Survey of Insomnia and Related Social Psychological Factors Among Medical Staff Involved in the 2019 Novel Coronavirus Disease Outbreak

Psychological burden of attention-deficit/hyperactivity disorder traits on medical workers under the COVID-19 outbreak: a cross-sectional web-based questionnaire survey

OBJECTIVES

There are numerous reports on the psychological burden of medical workers after the COVID-19 outbreak; however, no study has examined the influence of developmental characteristics on the mental health of medical workers. The objective of this study was to examine whether the developmental characteristics of medical workers are associated with anxiety and depression after the COVID-19 outbreak.

DESIGN

We conducted an online cross-sectional questionnaire survey in October 2020.

PARTICIPANTS AND SETTING

The data of 640 medical workers were analysed. The questionnaire included items on sociodemographic data, changes in their life after the COVID-19 outbreak and symptoms of depression, anxiety, attention-deficit/hyperactivity disorder (ADHD) traits and autism spectrum disorder traits.

MAIN OUTCOMES

Depression symptoms were assessed by the Patient Health Questionnaire-9 and anxiety symptoms were assessed by the Generalised Anxiety Disorder-7. A series of hierarchical multiple regression analyses were performed to test the effects of developmental characteristics on depression and anxiety symptoms after controlling for sociodemographic factors and changes in participants' lives after the COVID-19 outbreak.

RESULTS

Increases in physical and psychological burden were observed in 49.1% and 78.3% of the subjects, respectively. The results of a multiple regression analysis showed that ADHD traits were significantly associated with both depression (β=0.390, p<0.001) and anxiety (β=0.426, p<0.001). Autistic traits were significantly associated with depression (β=0.069, p<0.05) but not anxiety. Increased physical and psychological burden, being female, medical workers other than physicians and nurses, fear of COVID-19 and experience of discrimination were also significantly associated with both depression and anxiety.

CONCLUSION

Globally, the burden on medical workers increased. This study suggested that medical workers with higher ADHD traits may need special attention during the COVID-19 pandemic.

Sources of psychological distress among primary care physicians during the COVID-19 pandemic's first wave in Spain: a cross-sectional study

Background:

The COVID-19 pandemic is affecting people worldwide. In Spain, the first wave was especially severe.

Objectives:

This study aimed to identify sources and levels of distress among Spanish primary care physicians (PCPs) during the first wave of the pandemic (April 2020).

Methods:

A cross-sectional study was conducted using a survey that included sociodemographic data, a description of working conditions related to distress [such as gaps in training in protective measures, cleaning, and hygiene procedures in work setting, unavailability of personal protective equipments (PPEs) and COVID-19 RT-PCR test, and lack of staff due to be infected] and a validated scale, the ‘Self-applied Acute Stress Scale’ (EASE). The survey was answered by a non-probability sampling of PCPs working in family healthcare centres from different regions of Spain. Analysis of variance and multivariate linear regression analysis were performed.

Results:

In all, out of 518 PCP participants, 123 (23.7%) obtained high psychological distress scores. Only half of them had received information about the appropriate use of PPE. PCP characteristics associated with higher levels of distress include female gender [1.69; 95% confidence interval (CI) 0.54, 2.84]; lack of training in protective measures (1.96; 95% CI 0.94, 2.99); unavailable COVID-19 RT-PCR for health care workers after quarantine or COVID-19 treatment (−0.77 (−1.52, −0.02). Reinforcing disinfection of the work environment (P < 0.05), availability of PPEs (P < 0.05), and no healthcare professional was infected (P < 0.05) were related to the lowest distress score.

Conclusions:

A better understanding of the sources of distress among PCPs could prevent its effect on future outbreaks.

Systematic review of productivity loss among healthcare workers due to Covid-19

Objective

To assess existing evidence on the effects of COVID‐19 on healthcare workers (HCWs) using the health‐related productivity loss approach.

Methods

A systematic search of online databases including PubMed, Scopus, Ovid, Web of Science, and EMBASE was conducted up to 25 August 2020. Following two screening stages, studies related to the effects of COVID‐19 on healthcare workers were included in the study.

Results

82 studies were included in the analysis. The COVID‐19 related death rate among HCWs ranged from 0.00‐0.7%, while the positive test incidence varied between 0.00 and 24.4%. 39 evidences assessed psychological disorders. A wide range of psychological disorders observed among HCWs: 5.2 to 71.2% in anxiety, 1.00 to 88.3% in stress, 8.27 to 61.67% in insomnia, and 4.5 to 50.4% in depression.

Conclusions

The early evidence suggests that healthcare workers are one of the most vulnerable groups when it comes to positive COVID‐19 infection, mortality, and mental illness.

Psychological distress among healthcare providers during COVID-19 in Asia: Systematic review and meta-analysis

INTRODUCTION

COVID-19 pandemic is having a devastating effect on the mental health and wellbeing of healthcare providers (HCPs) globally. This review is aimed at determining the prevalence of depression, anxiety, stress, fear, burnout and resilience and its associated factors among HCPs in Asia during the COVID-19 pandemic.

MATERIAL AND METHODS

We performed literature search using 4 databases from Medline, Cinahl, PubMed and Scopus from inception up to March 15, 2021 and selected relevant cross-sectional studies. Publication bias was assessed using funnel plot. Random effects model was used to estimate the pooled prevalence while risk factors were reported in odds ratio (OR) with 95% CI.

RESULTS

We included 148 studies with 159,194 HCPs and the pooled prevalence for depression was 37.5% (95%CI: 33.8-41.3), anxiety 39.7(95%CI: 34.3-45.1), stress 36.4% (95%CI: 23.2-49.7), fear 71.3% (95%CI: 54.6-88.0), burnout 68.3% (95%CI: 54.0-82.5), and low resilience was 16.1% (95%CI: 12.8-19.4), respectively. The heterogeneity was high (I2>99.4%). Meta-analysis reported that both females (OR = 1.48; 95% CI = 1.30-1.68) and nurses (OR = 1.21; 95%CI = 1.02-1.45) were at increased risk of having depression and anxiety [(Female: OR = 1.66; 95% CI = 1.49-1.85), (Nurse: OR = 1.36; 95%CI = 1.16-1.58)]. Females were at increased risk of getting stress (OR = 1.59; 95%CI = 1.28-1.97).

CONCLUSION

In conclusion, one third of HCPs suffered from depression, anxiety and stress and more than two third of HCPs suffered from fear and burnout during the COVID-19 pandemic in Asia.

Requirements and Architecture of a Cloud Based Insomnia Therapy and Diagnosis Platform: A Smart Cities Approach

Insomnia is the most common sleep disorder worldwide. Its effects generate economic costs in the millions but could be effectively reduced using digitally provisioned cognitive behavioural therapy. However, traditional acquisition and maintenance of the necessary technical infrastructure requires high financial and personnel expenses. Sleep analysis is still mostly done in artificial settings in clinical environments. Nevertheless, innovative IT infrastructure, such as mHealth and cloud service solutions for home monitoring, are available and allow context-aware service provision following the Smart Cities paradigm. This paper aims to conceptualise a digital, cloud-based platform with context-aware data storage that supports diagnosis and therapy of non-organic insomnia. In a first step, requirements needed for a remote diagnosis, therapy, and monitoring system are identified. Then, the software architecture is drafted based on the above mentioned requirements. Lastly, an implementation concept of the software architecture is proposed through selecting and combining eleven cloud computing services. This paper shows how treatment and diagnosis of a common medical issue could be supported effectively and cost-efficiently by utilising state-of-the-art technology. The paper demonstrates the relevance of context-aware data collection and disease understanding as well as the requirements regarding health service provision in a Smart Cities context. In contrast to existing systems, we provide a cloud-based and requirement-driven reference architecture. The applied methodology can be used for the development, design, and evaluation of other remote and context-aware diagnosis and therapy systems. Considerations of additional aspects regarding cost, methods for data analytics as well as general data security and safety are discussed.

The COVID-19 Study of Healthcare and Support Personnel (CHAMPS): Protocol for a Longitudinal Observational Study

BACKGROUND

Early in the development of the COVID-19 pandemic, it was evident that health care workers, first responders, and other essential workers would face significant stress and workplace demands related to equipment shortages and rapidly growing infections in the general population. Although the effects of other sources of stress on health have been documented, the effects of these unique conditions of the COVID-19 pandemic on the long-term health and well-being of the health care workforce are not known.

OBJECTIVE

The COVID-19 Study of Healthcare and Support Personnel (CHAMPS) was designed to document early and longitudinal effects of the pandemic on the mental and physical health of essential workers engaged in health care. We will investigate mediators and moderators of these effects and evaluate the influence of exposure to stress, including morbidity and mortality, over time. We will also examine the effect of protective factors and resilience on health outcomes.

METHODS

The study cohort is a convenience sample recruited nationally through communities, professional organizations, networks, social media, and snowball sampling. Recruitment took place for 13 months to obtain an estimated sample of 2762 adults who provided self-reported information administered on the web through structured questionnaires about their work environment, mental and physical health, and psychosocial factors. Follow-up questionnaires will be administered after 6 months and annually thereafter to ascertain changes in health, well-being, and lifestyle. Participants who consented to be recontacted form the longitudinal cohort and the CHAMPS Registry may be contacted to ascertain their interest in ancillary studies for which they may be eligible.

RESULTS

The study was approved by the Institutional Review Board and launched in May 2020, with grants from Travere Therapeutics Inc, McKesson Corporation, anonymous donors, and internal funding from the M. Louise Fitzpatrick College of Nursing at Villanova University. Recruitment ended in June 2021 after enrolling 2762 participants, 1534 of whom agreed to participate in the longitudinal study and the registry as well as to be contacted about eligibility for future studies.

CONCLUSIONS

The CHAMPS Study and Registry will enable the acquisition of detailed data on the effects of extended psychosocial and workplace stress on morbidity and mortality and serve as a platform for ancillary studies related to the COVID-19 pandemic.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04370821; https://clinicaltrials.gov/ct2/show/NCT04370821.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/30757.

Understanding the Mediating Role of Anxiety and Depression on the Relationship Between Perceived Stress and Sleep Quality Among Health Care Workers in the COVID-19 Response

OBJECTIVE

There is an increasing amount of evidence exploring the adverse effects of perceived stress or anxiety and depression independently on sleep quality during the COVID-19 outbreak, although the underlying mechanisms are unclear. The aim of the current study was to explore the role of anxiety and depression as a potential mediator between perceived stress and sleep quality among health care workers.

METHODS

Data were collected through an online survey using the snowball sampling method and comprised 588 current health care workers in Zhejiang and Hubei provinces, China, from February to March 2020. We administered the Sleep Quality Questionnaire (SQQ), the Perceived Stress Scale (PSS-10), the Patient Health Questionnaire (PHQ-4) and the sociodemographic characteristics and COVID-19-related characteristics questionnaire. Structural equation modelling (SEM) was used to examine the direct and indirect relationships between perceived stress, anxiety and depression, and sleep quality.

RESULTS

The average scores for sleep quality and perceived stress were 16.01 (95% CI [15.40, 16.57]) and 15.46 (95% CI [15.05, 15.87]), respectively. The positive rates of anxiety and depression symptom tests were 9.86% and 10.37%, respectively. The SEM results indicated that the original relationship between perceived stress and sleep quality was beta = 0.52 (P < 0.001) and reduced to beta = 0.25 (P = 0.045) while introducing anxiety and depression as mediating variables. Perceived stress was positively associated with anxiety and depression (beta = 0.78, P = 0.014), and anxiety and depression were positively associated with sleep quality (beta = 0.42, P < 0.001).

CONCLUSION

Poor sleep quality and high perceived stress were common during the COVID-19 crisis. Reducing perceived stress could help reduce anxiety and depression symptoms, thereby improving sleep quality among health care workers. In an attempt to promote psychological resources, we should perhaps take multiple measures, including personal tailored intervention and organizational humanistic concern.

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 effect of Covid-19 on sleep quality, anxiety and depression on healthcare staff at a tertiary hospital in Turkey

BACKGROUND

The Covid-19 pandemic has forced healthcare staff into an unprecedented situation, such as making tough decisions and practising under enormous pressure.

AIM

This study was designed to investigate the effect of Covid-19 on sleep quality, anxiety and depression in healthcare staff at a tertiary hospital.

METHODS

This descriptive and cross-sectional study recruited healthcare staff working at a tertiary hospital. Those who had given their informed consent participated in this study between April 17 and May 17, 2020. Data were collected using the introductory information form, the Pittsburg Sleep Quality Index (PSQI), and the Hospital Anxiety Depression Scale (HADS). The data were then analyzed on the Statistical Package for the Social Sciences (SPSS) v.24.

RESULTS

The mean scores of the respondents derived from the HADS-Anxiety (HADS-A) and HADS-Depression (HADS-D) scales were 7.89 ± 4.60 and 7.22 ± 4.13, respectively. Their depression levels were established to be at risk, though their anxiety levels were not. The mean PSQI score turned out to be 8.42 ± 2.30 for the participants, most of whom (92.9%) experienced poor sleep quality. Total sleep quality of the respondents exhibited a moderate positive correlation with HADS-A scores and a weak positive correlation with HADS-D scores (p < 0.05).

CONCLUSION

Our major conclusion from the collected data is that healthcare staff suffered from poor sleep quality, and that their depression levels, but not anxiety levels, were at risk. Providing appropriate information about the health care of patients diagnosed with Covid-19 as well as offering regular psychoeducation-psychological support services and resting areas can reduce the susceptibility of healthcare staff to anxiety and depression and improve their overall sleep quality.

Depression, anxiety, stress, and sleep disturbances in doctors and general population during COVID-19 pandemic

AIM

The aim of the study is to assess and compare depression, anxiety, stress, and sleep disturbances among doctors and general population during COVID-19 pandemic.

MATERIALS AND METHODS

This cross-sectional, analytical, case-control, web-based study was conducted during September 2020 to examine the impact of pandemic on mental health. The participants completed basic sociodemographic questionnaire, Depression Anxiety Stress Scale-21 (DASS-21), and Athens Insomnia Scale (AIS).

RESULTS

Of the 321 participants, 320 provided basic data, 22 were on psychotropics. Out of the 298, 286 were matched for age and sex and were included. On DASS-21, 41.27% of doctors and 30.76% of general population reported depression; 40.56% doctors and 26.57% general population had anxiety; 38.46% of the doctors and 24.48% of general population reported stress. Statistical analysis revealed that doctors had significantly higher levels of anxiety and stress as compared to general population. On the AIS, more doctors (48.25%) suffered from insomnia compared to the general population (37.06%), but the difference was not statistically significant.

CONCLUSION

Physicians have significantly higher anxiety and stress while dealing with COVID-19 compared to general population.

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.

Fear of COVID-19 among the Indian youth: A cross-sectional study

BACKGROUND

Coronavirus disease is a highly infectious and fatal disease. It has caused distress in the form of fear, and anxiety among masses including youth. The psychosocial health of youth is important to build resilient nations after the pandemic is over.This study aimed to capture the level of COVID-19 fear among youth studying in a northern Indian university and to compare it with demographic variables.

MATERIALS AND METHODS

This was a cross-sectional study (April-May 2020) conducted among university students in North India. Fear of COVID-19 Scale (FCV-19S) was used for online survey using Google Forms. FCV-19S is a reliable tool for assessing the fear of COVID-19 among the general population. Descriptive statistics and principal component analysis (PCA) with varimax rotation were used for statistical analysis.

RESULTS

A total of 521 responses were recorded. The majority (78%) of the participants were in the age group of 18-23 years and more than half (57%) were pursuing graduation. The respondents belonged to 16 states and union territories in the country. A total of 17% reported severe fear, while a few reported moderate (17%) or mild (11%) fear on the FCV-19S. No respondent could be categorized with "no fear" based on the overall FCV-19S score. Approximately, 42% of respondents were nervous after watching news/social media posts about COVID-19. Based on PCA, factor 1 labeled as anxiety toward COVID-19, factor 2 media effect on shaping of fear, and factor 3 thanatophobia as contributing factors for fear among youth.

CONCLUSIONS

Reflection of fear among youth suggests that adequate knowledge about COVID-19, preventive steps, treatment options, etc., may be planned to allay fears among youth.

The Silent Pandemic: The Psychological Burden on Frontline Healthcare Workers during COVID-19

This narrative review explores the full scope of harmful psychological effects of the COVID-19 (Coronavirus Disease of 2019) pandemic on FLHCWs (Frontline healthcare workers). Additionally, we highlight the risk factors for worse outcomes. A literature review identified 24 relevant papers included in this synthesis. The majority of studies reported a high number of mental health conditions in HCWs (Healthcare workers) overall. Working in the frontline setting was repeatedly identified as an independent risk factor for poorer mental health. Additional risk factors, such as gender, occupational pressure, and low level of support from hospital administration, family, and the community, were also commonly identified. In the past, defined interventions have been shown to mitigate the psychological impact of high-stress situations on frontline workers. This review is aimed at identifying individuals at higher risk to help effectively target preventative measures in future stress situations in our healthcare system.

Psychological, physical, and social effects of the COVID-19 pandemic on hospital nurses

Aim

The study aim was to explore the physical, mental, and social effects of the COVID‐19 pandemic on Austrian nurses working in hospitals.

Background

The COVID‐19 pandemic required nurses to work extremely hard and over long periods, which can have physical, psychological, and social consequences.

Methods

This study was carried out using a qualitative descriptive design and data was collected through individual interviews using an interview guide. A qualitative content analysis was conducted taking both deductive and inductive approaches.

Findings

Eighteen nurses (average age of 34.7 years) participated in the study. Their general attitude and feelings regarding working during the COVID‐19 pandemic in the hospital setting were positive. Several behavioral changes in the nurses’ daily working and private daily lives were reported. Psychological impacts included the fear of infecting someone at home, insomnia, and sadness. Headaches, diarrhea, muscle tension, skin redness, and increased sweating were identified as the most common physical impacts. In terms of social impact, all nurses mentioned social isolation and the increased use of (new) media.

Conclusions

Working with people suffering from COVID‐19 had psychological and physical effects on caregivers. Caregivers felt socially isolated in their private environments; however, they often compensated for this isolation by using social media.

Implications for nursing and implications for nursing policy

Staff perceived the provision of sufficient information, regular team meetings, and the employer's positive reinforcement as supportive, enhancing their feelings of security.

We recommend providing more psychological support and making structural adjustments in daily clinical practice to counteract the negative effects of working during a pandemic.

Influence of sleep difficulty on post-traumatic stress symptoms among frontline medical staff during COVID-19 pandemic in China

Being a nurse was demonstrated to be a risk factor for post-traumatic stress symptoms (PTS) and insomnia among frontline staff during COVID-19 pandemic. The unidirectional relationship between insomnia and PTS highly suggested that insomnia could mediate the increasing risk of PTS among frontline nurses. However, no study had tried to clarify this mediation effect of insomnia during COVID-19 pandemic. This study aimed to investigate prevalence of insomnia and PTS among frontline doctors and nurses and to clarify the relationship between career (doctor/nurses), insomnia and PTS. A total of 211 frontline doctors and nurses completed the investigation. Insomnia was measured using a self-drafted questionnaire and PTS was assessed using primary care post-traumatic stress disorder screen (PC-PTSD). Three logistics regression models and one mediation model were performed to explore relationships between career, insomnia and PTS. The prevalence of PTS (PC-PTSD≥2) and insomnia (with 1 item in self-drafted insomnia questionnaire≥2) was 24.17% and 36.97%, respectively. Being a nurse was a shared risk factor of insomnia (OR = 4.16, 95%CI: 1.30 ~ 5.77, P = 0.023) and PTS (OR = 7.51, 95%CI: 1.89 ~ 40.50, P = 0.008). Compared to doctors, nurses had significantly higher prevalence of insomnia (46.32% vs. 20%, χ² = 13.27, P < 0.001) and PTS (30.14% vs. 13.33%, χ² = 6.57, P = 0.011). Insomnia was a significant partial mediator (B = 0.101, P = 0.026), which explained 32.53% proportions of relationship between being a nurse and PTS. PTS and insomnia were common symptoms, which should be considered in psychological aids among frontline medical staff. Insomnia might be a possible target of PTS intervention.

Willingness to Work amongst Australian Frontline Healthcare Workers during Australia's First Wave of Covid-19 Community Transmission: Results of an Online Survey

OBJECTIVES

The majority of research investigating healthcare workers' (HCWs) willingness to work during public health emergencies, asks participants to forecast their perceptions based on hypothetical emergencies, rather than in response to the actual public health emergencies they have experienced. This research explored frontline HCWs willingness to work during Australia's first wave of the COVID-19 pandemic among frontline HCWs.

METHODS

Participants (n = 580) completed an online questionnaire regarding their willingness to work during the pandemic.

RESULTS

A total of 42% of participants reported being less willing to work during the pandemic compared to before. Availability of personal protective equipment (PPE), concern expressed by family members, and viral exposure were significant barriers. A third of participants disagreed that some level of occupational risk for exposure to infectious disease was acceptable while a quarter of participants had received communications from their workplace concerning obligations to work during COVID-19.

CONCLUSIONS

The COVID-19 pandemic has impacted Australian frontline HCWs' willingness to work. Scarcity of PPE and exposure to the virus were the most cited reasons impacting on willingness to work. Appropriate policies and practices should be implemented and communicated efficiently to frontline HCW's. This research provides insight into the lived experiences of Australian healthcare professionals' willingness to work during a pandemic.

Students’ Perceptions of Verbal and Non-Verbal Communication Behaviors during and after the COVID-19 Pandemic

Aiming at shedding light on the implications the COVID-19 pandemic has had on the students’ social and personal lives, this study has focused on the verbal and non-verbal communication and on the surveyees’ personal lives during the pandemic as well as on the perspective of changing their communication behaviors after the pandemic. The 409 respondents, students at Politehnica University of Timisoara, took part in a survey, conducted between 1 April and 30 May 2021, that was posted on isondaje.ro, a Romanian online survey platform. The research has suggested the following results: the adjustment of the verbal communication by speaking in a more articulated manner or more loudly; the overuse of the upper part of the face to compensate for the concealed parts of the face due to face mask wearing; the analysis of the factors underlying the respondents’ actions, i.e., relational attitudes, various greeting forms, various non-verbal reactions, which are aspects that are likely to change even after the pandemic. The results have also presented the changes that interpersonal communication could go through under the pressure of the restrictions imposed by the pandemic, but also the ways through which people try to protect their most valuable asset, i.e., communication, which defines humanity and makes us unique as human beings.

Sleep disorders and related factors among frontline medical staff supporting Wuhan during the COVID-19 outbreak

Sleep problems among frontline medical staff during the COVID-19 epidemic require attention. A total of 249 frontline medical staff who were recruited to support Wuhan completed this cross-sectional study. A web-based questionnaire about insomnia, depression, anxiety, and fatigue was used to assess mental health status. The prevalence of sleep disorders among frontline medical staff was 50.6%. More time spent in Wuhan and a history of insomnia, depression, anxiety, and fatigue were associated with a higher risk of insomnia. People who stayed in Wuhan for a long time with a history of insomnia, depression, anxiety, and fatigue symptoms might be at high risk of insomnia.

[Pandémie COVID-19, sommeil et séquelles psychologiques: au nom du Réseau canadien du sommeil et des rythmes circadiens* et de la Société canadienne du sommeil*]

Les données recueillies lors de crises et tragédies passées prouvent que les problèmes de sommeil survenant durant ou peu de temps après un événement traumatique sont reliés à une probabilité accrue de développer des symptômes psychiatriques durables. Or la pandémie COVID-19 et ses conséquences à moyen et long-terme combinent plusieurs facteurs de risque pour le sommeil, tant pour les intervenants de la santé que la population générale. Notre relevé mensuel des publications scientifiques qui combinent COVID-19 et sommeil/insomnie entre janvier et juillet 2020 révèle un taux de croissance comparable pour les articles qui portent plus précisément sur la santé mentale mais aucune ne porte sur les résultats d’une intervention. Nous proposons qu’il faille agir rapidement sur les difficultés de sommeil en cette période de pandémie afin de protéger l’équilibre psychologique individuel à moyen et long terme, d’autant plus que les outils nécessaires à la prévention de l’insomnie, sa détection et son traitement sont à la portée de tous les professionnels de la santé mentale.

Parental psychological distress associated with COVID-19 outbreak: A large-scale multicenter survey from Turkey

AIMS

Pandemics can cause substantial psychological distress; however, we do not know the impact of the COVID-19 related lockdown and mental health burden on the parents of school age children. We aimed to comparatively examine the COVID-19 related the stress and psychological burden of the parents with different occupational, locational, and mental health status related backgrounds.

METHODS

A large-scale multicenter online survey was completed by the parents (n = 3,278) of children aged 6 to 18 years, parents with different occupational (health care workers-HCW [18.2%] vs. others), geographical (İstanbul [38.2%] vs. others), and psychiatric (child with a mental disorder [37.8%]) backgrounds.

RESULTS

Multivariable logistic regression analysis showed that being a HCW parent (odds ratio 1.79, p < .001), a mother (odds ratio 1.67, p < .001), and a younger parent (odds ratio 0.98, p = .012); living with an adult with a chronic physical illness (odds ratio 1.38, p < .001), having an acquaintance diagnosed with COVID-19 (odds ratio 1.22, p = .043), positive psychiatric history (odds ratio 1.29, p < .001), and living with a child with moderate or high emotional distress (odds ratio 1.29, p < .001; vs. odds ratio 2.61, p < .001) were independently associated with significant parental distress.

CONCLUSIONS

Parents report significant psychological distress associated with COVID-19 pandemic and further research is needed to investigate its wider impact including on the whole family unit.

Trastornos del sueño en emergencias y desastres

Los trastornos del sueño son frecuentes en la población y una causa importante de morbilidad. El objetivo de esta revisión es evaluar las alteraciones del sueño en periodos de emergencia y desastres. A lo largo de la historia, la esfera biopsicosocial y el sueño de las personas ha sido abrumada por múltiples eventos a gran escala, tales como desastres naturales, tragedias provocadas por el hombre, conflictos bélicos, crisis sociales y pandemias, cuya experiencia puede derivar en problemas de salud a corto, mediano y/o largo plazo. En los estudios analizados, se ha observado el impacto negativo de las emergencias y desastres en el sueño, por lo que ha cobrado gran relevancia la difusión y promoción de medidas que incentiven el buen dormir. Debido a la llegada del COVID-19 y a la situación de confinamiento por periodos prolongados en el hogar para prevenir su propagación, han surgido importantes consecuencias a nivel social. Ciertos factores ocupacionales y características de los desastres se asocian a mayor comorbilidad, un alto riesgo de experimentar agotamiento físico, trastornos psicológicos e insomnio en grupos altamente vulnerables, como lo son los profesionales de la salud, rescatistas y socorristas. El insomnio es el trastorno de sueño más frecuente en la población general y su empeoramiento en el contexto de pandemia por COVID-19 representa un nuevo problema en salud pública. Es por ello, que es indispensable promover campañas de prevención de salud física y mental orientados a la pesquisa precoz y manejo de patologías de la esfera psicosocial, dentro de las posibilidades socioeconómicas.

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.

Psychosocial Impact of COVID-19 Pandemic in Libya: A Cross-Sectional Study

Background: Since the outbreak of COVID-19 were announced in Wuhan, China, the virus has spread in most countries. After one year of restrictive measures applied by governments, it is unclear how this prolonged social distancing has affected the mental health of individuals in Libya. Therefore, the present study aims to assess the levels of perceived stress, depression, sleep disturbance, and self-efficacy associated with the pandemic in Libya and their association with the demographic factors. Methods: A cross-sectional study was conducted between October 10 and November 10, 2020 in 21 cities in Libya using an online survey. The survey collected socio-demographic variables and other important psychological variables using valid scales: namely, the Perceived Stress scale, the PROMIS Depression scale, the PROMIS Sleep Disturbance scale, and self-efficacy 6-item scale. Additionally, data were collected regarding eating and smoking habits, housing and living situations, and the preparedness of the public to manage the upcoming waves of the pandemic. Results: The questionnaire was accessed 746 times, and a total of 683 completed questionnaires were analyzed (response rate of 91.6%), with ages ranging from 18 to 94 years (Mean ± SD = 27.09 ± 10.57). Among the respondents, 58.4% were females and 77% were from the age group 18-29 years. The perceived stress, depression, and sleep disturbance symptoms were high in overall population. For stress, 52.7 and 17.1% of respondents reported moderate and high stress, and for sleep quality 28.8 and 8.1% reported moderate and high sleep disturbance, respectively. For depression, the overall median score was 20 (out of 40). The perceived stress, depression, and sleep disturbance were more prevalent among females and the younger age groups (18-29 years old). The overall self-efficacy median total score was 6.67 (out of 10), with a significantly higher median total score for males than females (7 vs. 6.33, p = 0.001). About 14.5% of the respondents were regular cigarette smokers, and most of them (79.8%) described their smoking habits during the previous month as more than typical. In addition, the reported eating habits of almost half of the respondents (43%) had changed, with about one-third (29.6%) reporting that their eating habits had become less healthy during the pandemic. Conclusion: The findings of this research suggest increased levels of stress, depression, and sleep disturbances as well as COVID-19-related fear during the pandemic, especially among young females. This alarming finding urgently calls for safe and low-barrier interventions to help mentally burdened individuals. This study makes a significant contribution in providing essential data on the psychological and social impacts on the Libyan population due to the COVID-19 pandemic.

The Threat of COVID-19 and Job Insecurity Impact on Depression and Anxiety: An Empirical Study in the USA

As the coronavirus disease 2019 pandemic causes a general concern regarding the overall mental health of employees worldwide, policymakers across nations are taking precautions for curtailing and scaling down dispersion of the coronavirus. In this study, we conceptualized a framework capturing recurring troublesome elements of mental states such as depression and general anxiety, assessing them by applying standard clinical inventory. The study explores the extent to which danger control and fear control under the Extended Parallel Processing Model (EPPM) threat impact job insecurity, with uncertainty phenomenon causing afflicting effect on the experiential nature of depression heightened by anxiety. With the aim to explore the job insecurity relationship with anxiety and depression, and measure the impact of EPPM threat, an empirical study was conducted in the United States on a sample of 347 white collar employees. Demographic data, EPPM threat, job insecurity, anxiety, and depression data were collected via a standardized questionnaire during the coronavirus disease 2019 (COVID-19) pandemic. The questionnaire consisting of multi-item scales was distributed online. All the scale items were evaluated on a 5-point Likert scale. SEM software AMOS version 23 was used to perform confirmatory factor analysis with maximum likelihood estimation. In the structural model, relationships between the threat of COVID-19, job insecurity, anxiety, and depression were assessed. The findings of the study suggest that job insecurity has a significant impact on depression and anxiety, whereas the threat of COVID-19 has a significant impact on depression. Mediating effects of job insecurity and EPPM threat impact on anxiety were not established in the study. The study contributes to the apprehension of the repercussions of major environmental disruptions on normal human functioning, and it investigates the effects of self-reported protective behaviors on risk perception. The study also explains the underlying mechanisms of coping behavior as possible antecedents to mental disorders. When subjected to stressful events, heightened psychological arousal causes physical and psychological challenges of affected employees to manifest as behavioral issues.

Impact de la pandémie COVID-19 sur le sommeil du personnel soignant

La pandémie liée à la COVID-19 a altéré de manière significative et importante la qualité du sommeil du personnel soignant.

Avec des différences selon le questionnaire utilisé, la spécialité du professionnel, et le pays étudié, environ la moitié des soignants ont développé des troubles du sommeil lors de cette crise sanitaire.

Les troubles du sommeil étaient marqués principalement par des symptômes d’insomnie, une mauvaise qualité du sommeil, un temps total de sommeil réduit, et des cauchemars fréquents.

Les altérations du sommeil affectaient à la fois les soignants de première et de seconde ligne au cours de la pandémie liée à la COVID.

Les études évaluant le sommeil des soignants confirment l’importance de diffuser les recommandations publiées par les experts du sommeil.

Global prevalence and determinants of mental health disorders during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

Coronavirus Disease 2019 (COVID-19) has infected more than 5 million and lost the lives of more than 300 thousand people globally. It is the first-ever deadly pandemic with a significant degree of fear, worry and concern in the population at large. Therefore, this Meta-Analysis aims to assess the global prevalence and determinants of mental health disorders.

METHODS

A three-stage search strategy was conducted on PubMed/Medline, Science direct LILACS and PsycINFO databases. The Heterogeneity among the included studies was checked with forest plot, χ2 test, I2 test, and the p-values. Publication bias was checked with a funnel plot and the objective diagnostic test was conducted with Egger's correlation, Begg's regression tests, and Trim and fill method.

RESULTS

The Meta-Analysis revealed that the pooled prevalence of anxiety and depression 33.59% (95% confidence interval (CI): 27.21 to 39.97, 30 studies, 88,543 participants) and 29.98% (95% confidence interval (CI): 25.32 to 34.64, 25 studies, 78,191 participants) respectively.

CONCLUSION

The review revealed that more than thirty percent of patients developed anxiety and depression during COVID-19 Pandemic. This presages the health care stakeholders to prevent and intervene in mental health disorders.

REGISTRATION

This review was registered in Prospero international prospective register of systematic reviews (CRD42020183146).

Positive screens for mental disorders among healthcare professionals during the first covid19 wave in Belgium

We examined the manifestation of major depressive disorder, generalized anxiety disorder, substance use disorder, post-traumatic stress disorder, and panic attacks among health care professionals during the first COVID-19 wave (n = 6409) by means of mental disorder screening instruments. Logistic regressions were used to gauge individual risk factors; population attributable risk proportions (PARP) were inferred to identify the most important risk factors at the societal level. Data were weighted to represent general profiles of Belgian health care professionals. Lifetime, pre-pandemic emotional problems and work-related factors during the first wave of COVID-19 were strongly associated (mean adjusted odds ratios of 3.79 and 1.47, respectively) with positive screens for current mental disorders (occurrence of 29.3%). Most prominently, the data suggest that disruptions of work-life balance account for more than a quarter of the observed mental health problems due to the combination of widespread occurrence and strong association.

Prevalence of Depression among Healthcare Workers during the COVID-19 Outbreak: A Systematic Review and Meta-Analysis

Background: There is evidence of a high psychological toll from the COVID-19 pandemic in healthcare workers. This paper was aimed at conducting a systematic review and meta-analysis of studies reporting levels of depression among healthcare workers during the COVID-19 and estimating the pooled prevalence of depression. Methods: We searched for cross-sectional studies listed on PubMed from 1 December 2019 to 15 September 2020 that reported prevalence of depression in healthcare workers, nurses, medical doctors, and COVID-19 frontline professionals. The pooled proportions of depression were calculated with random effects models. Results: We identified 57 studies from seventeen countries. The pooled prevalence of depression in healthcare workers was 24% (95% CI: 20–28%), 25% for nurses (95% CI: 18–33%), 24% for medical doctors (95% CI: 16–31%), and 43% for frontline professionals (95% CI: 28–59%). Conclusions: The proportion of depression in nurses and medical doctors during the COVID-19 pandemic was similar to that found in the general population as previously reported in other meta-analyses conducted with smaller numbers of studies. Importantly, almost half of the frontline healthcare workers showed increased levels of depression. There is need for a comprehensive, international response to prevent and treat common mental health problems in healthcare workers.

COVID-19 pandemic related long-term chronic stress on the prevalence of depression and anxiety in the general population

BACKGROUND

The COVID-19 pandemic has lasted for more than 1 year, causing far-reaching and unprecedented changes in almost all aspects of society. This study aimed to evaluate the long-term consequences of the COVID-19 pandemic on depression and anxiety, and explore the factors associated with it.

METHODS

A cross-sectional study using an online survey was conducted to assess mental health problems from February 2 to February 9, 2021 by using patient health questionnaire-9 (PHQ-9) and generalized anxiety disorder-7 (GAD-7). The insomnia severity index (ISI), demographic data and COVID-19 related variables were measured by a self-designed questionnaire. The factors associated with depressive and anxiety symptoms were identified by Pearson chi-square test and binary logistic regression analysis.

RESULTS

In the study that 1171 participants enrolled, the overall prevalence of depressive and anxiety symptoms among general people was 22.6 and 21.4% respectively in the present study. Living alone was a potential risk factor for depressive symptoms, while regular exercises was a potential protective factor. The prevalence of depressive and anxiety symptoms was significantly associated with the severity of insomnia symptoms and the negative feelings about pandemic.

CONCLUSION

COVID-19 pandemic- related chronic stress has brought about profound impacts on long-term mental health in the general population. The level of insomnia and a negative attitude towards the pandemic are significantly correlated with unfavorable mental health. However, we failed to found a significant association of age and gender with the mental health symptoms, although they were recognized as well-established risk factors during the outbreak by some other studies. This discrepancy may be because the acute and chronic effects of the pandemic are influenced by different factors, which reminds that more attention should be paid to the intrinsic psychological factors and physical reactions towards COVID-19.

A year in review: sleep dysfunction and psychological distress in healthcare workers during the COVID-19 pandemic

The Covid-19 outbreak has taken a substantial toll on the mental and physical wellbeing of healthcare workers (HCWs), impacting healthcare systems at a global scale. One year into the pandemic, the need to establish the prevalence of sleep dysfunction and psychological distress in the face of COVID-19, identify risk and protective factors and explore effective countermeasures remains of critical importance. Despite implicit limitations relating to the quality of available studies, a plethora of evidence to-date suggests that a considerable proportion of HCWs experience significant sleep disturbances (estimated to afflict every two in five HCWs) as well as mood symptoms (with more than one in five reporting high levels of depression or anxiety). Younger age, female gender, frontline status, fear or risk of infection, occupation, current or past mental health concerns, and a lower level of social support were all associated with a greater risk of disturbed sleep and adverse psychological outcomes. Furthermore, 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 predictors of traumatic stress/PTSD and burnout in HCWs. Finally, we highlight the role of resilience and tailored interventions in order to mitigate vulnerability and prevent long-term physical and psychological implications. Indeed, promoting psychological resilience through an enhanced social support network has proven crucial for HCWs in coping under these strenuous circumstances. Future research should aim to provide high quality information on the long-term consequences and the effectiveness of applied interventions.

Prevalence and Risk Factors of Mental Health Symptoms and Suicidal Behavior Among University Students in Wuhan, China During the COVID-19 Pandemic

Background: University students who are exposed to coronavirus disease 2019 (COVID-19) could be mentally distressed. We aimed to evaluate the pattern and risk factors of mental health and suicidal behavior among students who experienced long-term school closure due to the COVID-19 pandemic. Methods: This large-sample, cross-sectional, online survey was conducted from June 29, 2020, to July 18, 2020. Eleven thousand two hundred fifty four participants were recruited from 30 universities located in Wuhan, Hubei Province, China. The prevalence of symptoms of depression, anxiety, insomnia, and posttraumatic stress disorder (PTSD) and suicidal behavior was evaluated using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Insomnia Severity Index, Posttraumatic Stress Disorder Checklist for DSM-5, and questions about suicidal ideation and attempts, respectively. Logistic regression was used to explore risk factors for mental health problems and suicidal behavior. Results: The prevalence of mental health problems was 41.5% for depressive symptoms, 32.6% for anxiety symptoms, 35.0% for insomnia symptoms, 8.5% for PTSD symptoms, and 2.0% for suicidal behavior. Participants with high stress during the pandemic were at higher risk of symptoms of depression [adjusted odds ratio (OR) = 1.67, 95% confidence interval (CI) = 1.43-1.95, p < 0.01), anxiety (adjusted OR = 1.90, 95% CI = 1.63-2.23, p < 0.01), insomnia (adjusted OR = 1.64, 95% CI = 1.44-1.87, p < 0.01), PTSD (adjusted OR = 1.71, 95% CI = 1.38-2.11, p < 0.01) and suicidal behavior (adjusted OR = 3.51, 95% CI = 2.28-5.40, p < 0.01). Distant relationship with parents, changes in lifestyle and alcohol use during the pandemic were associated with higher risk of mental health symptoms and suicidal behavior, whereas regular physical exercise reduced the risk of mental health problems. Conclusions: The psychological symptoms and suicidal behavior were relatively high among students who attended university in Wuhan, China after 6 months of the COVID-19 outbreak in China. Comprehensive mental health services and suicide prevention strategies are essential for university students during the COVID-19 pandemic.

Public mental health problems during COVID-19 pandemic: a large-scale meta-analysis of the evidence

The coronavirus disease 2019 (COVID-19) pandemic has exposed humans to the highest physical and mental risks. Thus, it is becoming a priority to probe the mental health problems experienced during the pandemic in different populations. We performed a meta-analysis to clarify the prevalence of postpandemic mental health problems. Seventy-one published papers (n = 146,139) from China, the United States, Japan, India, and Turkey were eligible to be included in the data pool. These papers reported results for Chinese, Japanese, Italian, American, Turkish, Indian, Spanish, Greek, and Singaporean populations. The results demonstrated a total prevalence of anxiety symptoms of 32.60% (95% confidence interval (CI): 29.10-36.30) during the COVID-19 pandemic. For depression, a prevalence of 27.60% (95% CI: 24.00-31.60) was found. Further, insomnia was found to have a prevalence of 30.30% (95% CI: 24.60-36.60). Of the total study population, 16.70% (95% CI: 8.90-29.20) experienced post-traumatic stress disorder (PTSD) symptoms during the COVID-19 pandemic. Subgroup analysis revealed the highest prevalence of anxiety (63.90%) and depression (55.40%) in confirmed and suspected patients compared with other cohorts. Notably, the prevalence of each symptom in other countries was higher than that in China. Finally, the prevalence of each mental problem differed depending on the measurement tools used. In conclusion, this study revealed the prevalence of mental problems during the COVID-19 pandemic by using a fairly large-scale sample and further clarified that the heterogeneous results for these mental health problems may be due to the nonstandardized use of psychometric tools.

The Psychological Impact of COVID-19 Pandemic on Health Care Workers: A Systematic Review and Meta-Analysis

Objective: The COVID-19 epidemic has generated great stress throughout healthcare workers (HCWs). The situation of HCWs should be fully and timely understood. The aim of this meta-analysis is to determine the psychological impact of COVID-19 pandemic on health care workers.

Method: We searched the original literatures published from 1 Nov 2019 to 20 Sep 2020 in electronic databases of PUBMED, EMBASE and WEB OF SCIENCE. Forty-seven studies were included in the meta-analysis with a combined total of 81,277 participants.

Results: The pooled prevalence of anxiety is 37% (95% CI 0.31–0.42, I² = 99.9%) from 44 studies. Depression is estimated in 39 studies, and the pooled prevalence of depression is 36% (95% CI 0.31–0.41, I² = 99.6%). There are 10 studies reported the prevalence of insomnia, and the overall prevalence of insomnia is 32% (95% CI 0.23–0.42, I² = 99.5%). The subgroup analysis showed a higher incidence of anxiety and depression among women and the frontline HCWs compared to men and non-frontline HCWs respectively.

Conclusions: The COVID-19 pandemic has caused heavy psychological impact among healthcare professionals especially women and frontline workers. Timely psychological counseling and intervention ought to be implemented for HCWs in order to alleviate their anxiety and improve their general mental health.

Mental health outcomes among health-care workers dealing with COVID-19/severe acute respiratory syndrome coronavirus 2 pandemic: A systematic review and meta-analysis

INTRODUCTION

The psychological impact of COVID-19 on health-care workers (HCWs) has received attention from researchers to understand the extent of the effects of the ongoing pandemic on this population. The aim of this systematic review and meta-analysis was to synthesize the currently available literature on the topic to determine the prevalence of mental health problems in HCWs.

MATERIALS AND METHODS

We conducted a systematic review and meta-analysis, searching PubMed, PsycINFO, Scopus, and Cochrane Library databases for articles published from December 2019 to August 15, 2020. We identified studies reporting the prevalence of any mental health condition in HCWs involved directly or indirectly in providing services during the COVID-19 pandemic. The prevalence proportion for individual outcome was extracted as an estimate of interest. We performed random-effects meta-analyses evaluated using Q statistic, I 2 statistic, subgroup analyses, and sensitivity analyses and assessed study quality. This review was done in adherence to the Reporting Items for Systematic Reviews and Meta-Analysis and Meta-analysis of Observational Studies in Epidemiology guidelines. The study protocol was registered prospectively at PROSPERO (CRD42020182005).

RESULTS

We identified 1958 studies, of which 33 studies including 39703 participants (with a median = 393; range = 88-14825) were finally included for analysis. The estimated overall prevalence were as follows: depression 32.4% (95% confidence interval [CI]: 25.9-39.3, I 2 = 99%), anxiety 32.5% (95% CI: 26.4-39.0, I 2 = 99%), insomnia or sleep disturbance 36.6% (95% CI: 36.6-48.3, I 2 = 99%), and stress 37.7% (95% CI: 24.0-52.3, I 2 = 100%).

CONCLUSION

HCWs who are dealing with the COVID-19 pandemic have a significant prevalence of depression, anxiety, insomnia and poor sleep quality, and stress. The health-care workforce needs to practice self-care now more than ever, while health-care managers and policymakers need to factor in the mental health consequences of COVID-19 on their workforce.

Israeli Health Care Social Workers' Personal and Professional Concerns during the COVID-19 Pandemic Crisis: The Work-Family Role Conflict

This exploratory study focuses on the personal and professional concerns of Israeli social workers in hospitals and community health settings during the coronavirus (COVID-19) pandemic. Other studies omitted health care social workers' needs and concerns. Participants included 126 social workers (120 females, 5 males and 1 other gender identity) in hospitals and community health settings who completed an online survey during the height of the first wave of COVID-19 in Israel. Measures included questions on exposure to COVID-19, sense of safety at work, perceived support, and personal and professional concerns. Two open-ended questions about the social workers' concerns and the perceived concerns of their patients were included. The results showed that 17 per cent reported one of their inter-disciplinary team testing positive for COVID-19. Only one-third of the social workers felt safe from COVID-19 infection in their workplace. Mothers of dependent children were more concerned about income loss and about balancing work and family requirements than mothers of older children. 'Home-work conflict' was also a main theme in the qualitative data. In conclusion, the work-home role conflict took an especially heavy toll during the COVID-19 pandemic on social workers who were mothers to dependent children.

Prevalence of depression, anxiety and stress in china during COVID-19 pandemic: A systematic review with meta-analysis

BACKGROUND

The novel coronavirus disease which is believed to have initially originated in Wuhan city of China at the end of 2019 was declared as pandemic by March 2020 by WHO. This pandemic significantly impacted the mental health of communities around the globe. This project draws data from available research to quantify COVID-19 mental health issues and its prevalence in China during the early period of the COVID-19 crisis. It is believed that this pooling of data will give fair estimate of the effects of the COVID-19 pandemic on mental health.

METHODS

We conducted this study in accordance with PRISMA guidelines 2009. The protocol for this review is registered and published in PROSPERO (CRD42020182893). The databases used were Pubmed, Medline, Google scholar and Scopus. The studies were extracted according to pre-defined eligibility criteria and risk of bias assessment was conducted. The Meta-analysis was done using OpenMeta [analyst].

RESULTS

Total of 62382 participants in nineteen studies fulfilled the eligibility criteria. Stress was the most prevalent (48.1%) mental health consequence of Covid-19 pandemic, followed by depression (26.9%) and anxiety (21.8%). After performing subgroup analysis, prevalence of depression and anxiety in both females and frontline health care workers were high as compared to the prevalence in general Chinese population.

CONCLUSION

The prevalence of depression and anxiety is moderately high whereas pooled prevalence of stress was found to be very high in Chinese people during this Covid-19 crisis.

The global prevalence of depression, anxiety, stress, and, insomnia and its changes among health professionals during COVID-19 pandemic: A rapid systematic review and meta-analysis

BACKGROUND

During the COVID-19 pandemic, the health professionals who are at the frontline of this crisis have been facing extreme psychological disorders. This research aims to provide an overall scenario of the prevalence of depression, anxiety, stress, as well as insomnia and to inspect the changes in these prevalence over time by analyzing the existing evidence during this COVID-19 pandemic.

METHODS

A systematic search was performed on March 30, 2021, in PubMed, MEDLINE, Google Scholar databases, and Web of Science. To assess the heterogeneity, Q-test,I 2 statistics, and Meta regression and to search for the publication bias, Eggers's test and funnel plot were used. The random-effect model and subgroup analysis were performed due to the significant heterogeneity.

RESULTS

Among eighty-three eligible studies in the final synthesis, 69 studies (n = 144649) assessed the depression prevalence of 37.12% (95% CI: 31.80-42.43), 75 studies (n = 147435) reported the anxiety prevalence of 41.42% (95% CI: 36.17-46.54), 41 studies (n = 82783) assessed the stress prevalence of 44.86% (95% CI: 36.98-52.74), 21 studies (n = 33370) enunciated the insomnia prevalence of 43.76% (95% CI: 35.83-51.68). The severity of the mental health problems among health professionals increased over the time during January 2020 to September 2020.

LIMITATIONS

A significant level of heterogeneity was found among psychological measurement tools and across studies.

CONCLUSIONS

Therefore, it is an emergency to develop psychological interventions that can protect the mental health of vulnerable groups like health professionals.

Anxiety, depression, trauma-related, and sleep disorders among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis

Healthcare workers have been facing the COVID-19 pandemic, with numerous critical patients and deaths, and high workloads. Quality of care is related to the mental status of healthcare workers. This PRISMA systematic review and meta-analysis, on Pubmed/Psycinfo up to October 8, 2020, estimates the prevalence of mental health problems among healthcare workers during this pandemic. The systematic review included 70 studies (101 017 participants) and only high-quality studies were included in the meta-analysis. The following pooled prevalences were estimated: 300 % of anxiety (95 %CI, 24.2-37.05); 311 % of depression (95 %CI, 25.7-36.8); 565 % of acute stress (95 %CI - 30.6-80.5); 20,2% of post-traumatic stress (95 %CI, 9.9-33.0); 44.0 % of sleep disorders (95 %CI, 24.6-64.5). The following factors were found to be sources of heterogeneity in subgroups and metaregressions analysis: proportion of female, nurses, and location. Targeted prevention and support strategies are needed now, and early in case of future health crises.

Impact of COVID-19 on eating habits, physical activity and sleep in Brazilian healthcare professionals

BACKGROUND

During the coronavirus disease 2019 (COVID-19) pandemic, Brazilian healthcare professionals could have been experiencing impacts on their routine, behavior and mental health.

OBJECTIVE

To investigate changes in the daily life and sleeping habits of healthcare professionals in Brazil.

METHODS

We conducted an observational and cross-sectional study from May to July 2020. A Google Forms questionnaire was made available to Brazilian healthcare professionals on the WhatsApp mobile application and through the website of the Brazilian Hospital Services Company.

RESULTS

The sample (n=710) was mostly composed of women (80.8%), aged between 30 and 40 years old (46.6%), predominantly physicians (41.8%) and residing mostly in the state of Paraíba (66.9%), Brazil. Approximately two-thirds of the total sample had some sleep-related complaints, 25.8% due to difficulty initiating sleep, 29.6% due to difficulty staying asleep and 32.5% due to early morning waking. From the population studied, 28.7% (n=204) reported the use of insomnia medication, and 60.3% (n=123) of these were self-medicating. Some participants reported a change in diet (n=557; 78.5%), especially related to the increase in carbohydrate intake (n=174; 24.5%), and 27% (n=192) of the individuals reported an increase of the consumption of alcoholic beverages. Of the total, 561 (81.8%) reported a change in the practice of physical activity.

CONCLUSION

In this study, Brazilian healthcare professionals showed aspects of quality of life that were more affected during the COVID-19 pandemic than the prevalence seen in surveys of international studies for the general population.

The impact of SARS-Cov-2 on the Nervous system and Mental Health

The World Health Organization declared the pandemic situation caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) in March 2020, but the detailed pathophysiological mechanisms of Coronavirus disease 2019 (COVID-19) are not yet completely understood. Therefore, to date, few therapeutic options are available for patients with mild-moderate or serious disease. In addition to systemic and respiratory symptoms, several reports have documented various neurological symptoms and impairments of mental health. The current review aims to provide the available evidence about the effects of SARS-CoV-2 infection on mental health. The present data suggest that SARS-CoV-2 produces a wide range of impairments and disorders of the brain. However, a limited number of studies investigated the neuroinvasive potential of SARS-CoV-2. Although the main features and outcomes of COVID-19 are linked to severe acute respiratory illness, the possible damages on the brain should be considered, too.

Brain Mechanisms of COVID-19-Sleep Disorders

2020 and 2021 have been unprecedented years due to the rapid spread of the modified severe acute respiratory syndrome coronavirus around the world. The coronavirus disease 2019 (COVID-19) causes atypical infiltrated pneumonia with many neurological symptoms, and major sleep changes. The exposure of people to stress, such as social confinement and changes in daily routines, is accompanied by various sleep disturbances, known as 'coronasomnia' phenomenon. Sleep disorders induce neuroinflammation, which promotes the blood-brain barrier (BBB) disruption and entry of antigens and inflammatory factors into the brain. Here, we review findings and trends in sleep research in 2020-2021, demonstrating how COVID-19 and sleep disorders can induce BBB leakage via neuroinflammation, which might contribute to the 'coronasomnia' phenomenon. The new studies suggest that the control of sleep hygiene and quality should be incorporated into the rehabilitation of COVID-19 patients. We also discuss perspective strategies for the prevention of COVID-19-related BBB disorders. We demonstrate that sleep might be a novel biomarker of BBB leakage, and the analysis of sleep EEG patterns can be a breakthrough non-invasive technology for diagnosis of the COVID-19-caused BBB disruption.

Do Polish Nurses Have a Problem with Sleepiness during the Epidemiological Threat of the SARS-CoV-2 Virus?

Nurses may experience cumulative sleep deprivation in the current epidemiological situation, which is the COVID-19 disease. Lack of rest leads to decreased concentration. The research topic is important for improving patient safety in hospitals. Assessment and analysis of the level of sleepiness of nurses after 3 consecutive night shifts and its impact on functioning in social life. The study adopted the diagnostic survey method, which was conducted using a survey technique. The questionnaire consisted of 3 parts: personal particulars, the survey and the Karolinska Sleepiness Scale (KSS) version A. After the research, 164 correctly completed questionnaires were obtained. The level of somnolence in individual measurements after a night shift significantly increased among the nurses examined (P < .0001). Respondents who felt a higher level of drowsiness after a night shift thought that their work definitely influenced contact with their friends or family and had difficulty in performing household duties. There is no statistically significant relationship between the level of sleepiness and sociodemographic factors. After each night shift, the level of drowsiness in nurses increases. This may result in reduced alertness and attention levels on subsequent working days. Shift work has negative consequences in the form of depleted personal life. Further research into the effects of insufficient sleep among nurses should be conducted. This may be necessary for patient safety in healthcare centers. The awareness on the subject of healthy sleep among shift nurses should be raised. It is advisable to conduct research in order to assess the effectiveness of various therapies in dealing with sleep disorders among shift nurses. The interventions taken should be adapted to the current epidemiological situation, which is the COVID-19 disease.

The Impact of Epidemics and Pandemics on the Mental Health of Healthcare Workers: A Systematic Review

BACKGROUND

There is increasing evidence that healthcare workers (HCWs) experience significant psychological distress during an epidemic or pandemic. Considering the increase in emerging infectious diseases and the ongoing COVID-19 pandemic, it is timely to review and synthesize the available evidence on the psychological impact of disease outbreaks on HCWs. Thus, we conducted a systematic review to examine the impact of epidemics and pandemics on the mental health of HCWs.

METHOD

PubMed, PsycInfo, and PsycArticles databases were systematically searched from inception to June-end 2020 for studies reporting the impact of a pandemic/epidemic on the mental health of HCWs.

RESULTS

Seventy-six studies were included in this review. Of these, 34 (45%) focused on SARS, 28 (37%) on COVID-19, seven (9%) on MERS, four (5%) on Ebola, two (3%) on H1N1, and one (1%) on H7N9. Most studies were cross-sectional (93%) and were conducted in a hospital setting (95%). Common mental health symptoms identified by this review were acute stress disorder, depression, anxiety, insomnia, burnout, and post-traumatic stress disorder. The associated risk factors were working in high-risk environments (frontline), being female, being a nurse, lack of adequate personal protective equipment, longer shifts, lack of knowledge of the virus, inadequate training, less years of experience in healthcare, lack of social support, and a history of quarantine.

CONCLUSION

HCWs working in the frontline during epidemics and pandemics experience a wide range of mental health symptoms. It is imperative that adequate psychological support be provided to HCWs during and after these extraordinary distressful events.

Sleep patterns among Norwegian nurses between the first and second wave of the COVID-19 pandemic

Background

Nurses are in the frontline and play an important role in the battle against the COrona VIrus Disease-2019 (COVID-19) pandemic. Sleep problems among health care workers are likely to increase due to the pandemic. However, it is conceivable that negative health outcomes related to the pandemic fluctuate with the infection rate waves of the pandemic. The present study aimed to investigate sleep patterns among Norwegian nurses, after the first wave, during a period with very low rates of COVID-19.

Methods

Data stemmed from the cohort study “SUrvey of Shift work, Sleep and Health (SUSSH)” among Norwegian nurses. A total of 1532 nurses responded one time to a questionnaire between June and September in 2020 including items about demographics and work, information about COVID-19 and quarantine, sleep patterns and changes in sleep patterns due to the pandemic. Descriptive statistics for all relevant variables were calculated and McNemar tests were used to compare categorical variables.

Results

The majority of nurses (84.2%) reported no change in sleep duration after the first wave of the COVID-19 pandemic compared to before, 11.9% reported less sleep, and 3.9% reported more sleep. Similarly, 82.4% of the nurses reported no change in their sleep quality, whereas 16.2% of the nurses reported poorer sleep quality after the first wave of the pandemic compared to before. The majority of nurses reported no change in their sleep schedule due to the pandemic, although 9.6% of the nurses reported to go to bed later and 9.0% woke up earlier than before the pandemic.

Conclusions

Most existing literature exploring sleep among health care workers during the COVID-19 pandemic has been carried out during periods with high infection rates. In this study we aimed to investigate sleep patterns among Norwegian nurses following the first wave, during a period of low COVID-19 rates in Norway. Most of the nurses reported no change in neither sleep duration, sleep quality, bedtime, nor wake-up times compared to before the pandemic. Still, nearly 12% reported shorter sleep duration, and about 16% reported poorer sleep quality indicating that some nurses experienced worsening of their sleep following the pandemic.

Prevalence of insomnia and anxiety among healthcare workers during the COVID-19 pandemic in Jilin Province

The outbreak of the 2019 novel coronavirus disease (COVID-19) has impacted the mental health of healthcare providers at the frontline. Therefore, we conducted this study to estimate the prevalence rate of anxiety and insomnia and identify associated risk factors among healthcare workers in Jilin, China, during the period from January 25 to February 25, 2020. Zung's Self-Reported Anxiety Scale (SAS) and the Insomnia Severity Index (ISI) scale were used to diagnose anxiety and insomnia, respectively. Associated risk factors were identified through a multivariate logistic regression model. A total of 300 healthcare workers were invited and 236 completed the study. Of them, 234 (99.15%) were medical workers, 197 (83.47%) were working at frontline departments, and 159 (67.37%) were fighting against COVID-19. Fifty-seven respondents (24.15%) had anxiety (SAS index score ≥45) and 94 (39.83%) had insomnia (ISI score ≥8). Based on the multivariate analysis, contact with people from Hubei province during work (no vs not clear) [OR=0.25, 95%CI: 0.10-0.61] and personal protective equipment (PPE) (not in place vs in place) [OR=6.22, 95%CI: 2.23-17.40] were significantly correlated with anxiety. PPE (not in place vs in place) was the only significant risk factor of insomnia [OR=10.56, 95%CI: 4.00-27.87]. The prevalence of anxiety and insomnia was high in our study, reflecting the psychological impact of COVID-19 on healthcare workers. The unavailability of PPE in place was a significant risk factor of both anxiety and insomnia.

A Wake-up Call for Burnout in Portuguese Physicians During the COVID-19 Outbreak: National Survey Study

BACKGROUND

The COVID-19 outbreak has imposed physical and psychological pressure on health care professionals, including frontline physicians. Hence, evaluating the mental health status of physicians during the current pandemic is important to define future preventive guidelines among health care stakeholders.

OBJECTIVE

In this study, we intended to study alterations in the mental health status of Portuguese physicians working at the frontline during the COVID-19 pandemic and potential sociodemographic factors influencing their mental health status.

METHODS

A nationwide survey was conducted during May 4-25, 2020, to infer differences in mental health status (depression, anxiety, stress, and obsessive compulsive symptoms) between Portuguese physicians working at the frontline during the COVID-19 pandemic and other nonfrontline physicians. A representative sample of 420 participants stratified by age, sex, and the geographic region was analyzed (200 frontline and 220 nonfrontline participants). Moreover, we explored the influence of several sociodemographic factors on mental health variables including age, sex, living conditions, and household composition.

RESULTS

Our results show that being female (β=1.1; t=2.5; P=.01) and working at the frontline (β=1.4; t=2.9; P=.004) are potential risk factors for stress. In contrast, having a house with green space was a potentially beneficial factor for stress (β=-1.5; t=-2.5; P=.01) and anxiety (β=-1.1; t=-2.4; P=.02).

CONCLUSIONS

It is important to apply protective mental health measures for physicians to avoid the long-term effects of stress, such as burnout.

Sleep quality and COVID-19 outcomes: the evidence-based lessons in the framework of predictive, preventive and personalised (3P) medicine

Sleep quality and duration play a pivotal role in maintaining physical and mental health. In turn, sleep shortage, deprivation and disorders are per evidence the risk factors and facilitators of a broad spectrum of disorders, amongst others including depression, stroke, chronic inflammation, cancers, immune defence insufficiency and individual predisposition to infection diseases with poor outcomes, for example, related to the COVID-19 pandemic. Keeping in mind that COVID-19-related global infection distribution is neither the first nor the last pandemic severely affecting societies around the globe to the costs of human lives accompanied with enormous economic burden, lessons by predictive, preventive and personalised (3P) medical approach are essential to learn and to follow being better prepared to defend against global pandemics. To this end, under extreme conditions such as the current COVID-19 pandemic, the reciprocal interrelationship between the sleep quality and individual outcomes becomes evident, namely, at the levels of disease predisposition, severe versus mild disease progression, development of disease complications, poor outcomes and related mortality for both - population and healthcare givers. The latter is the prominent example clearly demonstrating the causality of severe outcomes, when the long-lasting work overload and shift work rhythm evidently lead to the sleep shortage and/or deprivation that in turn causes immune response insufficiency and strong predisposition to the acute infection with complications. This article highlights and provides an in-depth analysis of the concerted risk factors related to the sleep disturbances under the COVID-19 pandemic followed by the evidence-based recommendations in the framework of predictive, preventive and personalised medical approach.

Anxiety and associated factors among Ethiopian health professionals at early stage of COVID-19 pandemic in Ethiopia

Introduction

In late 2019, a new coronavirus disease known as COVID-19 (novel coronavirus disease 2019) was identified. As there is no any drug to treat this pandemic, the healthcare professionals are disproportionately at higher risk. The mental health outcome is expected to be high. Anxiety is expected to have a significant impact on health professionals, especially among those who work without adequate resources for self-protection.

Objectives

The objectives of this research was to assess self-reported anxiety symptoms and associated factors among Ethiopian healthcare professionals in the early stages of the pandemic.

Methods

We have conducted an online cross-sectional study to collect information from healthcare professionals in Ethiopia during the early stage of the outbreak from April 7, 2020 to May 19, 2020. GAD-7 was used for measurement of anxiety. We have used a cut of point of 10 and above to report anxiety symptoms. We have used Google Forms for online data collection and SPSS-22 for analysis. To determine associated factors for anxiety, a binary logistic regression model was used. Variables with p-value < 0.2 during the bivariable binary logistic regression were exported for further analysis in the multivariable binary logistic regression. Finally, variables with p-value <0.05 were considered as significantly associated with the outcomes.

Results

Three hundred and eighty-eight healthcare professionals filled the online questionnaire; Majority (71.1%) were males. Significant number of respondents (78.9%) reported lack of adequate personal protective equipment (PPE) at the work place. The prevalence of anxiety was 26.8%.

Being female (AOR: 1.88; 95% C.I:1.11, 3.19), visiting/treating 30–150 patients per day (AOR: 3.44; 95% C.I:1.51, 7.84), those employed at private healthcare institutions (AOR: 2.40; 95% C.I:1.17, 4.90), who do not believe that COVID-19 is preventable (AOR: 2.04; 95% C.I:1.04, 4.03) and those who reported lack of PPE (AOR: 1.98; 95% C.I:1.04, 3.79) were more likely to be anxious.

Conclusions

The anxiety prevalence among healthcare professionals in Ethiopia during early stage of COVID-19 pandemic was high. This study shows that lack of preventive equipment, being female, contact with many patients, low self-efficacy and working in private health facilities were risk factors for anxiety. Anxiety prevention among health professionals during COVID-19 pandemic requires a holistic approach including provision of sufficient PPE, improving self-efficacy and addressing problems both at public and private institutions and focusing more on female health professionals.

Risk and protective factors for anxiety during COVID-19 pandemic

BACKGROUND

Coronavirus Disease 2019 (COVID-19) is a global pandemic and an anxiety-provoking event. There are few studies to identify potential risk and protective factors related to anxiety during COVID-19 pandemic.

METHODS

We collected information on demographic data and lifestyles by a web-based survey of 19,802 participants from 34 provinces in China during COVID-19 pandemic. Level of anxiety was evaluated using the Self-Rating Anxiety Scale. We used ordinal multivariable logistic regression to estimate the associations of anxiety level with potential risk and protective factors. We further developed a new score to simplify the assessment of anxiety during COVID-19 crisis.

RESULTS

Among 19,802 participants, we found that those who were front-line medical personnel, suffered from chronic disease, with present symptoms of SARS-CoV-2 infection or contact history had 112, 93, 40 and 15% increased risk of higher anxiety level; while those with knowledge about personal protective measures or wore masks had 75 and 29% lower risk of higher anxiety level respectively. We developed a risk score by calculating the sum of single score of 17 factors. Each one increase of the risk score was associated with a 297% increase in anxiety index score. In categorical analysis, low risk (the risk score between 1 to 2), the moderate risk group (the risk score of 3) and high risk group (the risk score ≥ 4) had - 0.40 (95% CI: - 1.55, 0.76), 1.44 (95% CI: 0.27, 2.61) and 9.18 (95% CI: 8.04, 10.33) increase in anxiety index score, and 26% (95% CI: - 7, 72%), 172% (95% CI: 100, 270%), and 733% (95% CI: 516, 1026%) higher risk of anxiety respectively, when compared with the very low risk group (the risk score of 0). The AUC was 0.73 (95% CI, 0.72, 0.74) for the model fitted the developed risk score, with the cut-off point of 3.5.

CONCLUSIONS

These findings revealed protective and risk factors associated with anxiety, and developed a simple method of identifying people who are at an increased risk of anxiety during COVID-19 pandemic.

Sleep problems during COVID-19 pandemic and its' association to psychological distress: A systematic review and meta-analysis

BACKGROUND

The emerging novel coronavirus disease 2019 (COVID-19) has become one of the leading cause of deaths worldwide in 2020. The present systematic review and meta-analysis estimated the magnitude of sleep problems during the COVID-19 pandemic and its relationship with psychological distress.

METHODS

Five academic databases (Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, and Embase) were searched. Observational studies including case-control studies and cross-sectional studies were included if relevant data relationships were reported (i.e., sleep assessed utilizing the Pittsburgh Sleep Quality Index or Insomnia Severity Index). All the studies were English, peer-reviewed papers published between December 2019 and February 2021. PROSPERO registration number: CRD42020181644.

FINDINGS

168 cross-sectional, four case-control, and five longitudinal design papers comprising 345,270 participants from 39 countries were identified. The corrected pooled estimated prevalence of sleep problems were 31% among healthcare professionals, 18% among the general population, and 57% among COVID-19 patients (all p-values < 0.05). Sleep problems were associated with depression among healthcare professionals, the general population, and COVID-19 patients, with Fisher's Z scores of -0.28, -0.30, and -0.36, respectively. Sleep problems were positively (and moderately) associated with anxiety among healthcare professionals, the general population, and COVID-19 patients, with Fisher's z scores of 0.55, 0.48, and 0.49, respectively.

INTERPRETATION

Sleep problems appear to have been common during the ongoing COVID-19 pandemic. Moreover, sleep problems were found to be associated with higher levels of psychological distress. With the use of effective programs treating sleep problems, psychological distress may be reduced. Vice versa, the use of effective programs treating psychological distress, sleep problems may be reduced.

FUNDING

The present study received no funding.