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

Factors Associated with Insomnia Symptoms in a Longitudinal Study among New York City Healthcare Workers during the COVID-19 Pandemic

Background: Few studies have examined the longer-term psychological impact of COVID-19 in healthcare workers (HCWs). Purpose: We examined the 10-week trajectory of insomnia symptoms in HCWs during the COVID-19 pandemic. Methods: HCWs completed a web-based survey at baseline (9 April–11 May 2020) and every 2 weeks for 10 weeks. The main outcome was the severity of insomnia symptoms in the past week. Multivariable-adjusted generalized estimating equation analyses examined factors associated with insomnia symptoms. Results: n = 230 completed surveys at baseline. n = 155, n = 130, n = 118, n = 95, and n = 89 completed follow-ups at weeks 2, 4, 6, 8, and 10, respectively. Prevalence of insomnia symptoms of at least moderate severity was 72.6% at baseline, and 63.2%, 44.6%, 40.7%, 34.7%, and 39.3% at weeks 2, 4, 6, 8, and 10, respectively. In multivariable analyses, factors significantly associated with increased odds of insomnia symptoms were younger age (OR: 0.98, 95% CI: 0.96–1.00), working in a COVID-facing environment (OR: 1.75, 95% CI: 1.15–2.67) and hours worked (OR: 1.16, 95% CI: 1.06–1.27). Conclusions: The initial high rates of insomnia symptoms improved as time passed from the peak of local COVID-19 cases but four out of ten HCWs still had moderate-to-severe insomnia symptoms ten weeks after baseline.

China's Successful Recruitment of Healthcare Professionals to the Worst-Hit City: A Lesson Learned

The outbreak of coronavirus disease in 2019 (COVID-19) in Wuhan has led Chinese health authorities to recruit healthcare providers from the least-affected areas to provide care to the infected patients in Wuhan. We took further steps to explain some plausible reasons for their experiences. We used interpretative phenomenological analysis (IPA) to understand the subjective experiences, as well as the reasons for these experiences among the healthcare providers who had traveled from the least-affected parts of China to render aid during Wuhan’s COVID-19 outbreak. Using purposive and snowball sampling, healthcare professionals were recruited from three major hospitals in Jiangsu province. Semi-structured interviews were conducted from 1 September to 14 November 2020 in face-to-face contexts. Ten nurses and four doctors provided their informed consent for the study. The primary superordinate theme from the responses highlighted how social identity and individual needs were challenged by each individual’s professional ethics. COVID-19 not only presents significant risks to the health of nurses and medical doctors; it further challenges their emotional and psychosocial wellbeing. Care should be taken in allocating support and help, with the careful deployment of professional values and beliefs, so that any human resource as precious as medical doctors and nurses can be protected.

Correlates and Predictors of PTSD Symptoms Among Healthcare Workers During the COVID-19 Pandemic: Results of the egePan-VOICE Study

Background: The COVID-19 pandemic has led to ongoing challenges for healthcare systems across the world. Previous research has provided evidence for an increased prevalence of depression and anxiety as well as post-traumatic stress disorder (PTSD). In Germany, however, only scarce data on correlates and predictors for PTSD symptomatology in the context of the COVID-19 pandemic among healthcare workers (HCW) are available. Methods: This research is part of a large prospective web-based survey (egePan-VOICE study) among HCW in Germany. The current sample (N = 4,724) consisted of physicians (n = 1,575), nurses (n = 1,277), medical technical assistants (MTA, n = 1,662), and psychologists (n = 210). PTSD symptomatology was measured using the abbreviated version of the Impact of Event Scale (IES-6). In addition, sociodemographic, occupational, COVID-19-related, psychological (e.g., depressive symptoms and generalized anxiety), as well as work-related variables were assessed. Results: Our findings revealed significant higher PTSD symptoms with medium effect sizes among HCW reporting an increased self-report burden during the pandemic, increased fear of becoming infected or infecting relatives with the virus, sleep problems, feeling physically or mentally exhausted, as well as increased levels of depressiveness and generalized anxiety. According to multiple linear regression analysis, the most relevant predictors for higher IES-6 scores were increased level of generalized anxiety and depressiveness, increased fear of infecting relatives, as well as medical profession (MTA compared to physicians). Conclusion: Despite the cross-sectional design of our study, the here identified associations with PTSD symptomatology may provide a basis for future preventive interventions.

Psychological distress and health-related quality of life in patients after hospitalization during the COVID-19 pandemic: A single-center, observational study

Introduction

Illnesses requiring hospitalization are known to negatively impact psychological well-being and health-related quality of life (HRQoL) after discharge. The impact of hospitalization during the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) pandemic on psychological well-being and health-related quality of life is expected to be higher due to the exceptional circumstances within and outside the hospital during the pandemic surge. The objective of this study was to quantify psychological distress up to three months after discharge in patients hospitalized during the first coronavirus disease 2019 (COVID-19) pandemic wave. We also aimed to determine HRQoL, to explore predictors for psychological distress and HRQoL, and to examine whether psychological distress was higher in COVID-19 confirmed patients, and in those treated in Intensive Care Units (ICUs).

Methods

In this single-center, observational cohort study, adult patients hospitalized with symptoms suggestive of COVID-19 between March 16 and April 28, 2020, were enrolled. Patients were stratified in analyses based on SARS-CoV-2 PCR results and the necessity for ICU treatment. The primary outcome was psychological distress, expressed as symptoms of post-traumatic stress disorder (PTSD), anxiety, and depression, up to three months post-discharge. Health-related quality of life (HRQoL) was the secondary outcome. Exploratory outcomes comprised predictors for psychological distress and HRQoL.

Results

294 of 622 eligible patients participated in this study (median age 64 years, 36% female). 16% and 13% of these patients reported probable PTSD, 29% and 20% probable anxiety, and 32% and 24% probabledepression at one and three months after hospital discharge, respectively. ICU patients reported less frequently probable depression, but no differences were found in PTSD, anxiety, or overall HRQoL. COVID-19 patients had a worse physical quality of life one month after discharge, and ICU patients reported a better mental quality of life three months after discharge. PTSD severity was predicted by time after discharge and being Caucasian. Severity of anxiety was predicted by time after discharge and being Caucasian. Depression severity was predicted by time after discharge and educational level.

Conclusion

COVID-19 suspected patients hospitalized during the pandemic frequently suffer from psychological distress and poor health-related quality of life after hospital discharge. Non-COVID-19 and non-ICU patients appear to be at least as affected as COVID-19 and ICU patients, underscoring that (post-)hospital pandemic care should not predominantly focus on COVID-19 infected patients.

Traumatic Distress of COVID-19 and Depression in the General Population: Exploring the Role of Resilience, Anxiety, and Hope

International evidence published so far shows that the COVID-19 pandemic has negatively impacted on global mental health. Specifically, there is some research suggesting that the psychological distress related to depression, anxiety and posttraumatic stress has impacted on the psychological well-being of the general population. Yet, there is limited evidence on the relational paths between COVID-19 traumatic distress and depression. Participants of this cross-sectional study were 456 adults 18 years old or older from the general population (Mean age = 41.2 years, SD = 11.7) who completed an online questionnaire including measures assessing depression, anxiety, resilience, hope and traumatic distress related to COVID-19. Structural equation modelling was applied to examine the proposed mediation model. The results confirmed the proposed model, with traumatic distress of COVID-19, resilience, anxiety and hope explaining a considerable amount of variance (59%) in depression scores. Traumatic distress of COVID-19 was a strong positive predictor of depression, while anxiety, hope and resilience were both joint and unique mediators of this relationship. Exposure to the COVID-19 pandemic is strongly associated with depression in adults of the general population. The co-occurrence of anxiety may negatively contribute to experiencing higher levels of depression, while resilience and hope may act as buffers against depression associated with the impact of this pandemic. Our findings suggest that wide community-based interventions designed to promote resilience, build hope and reduce anxiety may help mitigate depression associated with exposure to the COVID-19 pandemic.

Microbiota-Gut-Brain Communication in the SARS-CoV-2 Infection

The coronavirus disease of 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome 2 (SARS-CoV-2). In addition to pneumonia, individuals affected by the disease have neurological symptoms. Indeed, SARS-CoV-2 has a neuroinvasive capacity. It is known that the infection caused by SARS-CoV-2 leads to a cytokine storm. An exacerbated inflammatory state can lead to the blood-brain barrier (BBB) damage as well as to intestinal dysbiosis. These changes, in turn, are associated with microglial activation and reactivity of astrocytes that can promote the degeneration of neurons and be associated with the development of psychiatric disorders and neurodegenerative diseases. Studies also have been shown that SARS-CoV-2 alters the composition and functional activity of the gut microbiota. The microbiota-gut-brain axis provides a bidirectional homeostatic communication pathway. Thus, this review focuses on studies that show the relationship between inflammation and the gut microbiota-brain axis in SARS-CoV-2 infection.

People who contracted COVID-19: the mediating role of shame and guilt in the link between threatening illness perception and mental health measures

Background and Objectives: The COVID-19 pandemic has affected the mental health of a range of people, including healthcare workers, the general population, and COVID-19 patients. This study examined the psychological distress, negative affect, and positive affect of people who contracted COVID-19 in Israel, and their relation to threatening illness perception, guilt, and shame.Design: Cross-sectional design.Methods: Three hundred and fifty-one participants who had contracted COVID-19 completed self-report questionnaires assessing the study variables.Results: The results revealed a direct positive link between threatening COVID-19 illness perception and psychological distress and negative affect, and a negative link with positive affect. In addition, shame and guilt were significant mediators; namely, threatening COVID-19 illness perception was linked with negative affect via guilt, and with psychological distress, negative affect, and positive affect via shame.Conclusions: Illness perception, shame, and guilt may have a significant negative effect on the mental health of people who contracted COVID-19, and should be acknowledged and addressed by professionals.

Mental health among healthcare workers and other vulnerable groups during the COVID-19 pandemic and other coronavirus outbreaks: A rapid systematic review

INTRODUCTION

Although most countries and healthcare systems worldwide have been affected by the COVID-19 pandemic, some groups of the population may be more vulnerable to detrimental effects of the pandemic on mental health than others. The aim of this systematic review was to synthesise evidence currently available from systematic reviews on the impact of COVID-19 and other coronavirus outbreaks on mental health for groups of the population thought to be at increased risk of detrimental mental health impacts.

MATERIALS AND METHODS

We conducted a systematic review of reviews on adults and children residing in a country affected by a coronavirus outbreak and belonging to a group considered to be at risk of experiencing mental health inequalities. Data were collected on symptoms or diagnoses of any mental health condition, quality of life, suicide or attempted suicide. The protocol for this systematic review was registered in the online PROSPERO database prior to commencing the review (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=194264).

RESULTS

We included 25 systematic reviews. Most reviews included primary studies of hospital workers from multiple countries. Reviews reported variable estimates for the burden of symptoms of mental health problems among acute healthcare workers, COVID-19 patients with physical comorbidities, and children and adolescents. No evaluations of interventions were identified. Risk- and protective factors, mostly for healthcare workers, showed the importance of personal factors, the work environment, and social networks for mental health.

CONCLUSIONS

This review of reviews based on primary studies conducted in the early months of the COVID-19 pandemic shows a lack of evidence on mental health interventions and mental health impacts on vulnerable groups in the population.

Psychological burden in patients with COVID-19 and their relatives 90 days after hospitalization: A prospective observational cohort study

OBJECTIVE

COVID-19 causes psychological distress for patients and their relatives at short term. However, little research addressed the longer-term psychological outcomes in this population. Therefore, we aimed to prospectively assess clinically relevant psychological distress in hospitalized patients with COVID-19 and their relatives 90 days after hospital discharge.

METHODS

This exploratory, prospective, observational cohort study included consecutive adult patients hospitalized in two Swiss tertiary-care hospitals between March and June 2020 for confirmed COVID-19 and their relatives. The primary outcome was psychological distress defined as clinically relevant symptoms of anxiety and/or depression measured with the Hospital Anxiety and Depression Scale (HADS) 90 days after discharge.

RESULTS

Clinically relevant psychological distress 90 days after hospital discharge was present in 23/108 patients (21.3%) and 22/120 relatives (18.3%). For patients, risk and protective factors associated with clinically relevant psychological distress included sociodemographic, illness-related, psychosocial, and hospital-related factors. A model including these factors showed good discrimination, with an area under the receiver-operating characteristic curve (AUC) of 0.84. For relatives, relevant risk factors were illness-related, psychosocial, and hospital-related factors. Resilience was negatively associated with anxiety and depression in both patients and relatives and regarding PTSD in relatives only.

CONCLUSION

COVID-19 is linked to clinically relevant psychological distress in a subgroup of patients and their relatives 90 days after hospitalization. If confirmed in an independent and larger patient cohort, knowledge about these potential risk and protective factors might help to develop preventive strategies.

The perceived impact of the COVID-19 pandemic on dental undergraduate students in the Italian region of Emilia-Romagna

INTRODUCTION

The outbreak and diffusion of the novel SARS-CoV2 coronavirus have caused an emergency status in the dental education system.

MATERIALS AND METHODS

An anonymous survey composed of 34 questions was delivered to students of the Master Degree Programme in Dentistry and Dental Prosthodontics of the Universities of Emilia-Romagna, the fifth Italian region most affected by the pandemic. The psychological impact of COVID-19 was assessed by means of the Generalised Anxiety Disorder-7 scale (GAD-7). Numerically recoded data were analysed using the Analysis of Variance (ANOVA), whilst to investigate the association between quantitative variables, the Pearson correlation coefficient (R) was computed.

RESULTS

The questionnaire was completed by 399 students (75%) out of 532. Most students experienced difficulties in working at the thesis during the COVID-19 emergency. For over half of them, online teaching could only partially replace traditional face-to-face lessons. The negative impact on the study career was judged as particularly high by sixth-year students. Clinical training activities were considered as exposing to the risk of contracting COVID-19 infection by the majority of the students. The level of concern of contracting COVID-19 infections during future university activities was positively correlated to risk perception related to clinical training.

CONCLUSION

The results of this survey could be used to train students to a correct risk assessment. Students reported experiencing concern whilst thinking of COVID-19 and 6.5% of them showed symptoms related to high levels of anxiety. These data may guide Universities in trying to reduce students' anxiety by means of correct communication strategies.

Illness severity and risk of mental morbidities among patients recovering from COVID-19: a cross-sectional study in the Icelandic population

OBJECTIVE

To test if patients recovering from COVID-19 are at increased risk of mental morbidities and to what extent such risk is exacerbated by illness severity.

DESIGN

Population-based cross-sectional study.

SETTING

Iceland.

PARTICIPANTS

A total of 22 861 individuals were recruited through invitations to existing nationwide cohorts and a social media campaign from 24 April to 22 July 2020, of which 373 were patients recovering from COVID-19.

MAIN OUTCOME MEASURES

Symptoms of depression (Patient Health Questionnaire), anxiety (General Anxiety Disorder Scale) and posttraumatic stress disorder (PTSD; modified Primary Care PTSD Screen for DSM-5) above screening thresholds. Adjusting for multiple covariates and comorbidities, multivariable Poisson regression was used to assess the association between COVID-19 severity and mental morbidities.

RESULTS

Compared with individuals without a diagnosis of COVID-19, patients recovering from COVID-19 had increased risk of depression (22.1% vs 16.2%; adjusted relative risk (aRR) 1.48, 95% CI 1.20 to 1.82) and PTSD (19.5% vs 15.6%; aRR 1.38, 95% CI 1.09 to 1.75) but not anxiety (13.1% vs 11.3%; aRR 1.24, 95% CI 0.93 to 1.64). Elevated relative risks were limited to patients recovering from COVID-19 that were 40 years or older and were particularly high among individuals with university education. Among patients recovering from COVID-19, symptoms of depression were particularly common among those in the highest, compared with the lowest tertile of influenza-like symptom burden (47.1% vs 5.8%; aRR 6.42, 95% CI 2.77 to 14.87), among patients confined to bed for 7 days or longer compared with those never confined to bed (33.3% vs 10.9%; aRR 3.67, 95% CI 1.97 to 6.86) and among patients hospitalised for COVID-19 compared with those never admitted to hospital (48.1% vs 19.9%; aRR 2.72, 95% CI 1.67 to 4.44).

CONCLUSIONS

Severe disease course is associated with increased risk of depression and PTSD among patients recovering from COVID-19.

Gender-Based Analysis of the Psychological Impact of the COVID-19 Pandemic on Healthcare Workers in Spain

Purpose: This study aims to analyze from a gender perspective the psychological distress experienced by the medical workforce during the peak of the pandemic in Spain. Methods: This is a single-center, observational analytic study. The study population comprised all associated health workers of the Cruces University Hospital, invited by email to participate in the survey. It consisted of a form covering demographic data, the general health questionnaire-28 (GHQ-28), and the perceived stress scale (PSS-14). We used multivariant regression analysis to check the effect of gender on the scores. We used gender analysis in both design and interpretation of data following SAGER guidelines. Results: Females made 74.6% of our sample, but their proportion was higher in lower-paid positions such as nursery (89.9%) than in higher-paid ones. The percentage of women categorized as cases with the GHQ-28 was 78.4%, a proportion significantly higher than in the male population (61.3%, p < 0.001). The multivariant regression analysis showed that being women, working as orderly hospital porters, and having a past psychiatric history were risk factors for higher scores in both the GHQ-28 and PSS-14. Conclusion: Women and those with lower-paid positions were at risk of higher psychological distress and worse quality of life within the medical workforce during the first wave of the pandemic. Gender analysis must be incorporated to analyze this fact better.

Challenges facing essential workers: a cross-sectional survey of the subjective mental health and well-being of New Zealand healthcare and 'other' essential workers during the COVID-19 lockdown

OBJECTIVES

To compare psychological outcomes, experiences and sources of stress over the COVID-19 lockdown in New Zealand in essential workers (healthcare and 'other' essential workers) with that of workers in nonessential work roles.

DESIGN

Online cross-sectional survey.

SETTING

Conducted in New Zealand over level 4 lockdown in April/May 2020.

PARTICIPANTS

Findings from employed participants (2495) are included in this report; 381 healthcare workers, 649 'other' essential workers and 1465 nonessential workers.

PRIMARY AND SECONDARY OUTCOME MEASURES

Measures included psychological distress (Kessler Psychological Distress Scale (K10)), anxiety (Generalised Anxiety Disorder (GAD-7)), well-being (WHO-5), alcohol use, subjective experiences and sources of stress. Differences between work categories were quantified as risk ratios or χ² tests.

RESULTS

After controlling for confounders that differed between groups of essential and nonessential workers, those in healthcare and those in 'other' essential work were at 71% (95% CI 1.29 to 2.27) and 59% (95% CI 1.25 to 2.02) greater risk respectively, of moderate levels of anxiety (GAD-7 ≥10), than those in nonessential work. Those in healthcare were at 19% (95% CI 1.02 to 1.39) greater risk of poor well-being (WHO-5 <13). There was no evidence of differences across work roles in risk for psychological distress (K10 ≥12) or increased alcohol use. Healthcare and 'other' essential workers reported increased workload (p<0.001) and less uncertainty about finances and employment than those in nonessential work (p<0.001). Healthcare and nonessential workers reported decreased social contact. No difference by work category in health concerns was reported; 15% had concerns about participants' own health and 33% about other people's health.

CONCLUSIONS

During the pandemic lockdown, essential workers (those in healthcare and those providing 'other' essential work) were at increased risk of anxiety compared with those in nonessential work, with those in healthcare also being at increased risk of poor well-being. This highlights the need to recognise the challenges this vital workforce face in pandemics.

How does the COVID-19 affect mental health and sleep among Chinese adolescents: a longitudinal follow-up study

OBJECTIVE

The Corona Virus Disease-19 (COVID-19) pandemic has evolved into the largest public health event in the world. Earlier COVID-19 studies have reported that the pandemic caused widespread impacts on mental health and sleep in the general population. However, it remains largely unknown how the prevalence of mental health problems and sleep disturbance developed and interacted in adolescents at different times in the epidemic.

METHODS

831 teenagers (aged 14-19) underwent a longitudinal follow-up study to evaluate the prevalence of mental health problems and sleep disturbance among adolescents before, during, and after the COVID-19 breakout in China and to explore the interaction between mental health and sleep across the three measurements. The chronotype, anxiety and depression level, sleep quality, and insomnia were investigated during each measurement.

RESULTS

The adolescents had delayed sleep onset and sleep offset time, longer sleep duration during the quarantine than before and after the epidemic, whereas their chronotype tended to morning type during the epidemic. Yet, the highest prevalence of anxiety, depression, poor sleeper, and insomnia symptoms were observed before but not during the COVID-19 breakout. The females and adolescents who were eveningness type showed significantly higher anxiety and depression levels, poorer sleep quality, and severe insomnia status than the males and the intermediate and morning types. Sleep disturbance was positively associated with mental problems among three measurements. Pre-measured depression level significantly predicted sleep disturbance level at follow-ups.

CONCLUSION

These findings suggested that adolescents' high prevalence of mental health and sleep problems occurred before the COVID breakout and decreased during and after the epidemic. Gender and chronotype were significant risk factors associated with affective and sleep disturbances. Depression positively predicted later sleep problems, but not vice versa.

Risk of COVID-19 morbidity and mortality among healthcare workers working in a Large Tertiary Care Hospital

OBJECTIVES

To estimate COVID-19 infection and outcomes among healthcare workers (HCWs) compared with non-HCWs.

METHODS

A prospective surveillance study was conducted among HCWs and non-HCWs eligible for treatment at a large tertiary care facility in Riyadh between March 1st to November 30th, 2020.

RESULTS

A total 13,219 cases with confirmed COVID-19 have been detected during the study; 1596 (12.1%) HCW patients (HCWPs) and 11623 (87.9%) non-HCWPs. Infection per 100 population was almost ten-fold higher in HCWs compared with non-HCWs (9.78 versus 1.01, p<0.001). The risk of infection in support staff (15.1%) was almost double the risk in other professional groups (p<0.001). Hospitalization (14.1% versus 1.8%, p<0.001), ICU admission (3.0% versus 0.5%, p<0.001), and case fatality (0.13% versus 2.77%, p<0.001) were significantly lower in HCWPs compared with non-HCWPs. The mortality per 100,000 population was significantly lower in HCWs compared with non-HCWs (12.3 and 28.1, p<0.001).

CONCLUSION

HCWs are at ten-fold higher risk of COVID-19 infection but have much better outcomes compared with non-HCWs. More strict infection control measures are still required to protect HCWs, including those who are not involved in direct patient care.

The role of Colombian psychiatrists in the midst of the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic is having an impact on multiple levels, one being the way of providing mental health care services. A study was proposed in order to identify the standpoints regarding the role we must assume as psychiatrists in the setting of this pandemic in Colombia.

METHODS

A study was developed employing a Delphi-type methodology. Three types of psychiatrist were included for the application of the instrument: directors of academic psychiatry programmes, directors of mental health institutions and private practitioners.

RESULTS

Responses were collected over the course of a month (between April and May) by 24 participants corresponding to 14 private practitioners (58.3%), 6 heads of academic programmes (25.1%) and 4 directors of mental health services (16.6%). The results, grouped around the psychiatric work, describe the impact generated by the pandemic and the possible role of the specialist.

CONCLUSIONS

Consistency was identified around the need to provide a differential approach according to the vulnerabilities of each group of people exposed to the pandemic; as well as the remote provision of health care through technology, often using videoconferencing.

[The Role of Colombian Psychiatrists in the Midst of the COVID 19 Pandemic]

INTRODUCTION

The COVID-19 pandemic is having an impact on multiple levels, one being the way of providing mental health care services. A study was proposed in order to identify the standpoints regarding the role we must assume as psychiatrists in the setting of this pandemic in Colombia.

METHODS

A study was developed employing a Delphi-type methodology. Three types of psychiatrist were included for the application of the instrument: directors of academic psychiatry programmes, directors of mental health institutions and private practitioners.

RESULTS

Responses were collected over the course of a month (between April and May) by 24 participants corresponding to 14 private practitioners (58.3%), 6 heads of academic programmes (25.1%) and 4 directors of mental health services (16.6%). The results, grouped around the psychiatric work, describe the impact generated by the pandemic and the possible role of the specialist.

CONCLUSIONS

Consistency was identified around the need to provide a differential approach according to the vulnerabilities of each group of people exposed to the pandemic; as well as the remote provision of health care through technology, often using videoconferencing.

Psychological burden of COVID-19 on mild and moderate chronic spontaneous urticaria

Background: The impact of coronavirus disease 2019 (COVID-19) related mental health status on chronic spontaneous urticaria (CSU) has not been addressed before. Objective: The aim of this study was to evaluate the depression, anxiety and stress levels, and the fear of COVID-19 in patients with mild-to-moderate CSU and to determine their impact on urticaria activity during the pandemic. Methods: A total of 509 patients with mild-to-moderate CSU were prospectively evaluated with validated scales, the Depression Anxiety Stress Scale 21 (DASS-21) and the Fear of COVID-19 Scale (FCV-19S) during the lockdown period (LP) and the return to normal period (RTNP). CSU activity was determined with the urticaria activity score summed over 7 days (UAS7) and medication scores (MS). UAS7 and MS before the pandemic were retrospectively collected from medical records. Results: The median UAS7 and MS were both significantly higher in the LP than in the median of related scores during the prepandemic period (p < 0.0001) and the RTNP (p < 0.0001). The mean FCV-19S and DASS-21 scores were both significantly higher in the LP than in the RTNP (p < 0.0001). The FCV-19S and the DASS-21 anxiety and stress subscales were significantly higher in women. The UAS7s were positively correlated with the FCV-19S and depression, anxiety, and stress subscale scores. Conclusion: Fear of COVID-19, anxiety, depression, and stress during the COVID-19 pandemic, especially when strict isolation measures are taken, have a significant impact on mental health and urticaria activity in patients with mild-to-moderate CSU, even though they are not infected. Psychological support for patients with CSU seems to be important to control disease activity during the pandemic.

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

Background

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

Methods

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

Results

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

Conclusions

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

Social Distancing in the Era of COVID-19: A Call for Maintaining Social Support for the Maternal Population

In the era of COVID-19, pregnant and postpartum women, an already vulnerable group, are facing unforeseen and compounding stressful events with reduced social protections. We argue that to prevent harmful consequences that may surpass the effects of the crisis itself for pregnant women and their families, it is imperative to prioritize maintaining formal and informal sources of social support for mothers in proposed infection control policies.

The high mental health burden of "Long COVID" and its association with on-going physical and respiratory symptoms in all adults discharged from hospital

During previous severe coronavirus outbreaks, 15% of survivors suffered from depression and 33% from post-traumatic stress disorder (PTSD) at a mean follow-up of 22.6 and 32.2 months, respectively [1]. A recent systematic review identified that whilst physical symptoms receive most attention, the effects of coronavirus disease 2019 (COVID-19) upon mental health may be equally important [2]. One meta-analysis estimated the prevalence of depression and PTSD in the general public during this pandemic at 24% and 15%, respectively [3]. In adults with pre-existing asthma and COPD, the prevalence of depression and PTSD was 31.5% and 11.3%, respectively [4]. For patients with acute COVID-19 infection, this increased to 42% for depression and 96% for symptoms consistent with PTSD [3].

Adults discharged from hospital with COVID-19 may experience “Long COVID”, where mental health symptoms are significant and linked to physical symptoms such as breathlessness. Clinicians should use brief screening questionnaires to support their recovery.https://bit.ly/3d22SJM

Perceived stress and associated factors among health care professionals working in the context of COVID-19 pandemic in public health institutions of southern Ethiopia 2020

INTRODUCTION

Health care professionals are at higher risk of developing stress-related problems during outbreaks, due to the overwhelming clinical workload, fear of contagion, and inadequate protective gears. So, in order to monitoring mental health issues and to understand the factors evidence-based interventions is important. Therefore, this study was aimed to assess perceived stress and associated factors among health care professionals working in the context of COVID-19, Southern Ethiopia.

METHODS

Institution based cross-sectional study was conducted among 798 health care professionals from the 1st May to 1st June 2020. The study participants were selected using simple random sampling technique after allocating a proportion to each health institute based on the size of health care professionals. A pre-tested and structured interviewer-administered questionnaire using KOBO collect survey tool was used to collect data. A total score of >20 points was considered as the cut off for experiencing perceived stress based on perceived stress scale. Both bivariable and multivariable logistic regression analysis were performed to identify associated factors. The level of statistical significance was set at a p-value of less than 0.05 in multivariable logistic regression.

RESULT

Nearly two-thirds 61.8% (95% CI: 58.4%, 65.2%) of HCPs had perceived stress. Not having COVID-19 updated information (AOR = 2.41, 95% CI: 1.31, 4.43), not at all confident on coping with stress (AOR = 9.94, 95% CI:3.74, 26.41), somewhat confident in coping with stress (AOR = 4.69, 95% CI:2.81, 7.84), moderately confident on coping with stress (AOR = 2.36, 95% CI: 1.46, 3.82), and not getting along well with people (AOR = 4.88, 95% CI: 1.42, 16.72) were positively association with perceived stress. However, feeling overwhelmed by the demand of everyday life (AOR = 0.52 95% CI: 0.35, 0.77) and worrying about what other people think about them (AOR = 0.48, 95% CI: 0.24, 0.81) were negatively associated with perceived stress.

CONCLUSION

COVID-19 update, confidence in coping with stress, getting along with people, worrying about what other people think about them, and feeling overwhelmed by the demand of everyday life were factors significantly associated with perceived stress. The provision of COVID-19 update to HCPs along with wider strategies to support their psychological wellbeing is vital.

Mid-term Psychiatric Outcomes of Patients Recovered From COVID-19 From an Italian Cohort of Hospitalized Patients

Background: Although the usual primary clinical manifestation of Coronavirus disease (COVID-19) is respiratory, several non-respiratory symptoms have been described, including neuropsychiatric ones. The aim of this study was to investigate the mid-term mental health outcomes in patients recovered from COVID-19, 3-4 months after discharge from the University Hospital Maggiore della Carità, Novara, Italy. Furthermore, we investigated the possible association of the mid-term mental health consequences of the COVID-19 infection with patients' clinical current status, persistent physical impairment and severity of acute phase of the disease. Methods: Prospective study involving 238 individuals recovered from COVID-19. In the context of a multi-disciplinary approach, patients' assessment included both a clinical interview performed by an experienced psychiatrist, trained in the use of the Mini-International Neuropsychiatric Interview to assess the presence of anxiety and depressive symptoms and self-administered questionnaires: Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Resilience Scale for Adults (RSA), Impact of Event Scale (IES). Results: At the psychiatric assessment 32.9 and 29.5% of participants showed anxiety and depressive symptoms, respectively. Changes in appetite and sleep patterns emerged for 15.6 and 31.2% of patients. According to the self-administered questionnaires, 7.1% of participants had moderate-severe anxiety levels (BAI), while 10.5% had mild to severe depression (BDI-II). Twenty-six (11%) participants were referred to further psychiatric consultation. Psychiatric symptoms showed no correlation with acute COVID-19 severity; in our sample patients with depressive symptoms at the clinical interview, as well as those with mild to severe levels of depression according to BDI-II scores, had lower forced expiratory volume in the 1st second (FEV1) values than those without and greater odds for persistent, poor tolerance for physical efforts. Conclusions: As could be expected, an approach including both a psychiatric interview and the use of self-administered questionnaires is likely to capture the psychiatric outcome of patients recovered from COVID-19 better than questionnaires alone. Anxiety and depressive symptoms at follow-up had no correlation with the severity of COVID acute manifestations, but rather with ongoing and persistent physical symptoms. Further studies and longer follow-up duration will allow a better understanding of the complex relationship between residual physical symptoms, quality of life and psychological health.

Nursing strategies for COVID-19 prevention and control in a selected dental clinic

Aim

To comprehensively introduce the prevention and control measures that we can take in dental clinics during the pandemic period of coronavirus disease 2019 (COVID‐19) and provide some practical experience for the development of nursing and health policies applicable to COVID‐19.

Background

The outbreak of COVID‐19 has placed the global health system under threat, which seriously influences the normal operations of human society. Safe and effective nursing measures should be taken to ensure the normal operation of dental clinics.

Sources of evidence

We searched and referenced many references on the PubMed database. Through the combination of related literatures and our experience, we describe various strategies, including personnel management, personal protection, disinfection and isolation, adopted in the dental clinic of our Chinese hospital during the pandemic of COVID‐19.

Discussion/Conclusions

We introduced strategies for the nursing staff in dental clinics to assist them with the prevention and control of COVID‐19. The successful implementation of the protective measures could ensure the safety of medical staff and patients, and contributed to the normal operation of dental clinics during the pandemic period.

Conclusions for nursing and health policy

During the pandemic, frontline nurses are under physical and mental pressure facing the threat of infection while at work. In addition to pandemic prevention, we should also pay attention to the needs of nursing staff. More reasonable and effective nursing and health policies should be formulated to ensure their safety and protect their rights and interests. This is the only way that the prevention and control of COVID‐19 can be achieved, and we can prepare for future public health events.

Suicide and Suicidal Behaviors in the Context of COVID-19 Pandemic in Bangladesh: A Systematic Review

BACKGROUND

Without integration of the available information, appropriate suicide preventive actions can be hindered. Therefore, this study attempts to review the Bangladeshi COVID-19-related suicide studies for the first time.

METHODS

For conducting a systematic review, the PRISMA guideline was adhered. Bangladeshi literatures concerning the COVID-19 pandemic related to either suicide case or suicidal behavior were identified within 1 to 10 April 2021, from the databases like PubMed, Scopus, PsycINFO, Web of Science, CINAHL, etc. Finally, a total of 9 literatures were included in this review.

RESULTS

Four literatures were cross-sectional studies assessing the prevalence and risk factors of suicidal behavior, and the rest five were retrospective suicide studies concerned with either case study (n=3) or case-series study (n=2). The prevalence of suicidal ideation was identified to be ranging between 5% and 19.0%, whereas the rate increased over time of the pandemic inception. Significant risk factors concerning suicidal behavior included the factors related to (i) socio-demographic variables: female gender, being divorced or widows or widowers or single in marital status, having lower levels of education, being urban residence, belonging to higher socioeconomic class, being unemployed, and having no children, (ii) behavior and health-related variables: lack of physical exercise, cigarette smoking, alcohol consuming, abnormal sleep status, more exposure to social media, and suffering from the higher number of physical health problems; (iii) COVID-19 pandemic-related variables: lower knowledge of COVID-19, lack of preventive COVID-19 behaviors, higher levels of COVID-19 fear, living in highly COVID-19 infected area, higher economic loss due to the pandemic, and experiencing relatives or acquaintances' death by the COVID-19; (iv) psychopathological variables: depression, anxiety, stress, insomnia, suicidal thought history, suicide attempt history, and family with a history of suicide.

CONCLUSION

Implementing cost-effective mental health strategies along with social and community awareness for increasing help-seeking behaviors of suicide risky individuals is highly suggested.

Associations of the COVID-19 pandemic with the economic status and mental health of people affected by the Fukushima disaster using the difference-in-differences method: The Fukushima Health Management Survey

Although the coronavirus disease 2019 (COVID-19) pandemic and relevant preventive measures can affect the economic status and mental health of the public, their effect remains unraveled owing to a limited number of surveys conducted before and during the COVID-19 pandemic. We investigated the association of COVID-19 and relevant measures with multivariate outcomes among people affected by the Fukushima disaster in 2011 using the difference-in-differences (DID) method. We then analyzed the associations between sociodemographic factors and outcomes. We assessed psychological distress, problem drinking, insomnia state, unemployment, household economic decline, and interpersonal problems using three questionnaire surveys administered in 2018, 2019, and 2020. Participants were grouped according to three time periods by dates of voluntary stay-at-home requests (February 26) and the declaration of emergency (April 16) in Japan. The years 2020 and 2019 were regarded as the treatment group and control group, respectively, after confirming that no DIDs were found between 2018 and 2019. We performed regression analyses to identify the risk factors for outcomes. The DIDs were significant for household economic decline after the declaration of emergency, whereas problem drinking significantly improved. No significant DIDs were observed for other mental health outcomes including psychological distress and insomnia state. Absence of counselors was positively and significantly associated with all outcomes in 2020. Overall, people affected by the Fukushima disaster experienced more economic damage after the declaration of emergency during the COVID-19 pandemic but their mental health status did not reduce. Identifying people who have no counselors and providing them with support are emergent requirements to prevent a subsequent mental health decline.

A review on the COVID-19-related psychological impact on older adults: vulnerable or not?

BACKGROUND

COVID-19 is a novel event of the twenty-first century. Therefore, contemporary research is required to determine the current pandemic's psychological impact on older populations. Soon after the COVID-19 outbreak, several narrative reviews and guidelines were released to support older adult's psychological wellbeing. However, a lack of data from original studies was reported until May 2020.

AIM

To identify studies published from May 2020 until January 2021 that quantitatively assessed the mental health impact of COVID-19 on older adults using validated psychometric tools.

METHOD

A comprehensive literature search of original research articles was conducted using specific terms. The screening procedure was conducted stepwise.

RESULTS

Among the 18 included studies, cross-sectional online surveys indicated that older adults were less psychologically distressed than younger ones. A longitudinal study revealed that COVID-19 did not have a major impact on loneliness and satisfaction with life. On the contrary, studies comparing pre- with peri-pandemic data revealed that older adults experienced more severe depressive/anxiety/stress symptoms and loneliness during the pandemic. Several studies reported though only subclinical symptoms, as well as low loneliness levels during the pandemic.

CONCLUSIONS

Research studies suggested that older age may buffer against the COVID-19-related impact on mental health. Despite evidence against generalised perceptions of vulnerability, older adults' ability to adapt to adversity may be uneven, depending on cultural, social, economic and other individual factors. Taken together, the impact, moreover the long-term impact of COVID-19, is expected to vary across countries and older subpopulations, and remains to be evaluated by prospective, longitudinal studies.

Yoga and Naturopathy intervention for reducing anxiety and depression of Covid-19 patients - A pilot study

Background

Coronavirus disease 2019 (Covid-19) infection has caused a prominent psychological and mental havoc among the patients. Till now, there is paucity in literature for the management of psychological problems among patients with Covid-19. So we aimed in our study to assess the effect of Yoga and Naturopathy intervention on anxiety and depression of Covid-19 patients.

Methods

This quasi experimental study was conducted among 130 Covid-19 positive patients admitted in a tertiary care hospital. Yoga and Naturopathic intervention was given for 60 min a day for two weeks. Hospital anxiety depression scale (HADS) and Corona anxiety scale (CAS) was used to assess the generalized anxiety and depression among the patients.

Results

Average age of the patients participated was 44 with the range from 36 to 53 years. Among them 85 were male and 45 were female. Of all 130 patients, 33% had symptoms of borderline depression, 9.2% had severe depression, 40% had borderline anxiety and 12.3% had severe anxiety. In CAS, 59 patients (45.38%) reported Covid-19 related dysfunctional anxiety. All the patients showed a significant reduction in the HADS- anxiety (P < 0.01), HADS-depression (p < 0.01) and CAS (p < 0.01) score after the intervention.

Conclusion

The present study showed significant reduction of anxiety and depression level among the Covid-19 patients. These interventions can be added to the conventional care for better mental and physical wellbeing of the patients after validating the findings with justified study design.

Psychological distress and alcohol use disorder during the COVID-19 era among middle- and low-income U.S. adults

PURPOSE

This study examined how exposure to events during the Coronavirus Disease-19 (COVID-19) era is linked to symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), COVID-19 era-related stress (CS), alcohol use disorder (AUD), and suicidal ideation (SI) in low and middle-income U.S adults.

METHODS

A national sample of 6,607 adults (4.4% who reported testing positive for COVID-19, 25.3% testing negative, and 70.3% untested) were recruited an online platform andcompleted the Patient Health Questionnaire-2, Generalized Anxiety Disorder-2, PTSD-Checklist for DSM-5, the Alcohol Use Disorder Identification-Consumption scale, and an item assessing SI in May-June 2020. A series of multivariable analyses were conducted.

RESULTS

In the total sample, 35.3% screened positive for current AUD, 33.6% for MDD, 33.6% for GAD, 24.6% for SI, and 20.2% for CS. Past 2-week SI (adjusted odds ratios [AORs]= 1.49-12.06), number of close friends (AORs= 1.40-2.72), history of AUD (AORs= 1.15-1.92), history of anxiety disorder (AORs= 1.07-2.63), and younger age (AORs= 0.97-0.98) were significantly associated with screening positive for MDD, GAD, CS, and AUD. COVID-19 status was not independently associated with these conditions, but the combination of testing positive for COVID-19, meeting criteria for AUD, and screening positive for MDD, GAD, or CS predicted a 96% probability for SI.

CONCLUSION

Predisposing factors are stronger predictors of psychological distress than personal COVID-19 infection or exposure. The additive effects of COVID-19 infection, alcohol use, and psychiatric problems in predicting SI suggest screening, monitoring, and treating these conditions in population-based prevention and treatment efforts may be important.

Immediate Psychosocial Impact on Healthcare Workers During COVID-19 Pandemic in China: A Systematic Review and Meta-Analysis

Objectives: The corona virus disease-2019 (COVID-19) pandemic spread globally, and we aimed to investigate the psychosocial impact on healthcare workers (HWs) in China during the pandemic.

Methods: In this systematic review and meta-analysis, we searched seven electronic databases for cross-sectional studies on psychosocial impact on HWs in relation to COVID-19 from January 1, 2020 to October 7, 2020. We included primary studies involving Chinese HWs during the pandemic, and data were extracted from the published articles. Our primary outcome was prevalence of anxiety, depression, and stress disorders. We pooled prevalence value with their 95% confidence interval using random effect models and assessed study quality on the basis of an 11-item checklist recommended by the Agency for Healthcare Research and Quality. The study protocol was registered in PROSPERO (CRD42020195843).

Results: We identified 25 articles comprising a total of 30,841 completed questionnaires and 22 studies for meta-analysis. The prevalence of anxiety, depression, and stress disorders was 34.4% (29.5–39.4%), 31.1% (24.5–37.7%), and 29.1% (24.3–33.8%) for HWs. The pooled prevalence of anxiety disorders for HWs from late January to early February was 46.4% (42.9–49.9%), significantly higher than those in mid-term February (28.0%, 23.9–32.1%) and after late February (27.6%, 16.0–39.2%). The pooled prevalence of depression disorders for HWs from late January to early February was 46.5% (38.8–54.2%), significantly higher than those in mid-term February (27.1%, 19.8–34.5%) and after late February (32.9%, 16.2–49.5%). HWs working in Hubei Province had a higher prevalence of anxiety (37.9 vs. 30.8%) and a lower prevalence of depression (27.5 vs. 34.7%) than those working in other regions. Nurses had a higher prevalence of anxiety (44.1 vs. 29.0%) and depression (34.1 vs. 29.2%) than other HWs.

Conclusions: About one-third of HWs in China suffered anxiety, depression, and stress at the early epidemic of COVID-19. HWs in Hubei Province, especially nurses, had a higher prevalence of psychological disorders. During the pandemic, a negative psychological state may persist in a proportion of Chinese HWs, fluctuating with the control of the pandemic. The long-term impact should continue to be observed. Attention should be paid to HWs for their psychological impact due to the pandemic.

Systematic Review Registration: The study protocol was registered with PROSPERO (CRD42020195843).

Contemporary Concise Review 2020: Sleep

Obstructive sleep apnoea (OSA) now affects one-seventh of the world's population. Treatment of even mild OSA can improve daytime sleepiness and quality of life. Recent modifications to uvulopalatopharyngoplasty may make it a more widely applicable treatment option in selected patients with OSA. Diet and exercise have effects on sleep apnoea severity independent of weight loss. Insomnia has become increasingly common during the coronavirus disease 2019 (COVID-19) pandemic.

Stress Perceived by University Health Sciences Students, 1 Year after COVID-19 Pandemic

Today’s COVID-19 situation can affect university Health Sciences students’ psychological health. This study aimed to analyze the stress caused by the impact of the COVID-19 pandemic on Health Sciences students from the University of Zaragoza (Spain) almost 1 year after the pandemic began. This cross-sectional descriptive study was conducted with a sample of 252 university students who completed a self-administered online questionnaire. It evaluated the impact of perceived stress with a modified scale (PSS-10-C), and assessed anxiety and depression on the Goldberg scale. Students presented stress (13.1%), anxiety (71.4%) and depression (81%). Females (81.7%) and the third-year Occupational Therapy students (p = 0.010) reported perceived stress. Nursing students perceived less stress (OR: 0.148; 95% CI: 0.026 to 0.842). University students developed stress and anxiety due to COVID-19 almost 1 year after the pandemic began. Psychological support measures for these groups should be prioritized.

Professional and Ethical Issues in United States Acute Care Physical Therapists Treating Patients With COVID-19: Stress, Walls, and Uncertainty

OBJECTIVE

To the authors' knowledge, no peer-reviewed research has explored professional and ethical issues encountered by physical therapists in treating patients with COVID-19. The purpose of this study was to explore the experiences of physical therapists regarding the professional and ethical issues they encountered during the COVID-19 pandemic.

METHODS

The current study used reflexive thematic analysis, a qualitative research design developed by Braun and Clarke, to analyze individual interviews.

RESULTS

Analysis of the coded interviews produced 6 primary themes (uncertainty, physical therapist's role, ethical dilemmas and moral distress, emotions, providing care and working conditions, and management and leadership influence) and associated subthemes.

CONCLUSION

Physical therapists reported numerous professional and ethical issues across the individual, organizational, and societal realms during the COVID-19 pandemic. This study highlights the need for education and resources to prepare physical therapists for professional and ethical issues encountered during pandemics. Specifically, there is a need to define the physical therapist's role in pandemics and prepare physical therapy personnel for dealing with ethical issues, stress, uncertainty, and organizational changes associated with pandemics. Ethical guidelines would support organizations in delineating fair processes for triage and allocation of scarce resources for acute care physical therapy during health care emergencies.

IMPACT

The COVID-19 pandemic has produced significant changes in health care and physical therapist practice. This study reports results of the first, to our knowledge, research study focusing on professional and ethical issues experienced by physical therapists in acute care during the COVID-19 pandemic. As the United States faces an unprecedented spike in COVID-19 cases and deaths, results of this study may contribute to physical therapists' preparation for and response to professional and ethical issues encountered in acute care during the pandemic.

Prevalence and factors associated with psychological burden in COVID-19 patients and their relatives: A prospective observational cohort study

BACKGROUND

Due to the dramatic measures accompanying isolation and the general uncertainty and fear associated with COVID-19, patients and relatives may be at high risk for adverse psychological outcomes. Until now there has been limited research focusing on the prevalence of psychological distress and associated factors in COVID-19 patients and their relatives. The objective of our study was to assess psychological distress in COVID-19 patients and their relatives 30 days after hospital discharge.

METHODS

In this prospective observational cohort study at two Swiss tertiary-care hospitals we included consecutive adult patients hospitalized between March and June 2020 for a proven COVID-19 and their relatives. Psychological distress was defined as symptoms of anxiety and/or depression measured with the Hospital Anxiety and Depression Scale (HADS), i.e., a score of ≥8 on the depression and/or anxiety subscale. We further evaluated symptoms of post-traumatic stress disorder (PTSD), defined as a score of ≥1.5 on the Impact of Event Scale-Revised (IES-R).

RESULTS

Among 126 included patients, 24 (19.1%) had psychological distress and 10 (8.7%) had symptoms of PTSD 30 days after hospital discharge. In multivariate logistic regression analyses three factors were independently associated with psychological distress in patients: resilience (OR 0.82; 95%CI 0.71 to 0.94; p = 0.005), high levels of perceived stress (OR 1.21; 95%CI 1.06 to 1.38; p = 0.006) and low frequency of contact with relatives (OR 7.67; 95%CI 1.42 to 41.58; p = 0.018). The model showed good discrimination, with an area under the receiver-operating characteristic curve (AUC) of 0.92. Among 153 relatives, 35 (22.9%) showed symptoms of psychological distress, and 3 (2%) of PTSD. For relatives, resilience was negatively associated (OR 0.85; 95%CI 0.75 to 0.96; p = 0.007), whereas perceived overall burden caused by COVID-19 was positively associated with psychological distress (OR 1.72; 95%CI 1.31 to 2.25; p<0.001). The overall model also had good discrimination, with an AUC of 0.87.

CONCLUSION

A relevant number of COVID-19 patients as well as their relatives exhibited psychological distress 30 days after hospital discharge. These results might aid in development of strategies to prevent psychological distress in COVID-19 patients and their relatives.

Mental Health of Medical Staff During the Coronavirus Disease 2019 Pandemic: A Systematic Review and Meta-Analysis

OBJECTIVE

This study aimed to quantify the prevalence of the adverse mental health outcomes in medical staff working in the hospital settings during the coronavirus disease 2019 (COVID-19) pandemic and explore the relative distribution of anxiety and depressive symptoms.

METHODS

PubMed, EMBASE, China National Knowledge Infrastructure, WANFANG DATA, and VIP Database for Chinese Technical Periodicals were searched for articles published from January 1, 2019, to April 19, 2020. The prevalence estimates of adverse mental health symptoms in medical staff were pooled using the random-effects model.

RESULTS

A total of 35 articles and data of 25,343 medical staff were used in the final analysis. The pooled prevalence estimates in medical staff during the COVID-19 pandemic were as follows (ordered from high to low): fear-related symptoms, 67% (95% confidence interval [CI] = 61%-73%); high levels of perceived stress, 56% (95% CI = 32%-79%), anxiety symptoms, 41% (95% CI = 35%-47%); insomnia, 41% (95% CI = 33%-50%); posttraumatic stress disorder symptoms, 38% (95% CI = 34%-43%); depressive symptoms, 27% (95% CI = 20%-34%); and somatic symptoms, 16% (95% CI = 3%-36%). The subgroup analysis revealed that the prevalence estimates of fear-related symptoms were consistently high.

CONCLUSIONS

Medical staff during the COVID-19 epidemic have a high prevalence of adverse mental health symptoms. Data-based strategies are needed to optimize mental health of medical staff and other health care professionals during times of high demand such as the COVID-19 and other epidemics.PROSPERO Registration: CRD42020182433.

Mental health of Health Care Workers (HCWs): a review of organizational interventions put in place by local institutions to cope with new psychosocial challenges resulting from COVID-19

The COVID-19 outbreak has been associated with significant occupational stressors and challenges for healthcare workers (HCWs) including the risk of exposure to SARS-CoV-2. Many reports from all over the world have already found that HCWs have significant levels of self-reported anxiety, depression and even symptoms of post-traumatic stress disorder. Therefore, supporting mental health of HCWs is a crucial part of the public health response to the COVID-19 pandemic. The aim of the present review is to ascertain the interventions put in place worldwide in reducing stress in HCWs during the COVID-19 outbreak. We evidenced how only few countries have published specific psychological support intervention protocols for HCWs. All programs were developed in university associated hospitals and highlighted the importance of multidisciplinary collaboration. All of them had as their purpose to manage the psychosocial challenges to HCW's during the pandemic in order to prevent mental health problems.Whether one program offers distinct benefit compared to the others cannot be known given the heterogeneity of the protocols and the lack of a rigorous protocol and clinical outcomes. Further research is crucial to find out the best ways to support the resilience and mental well-being of HCWs.

Depression and Suicidal Ideation in a Sample of Malaysian Healthcare Workers: A Preliminary Study During the COVID-19 Pandemic

Objective: The burden of suicidal behavior is anticipated to increase as a sequela of the COVID-19 pandemic. However, there is limited evidence on suicidal behavior among healthcare workers, an at-risk population. Our study aimed to investigate suicidal ideation in terms of the rate and associated factors in a sample of Malaysian healthcare workers during the early-phase of the COVID-19 pandemic. Methods: A subpopulation analysis (N = 171) was conducted within a larger, nation-wide cross-sectional study of Malaysian healthcare worker psychological distress from March 18-21, 2020. Current suicidal ideation was measured with item 9 of the Patient Health Questionnaire-9 (PHQ-9). The following independent variables were assessed: socio-demographic profile, occupation and service-related factors, health-anxiety (Health Anxiety Inventory, HAI), lifetime anxiety disorder and severity of depression (PHQ-9). Results: The proportion of healthcare workers with current suicidal ideation (19/171) and clinical depression (17/171) were 11.1 and 9.9%, respectively. Multivariable analysis showed that clinical depression was the most significant factor associated with current suicidal ideation (p < 0.001, OR = 55.983, 95% CI = 9.015-347.671) followed by mild (subthreshold) depression (p = 0.001, OR = 115.984, 95% CI = 2.977-85.804). Service duration of more than 10 years was associated with significantly less suicidal ideation (p = 0.049, OR = 0.072, 95% CI = 0.005-0.993). Conclusions: Depression (subthreshold and especially within the clinical range) and early-career status (<10 years in service) may be target areas of early intervention for reduction of suicidal ideation amongst healthcare workers who have served during the COVID-19 pandemic. Further research is warranted to elucidate specific occupational stressors related to COVID-19 work conditions to tailor appropriate suicide preventive strategies in this population.

Evaluations of Healthcare Providers' Perceived Support From Personal, Hospital, and System Resources: Implications for Well-Being and Management in Healthcare in Montreal, Quebec, During COVID-19

Increased stressful experiences are pervasive among healthcare providers (HCPs) during the COVID-19 pandemic. Identifying resources that help mitigate stress is critical to maintaining HCPs' well-being. However, to our knowledge, no instrument has systematically examined how different levels of resources help HCPs cope with stress during COVID-19. This cross-sectional study involved 119 HCPs (64 nurses and 55 physicians) and evaluated the perceived availability, utilization, and helpfulness of a list of personal, hospital, and healthcare system resources. Participants also reported on their level of burnout, psychological distress, and intentions to quit. Results revealed that HCPs perceived the most useful personal resource to be family support; the most useful hospital resources were a safe environment, personal protective equipment, and support from colleagues; the most useful system resources were job protection, and clear communication and information about COVID. Moreover, HCPs who perceived having more available hospital resources also reported lower levels of psychological distress symptoms, burnout, and intentions to quit. Finally, although training and counseling services were perceived as useful to reduce stress, training was not perceived as widely available, and counseling services, though reported as being available, were underutilized. This instrument helps identify resources that support HCPs, providing implications for healthcare management.

Remote care for mental health: qualitative study with service users, carers and staff during the COVID-19 pandemic

OBJECTIVES

To explore the experiences of service users, carers and staff seeking or providing secondary mental health services during the COVID-19 pandemic.

DESIGN

Qualitative interview study, codesigned with mental health service users and carers.

METHODS

We conducted semistructured, telephone or online interviews with a purposively constructed sample; a lived experience researcher conducted and analysed interviews with service users. Analysis was based on the constant comparison method.

SETTING

National Health Service (NHS) secondary mental health services in England between June and August 2020.

PARTICIPANTS

Of 65 participants, 20 had either accessed or needed to access English secondary mental healthcare during the pandemic; 10 were carers of people with mental health difficulties; 35 were members of staff working in NHS secondary mental health services during the pandemic.

RESULTS

Experiences of remote care were mixed. Some service users valued the convenience of remote methods in the context of maintaining contact with familiar clinicians. Most participants commented that a lack of non-verbal cues and the loss of a therapeutic 'safe space' challenged therapeutic relationship building, assessments and identification of deteriorating mental well-being. Some carers felt excluded from remote meetings and concerned that assessments were incomplete without their input. Like service users, remote methods posed challenges for clinicians who reported uncertainty about technical options and a lack of training. All groups expressed concern about intersectionality exacerbating inequalities and the exclusion of some service user groups if alternatives to remote care are lost.

CONCLUSIONS

Though remote mental healthcare is likely to become increasingly widespread in secondary mental health services, our findings highlight the continued importance of a tailored, personal approach to decision making in this area. Further research should focus on which types of consultations best suit face-to-face interaction, and for whom and why, and which can be provided remotely and by which medium.

Media Exposure Related to the PTSS During COVID-19 Pandemic: The Mediating Role of Risk Perception

Objectives: The objectives of this study are to assess the relationship between media exposure and post-traumatic stress symptoms (PTSS) and to highlight the underlying mechanisms mediated by risk perception. Methods: This survey was conducted online in China from February 1st to February 10th, 2020. A total of 2,858 Chinese citizens aged ≥18 years from 31 provinces and autonomous regions were recruited to participate in a cross-sectional study. Self-report questionnaires were used to assess media exposure, PTSS, and risk perception. Results: The prevalence of respondents with heightened PTSS scores was 22.2%. After controlling for covariates, media exposure (more than five times a day) was significantly and positively associated with a high level of PTSS (B = 4.11, p < 0.001), and risk perception (worry and severity) significantly mediated the relationship between media exposure and PTSS (all 95% CIs did not include 0). Conclusions: Based on these findings, the frequency of media exposure was associated with PTSS. Risk perception (worry and severity) mediated the relationship between media exposure and PTSS. The mental health, particularly PTSS, of the general population should be closely monitored and "infodemics" should be combatted while addressing the COVID-19 outbreak; cognitive interventions may be promising.

The effects of COVID-19 continuous traumatic stressors on mental health and cognitive functioning: A case example from Turkey

There is a need to accurately assess the specific impacts of the various traumatic stressors caused by COVID-19 on mental health. The goal was to evaluate the impact of different types of COVID-19 stressors (infection fears, lockdown, and economic stressors) on mental health and cognitive functioning. We used a sample of 262 Turkish adults. We administered an online questionnaire that included measures of COVID-19 traumatic stressors, PTSD, depression, anxiety, executive function deficits, and cumulative stressors and traumas (CST). The analyses included correlations, hierarchical regression, path analysis, and PROCESS mediation analysis. All COVID-19 traumatic stressors types and their cumulative load predicted PTSD, depression, anxiety, and executive function deficits after controlling for previous cumulative stressors and traumas and COVID-19 infection. COVID-19 lockdown’s stressors were the strongest predictors, compared to COVID-19 fears and economic stressors. Path analysis and PROCESS mediation results indicated that COVID-19 traumatic stressors had direct effects on working memory deficits, direct and indirect effects on PTSD, depression, and anxiety, and indirect effects on inhibition deficits. Anxiety, depression, and inhibition deficits mediated its indirect effects on PTSD. The results have conceptual and clinical implications. COVID-19 continuous posttraumatic stress syndrome that includes comorbid PTSD, depression, anxiety, and executive function deficits is different and does not fit within the current trauma frameworks. There is a need for a paradigm shift in current stress and trauma frameworks to account for the COVID-19 continuous global stressors and for clinical innovations in intervention to help its victims.

Is Watching TV Series an Adaptive Coping Strategy During the COVID-19 Pandemic? Insights From an Italian Community Sample

Social distancing and lockdown due to the COVID-19 pandemic substantially impacted individuals' daily habits and well-being. Within such a context, digital technology may provide a welcome source of alternative forms of connection and entertainment. Indeed, streaming services showed a remarkable increase in membership subscriptions throughout the period considered. However, excessive involvement in watching TV series has recently become a subject of scholarly concern as it may represent an emerging form of addictive behavior with the features of what has been labeled as "binge-watching" (i.e., watching multiple episodes of TV series in a single session). The current study aimed to assess TV series watching behaviors and related motivations, as well as their relationships with depression, stress and anxiety, in a sample of Italian adults during the COVID-19 lockdown. Specifically, we aimed to explore which patterns of motivations and emotional states influenced either a high but healthy engagement in watching TV series, or promoted problematic and uncontrolled watching behavior under such circumstances. A total of 715 adults (M = 31.70, SD = 10.81; 71.5% female) from all over Italy were recruited (from 1st to 30th April 2020) through advertisements via social media platforms of Italian university communities and other online groups. Two multiple hierarchical regression analyses were performed with non-problematic and problematic TV series watching set as dependent variables. Results showed that people spent more time watching TV series during the pandemic lockdown, especially women who also reported higher levels of anxiety and stress than men. Moreover, both non-problematic (R 2 = 0.56; p < 0.001) and problematic (R 2 = 0.33; p < 0.001) TV series watching behaviors were equally induced by anxiety symptoms and escapism motivation, thereby suggesting that watching TV series during the COVID-19 lockdown probably served as a recovery strategy to face such a stressful situation. Finally, our findings also suggest that enrichment motives may protect from uncontrolled and potentially addictive watching behaviors. These findings, therefore, hold important implications, particularly for avoiding the over-pathologization of excessive involvement in online activities emerging as a result of specific distressing situations.

The prevalence of anxiety and depression among healthcare workers during the COVID-19 pandemic: An umbrella review of meta-analyses

BACKGROUND

Healthcare workers, who are at the forefront of the fight against COVID-19, are particularly susceptible to physical and mental health consequences such as anxiety and depression. The aim of this umbrella review of meta-analyses is to determine the prevalence of anxiety and depression among healthcare workers during the COVID-19 pandemic.

METHODS

Using relevant keywords, data resources including PubMed, Scopus, Web of Science, Cochrane, ProQuest, Science Direct, Google Scholar and Embase were searched to obtain systematic reviews and meta-analyses reporting the prevalence of anxiety and depression among healthcare workers during the COVID-19 pandemic from the beginning of January to the end of October 2020. The random effects model was used for meta-analysis, and the I2 index was employed to assess heterogeneity among studies. Data was analyzed using STATA 14 software.

RESULTS

In the primary search, 103 studies were identified, and ultimately 7 studies were included in the umbrella review. The results showed that the overall prevalence of anxiety and depression among healthcare workers during the COVID-19 pandemic was 24.94% (95% CI: 21.83-28.05, I2 = 0.0%, P = 0.804) and 24.83% (95% CI: 21.41-28.25, I2 = 0.0%, P = 0.897), respectively.

CONCLUSION

This umbrella review shows that the prevalence of anxiety and depression is relatively high among healthcare workers during the COVID-19 pandemic. Healthcare workers should be provided with resources to minimize this risk.

Patterns of Psychological Responses among the Public during the Early Phase of COVID-19: A Cross-Regional Analysis

This study aimed to compare the mediation of psychological flexibility, prosociality and coping in the impacts of illness perceptions toward COVID-19 on mental health among seven regions. Convenience sampled online survey was conducted between April and June 2020 from 9130 citizens in 21 countries. Illness perceptions toward COVID-19, psychological flexibility, prosociality, coping and mental health, socio-demographics, lockdown-related variables and COVID-19 status were assessed. Results showed that psychological flexibility was the only significant mediator in the relationship between illness perceptions toward COVID-19 and mental health across all regions (all ps = 0.001-0.021). Seeking social support was the significant mediator across subgroups (all ps range = <0.001-0.005) except from the Hong Kong sample (p = 0.06) and the North and South American sample (p = 0.53). No mediation was found for problem-solving (except from the Northern European sample, p = 0.009). Prosociality was the significant mediator in the Hong Kong sample (p = 0.016) and the Eastern European sample (p = 0.008). These findings indicate that fostering psychological flexibility may help to mitigate the adverse mental impacts of COVID-19 across regions. Roles of seeking social support, problem-solving and prosociality vary across regions.

Prevalence of post-traumatic stress symptoms among people influenced by coronavirus disease 2019 outbreak: A meta-analysis

BACKGROUND

As one of the most widely researched consequence of traumatic events, the prevalence of post-traumatic stress symptoms among people exposed to the trauma resulting from coronavirus disease 2019 (COVID-19) outbreak varies greatly across studies. This review aimed at examining the pooled prevalence of post-traumatic stress symptoms among people exposed to the trauma resulting from COVID-19 outbreak.

METHODS

Systematic searches of databases were conducted for literature published on PubMed, EMBASE, Web of Science, the Cochrane Library, PsycArticle, and Chinese National Knowledge Infrastructure until October 14, 2020. Statistical analyses were performed using R software (PROSPERO registration number: CRD42020180309).

RESULTS

A total of 106,713 people exposed to the trauma resulting from the COVID-19 outbreak were identified in the 76 articles, of which 33,810 were reported with post-traumatic stress symptoms. The pooled prevalence of post-traumatic stress symptoms among people exposed to the trauma resulting from COVID-19 outbreak was 28.34%, with a 95% confidence interval of 23.03-34.32%. Subgroup analysis indicated that older age, male and bigger sample size were associated with higher prevalence of post-traumatic stress symptoms. After controlling for other factors, the results of meta-regression showed that the influence of gender and sample size on prevalence is no longer significant.

CONCLUSIONS

Symptoms of post-traumatic stress disorder (PTSD) were very common among people exposed to the trauma resulting from COVID-19 outbreak. Further research is needed to explore more possible risk factors for post-traumatic stress symptoms and identify effective strategies for preventing PTSD-related symptoms among people exposed to the trauma resulting from COVID-19 outbreak.

Association of Symptoms of Posttraumatic Stress Disorder With Posttraumatic Psychological Growth Among US Veterans During the COVID-19 Pandemic

This survey study uses self-reported data from the 2019-2020 National Health and Resilience in Veterans Study to assess the association of symptoms of posttraumatic stress disorder (PTSD) with posttraumatic psychological growth among US veterans during the COVID-19 pandemic.