Effects of Covid-19 Lockdown on Mental Health and Sleep Disturbances in Italy

Insomnia during the COVID-19 pandemic: the role of depression and COVID-19-related risk factors

The COVID-19 pandemic has resulted in dramatic changes to sleep patterns and higher prevalence of insomnia, which threaten overall mental and physical health. We examined whether safety behaviors in response to COVID-19, worry in response to COVID-19, and depression predicted insomnia, with age, race, and sex as covariates. A community sample from the United States (n = 321, Mage = 40.02, SD = 10.54; 53.6% female) recruited using online crowdsourcing completed self-report measures in May of 2020 and again three months later. At baseline, our model accounted for 68.1% of the variance in insomnia, with depression as the only significant predictor (β = .70, p < .001). In the longitudinal analyses, only baseline insomnia symptoms predicted 3-month follow-up insomnia symptoms (β = .70, p < .001; 67.1% of variance). Of note, COVID-19 worry and some COVID-19 safety behaviors were related to 3-month follow-up safety behaviors, but not insomnia. Our findings demonstrated that depression is an important factor to consider for concurrent insomnia symptoms. Our results have implications regarding the development of interventions for insomnia during the COVID-19 pandemic and suggest that clinicians should consider depression when assessing for and treating insomnia symptoms.

The effects of the COVID-19 pandemic on patients with narcolepsy

STUDY OBJECTIVES

To the best of our knowledge, there has not as yet been any study on the effects of the COVID-19 pandemic on patients with narcolepsy, in particular, in relation to its impact on sleep schedules, symptoms, the need for medication, work, income, and quality of life. This study therefore aimed to explore these factors and their possible influence on sleep, circadian timing, and narcolepsy symptoms during the pandemic.

METHODS

Patients with narcolepsy who had been in quarantine for at least 3 months completed a 36-question online survey. Questions targeted the conditions of the quarantine, sleep-related behaviors, and factors known to affect sleep and circadian rhythms (work status, income, appetite, narcolepsy symptoms, and medication), as well as the quality of life during the quarantine period.

RESULTS

The routines of the participants had been altered by quarantine, with changes in their place of work, and an increase in narcolepsy symptoms, such as cataplexy, sleep paralysis, hallucinations, nocturnal awakenings, and sleepiness. Sleep and wake times changed, resulting in altered sleep patterns in most of the sample. No association between changes in the place of work and narcolepsy symptoms was found. Regarding medication, the participants used fewer antidepressant pills but took more stimulants. Appetite was increased and self-reported quality of life decreased during the period.

CONCLUSIONS

During the quarantine, the patients with narcolepsy reported changes in their bedtime and waking-up schedules, suggesting a tendency to circadian misalignment. In Brazil, the effects of the COVID-19 outbreak have gone beyond the direct action of the virus because of the collateral damage it has caused in respect to unemployment, financial hardship, and a reduction in quality of life. These impacts have been amplified in Brazil because of the level of social inequality found in the country, and they have particularly affected vulnerable patients with rare diseases, such as the narcolepsy population.

A survey on different dimensions for graphical keyword extraction techniques: Issues and Challenges

The transmission from offline activities to online activities due to the social disorder evolved from COVID-19 pandemic lockdown has led to increase in the online economic and social activities. In this regard, the Automatic Keyword Extraction (AKE) from textual data has become even more interesting due to its application over different domains of Natural Language Processing (NLP). It is observed that the Graphical Keyword Extraction Techniques (GKET) use Graph of Words (GoW) in literature for analysis in different dimensions. In this article, efforts have been made to study these different dimensions for GKET, namely, the GoW representation, the statistical properties of GoW, the stability of the structure of GoW, the diversity in approaches over GoW for GKET, and the ranking of nodes in GoW. To elucidate these different dimensions, a comprehensive survey of GKET is carried in different domains to make some inferences out of the existing literature. These inferences are used to lay down possible research directions for interdisciplinary studies of network science and NLP. In addition, the experimental results are analysed to compare and contrast the existing GKET over 21 different dataset, to analyse the Word Co-occurrence Networks (WCN) for 15 different languages, and to study the structure of WCN for different genres. In this article, some strong correspondences in different disciplinary approaches are identified for different dimensions, namely, GoW representation: ’Line Graphs’ and ’Bigram Words Graphs’; Feature extraction and selection using eigenvalues: ’Random Walk’ and ’Spectral Clustering’. Different observations over the need to integrate multiple dimensions has open new research directions in the inter-disciplinary field of network science and NLP, applicable to handle streaming data and language-independent NLP.

Developing Resilience During the COVID-19 Pandemic: Yoga and Mindfulness for the Well-Being of Student Musicians in Spain

Here, we report on a quasi-experimental study to explore the applicability and perceived benefits of the CRAFT program, which is based on mindfulness, yoga, positive psychology, and emotional intelligence, to improve higher education student musicians' health and well-being during the lockdown. A subset of student musicians at a Higher Conservatory of Music in Spain followed the CRAFT program during the academic year 2019/2020, 1 h per week as part of their curriculum. Students enrolled in CRAFT-based elective subjects formed the CRAFT program group (n = 40), while other students represented the control group (n = 53). The onset of the national lockdown elicited by the COVID-19 pandemic occurred halfway through the program, which was subsequently delivered in an online format. We administered an online survey to explore the effect that the exposure to the CRAFT program had in terms of how participants dealt with various health and well-being concerns arising from the COVID-19 lockdown. There was a significantly higher proportion of proactive participants in the CRAFT program group, 92%, than in the control group, 58%, in terms of implementing practices to improve their health and well-being during the lockdown. Additionally, significantly more participants acknowledged perceived benefits from their practices in the CRAFT program group, 78%, than in the control group, 52%. Among proactive participants, yoga/meditation was the most implemented in the CRAFT program group, followed by exercise, and other yoga/meditation practices, whereas in the control group, exercise and Alexander technique-based practices were the most applied. In the CRAFT program group, the highest rate of perceived benefits was from yoga/meditation CRAFT-based practices, 51%, followed by exercise, 32%, and other yoga/meditation practices, 27%, whereas in the control group, benefits were reported by 29% of exercising participants and 16% for those having practiced the Alexander technique. A similar pattern was observed when excluding participants with previous yoga/meditation experience. This study revealed how participants can independently apply learned skills from the CRAFT program in response to a naturally occurring life event of unprecedented global impact, suggesting that previous exposure to mindfulness and yoga is likely to have a beneficial effect on how young adults react towards exceptionally stressful conditions.

Impact of the early COVID-19 era on endometriosis patients: Symptoms, stress, and access to care

Introduction:

Monitoring the impact of natural disasters such as pandemics on health and wellbeing is a public health priority. Stress is proven to affect pain intensity and quality of life of endometriosis patients. A cross-sectional study was conducted to determine whether the measures implemented to mitigate COVID-19 infections had a substantial impact on risk behaviors, endometriosis symptoms, stress, and access to healthcare.

Methods:

Electronic questionnaires that measured COVID-19 impact and peri-traumatic stress were disseminated through social media over June–September 2020 and completed by 82 adult patients with endometriosis living in Puerto Rico. Descriptive data analysis and correlations were done in quantitative data and systematic analysis of free text was done on qualitative responses.

Results:

Participants self-reported worsening of endometriosis symptoms and high levels of peri-traumatic stress, as well as changes in risk behaviors (exercise, nutrition, sedentarism, sleep) during the pandemic in comparison to the previous months. They also reported substantial barriers in access to medical appointments, scheduled procedures, and prescriptions. Electronic health modalities (telemedicine, mobile apps) were considered acceptable alternatives for gynecologic care during natural disasters.

Conclusion:

The COVID-19 pandemic negatively impacts the health and wellbeing of endometriosis patients while imposing substantial restrictions on access to health care. These timely insights will guide the development and implementation of plans to address barriers to health care and minimize long-term detrimental effects of natural disasters on the health of those living with stress-related disorders such as endometriosis.

“Dies Irae?” The Role of Religiosity in Dealing with Psychological Problems Caused by The COVID-19 Pandemic—Studies on a Polish Sample

Based on Huber’s centrality of religiosity concept, a non-experimental research project was designed in a group of 178 women and 72 men, voluntary participants in online studies, quarantined at home during the first weeks (the first wave) of the pandemic, to determine whether and to what extent religiosity, understood as a multidimensional construct, was a predictor of the worsening of PTSD and depression symptoms in the conditions of the COVID-19 pandemic. The study made use of CRS Huber’s scale to study the centrality of religiosity, Spitzer’s PHQ-9 to determine the severity of depression, and Weiss and Marmar’s IES-R to measure the symptoms of PTSD. Our study, which provided interesting and non-obvious insights into the relationship between the studied variables, did not fully explain the protective nature of religiosity in dealing with pandemic stress. Out of five components of religiosity understood in accordance with Huber’s concept (interest in religious issues, religious beliefs, prayer, religious experience, and cult), two turned out to contribute to modifications in the severity of psychopathological reactions of the respondents to stress caused by the pandemic during its first wave. A protective role was played by prayer, which inhibited the worsening of PTSD symptoms, whereas religious experience aggravated them. This means that in order to interpret the effect of religiosity on the mental functioning of the respondents in a time of crisis (the COVID-19 pandemic), we should not try to explain this effect in a simple and linear way, because religious life may not only bring security and solace, but also be a source of stress and an inner struggle.

Impact of COVID-19 pandemic on mental health among general Bangladeshi population: a cross-sectional study

OBJECTIVES

Mental health problems significantly increased worldwide during the coronavirus (COVID-19) pandemic. At the early stage of the outbreak, the government of Bangladesh imposed lockdown and quarantine approaches to prevent the spread of the virus, which impacted people's daily life and health. The COVID-19 pandemic has also affected people's economic status, healthcare facilities and other lifestyle factors in Bangladesh. We aimed to assess the impact of the COVID-19 pandemic on mental health among the Bangladeshi population.

METHODS

We conducted an online cross-sectional survey among 672 Bangladeshi people aged between 15 and 65 years all over the country from 15 April to 10 May 2020. After obtaining electronic consent, we conducted a survey assessing people's sociodemographic profiles and psychometric measures. We used The University of California, Los Angeles (UCLA) Loneliness Scale-8, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-Item Scale and Pittsburgh Sleep Quality Index to assess loneliness, depression, anxiety and sleep disturbance, respectively.

RESULTS

The prevalence of loneliness, depression, anxiety and sleep disturbance was estimated at 71% (mild: 32%, moderate: 29%, severe: 10%), 38% (mild: 24%, moderate: 11%, severe: 3%), 64% (mild: 30%, moderate: 17%, severe: 17%) and 73% (mild: 50%, moderate: 18%, severe: 5%), respectively. In Bangladesh, the key factors associated with poor mental health during COVID-19 were female sex, unemployment, being a student, obesity and living without a family. The present study also identified statistically significant interrelationships among the measured mental health issues.

CONCLUSIONS

A large portion of respondents reported mental health problems during the COVID-19 pandemic in Bangladesh. The present study suggests longitudinal assessments of mental health among Bangladeshi people to determine the gravity of this issue during and after the pandemic. Appropriate supportive programmes and interventional approaches would address mental health problems in Bangladesh during the COVID-19 pandemic.

Examining changes in sleep duration associated with the onset of the COVID-19 pandemic: Who is sleeping and who is not?

Introduction

The COVID-19 pandemic has resulted in social isolation and reports of insomnia. However, reports of changes in sleep duration and associated factors are few.

Methods

Data were from an online survey of adults recruited via social media that included a question asking whether the respondent slept less or more after the onset of the pandemic. Analyses determined the association between changes in sleep duration and self reported sociodemographic and occupational information; beliefs about COVID-19; changes in sleep patterns; and responses pertaining to loneliness, anxiety, and depression.

Results

There were 5,175 respondents; 53.9% had a change in sleep duration. 17.1% slept less and 36.7% slept more. Sleeping more was related to greater education, being single/divorced/separated, unemployed or a student. Being retired, divorced/separated or a homemaker, and living in the Mountain or Central time zones were associated with less sleep. Beliefs that COVID-19 would result in personal adverse consequences was associated with both more and less sleep. However, the strongest associations with both more and less sleep were seen with depression, anxiety, and loneliness with adjusted odds ratios ranging from 1.92 ( 95% CI 1.67-2.21) for sleeping more and loneliness to 5.29 ( 95% CI 4.1-6.7) for sleeping less and anxiety.

Conclusions

Changes in sleep duration since the start of the COVID-19 pandemic were highly prevalent among social media users and were associated with several sociodemographic factors and beliefs that COVID-19 would have adverse personal impacts. However, the strongest associations occurred with worse mental health suggesting that improvements may occur with better sleep.

Impact of the COVID-19 pandemic on psychological well-being of students in an Italian university: a web-based cross-sectional survey

Background

Italy was the first European country to implement a national lockdown because of the COVID-19 pandemic. Worldwide, this pandemic had a huge impact on the mental health of people in many countries causing similar reaction in terms of emotions and concerns at the population level. Our study investigated the impact of the COVID-19 pandemic on psychological well-being in a cohort of Italian university students.

Methods

We conducted a cross-sectional survey in the period immediately after the first lockdown through the administration of a questionnaire on the personal websites of students attending their undergraduate courses at the Università Cattolica del Sacro Cuore. We used the Patient-Health-Engagement-Scale, Self-Rating-Anxiety-Scale, and Self-Rating-Depression-Scale to assess engagement, anxiety symptoms, and depression symptoms of our sample.

Results

The sample size was 501 subjects, of which 35.33% were classified as anxious and 72.93% as depressed. Over 90% of respondents had good understanding of the preventive measures despite over 70% suffered from the impossibility of physically seeing friends and partners. Around 55% of students would have been willing to contribute much more to face the pandemic. An increase in the occurrences of anxiety was associated with being female, being student of the Rome campus, suffering from the impossibility of attending university, being distant from colleagues, and being unable of physically seeing one’s partner. Performing physical activity reduced this likelihood.

Conclusion

University students are at risk of psychological distress in the case of traumatic events. The evolution of the pandemic is uncertain and may have long-term effects on mental health. Therefore, it is crucial to study the most effective interventions to identify vulnerable subgroups and to plan for acute and long-term psychological services to control and reduce the burden of psychological problems.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12992-021-00680-w.

Bio-psychosocial study on the impact of the COVID-19 lockdown on depression and anxiety in a sample of 1753 French-speaking subjects

The aim of this article was to study the impact of the COVID19 lockdown on anxiety and depressive symptoms on the basis of responses to an online survey from 1753 French-speaking subjects, conducted between April 27 and May 11, 2020.

Method

Using a biopsychosocial model, the effects of socio-demographic characteristics (age, gender at birth, socio-professional category, sexual orientation), lockdown conditions (material factors: urban density of the place of residence, surface area of the place of residence during lockdown), social characteristics: living with a partner during lockdown, presence of children during lockdown) and psychosocial history (attachment styles) on anxiety – evaluated on the GAD7 – and depression – evaluated on the MDI – were investigated. Ordinal regression analyses were conducted.

Results

The rates of depression observed (moderate or severe depression: 22.5%) and anxiety (moderate or severe anxiety: 18.4%) were higher than usual but lower than what has been documented in other studies on the effects of lockdown. Women appeared to be more vulnerable than men (Anxiety: AOR = 1.647, CI 95% = 1.647–2.530; Depression: AOR = 1.622, CI 95% = 1.274–2.072). Bisexual individuals had an increased likelihood of anxiety symptoms (AOR = 1.962, CI 95% = 1.544–2.490) and depression (AOR = 1.799, CI 95% = 1.394–2.317). For homosexuals, only links with depression were observed (AOR = 1.757, CI 95% = 1.039–2.906). People in a situation of economic vulnerability were more prone to anxiety disorders (e.g. people with no working activity: AOR = 1.791, CI 95% = 1.147–2.790) or depression (e.g. people with no working activity: AOR = 2.581, CI 95% = 1.633–4.057). Links with attachment styles were also found. Fearful subjects were particularly vulnerable (anxiety: AOR = 2.514, CI 95% = 1.985–3.190; depression: AOR = 2.521, CI 95% = 1.938–3.289), followed by subjects with an anxious attachment style (anxiety: AOR = 1.949, CI 95% = 1.498–2.540; depression: AOR = 1.623, CI 95% = 1.207–2.181). The impact of lockdown on avoidant subjects only concerned depression (AOR = 1.417, CI 95% = 1.034–1.937). Being with a partner during lockdown appeared to have a protective effect against depression (AOR = .693, CI 95% = .555–.866). Neither the presence of children, the surface area of the lockdown residence, nor the population density of the place of residence was associated with anxiety or depression.

Conclusion

The impact of lockdown on mental health depends on a range of dimensions that need to be apprehended in order to tailor post-lockdown psychological and social support. Management based on a biopsychosocial approach should be favored.

Psychological pressure and changes in food consumption: the effect of COVID-19 crisis

In this paper, we investigate the short-term and long-term effects of the COVID-19 emergency on consumers' decision of changing dietary habit. We used a certified dataset reporting information about 456 Italian consumers during the lockdown in the first wave of the pandemic emergency (April 2020). The survey collected data about changes in food purchases, respondents' mood during the lockdown, conspiracist beliefs, exposure to the virus, and planned food purchasing behavior after the lockdown. We used the data to construct measures of the psychological pressure exerted by the COVID-19 emergency on consumers. We use an endogenous selection regression model to assess the impact of psychological pressure on the decision of changing food purchased. The analysis identified two opposite approaches to change in food purchasing decisions: impulsive approach and reflective approach. The former is associated with a higher probability of changing food purchase but a lower probability to keep the changes in the long run than the latter. Our results suggest that COVID-19 psychological pressure was associated with impulsive approach to buy food. Consequently, food-purchasing behavior is expected to revert to pre-COVID 19 habits when the emergency is over.

COVID-19: Are School Counseling Services Ready? Students' Psychological Symptoms, School Counselors' Views, and Solutions

The purpose of the current study was to investigate the effects of COVID-19 on high school students' psychological symptoms and to understand how ready counselors and school counseling services are based on the data we have. Therefore, this research is designed under two different studies: (A) Study 1: Effects of COVID-19 pandemic on students' psychological symptoms and (B) Study 2: Views and expectations of students and school counselors about school counseling services. The first study was a quantitative study and included 549 high school students (398 female, 151 male). A structural equation model (SEM) was created to examine the effects of COVID-19 pandemic on participants' psychological symptoms. The Impact of Event Scale-Revised (IES-R) scores showed that 107 (19.50%) individuals had a score of 50 and above pointing out that individuals in this group had severe impact of event/trauma symptomologies. The SEM analysis indicated that IES-R scores had a total effect of 0.79 on anxiety, 0.75 on depression, 0.74 on negative self-concept, 0.68 on somatization, and 0.66 on hostility scores. Furthermore, female students had significantly higher scores on anxiety, depression, negative self-concept, somatization, hostility, and impact of events variables than male students. Study 2 was a qualitative design and consisted of five school counselors and five students from different schools. The results indicated that students' difficulties during the coronavirus disease 2019 (COVID-19) outbreak were educational, cognitive, emotional, physiological, relational, technological, and related to routines. Academic, social, emotional, and behavioral issues came to the fore among the difficulties that can be experienced if students start face-to-face education. On the other hand, the school counselors listed that family relations, personal-social, emotional, and academic themes were the difficulties experienced by the students at the beginning of the COVID-19. In addition, when COVID-19 started, the services offered by school counselors were discussed under (1) services for the student, (2) services for the family, and (3) services for the teacher. Finally, according to the opinions of the school counselors, if students start face-to-face education, they may experience emotional, academic, and relational difficulties. In summary, it is vital that student personality services be prepared and implemented by school counseling services for schools based on the results.

The impact of lockdown policy on depressive symptoms among pregnant women in China: mediating effects of internet use and family support

BACKGROUND

Although more and more attention has been paid to the psychological consequences of the lockdown policy amongst pregnant women, the underlying mechanism linking the lockdown policy to maternal depression has not been studied in the context of China. This study aimed to explore the association between the lockdown policy and maternal depressive symptoms, and whether such association was mediated by internet use and/or family support.

METHODS

This cross-sectional study used multi-stage sampling techniques in central and western China. Data were collected from 1266 pregnant women using a structtured questionnaire that measured internet use, family support, and depressive symptoms. The Patient Health Questionnaire-9 (PHQ-9) was used to measure depressive symptoms. Internet use was measured by length of usage and varierity of purpose for internet use. Family support was measureed by spousal support and parental support. The structural equation modelling was employed to conduct mediation analysis to test the specificity of the hypothetical paths.

RESULTS

Overall, 527 respondents (41.63%) presented depressive symptoms. The lockdown policy was negatively associated with depressive symptoms in pregnant women (β = - 0.925, 95% CI = -1.510, - 0.360). The impact of the lockdown policy on depressive symptoms was partially mediated by internet use (β = 1.589, 95% CI = 0.730, 2.807) and family support (β = - 0.162, 95% CI = - 0.341, - 0.017), accounting for 42.67% of the total effect.

CONCLUSIONS

The lockdown policy was generally associated with fewer depressive symptoms in pregnant women. The lockdown policy increased maternal depressive symptoms through increased internet use, but decreased maternal depressive symptoms through enhanced family support. The findings suggest that the psychological consequence of the lockdown policy may vary across different populations, and warrant the need to take into consideration the features of subgroups.

Beyond COVID-19: a cross-sectional study in Italy exploring the covid collateral impacts on healthcare services

With COVID-19, populations are facing unmet health needs due to fear of contagion, lockdown measures and overload of Healthcare services (HCS). The COCOS study aimed to investigate reduced healthcare access among Italian citizens, additionally looking for specific subgroups that will primarily need health services in the next future. A cross-sectional online survey was performed during the Italian lockdown between April and May 2020. Descriptive, univariable and multivariable (logistic regression models) analyses were performed: results are expressed as Odd Ratios and Adjusted Odd Ratios (ORs and AdjORs). Totally, 1,515 questionnaires were collected. Median age was 42 years (IQR 23), 65.6% were females. Around 21.8% declared to suffer from chronic diseases. About 32.4% faced a delay of a scheduled Medical Service (MS) by provider decision, 13.2% refused to access scheduled MS for the fear of contagion, and 6.5% avoided HCS even if having an acute onset issue. Alarmingly, 1.5% avoided Emergency Department when in need and 5.0% took medications without consulting any physician: patients suffering from chronic conditions resulted to be more prone to self-medication (AdjOR [95% CI]: 2.16 [1.16-4.02]). This study demonstrated that indirect effects of COVID-19 are significant. Large groups of population suffered delays and interruptions of medical services, and the most vulnerable were the most affected. Immediate efforts are needed to reduce the backlog that HCSs incurred in.

A longitudinal study of mental health before and during COVID-19 lockdown in the French population

BACKGROUND

The impact of general population lockdown implemented in the face of the COVID-19 epidemic needs to be evaluated. We describe here a longitudinal study on the mental health of adults in France.

METHODS

We did a secondary analysis of a web-based cohort, initially set up to study home and leisure injuries, in order to measure the consequences of the national lockdown implemented in France from 17 March 2020 to 11 May 2020, and to assess potential vulnerability and resilience factors. Eligible participants were invited to answer an online questionnaire designed to assess their living conditions and health during lockdown. Comparisons were done with answers provided 4.8 years earlier on average.

RESULTS

On 15th April 2020, we sent email invitations to 9598 participants recruited between November 2014 and December 2019 and 1237 volunteers took part in the study by completing the online questionnaire. The proportion of those with anxiety symptoms markedly increased from 17.3 to 20.1%. The average self-rated level of mental health decreased from 7.77 to 7.58. Women, the elderly and the youngest appeared to be more vulnerable. A small living space (less than 30 m²) was associated with an increase in depression symptoms (PHQ-9 score), and poorer self-rated physical health at recruitment was associated with an increase in anxiety symptoms (GAD-7 score). On the contrary, the average self-rated level of physical health markedly increased from 7.44 to 7.94 between recruitment and lockdown, and the proportion of those who reported a level of 9 or 10 jumped from 25.7% at recruitment to 43.1% during lockdown.

CONCLUSIONS

Mental health deteriorated during lockdown in France during the 2020 COVID-19 crisis. Overall, self-rated physical health improved but those who experienced a worse physical health were more likely to report anxiety symptoms.

The Impact of COVID-19 on the mental health of dialysis patients

Background

Studies have shown increased anxiety, depression, and stress levels among different populations during the coronavirus disease 2019 (COVID-19) pandemic. However, the impact of the pandemic on the mental health of dialysis patients remains unknown. The aim of this study was to investigate the mental health of dialysis patients during the COVID-19 pandemic compared to the period preceding the pandemic.

Methods

Data originate from the ongoing multicentre observational Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO). Patients who filled in a health-related quality of life (HRQoL) questionnaire during the pandemic and six to three months prior were included. The mean difference in Mental Component Summary (MCS) score of the Short Form 12 (SF-12) was analysed with multilevel linear regression. A McNemar test was used to compare presence of mental health-related symptoms during and prior to the COVID-19 pandemic.

Results

A total of 177 patients were included. The mean MCS score prior to COVID-19 was 48.08 ± 10.15, and 49.00 ± 10.04 during the COVID-19 pandemic. The adjusted mean MCS score was 0.93 point (95% CI − 0.57 to 2.42) higher during the COVID-19 pandemic than during the period prior to the pandemic. Furthermore, no difference in the presence of the following mental health-related symptoms was found during the COVID-19 pandemic: feeling anxious, feeling sad, worrying, feeling nervous, trouble falling asleep, and trouble staying asleep.

Conclusions

The mental health of dialysis patients appears to be unaffected by the COVID-19 pandemic. Dialysis patients may be better able to cope with the pandemic, since they have high resilience and are less impacted by social distancing measures.

Trial registration number

Netherlands Trial Register NL6519, date of registration: 22 August 2017.

Graphic abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s40620-021-01005-1.

The interplay between risk and protective factors during the initial height of the COVID-19 crisis in Italy: The role of risk aversion and intolerance of ambiguity on distress

The present study aimed to test a model of relations to ascertain the determinants of distress caused by lockdown for COVID-19. It was hypothesized that the exposure to the COVID-19 increased distress directly and through the mediation of worry, health-related information seeking, and perception of the utility of the lockdown. It was also expected that higher levels of ambiguity intolerance corresponded to higher distress directly and through the mediation of worry, health information seeking behaviors, and perceived utility of the lockdown. Finally, it was expected that risk aversion positively influenced distress directly and through the increasing of worry, health-related information seeking behavior, and more positive perception of the utility of the lockdown The study was conducted in Italy during the mandatory lockdown for COVID-19 pandemic on 240 individuals (age range 18-76). Data recruitment was conducted via snowball sampling. COVID-19 exposure was positively associated with worry and health-related information seeking. Risk-aversion was positively associated with health-related information seeking and perceived utility of the lockdown to contain the spread of the virus. Worry and health-related information seeking were positively associated with distress, whereas the perceived utility of the lockdown was negatively associated with distress. Intolerance for the ambiguity was directly linked to distress with a positive sign. Findings suggest that risk aversion represents both a risk factor and a protective factor, based on what kind of variable mediates the relationship with distress, and that the intolerance to the ambiguity is a risk factor that busters distress.

A national COVID-19 quarantine survey and its impact on the Italian sports community: Implications and recommendations

The outbreak of the 2019 coronavirus disease (COVID-19) created an international public health emergency, challenging the psychological resilience of the general population. Regarding this matter, a web-based survey was performed. Data were collected from the following 1,668 self-selected volunteers: 800 athletes (28.30 ± 10.93 years old); 558 coaches (36.91 ± 11.93 years old); and 310 sports managers (42.07 ± 13.38 years old). To assess the level of psychological stress, an Impact of the Event Scale-Revised (IES-R) questionnaire was used. The results indicated that 34.4% of the participants who were interviewed were affected by subjective distress while 26.4% rated their psychological impact from the sports activity interruption as severe. Separated one-way analysis of variance (ANOVA) tests showed significant differences in the IES-R total score (TS), indicating that the level of stress in terms of gender revealed that women were more stressed than men (p = 0.000), for "sports roles" in which the manager and coaches were more stressed than the athletes (p < 0.05), and "type of sport" in which fitness and individual athletes were more stressed than team athletes (p < 0.01). The middle-level athletes showed significantly more hyperarousal levels than high-level athletes (p = 0.012). The results of this survey may raise awareness of this problem and help athletic associations to have appropriate guidelines in order to better sustain their memberships and organize an optimal resumption of their sports activities. Along these lines, social interactions, which are typical of team sports, are crucial to warrant resilience and psychological health. The athletes by managing independently the new rules and measures, thanks to a clear communication, could improve their adaptive stress reaction.

Relation among Perceived Weight Change, Sedentary Activities and Sleep Quality during COVID-19 Lockdown: A Study in an Academic Community in Northern Italy

In Italy, COVID-19 lockdown was imposed from 8 March until 3 May 2020 with negative consequences on the lifestyles and health of people. Within this context, the paper aims: (i) to analyse the impact of COVID-19 lockdown on perceived weight changes; (ii) to evaluate factors associated with the perception of weight changes (Body Mass Index (BMI), sleep quality, time spent in sedentary activities), in an Italian academic community of students and workers. A total of 3666 participants took part in this cross-sectional study (2838 students and 828 workers, of whom 73.0% were female). T-test, Chi-square test and the two-way ANOVA were used. Results showed that 43.3% of participants perceived a weight gain. Workers experienced a more substantial increase in body weight (0.7 kg) compared to students (0.3 kg; p = 0.013). A significant difference between preobese/obese workers (0.9 kg) and students (-0.3 kg; p < 0.001) was found. Overall, 57.0% of the sample was characterized by high levels of sedentary activities. Sedentary people noticed a higher weight gain (0.4 kg) compared to less sedentary people (0.3 kg; p = 0.048). More than 45% of participants reported a worsening of sleep quality and showed a perceived increase in body weight (0.5 kg) in comparison to those who improved their sleep quality (no weight change; p = 0.001). Designing tailored interventions to promote health-related behaviours during lockdown periods is essential.

Sleep and Mental Health Disturbances Due to Social Isolation during the COVID-19 Pandemic in Mexico

The coronavirus disease (COVID-19) that broke out in China in December 2019 rapidly became a worldwide pandemic. In Mexico, the conditions requiring the declaration of a sanitary emergency were reached by the last week of March 2020, and health authorities' limited mobility and imposed social isolation were the main strategies to keep the virus from spreading. Thus, daily living conditions changed drastically in a few days, generating a stressful situation characterized by an almost complete lack of mobility, social isolation, and forced full-time interactions with family members. Soon, complaints of sleep disturbances, anxiety, and symptoms of depression were reported. The present study reports the results of an online survey performed during the first two months of isolation. Questionnaires exploring sleep disturbances, anxiety, and depression were sent to people who responded to an open invitation. A total of 1230 participants filled out the sleep questionnaire, 812 responded to the anxiety questionnaire, and 814 responded to the depression questionnaire. Both men and women reported poor sleep quality, but women showed a higher proportion (79%) than men (60%); young women were more likely to be affected by social isolation. Concerning anxiety and depression, both sexes reported high similar symptoms. These data suggest that stressful conditions related to social isolation and the economic uncertainty caused by the pandemic may induce mental health disturbances, which may become worse with sleep restriction.

Students' attitude and sleep pattern during school closure following COVID-19 pandemic quarantine: a web-based survey in south of Iran

Background

School closure is one of the main policies of global health care strategies performed worldwide. Despite all benefits, there might be some threats for younger groups spending their time in quarantine. This study aims to determine the impacts of lockdown and school closure on children’s major lifestyle aspects, especially their leisure and sleep pattern during the COVID-19 pandemic.

Methods

For the purpose of this study, an online questionnaire was distributed from 14th to 31st of March 2020 among the schools and students from the first grade to the 12th grade (before university) in Fars province, southern Iran. The questionnaire consisted of five sections which included data regarding the students’ general information, activity priorities, adherence to quarantine, attitude toward school closure, and sleep patterns.

Results

In our study, 20,697 filled questionnaires were received from the participants with an average age of 13.76 years; 29.7% of them were male, 80.6% were from urban areas, and 83.3% were from public schools. The overall first preference of students during school closure was mobile and computer games (30.1%), followed by studying (26.6%) and watching television (13.8%). Our results demonstrated that the majority of students adhered to social distancing and there was also a significant correlation among education levels and desire for schools to be closed till the end of the semester (P = 0.015). Also, regarding sleep patterns, the majority (53.5%) had above 12 h of sleep throughout the day.

Conclusion

It seems that lockdown following COVID-19 pandemic has changed various aspects of the students’ lifestyle remarkably, especially by increasing screen time and even sleep duration and pattern. We believe that certain strategies should be implemented by the Health and Educational Ministry to control not only the visible side effects of the quarantine period, but also the collateral consequences on their psychological and mental health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12199-021-00950-4.

The association between perceived stress with sleep quality, insomnia, anxiety and depression in kidney transplant recipients during Covid-19 pandemic

Background

The psychological distress and sleep problems caused by current Covid-19 outbreak is not well known in kidney transplant recipients. In this study, we aimed to investigate the association between perceived stress with sleep quality, insomnia, anxiety, depression and kidney function in kidney transplant recipients during the Covid-19 pandemic.

Material and methods

A hundred-six kidney transplant recipients were enrolled. Questionnaire of "Socio-demographics", "Perceived Stress Scale (PSS)", "Pittsburgh Sleep Quality Index (PSQI)", "Insomnia Severity Index (ISI)" and “Hospital Anxiety Depression Scale (HADS)” are performed. The laboratory data is recorded. The perceived stress related to Covid-19 pandemic and its associations were investigated.

Results

The mean age of patients was 44.2±13.3 years, and 65 of the patients (61.3%) were men. Forty-nine (46.2%) of the patients had high-perceived stress; 51 (48.1%) of the patients had poor sleep quality, 40 (37.7%) of the patients had insomnia, 25 (23.6%) of the patients had anxiety and 47 (44.3%) of the patients had depression. The patients having a history of Covid-19 infection in own or closed relatives (9.09±4.17 vs 6.49±4.16, p:0.014) and the patients who have a rejection episode any of time (8.24±5.16 vs 6.37±3.57, p:0.033) have had significantly higher anxiety scores, when they compared to others. The high PSS were positively correlated with PSQI, ISI, HAD-A and HAD-D. Regression analyses revealed that high-perceived stress is an independent predictor of anxiety and depression. There was not significant difference between kidney function with PSS, PSQI, ISI, HAD-A and HAD-D.

Conclusions

High PSS is positively correlated with poor sleep quality and insomnia and also an independent predictor of anxiety and depression in kidney transplant recipients during the outbreak of Covid-19. As the pandemic is still spreading worldwide quickly early identification and intervention of sleep disturbances and psychiatric disorders are essential to protect graft function with high compliance to treatment in transplantation patients.

Impact of COVID-19 on mental health of employed women residing in Delhi-NCR, India: Mediating role of working from-for home

Women, who are "supposed" to do all their official and household work are now required to do all of it simultaneously because of lockdown amid covid-19. I did this study to analyze the perceived stress and depressive tendencies among the non-clinical population of employed women residing in Delhi-NCR and whether work from-for home is acting as a mediator between the two. Further, marital status and family status were also taken into consideration. A sample of two-hundred-three responses depicted that there is a significant and positive correlation between perceived stress and depressive tendencies. Further, working from-for home significantly acts as a mediator between the two variables. Moreover, there is no significant interaction between family status and working from-for home on depressive tendencies. However, there is a significant interaction between marital status and working from-for home on depressive tendencies. The implications, limitations, and future suggestions are discussed in the end.

Digital Interventions to Support Population Mental Health in Canada During the COVID-19 Pandemic: Rapid Review

BACKGROUND

The COVID-19 pandemic has resulted in a number of negative health related consequences, including impacts on mental health. More than 22% of Canadians reported that they had felt depressed in the last week, in response to a December 2020 national survey. Given the need to physically distance during the pandemic, and the increase in demand for mental health services, digital interventions that support mental health and wellness may be beneficial.

OBJECTIVE

The purpose of this research was to identify digital interventions that could be used to support the mental health of the Canadian general population during the COVID-19 pandemic. The objectives were to identify (1) the populations these interventions were developed for, inclusive of exploring areas of equity such as socioeconomic status, sex/gender, race/ethnicity and culture, and relevance to Indigenous peoples and communities; (2) the effect of the interventions; and (3) any barriers or facilitators to the use of the intervention.

METHODS

This study was completed using a Cochrane Rapid Review methodology. A search of Embase, PsycInfo, Medline, and Web of Science, along with Google, Million Short, and popular mobile app libraries, was conducted. Two screeners were involved in applying inclusion criteria using Covidence software. Academic articles and mobile apps identified were screened using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields resource, the American Psychiatric Association App Evaluation Framework, and the Mental Health Commission of Canada's guidance on app assessment and selection.

RESULTS

A total of 31 mobile apps and 114 web-based resources (eg, telemedicine, virtual peer support groups, discussion forums, etc) that could be used to support the mental health of the Canadian population during the pandemic were identified. These resources have been listed on a publicly available website along with search tags that may help an individual make a suitable selection. Variability exists in the populations that the interventions were developed for, and little assessment has been done with regard to areas of equity. The effect of the interventions was not reported for all those identified in this synthesis; however, for those that did report the effect, it was shown that they were effective in the context that they were used. A number of barriers and facilitators to using these interventions were identified, such as access, cost, and connectivity.

CONCLUSIONS

A number of digital interventions that could support population mental health in Canada during the global COVID-19 pandemic were identified, indicating that individuals have several options to choose from. These interventions vary in their purpose, approach, design, cost, and targeted user group. While some research and digital interventions addressed equity-related considerations, more research and focused attention should be given to this area.

Mental Health Consequences of Lockdown During the COVID-19 Pandemic: A Cross-Sectional Study

Objective

We aimed to provide an overview of the psychological status and behavioral consequences of the lockdown during the COVID-19 pandemic in Libya.

Methods

A cross-sectional study was conducted among the Libyan population through May and June 2020 in more than 20 cities. The survey comprised basic demographic data of the participants and anxiety symptoms measured using the seven-item Generalized Anxiety Disorder scale (GAD-7) with ≥15 as the cut-off score for clinically significant anxiety symptoms. Additionally, a survey regarding the lockdown effect was administered, which consisted of several parts, to measure the lockdown status.

Results

A total of 8084 responses were recorded, of which, 5090 (63%) were women and 2994 (37%) were men. The mean age (SD) for study participants was 27.2 (8.9) years. Among the participants, 1145 (14.2%) reached the cut-off score to detect anxiety symptoms; however, of the study variables, only five were predictors of clinically significant anxiety: age, gender, marital status, work status, being a financial supporter for the family, and being infected with COVID-19. Women had 1.19 times higher odds to exhibit anxiety symptoms than men. Increasing age was significantly associated with reduced likelihood of exhibiting anxiety symptoms, whereas being married was significantly associated with higher likelihood of anxiety symptoms, compared to not being married. Being suspended from work was associated with an increase in the likelihood of anxiety symptoms. However, we found that being infected with COVID-19 was associated with a 9.59 times higher risk of exhibiting severe anxiety symptoms. Among the study participants, 1451 (17.9%) reported a physical and/or verbal abuse episode from family members, 958 (11.9%) reported abuse outside the family, and 641 (7.9%) reported abuse from enforcers, during the lockdown.

Conclusion

Our study provided an overview of the psychological and behavioral status, among those who resided in Libya during the civil war and COVID-19 pandemic. The study demonstrates a concerningly high level of clinically significant anxiety during lockdown among the Libyan population during Libya’s lockdown period.

The Impact of COVID-19 Lockdown on People With Epilepsy and Vagal Nerve Stimulation

Objectives: Restrictive measures adopted during the COVID-19 pandemic, in order to limit contagion, have had a severe impact on mental health. The burden of lockdown has been particularly heavy on patients with chronic neurologic diseases such as People with Epilepsy (PwE). Our survey aims to describe the struggles and needs of Drug-Resistant (DR) PwE with implanted Vagal Nerve Stimulator (VNS) during the first wave of the COVID-19 lockdown in order to find strategies that help patients cope with present or future periods of restriction. Methods: We collected answers from 30 respondents who underwent an online survey including socio-demographic and clinical information and COVID-19-related information. Depression, anxiety symptoms, and sleep quality were investigated in patients through BDI II, GAD-7, and the PSQI scale. Results: In all, 46% of our sample reported an increase in the number of seizures; the entire sample complained of epilepsy-related issues (medication availability, VSN adjustments, anxiety, sleep disturbance); one out of three participants reported major epilepsy issues felt urgent; 30% had to postpone scheduled examination. Significantly higher scores for depression and anxiety scales were found in patients who perceived seizure frequency worsening and reported major epilepsy-related issues. Conclusion: Preliminary findings showed that the first lockdown influenced the clinical and psychological status of PwE and was related to seizures worsening. The lack of medical assistance and control on VNS therapy left patients to cope with the situation without a chance to contact a specialist. We discuss how a wider implementation of telemedicine programs could facilitate remote assistance of PwE with a VNS implant.

Prospective Examination of Adolescent Sleep Patterns and Behaviors Before and During COVID-19

Study Objectives

To prospectively examine changes in adolescent sleep before and during the COVID-19 pandemic in adolescents with and without ADHD.

Methods

Participants were 122 adolescents (ages 15–17; 61% male; 48% with ADHD). Parents reported on adolescents’ sleep duration and difficulties initiating and maintaining sleep (DIMS); adolescents reported on sleep patterns, sleep duration, delayed sleep/wake behaviors, and daytime sleepiness before (September 2019 to February 2020) and during (May–June 2020) COVID-19. Adolescents also reported on their health behaviors, COVID-19-related negative affect, and difficulties concentrating due to COVID-19.

Results

Parents reported adolescents had more DIMS during COVID-19 than before COVID-19, with clinically elevated rates increasing from 24% to 36%. Both bedtimes and waketimes shifted later during COVID-19, and adolescents reported more delayed sleep/wake behaviors. Adolescents also reported less daytime sleepiness and longer school night sleep duration during COVID-19. In considering differences between adolescents with and without ADHD, adolescents with ADHD did not experience an increase in school night sleep duration and were less likely to obtain recommended sleep duration during COVID-19. In the full sample, controlling for ADHD status, COVID-19-related sadness/loneliness was associated with increases in DIMS, and spending less time outside and more COVID-19-related worries/fears were associated with increases in delayed sleep/wake behaviors during COVID-19.

Conclusions

COVID-19 had negative and positive impacts on adolescent sleep. Adolescents with ADHD did not experience the benefit of increased school night sleep duration during COVID-19 like adolescents without ADHD. Negative affect and health behaviors may be useful intervention targets for reducing negative impacts of COVID-19 for adolescent sleep.

Taking a lesson from the COVID-19 pandemic: Preventing the future outbreaks of viral zoonoses through a multi-faceted approach

The pandemic of the novel coronavirus disease 2019 (COVID-19) has caused a significant burden to healthcare systems, economic crisis, and public fears. It is also a lesson to be learned and a call-to-action to minimize the risk of future viral pandemics and their associated challenges. The present paper outlines selected measures (i.e., monitoring and identification of novel viral agents in animals, limitations to wildlife trade, decreasing hunting activities, changes to mink farming and meat production), the implementation of which would decrease such a risk. The role of viral surveillance systems and research exploring the virus strains associated with different animal hosts is emphasized along with the need for stricter wild trade regulations and changes to hunting activities. Finally, the paper suggests modifications to the meat production system, particularly through the introduction of cultured meat that would not only decrease the risk of exposure to novel human viral pathogens but also strengthen food security and decrease the environmental impacts of food production.

Sleep and Psychological Difficulties in Italian School-Age Children During COVID-19 Lockdown

Objective

On March 10, 2020, the Italian Government ordered a national lockdown to limit the viral transmission of coronavirus disease 2019 infections. This study investigated how these restrictive measures have impacted sleep quality, timing, and psychological difficulties in school-age children and their mothers during the lockdown.

Methods

In an online survey, 299 mothers reported their sleep habits, experience of time, and psychological difficulties as well as those of their children (6–10 years old) during and, retrospectively, before the lockdown.

Results

During the lockdown, children showed a marked delay in sleep timing—that is, later bedtime and rise time—and a mild worsening in sleep quality. They were less prone to respect daily routines or to keep track of the passage of time. They showed increased emotional, conduct, and hyperactive symptoms, and the increase in these psychological difficulties was predicted by the change in sleep quality, boredom, and mothers’ psychological difficulties. In addition, mothers showed a delayed sleep timing and worsening of sleep quality during the lockdown, in varying degrees depending on their working conditions. Mothers who kept working regularly outside their homes during lockdown reported more regular sleep patterns, whereas mothers who stopped working showed more emotional symptoms and relevant changes in their perception of time.

Conclusions

Overall, given the evidence of the adverse behavioral and psychological impact of home confinement and social restrictions, effective measures needed to be in place to mitigate long-term effects on children and their mothers, especially those who have had to stop working during lockdown.

Immune Fitness and the Psychosocial and Health Consequences of the COVID-19 Pandemic Lockdown in The Netherlands: Methodology and Design of the CLOFIT Study

This article provides an overview of the design and methodology of the "Corona lockdown: how fit are you?" (CLOFIT) study, including the questionnaires and scales that were included in the online survey. The aim of the CLOFIT study was to investigate the psychosocial and health consequences of the coronavirus disease 2019 (COVID-19) pandemic in the Netherlands. The survey was conducted among the Dutch population to collect data on immune fitness and the psychological and health consequences of the 2019 coronavirus disease (COVID-19) pandemic lockdown in the Netherlands. The CLOFIT dataset contains measures from N = 1910 participants and is broadly representative of the Dutch general population. The dataset represents both sexes, a range of ages including the elderly, different education levels, and ethnic backgrounds. The cohort also includes people with a diverse health status and range of medication use.

Insomnia among employees in occupations with critical societal functions during the COVID-19 pandemic

Objective

This study investigates insomnia among employees in occupations critical to the functioning of society (e.g health, education, welfare and emergency services) during the COVID-19 pandemic. Many of these workers experience higher job pressure and increased risk of infection due to their work. It is crucial to investigate which factors that can contribute to insomnia in these important sectors.

Methods

Data was collected using an online survey administered in June 2020. The questionnaire measured demographic variables, sleep, stress, psychosocial factors and health concerns (i.e worrying about health consequences related to the pandemic). The sample in the present study consisted of 1327 (76% females) employees in organizations with societal critical functions.

Results

The employees reported higher levels of insomnia symptoms compared to normative data collected before the pandemic. Health concerns specifically related to COVID-19 had the strongest association to insomnia, followed by work stress. Job demands (i.e workload, time pressure and overtime) had merely a weak association to insomnia.

Conclusion

Worrying about consequences the pandemic can have on your own health and the health of your family or colleagues have a stronger negative impact on sleep than work pressure during the COVID-19 pandemic. Impaired sleep can have detrimental effects on performance and health, and a stronger focus on preventing insomnia as a mean of sustaining critical societal functions both during and after the pandemic is warranted. Organizations should consider interventions aimed at reducing health concerns among their employees during the COVID-19 pandemic.

The Effects of the Health System Response to the COVID-19 Pandemic on Chronic Disease Management: A Narrative Review

BACKGROUND

Individuals with chronic conditions require ongoing disease management to reduce risks of adverse health outcomes. During the COVID-19 pandemic, health care for non-COVID-19 cases was affected due to the reallocation of resources towards urgent care for COVID-19 patients, resulting in inadequate ongoing care for chronic conditions.

METHODS

A keyword search was conducted in PubMed, Google Scholar, Science Direct, and Scopus for English language articles published between January 2020 and January 2021.

FINDINGS

During the COVID-19 pandemic, in-person care for individuals with chronic conditions have decreased due to government restriction of elective and non-urgent healthcare visits, greater instilled fear over potential COVID-19 exposure during in-person visits, and higher utilization rates of telemedicine compared to the pre-COVID-19 period. Potential benefits of a virtual-care framework during the pandemic include more effective routine disease monitoring, improved patient satisfaction, and increased treatment compliance and follow-up rates. However, more needs to be done to ensure timely and effective access to telemedicine, particularly for individuals with lower digital literacy. Capitation primary care models have been proposed as a more financially-robust approach during the COVID-19 pandemic than fee-for-service primary care models; however, the interplay between different primary models and the health outcomes is still poorly understood and warrants further investigation. Shortages of medication used to manage chronic conditions were also observed at the beginning of the COVID-19 pandemic due to global supply chain disruptions. Finally, patients with chronic conditions faced lifestyle disruptions due to the COVID-19 pandemic, specifically in physical activity, sleep, stress, and mental health, which need to be better addressed.

INTERPRETATION

Overall, this review elucidates the disproportionately greater barriers to primary and specialty care that patients with chronic diseases face during the COVID-19 pandemic and emphasizes the urgent need for better chronic disease management strategies moving forward.

The Coronavirus Pandemic: A Possible Model of the Direct and Indirect Impact of the Pandemic on Sleep Quality in Italians

PURPOSE

This study aimed to assess the direct and indirect impact of COVID-19-related aspects on self-reported sleep quality, considering the moderator role of some psychological variables.

METHODS

During the first weeks of the lockdown in Italy, 2286 respondents (1706 females and 580 males; age range: 18-74 years) completed an online survey that collected sociodemographic information and data related to the experience with the COVID-19 pandemic. Some questionnaires assessed sleep quality, psychological well-being, general psychopathology, Post-Traumatic Stress Disorders symptoms, and anxiety. The path analysis was adopted.

RESULTS

The study confirms a direct effect of some aspects ascribable to the pandemic, with a mediator role of the psychological variables. Lower sleep quality was directly related to the days spent at home in confinement and the knowledge of people affected by the COVID-19. All the other aspects related to the COVID-19 pandemic influenced sleep quality through the mediator effect of psychological variables.

CONCLUSION

This study highlighted that the psychological condition of the population has been influenced by the COVID-19 pandemic and the government actions taken to contain it, but it has also played an important role in mediating the quality of sleep, creating a vicious circle on people's health. The results suggest that a health emergency must be accompanied by adequate social support programs to mitigate the fear of infection and promote adequate resilience to accept confinement and social distancing. Such measures would moderate psychological distress and improve sleep quality.

COVID-19 pandemic distress among a sample of Italian psycho-oncologists: risk of isolation and loneliness

Purpose:

To measure the prevalence and characteristics of distress and hope for the future among psycho-oncologists, who faced the coronavirus disease 2019 (COVID-19) emergency along with other healthcare workers.

Methods:

A web-based study was conducted among members of the Italian Society of Psycho-Oncology between May 29 and June 5, 2020.

Results:

A total of 237 members, aged 28–72 years, completed the COVID-19 Peritraumatic Distress Index (CPDI), Impact of Event Scale–Revised (IES-R), and HOPE questionnaires; 86.92% were female, 58.65% worked in hospitals, 21.10% were exposed to COVID-19, 11.39% experienced peritraumatic distress, and 3.38% had posttraumatic stress disorder symptoms. Peritraumatic distress was associated with living alone (adjusted odds ratio [AOR] 3.05; 95% confidence interval [CI] 1.41–8.13), using sleep remedies (AOR 3.79; 95% CI 1.41–10.21), and the perception of being avoided by family or friends because of work (AOR 2.69; 95% CI 1.02–7.11); high HOPE-Agency scores were associated with the absence of peritraumatic stress (AOR 0.40; 95% CI 0.16–0.96) after adjustment for age and sex.

Conclusions:

Psycho-oncologists showed greater resilience than other healthcare workers as they are trained to help others, but also to review their own values and behavior in light of stressful events. Of interest is the association between peritraumatic distress and social isolation, real or perceived. Healthcare institutions should pay attention to the mental well-being of their employees by promoting distress screening using simple tools such as the CPDI and implementing support interventions. Psycho-oncology associations should introduce policies aimed at developing a sense of social connectedness by providing an interactive system of orientation and scientific reference.

COVID-19 lockdown: impact on online gambling, online shopping, web navigation and online pornography

BACKGROUND

The COVID-19 pandemic and control measures may have had an impact on unpleasant emotions experimented during the lockdown (LD). This may have increased the number of hours spent online and could have impacted the quality of the enacted behavior, in terms of loss of control of Internet use. In this online survey, we were interested in measure how much loss of control was perceived regarding online gambling, online shopping, the fruition of online pornographic content and web navigation.

DESIGN AND METHODS

The online survey was carried out during the COVID-19 pandemic in the post-lockdown and 1232 subjects participated in the survey. In the participating sample, healthcare workers (HW) were 43.1% of the sample, of which 18.7% were directly involved in the Coronavirus emergency, and 52.3% of the sample is not a HW. Only 0.6% of the sample gambled online and 37.5% of those reported losing control of their gambling mode. Most of the sample shopped online during the LD (70.1%), but only 7.2% of those lost control by buying and/or spending more than what they had set themselves.

RESULTS

Significant data emerged showing that those who lost control while online shopping also lost control regarding the amount of time spent online (p<0.001); 21.6% of the sample, reported making use of online pornographic material during LD, 4.7% of them stated that the frequency increased and 5.1% reported losing control by having spent more money or more time than what was intended. Finally, 44.7% of the sample have experienced loss of control during the web navigation. Furthermore, during the LD 67.8% of the sample reports having experienced unpleasant emotions. Of these, 8.4% state that they enacted behaviors such as online gambling, online shopping, online pornographic material viewing and web navigation to counter their negative emotions. Interestingly, we found a correlation between loss of control during web navigation and online shopping and the emotional states "upset", "scared" and "restless" (p<0.05).

CONCLUSION

To conclude, there was no significant increase in potentially addictive behaviors, nor an increase in loss of control of these behaviors when enacted online. However, the loss of control in online shopping and web navigation was significantly correlated to the unpleasant emotional states of nervousness, fear and restlessness, whereas those who reported feeling strong and able to handle the situation experienced a lower loss of control in their web navigation. These correlations may suggest that these online behaviors may act as modulators of unpleasant emotional states.

COVID-19 psychological factors associated with pain status, pain intensity, and pain-related interference

The 2019 novel SARS-CoV2 disease causing COVID-19 has had a devastating impact on the world, and those with pain conditions may be at heightened risk for these negative consequences. Given COVID-19 limitations, including social distancing and stay-at-home orders, pain is likely largely going untreated, leading to greater pain and associated consequences. Mental health symptoms, which have been found to be elevated due to COVID-19, may contribute to elevated pain experience, but little work has examined how COVID-19-specific mental health factors may be associated with pain. Therefore, the current study examined (1) how COVID-19-specific psychological factors and general mental health symptoms differ between those with pain and without, and (2) among those with pain, which psychological factors were most strongly associated with pain experience. Results from a national (U.S. based) online sample of 174 adults (42.5% female, M_age = 37.80 years, SD = 11.30, 88 with pain) collected between April and May 2020 indicated that, compared to those individuals reporting no pain, those with pain reported significantly higher values on all variables. Additionally, COVID-19 fear and sleep problems were associated with pain intensity, and for pain-related interference, fear, sleep problems, and depression were significantly associated. These results highlight the potential importance of COVID-19-specific psychological factors in pain experience.

Severe Mental Health Symptoms during COVID-19: A Comparison of the United Kingdom and Austria

This study evaluated severe psychological symptoms in the United Kingdom and Austria after four weeks of lockdown due to COVID-19. Two cross-sectional online surveys were performed with representative population samples according to age, gender, region, and education. Depressive symptoms were measured with the Patient Health Questionnaire (PHQ-9), anxiety symptoms with the Generalized Anxiety Disorder scale (GAD-7), and insomnia symptoms with the Insomnia Severity Index (ISI). The sample size was N = 1005 for Austria (52% women) and N = 1006 (54% women) for the UK. In total, 3.2% of the Austrian sample and 12.1% of the UK sample had severe depressive symptoms (PHQ-9 ≥ 20 points; χ2(1) = 57.24; p < 0.001), 6.0% in Austria vs. 18.9% in the UK had severe anxiety symptoms (GAD-7 ≥ 15 points; χ2(1) = 76.17; p < 0.001), and 2.2% in Austria and 7.3% in the UK had severe insomnia (ISI; ≥22 points; χ2(1) = 28.89; p < 0.001). The prevalence of severe depressive, anxiety or insomnia symptoms was around three times higher in the UK than in Austria.

Pandemic dreams: quantitative and qualitative features of the oneiric activity during the lockdown due to COVID-19 in Italy

Objective

The lockdown due to COVID-19 pandemic had a strong impact on daily habits, emotional experience, mental health and sleep. A large body of evidence suggests that dreams are affected by both waking experiences and sleep pattern. In this view, the lockdown should have induced intense modifications in dreaming activity. The aim of the study was to assess dream features during the lockdown in Italy.

Methods

We used an online survey to collect self-reported demographic, clinical, sleep and dream data. Our sample included 1091 participants.

Results

Results point to an increased dream frequency, emotional load, vividness, bizarreness and length during the lockdown, compared to a pre-lockdown period. Higher dream frequency and specific qualitative features were found in females and subjects with poor sleep quality, nocturnal disruptive behaviours and depressive symptoms. Most of the dream features assessed during the lockdown were predicted by age, gender, depressive symptoms, presence/absence of other people at home, and territorial area. A specific focus on sleep features revealed that sleep duration and several sleep quality indexes were the best predictors of dream variables. During the lockdown, dreams were also characterized by increased negative emotions, which were particularly frequent in females, younger adults, and participants with poor sleep quality, nocturnal disruptive behaviours, anxiety and depressive symptoms.

Conclusions

Our results confirm the hypothesis of a strong influence of the pandemic on dreaming, supporting both the hypothesis of continuity between wake and sleep mental processes and the view of a crucial influence of sleep quality and duration on dreaming activity.

Quality of sleep among social media users during the lockdown period due to COVID-19 in Spain

Aims

To analyse the quality of sleep of the Spanish population during the lockdown due to COVID-19.

Design

Cross-sectional descriptive study using a web based survey design.

Methods

Pittsburgh Sleep Quality Index questionnaire and sociodemographic, occupational, health and sleep quality variables were used to collect data during the first month of the lockdown period due to COVID-19 (March–April 2020). A snowball sampling was carried out, where participants were asked to disseminate and distribute the questionnaire among their own profiles in social networks.

Results

A representative sample of 5220 participants aged ≥18 years old took part in the study. The global PSQI score was 8.17 points (SD 4.43). A statistical association was found between the global PSQI score and several of the variables collected. Findings show that the quality of sleep was worse among women (p < 0.001), single participants (p 0.02), those working in rotating shifts (p < 0.001), on-site workers (p < 0.001), and people diagnosed with COVID-19 or who had someone in their environment diagnosed with the virus (p < 0.001).

Conclusion

Findings show that the Spanish population has experienced poor quality of sleep during the lockdown period. Being a woman, working in rotating shifts, having suffered from COVID-19 or having someone close suffering from COVID-19, being unemployed or being affected by a Temporary Redundancy Scheme, as well as spending long hours in bed were associated with poorer sleep quality. On the contrary, being older and sleeping longer hours were associated with a better sleep quality.

COVID-19 Lockdown and Self-Perceived Changes of Food Choice, Waste, Impulse Buying and Their Determinants in Italy: QuarantEat, a Cross-Sectional Study

Data about self-perceived food choice (FC) changes and their determinants during COVID-19 lockdowns are limited. This study investigated how the Italian lockdown affected self-perceived food purchases (FP), occurrence of impulse buying (IB), household food waste production (HFWP) and their determinants. A web-based cross-sectional survey was distributed in May 2020, collecting an opportunistic sample of the Italian population. A total of 1865 (70% females) people were enrolled, the median age was 29 (IQR 16.0). Most of the sample increased overall FP (53.4%), food consumption (43.4%), reduced HFWP (53.7%) and halved the prevalence of IB (20.9%) compared to the period before the lockdown (42.5%). Baking ingredients, fresh vegetables, fresh fruit and chocolate had the largest sales increase by individuals, while bakery products, fresh fish and salted snacks purchases highly decreased. Increased FP was associated with the occurrence of IB (adjOR 2.48, p < 0.001) and inversely associated with not having worked during lockdown (adjOR 0.71, p = 0.003). Multivariable logistic regressions revealed occurrence of IB was associated with low perceived dietary quality (adjOR 2.22, p < 0.001), resulting at risk, according to the Emotional Overeating Questionnaire (EOQ, adjOR 1.68, p < 0.001), and inversely associated with decreased HFWP (adjOR 0.73, p < 0.012). Reduced HFWP was associated with higher perceived dietary quality (adjOR 2.27, p < 0.001) and negatively associated with low score at WHO-5 Well-Being Index (adjOR 0.72, p = 0.002). The Italian lockdown highly affected FC behaviours, leading to positive and sustainable habits towards food purchase and consumption. Public health interventions are needed to keep these new positive effects and avoid negative consequences in case of future lockdowns.

How the Coronavirus Lockdown Impacts the Impoverished in India

In response to the coronavirus pandemic, several countries have imposed curfews, quarantines, and lockdowns to restrict the spread of the infection among people. India had initiated a nationwide lockdown to combat the pandemic starting from the last week of March until the end of May 2020. But, the lockdown had continued subsequently in several red zones across parts of the country for few months. However, scientists have criticized the government's abrupt lockdown since it prevented people from preparing for the worst aftermath. Besides, the curfews have blocked millions of impoverished migrant workers from leaving cities to return to their homes in distant rural villages. As a result, the destitute workers have endured enormous hardship and outright discrimination desolately leading to their added physical and mental distress, pain, suffering, and death. Most of the victims of the lockdown have belonged to the economically distressed lower social classes of the Indian caste hierarchy. This article outlines their sufferings triggered by the long drawn-out lockdown episode.

Changes in Drug Use Patterns during the COVID-19 Pandemic in Italy: Monitoring a Vulnerable Group by Hair Analysis

From 22 March until 18 May 2020, a complete lockdown in Italy was ordered as a countermeasure against the COVID-19 pandemic. Social isolation measures affect some populations more than others, and people with drug and/or alcohol disorders (SUDs) are more likely to be adversely affected. This study presents, for the first time, laboratory data on the use of alcohol and drugs in a high-risk population during Italy's first wave of the COVID-19 pandemic. Thirty subjects with SUDs were monitored for the use of illicit drugs and alcohol every 3 months before, during and after the lockdown, by hair analysis. The number of samples positive for heroin, cocaine, MDMA and cannabis fell considerably during the lockdown and then resumed to pre-lockdown levels when the period of confinement was over. Interestingly, the consumption of benzodiazepines and alcohol followed the opposite trend; both the number of benzodiazepine-positive samples and the level of alcohol consumption increased and remained high, even at the end of the lockdown. The confinement measures produced significant changes in drug/alcohol use patterns, with a shift toward the use of substances that were more easily accessible, used as self-medication for negative feelings, and used to alleviate the effects of abstinence from drugs that were no longer readily available.

Students' mental health problems before, during, and after COVID-19 lockdown in Italy

The lockdown due to the coronavirus pandemic may have exacerbated mental health problems. To what degree mental health may be affected by social isolation is still poorly known. We collected prospective data on students' mental health in two instances: (i) in October and December 2019, and (ii) 6 months later, in April 2020 amidst the COVID-19 lockdown in Italy and in mid-May/June 2020, after the lifting of lockdown. A total of 358 Italian students aged 18-30 completed socio-demographic questionnaires and the Beck Depression Inventory - 2 (BDI-2), the Beck Anxiety Inventory (BAI), the Obsessive-Compulsive Inventory - Revised (OCI-R), the Eating Habits Questionnaire (EHQ), and the Eating Disorder Inventory-3 (EDI-3). We applied multiple regression models to evince any changes in the aforementioned questionnaire scores during and after lockdown with respect to the scores before lockdown. Students reported on average worse depressive symptoms during lockdown than 6 months before isolation (median increase in the BDI-2 score +2; IQR = -3, 6; β = 0.09 ± 0.03, p = 0.005), with students without any established diagnosis of psychopathology being affected the most. The regression models predict that 86.2% (IQR = 67.9, 91.4%) of students would not experience a clinically significant worsening of symptoms, while approximately 6% of our target population could develop more severe depressive symptoms. This study supports the view that depressive symptomatology may be aggravated during lockdown, but also highlights that after the lifting of lockdown any changes quickly vanished, as the BDI-2 scores were not different from the ones reported before lockdown.

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

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

Cognitive and mental health changes and their vulnerability factors related to COVID-19 lockdown in Italy

The COVID-19 pandemic and government imposed social restrictions like lockdown exposed most individuals to an unprecedented stress, increasing mental health disorders worldwide.

We explored subjective cognitive functioning and mental health changes and their possible interplay related to COVID-19-lockdown. We also investigated potential risk factors to identify more vulnerable groups. Across Italy, 1215 respondents completed our Qualtrics-based online-survey during the end of a seven to 10-week imposed lockdown and home confinement (from April 29 to May 17, 2020). We found subjective cognitive functioning and mental health severely changed in association with the lockdown. Under government regulations, cognitive complaints were mostly perceived in routine tasks involving attention, temporal orientation and executive functions—with no changes in language abilities. A paradoxical effect was observed for memory, with reduced forgetfulness compared to pre-lockdown. We found higher severity and prevalence of depression, anxiety disorders, abnormal sleep, appetite changes, reduced libido and health anxiety: with mild-to-severe depression and anxiety prevalence climbing to 32 and 36 percent, respectively, under restrictions. Being female, under 45 years, working from home or being underemployed were all identified as relevant risk factors for worsening cognition and mental health. Frequent consumers of COVID-19 mass media information or residents in highly infected communities reported higher depression and anxiety symptoms, particularly hypochondria in the latter. If similar restrictions are reimposed, governments must carefully consider these more vulnerable groups in their decisions, whilst developing effective global and long-term responses to the cognitive and mental health challenges of this type of pandemic; as well as implementing appropriate psychological interventions with specific guidelines: particularly regarding exposure to COVID-19 mass-media reports.

Gender specific excess mortality in Italy during the COVID-19 pandemic accounting for age

Since the beginning of the COVID-19 pandemic, data have been accumulated to examine excess mortality in the first half of 2020. Mortality in the preceding year or years is used to calculate the expected number of deaths, which is then compared with the actual number of deaths in 2020. We calculated weekly age- and sex-specific mortality rates for 93.1% of the Italian municipalities for the years 2015-2019 and for the first 26 weeks in 2020. We assumed the mortality experience during 2015-2019 as the reference period to calculate standardised mortality ratios. Furthermore, in order to compare the mortality experience of males and females, we calculated sex- and age- specific weekly direct standardised mortality rates and differences between the observed and expected number of deaths. We observed considerable changes in the demographics in the Italian population between the years 2015 and 2020, particularly among people 60 years and older and among males. The population is aging and the proportion of elderly males has increased, which was not reflected adequately in previous estimates of excess mortality. Standardized excess mortality results show that in Italy between the 8th and 26th weeks in 2020, there were 33,035 excess deaths, which is only 643 fewer deaths than the official COVID-19 death toll for this time period. A comparative increase in the mortality rates was observed in March among both sexes, but particularly for males. Comparisons with recently published data show considerably higher excess deaths, but these data were either not covering the complete country or did not account for age and sex. Neglecting the demographic changes in a region, even over a short time span, can result in biased estimates.

The Impact of COVID-19 Quarantine on Patients With Dementia and Family Caregivers: A Nation-Wide Survey

Introduction

Previous studies showed that quarantine for pandemic diseases is associated with several psychological and medical effects. The consequences of quarantine for COVID-19 pandemic in patients with dementia are unknown. We investigated the clinical changes in patients with Alzheimer’s disease and other dementias, and evaluated caregivers’ distress during COVID-19 quarantine.

Methods

The study involved 87 Italian Dementia Centers. Patients with Alzheimer’s Disease (AD), Dementia with Lewy Bodies (DLB), Frontotemporal Dementia (FTD), and Vascular Dementia (VD) were eligible for the study. Family caregivers of patients with dementia were interviewed by phone in April 2020, 45 days after quarantine declaration. Main outcomes were patients’ changes in cognitive, behavioral, and motor symptoms. Secondary outcomes were effects on caregivers’ psychological features.

Results

4913 patients (2934 females, 1979 males) fulfilled the inclusion criteria. Caregivers reported a worsening in cognitive functions in 55.1% of patients, mainly in subjects with DLB and AD. Aggravation of behavioral symptoms was observed in 51.9% of patients. In logistic regression analysis, previous physical independence was associated with both cognitive and behavioral worsening (odds ratio 1.85 [95% CI 1.42–2.39], 1.84 [95% CI 1.43–2.38], respectively). On the contrary, pandemic awareness was a protective factor for the worsening of cognitive and behavioral symptoms (odds ratio 0.74 [95% CI 0.65–0.85]; and 0.72 [95% CI 0.63–0.82], respectively). Approximately 25.9% of patients showed the onset of new behavioral symptoms. A worsening in motor function was reported by 36.7% of patients. Finally, caregivers reported a high increase in anxiety, depression, and distress.

Conclusion

Our study shows that quarantine for COVID-19 is associated with an acute worsening of clinical symptoms in patients with dementia as well as increase of caregivers’ burden. Our findings emphasize the importance to implement new strategies to mitigate the effects of quarantine in patients with dementia.

Self-reported changes in anxiety, depression and suicidality during the COVID-19 lockdown in Greece

INTRODUCTION

There are only a few published empirical data on COVID-19's effects on the mental health.

MATERIAL AND METHODS

During lockdown, an online questionnaire registered demographic, health data, previous psychiatric history, current anxiety, depression and suicidality, believing in conspiracy theories and other domains. Data from 3399 persons were used (81.08% females; aged 34.02 ± 9.72 and 18.27% males; aged 36.38±10.33). Distress and clinical depression were identified with the use of cut-off and a previously developed algorithm respectively.

STATISTICAL ANALYSIS

A post-stratification method was used; descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables.

RESULTS

Clinical depression was present in 9.31% of the stratified sample, while 8.5% had severe distress; increased anxiety was present in more than 45%. Suicidal thoughts increased in 10.40% and decreased in 4.42%. Beliefs in conspiracy theories were widely prevalent; at least half of cases were following various misconceptions. A model for the development of depression was created with general health status, previous history of depression, self-harm and suicidal attempts, family responsibility, economic change, and age acting as risk factors, while keeping a daily routine, pursuing religiousness/spirituality, and believing in conspiracy theories acting as protective factors.

CONCLUSIONS

The model developed here revealed multiple vulnerabilities and an interplay leading from simple anxiety to clinical depression and suicidality through distress. This could be of practical utility since most of these factors are modifiable. Future research, as well as interventions, should focus specifically on them.