single, with nearly all participants Saudi nationals. The overall prevalence of anxiety related to COVID-19 was 27%. Factors most strongly related to reporting anxiety included having a diagnosis of COVID-19, spending 1- ≥ 3 h focused on COVID-19, having a previous mental illness history, being a current or former smoker, being female, having a previous diagnosis of chronic or respiratory illness, being below age 40, having a limited standard of living, and being a student. Our study reveals how critical it is to emphasize preventive mental health care during pandemics and what factors may make some individuals most vulnerable to anxiety. Further research is recommended to examine GAD levels pre, during and post pandemic. Additional research to explore the long-term impact of the pandemic on mental health is also needed. being a student, and a limited standard of living.

Physical activity to ameliorate the negative mental health effects of COVID-19-induced confinement

Mental health is strongly affected by physical (PA) and sedentary (SA) activity. In the current study, the relationships of PA and sedentary activity (SA) with mental status amid confinement caused by COVID-19 were examined. The study is self-reporting, survey-based, and cross-sectional in design. The study was conducted in Jordan and included 1744 participants (≥18 years old). The participants' mental status was obtained using the Depression-Anxiety-Stress Scale (DASS). The results showed involvement in both PA and SA during COVID-19-induced confinement. The involvement includes walking (77.2%), running (70.3%), cycling (84.9%), swimming (83.1%), sports (82.9%), weightlifting (86.4%), watching TV (79.4%), using electronics (86.3%), and logging to social media (85.1%). Lower DASS scores were associated (p < 0.05) with lower walking, running, and weightlifting but not (p > 0.05) with cycling and swimming PA. Additionally, DASS scores (p < 0.05) were associated with changes in television viewing but not (p > 0.05) with electronics and social media use during confinement. In conclusion, individuals who experienced higher levels of stress, anxiety, and depression were more likely to turn to more PA and less SA. These findings are important and suggest that individuals during confinement find PA a useful strategy to mitigate the negative mental effects of the pandemic.

Knowledge, attitudes, practices and fear of COVID-19 among Iranians: A quick online survey

To control COVID-19, several strategies were proposed in Iran since the start of the outbreak. The number of reported infected people and its consequent death toll herald relative inadequacies in the quality and extent of the measures in curbing the COVID-19 transmission cycle. This study was conducted to investigate knowledge, attitude, precautionary practices and degree of fear related to COVID-19 in a sample of Iranian population. This study was conducted among 457 residents of Kurdistan Province, Iran, through social networks and social media (WhatsApp and Telegram). Knowledge, attitude and practice and fear of COVID-19 were collected using valid tools. Multiple logistic regression and multivariate linear regression analyses were used to identify factors associated with binary outcome attitudes, practices and continuous variables knowledge and fear of COVID-19, respectively. The mean (SD) age of participants was 37.86 (10.42); of them, 252 (55.1%) were men, and more than two-thirds were married (74.8%). About 10% of the respondents were in believed that COVID-19 could create a type of social stigma. Level of knowledge about COVID-19 in 77.8% of the study attendees was acceptable, and 352 of them (70%) were confident that the virus would eventually be successfully controlled in the world, but only 252 of the attendants (50%) had confidence about successful control of COVID-19 in Iran. Applying multiple logistic regression, knowledge (OR: 1.18, p = 0.028) and fear (OR: 1.04, p = 0.028) of COVID-19 were associated with positive attitude towards controllability of COVID-19. Gender (OR: 1.96, p = 0.012), sources of information (OR: 5.00, p = 0.005) and knowledge (OR: 1.27, p = 0.006) were also indicated association with taking precautionary practices to control COVID-19. Further studies are recommended to boost level of knowledge, strengthen positive attitude and ameliorate behavioural pattern for successful control of COVID-19 in Iran.

Self-reported mental health during the COVID-19 pandemic and its association with alcohol and cannabis use: a latent class analysis

BACKGROUND

Mental health problems and substance use co-morbidities during and after the COVID-19 pandemic are a public health priority. Identifying individuals at high-risk of developing mental health problems and potential sequela can inform mitigating strategies. We aimed to identify distinct groups of individuals (i.e., latent classes) based on patterns of self-reported mental health symptoms and investigate their associations with alcohol and cannabis use.

METHODS

We used data from six successive waves of a web-based cross-sectional survey of adults aged 18 years and older living in Canada (6,021 participants). We applied latent class analysis to three domains of self-reported mental health most likely linked to effects of the pandemic: anxiety, depression, and loneliness. Logistic regression was used to characterize latent class membership, estimate the association of class membership with alcohol and cannabis use, and perform sex-based analyses.

RESULTS

We identified two distinct classes: (1) individuals with low scores on all three mental health indicators (no/low-symptoms) and (2) those reporting high scores across the three measures (high-symptoms). Between 73.9 and 77.1% of participants were in the no/low-symptoms class and 22.9-26.1% of participants were in the high-symptom class. We consistently found across all six waves that individuals at greater risk of being in the high-symptom class were more likely to report worrying about getting COVID-19 with adjusted odds ratios (aORs) between 1.72 (95%CI:1.17-2.51) and 3.51 (95%CI:2.20-5.60). Those aged 60 + were less likely to be in this group with aORs (95%CI) between 0.26 (0.15-0.44) and 0.48 (0.29-0.77) across waves. We also found some factors associated with class membership varied at different time points. Individuals in the high-symptom class were more likely to use cannabis at least once a week (aOR = 2.28, 95%CI:1.92-2.70), drink alcohol heavily (aOR = 1.71, 95%CI:1.49-1.96); and increase the use of cannabis (aOR = 3.50, 95%CI:2.80-4.37) and alcohol (aOR = 2.37, 95%CI:2.06-2.74) during the pandemic. Women in the high-symptom class had lower odds of drinking more alcohol during the pandemic than men.

CONCLUSIONS

We identified the determinants of experiencing high anxiety, depression, and loneliness symptoms and found a significant association with alcohol and cannabis consumption. This suggests that initiatives and supports are needed to address mental health and substance use multi-morbidities.

Predicting mental burnout among Israeli Home Front Command soldiers during the COVID-19 pandemic

BACKGROUND

The present study examined personality, situational and organizational predictors of burnout during COVID-19 in a military setting, based on the salutogenic theory of health (Antonovsky, 1987).

METHOD

Questionnaires were completed by 116 reserve Israeli Home Front Command medical staff (71% males). Background variables (e.g., gender), personality variables (self-efficacy and sense of coherence - SOC), situational variables (state-anxiety, self-rated health and sense of threat) and organizational variables (satisfaction with military's and government's handling of the COVID-19 crisis) were measured as predictors of burnout.

RESULTS

Females had higher levels of state anxiety and burnout compared to males. Females also reported a lower level of satisfaction with the military's handling of the COVID-19 crisis than males. SOC and state anxiety were the only statistically significant predictors of burnout after controlling for sociodemographic variables. The entire model explained 59.4% of the burnout variance.

CONCLUSION

In accordance with salutogenic theory, SOC is associated with active adaptation through use of generalized and specific resistance resources to avoid burnout in a stressful milieu. Psychological support, psychoeducation and simulation training are offered to increase manageability in crisis situations.

LIMITATIONS

Following a large dropout rate due to being quarantined, the final sample size was much smaller than planned. Also, although previous longitudinal studies have found SOC to be a causal factor in burnout, the present cross-sectional design limits such conclusions.

Greek teachers' resilience levels during the COVID-19 pandemic lockdown and its association with attitudes towards emergency remote teaching and perceived stress

The mandatory closure of schools due to the Covid-19 pandemic affected the mental health, and, by extension, the personal and professional life of teachers. This study explored their level of resilience during the pandemic and its association with attitudes towards emergency remote teaching and perceived stress. Data were collected through the administration of three self-report instruments: (a) the "Teachers' Professional Attitudes and Behaviors Scale", (b) the "Teachers' Resilience Scale", and (c) the "Perceived Stress Scale". The sample consisted of 1415 general teachers from central Greece. Teachers were found to possess neutral attitudes towards emergency remote teaching, moderate levels of resilience, and experienced slightly increased levels of stress. The examined constructs were largely influenced by some of the teachers' demographic and professional characteristics. Teachers' perceptions of resilience predicted their attitudes to emergency remote teaching and stress levels during the pandemic. The study has reaffirmed the importance of holding sufficient levels of resilience to cope with adverse circumstances and has offered clear directions about which groups of teachers are in most need for counselling and professional support so that their resilience is strengthened.

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

Background

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

Methods

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

Results

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

Conclusion

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

Psychological state and its correlates of local college students in Wuhan during COVID-19 pandemic

In 2020, the lockdown of Wuhan due to the outbreak of COVID-19 impacted various aspects of local college students' life and may further negatively affect their psychological state. This study was conducted among 652 Wuhan local college students during the quarantine of this city. We assessed their psychological state using Depression-Anxiety-Stress Scale 21 and evaluated their living condition including diet, schedule, recreational activities, social contact, academic life, and attention paid to pandemic news. Results showed that 16.87% of the students reported stress, 28.68% with anxiety, and 35.12% had depression. According to multivariate logistic regression analysis, having a medical background was associated with higher stress levels; students who had an irregular diet and schedule were more likely to develop stress, anxiety, and depression; students with their academic life affected had a higher prevalence of anxiety and depression. By studying local students in the hardest-hit area during the pandemic, our findings can provide references for the improvement of college students' mental health in the long term.

Increased Risk Perception, Distress Intolerance and Health Anxiety in Stricter Lockdowns: Self-Control as a Key Protective Factor in Early Response to the COVID-19 Pandemic

Studies provide evidence that distress, (health) anxiety, and depressive symptoms were high during the first weeks of COVID-19 lockdown restrictions, decreasing over time (possibly due to individuals’ protective psychological factors). Relations between different lockdown restrictions, mental health issues, and protective factors need to be explored, since even small lockdown effects might increase the risk of future mental health issues. We merged objective lockdown stringency data with individual data (N = 1001) to examine differences in lockdown effects in strict lockdown (Romania) and mild lockdown (Hungary) conditions between March and May 2020 on stressors and mental health symptoms, taking protective factors into account. The stricter lockdown in Romania revealed higher levels of perceived risk of infection, distress intolerance, and COVID-19 health anxiety. Protective psychological factors were not affected by the lockdown measures. Surpassing psychological flexibility and resilient coping, self-control proved to be the most promising protective factor. It is recommended that future research merge objective data with study data to investigate the effects of different COVID-19 lockdown measures on mental health and protective factors. Policy decisions should consider lockdown-dependent consequences of mental health issues. Intervention programs are suggested to mitigate mental health issues and to strengthen peoples’ protective psychological factors.

Gender differences in sleep disruption during COVID-19: cross-sectional analyses from two UK nationally representative surveys

OBJECTIVE

COVID-19 related measures have impacted sleep on a global level. We examine changes in sleep problems and duration focusing on gender differentials.

DESIGN

Cross-sectional analyses using two nationally representative surveys collected during the first and second month after the 2020 lockdown in the UK.

SETTING AND PARTICIPANTS

Participants (age 17 years and above) from the first wave of the Understanding Society COVID-19 Study are linked to the most recent wave before the pandemic completed during 2018 and 2019 (n=14 073). COVID-19 Survey Data was collected from 2 to 31 May 2020 (n=8547) with participants drawn from five nationally representative cohort studies in the UK.

ANALYSIS

We conducted bivariate analyses to examine gender gaps in change in sleep problems and change in sleep duration overall and by other predictors. A series of multivariate ordinary least squares (OLS) regression models were estimated to explore predictors of change in sleep problems and change in sleep time.

RESULTS

People in the UK on average experienced an increase in sleep loss during the first 4 weeks of the lockdown (mean=0.13, SD=0.9). Women report more sleep loss than men (coefficient=0.15, 95% CI 0.11 to 0.19). Daily sleep duration on average increased by ten minutes (mean=-0.16, SD=1.11), with men gaining eight more minutes of sleep per day than women (coefficient=0.13, 95% CI 0.09 to 0.17).

CONCLUSION

The COVID-19 related measures amplified traditional gender roles. Men's sleep was more affected by changes in their financial situation and employment status related to the crisis, with women more influenced by their emotional reaction to the pandemic, feeling anxious and spending more time on family duties such as home schooling, unpaid domestic duties, nurturing and caregiving. Based on our findings, we provide policy advice of early, clear and better employment protection coverage of self-employed and precarious workers and employer recognition for parents.

Comparison of Students' Mental Wellbeing, Anxiety, Depression, and Quality of Life During COVID-19's Full and Partial (Smart) Lockdowns: A Follow-Up Study at a 5-Month Interval

Objective

Scholars have debated the COVID-19's full and partial lockdowns' effectivity to control the transmission of the new case. They emphasized the provision of required economic and social resources worldwide. Past literature related to COVID-19 has contributed little evidence to examine the efficacy of full and partial lockdown measures with experimental perspectives at different intervals. This study bridges this literature gap and explores the full and smart lockdowns' impacts on Pakistani students' mental health, depression, quality of life, and anxiety symptoms, during the various waves of the COVID-19 pandemic.

Method

This pretest and posttest experimental designed web-based survey recruited 40 students from March 23 to August 23, 2020, and recorded their responses. The study incorporated four standardized psychological instruments to receive the desired datasets related to students' mental health, quality of life, anxiety, and depression. Researchers shared data links with the participants via social media, WhatsApp. The study applied one-way and multivariate ANOVA tests (analysis of variance) to draw the desired results.

Results

This study's findings suggest that both full and partial COVID-19 lockdowns effectively improve students' mental health and quality of life. These measures help reduce anxiety and depressive symptoms among university students. The study results exhibit that partial lockdown (PL) is more effective in improving quality of life. Besides, PL helps reduce anxiety symptoms than complete lockdown among Pakistani students.

Conclusion

The present study's findings suggest that students are vulnerable. They need particular interventions and preventive measures to protect and improve their mental health and quality of life during a global pandemic. As the stressful experience of the epidemic persists in Pakistan. It will also be interesting to examine the psychological impact of the successive waves of the COVID-19 pandemic.

The psychometric properties of the Bangla Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): preliminary reports from a large-scale validation study

BACKGROUND

The Posttraumatic Stress Disorder Checklist (PCL-5) is the most widely used screening tool in assessing posttraumatic stress disorder symptoms, based on the Diagnostic and Statistical Manual of Mental disorders (DSM-5) criteria. This study aimed to evaluate the psychometric properties of the newly translated Bangla PCL-5.

METHODS

A cross-sectional survey was carried out among 10,605 individuals (61.0% male; mean age: 23.6 ± 5.5 [13-71 years]) during May and June 2020, several months after the onset of the COVID-19 outbreak in Bangladesh. The survey included the Bangla PCL-5 and the PHQ-9 depression scale. We used confirmatory factor analysis to test the four-factor DSM-5 model, the six-factor Anhedonia model, and the seven-factor hybrid model.

RESULTS

The Bangla PCL-5 displayed adequate internal consistency (Cronbach's alpha = 0.90). The Bangla PCL-5 score was significantly correlated with scores of the PHQ-9 depression scale, confirming strong convergent validity. Confirmatory factor analyses indicated the models had a good fit to the data, including the four-factor DSM-5 model, the six-factor Anhedonia model, and the seven-factor hybrid model. Overall, the seven-factor hybrid model exhibited the best fit to the data.

CONCLUSIONS

The Bangla PCL-5 appears to be a valid and reliable psychometric screening tool that may be employed in the prospective evaluation of posttraumatic stress disorder in Bangladesh.

One Word to Describe My Experience as a COVID-19 Survivor Six Months after Its Onset: Findings of a Qualitative Study

The COVID-19 pandemic emotionally affected the lives of patients cared for in different settings. However, a comprehensive view of the whole experience as lived by survived patients, from the onset of the disease and over time, is substantially unknown to date. A descriptive qualitative design was implemented according to the Standards for Reporting Qualitative Research. Adult patients (=1067) cared for during the first wave (March/April 2020) capable of answering an interview and willing to participate were interviewed (=397) by phone with an interview guide including open- and closed-ended questions. In this context, they were asked to summarise with a metaphor their entire COVID-19 experience at six months. Then, the emotional orientation (positive, neutral, or negative) of the metaphors expressed was identified. The participants were mainly female (206; 51.9%), with an average age of 52.6 years (CI 95% 50.4–53.6), reporting a mild severity of COVID-19 disease at the onset (261; 65.7%) and the perception of being completely healed (294; 70%) at six months. The patients summarised their experiences mainly using negative-oriented (248; 62.5%) metaphors; only 54 (13.6%) reported positive-oriented metaphors and a quarter (95; 23.95) neutral-oriented metaphors. Nearly all positive-oriented metaphors were reported by patients with symptoms at the onset (53; 98.1%), a significantly higher proportion compared to those reporting negative- (219; 88.3%) and neutral–oriented (78; 82.1%) metaphors (p = 0.014). While no other clinical features of the disease were associated, among females, significantly more negative-oriented metaphors emerged. Moreover, neutral-oriented metaphors were reported by younger patients (49.5 years, CI 95% 64.11–52.92) as compared to those negative and positive that were reported by more mature patients (53.9; CI 95% 52.04–55.93 and 54.8; CI 95% 50.53–59.24, respectively) (p = 0.044). Nurses and healthcare services require data to predict the long-term needs of patients. Our findings suggest that, for many patients, the COVID-19 lived experience was negative over time.

Impact of the COVID-19 Pandemic on Maternal Well-Being during Pregnancy

The outbreak of a pandemic has negative psychological effects. We aimed to determine the impact of the SARS-CoV-2 pandemic during pregnancy and identify the risk factors for maternal well-being. A multicenter, prospective, population-based study was carried out that included women (n = 1320) who were pregnant during the SARS-CoV-2 pandemic in Barcelona (Spain) compared against a pre-pandemic cohort (n = 345). Maternal well-being was assessed using the validated World Health Organization Well-Being Index Questionnaire (WHO-5 Index). Pregnant women attended during the COVID-19 pandemic showed worst WHO-5 well-being scores (median (IQR) of 56 (36−72) for the pandemic cohort vs. 64 (52−76) for the pre-pandemic cohort p < 0.001), with 42.8% of women presenting a poor well-being score vs. 28% for the pre-pandemic cohort (p < 0.001). Presence of a previous psychiatric disorder (OR 7.1; 95% CI 2.6−19, p < 0.001), being in the third trimester of pregnancy (OR 1.7; 95% CI 1.5−2, p < 0.001), or requiring hospital admission for COVID-19 (OR 4.7; 95% CI 1.4−16.7, p = 0.014), significantly contributed to low maternal well-being during the COVID-19 pandemic (multivariate analysis). Being infected by SARS-CoV-2 was not associated with a lower well-being score. We conclude that, during the COVID-19 pandemic, there were higher rates of poor maternal well-being; the infection of SARS-CoV-2 itself did not worsen maternal well-being, but other factors as psychiatric disorders, being in the third trimester of pregnancy or hospital admission for COVID-19 disease did.

Gender Differences in the Impact of COVID-19 Pandemic on Mental Health of Italian Academic Workers

The 2020 pandemic for coronavirus SARS-CoV-2 infection has required strict measures for virus spreading reduction, including stay-at-home orders. To explore gender differences in mental health status after the first wave of the pandemic and in teleworking, we analyzed the frequency and distribution of emotions and coping strategies for facing the pandemic stratified by gender using data from an online survey conducted at the University of Salerno, Italy, between 11 May and 10 June 2020. The online questionnaire included 31 items on demographics, teleworking, COVID-19 emergency, and gender-based violence, with multiple-choice answers for some questions. Females felt significantly sadder (p = 0.0019), lonelier (p = 0.0058), more fearful (p = 0.0003), and more insecure (p = 0.0129) than males, experienced more sleep disorders (p = 0.0030), and were more likely to sanitize surfaces compared to males (p < 0.0001). Our results show gender differences in awareness and concerns about the COVID-19 pandemic that differently influenced mood, as females were more frightened and worried than males.

Personality disorders (PD) and interpersonal violence (IV) during COVID-19 pandemic: a systematic review

Not only did the ongoing CoronaVIrus Disease-19 (COVID-19) pandemic cause a massive number of casualties, but also there is growing concern that the burden of its psychological aftermaths will only show up years down the road. This systematic review summarises the existing literature reporting the impact of COVID-19 on personality disorders (PDs)-related violence. MEDLINE and APA PsycINFO were independently searched for relevant studies by two authors. Eligible studies had to be identifiable through database searching, published and fully accessible. This systematic review was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. An initial pool of 241 studies were found, out of which 69 met the selection criteria and were, therefore, included. The majority reported a worse Mental Health Outcome (MHO) during the pandemic as related to dysfunctional personality and positive personality traits predicting a better outcome. Furthermore, increased levels of interpersonal violence (IV) and self-directed violence were reported. Further research should be conducted on the reciprocal interaction of PDs and IV during the time of pandemic. Nevertheless, the dramatic impact of restrictive measures on PDs has still to be appropriately addressed.

Supporting business educators and students against COVID-19 trauma using trauma-focused cognitive behavioral therapy

BACKGROUND

The outbreak of COVID-19 manifests in peoples' mental health and psychological dispositions and may also result to acute distress, depression, anxiety and post-traumatic stress disorder (PTSD) on victims. The objective of this study was to support business educators' and students' mental health against coronavirus trauma using trauma-focused cognitive behavioral therapy (TF-CBT).

METHODS

The participants (n = 74 - educators and students) who indicated PTSD symptoms based on the self-reporting questionnaire they filled, were randomly assigned to treatment and waitlist control groups. The TF-CBT manual was used for the intervention. The intervention was a 14-week treatment with 2 weeks follow-up meeting. Using repeated measures of Analysis of Variance, we determined the level of improvement of each participant in the treatment group against Coronavirus trauma at the end of the intervention.

RESULTS

The study established that gender has no significant difference in determining the effects of Coronavirus trauma on participants. Through intervention, the PTSDs and depression arising from Coronavirus event were significantly reduced in the treatment group. Again, there was a significant improvement in the participants' general mental health at the end of the intervention. Hence, we established the implication for research and practice in line with the outcome of the study. The study advocates that TF-CBT should be employed by educational institutions in Nigeria to cushion the traumatic effects of coronavirus and future disasters on both workers and students.

CONCLUSION

We conclude that mental health problems remain a serious challenge among business educators and students in this COVID-19 pandemic era. The study established that low educational qualifications, PTSD symptoms and negative coping strategies are the factors aggravating the general low mental health of the study participants. Finally, we advocate that the educational institutions in Nigeria should adopt TF-CBT interventions to support staff and students' mental health against adverse effects of COVID-19.

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

Introduction

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

Materials and Methods

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

Results

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

Conclusion

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

Sex differences in the experience of COVID-19 post-traumatic stress symptoms by adults in South Africa

BACKGROUND

The COVID-19 pandemic has created multiple mental health challenges. Many residents in South Africa face pre-existing elevated levels of stress and the pandemic may have had varying impacts on sub-populations. The aims of this study were to determine: 1) the factors associated with post-traumatic stress symptoms (PTSS) and 2) sex differences in the factors associated with PTSS in adults residing in South Africa during the COVID-19 pandemic.

METHODS

Study participants aged 18 years and above, were recruited for this cross-sectional study through an online survey implemented from June 29, 2020 to December 31, 2020. The outcome variable was PTSS; explanatory variables were sex at birth, COVID-19 status, social isolation and access to emotional support. Confounders considered were age, education level completed and current work status. Logistic regressions were used to determine the association between the outcome and explanatory variables after adjusting for confounders.

OUTCOMES

There were 489 respondents. Among all respondents, those who were older (AOR: 0.97; 95% CI: 0.95 - 0.99) and had access to emotional support from family and relatives (AOR: 0.27; 95% CI: 0.14 - 0.53) had significantly lower odds of PTSS. Respondents who felt socially isolated had higher odds of PTSS (AOR: 1.17; 95% CI: 1.08 - 1.27). Females had higher PTSS scores and higher odds of PTSS compared to males (AOR: 2.18; 95% CI: 1.41-3.39). Females (AOR: 0.27; 95% CI: 0.08 - 0.95) and males (AOR: 0.26; 95% CI: 0.11, 0.59) who had access to emotional support had significantly lower odds of PTSS than those who had no support. Females (AOR: 1.15; 95% CI: 1.04 -1.27) and males (AOR: 1.19; 95% CI: 0.11, 0.59) who felt socially isolated had higher odds of PTSS compared to those who did not feel socially isolated.

INTERPRETATION

Compared to males, females had higher scores and higher odds of reporting PTSS during the COVID-19 pandemic. Access to emotional support ameliorated the odds of having PTSS for both sexes, while feeling socially isolated worsened the odds for both sexes.

Individual obsessive-compulsive traits are associated with poorer adjustment to the easing of COVID-19 restrictions

BACKGROUND

As COVID-19 restrictions ease, the public are expected to relinquish previously enforced safety behaviors and resume a more normal lifestyle. Despite these aims, our recent survey of 438 adults from the general population, during a temporary release of lockdown in the United Kingdom (July-November 2020), showed that 25% of the public find re-adjustment problematic. This was especially the case in those with a history of mental disorder and obsessive-compulsive (OC) traits and symptoms, including rigidity as measured by a neurocognitive test of attentional flexibility. To aid in identifying those most at risk, we performed a secondary analysis on the data to determine which specific OC traits were related to specific aspects of behavioral adjustment.

METHODS

Correlational and multiple regression analyses were performed to determine associations between the eight individual personality traits constituting DSM-5 Obsessive-Compulsive Personality Disorder (OCPD), as measured by the self-rated Compulsive Personality Assessment Scale (CPAS) and a range of self-rated Post-Pandemic Adjustment Questionnaire items.

RESULTS

Three items on the Post-Pandemic Adjustment Questionnaire correlated with individual CPAS items: 'General difficulties adjusting' correlated with perfectionism, preoccupation with details, over-conscientiousness and need for control; 'social avoidance' correlated with perfectionism and preoccupation with details; and 'disinfecting behaviors' correlated with preoccupation with details and miserliness (Pearson's r - all p < .001). Intriguingly, none of the adjustment items correlated significantly with self-rated rigidity.

CONCLUSIONS

Several OCPD traits predict post-pandemic adjustment difficulties, but perfectionism and preoccupation-with-details showed the most robust correlations. These traits constitute a platform for the development of new screening and interventional strategies aimed at restoring public mental health and wellbeing. Cognitive rigidity may be more reliably evaluated using an objective form of assessment.

Impacts of air pollution on COVID-19 case fatality rate: a global analysis

The coronavirus disease 2019 (COVID-19) pandemic is still rapidly spreading globally. To probe high-risk cities and the impacts of air pollution on public health, this study explores the relationship between the long-term average concentration of air pollution and the city-level case fatality rate (CFR) of COVID-19 globally. Then, geographically weighted regression (GWR) is applied to examine the spatial variability of the relationships. Six air pollution factors, including nitrogen dioxide (NO₂), sulfur dioxide (SO₂), ozone (O₃), PM_2.5 (particles with diameter ≤2.5 μm), PM₁₀ (particles with diameter ≤10 μm), and air quality index (AQI), are positively associated with the city-level COVID-19 CFR. Our results indicate that a 1-unit increase in NO₂ (part per billion, PPB), SO₂ (PPB), O₃ (PPB), PM_2.5 (microgram per cubic meter, μg/m³), PM₁₀ (μg/m³), AQI (score), is related to a 1.450%, 1.005%, 0.992%, 0.860%, 0.568%, and 0.776% increase in the city-level COVID-19 CFR, respectively. Additionally, the effects of NO₂, O₃, PM_2.5, AQI, and probability of living with poor AQI on COVID-19 spatially vary in view of the estimation of the GWR. In other words, the adverse impacts of air pollution on health are different among the cities. In summary, long-term exposure to air pollution is negatively related to the COVID-19 health outcome, and the relationship is spatially non-stationary. Our research sheds light on the impacts of slashing air pollution on public health in the COVID-19 pandemic to help governments formulate air pollution policies in light of the local situations.

Sleep disturbances during the COVID-19 pandemic: A systematic review, meta-analysis, and meta-regression

This systematic review and meta-analysis evaluated the extent of sleep disturbances during the COVID-19 pandemic. Eleven databases and six preprint repositories were searched for the period from November 1, 2019, to July 15, 2021. The DerSimonian and Laird method was used to develop random-effect meta-analyses. Two hundred and fifty studies comprising 493,475 participants from 49 countries were included. During COVID-19, the estimated global prevalence of sleep disturbances was 40.49% [37.56; 43.48%]. Bayesian meta-analysis revealed an odds of 0.68 [0.59; 0.77] which translates to a rate of approximately 41%. This provides reassurance that the estimated rate using classical meta-analysis is robust. Six major populations were identified; the estimated prevalence of sleep problem was 52.39% [41.69; 62.88%] among patients infected with COVID-19, 45.96% [36.90; 55.30%] among children and adolescents, 42.47% [37.95; 47.12%] among healthcare workers, 41.50% [32.98; 50.56%] among special populations with healthcare needs, 41.16% [28.76; 54.79%] among university students, and 36.73% [32.32; 41.38%] among the general population. Sleep disturbances were higher during lockdown compared to no lockdown, 42.49% versus 37.97%. Four in every ten individuals reported a sleep problem during the COVID-19 pandemic. Patients infected with the disease, children, and adolescents appeared to be the most affected groups.

Post-traumatic stress disorder in patients with rheumatic disease during the COVID-19 outbreak: a cross-sectional case-control study in China

OBJECTIVE

The COVID-19 pandemic is not only a traumatic event, but a collective stressor unfolding over time, causing devastating implications for the mental health. This study aimed to shed light on the mental health status of patients with rheumatic disease (RD) during the massive outbreak of COVID-19 in China, especially the prevalence and severity of post-traumatic stress disorder (PTSD) compared with healthy individuals.

METHODS

A total of 486 patients with RD and 486 age-matched and sex-matched healthy individuals were recruited into the study. For each participant, we collected demographic and clinical characteristics data. The PTSD Checklist for DSM-5 (PCL-5) and four items from the Pittsburgh Sleep Quality Index (PSQI) were used to investigate the prevalence and severity of PTSD and sleep quality, respectively.

RESULTS

Compared with healthy control subjects (n=486), patients with RD (n=486) had a higher prevalence of PTSD (12.1% vs 4.1%; p<0.001). Higher total scores on the PCL-5 and on all four items from the PSQI (p≤0.001) were also observed. Female, old age, poor sleep quality, long duration of RD, poor subjective evaluation of the disease and pessimistic subjective perception of the epidemic were identified as risk factors of PTSD in patients with RD during the COVID-19 epidemic.

CONCLUSION

During the COVID-19 outbreak, patients with RD presented a higher prevalence and severity of PTSD and showed more sleep disturbances. Our findings confirm the importance of psychological assessment and mental healthcare out of regular clinical care for patients with RD during the pandemic.

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

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

Determinantes del Bienestar Subjetivo en Adultos Mexicanos durante el Primer periodo de Confinamiento por Covid-19

El confinamiento por Covid-19 tiene un impacto psicológico tanto negativo como positivo en las personas, por ello, se examinan las relaciones entre el estrés, apego, los valores culturales (individualismo-colectivismo) y la posible mediación de la resiliencia entre estas variables con el bienestar subjetivo durante la etapa inicial de pandemia en México, de marzo a mayo del 2020. Método: Con un diseño transversal de tipo correlacional participaron 287 adultos mexicanos hombres y mujeres con un rango de edad de 18 a 71 años (M= 35.16, DE= 14.14). Aplicándose en línea las escalas: estrés percibido, escala de apego, individualismo-colectivismo, resiliencia, y para bienestar subjetivo las escalas de satisfacción con la vida y de afecto positivo-negativo. Resultados: Los análisis mostraron impacto diferencial según sexo y rango de edad. Se aplicó un modelo de trayectorias el cual resultó con índices de ajuste aceptables lo que revela efectos conjuntos directos, indirectos y totales por lo que se comprueba el efecto mediador de la resiliencia. Conclusiones: es necesario dotar de habilidades para la vida para el manejo emocional que generen mayor bienestar en la población.

Quality of Life in Patients with Pancreatic Cancer before and during the COVID-19 Pandemic

Background: Coronavirus disease 19 (COVID-19) substantially affects cancer patients due to adverse outcomes and disruptions in cancer care. Recent studies have indicated the additional stress and anxiety burden arising from the pandemic and impairing quality of life in this vulnerable group of patients. However, patients with cancer represent a heterogenous group. Therefore, we conducted a study on patients with pancreatic cancer, requiring demanding surgical interventions and chemotherapy regimens due to its aggressive tumor biology, to explore the pandemic’s impact on quality of life within this homogenous cohort. Methods: In a descriptive observational study, the quality of life of patients who had undergone pancreatic surgery for tumor resection at our institution between 2014 and the beginning of the pandemic in March 2020 was assessed. For HRQoL measurement, we used the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30), comparing their situation before the pandemic and since its beginning. An additional self-developed questionnaire was applied to assess the life circumstances during the pandemic. Results: Our cohort included 26 patients. Scores from the survey in HRQoL revealed no significant changes over time between before and during the pandemic. A medium deterioration in HRQoL was apparent in social functioning, as well as a small deterioration in role functioning and emotional functioning. Worries concerning a potential impact of COVID-19 on personal health were expressed. Psychological limitations in QoL were mainly attributed to the pandemic, whereas physical limitations in QoL were rather associated with the underlying disease of pancreatic cancer. Conclusion: The COVID-19 pandemic is causing considerable social and emotional distress among pancreatic cancer patients. These patients will benefit from psychological support during the pandemic and beyond. Long-time survivors of pancreatic cancer, such as those included in our cohort, appear to have improved resilience facing the psychosocial challenges of the pandemic. For pancreatic cancer, surgical care is considered the cornerstone of treatment. Prolonged delays in healthcare cause serious damage to mental and physical health. To date, the longer-term clinical consequences are not known and can only be estimated. The potential tragic outcome for the vulnerable group of pancreatic cancer patients highlights the urgency of timely healthcare decisions to be addressed in the future.

Pandemic Exposure, Post-traumatic Stress Disorder, Conflict Behaviors, and Online Aggressive Behaviors Among College Students During the COVID-19 Pandemic: Examining the Moderating Role of Gender

The COVID-19 pandemic impacts people's mental health and behaviors, but the influence mechanism between pandemic exposure, conflict behaviors, and online aggressive behaviors during the COVID-19 outbreak remains unclear. This study will address this gap. Data were collected from 1,153 college students in an online survey that included an pandemic experiences scale, a post-traumatic stress disorder (PTSD) scale, a conflict behaviors scale, and an online aggressive behaviors scale. Structural equation modeling and multi-group comparisons were used to analyze the data. Pandemic exposure positively predicted conflict and online aggressive behaviors through hyperarousal symptoms, and negatively predicted these behaviors through intrusive symptoms. The mediating roles of avoidance and negative alterations in cognition and mood symptoms in the relations between pandemic exposure and conflict behaviors and online aggressive behaviors were non-significant. Among male students, pandemic exposure directly predicted conflict and online aggressive behaviors, but for female students, pandemic exposure indirectly influenced these behaviors through intrusive and hyperarousal symptoms. The intrusive and hyperarousal symptoms play mediating roles in the relations between pandemic exposure and conflict behaviors and online aggressive behaviors. Gender plays a moderating role in the above mediating mechanism.

Optimism as a protective factor against the psychological impact of COVID-19 pandemic through its effects on perceived stress and infection stress anticipation

The 2019 coronavirus disease (COVID-19) and the recommended social isolation presented a challenge to people's mental health status. Optimism is a psychological factor that plays a key role in the evaluation of stressful situations. The purpose of this study was to investigate the mediating role of perceived stress and Covid-19-related stress anticipation in the relationship between optimism and post-traumatic stress symptoms. Our sample included 1015 participants ranging in age from 18 to 79 years, 80% of whom were Spaniards. At the beginning of the worldwide pandemic, participants were confined to their homes for at least seven days and completed an online survey measuring various sociodemographic and psychological variables. We found an indirect effect of optimism on intrusion and hyperarousal through perceived stress and stress anticipation. In addition, we observed an indirect effect of optimism on avoidance through perceived stress. Finally, the results showed a significant indirect effect of optimism on the total post-traumatic stress symptoms score through perceived stress and stress anticipation. Our results indicate that positive beliefs inherent to optimism are related to less psychological impact of the COVID-19 outbreak.

The more mindfulness practice, the more post-trauma stress symptoms? Trait mindfulness and PTSS during the COVID-19 pandemic

Investigating the contributing factors of post-traumatic stress symptoms (PTSS) has always been an important topic in the field of traumatic psychology research. The current study explored the influences of pandemic/epidemic experiences, meditation experiences, and trait mindfulness on PTSS and the mediating role of emotional resilience during the COVID-19 pandemic. A total of 522 participants in Hubei province completed the Five Facet Mindfulness Questionnaire, the Adolescents' Emotional Resilience Questionnaire, and the PTSD Checklist for DSM-5. The results showed that (1) participants who had family or friends diagnosed with COVID-19 scored higher on avoidance. (2) Participants who had family or friends had been diagnosed with SARS or H1N1 scored higher on PTSS. (3) Participants with meditation experience scored significantly higher on all dimensions of PTSS, other than avoidance. (4) The mediating role of recovering from negative emotions in the relationship between trait mindfulness and PTSS was significant (95%CI= [-0.212, -0.094]), while the generating positive emotion was not significant (95%CI= [-0.050, 0.071]). Individuals with pandemic/epidemic experience are more likely to have a high level of PTSS. Individuals who have meditation experience also express a higher level of PTSS, which may be a result of the quality of meditation. Trait mindfulness and the ability to recover from negative emotions were protective factors against PTSS.

Attachment style and mental health during the later stages of COVID‐19 pandemic: the mediation role of loneliness and COVID-19 anxiety

Background

An insecure attachment style is an important risk factor for psychological problems. The aim of this study was to use Bartholomew and Horowitz’s model (Bartholomew and Horowitz in J Pers Soc Psychol 61(2): 226, 2019) to test a sample of Italian individuals to determine the mediation role of loneliness and COVID-19-related anxiety symptoms in the relationship between attachment styles and mental health issues in the context of the pandemic.

Method

A cross-sectional research study was conducted using a sample of 330 Italian participants (82.1% women; mean age = 34.3 years; SD = 13.16) who completed online self-reported measures of attachment styles (RQ), loneliness (RULS), COVID-19-related anxiety symptoms (C-19ASS) and mental health problems (GHQ-12). Serial mediation analyses were performed, and bootstrap tests were included.

Results

Our results supported the hypothesized model with respect to each attachment style (p < 0.001). In particular, insecure attachment styles predict mental health problems both directly and indirectly, through loneliness and COVID-19-related anxiety symptoms. In addition, loneliness directly influences mental health problems and also mediates the relationship between insecure attachment styles and COVID-19-related anxiety symptoms which, in turn, positively predict mental health problems.

Conclusions

Our findings reinforce the importance of attachment in people’s processes of adapting to experiences during the coronavirus pandemic. The study makes an important contribution to developing effective prevention and intervention strategies to support people’s wellbeing in the context of the pandemic.

Income and social support related with mental health during COVID-19 outbreak in China

To investigate psychological response of Chinese public during the regular prevention and control of Corona Virus Disease 2019 (COVID-19), and explore the relationship among income loss, social support and mental health.Five hundred twenty-six participants were randomly selected by snowball sampling method. Chinese version of Perceived Psychological Stress Scale, Perceived Social Support Scale, self-rating anxiety scale, and the PTSD Checklist for DSM-5 were used to measure the levels of psychological stress, social support, anxiety, and post-traumatic stress disorder (PTSD) symptoms. Demographic variables, income loss and income satisfaction during the outbreak period were also collected.The prevalence rate of anxiety, PTSD symptoms and stress problems were 19.8%, 23.8%, and 24.7% respectively. Multiple Regression Analysis illustrated that social support associated with stress, anxiety and PTSD after controlling demographic variables; for non-student samples, stress, anxiety, and PTSD were corelated with change in income and social support.During the regular prevention and control of COVID-19, social support might help reducing stress, anxiety, and PTSD symptoms. In addition to social support, change of income level was also an important factor for mental health. This study suggested the importance of maintaining a steady income after acute outbreak of COVID-19.

Attention to negative information and PTSSs during the COVID-19: A moderated mediational model

Post-traumatic stress symptoms (PTSSs) have been a common negative psychological response during the COVID-19 pandemic. Previous theories emphasized the unique effects of cognitive and family factors on PTSSs and overlooked their combined role, which suggested that the mechanisms underlying PTSSs were not fully understood. To fill this gap, this study aimed to examine the associations between attention to negative information, blaming others, parent-child relationship and PTSSs, as well as the combined role of these factors on PTSSs. During the COVID-19 pandemic, 1153 college students completed self-report questionnaires. Results indicated that attention to negative information increased PTSSs, both directly and via blaming others. Moreover, parent-child relationship buffered both the exacerbating effect of attention to negative information on blaming others and the effect of blaming others on worsening PTSSs. The current study integrates existing theories, expands the field of trauma research through considering the effect of cognitive and family factors on PTSSs, and provides theoretical support for interventions to relieve PTSSs.

The Show Must Go On: A Snapshot of Italian Academic Working Life during Mandatory Work from Home through the Results of a National Survey

During the COVID-19 pandemic, universities worldwide have provided continuity to research and teaching through mandatory work from home. Taking into account the specificities of the Italian academic environment and using the Job Demand-Resource-Recovery model, the present study provides, through an online survey, for the first time a description of the experiences of a large sample of academics (N = 2365) and technical and administrative staff (N = 4086) working in Italian universities. The study analyzes the main differences between genders, roles or work areas, in terms of some job demands, recovery experiences, and outcomes, all important dimensions to achieve goals 3, 4, and 5 of the 2030 Agenda for Sustainable Development. The results support the reflections on gender equality measures in universities and provide a general framework useful for further in-depth analysis and development of measures in order to improve well-being (SDG 3), quality of education (SDG 4), and gender equality (SDG 5).

The Relationship between Acceptance and Sleep–Wake Quality before, during, and after the First Italian COVID-19 Lockdown

Several studies have reported that the COVID-19 pandemic has had deleterious effects on sleep quality and mood, but the mechanisms underlying these effects are not clearly understood. Recently, it has been shown that the acceptance component of mindfulness reduces anxiety, and, in turn, lower anxiety improves sleep quality. The purpose of this cross-sectional study was to assess changes in mindfulness traits, sleep–wake quality, and general distress, before, during, and after the first COVID-19 wave, testing the model in which acceptance influences sleep through anxiety in each period. A total of 250 participants were recruited before (Pre-Lockdown group: 69 participants, 29 females, 33.04 ± 12.94 years), during (Lockdown group: 78 participants, 59 females, 29.174 ± 8.50 years), and after (After-Lockdown group: 103 participants, 86 females, 30.29 ± 9.46 years) the first Italian lockdown. In each group, self-report questionnaires, assessing mindfulness facets, distress, and sleep–wake quality, were administered and assessed. The Lockdown group reported lower acceptance and higher depression, while the After-Lockdown group reported lower sleep–wake quality and higher anxiety. The results of the path analysis confirmed that higher acceptance reduced anxiety and higher anxiety decreased sleep–wake quality in all groups. Our results confirm that acceptance influences sleep through the mediating role of anxiety.

The effect of the COVID-19 pandemic on mental health in individuals with pre-existing mental illness

BACKGROUND

There is evidence that the COVID-19 pandemic has negatively affected mental health, but most studies have been conducted in the general population.

AIMS

To identify factors associated with mental health during the COVID-19 pandemic in individuals with pre-existing mental illness.

METHOD

Participants (N = 2869, 78% women, ages 18-94 years) from a UK cohort (the National Centre for Mental Health) with a history of mental illness completed a cross-sectional online survey in June to August 2020. Mental health assessments were the GAD-7 (anxiety), PHQ-9 (depression) and WHO-5 (well-being) questionnaires, and a self-report question on whether their mental health had changed during the pandemic. Regressions examined associations between mental health outcomes and hypothesised risk factors. Secondary analyses examined associations between specific mental health diagnoses and mental health.

RESULTS

A total of 60% of participants reported that mental health had worsened during the pandemic. Younger age, difficulty accessing mental health services, low income, income affected by COVID-19, worry about COVID-19, reduced sleep and increased alcohol/drug use were associated with increased depression and anxiety symptoms and reduced well-being. Feeling socially supported by friends/family/services was associated with better mental health and well-being. Participants with a history of anxiety, depression, post-traumatic stress disorder or eating disorder were more likely to report that mental health had worsened during the pandemic than individuals without a history of these diagnoses.

CONCLUSIONS

We identified factors associated with worse mental health during the COVID-19 pandemic in individuals with pre-existing mental illness, in addition to specific groups potentially at elevated risk of poor mental health during the pandemic.

Dysregulated TP53 Among PTSD Patients Leads to Downregulation of miRNA let-7a and Promotes an Inflammatory Th17 Phenotype

Post-traumatic stress disorder (PTSD) is a psychiatric disorder and patients diagnosed with PTSD often express other comorbid health issues, particularly autoimmune and inflammatory disorders. Our previous reports investigating peripheral blood mononuclear cells (PBMCs) from PTSD patients showed that these patients exhibit an increased inflammatory T helper (Th) cell phenotype and widespread downregulation of microRNAs (miRNAs), key molecules involved in post-transcriptional gene regulation. A combination of analyzing prior datasets on gene and miRNA expression of PBMCs from PTSD and Control samples, as well as experiments using primary PBMCs collected from human PTSD and Controls blood, was used to evaluate TP53 expression, DNA methylation, and miRNA modulation on Th17 development. In the current report, we note several downregulated miRNAs were linked to tumor protein 53 (TP53), also known as p53. Expression data from PBMCs revealed that compared to Controls, PTSD patients exhibited decreased TP53 which correlated with an increased inflammatory Th17 phenotype. Decreased expression of TP53 in the PTSD population was shown to be associated with an increase in DNA methylation in the TP53 promotor region. Lastly, the most significantly downregulated TP53-associated miRNA, let-7a, was shown to negatively regulate Th17 T cells. Let-7a modulation in activated CD4+ T cells was shown to influence Th17 development and function, via alterations in IL-6 and IL-17 production, respectively. Collectively, these studies reveal that PTSD patients could be susceptible to inflammation by epigenetic dysregulation of TP53, which alters the miRNA profile to favor a proinflammatory Th17 phenotype.

The relationship between adolescent risk perception and emotions during the COVID-19: a short-term longitudinal study

This study explores the relationship between adolescents' perceptions of epidemic risk and their emotions through three follow-up surveys during the early stages of the COVID-19 pandemic on February 11th (T1), 18th (T2), and 25th (T3), 2020. Three hundred and four adolescents in different academic stages (junior high middle school, senior high middle school, and university) participated in the online survey, and cross-lag analysis was used to examine the causal relationship between epidemic risk perceptions and positive and negative emotions. The results found that the individual's positive emotions were significantly higher than the negative emotions in T1, T2 and T3. Cross-lag analysis found that for positive emotions, T2 positive emotions could negatively predict T3 epidemic risk perceptions, and T2 epidemic risk perceptions could negatively predict the individual's T3 positive emotions. For negative emotions, risk perceptions at T1 could positively predict negative emotions at T2, and at the same time, negative emotions at T1 could also positively predict epidemic risk perceptions at T2. This indicates that during the early stages of the COVID-19 pandemic, there was a causal relationship between the perceptions of epidemic risk and the emotions of adolescents, and this relationship had high stability among groups of different genders and academic stages.

Greenspace and park use associated with less emotional distress among college students in the United States during the COVID-19 pandemic

The COVID-19 pandemic has negatively affected many people's psychological health. Impacts may be particularly severe among socially vulnerable populations such as college students, a group predisposed to mental health problems. Outdoor recreation and visits to greenspaces such as parks offer promising pathways for addressing the mental health challenges associated with COVID-19. During the early stages of the pandemic (March-May 2020), we surveyed 1280 college students at four large public universities across the United States (U.S.) to assess how, and why, outdoor recreation and park use changed since the emergence of COVID-19. We also measured students' self-reported levels of emotional distress (a proxy for psychological health) and assessed potential demographic and contextual correlates of distress, including county-level per capita park area and greenness, using generalized linear models. We found that 67% of students reported limiting outdoor activities and 54% reported reducing park use during the pandemic. Students who reduced their use of outdoor spaces cited structural reasons (e.g., lockdowns), concerns about viral transmission, and negative emotions that obstructed active lifestyles. Students who maintained pre-pandemic park use levels expressed a desire to be outdoors in nature, often with the explicit goal of improving mental and physical health. Emotional distress among students was widespread. Models showed higher levels of emotional distress were associated with reducing park use during the pandemic and residing in counties with a smaller area of parks per capita. This study of U.S. college students supports the value of park-based recreation as a health promotion strategy for diverse populations of young adults during a time of crisis.

"Post-traumatic Stress Disorder and Difficulties in Emotion Regulation Among University Students under the COVID-19 Condition"

"The new global situation of COVID-19 affects the whole world in all aspects of life including mental health. The study’s goal is to detect the relationship between post-traumatic stress disorder (PTSD) and Emotion Regulation (ER) difficulties under the COVID-19 condition. Methods: University students were asked to complete: 1) Emotion Regulation Difficulties Questionnaire (DERS) 2) PTSD Checklist (PCL- 5). 3) Life Events Checklist for DSM-5 (LEC-5). Results: There were 441 students with suspected COVID-19 symptoms out of 1195 students. When compared to students who did not have suspected COVID-19 symptoms, those who did had a greater prevalence of PTSD symptoms (18.2% vs. 4.7%) and DERS (34.5% vs. 23.3%). Additionally, correlation studies demonstrated a significant positive link (Ps< .01) between the PCL, the overall DERS, and all six categories of emotion regulation difficulties. Conclusion: Students with suspected COVID-19 symptoms have more difficulty with emotion regulation and post-traumatic stress disorder than students without such symptoms. This research recommends that during the pandemic, health professionals should implement a suitable psychological intervention for students who exhibit COVID-19 symptoms."

Psychological State of Parents of Children with Primary Immunodeficiencies During the COVID-19 Pandemic

Background: COVID-19 has affected humanity not only physically but also mentally. It was expected to have impact on high-risk groups such as the immunocompromised patients and parents/caregivers of them. Our study was aimed to investigate the COVID-19 related anxiety, post-traumatic stress levels, and sleep-related parameters of the parents of children with primary immunodeficiency. Methods: Parents of children with primary immunodeficiency and age and gender-matched control group completed questionnaires. Results: Anxiety and post-traumatic stress levels of the study group were found to be significantly higher than the control group. Furthermore, sleep time of the study group was significantly lower than the control group. The subjective sleep quality of the study group was also lower in the study group, but the difference did not reach a significant level. Conclusions: In the ongoing and other possible pandemic processes, professional support for the parents of these children is of great importance.