Acute mental health responses during the COVID-19 pandemic in Australia

Pandemic Prevention: Lessons from COVID-19

Coronavirus disease 2019 (COVID-19) is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which appeared in late 2019, generating a pandemic crisis with high numbers of COVID-19-related infected individuals and deaths in manifold countries worldwide. Lessons learned from COVID-19 can be used to prevent pandemic threats by designing strategies to support different policy responses, not limited to the health system, directed to reduce the risks of the emergence of novel viral agents, the diffusion of infectious diseases and negative impact in society.

Mental Health of Young Australians during the COVID-19 Pandemic: Exploring the Roles of Employment Precarity, Screen Time, and Contact with Nature

The coronavirus disease 2019 (COVID-19) pandemic is widely understood to have contributed to mental health problems. In Australia, young people (18-24 years) have been disproportionately affected. To date, research has predominantly focused on the presence or absence of mental illness symptoms, while aspects of mental well-being have been overlooked. We aimed to explore associations between potential risk and protective factors and mental health more comprehensively, using the Complete State Model of Mental Health. An online survey of 1004 young Australians (55% female; M age = 21.23) was undertaken. Assessment of both mental illness and mental well-being enabled participants to be cross-classified into four mental health states. Those with 'Floundering' (13%) or 'Struggling' (47.5%) mental health reported symptoms of mental illness; a 'Languishing' group (25.5%) did not report symptoms of mental illness but mental well-being was compromised relative to those who were 'Flourishing' (14%) with high mental well-being. Multinomial logistic regressions were used to examine associations, adjusting for socio-demographic confounders. Protective factors associated with Flourishing mental health included being in secure employment, using screen time to connect with others, and reporting high levels of hope. Both incidental and purposive contact with nature were also associated with Flourishing, while a lack of green/bluespace within walking distance was associated with Languishing, absence of outdoor residential space was associated with Floundering, and lower neighbourhood greenness was associated with all three suboptimal mental health states. Precarious employment, financial stress, living alone, reporting decreased screen time during lockdowns, lower levels of hope, and high disruption of core beliefs were also associated with Struggling and Floundering mental health. Those who were Languishing reported somewhat less hardship and little disruption to core beliefs, but lower levels of hope compared to young people who were Flourishing. This study highlights that young adults require dedicated mental health services to deal with current burden, but should also be supported through a range of preventive strategies which target mental health risk factors, like precarious employment, and enhance protective factors, such as urban green infrastructure.

Change in modifiable dementia risk factors during COVID-19 lockdown: The experience of over 50s in Tasmania, Australia

INTRODUCTION

Containment measures implemented to minimize the spread of coronavirus disease 2019 (COVID-19) are reported to be negatively affecting mental health, diet, and alcohol consumption. These factors, as well as poor cardiometabolic health and insufficient physical and cognitive activity, are known to increase the risk of developing dementia. COVID-19 "lockdown" measures may have exacerbated these dementia risk factors among people in mid-to-later life.

METHODS

We compared longitudinal data from before (October 2019) and during (April-June 2020) the first COVID-19 lockdown period in Tasmania, Australia. Participants (n = 1671) were 50+ years of age and engaged in a public health program targeting dementia risk reduction, with one-third participating in the Preventing Dementia Massive Open Online Course (PD-MOOC). Regression models were used to assess changes in smoking, alcohol use, body mass index (BMI), diet, physical exercise, cognitive and social activity, anxiety and depression, and management of cholesterol, diabetes, and blood pressure. Where significant changes were noted, the moderating influence of being in current employment, living with others, and completing the PD-MOOC was tested.

RESULTS

Although friend networks contracted marginally during lockdown, no detrimental effects on modifiable dementia risk factors were noted. Anxiety levels and alcohol consumption decreased, there was no change in depression scores, and small but significant improvements were observed in cognitive and physical activity, smoking, diet, and BMI. Stronger improvements in cognitive activity were observed among people who were cohabiting (not living alone) and both cognitive activity and adherence to the MIND diet (Mediterranean-DASH diet Intervention for Neurological Delay) improved more for people who participated in the PD-MOOC.

DISCUSSION

Longitudinal data did not show widespread negative effects of COVID-19 lockdown on modifiable dementia risk factors in this sample. The results counter the dominant narratives of universal pandemic-related distress and suggest that engaging at-risk populations in proactive health promotion and education campaigns during lockdown events could be a protective public health strategy.

The COVID-19-Related Lockdown in Qatar: Associations Among Demographics, Social Distancing, Mood Changes, and Quality of Life

The worldwide spread of the coronavirus disease (COVID-19), the absence of medical treatment and vaccination, the delayed onset of symptoms, and the rapid human-to-human transmission have led the vast majority of countries to impose strict social distancing procedures. Whereas it appears that social distancing is an effective strategy for mitigating spread, it may also result in a variety of unintended negative consequences to individuals' psychological well-being and mental health. During the peak of the COVID-19 pandemic, the present study examined associations among some demographic variables (gender, age, marital and working statuses, and having a family member or a friend infected with COVID-19), acceptance of social distancing, mood changes, and quality of life (QoL) in Qatar, a high-income Middle Eastern Arabic-speaking country. Older, married, and working participants were more accepting of social distancing than younger, unmarried, and non-working participants, respectively. Participants indicated that, during this time, they became more distressed, upset, scared, irritable, nervous, and afraid, and less inspired and determined. In a stark contrast, more individuals indicated that they became more interested, alert, and attentive, whereas higher percentages of participants reported feeling less guilty, hostile, and ashamed. Social distancing correlated positively with negative affect, whereas social avoidances correlated positively with positive affect and with physical, psychological, social, and environmental QoL. Finally, positive affect correlated positively, and negative affect correlated negatively, with these four domains of QoL. These results highlight the need for public health and clinical providers to consider peoples' psychological well-being and mental health during the COVID-19 pandemic.

Impact of the COVID-19 pandemic on South Australia's emergency departments: evidence from two lockdowns

Objective This study assessed the impact of the COVID-19 pandemic on emergency departments (EDs) in South Australia, measured by changes in the number and casemix of patients in the system over time. Methods Data from the South Australia Emergency Department Dashboard, updated every 30min, were analysed for the period 4 October-21 December 2020. The Dashboard reports live counts of the number and type of patients in each of the six adult metropolitan public EDs in Adelaide, South Australia. Results There was a significant difference in the mean daily average occupied ED capacity before and during two distinct increases in COVID-19 cases in South Australia. An increase in COVID-19 cases coincided with a decrease in patients in EDs (Pearson's r =-0.93 and -0.67; P Conclusions During the two periods of COVID-19 case growth in South Australia, there was a significant drop in the number of patients presenting to the major public EDs and a change in the casemix of patients over time. What is known about the topic? EDs in Australia often operate at or over capacity, with frequent reports of ambulance ramping, access block and long waiting times. There have been reports internationally of significant declines in ED presentations throughout the COVID-19 pandemic. What does this paper add? This paper uses a novel publicly available data source that is available in real time to contribute a new perspective from South Australia, which has experienced two distinct periods of strict restrictions and lockdown. The research showed that the number of mental health presentations remained consistently high, despite a significant overall decline in ED occupancy. What are the implications for practitioners? This study demonstrates that South Australians are accessing emergency medical treatment differently in response to the COVID-19 pandemic. In the context of an overall decline in presentation numbers, the number of mental health-related presentations has not changed significantly, suggesting that this trend should be closely monitored. The findings corroborate the national concern that unwell people have avoided accessing emergency medical care during the pandemic, leading to worse outcomes and increased need for healthcare resources at a later date. It will be important to monitor and quickly detect further changes in ED usage using real-time data as the pandemic evolves, as well as in any future significant health crises.

Peritraumatic Distress during the COVID-19 Pandemic in Seoul, South Korea

The coronavirus disease (COVID-19) pandemic is traumatic and causes a substantial psychological burden on the general public. The aim of the present study is to examine the severity and prevalence of peritraumatic distress among the citizens of Seoul, which conducted preemptive and aggressive social distancing policy before the central government during the early stage of COVID-19. Furthermore, this study aims to explore the associated risk factors for peritraumatic distress, including risk perception, fear, and COVID-19-related experiences. We conducted an online survey to 813 participants at the end of the first wave of COVID-19 in South Korea. Peritraumatic distress inventory (PDI) was used to measure the level of pandemic-related distress. One-third of participants were at risk for the development of clinically elevated peritraumatic distress. The perception of risk, fear of COVID-19, and stigma were significantly associated with elevated levels of distress. Individuals who had poor health, or who spent more than 1 h per day using the media, also expressed a higher level of distress. Moreover, the level of disruption of daily life and financial difficulties due to the COVID-19 pandemic is significantly associated with a higher level of peritraumatic distress. The results of this study highlight the urgent need to develop evidence-based and tailored public mental health interventions, along with various measures to help recovery to daily life.

Global health disparities in vulnerable populations of psychiatric patients during the COVID-19 pandemic

The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population. In this narrative review, we examine the impact of the pandemic on significant global health disparities affecting vulnerable populations of psychiatric patients: People of diverse ethnic background and color, children with disabilities, sexual and gender minorities, pregnant women, mature adults, and those patients living in urban and rural communities. The identified disparities cause worsened mental health outcomes placing psychiatric patients at higher risk for depression, anxiety and posttraumatic stress disorder symptoms. Those psychiatric patients who are ethnic minorities display barriers to care, including collective trauma and structural racism. Sexual and gender minorities with mental illness face discrimination and limited access to treatment. Pregnant women with psychiatric diagnoses show higher exposure to domestic violence. Children with disabilities face a higher risk of worsening behavior. Mature adults with psychiatric problems show depression due to social isolation. Psychiatric patients who live in urban communities face pollutants and overcrowding compared to those living in rural communities, which face limited access to telehealth services. We suggest that social programs that decrease discrimination, enhance communal resilience, and help overcome systemic barriers of care should be developed to decrease global health disparities in vulnerable population.

Mental health policy: protecting community mental health during the COVID-19 pandemic

Despite the growing interest in the treatment and management of COVID-19, communities still end up experiencing multiple stresses with mental health crisis, due to the pandemic. When this is not addressed, it causes stress in the long run, with further mental health damage in individuals and the communities. Furthermore, relevant policy related to the community mental health was identified as awareness in promoting mental issues, yet there are still failures recorded in the aspect of adequately addressing the well-being concerns. This study aims to support community mental health during the crisis, through useful information from relevant articles. It also explains some perspectives from literature reviews, case reports, with society responses from Google Scholar, Science Direct, and Proquest databases concerning recent community mental health issues, and government policy on the impact of the COVID-19 pandemic. The inclusion criteria required articles that were peer-reviewed, by using i) English language March-September 2020; ii) Presented empirical studies related to COVID-19 (quantitative and qualitative); iii) Searched terms related to the general and community mental health, their policy, and COVID-19 pandemic. This study showed 19 articles related to community mental health issues or psychological wellbeing topics. The interventions provided to strengthen community mental health during the pandemic included emergency psychological crisis treatment, hotline assistance, online counseling service with mental care course, and outpatient consultation. Therefore, community mental health issues should be addressed with physical wellness. In addition, the community plays a key role in influencing stakeholders and governments, to increase the priority in supporting mental health.

Impact of the COVID-19 Pandemic on Older Adults: Rapid Review

BACKGROUND

The COVID-19 pandemic has drastically changed the lives of countless members of the general population. Older adults are known to experience loneliness, age discrimination, and excessive worry. It is therefore reasonable to anticipate that they would experience greater negative outcomes related to the COVID-19 pandemic given their increased isolation and risk for complications than younger adults.

OBJECTIVE

This study aims to synthesize the existing research on the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults. The secondary objective is to investigate the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults with Alzheimer disease and related dementias.

METHODS

A rapid review of the published literature was conducted on October 6, 2020, through a search of 6 online databases to synthesize results from published original studies regarding the impact of the COVID-19 pandemic on older adults. The Human Development Model conceptual framework-Disability Creation Process was used to describe and understand interactions between personal factors, environmental factors, and life habits. Methods and results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement.

RESULTS

A total of 135 records were included from the initial search strategy of 13,452 individual studies. Of these, 113 (83.7%) studies were determined to be of level 4 according to the levels of evidence classification by the Centre for Evidence-Based Medicine. The presence of psychological symptoms, exacerbation of ageism, and physical deterioration of aged populations were reported in the included studies. Decreased social life and fewer in-person social interactions reported during the COVID-19 pandemic were occasionally associated with reduced quality of life and increased depression. Difficulties accessing services, sleep disturbances, and a reduction of physical activity were also noted.

CONCLUSIONS

Our results highlight the need for adequate isolation and protective measures. Older adults represent a heterogeneous group, which could explain the contradictory results found in the literature. Individual, organizational, and institutional strategies should be established to ensure that older adults are able to maintain social contacts, preserve family ties, and maintain the ability to give or receive help during the current pandemic. Future studies should focus on specific consequences and needs of more at-risk older adults to ensure their inclusion, both in public health recommendations and considerations made by policy makers.

The Impact of the COVID-19 Pandemic on Mental Health: Evidence from Cyprus

The aim of the current study was to examine mental health effects of the first wave of COVID-19 (Corona Virus Disease-19) in Cyprus. Accordingly, 388 individuals aged 18–65+ responded to the Components of Mental Health Questionnaire that was distributed via social media for two weeks assessing how emotional distress, support and interest in self and others, lifestyle changes, engagement in protective measures, and avoidant behaviors were related to participants’ gender, age, and place of residency. Additionally, we measured the level of concern of individuals during and after the first wave outbreak of the pandemic. The results suggest that (a) females experience higher levels of anxiety, stress, fear, worry, and despair than males and are more likely to undertake protective measures, (b) older individuals and those who live in urban areas perceive greater social support and interest in the emotional experience of significant others, (c) emotional distress and support and interest in self and others are associated with all other variables, indicating the importance of these constructs to the experience of a pandemic, and (d) there was a decrease in participants’ concern after the end of the first wave of the pandemic. Mental health professionals could find this information useful when developing and implementing prevention programs that aim to offer psychological support during this stressful period.

Psychological Responses According to Gender during the Early Stage of COVID-19 in Spain

BACKGROUND

Current research has pointed out an increased risk of mental health problems during the COVID-19 pandemic in women compared to men, however the reason for this difference remains unclear. The aim of this research is to study early psychological responses to the pandemic in the Spanish general population, focusing on gender differences.

METHODS

Nine to 14 days after the declaration of a state of emergency an online survey was conducted assessing sociodemographic, health, behavioral and COVID-19-related variables. Mental health status was evaluated by the Depression, Anxiety and Stress Scale (DASS-21), the Impact of Event Scale-Revised (IES-R), and the Self-Care Scale (SCS).

RESULTS

The study included 3520 respondents: 2611 women and 909 men. Women scored significantly higher in DASS-21 and IES-R (p < 0.05) and were more likely to somatize, suffer from hypochondriasis, sleeping disturbances and claustrophobia (p < 0.05). Being a woman can be considered a risk factor for intrusive thoughts, avoidance mechanisms, stress and anxiety (Odd Ratio = 2.7/2.3/2.3/1.6). The risk of presenting posttraumatic symptoms and emotional distress was greater in women (Odd Ratio = 6.77/4.59). General linear models to predict IES-R and DASS-21 scores clarified which variables were gender specific, such as main concerns.

CONCLUSIONS

This study provides evidence that at early stages of the pandemic, women mental health was more impacted and that both genders show different concerns. Gender perspective in secondary and tertiary prevention strategies must be taken into account when facing the distress associated with the pandemic.

A mental health paradox: Mental health was both a motivator and barrier to physical activity during the COVID-19 pandemic

The COVID-19 pandemic has impacted the mental health, physical activity, and sedentary behavior of people worldwide. According to the Health Belief Model (HBM), health-related behavior is determined by perceived barriers and motivators. Using an online survey with 1669 respondents, we sought to understand why and how physical activity and sedentary behavior has changed by querying about perceived barriers and motivators to physical activity that changed because of the pandemic, and how those changes impacted mental health. The following results were statistically significant at p < .05. Consistent with prior reports, our respondents were less physically active (aerobic activity, -11%; strength-based activity, -30%) and more sedentary (+11%) during the pandemic as compared to 6-months before. The pandemic also increased psychological stress (+22%) and brought on moderate symptoms of anxiety and depression. Respondents' whose mental health deteriorated the most were also the ones who were least active (depression r = -.21, anxiety r = -.12). The majority of respondents were unmotivated to exercise because they were too anxious (+8%,), lacked social support (+6%), or had limited access to equipment (+23%) or space (+41%). The respondents who were able to stay active reported feeling less motivated by physical health outcomes such as weight loss (-7%) or strength (-14%) and instead more motivated by mental health outcomes such as anxiety relief (+14%). Coupled with previous work demonstrating a direct relationship between mental health and physical activity, these results highlight the potential protective effect of physical activity on mental health and point to the need for psychological support to overcome perceived barriers so that people can continue to be physically active during stressful times like the pandemic.

Sex Differences in the Association Between Stress, Loneliness, and COVID-19 Burden Among People with HIV in the United States

Little is known about the psychological implications of the coronavirus disease 2019 (COVID-19) pandemic on people with HIV. The purpose of this study was to assess the impact of COVID-19 among men and women with HIV in Miami, Florida. We hypothesized that the burden of the COVID-19 pandemic will be higher for women, and psychological factors will increase COVID-19 burden among them. People with (n = 231) and without HIV (n = 42) residing in Miami, Florida completed a survey assessing psychological outcomes such as loneliness, depression, and stress, as well as the burden of COVID-19, on their daily lives. t-Tests and chi-square analyses were used to assess sex differences in study variables. Logistic regression was used to compare the interaction effects predicting stress and loneliness by COVID-19 burden and sex. A total of 273 completed the survey; the outcomes of the study, loneliness, and stress did not differ by HIV status (p = .458 and p = .922). Overall, men and women reported similar prevalence of COVID-19 burden. However, a greater proportion of women reported losing childcare than men (18% vs. 9%, p = .029, respectively), as well as losing mental health care (15% vs. 7%, p = .049, respectively). There was a significant interaction between COVID-19 burden and sex for loneliness and stress such that the association between COVID-19 burden and loneliness was greater for women (p < .001) than for men (p = .353) and the association between COVID-19 burden and stress was greater for women (p = .013) than men (p = .628). Both men and women with HIV are impacted by the COVID-19 pandemic, but women may experience higher levels of stress and loneliness than men. Sex differences may require tailored interventions to more effectively mitigate the impact of the pandemic on mental health.

Psychological Health, Sleep Quality, Behavior, and Internet Use Among People During the COVID-19 Pandemic: A Cross-Sectional Study

Background: The COVID-19 pandemic has led to an increase in the risk of suicide, uncertainty, mental stress, terror, annoyance, weariness, financial issues, and frustration. We aim to determine the prevalence of insomnia, depressive and anxiety symptoms, and their associated factors among Libyan populations during the COVID-19 pandemic and the civil war. Methods: An online cross-sectional survey was conducted among the Libyan population between July 18 and August 23, 2020. The data collected included basic demographic characteristics, level of education, employment status, COVID-19-related questions, and questions about abuse and domestic violence. This study assessed the psychological status of participants who were screened for anxiety symptoms using the seven-item Generalized Anxiety Disorder scale (GAD-7). Depressive symptoms were also screened for using the two-item Patient Health Questionnaire (PHQ-2) and the Insomnia Severity Index (ISI). Binomial logistic regression was used to predict the probability of insomnia, anxiety and depressive symptoms. Results: A total of 10,296 responses were recorded. Among the participants, 4,756 (46.2%) obtained a cut-off score of ≥ 3 which indicated depressive symptoms. For anxiety, 1,952 participants (19%) obtained a cut-off score of ≥ 15, which indicated anxiety symptoms. For the ISI, the mean (SD) was 11.4 (6.1) for the following categories: no clinical insomnia (0-7) 3,132 (30.4%), sub-threshold insomnia (1-7) 3,747 (36.4%), moderate severity clinical insomnia (8-14) 2,929 (28.4%), and severe clinical insomnia (15-21) 488 (4.7%). Logistic regression analysis showed that depressive symptoms were statistically associated with age, marital status, education level, occupational category, financial problems during the COVID-19 pandemic, health status, having a COVID-19 infection, current health status, suicide ideation, abuse or domestic violence, and lockdown compliance (p < 0.05). The regression analysis revealed a statistically significant association between anxiety symptoms and age, education level, occupational status, financial problems during the COVID-19 pandemic, having a COVID-19 infection, health status, suicide ideation, abuse or domestic violence, and lockdown compliance (p < 0.05). The regression analysis revealed a statistically significant association between insomnia and all study variables with the exception of age, educational level, and occupational status (p < 0.05). Conclusion: Confronted with the COVID-19 outbreak, the Libyan population exhibited high levels of psychological stress manifested in the form of depressive and anxiety symptoms, while one-third of the Libyan population suffered from clinical insomnia. Policymakers need to promote effective measures to reduce mental health issues and improve people's quality of life during the civil war and the COVID-19 pandemic.

Psychosocial effects of social media on the Saudi society during the Coronavirus Disease 2019 pandemic: A cross-sectional study

The Coronavirus Disease 2019 (COVID-19) pandemic has been posing a substantial challenge to human survival and well-being, which rely on the actions and behaviors of individuals. It is essential that accurate information is distributed; however, misinformation has been spread via social media. Consequently, the resulting panic has to be addressed while putting essential public health measures in place. It is also important to explore the link between the social media exposure and well-being. Therefore, in the current study, we aimed to identify the levels of anxiety, depression, and social isolation among individuals during the COVID-19 pandemic. Additionally, we explored the relationship between exposure to misleading social media news and anxiety, depression, and social isolation. A cross sectional design was employed to collect data from 371 Saudi participants (aged 16–60 years), using the Generalized Anxiety Disorder-7, Centre for Epidemiological Studies Depression Scale, and de Jong Gierveld Loneliness Scale. Results showed that the prevalence of anxiety, depression, and social isolation was 47.82%, 47.57%, and 46.42%, respectively. Further, more than 83% of the participants reported using social media frequently during the pandemic. We found that exposure to misinformation via social media has a significant positive relationship with anxiety, depression, and social isolation. However, Due to the cross-sectional nature of this study it cannot be determined whether social media causes negative mental health outcomes, or if individuals experiencing greater depression, anxiety and social isolation turn to social media more than others, or if some third variable might explain both. Based on our findings, we present specific suggestions related to the COVID-19 pandemic to the government of Saudi Arabia. Minoring and filtering out misleading information with the cooperation of the World Health Organization (WHO) can promote the spread of accurate news in Saudi Arabia.

Influence of the COVID-19 Pandemic on Mood and Training in Australian Community Tennis Players

The COVID-19 outbreak has led to the implementation of strict restrictions in Australia, which have severely impacted sporting activities. Tennis is played by 6.2% of the population within the Oceania region, and is a valuable sport for maintaining social, mental, and physical health. Current literature indicates the COVID-19 pandemic has negatively affected the mental health of Australian residents. The aim of this study was to investigate changes in training and match play due to the outbreak, and its effects on emotional well-being of Australian senior tennis players. Additionally, explore any differences between middle aged (41–60 years) and senior (61 years and over) Australian tennis players. An online survey was used to assess training and match play habits, as well as ascertain the emotional well-being of tennis players. The survey was active from 24th April 2020 until 6th June 2020. Participants were adult (41+ years) tennis players from Australia. Wilcoxon signed rank tests were performed to check for differences in training hours and tennis matches played. Mann–Whitney U tests were used to assess the difference in Brief Emotional Experience Scale (BEES) scores, employment status as well as the training hours and tennis matches played between the two age groups. A Kendall's Tau B correlation test was performed to assess the associations of training, match play and demographic characteristics with BEES scores. Kruskal–Wallis tests assessed differences in BEES scores between participants of differing match play formats, tennis experience and cessation of tennis training time periods. There were 245 respondents who met our inclusion criteria. Tennis training hours along with the tennis matches played significantly decreased during COVID-19 compared to pre-COVID-19, 85.09 and 88.48%, respectively. No significant (p > 0.05) differences were observed between age groups for any of the training modality hours, nor was there any significant difference in number of tennis matches played. The participants average BEES score was 0.99 ± 1.27, indicating that respondents had a positive emotional well-being during the COVID-19 pandemic. The emotional well-being of the senior group was significantly (P = 0.002) higher than the middle aged group. Together, our results show that training and tennis match play decreased during the COVID-19 pandemic, however the emotional well-being of senior tennis players in Australia appeared to not be negatively affected.

Relationship Between Acute Stress Responses and Quality of Life in Chinese Health Care Workers During the COVID-19 Outbreak

This study aimed to determine the relationship between acute stress and quality of life and explore their influencing factors on health care workers. A descriptive cross-sectional study was conducted, and a sample of 525 health care workers was recruited from 15 hospitals through a convenient sampling method. Participants completed an online self-report questionnaire to assess their acute stress and quality of life. Descriptive and multiple linear regression statistics were used for this analysis. The results regarding acute stress responses varied significantly among the differences in marital status, physical activity, work status, perceived risk of contracting COVID-19, and the expected duration of the pandemic. Moreover, a younger age, lack of physical activity, being a front-line medical staff, and higher acute stress scores indicated a worse quality of life. Healthcare workers’ acute stress was negatively correlated with their quality of life. Therefore, the authorities should pay special attention to health care workers’ mental health and provide them with timely protection during the pandemic.

Differential Susceptibility to the Impact of the COVID-19 Pandemic on Working Memory, Empathy, and Perceived Stress: The Role of Cortisol and Resilience

There are important individual differences in adaptation and reactivity to stressful challenges. Being subjected to strict social confinement is a distressful psychological experience leading to reduced emotional well-being, but it is not known how it can affect the cognitive and empathic tendencies of different individuals. Cortisol, a key glucocorticoid in humans, is a strong modulator of brain function, behavior, and cognition, and the diurnal cortisol rhythm has been postulated to interact with environmental stressors to predict stress adaptation. The present study investigates in 45 young adults (21.09 years old, SD = 6.42) whether pre-pandemic diurnal cortisol indices, overall diurnal cortisol secretion (AUCg) and cortisol awakening response (CAR) can predict individuals' differential susceptibility to the impact of strict social confinement during the Coronavirus Disease 2019 (COVID-19) pandemic on working memory, empathy, and perceived stress. We observed that, following long-term home confinement, there was an increase in subjects' perceived stress and cognitive empathy scores, as well as an improvement in visuospatial working memory. Moreover, during confinement, resilient coping moderated the relationship between perceived stress scores and pre-pandemic AUCg and CAR. In addition, in mediation models, we observed a direct effect of AUCg and an indirect effect of both CAR and AUCg, on change in perceived self-efficacy. These effects were parallelly mediated by the increase in working memory span and cognitive empathy. In summary, our findings reveal the role of the diurnal pattern of cortisol in predicting the emotional impact of the COVID-19 pandemic, highlighting a potential biomarker for the identification of at-risk groups following public health crises.

A Cross-Country Examination on the Fear of COVID-19 and the Sense of Loneliness during the First Wave of COVID-19 Outbreak

The aim of the current study is to examine gender, age. and cross-country differences in fear of COVID-19 and sense of loneliness during the lockdown, by comparing people from those countries with a high rate of infections and deaths (e.g., Spain and Italy) and from countries with a mild spread of infection (e.g., Croatia, Serbia, Slovakia, Slovenia, and Bosnia and Herzegovina). A total of 3876 participants (63% female) completed an online survey on "Everyday life practices in COVID-19 time" in April 2020, including measures of fear of COVID-19 and loneliness. Males and females of all age groups in countries suffering from the powerful impact of the COVID-19 pandemic reported greater fear of COVID-19 and sense of loneliness. In less endangered countries, females and the elderly reported more symptoms than males and the young; in Spanish and Italian samples, the pattern of differences is considerably more complex. Future research should thoroughly examine different age and gender groups. The analysis of emotional well-being in groups at risk of mental health issues may help to lessen the long term social and economic costs due to the COVID-19 outbreak.

Indirect Impacts of COVID-19: A Case Study of Evidence, Advice and Representation From Consumer and Community Members in New South Wales Australia

The COVID-19 pandemic continues to affect health care systems globally, and there is widespread concern about the indirect impacts of COVID-19. Indirect impacts are caused by missed or delayed health care—not as a direct consequence of COVID-19 infections. This study gathered experiences of, and perspectives on, the indirect impacts of COVID-19 for health consumers, patients, their families and carers, and the broader community in New South Wales, Australia. A series of semi-structured virtual group discussions were conducted with 33 health consumers and community members between August 24 and August 31, 2020. Data were analyzed using an inductive thematic analysis approach. The analysis identified 3 main themes: poor health outcomes for individuals; problems with how health care is designed and delivered; and increasing health inequality. This case study provides insight into the indirect impacts of COVID-19. Health systems can draw on the insights learned as a source of experiential evidence to help identify, monitor and respond to the indirect impacts of COVID-19.

The voice of mental health practice in Australia: a mixed-method cross-sectional study of gaps and areas of need

OBJECTIVES

To examine the perceptions of health professionals regarding the gaps in mental health service provision in Australia and their need for assistance in managing patients with mental illness.

METHOD

A total of 570 health professionals participated in an anonymous online survey in January 2018 that assessed: i) health professionals' current levels of need for assistance in the management of patients with mental health conditions; and ii) perceived gaps in the mental health care system, and how these can be addressed. Data were analysed using a mixed-methods approach.

RESULTS

Of those surveyed, 71.2% of health professionals and 77.3% of general practitioners reported that they required assistance in managing their patients with at least one stage of care for at least one type of mental disorder. Qualitative analyses revealed eight major themes in health professionals' perceptions of gaps in mental health service provision, including affordability and accessibility, the problems with crisis-driven care and the 'missing middle'.

CONCLUSION

Overall, the results of this study provide a concerning insight into the substantial gaps in mental health care within the Australian system. Implications for public health: The results of this study add weight to ongoing calls for reform of and increased investment in the Australian mental health care system.

Connection to... Addressing Digital Inequities in Supporting the Well-Being of Young Indigenous Australians in the Wake of COVID-19

(1) Background: This article examines whether connection to digital technologies helps connect young Indigenous people in Australia to culture, community and country to support good mental health and well-being and protect against indirect and potentially long-term effects of COVID-19. (2) Method: We reviewed literature published between February and November 2020 and policy responses related to digital strategies. We searched PubMed, Google Scholar, government policy websites and key Indigenous literature sources, identifying 3460 articles. Of these, 30 articles and 26 policy documents were included and analysed to identify existing and expected mental health outcomes among Indigenous young people associated with COVID-19 and more broadly. (3) Results: There are inequities in affordable access to digital technologies. Only 63% of Indigenous people have access to internet at home. Digital technologies and social media contribute to strong cultural identity, enhance connections to community and country and improve mental health and social and emotional well-being outcomes. (4) Discussion: Access to digital technologies can facilitate healing and cultural continuity, self-determination and empowerment for young people to thrive, not just survive, in the future. (5) Conclusion: More targeted policies and funding is urgently needed to promote digital technologies to enhance Indigenous young people's access to mental health and well-being services, maintain cultural connections and evaluate the effectiveness of these initiatives using Indigenous well-being indicators.

Use of telehealth mental health services during the COVID-19 pandemic

During the COVID-19 pandemic, specific mental health telehealth services in Australia have been an important source of help for the increasingly stressed population. This study examined trends in the uptake of telehealth items for mental health during the first 6 months of the COVID-19 pandemic using administrative Medicare data. During the peak of the pandemic there was a 50% reduction in the in-person consultations for mental health but also a substantial increase in uptake largely of the newly introduced temporary Medicare Benefits Schedule telehealth services. Further, the use of telehealth varied across age, gender and state/territory. These findings have important implications for the allocation of resources for telehealth, both now, and into the post-COVID-19 era.

Relations between Child and Parent Fears and Changes in Family Functioning Related to COVID-19

In adults, higher anxiety level related to COVID-19 has been associated with having a pre-existing medical or mental health condition and poor sleep quality. However, no study yet has looked at these links in children. The present study's main aim was to assess family changes associated with child and parent fears and concerns about COVID-19. We conducted a cross-sectional study among 144 families with children aged 9-12 years during the COVID-19 lockdown period. Families came from Quebec, Canada, and the survey was done in the early stages of the lockdown (April-May 2020). A phone-based survey assessed parent and child COVID-19-related fears and concerns, family-related changes and health issues. Results showed the more fears parents have about COVID-19, the more fears their child also has. Moreover, changes in family sleep habits were associated with parental and child fears and concerns about COVID-19. Reduced access to health services was associated with parental concerns about COVID-19. If another lockdown was to be put in place in the future, it would be important to inform families on the importance of sleep schedules and to maintain or increase health appointments when possible.

Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study

BACKGROUND

There is major concern about the impact of the global COVID-19 outbreak on mental health. Several studies suggest that mental health deteriorated in many countries before and during enforced isolation (ie, lockdown), but it remains unknown how mental health has changed week by week over the course of the COVID-19 pandemic. This study aimed to explore the trajectories of anxiety and depression over the 20 weeks after lockdown was announced in England, and compare the growth trajectories by individual characteristics.

METHODS

In this prospective longitudinal observational study, we analysed data from the UCL COVID-19 Social Study, a panel study weighted to population proportions, which collects information on anxiety (using the Generalised Anxiety Disorder assessment) and depressive symptoms (using the Patient Health Questionnaire) weekly in the UK since March 21, 2020. We included data from adults living in England who had at least three repeated measures between March 23 and Aug 9, 2020. Analyses were done using latent growth models, which were fitted to account for sociodemographic and health covariates.

FINDINGS

Between March 23, and Aug 9, data from over 70 000 adults were collected in the UCL COVID-19 Social Study. When including participants living in England with three follow-up measures and no missing values, our analytic sample consisted of 36 520 participants. The average depression score was 6·6 (SD=6·0, range 0-27) and the average anxiety score 5·7 (SD=5·6, range 0-21) in week 1. Anxiety and depression levels both declined across the first 20 weeks following the introduction of lockdown in England (b=-1·93, SE=0·26, p<0·0001 for anxiety; b=-2·52, SE=0·28, p<0·0001 for depressive symptoms). The fastest decreases were seen across the strict lockdown period (between weeks 2 and 5), with symptoms plateauing as further lockdown easing measures were introduced (between weeks 16 and 20). Being a woman or younger, having lower educational attainment, lower income, or pre-existing mental health conditions, and living alone or with children were all risk factors for higher levels of anxiety and depression at the start of lockdown. Many of these inequalities in experiences were reduced as lockdown continued, but differences were still evident 20 weeks after the start of lockdown.

INTERPRETATION

These data suggest that the highest levels of depression and anxiety occurred in the early stages of lockdown but declined fairly rapidly, possibly because individuals adapted to circumstances. Our findings emphasise the importance of supporting individuals in the lead-up to future lockdowns to try to reduce distress, and highlight that groups already at risk for poor mental health before the pandemic have remained at risk throughout lockdown and its aftermath.

FUNDING

Nuffield Foundation, UK Research and Innovation, Wellcome Trust.

Perceived Benefits and Harms of the COVID-19 Pandemic on Family Well-Being and Their Sociodemographic Disparities in Hong Kong: A Cross-Sectional Study

We assessed the perceived benefits and harms of COVID-19 on family and their associations with sociodemographic factors in Chinese adults in Hong Kong. We conducted an online population-based survey and collected 4891 responses in 6 days. Prevalence estimates were weighted by sex, age, and education of the general population, and associations were analyzed using logistic regression. Our results showed both perceived benefits: 19.0% for family physical health, 7.2% family mental health, and 13.5% family relationships; and harms: 2.3% for family physical health, 37.9% family mental health, 18.6% family relationships, and 37.8% decreased family income. More female or older respondents reported perceived benefits but fewer of them reported perceived harms. More respondents with higher than lower socioeconomic scores (SES) reported perceived benefits on family physical and mental health and family relationships, but more respondents with lower than higher SES reported perceived harm on family income. As the pandemic continues with uncertainties, further studies on the dynamics of benefits and harms are needed. Urgent and additional assistance to underprivileged families and at-risk individuals are needed to reduce the inequities amidst the COVID-19 pandemic.

COVID-19 Impact on Smokers Participating in Smoking Cessation Trials: The Experience of Nondaily Smokers Participating in a Smartphone App Study

Objectives: To provide initial insight into how the COVID-19 pandemic could affect smoking behaviors and cessation efforts that were underway at its onset. Methods: An additional survey was added to follow-up assessments in an ongoing smoking cessation study for nondaily smokers: a measure of impact of COVID-19 and a subset of previously administered scales measuring smoking, emotional well-being, and alcohol use. Pre-post tests were conducted (84 ± 28 days apart). Results: Participants (81/100 of enrolled; 67% female, 75% white, 10% Hispanic, 37 ± 11 years old) reported experiencing changes regarding work (35% income reduction/loss; 35% remote work) and living situation (15% consolidated residences). Participants reported their motivation to quit smoking "slightly" increased after COVID-19 (p < 0.001), more so in those having achieved 30-day abstinence (p = 0.0045). Worry, fear, and a desire to support the greater good increased (ps < 0.05). Increases in motivation to quit correlated positively with prosocial and wellness changes. Data from pre- to post-COVID-19 onset showed decreases in emotional well-being (increased stress, negative affect, decreased coping, positive affect, all ps < 0.01), but not changes in smoking abstinence (p = 0.65), readiness to quit (p = 0.16), smoking frequency (p = 0.96), or cigarettes per day (p = 0.96). Heavy drinking decreased (p < 0.01). Trying e-cigarettes increased (p = 0.04). Conclusions: Nondaily smokers participating in a smoking cessation study during the COVID-19 pandemic reported worsened emotional well-being without effects on smoking outcomes and said their motivation to quit was slightly increased. Correlations of motivation to quit with prosocial and wellness changes suggest that targeting these constructs may be particularly helpful during a pandemic.

Mental health status and risk factors during Covid-19 pandemic in the Croatia's adult population

Background: The Covid-19 pandemic is associated with adverse mental health outcomes for people worldwide.Objective: The study aimed to assess mental health during the Covid-19 pandemic and the key risk factors from the human ecology perspective in Croatia's adult population.Method: An online panel survey with 1,201 adult participants (50.1% women) was done with a nationally representative sample in terms of gender, age, and country region four months after the nation lockdown began and two months after most of the restrictions were lifted. Indicators of mental health included symptoms of adjustment disorder (ADNM-8); depression, anxiety, and stress (DASS-21); symptoms of post-traumatic stress disorder (PC-PTSD-5); and well-being (WHO-5).Results: In the entire sample, 9.8% (95% confidence interval [CI]: 7.9%, 14.0%) of the participants were at risk of adjustment disorder, 7.7% (95% CI: 6.7%, 11.9%) were at risk of depression disorder, and 7.8% (95% CI: 5.3%, 10.3%) were at risk of anxiety disorder. In addition, 7.2% (95% CI: 5.3%, 10.2%) were experiencing high levels of stress. The average well-being score was 56.5 (SD = 21.91) on a scale from 0 to 100. Among the participants who have lifetime traumatic experience (n = 429), 14% (95% CI: 10.6%, 17.2%) were at risk for PTSD. Key risk factors for specific mental health outcomes differed, but the common ones included: current health status, previous mental health diagnosis, and psychological resilience. Being younger, having a below-average income, and excessively following news about Covid-19 were predictive for some of the mental health problems.Conclusions: Together, the key risk factors identified in this study indicate the need for public health interventions addressing the general population's mental health, but also for specific risk groups. Lower rates of mental health symptoms assessed soon after lifting quarantine measures that have been found in other studies may indicate human resilience capacity.

The association between COVID-19 related stressors and mental health in refugees living in Australia

BACKGROUND

Refugees may be particularly vulnerable to the adverse effects of the COVID-19 pandemic on mental health due to their traumatic pasts and the challenges of the postmigration environment.

OBJECTIVE

To evaluate the prevalence of COVID-19 related stressors and their relationship to key mental health and functioning outcomes in a resettled refugee sample.

METHOD

N = 656 refugees and asylum seekers living in Australia completed a survey in June 2020 to index their mental health (posttraumatic stress disorder (PTSD), depression, health anxiety and disability) and COVID-19 experiences. The relationship between COVID-19 stressors and mental health was examined using a series of hierarchical linear regression models while controlling for other key demographic factors.

RESULTS

Refugees' most prevalent stressors related to worries of being infected by COVID-19 or the risk COVID-19 posed to others, which predicted health anxiety and PTSD. Social-related difficulties predicted depression and disability symptoms. Accessing and trusting information from authorities were the least prevalent stressors and were not significantly associated with mental health outcomes; neither was accessing basic supplies and financial support. Fears relating to the future such as concerns about visa application processes predicted health anxiety and disability. Crucially, the strongest predictor of all mental health outcomes was COVID-19 serving as a reminder of difficult past events.

CONCLUSIONS

Refugees may be uniquely affected by COVID-19 because the pandemic serves as a reminder of their past conflict and persecution trauma. It is critical that mental health strategies accommodate the specific needs of refugees during the COVID-19 pandemic.

Emotional Well-Being Under Conditions of Lockdown: An Experience Sampling Study in Austria During the COVID-19 Pandemic

The coronavirus (COVID-19) pandemic and attendant lockdown measures present serious threats to emotional well-being worldwide. Here, we examined the extent to which being outdoors (vs. indoors), the experience of loneliness, and screen-time are associated with emotional well-being during the COVID-19 pandemic using an experiencing sampling method. In April 2020, Austrian adults (N = 286, age M = 31.0 years) completed a 21-day experience sampling phase in which they reported their emotional well-being (i.e., happiness), whether they were indoors or outdoors, and loneliness at three random time-points each day, as well as their daily screen-time. Results indicated that being outdoors was associated with higher emotional well-being, whereas greater loneliness and greater daily screen-time were associated with poorer well-being. Additionally, the impact of loneliness on well-being was weaker when participants were outdoors than indoors. These results have health policy implications for the promotion of population well-being during pandemics.

Stress-related emotional and behavioural impact following the first COVID-19 outbreak peak

The COVID-19 pandemic poses multiple psychologically stressful challenges and is associated with an increased risk for mental illness. Previous studies have focused on the psychopathological symptoms associated with the outbreak peak. Here, we examined the behavioural and mental-health impact of the pandemic in Israel using an online survey, during the six weeks encompassing the end of the first outbreak and the beginning of the second. We used clinically validated instruments to assess anxiety- and depression-related emotional distress, symptoms, and coping strategies, as well as questions designed to specifically assess COVID-19-related concerns. Higher emotional burden was associated with being female, younger, unemployed, living in high socioeconomic status localities, having prior medical conditions, encountering more people, and experiencing physiological symptoms. Our findings highlight the environmental context and its importance in understanding individual ability to cope with the long-term stressful challenges of the pandemic.

Emotional Well-Being Under Conditions of Lockdown: An Experience Sampling Study in Austria During the COVID-19 Pandemic

The coronavirus (COVID-19) pandemic and attendant lockdown measures present serious threats to emotional well-being worldwide. Here, we examined the extent to which being outdoors (vs. indoors), the experience of loneliness, and screen-time are associated with emotional well-being during the COVID-19 pandemic using an experiencing sampling method. In April 2020, Austrian adults (N = 286, age M = 31.0 years) completed a 21-day experience sampling phase in which they reported their emotional well-being (i.e., happiness), whether they were indoors or outdoors, and loneliness at three random time-points each day, as well as their daily screen-time. Results indicated that being outdoors was associated with higher emotional well-being, whereas greater loneliness and greater daily screen-time were associated with poorer well-being. Additionally, the impact of loneliness on well-being was weaker when participants were outdoors than indoors. These results have health policy implications for the promotion of population well-being during pandemics.

Use of Asynchronous Virtual Mental Health Resources for COVID-19 Pandemic-Related Stress Among the General Population in Canada: Cross-Sectional Survey Study

BACKGROUND

The COVID-19 pandemic has resulted in profound mental health impacts among the general population worldwide. As many in-person mental health support services have been suspended or transitioned online to facilitate physical distancing, there have been numerous calls for the rapid expansion of asynchronous virtual mental health (AVMH) resources. These AVMH resources have great potential to provide support for people coping with negative mental health impacts associated with the pandemic; however, literature examining use prior to COVID-19 illustrates that the uptake of these resources is consistently low.

OBJECTIVE

The aim of this paper is to examine the use of AVMH resources in Canada during the COVID-19 pandemic among the general population and among a participant subgroup classified as experiencing an adverse mental health impact related to the pandemic.

METHODS

Data from this study were drawn from the first wave of a large multiwave cross-sectional monitoring survey, distributed from May 14 to 29, 2020. Participants (N=3000) were adults living in Canada. Descriptive statistics were used to characterize the sample, and bivariate cross-tabulations were used to examine the relationships between the use of AVMH resources and self-reported indicators of mental health that included a range of emotional and coping-related responses to the pandemic. Univariate and fully adjusted multivariate logistic regression models were used to examine associations between sociodemographic and health-related characteristics and use of AVMH resources in the subgroup of participants who reported experiencing one or more adverse mental health impacts identified in the set of self-reported mental health indicators.

RESULTS

Among the total sample, 2.0% (n=59) of participants reported accessing AVMH resources in the prior 2 weeks to cope with stress related to the COVID-19 pandemic, with the highest rates of use among individuals who reported self-harm (n=5, 10.4%) and those who reported coping "not well" with COVID-19-related stress (n=22, 5.5%). Within the subgroup of 1954 participants (65.1% of the total sample) who reported an adverse mental health impact related to COVID-19, 54 (2.8%) reported use of AVMH resources. Individuals were more likely to have used AVMH resources if they had reported receiving in-person mental health supports, were connecting virtually with a mental health worker or counselor, or belonged to a visible minority group.

CONCLUSIONS

Despite substantial government investment into AVMH resources, uptake is low among both the general population and individuals who may benefit from the use of these resources as a means of coping with the adverse mental health impacts of the COVID-19 pandemic. Further research is needed to improve our understanding of the barriers to use.

Changes in demand for emergency ambulances during a nationwide lockdown that resulted in elimination of COVID-19: an observational study from New Zealand

OBJECTIVE

To examine the impact of a 5-week national lockdown on ambulance service demand during the COVID-19 pandemic in New Zealand.

DESIGN

A descriptive cross-sectional, observational study.

SETTING

High-quality data from ambulance electronic clinical records, New Zealand.

PARTICIPANTS

Ambulance records were obtained from 588 690 attendances during pre-lockdown (prior to 17 February 2020) and from 36 238 records during the lockdown period (23 March to 26 April 2020).

MAIN OUTCOME MEASURES

Ambulance service utilisation during lockdown was compared with pre-lockdown: (a) descriptive analyses of ambulance events and proportions of event types for each period, (b) absolute rates of ambulance attendance (event types/week) for each period.

RESULTS

During lockdown, ambulance patients were more likely to be attended at home and less likely to be aged between 16 and 25 years. There was a significant increase in the proportion of lower acuity patients (Status 3 and Status 4) attended (p<0.001) and a corresponding increase in patients not transported from scene (p<0.001). Road traffic crashes (p<0.001) and alcohol-related incidents (p<0.001) significantly decreased. There was a decrease in the absolute number of weekly ambulance attendances (ratio (95% CI), 0.89 (0.87 to 0.91), p<0.001), attendances to respiratory conditions (0.74 (0.61 to 0.86), p=0.01), and trauma (0.81 (0.77 to 0.85), p<0.001). However, there was a significant increase in ambulance attendances for mental health conditions (1.37 (1.22 to 1.51), p=0.005).

CONCLUSIONS

Despite the relative absence of COVID-19 in the community during the 5-week nationwide lockdown, there were significant differences in ambulance utilisation during this period. The lockdown was associated with an increase in ambulance attendances for mental health conditions and is of concern. In considering future lockdowns, the potential implications on a population's mental well-being will need to be seriously considered against the benefits of elimination of virus transmission.

Risk Factors Underlying COVID-19 Lockdown-Induced Mental Distress

Recent reports suggest that the COVID-19 lockdown resulted in changes in mental health, however, potential age-related changes and risk factors remain unknown. We measured COVID-19 lockdown-induced stress levels and the severity of depressive symptoms prior to and during the COVID-19 lockdown in different age groups and then searched for potential risk factors in a well-characterized general population-based sample. A total of 715 participants were tested for mental distress and related risk factors at two time-points, baseline testing prior to COVID-19 and follow-up testing during COVID-19, using a battery of validated psychological tests including the Perceived Stress Scale and the Patient Health Questionnaire. Longitudinal measurements revealed that the prevalence of moderate to high stress and the severity of depressive symptoms increased 1.4- and 5.5-fold, respectively, during the COVID-19 lockdown. This surge in mental distress was more severe in women, but was present in all age groups with the older age group exhibiting, cross-sectionally, the lowest levels of mental distress prior to and during the lockdown. Illness perception, personality characteristics such as a feeling of loneliness, and several lifestyle components were found to be associated with a significant increase in mental distress. The observed changes in mental health and the identified potential risk factors underlying these changes provide critical data justifying timely and public emergency-tailored preventive, diagnostic, and therapeutic mental health interventions, which should be integrated into future public health policies globally.

Alcohol Use and COVID-19: Can we Predict the Impact of the Pandemic on Alcohol Use Based on the Previous Crises in the 21st Century? A Brief Review

The enormous health and economic challenges precipitated by the 2019 coronavirus disease (COVID-19) pandemic are comparable or even greater than those associated with previous historical world crises. Alcohol use, especially drinking to cope with stress, is a concern, as an increase in its sales has been reported in some countries during the quarantine. This study aims to provide a better understanding of what to expect in terms of alcohol consumption, risk factors for excessive use, and its potential consequences during this pandemic based on previous experiences. We investigated how traumatic events related to alcohol consumption. Studies on mass traumatic events (i.e., terrorism as 9/11), epidemic outbreaks (i.e., severe acute respiratory syndrome [SARS] in 2003), economic crises (such as 2008's Great Recession), and COVID-19 were selected. The main keywords used to select the studies were alcohol use, drinking patterns, alcohol use disorders, and alcohol-related consequences. Previous studies reported increases in alcohol use associated with those events mediated, at least partially, by anxiety and depressive symptoms, and posttraumatic stress disorder (PTSD). Being male, young, and single also seems to be associated with a higher vulnerability to develop risky drinking behavior after those tragic events. The discussion of previous risk and protective factors can contribute to elaborate more specific public health policies to mitigate the impact of the current pandemic on people's mental health, especially alcohol-related problems.

Social, financial and psychological stress during an emerging pandemic: observations from a population survey in the acute phase of COVID-19

INTRODUCTION

The negative impacts of COVID-19 have rippled through every facet of society. Understanding the multidimensional impacts of this pandemic is crucial to identify the most critical needs and to inform targeted interventions. This population survey study aimed to investigate the acute phase of the COVID-19 outbreak in terms of perceived threats and concerns, occupational and financial impacts, social impacts and stress between 3 April and 15 May 2020.

METHODS

6040 participants are included in this report. A multivariate linear regression model was used to identify factors associated with stress changes (as measured by the Cohen's Perceived Stress Scale (PSS)) relative to pre-outbreak retrospective estimates.

RESULTS

On average, PSS scores increased from low stress levels before the outbreak to moderate stress levels during the outbreak (p<0.001). The independent factors associated with stress worsening were: having a mental disorder, female sex, having underage children, heavier alcohol consumption, working with the general public, shorter sleep duration, younger age, less time elapsed since the start of the outbreak, lower stress before the outbreak, worse symptoms that could be linked to COVID-19, lower coping skills, worse obsessive-compulsive symptoms related to germs and contamination, personalities loading on extraversion, conscientiousness and neuroticism, left wing political views, worse family relationships and spending less time exercising and doing artistic activities.

CONCLUSION

Cross-sectional analyses showed a significant increase from low to moderate stress during the COVID-19 outbreak. Identified modifiable factors associated with increased stress may be informative for intervention development.

TRIAL REGISTRATION NUMBER

NCT04369690; Results.

Safe but Lonely? Loneliness, Anxiety, and Depression Symptoms and COVID-19

Background

The COVID-19 pandemic has led governments worldwide to implement unprecedented response strategies. While crucial to limiting the spread of the virus, “social distancing” may lead to severe psychological consequences, especially in lonely individuals.

Methods

We used cross-sectional (n = 380) and longitudinal (n = 74) designs to investigate the links between loneliness, anxiety, and depression symptoms (ADS) and COVID-19 risk perception and affective response in young adults who implemented social distancing during the first 2 weeks of the state of epidemic threat in Poland.

Results

Loneliness was correlated with ADS and with affective response to COVID-19’s threat to health. However, increased worry about the social isolation and heightened risk perception for financial problems was observed in lonelier individuals. The cross-lagged influence of the initial affective response to COVID-19 on subsequent levels of loneliness was also found.

Conclusion

The reciprocal connections between loneliness and COVID-19 response may be of crucial importance for ADS during the COVID-19 crisis.

Anxiety and depression symptoms, and lack of emotional support among the general population before and during the COVID-19 pandemic. A prospective national study on prevalence and risk factors

BACKGROUND

The effects of the COVID-19 pandemic on the mental health and emotional support among the general population are unclear. We therefore assessed if the prevalence of high Anxiety and Depression Symptoms (ADS) levels and lack of Emotional Support (ES) increased, and if risk factors of ADS and ES changed.

METHODS

Data was extracted from surveys conducted with the Dutch longitudinal population-based LISS panel (N = 3,983). ADS and ES were assessed in March 2019 and 2020. Risk factors for ADS and ES were extracted from surveys in November 2018 and 2019. These were: ADS, gender, education, domestic situation, employment, age, ethnicity, lung and heart problems, and diabetes.

RESULTS

The prevalence of high ADS levels and lack of ES did not increase compared to the pre-outbreak prevalence. ADS, non-native ethnic background, (partial) work disabilities and lung problems were predictive of both ADS and lack of ES in March 2019 and 2020. Job seekers, students and those who take care of housekeeping were more at risk for ADS in March 2020, but not in 2019. While 35-49 years old respondents were less at risk for ADS in March 2019, they were more at risk in 2020. Parents with child(ren) at home and those who take care of housekeeping more often lacked ES in March 2020, but not in 2019.

LIMITATIONS

No other mental health problems were assessed.

CONCLUSIONS

No increase in the prevalence of ADS and lack of ES was found. Some risk factors remained significant after the outbreak, while others changed notably.

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

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

Before-and-after online community survey on knowledge and perception of COVID-19 pandemic

BACKGROUND

COVID-19 pandemic impacts many communities worldwide. In this study the Poles' knowledge about COVID-19 as well as people's behaviours, attitudes and fears during the pandemic were assessed. Changes in these between the outset of the pandemic and the imposition of the strictest lockdown measures in Poland were investigated.

METHODS

Physicians, nurses, students of medicine-oriented faculties, non-medical professionals, students of non-medicine-oriented faculties and secondary school students were surveyed by an anonymous online questionnaire two times: at the onset of the pandemic and in the second week of the strictest lockdown. Statistical analyses were performed using non-parametric tests - Pearson Chi Square, Kruskal-Wallis tests.

RESULTS

In total 2618 responses were collected. At the beginning people knew that the respiratory system was attacked (97.9%); correctly identified the major symptoms of COVID-19 (95.0%) and ways to prevent infection: hand washing (99.8%), covering mouth (85.9%) and the need to call sanitary-epidemiological services if one experienced COVID-19-like symptoms (92.1%). The biggest changes between the first and second phase of the study concerned behaviours: more people wearing facial masks (+ 37.5%) and staying at home (+ 66.1%). Respondents in the second wave of the survey were also more scared of the pandemic (+ 19.6%), economic crisis (+ 64.1%), and worried about their families (+ 26.5%). However, they were less afraid of the quarantine (lockdown) (- 18.2%). Nurses and physicians were the most worried groups.

CONCLUSIONS

The study showed that even at the outset of the pandemic Polish population had a good initial knowledge about symptoms, transmission, and preventive behaviours regarding COVID-19. People revealed more short-term concerns, such as the worries about coping with quarantine and isolation. After a month, the knowledge and the concerns among the respondents changed. A shift towards long-term pandemic management issues was observed. Respondents reported to experience more fears concerning the pandemic in general, as well as economic and healthcare crises. Medical professionals reported higher level of fear of the pandemic than other groups included in this study. This study uses before-and-after approach which highlights the changes in people's knowledge and perception of the COVID-19 pandemic during the pandemic's progression.

Purchasing, consumption, demographic and socioeconomic variables associated with shifts in alcohol consumption during the COVID-19 pandemic

INTRODUCTION AND AIMS

Restrictions introduced to reduce the spread of COVID-19 have had major impacts on the living circumstances of Australians. This paper aims to provide insight into shifts in alcohol consumption and associated factors during the epidemic.

DESIGN AND METHODS

A cross-sectional convenience sample of 2307 Australians aged 18 and over who drank at least monthly was recruited through social media. Respondents were asked about their alcohol consumption and purchasing in 2019 prior to the epidemic plus similar questions about their experiences in the month prior to being surveyed between 29 April and 16 May 2020.

RESULTS

Reports of average consumption before (3.53 drinks per day [3.36, 3.71 95% confidence interval]) and during (3.52 [3.34, 3.69]) the pandemic were stable. However, young men and those who drank more outside the home in 2019 reported decreased consumption during the pandemic, and people with high levels of stress and those who bulk-bought alcohol when restrictions were announced reported an increase in consumption relative to those who did not.

DISCUSSION AND CONCLUSIONS

A reported increase in consumption among those experiencing more stress suggests that some people may have been drinking to cope during the epidemic. Conversely, the reported decrease in consumption among those who drank more outside of their home in 2019 suggests that closing all on-trade sales did not result in complete substitution of on-premise drinking with home drinking in this group. Monitoring of relevant subgroups to assess long-term changes in consumption in the aftermath of the epidemic is recommended.

A Mobile Health Intervention (LifeBuoy App) to Help Young People Manage Suicidal Thoughts: Protocol for a Mixed-Methods Randomized Controlled Trial

BACKGROUND

Self-help smartphone apps offer a new opportunity to address youth suicide prevention by improving access to support and by providing potentially high fidelity and cost-effective treatment. However, there have been very few smartphone apps providing evidence-based support for suicide prevention in this population. To address this gap, we developed the LifeBuoy app, a self-help smartphone app informed by dialectical behavior therapy (DBT), to help young people manage suicidal thoughts in their daily life.

OBJECTIVE

This study describes the protocol for a randomized controlled trial to evaluate the efficacy of the LifeBuoy app for reducing suicidal thoughts and behaviors, depression, anxiety, and psychological distress, and improving general mental well-being in young adults aged 18 to 25 years.

METHODS

This is a randomized controlled trial recruiting 378 young adults aged between 18 and 25 years and comparing the LifeBuoy app with a matched attention control (a placebo app with the same display but no DBT components). The primary outcome is suicidal thoughts measured by the Suicidal Ideation Attributes Scale (SIDAS). The secondary outcomes are suicidal behavior, depression, anxiety, psychological distress, and general mental well-being. The changes in the levels of insomnia, rumination, suicide cognitions, distress tolerance, loneliness, and help seeking before and after using the app are evaluated in this study. The study also addresses risk factors and responses to the intervention. A series of items assessing COVID-19 experiences is included in the trial to capture the potential impact of the pandemic on this study. Assessments will occur on the following three occasions: baseline, postintervention, and follow-up at 3 months postintervention. A qualitative interview about user experience with the LifeBuoy app will take place within 4 weeks of the final assessment. Using linear mixed models, the primary analysis will compare the changes in suicidal thoughts in the intervention condition relative to the control condition. To minimize risks, participants will receive a call from the team clinical psychologist by clicking a help button in the app or responding to an automated email sent by the system when they are assessed with elevated suicide risks at the baseline, postintervention, and 3-month follow-up surveys.

RESULTS

The trial recruitment started in May 2020. Data collection is currently ongoing.

CONCLUSIONS

This is the first trial examining the efficacy of a DBT-informed smartphone app delivered to community-living young adults reporting suicidal thoughts. This trial will extend knowledge about the efficacy and acceptability of app-based support for suicidal thoughts in young people.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12619001671156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378366.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/23655.

The psychological burden experienced by Chinese citizens during the COVID-19 outbreak: prevalence and determinants

BACKGROUND

The present study is aims to investigate the prevalence and determinants of depression and anxiety among the general population in the context of coronavirus disease 2019 (COVID-19) outbreak in China.

METHODS

A cross-sectional self-report survey methodology was used to gather the following data from Chinese citizens: sociodemographic information, physical and mental health disorder history, daily online time, social media exposure, feeling toward social media exposure, perception of the disease, infection cases in the local area, and previous experiences with stressful life incidents. Levels of anxiety and depression were self-reported employing the Generalized Anxiety Disorder 7-item scale and the Patient Health Questionnaire 9-item scale, respectively.

RESULTS

Among the 6130 participants, the prevalence of anxiety and depression was 7.1 and 12%, respectively. Multiple logistic regression analysis revealed that psychological disturbances were associated with gender, people with religious background, being a medical professional, having physical or mental health disease, difficulty accessing medical aids, experience with traumatic incidents, the perceived possibility of sequelae after being cured of COVID-19, daily online time, the source of the information relevant to COVID-19, frequency of receiving information regarding COVID-19, and negative feelings triggered by social media.

CONCLUSIONS

There needs to be a consistent message from authorities to reduce the panic and confusion of the public, and to decrease public exposure to persistently negative information. It is necessary to help people transform their negative experiences into positive changes especially for individuals with physical illness, individuals with mental health disorders, and medical professionals.

An Assessment of the Novel COVISTRESS Questionnaire: COVID-19 Impact on Physical Activity, Sedentary Action and Psychological Emotion

Globally the COVID-19 pandemic outbreak has triggered an economic downturn and a rise in unemployment. As a result, global communities have had to face physical, health, psychological and socio-economical related stressors. The purpose of this study was to assess and report the impact of isolation and effect of coronavirus on selected psychological correlates associated with emotions. Following ethical approval, a mixed methods observational study was conducted using the validated COVISTRESS questionnaire. Two observational study scenarios were evaluated namely "Prior" to the COVID-19 outbreak and "Currently", i.e., during the COVID-19 pandemic. 10,121 participants from 67 countries completed the COVISTRESS questionnaire. From the questionnaire responses only questions that covered the participant's occupation; sociodemographic details, isolation and impact of coronavirus were selected. Further analyses were performed on output measures that included leisure time, physical activity, sedentary time and emotions. All output measures were evaluated using the Visual Analogue Scale (VAS) with an intensity ranging from 0-100. Descriptive statistics, Wilcoxon signed-rank test and Spearman correlational analysis were applied to the leisure time, physical activity, sedentary time and emotional feeling datasets; p = 0.05 was set as the significance level. Both males and females displayed similar output measures. The Wilcoxon signed rank test showed significant differences with respect to "Prior" COVID-19 and "Currently" for sedentary activity (Z = -40.462, p < 0.001), physical activity (Z = -30.751, p < 0.001) and all other emotional feeling output measures. A moderate correlation between "Prior" COVID-19 and "Currently" was observed among the Males (r = 0.720) in comparison to the Females (r = 0.639) for sedentary activity while weaker correlations (r < 0.253) were observed for physical activity and emotional feeling measurements, respectively. Our study reported incremental differences in the physical and psychological output measures reported, i.e., "Prior" COVID-19 and "Currently". "Prior" COVID-19 and "Currently" participants increased their sedentary habits by 2.98%, and the level of physical activity reduced by 2.42%, depression levels increased by 21.62%, anxiety levels increased by 16.71%, and stress levels increased by 21.8%. There were no correlations (r) between leisure, physical activity and sedentary action (i.e., "Prior" = -0.071; "Currently" = -0.097); no correlations (r) between leisure physical activity and emotion (i.e., -0.071 > r > 0.081) for "Prior"; and poor correlations (r) between leisure, physical activity and sedentary action (i.e., -0.078 > r > 0.167) for "Current". The correlations (r) between sedentary action and emotion for "Prior" and "Currently" were (-0.100 > r > 0.075) and (-0.040 > r > 0.041) respectively. The findings presented here indicate that the COVISTRESS project has created awareness in relation to the physical and psychological impact resulting from the COVID-19 pandemic. The findings have also highlighted individual distress caused by COVID-19 and associated health consequences for the global community.

The trajectory of loneliness in response to COVID-19

Social distancing and "stay-at-home" orders are essential to contain the coronavirus outbreak (COVID-19), but there is concern that these measures will increase feelings of loneliness, particularly in vulnerable groups. The present study examined change in loneliness in response to the social restriction measures taken to control the coronavirus spread. A nationwide sample of American adults (N = 1,545; 45% women; ages 18 to 98, M = 53.68, SD = 15.63) was assessed on three occasions: in late January/early February 2020 (before the outbreak), in late March (during the President's initial "15 Days to Slow the Spread" campaign), and in late April (during the "stay-at-home" policies of most states). Contrary to expectations, there were no significant mean-level changes in loneliness across the three assessments (d = .04, p > .05). In fact, respondents perceived increased support from others over the follow-up period (d = .19, p < .01). Older adults reported less loneliness overall compared to younger age groups but had an increase in loneliness during the acute phase of the outbreak (d = .14, p < .05). Their loneliness, however, leveled off after the issuance of stay-at-home orders. Individuals living alone and those with at least one chronic condition reported feeling lonelier at baseline but did not increase in loneliness during the implementation of social distancing measures. Despite some detrimental impact on vulnerable individuals, in the present sample, there was no large increase in loneliness but remarkable resilience in response to COVID-19. (PsycInfo Database Record (c) 2020 APA, all rights reserved).