Prevalence of psychological morbidities among general population, healthcare workers and COVID-19 patients amidst the COVID-19 pandemic: A systematic review and meta-analysis

Psychological Distress Among Occupational Health Professionals During Coronavirus Disease 2019 Pandemic in Spain: Description and Effect of Work Engagement and Work Environment

The impact of the coronavirus disease 2019 (COVID-19) pandemic on the mental health of hospital health professionals has been widely described, but few studies have focused on occupational health professionals. Therefore, the objective of this study was to assess psychological distress (PD) of occupational health workers and its relationship with their work engagement (WE) and work environment characteristics. A cross-sectional survey was conducted. A sample of 499 nurses and physicians participated in the study. Variables included demographic data, work environment characteristics, work engagement Utrecht Work Engagement Scale (UWES-9) and psychological distress General Health Questionnaire (GHQ-12). The Chi-square Automatic Interaction Detection method was performed for data analysis. Data collection took place via the internet between April 23 and June 24, 2020. A total of 65.53% of the participants had PD, and the total mean score of the UWES-9 scale was 34.80 (SD = 10.69). Workload, conflicts, stressful situations, and less job satisfaction were significantly related to a higher percentage of PD (p < 0.05). Participants with low engagement showed higher levels of PD (76.7%; p < 0.001). The dedication was revealed as the most significant dimension. Interventions aimed at promoting resilience and coping strategies are suggested. WE should be fostered as a preventive measure against PD among occupational health workers. By protecting workers, occupational health departments have a shared responsibility with public health in containing the pandemic. Therefore, it is essential to prevent the psychological impact that this responsibility may have on occupational health workers by implementing prevention measures.

The Global Prevalence of Depression, Anxiety, Stress, and Insomnia Among General Population During COVID-19 Pandemic: A Systematic Review and Meta-analysis

This study aimed to examine research findings related to depression, anxiety, stress, and insomnia during the COVID-19 pandemic. This study also explored periodic changes in the prevalence of depression, anxiety, stress, and insomnia among the general people during this pandemic. We performed a meta-analysis by searching articles from several sources (PubMed, MEDLINE, and Google Scholar). We used the random-effects models, subgroup analysis, and heterogeneity test approaches. Results show that the prevalence of depression, stress, and insomnia increased during March to April 2020 (30.51%, 29.4%, and 25%, respectively) compared to the study period before February 2020 (25.25%, 16.27%, and 22.63%, respectively) and followed in May to June 2020 (16.47%, 5.1%, and 19.86, respectively). The prevalence of depression and anxiety from k = 30 studies was 28.18% (95% CI: 23.81–32.54) and 29.57% (95% CI: 24.67–34.47), respectively. And the prevalence of stress (k = 13) was 25.18% (95% CI: 14.82–35.54), and the prevalence of insomnia (k = 12) was 23.50% (95% CI: 16.44–30.57). These prevalence estimates during the pandemic are very high compared to normal times. Hence, the governments and policymakers should apply proven strategies and interventions to avoid psychological adversity and improve overall mental health during the COVID-19 pandemic.

The COVID-19 pandemic impacts psychiatric outcomes and alcohol use among college students

BACKGROUND

The COVID-19 pandemic has imposed fundamental challenges on nearly every area of life.

OBJECTIVE

The purpose of the current study was to expand on the literature on the impact of the pandemic on college students by a) examining domains of impact of the pandemic on psychiatric and alcohol outcomes and b) controlling for pre-pandemic outcomes.

METHOD

Participants included 897 college students (78.6% female) from a larger longitudinal study on college student mental health. Structural equation models were fit to examine how COVID-19 impact (exposure, worry, food/housing insecurity, change in social media use, change in substance use) were associated with PTSD, anxiety, depression, suicidal ideation, and alcohol phenotypes. Models were fit to adjust for pre-pandemic symptoms.

RESULTS

No effects of COVID-19 exposure remained after adjusting for earlier outcomes. COVID-19 worry predicted PTSD, depression, and anxiety, even after adjusting for earlier levels of outcomes (β's: .091-.180, p's < .05). Housing/food concerns predicted PTSD, anxiety, and depression symptoms as well as suicidal ideation (β's: .085-.551, p's < .05) after adjusting for earlier levels of symptoms. Change in media use predicted alcohol consumption (β's: ± .116-.197, p's < .05). Change in substance use affected all outcomes except suicidality (β's: .112-.591, p's < .05).

CONCLUSIONS

Domains of COVID-19 impact had differential effects on mental health and substance outcomes in college students during the first wave of the coronavirus pandemic. Future studies should examine the trajectory of these factors on college student mental health across waves of the pandemic.

Determinants of poor sleep quality in adults during the coronavirus disease pandemic: COVID-Inconfidentes, a population-based study

BACKGROUND

The coronavirus disease (COVID-19) pandemic has adversely affected the health of the global population, with sleep quality being one of the affected parameters.

OBJECTIVES

To evaluate sleep quality and its associated factors in adults during the COVID-19 pandemic in Brazil.

DESIGN AND SETTING

A population-based cross-sectional serological survey of 1,762 adults in the Iron Quadrangle region of Brazil.

METHODS

The Pittsburgh Sleep Quality Index was used to assess sleep quality. Sociodemographic variables, health conditions, health-related behaviors, anxiety, vitamin D levels, weight gain/loss, and pandemic characteristics were assessed using a structured questionnaire. Univariate and multivariate analyses using Poisson regression with robust variance were performed to identify factors associated with sleep quality.

RESULTS

More than half of the participants reported poor sleep quality (52.5%). Multivariate analysis revealed that the factors associated with poor sleep quality included living alone (prevalence ratio [PR] = 1.34; 95% confidence interval [CI]: 1.04-1.73), anxiety disorder (PR = 1.32; 95% CI: 1.08-1.62), 5.0% weight loss (PR = 1.21; 95% CI: 1.02-1.44), 5.0% weight gain (PR = 1.27; 95% CI: 1.03-1.55), vitamin D deficiency (PR = 1.16; 95% CI: 1.01-1.35), and COVID-19 symptoms (PR = 1.29; 95% CI: 1.10-1.52).

CONCLUSIONS

Our study revealed that more than half of the participants experienced poor sleep quality during the COVID-19 pandemic. Factors associated with poor sleep quality included vitamin D deficiency and weight changes related to the pandemic.

Mental State of Inpatients With COVID-19: A Computational Psychiatry Approach

BACKGROUND

The overload of healthcare systems around the world and the danger of infection have limited the ability of researchers to obtain sufficient and reliable data on psychopathology in hospitalized patients with coronavirus disease 2019 (COVID-19). The relationship between severe acute respiratory syndrome with the coronavirus 2 (SARS-CoV-2) infection and specific mental disturbances remains poorly understood.

AIM

To reveal the possibility of identifying the typology and frequency of psychiatric syndromes associated with acute COVID-19 using cluster analysis of discrete psychopathological phenomena.

MATERIALS AND METHODS

Descriptive data on the mental state of 55 inpatients with COVID-19 were obtained by young-career physicians. Classification of observed clinical phenomena was performed with k-means cluster analysis of variables coded from the main psychopathological symptoms. Dispersion analysis with p level 0.05 was used to reveal the clusters differences in demography, parameters of inflammation, and respiration function collected on the basis of the original medical records.

RESULTS

Three resulting clusters of patients were identified: (1) persons with anxiety; disorders of fluency and tempo of thinking, mood, attention, and motor-volitional sphere; reduced insight; and pessimistic plans for the future (n = 11); (2) persons without psychopathology (n = 37); and (3) persons with disorientation; disorders of memory, attention, fluency, and tempo of thinking; and reduced insight (n = 7). The development of a certain type of impaired mental state was specifically associated with the following: age, lung lesions according to computed tomography, saturation, respiratory rate, C-reactive protein level, and platelet count.

CONCLUSION

Anxiety and/or mood disturbances with psychomotor retardation as well as symptoms of impaired consciousness, memory, and insight may be considered as neuropsychiatric manifestations of COVID-19 and should be used for clinical risk assessment.

Quarantine and demographic characteristics as predictors of perceived stress and stress responses during the third year of COVID-19 in China

BACKGROUND

Quarantine as one of the most effective epidemic prevention measures, significantly increased people's stress levels. Ongoing monitoring of the stress status of people under quarantine during the pandemic is an important part of assessing the long-term impact of COVID-19 on mental health. This study aimed to gain a more comprehensive understanding of the stress status of people under quarantine, including perceived stress and stress responses, during the third year of the COVID-19 pandemic in China.

METHODS

An anonymous online survey was conducted among 464 participants from 39 cities in China from March 31 to April 12, 2022. The survey included three questionnaires: a self-designed questionnaire collecting demographic information and quarantine characteristics, the Perceived Stress Scale (PSS-10) and the Stress Response Questionnaire (SRQ). The t-test or one-way ANOVA or the Welch F-test were used to examine the differences among demographic and quarantine variables of perceived stress and stress responses, then multiple linear regressions were performed to identify the predictors of perceived stress and stress responses.

RESULTS

428 valid respondents were finally included. The average scores of perceived stress, total stress response, emotional response, physical response, and behavioral response were 14.70 ± 7.02, 50.24 ± 22.48, 20.35 ± 9.99, 15.23 ± 7.25, and 11.39 ± 5.27, respectively. The regression analysis showed that the degree of financial worries and days of continuous quarantine were the predictors of perceived stress. The degree of financial worries was a vital factor in predicting total stress response, emotional response, physical response and behavioral response, and in predicting emotional response, age was also a significant predictor.

CONCLUSION

The stress status of individuals under quarantine was generally stable but still needs further attention during the third year of the COVID-19 pandemic. People who are young, have a high degree of financial worries and have been quarantined for a long time may be at a higher risk of perceived stress and stress responses. Relevant authorities should pay closer attention to the risk groups, and additional support and assistance might be required for those mostly worried about their financial situations under quarantine.

Operational Stress Control Service: An Organizational Program to Support Health Care Worker Well-Being

OBJECTIVE

This manuscript details the methods, outcomes, and lessons learned from a successful multi-dimensional, interdisciplinary, institutional response to HCW well-being during the COVID-19 pandemic.

METHODS

Operational Stress Control Service (OSCS) is a model for the prevention and management of stress and trauma implemented within an occupational system. Communication, Employee Wellness, and Intervention were targeted program aspects, adapted from an established US military protocol.

RESULTS

Since April 2020, OSCS has received 4660 unique survey responses; reached 1007 employees in-person; informed 125 leadership-hosted videoconferences; and assisted 13 departments with grief and morale-related challenges.

CONCLUSIONS

OSCS improved communication across the organization and allowed for rapid deployment of solutions to maintain effective operations. Results highlight the benefit of multiple avenues of frequent, bottom-up, and top-down communication. Creating such services during times of normalcy might be considered in preparation for future crisis.

Risk and protective factors for the possible development of post-traumatic stress disorder among intensive care professionals in France during the first peak of the COVID-19 epidemic

BACKGROUND

Intensive care units (ICU) are among the healthcare services most affected by the COVID-19 crisis. Stressors related to insecurity, unpredictability, patient death and family distress are significant, and put healthcare workers (HCWs) at high risk of post-traumatic stress disorder (PTSD). The aims of this study were to measure the prevalence of post-traumatic stress disorder in HCWs and to identify risk factors and protective factors during the epidemic in France.

METHODS

During the first peak of the epidemic (from 22 April to 13 May 2020), we assessed sources of stress (PS-ICU scale), mental health (GHQ-12) and coping strategies (Brief-COPE). Three months later (03 June to 6 July 2020), PTSD was assessed using the IES-R scale, with additional questions about sources of support. Data were collected using self-report questionnaires administered online.

RESULTS

Among 2153 professionals who participated in the study, 20.6% suffered from potential PTSD, mostly intrusion symptoms. Risk factors for the development of PTSD were having experienced additional difficult events during the crisis, having a high level of psychological distress, a high level of perceived stress related to the workload and human resources issues, the emotional burden related to the patient and family, and stressors specific to COVID-19 during the first peak of the crisis. The use of positive thinking coping strategies decreased the relationship between perceived stress and the presence of PTSD, while social support seeking strategies increased the relationship. Finally, the HCWs preferred to use support from colleagues, relatives and/or a psychologist, and very few used the telephone hotlines.

CONCLUSION

The epidemic has had a strong traumatic impact on intensive care HCWs. Given the risk of PTSD, we need to consider implementing easily-accessible support services that focus on positive thinking coping strategies, during and after the crisis.

Children and Adolescents Psychological Distress Scale During COVID-19 Pandemic: Validation of a Psychometric Instrument (CONFEADO Study)

AIM AND OBJECT PURPOSE OF THE STUDY

In March 2020, the WHO declared a pandemic (COVID-19) due to the SARS-CoV-2 virus. In France, school closures and lockdowns were implemented. In this unprecedented context for French adolescents and children, the CONFEADO study surveyed children aged 9 to 18 years to assess their mental health, psychological distress, and resilience during and after the lockdown in relation to their living and housing conditions. To assess psychological distress, a psychometric tool (Children and Adolescent Psychological Distress Scale-CAPDS-10) was specifically designed for the research. This article presents the psychometric validity of the CAPDS-10.

METHODS

This cross-sectional study collected data from June 9 to September 14, 2020, from children and adolescents (9 to 18 years of age) via an online questionnaire after sending it to a large network of partners. Psychological distress, resilience, and trait anxiety were assessed using the CAPDS-10, the Child and Youth Resilience Measure (CYRM), and the State-Trait Anxiety Inventory for Children (STAIC). The CAPDS-10 measured perceived psychological distress in the most recent 2 weeks (primary endpoint). The predictive power of the CAPDS-10 was determined by statistical analysis. We proceeded to a confirmatory factor analysis to validate the scale at a clinical level. We carried out a psychometric validation with a step to verify the uni-dimensionality of the scale (PCA analysis) and the calculation of convergent and divergent validity, correlation coefficient between items and subscales, Cronbach's alpha for reliability, determination of a cut-off score for the AUROC index.

RESULTS

Three thousand and forty eight children and adolescents completed the CAPDS-10. Analysis confirmed a three-factor model (anxiety, depression, and aggressive behavior) (RMSEA = 0.072 [0.067; 0.077], CFI = 0.954), with a correlation coefficient between items >0.4. PCA analysis concluded that the scale is unidimensional. Reliability was satisfactory with Cronbach's alpha coefficients >0.7 (0.86). In addition, prediction was good with an AUROC index equal to 0.73 and a threshold score for severe distress greater than or equal to 19.

CONCLUSION

The CAPDS-10 measures psychological distress over the most recent 2-week period with good psychometric qualities. It could be used in crisis or prevention contexts in the general population or in clinical settings.

COVID-19 and psychological distress among the general population of India: Meta-Analysis of observational studies

Background:

There is scanty evidence regarding the magnitude of COVID-19-related psychological distress (PD) among the general population of India.

Objectives:

This study aimed to estimate the pooled prevalence of PD among the general public of India during the COVID-19 pandemic.

Material and Methods:

We conducted a meta-analysis of 21 online surveys conducted across the Indian subcontinent and published between 2020 and 2021.

Results:

Overall estimates of PD among the general public during the COVID-19 pandemic by the random-effects model is 33.3% (95% confidence interval: 23.8%-42.8%; n = 21 studies). The level of heterogeneity was high among the included studies (I2 = 99.67%). In subgroup analysis, it was found that the survey tool and the methodological quality had a significant effect on the overall prevalence estimates. Approximately 33% of the general public reported to have PD during the COVID-19 pandemic in India, although the overall prevalence varied based on survey tools and quality of studies.

Conclusion:

As the pandemic crisis seems to be ebbing across the world, the current findings are a wake-up call to devise pragmatic strategies to curtail the burden of similar pandemics and to successfully meet the challenges ahead.

The longitudinal associations of physical activity, time spent outdoors in nature and symptoms of depression and anxiety during COVID-19 quarantine and social distancing in the United States

Stressors associated with COVID-19 pandemic stay-at-home orders are associated with increased depression and anxiety and decreased physical activity. Given that physical activity and time spent outdoors in nature are associated with improved mental health, we examined the longitudinal association of these variables during the pandemic. Over 20,000 adults who participated in the U.S. Kaiser Permanente Research Bank, did not report COVID-19 symptoms, and responded to an online baseline and 3 follow-up surveys over approximately 3 months formed the cohort. Physical activity was assessed from a modified survey, time spent outdoors was assessed from one question, and anxiety and depression scores were assessed from validated instruments. Almost 60% were women, 82.8% were non-Hispanic white, and more than 93% of respondents were over the age of 50. Less in-person contact with friends and visiting crowded places was highly prevalent (>80%) initially and decreased somewhat (>70%). Participants in the lowest physical activity category (no physical activity) had the highest depression and anxiety scores compared to each successive physical activity category (p < 0.001). Spending less time outdoors was associated with higher depression and anxiety scores. This effect was greater for participants in the younger age categories compared with older age categories. The effect of less time spent outdoors on anxiety (p = 0.012) and depression (p < 0.001) scores was smaller for males than females. Results suggest that physical activity and time outdoors is associated with better mental health. People should be encouraged to continue physical activity participation during public health emergencies.

You can't do anything about it, but you can make the best of it: a qualitative analysis of pandemic-related experiences in six European countries

BACKGROUND

The complex system of stressors related to the coronavirus disease 2019 (COVID-19) pandemic has affected the global population, provoking a broad range of psychological reactions. Although numerous studies have investigated the mental health impact of COVID-19, qualitative research and cross-country comparisons are still rare.

OBJECTIVE

This qualitative study aimed to explore self-perceived challenges and opportunities related to COVID-19 across six European countries. The overall objective was to provide a differentiated picture of individual subjective experiences in the early stages of the pandemic.

METHOD

The present study included 7309 participants from Austria, Croatia, Georgia, Greece, Poland, and Portugal. We performed qualitative content analysis according to Mayring analyse open-ended questions regarding stressful events, positive and negative aspects of the pandemic, and recommendations to cope with the pandemic situation. MAXQDA software was used for data management and analysis.

RESULTS

Participants' accounts were moderately consistent across the countries. The most prominent themes regarding stressful and negative pandemic aspects included: Restrictions and changes in daily life, Emotional distress, and Work and finances. Answers about positive pandemic consequences were mainly centred around the themes Reflection and growth, Opportunity for meaningful/enjoyable activities, and Benefits on interpersonal level. Key themes identified from participants' recommendations to cope with the pandemic included Beneficial behavioural adjustment, Beneficial cognitive-emotional strategies, and Social support.

CONCLUSIONS

Participants experienced various challenges, but also shared several positive pandemic consequences and recommendations to cope with the pandemic. These first-hand data could inform mental health practices to promote well-being during COVID-19 and similar global challenges in the participating countries and possibly beyond.

HIGHLIGHTS

We examined COVID-19-related experiences in 7309 adults from six European countries.Besides challenges, participants identified many positive pandemic consequences.Participants' recommendations to cope with COVID-19 included behavioural and cognitive-emotional strategies.

A large scale meta-analytic atlas of mental health problems prevalence during the COVID-19 early pandemic

The COVID‐19 pandemic and related restrictions can impact mental health. To quantify the mental health burden of COVID‐19 pandemic, we conducted a systematic review and meta‐analysis, searching World Health Organization COVID‐19/PsycInfo/PubMed databases (09/29/2020), including observational studies reporting on mental health outcomes in any population affected by COVID‐19. Primary outcomes were the prevalence of anxiety, depression, stress, sleep problems, posttraumatic symptoms. Sensitivity analyses were conducted on severe mental health problems, in high‐quality studies, and in representative samples. Subgroup analyses were conducted stratified by age, sex, country income level, and COVID‐19 infection status. One‐hundred‐seventy‐three studies from February to July 2020 were included (n = 502,261, median sample = 948, age = 34.4 years, females = 63%). Ninety‐one percent were cross‐sectional studies, and 18.5%/57.2% were of high/moderate quality. The highest prevalence emerged for posttraumatic symptoms in COVID‐19 infected people (94%), followed by behavioral problems in those with prior mental disorders (77%), fear in healthcare workers (71%), anxiety in caregivers/family members of people with COVID‐19 (42%), general health/social contact/passive coping style in the general population (38%), depression in those with prior somatic disorders (37%), and fear in other‐than‐healthcare workers (29%). Females and people with COVID‐19 infection had higher rates of almost all outcomes; college students/young adults of anxiety, depression, sleep problems, suicidal ideation; adults of fear and posttraumatic symptoms. Anxiety, depression, and posttraumatic symptoms were more prevalent in low‐/middle‐income countries, sleep problems in high‐income countries. The COVID‐19 pandemic adversely impacts mental health in a unique manner across population subgroups. Our results inform tailored preventive strategies and interventions to mitigate current, future, and transgenerational adverse mental health of the COVID‐19 pandemic.

A systematic review and meta‐analysis to quantify the impact of mental health burden of COVID‐19 pandemic and related restrictions.

The highest prevalence emerged for posttraumatic symptoms in COVID‐19 infected people (94%).

Females and people with COVID‐19 infection had higher rates of almost all outcomes.

In low‐/middle‐income nations, the prevalence of anxiety, depression, and posttraumatic symptoms is high.

Sleep Duration as the Main Indicator of Self-Rated Wellness and Health among Healthcare Workers Involved in the COVID-19 Pandemic

Objective: This study was performed during the COVID-19 pandemic to better understand the indicators of self-rated wellness and health among healthcare workers. Methods: Sleep pattern, mood status, nutritional condition, physical activity, habits and the subjective wellness and health index of the healthcare workers of a university affiliated hospital were surveyed. Paired t-tests were performed to compare the participants’ quality of life before and after the outbreak of COVID-19. Multivariable linear regression models with a backward elimination stepwise process determined the parameters that significantly correlated with self-reported wellness and health. Results: Of the 200 healthcare workers who participated in this study, 119 (60%) were female and 81 (40%) were male, with a mean (SD) age of 28.8 (5.9) years. We found that the COVID-19 pandemic significantly changed many lifestyle factors compared to the pre-pandemic states. The scores of sleep quality, mood status, pre-planned physical activity and social activity were reduced by 30%, 40%, 50% and 70%, respectively. The average night sleep duration before the pandemic was 7 h and 22 min, whereas during the pandemic it decreased to 6 h and 44 min, a debt of 38 min in sleep duration every night. As found by multivariable regression modelling, self-reported wellness and health before the pandemic period was associated with wake-up time, mood status, physical activity and diet. During the pandemic period, in addition to these variables, night sleep duration (β = 0.049, p = 0.049) and nap duration (β = 0.009, p = 0.01) were left in the final multivariable model and correlated significantly with the wellness and health index. Conclusion: COVID-19 has detrimentally affected healthcare workers’ well-being and quality of life. Sleep duration was the main factor correlated with subjective wellness and health index during the current COVID-19 pandemic.

Protecting vulnerable communities and health professionals from COVID-19 associated mental health distress: a comprehensive approach led by a public-civil partnership in rural Chiapas, Mexico

BACKGROUND

The COVID-19 pandemic has stricken mental health worldwide. Marginalized populations in low- and middle-income countries have been the most affected, as they were already experiencing barriers to accessing mental health care prior to the pandemic and are unequally exposed to the stressors associated with the health emergency, such as economic ravages or increased risk of complicated disease outcomes.

OBJECTIVE

The aim of this paper is to describe a comprehensive initiative resulting from a public-civil partnership to address the increased burden of mental health illness associated with the COVID-19 pandemic in rural Chiapas, Mexico.

METHODS

To address the emerging health needs of the general population and health professionals resulting from the pandemic, Compañeros En Salud (CES), a non-profit civil society organization based in Chiapas, implemented a comprehensive strategy to compensate for the shortage of mental health services in the region in collaboration with the Chiapas Ministry of Health. The strategy included three components: capacity building in mental health care delivery, psychosocial support to the general population, and provision of mental health care to CES collaborating staff. In this capacity building article, implementers from CES and the government share descriptive information on the specific interventions carried out and their beneficiaries, as well as a critical discussion of the strategy followed.

RESULTS

Through this strategy, we have been successful in filling the gaps in the public health system to ensure that CES-served populations and CES-collaborating health professionals have access to mental health care. However, further studies to quantify the impact of this intervention in alleviating the burden of mental health illnesses associated with the pandemic are needed.

CONCLUSIONS

The current situation represents an opportunity to reimagine global mental health. Only through the promotion of community-based initiatives and the development of integrated approaches will we ensure the well-being of marginalized populations.

Receipt, Spending, and Clinical Correlates of the Economic Impact Payment Among Middle- and Low-Income U.S. Adults

OBJECTIVE

This study examined characteristics and planned expenses of U.S. adults who received the economic impact payment (EIP) during the COVID-19 pandemic.

METHODS

Using a nationally representative sample of 6,607 middle- and low-income U.S. adults, the authors examined the proportion and correlates of EIP receipt among eligible adults and the associations among planned EIP-financed expenses, challenges with paying expenses, and clinical characteristics.

RESULTS

Of the sample, 78.8% reported that they received the EIP, and 82.3% of EIP recipients reported that it had a positive impact on their life. Being a veteran (odds ratio [OR]=2.59), being married (OR=1.82), having a history of schizophrenia spectrum disorder (OR=1.74) or posttraumatic stress disorder (OR=1.51), and screening negative for recent suicidal ideation (OR=0.49) were associated with EIP receipt. Planned expenses with the EIP were savings, paying debt, and rent and accounted for 63.4% of the total amount. Screening positive for mental health or drug use problems was positively associated with greater planned expenses for substances and gambling. EIP receipt also was associated with fewer problems paying daily expenses, but participants who screened positive for mental health or alcohol use problems were more likely to report problems paying past-month daily expenses.

CONCLUSIONS

Unconditional cash transfers such as the EIP may be important for sustaining the living situation of middle- and low-income populations. The management of funds is important to consider, especially among adults experiencing mental health and substance abuse problems, and such cash transfers may represent opportunities for financial literacy and money management interventions.

Prevalence of Depressive Symptoms in Patients With Psoriatic Arthritis: Have Numbers Changed During the COVID-19 Pandemic?

This longitudinal analysis compares the prevalence of depressive symptoms in patients with psoriatic arthritis in the context of the COVID-19 pandemic. Data from a national patient register in Germany were analyzed regarding the Patient Health Questionnaire 2 (PHQ-2) to identify cases suspicious for depression at two time points, i.e., before and during the COVID-19 pandemic. Only patients with complete concurrent information on the Disease Activity in Psoriatic Arthritis Score (DAPSA) were included in the analysis. The frequency of depressive symptoms in psoriatic arthritis patients during the COVID-19 pandemic did not differ from the prevalence rates measured before. In addition, prevalence rates for depressive symptoms did not differ when stratifying the patient sample for DAPSA levels of disease activity measured before the pandemic. These results were confirmed further in a sensitivity analysis, limiting the second PHQ-2 assessment to lockdown periods only. However, longitudinal data on the prevalence of depressive symptoms in patients with rheumatic diseases, in general, and psoriatic arthritis, in particular, are scarce in the context of the COVID-19 pandemic. For a sensible comparison of prevalence rates for depressive symptoms in the future, underlying SARS-CoV-2 infection rates and resulting local healthcare disruptions need to be taken into account, besides the potential use of different depression screening tools to evaluate resulting numbers sensibly and draw corresponding conclusions for patient care.

Mental Health Monitoring Based on Multiperception Intelligent Wearable Devices

In order to improve the accuracy of the evaluation results of multiperception intelligent wearable devices, the mathematical statistical characteristics based on speech, behavior, environment, and physical signs are proposed; first, the PCA feature compression algorithm was used to reduce the dimension of these features, and the differences among different training samples were compared and analyzed; then, three weak classifiers are designed using the logistic regression algorithm, and finally, a strong classifier with higher prediction accuracy is designed according to the boosting decision fusion method and ensemble learning idea. The results showed that the accuracy of the logistic regression model trained with the feature data of voice PCA was 0.964, but the recall rate and crossover results were significantly reduced to 0.844 and 0.846, respectively. The accuracy, accuracy and recall of the decision fusion model based on the boosting method and integrated learning are 0.969, and the prediction accuracy of K-folds cross-validation is also as high as 0.956; the superposition fusion results of three weak classifiers achieve a better classification effect.

The Prevalence of Post-traumatic Stress Disorder Among Health Care Workers During the COVID-19 Pandemic: An Umbrella Review and Meta-Analysis

Introduction: Frontline health care workers (HCWs) have had an increased risk of developing health problems during the COVID-19 pandemic. In addition to physical illness, they have experienced mental health challenges, including post-traumatic stress disorder (PTSD). The aim of this study is to investigate the prevalence of PTSD among HCWs during the COVID-19 pandemic via an umbrella review and meta-analysis. Methods: This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline to perform a systematic literature search using various medical databases (Web of science, PubMed, Scopus, Cochrane, ProQuest, Science Direct, Embase, and Google scholar). The search included all articles published through the first of January 2020 the end of March 2021. The systematic review and meta-analysis studies that reported the prevalence of PTSD among health care workers were included in the study, and studies that reported the prevalence of PTSD in normal people or other epidemics were excluded. The random effects model was used to perform a meta-analysis, and the I 2 index was used to evaluate heterogeneity among studies. Publication bias was assessed using the Egger test. Data was analyzed using STATA (version 14) software. Results: The initial literature search yielded 145 studies. After excluding duplicates and assessing the quality of the studies, 7 studies were selected for meta-analysis. The results showed that the overall prevalence of PTSD among HCWs during the COVID-19 pandemic was 13.52% (95% CI: 9.06-17.98, I 2 = 65.5%, p = 0.008). Conclusion: There is a high prevalence of PTSD among frontline HCWs during the COVID-19 pandemic. It is important to invest in efforts to screen HCWs for mental health disorders such as PTSD and provide them with mental health support.

Sleep Dysfunction in COVID-19 Patients: Prevalence, Risk Factors, Mechanisms, and Management

During the COVID-19 pandemic, the need to establish the prevalence of sleep dysfunction and psychological distress, identify predisposing and protective factors, and explore effective management strategies remains an important priority. Evidence to date suggests that a considerable proportion of COVID-19 patients experience significant sleep disturbances (estimated to afflict up to 50-75%) as well as psychological distress such as depression, anxiety, and traumatic stress. Duration of hospitalization, pre-existing mental health concerns, lower absolute lymphocyte count, and increased neutrophil-to-lymphocyte ratio have been all associated with a greater risk of sleep dysfunction in infected and hospitalized patients. Furthermore, in this review, we discuss the link between sleep deprivation, susceptibility to viral infections, and psychosocial wellbeing in relevance to COVID-19 and summarize the existing evidence regarding the presence and role of sleep apnea in infected individuals. Finally, we highlight the importance of suitable interventions in order to prevent and manage sleep dysfunction and avoid long-term physical and psychological implications. Future research should aim to provide high-quality information including in high risk, underserved, or difficult to reach populations and on the long-term consequences and effectiveness of applied interventions.

Mental Health Disorders in Nurses During the COVID-19 Pandemic: Implications and Coping Strategies

Nurses caring for patients who contract coronavirus disease 2019 (COVID-19) have experienced significant traumas in the form of increased workloads, negative patient outcomes, and less social support system access. Nurses should be provided with information regarding early detection, coping skills and treatment for anxiety, depression, post-traumatic stress syndrome (PTSS)/post-traumatic stress disorder (PTSD), and other mental health disorders. Early intervention is important as mental health disorders can cause dysfunction, internal suffering, and in the most extreme situations, lead to death if not properly cared for. Healthcare corporations should consider providing coverage for mental health treatment for employees who experience COVID-19 traumas. With the implementation of healthy coping skills and therapeutic intervention, nurses will be able to let go of the negative impacts that the COVID-19 pandemic has caused and reintegrate into their roles as caring and entrusted health care providers. The current paper evaluates the mental health disorders encountered by nurses in the COVID-19 era based on the current medical literature and aims to provide practical coping strategies.

COVID-19 Infection: A Neuropsychiatric Perspective

As a potentially life-threatening disease with no definitive treatment and without fully implemented population-wide vaccination, COVID-19 has created unprecedented turmoil in socioeconomic life worldwide. In addition to physical signs from the respiratory and many other systems, the SARS-CoV-2 virus produces a broad range of neurological and neuropsychiatric problems, including olfactory and gustatory impairments, encephalopathy and delirium, stroke and neuromuscular complications, stress reactions, and psychoses. Moreover, the psychosocial impact of the pandemic and its indirect effects on neuropsychiatric health in noninfected individuals in the general public and among health care workers are similarly far-ranging. In addition to acute neuropsychiatric manifestations, COVID-19 may also produce late neuropsychiatric sequelae as a function of the psychoneuroimmunological cascade that it provokes. The present article presents a state-of-the-science review of these issues through an integrative review and synthesis of case series, large-cohort studies, and relevant meta-analyses. Heuristics for evaluation and further study of the neuropsychiatric manifestations of SARS-CoV-2 infection are offered.

Factors associated with post-traumatic growth in response to the COVID-19 pandemic: Results from a national sample of U.S. military veterans

RATIONALE

The COVID-19 pandemic has had numerous negative effects globally, contributing to mortality, social restriction, and psychological distress. To date, however, the majority of research on the psychological impact of the COVID-19 pandemic has focused on negative psychological outcomes, such as depression, anxiety, and posttraumatic stress disorder (PTSD).

OBJECTIVE

Although there is debate about the constructive vs. illusory nature of post-traumatic growth (PTG), it has been found to be prevalent in a broad range of trauma survivors, including individuals affected by the COVID-19 pandemic. The objective of this study was to identify pre- and peri-pandemic factors associated with pandemic-related PTG in a national sample of U.S. veterans.

METHODS

Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed a nationally representative cohort of 3078 U.S. veterans. A broad range of pre-pandemic and 1-year peri-pandemic factors associated with pandemic-related PTG were evaluated. Curve estimation and receiver operating characteristic curve analyses were conducted to characterize the association between pandemic-related PTSD symptoms and PTG.

RESULTS

Worries about the effect of the pandemic on one's physical and mental health, PTG in response to previous traumas (i.e., new possibilities and improved interpersonal relationships), and pandemic-related avoidance symptoms were the strongest correlates of pandemic-related PTG. An inverted-U shaped relationship provided the best fit to the association between pandemic-related PTSD symptoms and endorsement of PTG, with moderate severity of PTSD symptoms optimally efficient in identifying veterans who endorsed PTG.

CONCLUSIONS

Results of this study suggest that psychosocial interventions that promote more deliberate and organized rumination about the pandemic and enhance PTG in response to prior traumatic events may help facilitate positive psychological changes related to the COVID-19 pandemic in U.S. military veterans. Longitudinal studies on functional correlates of PTG may help inform whether these changes are constructive vs. illusory in nature.

Soporific effect of modified Suanzaoren Decoction on mice models of insomnia by regulating Orexin-A and HPA axis homeostasis

AIM

Modified Suanzaoren Decoction (MSZRD) is obtained by improving Suanzaoren Decoction (SZRT), a traditional Chinese herbal prescription that has been used to treat insomnia for more than thousands of years. Our previous study showed that MSZRD can improve the gastrointestinal discomfort related insomnia by regulating Orexin-A. This study is the first study to evaluate the effects and possible mechanisms of MSZRD in mice with insomnia caused by p-chlorophenylalanine (PCPA) combined with multifactor random stimulation.

METHODS

After 14 days of multifactor stimulation to ICR mice, a PCPA suspension (30 mg/mL) was injected intraperitoneally for two consecutive days to establish an insomnia model. Three different doses of MSZRD (3.6, 7.2, and 14.4 g/kg/day) were given to ICR mice for 24 days. The food intake and back temperature were measured, and behavioral tests and pentobarbital sodium-induced sleep tests were conducted. The levels of Orexin-A, corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), and adrenocortical hormones (CORT) in the serum and 5-hydroxytryptamine (5-HT), dopamine (DA), and norepinephrine (NE) in hypothalamus were measured using enzyme-linked immunosorbent assay (ELISA) kits. The levels of γ-aminobutyric acid (GABA) and glutamic acid (Glu) were measured by high-performance liquid chromatography (HPLC). The expression of 5HT1A receptor (5-HTRIA) and orexin receptor 2 antibody (OX2R) was measured by Western blot (WB) and immunohistochemical staining (ICH). Hematoxylin and eosin (H&E) staining and Nissl staining were used to assess the histological changes in hypothalamus tissue.

RESULTS

Of note, MSZRD can shorten the sleep latency of insomnia mice (P < 0.05, 0.01), prolonged the sleep duration of mice (P < 0.05, 0.01), and improve the circadian rhythm disorder relative to placebo-treated animals. Furthermore, MSZRD effectively increased the content of 5-HT and 5-HTR1A protein in the hypothalamus of insomnia mice (P < 0.05, 0.01), while downregulated the content of DA and NE (P < 0.05, 0.01). Importantly, serum GABA concentration was increased by treatment with MSZRD (P < 0.05), as reflected by a decreased Glu/GABA ratio (P < 0.05). Moreover, MSZRD decreased the levels of CORT, ACTH, and CRH related hormones in HPA axis (P < 0.05, 0.01). At the same time, MSZRD significantly downregulated the serum Orexin-A content in insomnia mice (P < 0.05), as well as hypothalamic OX2R expression (P < 0.05). In addition, MSZRD also improved the histopathological changes in hypothalamus in insomnia mice.

CONCLUSION

MSZRD has sleep-improvement effect in mice model of insomnia. The mechanism may be that regulating the expression of Orexin-A affects the homeostasis of HPA axis and the release of related neurotransmitters in mice with insomnia.

[Immunotherapy adaptation in lung cancer during the COVID-19 pandemic]

INTRODUCTION

COVID-19 pandemics required changes in medical practices. In thoracic oncology, pembrolizumab was doubled to 400mg every 6weeks, nivolumab to 480mg every 4weeks. The objective of our study was to assess the impact on quality of life, and on psychological state, as well as the tolerance, of this new schedule.

METHODS

Thoracic oncologic patients who underwent these therapeutic changes in our center during the first COVID-19 epidemic wave were included. Their quality of life was assessed using the Quality of Life Questionnaire-30, their psychological state by the Hospital Anxiety Depression (HAD) scale. We also reported the preferred administration schedule, as well as adverse events.

RESULTS

Thirty patients were included. The overall quality of life was preserved. Rates on HAD scale were low. Tolerance was acceptable. In majority, patients preferred the new procedure. They had a significantly better quality of life compared to those who preferred the old one.

CONCLUSIONS

This new immunotherapy schedule in thoracic oncology is well tolerated and allows a preservation of quality of life. This therapeutic option may be favored in the context of COVID-19 pandemics.

Psychosocial impact of the COVID-19 pandemic on 4378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic

OBJECTIVES

This study reports preliminary findings on the prevalence of, and factors associated with, mental health and well-being outcomes of healthcare workers during the early months (April-June) of the COVID-19 pandemic in the UK.

METHODS

Preliminary cross-sectional data were analysed from a cohort study (n=4378). Clinical and non-clinical staff of three London-based NHS Trusts, including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire. Secondary outcomes are probable anxiety (seven-item Generalised Anxiety Disorder), depression (nine-item Patient Health Questionnaire), post-traumatic stress disorder (PTSD) (six-item Post-Traumatic Stress Disorder checklist), suicidal ideation (Clinical Interview Schedule) and alcohol use (Alcohol Use Disorder Identification Test). Moral injury is measured using the Moray Injury Event Scale.

RESULTS

Analyses showed substantial levels of probable CMDs (58.9%, 95% CI 58.1 to 60.8) and of PTSD (30.2%, 95% CI 28.1 to 32.5) with lower levels of depression (27.3%, 95% CI 25.3 to 29.4), anxiety (23.2%, 95% CI 21.3 to 25.3) and alcohol misuse (10.5%, 95% CI 9.2 to 11.9). Women, younger staff and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one's moral code) was strongly associated with increased levels of probable CMDs, anxiety, depression, PTSD symptoms and alcohol misuse.

CONCLUSIONS

Our findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic.

Neurobiology of COVID-19: how can the virus affect the brain?

Severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) causes the coronavirus disease 2019 (COVID-19), which has been declared a public health emergency of international interest, with confirmed cases in most countries. COVID-19 presents manifestations that can range from asymptomatic or mild infections up to severe manifestations that lead to hospitalization and death. A growing amount of evidence indicates that the virus may cause neuroinvasion. Postmortem brain study findings have included edema, hemorrhage, hydrocephalus, atrophy, encephalitis, infarcts, swollen axons, myelin loss, gliosis, neuronal satellitosis, hypoxic-ischemic damage, arteriolosclerosis, leptomeningeal inflammation, neuronal loss, and axon degeneration. In addition, the COVID-19 pandemic is causing dangerous effects on the mental health of the world population, some of which can be attributed to its social impact (social distancing, financial issues, and quarantine). There is also a concern that environmental stressors, enhanced by psychological factors, are contributing to the emergence of psychiatric outcomes during the pandemic. Although clinical studies and diagnosing SARS-CoV-2-related neurological disease can be challenging, they are necessary to help define the manifestations and burden of COVID-19 in neurological and psychiatric symptoms during and after the pandemic. This review aims to present the neurobiology of coronavirus and postmortem neuropathological hallmarks.

Effects of COVID-19 lockdown on eating disorders and obesity: A systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to examine: the pooled prevalence of symptomatic behaviours and mental health deterioration amongst individuals with eating disorders (EDs) and obesity during the COVID-19 confinement. Moreover, we examined changes in EDs and distress before and during the confinement, and the association between psychosocial factors and EDs symptoms.

METHOD

A systematic search was carried out in biomedical databases from January 2020 to January 2021. Both cross-sectional and longitudinal studies that used quantitative measures of ED symptoms and psychological distress during and after the COVID-19 confinement were included.

RESULTS

A total of 26 studies met inclusion criteria (n = 3399, 85.7% female). The pooled prevalence of symptomatic deterioration in EDs was 65% (95% CI[48,81], k = 10). The pooled prevalence of increased weight in obesity was 52% (95% CI[25,78], k = 4). More than half of the participants experienced depression and anxiety. Moreover, at least 75% of the individuals with EDs reported shape and eating concerns, and increased thinking about exercising. However, the pooled analyses of longitudinal studies showed no significant differences from pre-pandemic levels to the first lockdown phase in Body Mass Index and ED symptoms, whereas only few studies suggested increased distress, particularly among individuals with anorexia nervosa.

CONCLUSIONS

The majority of individuals with EDs and obesity reported symptomatic worsening during the lockdown. However, further longitudinal studies are needed to identify vulnerable groups, as well as the long-term consequences of COVID-19.

Sleep quality and related factors in a sample of Turkish healthcare workers during the COVID-19 pandemic: A cross-sectional study

BACKGROUND

Increasing workloads and psychological pressure have led to fatigue among healthcare workers during the COVID-19 pandemic. Increasing stress and social isolation can also lead to sleep problems. The purpose of this study was to evaluate sleep quality and related factors among healthcare workers during the COVID-19 pandemic in Turkey.

METHODS

The data in this cross-sectional study were collected using an online questionnaire. This included sociodemographic data, the Multidimensional Scale of Perceived Social Support, the National Stressful Events Survey PTSD Short Scale and the Pittsburgh Sleep Quality Index.

RESULTS

Two hundred seventy-eight physicians, 104 nurses and 52 dentists were enrolled. The total prevalence of poor sleep quality was 56.7%. The prevalence of poor sleep quality was 67.3% in nurses, 55.4% in physicians and 42.3% in dentists. Poor sleep quality was more prevalent among women, nurses, hospital workers, frontline workers, individuals with <5 years of work experience, those with low social support and individuals with increased traumatic stress levels. High levels of social support and family social support were identified as protective factors against poor sleep quality. Multivariate regression analyses showed that poor sleep quality was significantly associated with working in hospitals and high traumatic stress levels during the COVID-19 pandemic.

CONCLUSIONS

Poor sleep quality was common among healthcare workers during the COVID-19 pandemic. Working in hospitals and high traumatic stress levels were identified as factors associated with poor sleep quality.

A Mid-to-Long Term Comprehensive Evaluation of Psychological Distress and Erectile Function in COVID-19 Recovered Patients

BACKGROUND

The psychological and sexual health of different populations are negatively affected during the coronavirus disease 2019 (COVID-19) pandemic. However, little is known about psychological distress and erectile function of male recovered patients with COVID-19 in the long term.

AIM

We aimed to evaluate psychological distress and erectile function of male recovered patients with COVID-19 in the mid-to-long terms.

METHODS

We recruited 67 eligible male recovered patients with COVID-19 and followed them up twice within approximately 6 months of recovery time. The psychological distress and erectile function were assessed by validated Chinese version of paper questionnaires.

OUTCOMES

The primary outcomes were Symptom Checklist 90 questionnaire for psychological distress and International Index of Erectile Function-5 for erectile function.

RESULTS

In the first visit, COVID-19 patients with a median recovery time of 80 days mainly presented the following positive symptoms: Obsessive-Compulsive, additional items (ADD), Hostility, Interpersonal Sensitivity, Depression, and Somatization; while the dimension scores in Somatization, Anxiety, ADD, and Phobia were higher than Chinese male norms. Besides, the prevalence of erectile dysfunction (ED) in the first-visit patients was significantly higher than Chinese controls. In the second visit, the primary psychological symptoms of COVID-19 patients with a median recovery time of 174 days were Obsessive-Compulsive, ADD, Interpersonal Sensitivity, and Hostility, while all dimensions scores of Symptom Checklist 90 were lower than Chinese male norms. Moreover, second-visit patients had no significant difference with Chinese controls in ED prevalence. In addition, it suggested that GSI was the independent risk factor for ED in the regression analysis for the first-visit patients.

CLINICAL IMPLICATIONS

The study showed the changes of psychological symptoms and erectile function in COVID-19 recovered patients, and provided reference on whether psychological and sexual supports are needed after a period of recovery.

STRENGTHS AND LIMITATIONS

To our knowledge, it is the first study to comprehensively evaluate the psychological distress and erectile function of COVID-19 recovered patients in the mid-to-long terms. The main limitations were the low number of analyzed participants, and the psychological distress and erectile function of healthy Chinese men over the same period were not evaluated, and the psychological and sexual related data of participants prior to COVID-19 were not available. Additionally, there was a selection bias in comparing COVID-19 patients with healthy controls.

CONCLUSION

With less impact of COVID-19 event, the impaired erectile function and psychological distress improved in COVID-19 recovered patients with a recovery time of nearly half a year. Hu B, Ruan Y, Liu K, et al. A Mid-to-Long Term Comprehensive Evaluation of Psychological Distress and Erectile Function in COVID-19 Recovered Patients. J Sex Med 2021;18:1863-1871.

Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: A 6-month multi-centre prospective study

Aim

The long-term stress, anxiety and job burnout experienced by healthcare workers (HCWs) are important to consider as the novel coronavirus disease (COVID-19) pandemic stresses healthcare systems globally. The primary objective was to examine the changes in the proportion of HCWs reporting stress, anxiety, and job burnout over six months during the peak of the pandemic in Singapore. The secondary objective was to examine the extent that objective job characteristics, HCW-perceived job factors, and HCW personal resources were associated with stress, anxiety, and job burnout.

Method

A sample of HCWs (doctors, nurses, allied health professionals, administrative and operations staff; N = 2744) was recruited via invitation to participate in an online survey from four tertiary hospitals. Data were gathered between March-August 2020, which included a 2-month lockdown period. HCWs completed monthly web-based self-reported assessments of stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7), and job burnout (Physician Work Life Scale).

Results

The majority of the sample consisted of female HCWs (81%) and nurses (60%). Using random-intercept logistic regression models, elevated perceived stress, anxiety and job burnout were reported by 33%, 13%, and 24% of the overall sample at baseline respectively. The proportion of HCWs reporting stress and job burnout increased by approximately 1·0% and 1·2% respectively per month. Anxiety did not significantly increase. Working long hours was associated with higher odds, while teamwork and feeling appreciated at work were associated with lower odds, of stress, anxiety, and job burnout.

Conclusions

Perceived stress and job burnout showed a mild increase over six months, even after exiting the lockdown. Teamwork and feeling appreciated at work were protective and are targets for developing organizational interventions to mitigate expected poor outcomes among frontline HCWs.

Depression, anxiety and stress symptoms in Brazilian university students during the COVID-19 pandemic: Predictors and association with life satisfaction, psychological well-being and coping strategies

Background

The COVID-19 pandemic raises concerns about the mental health of the world population. Protection measures to prevention the disease impacted education and undergraduate students were exposed to additional stressors.

Objectives

Analyze depression, anxiety and stress symptoms in undergraduates, their respective predictors and the association with satisfaction with life, psychological well-being and coping strategies.

Methods

An online cross-sectional study was conducted from September 14 to October 19, 2020, involving undergraduate students enrolled in 33 courses from 5 public university campuses in the state of Parana, Brazil, using: questionnaire with sociodemographic, academic, health and pandemic effects variables; Depression, Anxiety and Stress Scale-21 (DASS-21); Satisfaction with Life Scale (SWLS); Psychological Well-Being (PWB); BriefCOPE. The convenience sample was composed of 1,224 participants, with 18 years old or older, that completed all research instruments. Spearman correlation and logistic analysis (univariate and multivariate) were applied to the collected data.

Results

Most of the undergraduates presented symptoms of depression (60.5%), anxiety (52.5%) and stress (57.5%). Depression, anxiety and stress presented significant correlations in common: negative with satisfaction with life, all dimensions of psychological well-being, and 3 adaptive copings (active coping, planning, positive reframing); positive with 5 maladaptive copings (behavioral disengagement, denial, self-blame, self-distraction, substance use). In addition, there were 7 common predictors for symptoms of depression, anxiety and stress: female; age 18–24 years old; having a chronic disease; lower scores in 2 dimensions of psychological well-being (positive relations with others, self-acceptance); higher scores in 2 maladaptive copings (self-blame, substance use).

Conclusions

The data indicate a high prevalence of symptoms of depression, anxiety and stress, and suggest that higher scores of satisfaction with life, psychological well-being dimensions and adaptive copings may present protective effects in undergraduates during a pandemic crisis.

Mental Health during the COVID-19 Crisis in Africa: A Systematic Review and Meta-Analysis

We aim to provide a systematic review and meta-analysis of the prevalence rates of mental health symptoms among major African populations during the COVID-19 pandemic. We include articles from PubMed, Embase, Web of Science, PsycINFO, and medRxiv between 1 February 2020 and 6 February 2021, and pooled data using random-effects meta-analyses. We identify 28 studies and 32 independent samples from 12 African countries with a total of 15,071 participants. The pooled prevalence of anxiety was 37% in 27 studies, of depression was 45% in 24 studies, and of insomnia was 28% in 9 studies. The pooled prevalence rates of anxiety, depression, and insomnia in North Africa (44%, 55%, and 31%, respectively) are higher than those in Sub-Saharan Africa (31%, 30%, and 24%, respectively). We find (a) a scarcity of studies in several African countries with a high number of COVID-19 cases; (b) high heterogeneity among the studies; (c) the extent and pattern of prevalence of mental health symptoms in Africa is high and differs from elsewhere-more African adults suffer from depression rather than anxiety and insomnia during COVID 19 compared to adult populations in other countries/regions. Hence, our findings carry crucial implications and impact future research to enable evidence-based medicine in Africa.

Mental Health during the COVID-19 Crisis in Africa: A Systematic Review and Meta-Analysis

We aim to provide a systematic review and meta-analysis of the prevalence rates of mental health symptoms among major African populations during the COVID-19 pandemic. We include articles from PubMed, Embase, Web of Science, PsycINFO, and medRxiv between 1 February 2020 and 6 February 2021, and pooled data using random-effects meta-analyses. We identify 28 studies and 32 independent samples from 12 African countries with a total of 15,071 participants. The pooled prevalence of anxiety was 37% in 27 studies, of depression was 45% in 24 studies, and of insomnia was 28% in 9 studies. The pooled prevalence rates of anxiety, depression, and insomnia in North Africa (44%, 55%, and 31%, respectively) are higher than those in Sub-Saharan Africa (31%, 30%, and 24%, respectively). We find (a) a scarcity of studies in several African countries with a high number of COVID-19 cases; (b) high heterogeneity among the studies; (c) the extent and pattern of prevalence of mental health symptoms in Africa is high and differs from elsewhere-more African adults suffer from depression rather than anxiety and insomnia during COVID 19 compared to adult populations in other countries/regions. Hence, our findings carry crucial implications and impact future research to enable evidence-based medicine in Africa.

Long-Term Impact of Economic Downturn and Loneliness on Psychological Distress: Triple Crises of COVID-19 Pandemic

Background: The COVID-19 crisis poses global mental health and global economy challenges. However, there is a lack of longitudinal research investigating whether financial instability and social disruption may increase the risk of developing mental health problems over time that may potentially outlast the pandemic. Methods: We conducted an online survey for members of the general population (n = 2703) in Germany during the twelve months spanning from April 2020 to March 2021. We investigated the development of COVID-19 related psychological distress, the number of unemployed people, federal government debt, income distribution, and loneliness over the time period. Results: Over a period of twelve months, 53.6% of respondents in Germany reported experiencing psychological distress, varying from mild levels, 34.2%, to severe levels, 19.4%, of distress. High federal government debt, high incident COVID-19 cases, low incomes, and the prevalence of loneliness were found to be associated with increased long-term mental health problems. Psychological distress scores were most strongly increased in female and young respondents as well as those who reported fewer years of education, low income, and higher loneliness. Conclusions: Our study highlights factors that have a long-term impact on mental health amid the COVID-19 pandemic. We suggest that specific mental-health services could be offered to support high-risk groups experiencing financial fragility and loneliness. For purposes of safeguarding their mental health there is a need to monitor and track such risk factors in real time.

Mental health impact of COVID-19 among health-care workers: An exposure-based cross-sectional study

BACKGROUND

Health-care workers (HCWs) in COVID-19 pandemic have faced the major impact in providing care to infected persons. Most of the studies on mental health impact among HCW have not incorporated paramedical staff. Furthermore, they have not compared psychological morbidity among HCW on the basis of high COVID exposure (HCE) and low COVID exposure (LCE). To address the above gap, this study aimed at evaluating mental health impact among HCW and its associated risk factors.

MATERIALS AND METHODS

Consecutive 200 HCWs each in the HCE and LCE groups (between the age group of 18 and 60 years) were enrolled from two tertiary care hospitals providing COVID-19 treatment from August 1, 2020. After collection of sociodemographic data, participants were administered Impact of Event Scale-Revised, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 Scale.

RESULTS

The difference in stress, depression, and anxiety symptom scores between the HCE and LCE groups was not statistically significant. Multiple regression analysis revealed that female sex was associated with higher scores in all the three domains. The effect remained significant even after adjusting for effect of other risk factors.

CONCLUSION

HCE or LCE was associated with similar impact in terms of stress, depression, and anxiety among HCWs. Female HCWs had a higher prevalence of stress, depression, and anxiety. Doctors, nurses, and paramedics had a similar prevalence of stress, depression, and anxiety when odds were adjusted.

The prevalence of insomnia among health care workers amid the COVID-19 pandemic: An umbrella review of meta-analyses

BACKGROUND

Health care workers (HCWs) during the COVID-19 pandemic experience numerous psychological problems, including stress and anxiety. These entities can affect their sleep quality and predispose them to insomnia. The aim of the present study was to investigate the prevalence of insomnia among HCWs during the COVID-19 crisis via an umbrella review.

METHODS

The PRISMA guideline was used to conduct this review. By searching relevant keywords in databases of Scopus, PubMed, Web of Science, and Google Scholar, studies that reported the prevalence of insomnia among HCWs during the COVID-19 pandemic (January 2020 to the end of January 2021) and had been published in English were identified and evaluated. The random effects model was used for meta-analysis, and the I2 index was used to assess heterogeneity. The Egger test was used to determine publication bias. Based on the results of the primary search, 96 studies were identified, and ultimately 10 eligible studies entered the meta-analysis phase.

RESULTS

The results of the umbrella review of meta-analyses showed that the prevalence of insomnia among HCWs during the COVID-19 pandemic was 36.36% (95% CI: 33.36-39.36, I2 = 59.6%, p = 0.006).

CONCLUSIONS

The results of this umbrella review of meta-analyses showed a relatively high prevalence of insomnia among HCWs during the COVID-19 pandemic. As insomnia can be associated with other psychological problems, policymakers and health managers should regularly screen HCWs for psychological disorders as well as a possible tendency for suicide. Furthermore, by treating insomnia, one can reduce the incidence of these psychological disorders.

Post-COVID-19 acute sarcopenia: physiopathology and management

In this review, we discuss the pathophysiologic and management aspects of acute sarcopenia in relation to SARS-CoV-2 infection. COVID-19 is as a multi-organ infectious disease characterized by a severe inflammatory and highly catabolic status, influencing the deep changes in the body build, especially the amount, structure, and function of skeletal muscles which would amount to acutely developed sarcopenia. Acute sarcopenia may largely impact patients’ in-hospital prognosis as well as the vulnerability to the post-COVID-19 functional and physical deterioration. The individual outcome of the COVID-19 and the degree of muscle mass and functional loss may be influenced by multiple factors, including the patient’s general pre-infection medical and functional condition, especially in older adults. This paper gathers the information about how the SARS-CoV-2 hyper-inflammatory involvement exacerbates the immunosenescence process, enhances the endothelial damage, and due to mitochondrial dysfunction and autophagy, induces myofibrillar breakdown and muscle degradation. The aftermath of these acute and complex immunological SARS-CoV-2-related phenomena, augmented by anosmia, ageusia and altered microbiota may lead to decreased food intake and exacerbated catabolism. Moreover, the imposed physical inactivity, lock-down, quarantine or acute hospitalization with bedrest would intensify the acute sarcopenia process. All these deleterious mechanisms must be swiftly put to a check by a multidisciplinary approach including nutritional support, early physical as well cardio-pulmonary rehabilitation, and psychological support and cognitive training. The proposed holistic and early management of COVID-19 patients appears essential to minimize the disastrous functional outcomes of this disease and allow avoiding the long COVID-19 syndrome.

The impact of the COVID-19 pandemic on mental health of nurses in British Columbia, Canada using trends analysis across three time points

PURPOSE

This study examined trends over time in the prevalence of anxiety and depression among Canadian nurses: 6 months before, 1-month after, and 3 months after COVID-19 was declared a pandemic.

METHODS

This study adopted a repeated cross-sectional design and surveyed unionized nurses in British Columbia (BC), Canada on three occasions: September 2019 (Time 1, prepandemic), April 2020 (Time 2, early-pandemic) and June 2020 (Time 3).

RESULTS

A total of 10,117 responses were collected across three timepoints. This study found a significant increase of 10% to 15% in anxiety and depression between Time 1 and 2, and relative stability between Time 2 and 3, with Time 3 levels still higher than Time 1 levels. Cross-sector analyses showed similar patterns of findings for acute care and community nurses. Long-term care nurses showed a two-fold increase in the prevalence of anxiety early pandemic, followed by a sharper decline mid pandemic.

CONCLUSIONS

COVID-19 has had short- and mid-term mental health implications for BC nurses particularly among those in the long-term care sector. Future research should evaluate the impact of COVID-19 on the mental health of health workers in different contexts, such as jurisdictional analyses, and better understand the long-term health and labor market consequences of elevated mental health symptoms over an extended time period.

Emotional Impact on Health Personnel, Medical Students, and General Population Samples During the COVID-19 Pandemic in Lima, Peru

Background

The aim of the study is to compare the emotional effects of COVID-19 among three different groups, namely: health personnel, medical students, and a sample of the general population.

Methods

375 participants were recruited for this study, of which 125 were medical students (preclinical studies, 59; clinical studies, 66), 125 were health personnel (COVID-19 frontline personnel, 59; personnel not related with COVID-19, 66), and 125 belonged to the general population. The PHQ-9, GAD-7, and CPDI scales were used to assess the emotional impact. A multinomial logistic regression was performed to measure differences between groups, considering potential confounding factors.

Results

Regarding CPDI values, all other groups showed reduced values compared to COVID-19 frontline personnel. However, the general population, preclinical and clinical medical students showed increased PHQ-9 values compared to COVID-19 frontline personnel. Finally, confounding factors, gender and age correlated negatively with higher CPDI and PHQ-9 scores.

Conclusions

Being frontline personnel is associated with increased COVID-19-related stress. Depression is associated, however, with other groups not directly involved with the treatment of COVID-19 patients. Female gender and younger age correlated with COVID-19-related depression and stress.

Anxiety and depression among healthcare workers during the COVID-19 pandemic: a systematic umbrella review of the global evidence

OBJECTIVES

To summarise the evidence relating to the prevalence of anxiety and depression among healthcare workers (HCWs) during the COVID-19 pandemic.

DESIGN

An umbrella review of systematic reviews was undertaken using the Joanna Briggs Institute (JBI) methods.

DATA SOURCES

The Cochrane database of systematic reviews, JBI Evidence Synthesis, MEDLINE, Web of Science, PsycINFO, Embase and CINAHL were searched in March 2021 for reviews published in English.

ELIGIBILITY CRITERIA

Systematic reviews reporting the prevalence of anxiety and depression among HCWs during the COVID-19 pandemic. Two researchers screened each abstract and independently reviewed full text articles. Study quality was assessed using the JBI critical appraisal tool for systematic reviews, and the degree of overlap in primary studies was calculated.

RESULTS

Ten systematic reviews (100 unique studies), including 169 157 HCWs from 35 countries were included. The prevalence of anxiety among all HCWs ranged from 22.2% (95% CI 21.3% to 23.1%) to 33.0% (95% CI 31.9% to 34.1%). The prevalence of anxiety among physicians (n=5820) was reported to be between 17% and 19.8% and for nurses (n=14 938) between 22.8% and 27%. The prevalence of depression among all HCWs ranged from 17.9% (95% CI 17.1% to 18.8%) to 36% (95% CI 34.9% to 37.1%). The prevalence of depression among physicians (n=643) and nurses (n=8063) was reported to be 40.4% and 28%, respectively.

CONCLUSIONS

There is wide variation evident in the presence of anxiety and depression among HCWs. In particular, the prevalence of depression among physicians was high. Strategies to reduce the incidence of anxiety and depression are urgently required.

PROSPERO REGISTRATION NUMBER

CRD42021238960.

Psychological distress and perceived job stressors among hospital nurses and physicians during the COVID-19 outbreak

Aims

The study examined self‐reported job‐related stressors induced by the COVID‐19 pandemic and psychological distress among hospital nurses and physicians. In addition, we explored the role of negative affect (NA) and background variables in relation to COVID‐19‐related job stressors and psychological distress.

Background

During COVID‐19 pandemic, hospital nurses and physicians were exposed to highly enduring occupational stress, that stem from subjective appraisal of inadequate job resources (i.e., personal protection equipment, information on how to manage safely in the ongoing work and organizational attention to the needs arising from the ongoing work).

Design

Cross‐sectional design.

Methods

Between May and July 2020, 172 nurses and physicians working at a medical centre in Israel filled in self‐report questionnaires about sociodemographic data, COVID‐19‐related job stressors, psychological distress and NA.

Results

Our results confirmed the positive direct link between perceived COVID‐19‐related job stressors and psychological distress among hospital nurses and physicians. NA was found to serve as a mediator in this association (indirect link). Furthermore, nurses and physicians' seniority was related positively to psychological distress and also played a moderator role in the indirect link.

Conclusion

We recommend to monitor the mental health of hospital nurses and physicians and to provide a platform to address their job stressor concerns related to COVID‐19, and share helpful coping strategies.

Impact statement

During the abrupt COVID‐19 outbreak, hospital nurses and physicians face challenges that might raise NA and psychological distress. Our study revealed that among hospital nurses and physicians, COVID‐19‐related perceived job stressors and psychological distress were positively linked, and NA plays a mediating role in this association. Among nurses and physicians with moderate or high years of seniority (>11 years), higher COVID‐19‐related perceived job stressors associated with higher NA, which in turn was associated with greater psychological distress. Policymakers would be wise to provide a platform to address hospital nurses and physicians' mental health.

Prevalence of post-traumatic stress disorder on health professionals in the era of COVID-19 pandemic, Northwest Ethiopia, 2020: A multi-centered cross-sectional study

OBJECTIVE

This study aimed to assess the prevalence and associated factors of post-traumatic stress disorder among health professionals working in South Gondar Zone hospitals in the era of the COVID-19 pandemic, Amhara Ethiopia 2020.

METHODS

Institutional based cross-sectional study design was conducted. A total of 396 respondents completed the questionnaire and were included in the analysis. A previously adapted self-administered pretested standard questionnaire, Impact of Event Scale-Revised (IES-R-22) was used to measure post-traumatic stress disorder. Data was entered into Epi data version 4.4.2 then exported to SPSS version 24 for analysis. Descriptive and analytical statistical procedures, bivariate, and multivariate binary logistic regressions with odds ratios and 95% confidence interval were employed. The level of significance of association was determined at a p-value < 0.05.

RESULTS

The prevalence of post-traumatic stress disorder among health care providers in this study was 55.1% (95% CI: 50.3, 59.6). Lack of standardized PPE supply (AOR = 2.5 7,95CI;1.37,4.85), respondents age > 40 years (AOR = 3.95, 95CI; 1.74, 8.98), having medical illness (AOR = 4.65, 95CI;1.65,13.12), perceived stigma (AOR = 1.97, 95CI;1.01, 3.85), history of mental illness(AOR = 8.08,95IC;2.18,29.98) and having poor social support (AOR = 4.41,95CI;2.65,7.3) were significantly associated with post-traumatic stress disorder at p-value < 0.05. Conversely, being a physician (AOR = 0.15, 95CI; 0.04, 0.56) was less affected by PTSD.

CONCLUSIONS

The prevalence of post-traumatic stress disorder among health care providers in this study was high. Adequate and standardized PPE supply, giving especial emphasis to those care providers with medical illness, history of mental illness, and having poor social support, creating awareness in the community to avoid the stigma faced by health care providers who treat COVID patients is recommended.

Dietary macronutrient intake according to sex and trait anxiety level among non-diabetic adults: a cross-sectional study

Background

Studies suggest that anxiety is correlated with eating behavior, however, little is known about the association between anxiety status as predictor of dietary macronutrient intake. The aim of the present study was to investigate the sex-stratified cross-sectional associations of trait anxiety with intake of various macronutrients in a large population-based sample of non-diabetic adults.

Methods

N = 20,231 participants (mean age = 53.7 ± 13.6 years) of the NutriNet-Santé web-cohort, who had completed the trait anxiety subscale of the Spielberger State-Trait Anxiety Inventory (T-STAI; 2013–2016) were included in the analyses. Dietary intake was calculated from at least 3 self-administered 24-h dietary records. The associations of interest were assessed by multiple linear regression stratified by sex, owing to significant interaction tests.

Results

In total, 74.3% (n = 15,033) of the sample were females who had a significantly higher mean T-STAI score than did males (39.0 versus 34.8; p < 0.01). Among females, the fully-adjusted analyses showed significant positive associations of T-STAI with total carbohydrate intake (β = 0.04; p < 0.04), complex carbohydrate intake (β = 0.05; p < 0.02), and percentage energy from carbohydrates (β = 0.01; p < 0.03), as well as a significant inverse association of T-STAI with percentage energy from fat (β = -0.01; p < 0.05). As regards males, the only significant finding was an inverse association between T-STAI and percent of the mean daily energy from protein (fully-adjusted model: β = -0.01; p = 0.05).

Conclusion

This cross-sectional study found modest sex-specific associations between anxiety status and macronutrient intake among French non-diabetic adults. Prospective studies are needed to further elucidate the observed associations.

Overview of behavioural and psychological consequences of COVID 19

PURPOSE OF REVIEW

The paper aims to provide an overview of the psychological and behavioural impacts of the COVID-19 pandemic, with a focus on variations in behavioural response in different geographical areas due to the existence of different social-cultural contexts.

RECENT FINDINGS

Whilst anxiety, depression and economic stressors are common findings worldwide, specific behavioural responses are heavily influenced by government stances, misinformation, conspiratorialism and competing demands of resource scarcity. This has led to very different understandings of the pandemic even in geographically close areas, and more so when comparing disparate regions such as Africa, South America and Europe. The paper also comments on the absence of robust evidence regarding increases of suicidality and violence on a global level, whilst noting evidence certainly exists in specific regions.

SUMMARY

The psychological and behavioural impact of COVID is heavily influenced by the local lens. Beyond a very broad brush approaches, expected behaviours from one area cannot easily be extrapolated to others. Where possible, clinicians should be guided by local data, ideally placing expectations of responses in a cultural context.

A living systematic review of the psychological problems in people suffering from COVID-19

OBJECTIVES

We aimed to investigate the psychological problems on people infected with SARS-CoV-2 during the pandemic.

METHODS

In this living systematic review and meta-analyses, we searched seven electronic databases for cross-sectional studies and longitudinal studies on psychological problems on COVID-19 patients from Jan 1, 2020 to Oct 7, 2020. The primary outcome was prevalence of various psychological problems such as anxiety, depression, stress, insomnia, somatization, and fear. We pooled data for prevalence with their 95% confidence interval (CI) using random effect models and assessed the study quality based on the 11-item checklist recommended by the Agency for Healthcare Research and Quality.

RESULTS

Fourty-four studies, including studies from China(35), Italy(2), Iran(2), India(1), Korea(1), Ecuador(1), Switzerland(1), Germany(1), were identified by comprising a total of 8587 completed questionnaires and 38 studies for meta-analyses. The prevalence of anxiety, depression, post-traumatic stress disorder(PTSD), insomnia, somatization, and fear in patients with COVID-19 was 16.6% (10.1%-23.1%), 37.7% (29.3%-46.2%), 41.5% (9.3%-73.7%), 68.3% (48.6%-88.0%), 36.5% (20.2%-52.8%), 47.6% (9.4%-85.7%), respectively. The prevalence of anxiety, depression, and insomnia in severe COVID-19 patients (intensive care unit inpatients) was higher than mild or clinically stable COVID-19 patients.

LIMITATIONS

A significant degree of heterogeneity in terms of populations, sampling methods, scales was noted across studies.

CONCLUSIONS

There existed high proportions of COVID-19 patients with psychological problem. The prevalence of psychological problems was closely related to the patients themselves, their surroundings and social support. It is imperative to provide ontime psychological care service for COVID-19 patients and to follow-up them for a longer period.

Prevalence of Psychological Impacts on Healthcare Providers during COVID-19 Pandemic in Asia

COVID-19 has impacted people psychologically globally, including healthcare providers. Anxiety, depression, and stress are the most common impacts that have affected these people. Thus, this study was aimed to ascertain the estimated prevalence of psychological impacts among healthcare providers in the Asian region. A systematic search was performed in the MEDLINE, CINAHL, and Scopus databases for original research articles published between 2020 and April 2021. Only studies published in English were included. The quality of data was assessed using the Joanna Briggs Institute Meta-Analysis, and the analysis was performed using generic inverse variance with a random-effects model by Review Manager software. A total of 80 studies across 18 countries in Asia region were pooled to assess the data prevalence on anxiety (34.81% (95% CI: 30.80%, 38.83%)), depression (34.61% (95% CI: 30.87%, 38.36%)), stress (31.72% (95% CI: 21.25%, 42.18%)), insomnia (37.89% (95% CI: 25.43%, 50.35%)), and post-traumatic stress disorder (15.29% (95% CI: 11.43%, 19.15%)). Subgroup analyses were conducted across regions, type of healthcare providers, sex, and occupation. This review has identified a high prevalence of anxiety, depression, stress, and insomnia but a low prevalence of post-traumatic stress disorder among healthcare providers in Asia regions. Effective intervention support programs are urgently needed to improve psychological health of healthcare providers and maintaining the health system.