Prevalence and risk factors of mental distress in China during the outbreak of COVID-19: A national cross-sectional survey

Social isolation, loneliness, and mental health among older adults during COVID-19: a scoping review

COVID-19 continues to have detrimental effects worldwide, especially on vulnerable populations. The burden of mental health concerns and psychological well-being resulting from social isolation and loneliness induced by COVID-19 are increasingly recognized in old age. The aim is to determine the extent of social isolation and loneliness among older adults, the methodologies used, the effect on mental health during COVID-19, and review intervention strategies and lifestyle changes to improve the current situation through the recommendations of the studies included. The articles published on PubMed, ProQuest, and Scopus databases from December 2019 to December 2021 with the following keywords ("Older Adults" "Social Isolation," "Loneliness," "Mental Health," "COVID-19") in English were included. Older adults have faced a serious burden of social isolation and adverse mental health effects during COVID-19. Anxiety, depression, stress, and insomnia are the major mental health concerns among older adults worldwide. It is suggested that spousal support and social networks, adaptive organizational change, and a responsive public sector are critical in reducing the obstacles to older adults. COVID-19 resilience among the aging population can be remarkable if adequately cared for with senior-friendly pandemic-related intervention strategies, policies and legislation.

Prevalence of depression, anxiety in China during the COVID-19 pandemic: an updated systematic review and meta-analysis

Background

Mental health risks associated with the aftermath of the COVID-19 pandemic are often overlooked by the public. The aim of this study was to investigate the effects of the COVID-19 pandemic on depression and anxiety disorders in China.

Methods

Studies were analyzed and extracted in accordance with the PRISMA 2020 flowchart. The studies were screened and extracted using electronic databases including PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov according to the predefined eligibility criteria. The Cochrane Review Manager software 5.3.1 was used for data analysis and the risk of bias assessment.

Results

As of 2023, a total of 9,212,751 Chinese have been diagnosed with COVID-19 infection. A total of 913,036 participants in 44 studies were selected following the eligibility criteria, the statistical information of which was collected for meta-analysis. The pooled prevalence of depression and anxiety were 0.31 (95% CI: 0.28, 0.35; I2 = 100.0%, p < 0.001) and 0.29 (95% CI: 0.23, 0.36; I2 = 100.0%, p < 0.001), respectively. After performing a subgroup analysis, the prevalence of depression among women, healthcare workers, students, and adolescents was 0.31 (95% CI: 0.22, 0.41), 0.33 (95% CI: 0.26, 0.44), 0.32 (95% CI: 0.26, 0.39), and 0.37 (95% CI: 0.31, 0.44), respectively.

Conclusion

The prevalence of depression and anxiety among the Chinese was overall high. Monitoring and surveillance of the mental health status of the population during crises such as sudden global pandemics are imperative.

Systematic review registration

https://clinicaltrials.gov/, identifier [CRD42023402190].

Confidence in COVID-19 vaccines moderates the association between vaccination status and mental distress

Previous research has demonstrated that becoming vaccinated with the Coronavirus vaccine may lower mental distress. However, it remains uncertain whether this relationship holds amid concerns of vaccine side effects and doubts of the vaccine's protective capabilities. We presented three studies that showed how vaccine confidence negatively influences the relationship between vaccine uptake and mental distress. Using two-way fixed effects regression models, Study 1 analyzes longitudinal survey of respondents from Los Angeles County in the US, while Study 2 uses the same analytical strategy but generalises findings by analysing longitudinal data of participants across all 50 US states. Main results of both studies show that (i) vaccination uptake is linked with reduced mental distress among individuals with high vaccine confidence (ii) vaccine uptake has no effect on mental distress among individuals with low vaccine confidence. Lastly, Study 3 applies multilevel analysis to a large-scale pseudo-panel study of 15 developed countries. Results for the third study corroborate finding (i) but not (ii) in that the multinational study finds that vaccine uptake is actually associated with higher mental distress among individuals with low vaccine confidence. In sum, our paper shows that the palliative effect of vaccination on mental health only exists when vaccine confidence is high. Results are mixed on whether vaccination affects mental distress when individual vaccine confidence is low.

Depression mediates the relationship between social capital and health-related quality of life among Chinese older adults in the context of the COVID-19 pandemic: A cross-sectional study

AIM

To explore the association between social capital and health-related quality of life (HRQoL) and to determine whether depression mediates the association among Chinese older adults in the context of the COVID-19 pandemic.

DESIGN

A descriptive cross-sectional research design.

METHODS

The Geriatric Depression Scale-15, Social Capital Questionnaire and 12-item Short-Form Health Survey were used to investigate 1201 older adults selected from Jinan, Shandong Province, China, using a multistage stratified cluster random sampling method.

RESULTS

Pearson's correlation analysis revealed a significant positive correlation between social capital and HRQoL (r = 0.269, p < 0.01). Multivariate linear regression analyses demonstrated that social capital was significantly negatively associated with depression (β = -0.072, p < 0.001) and that depression was associated with HRQoL (β = -1.031, p < 0.001). The mediation analyses showed that depression mediated the association between social capital and HRQoL, and the indirect effect size was 0.073 (95% confidence interval: 0.050, 0.100).

Exploring Loneliness, Fear and Depression among Older Adults during the COVID-19 Era: A Cross-Sectional Study in Greek Provincial Towns

BACKGROUND

With the onset of the COVID-19 pandemic, life changed abruptly for older adults in Greece. Social isolation, lockdowns, the fear of serious illness and death, all contributed to an increased risk of developing depression.

OBJECTIVE

To explore the presence and severity of depression in older adults in Greek provincial towns during the pandemic and to explore any possible relationships with loneliness and fear.

METHODS

A convenience sample of 200 participants aged >65, completed a socio-demographic form, the Revised UCLA Loneliness Scale, the Geriatric Depression-15 Scale (GDS-15) and the COVID-19 Fear Scale (FCV-19S). Data were collected from April to May 2022.

RESULTS

The average age of participants was 76.6 years and 35.5% of the participants presented depressive symptoms (mean prevalenceof depression 5 ± 3.7). A moderate to low level of loneliness (mean value 39 ± 11.3) and a moderate level of COVID-19 fear (mean value 18.9 ± 6.5) were also experienced. Higher levels of loneliness were found among participants with lower perceived health status and among those participants registered in Primary Health and Social Care (PHSC) services. Loneliness was positively correlated with depression (r = 0.7, p < 0.001), and increased loneliness and depression were associated with an increase in fear of COVID-19 (r = 0.2, p = 0.01 for both).

CONCLUSIONS

During the pandemic, older adults experienced loneliness, fear of COVID-19 and depression which were positively associated with each other. It is imperative to develop PHSC policies that are aimed at addressing the mental health problems of the older population, which have been caused by the COVID-19 pandemic, through developing their resilience, offering psychological support and promoting social connections.

Evaluating the impact of COVID-19 pandemic on the physicians' psychological health: A systematic scoping review

Background

COVID-19 has endangered healthcare systems at multiple levels worldwide. Published data suggests that moral dilemmas faced during these unprecedented times have placed physicians at the intersections of ethical and unethical considerations. This phenomenon has questioned the physicians' morality and how that has affected their conduct. The purpose of our review is to tap into the spectrum of the transforming optics of patient care during the pandemic and its impact on psychological wellbeing of physicians.

Methods

We adopted the Arksey and O'Malley's framework, defining research questions, identifying relevant studies, selecting the studies using agreed inclusion and exclusion criteria, charting the data, and summarizing and reporting results. Databases of PubMed/Medline, Web of Science, Scopus, Science Direct, CINAHL, and PsycInfo were searched using a predefined search string. The retrieved titles and abstracts were reviewed. Later, a detailed full-text analysis of the studies which matched our inclusion criteria was performed.

Results

Our first search identified 875 titles and abstracts. After excluding duplicates, irrelevant, and incomplete titles, we selected 28 studies for further analysis. The sample size in 28 studies was 15,509 with an average size of 637 per study. Both quantitative and qualitative approaches were used, with cross-sectional surveys being utilized in all 16 quantitative studies. Using the data from semi-structured interviews, several discrete codes were generated, which led to the identification of five main themes; mental health, individual challenges, decision-making, change in patient care, and support services.

Conclusion

This scoping review reports an alarming rise in psychological distress, moral injury, cynicism, uncertainty, burnout, and grief among physicians during the pandemic. Decision-making and patient care were mostly regulated by rationing, triaging, age, gender, and life expectancy. Poor professional controls and institutional services potentially led to physicians' crumbling wellbeing. This research calls for the remediation of the deteriorating mental health and a restoration of medical profession's advocacy and equity.

The Mediating Role of Perceived Stress and Academic Procrastination between Physical Activity and Depressive Symptoms among Chinese College Students during the COVID-19 Pandemic

Depressive symptoms, a prevalent mood illness, significantly harm college students' physical and mental health. Individuals have experienced some degree of psychological harm as a result of the COVID-19 pandemic. Taking this into account, the purpose of this study was to investigate the relationship between physical activity (PA) and depressive symptoms among college students during the COVID-19 pandemic, as well as the mediating roles of perceived stress and academic procrastination. A total of 586 college students were subjected to the Physical Activity Scale (PARS-3), the Perceived Stress Scale (PSS-10), the Procrastination Assessment Scale-Students (PASS), and the Patient Health Questionnaire (PHQ-9). Findings from this research demonstrated that there was a significant positive correlation between perceived stress, academic procrastination, and depressive symptoms, while PA was significantly negatively correlated with perceived stress, academic procrastination, and depressive symptoms. The results of the chain mediation analysis showed that PA had a significant direct effect on depressive symptoms. Perceived stress, academic procrastination, and perceived stress-academic procrastination had significant mediating and chain mediating effects on the relationship between PA and depressive symptoms. In conclusion, PA among college students during the COVID-19 pandemic affects their depressive symptoms directly and indirectly through the independent mediating effect of perceived stress and academic procrastination, as well as the chain mediating effect of perceived stress and academic procrastination.

Centrality and bridge symptoms of anxiety, depression, and sleep disturbance among college students during the COVID-19 pandemic-a network analysis

Symptoms of depression and anxiety usually co-occur and are inextricably linked to sleep disturbance. However, little is known about the symptom-to-symptom relationships among these three mental disorders. Hence, to improve our understanding of concurrent depression, anxiety, and sleep disturbance, we used the network analysis approach to construct an interplay relationship among the above three mental disorders and identify which specific symptoms bridge these aggregations. We collected data from a large sample (N = 6710, male = 3074, female = 3636; mean age = 19.28) at a university. We estimated the symptom network structure of depression, anxiety, and sleep disturbance as assessed by the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Youth Self-Rating Insomnia Scale during the COVID-19 lockdown. We further investigated four goals: first, identifying the individual core symptoms in the network by the index of "expected influence"; second, determining the bridge symptoms that play roles in linking different mental disorders by the index of bridge expected influence (1-step); third, examining the robustness of all results; and fourth, providing an overall structure that may or may not differ by sex. The network structure was stable, accurate, and predictable. Items referring to sleep dissatisfaction, poor sleep quality, and uncontrollable worry were potentially core symptoms in the interplay among depression, anxiety, and sleep disturbance. Sleep, guilt, restlessness, irritability, and feeling afraid can function as bridges among depression, anxiety, and sleep disturbance, which is clinically relevant and theoretically important. The results suggested that the network structures significantly differed between the female and male networks. Robustness tests also revealed that the results were reliable.

Effectiveness of a resilience-targeted intervention based on "I have, I am, I can" strategy on nursing home older adults' suicidal ideation: A randomized controlled trial

BACKGROUND

Despite the potential for benefit, resilience remains an emergent area in late-life mental health care, and evidence of resilience intervention for suicide among nursing home residents is especially limited. This study aims to evaluate the effects of a resilience-targeted program based on the "I have, I am, and I can" strategy on suicidal ideation and related problems.

METHODS

From the 562 nursing home residents who were contacted, 68 with suicidal ideation were recruited and then randomly assigned to a resilience intervention group (eight-week resilience training; n = 34) or a wait-list control group (eight-week health education; n = 34). Self-reported suicidal ideation, and depression and anxiety symptoms as outcomes, and resilience as potential mediators were assessed at baseline, postintervention, and one-month follow-up.

RESULTS

Resilience training participants reported significant improvement in suicidal ideation (group × time interaction x²=12.564, p = 0.002) and depression symptoms (x²=9.441, p = 0.009) compared to wait-list control group participants. Changes in resilience mediated the intervention's effects on changes in suicidal ideation and depression symptoms. Limitations The observed effects must be considered preliminary due to the small sample size.

CONCLUSIONS

The findings support the benefits of resilience training based on the "I have, I am, and I can" strategy in reducing suicidal ideation and suicide-related symptoms in nursing home older adults, and provide insight into possible mechanisms.

Mental health symptoms during the COVID-19 pandemic in developing countries: A systematic review and meta-analysis

Background

This systematic review aims to 1) summarize the prevalence of anxiety, depression, distress, insomnia, and PTSD in the adult population during the first year of the COVID pandemic in developing countries and 2) uncover and highlight the uneven distribution of research on mental health in all developing countries across regions.

Methods

Several literature databases were systemically searched for meta-analyses published by September 22, 2021, on the prevalence rates of mental health symptoms in developing countries worldwide. We meta-analysed the raw data of the individual empirical results from the previous meta-analysis papers in developing countries in different regions.

Results

The prevalence rates of mental health symptoms were summarized based on 341 empirical studies with a total of 1 704 072 participants from 40 out of 167 developing countries in Africa, Asia (East, Southeast, South, and West), Europe, and Latin America. Comparatively, Africa (39%) and West Asia (35%) had the worse overall mental health symptoms, followed by Latin America (32%). The prevalence rates of overall mental health symptoms of medical students (38%), general adult students (30%), and frontline health care workers (HCWs) (27%) were higher than those of general HCWs (25%) and general populations (23%). Among five mental health symptoms, distress (29%) and depression (27%) were the most prevalent. Interestingly, people in the least developing countries suffered less than those in emergent and other developing countries. The various instruments employed lead to result heterogeneity, demonstrating the importance of using the well-established instruments with the standard cut-off points (eg, GAD-7, GAD-2, and DASS-21 for anxiety, PHQ-9 and DASS-21 for depression, and ISI for insomnia).

Conclusions

The research effort on mental health in developing countries during COVID-19 has been highly uneven in the scope of countries and mental health outcomes. This meta-analysis, the largest on this topic to date, shows that the mental health symptoms are highly prevalent yet differ across regions. The accumulated systematic evidence from this study can help enable the prioritization of mental health assistance efforts to allocate attention and resources across countries and regions.

How to improve the COVID-19 health education strategy in impoverished regions: a pilot study

Background

It is of great challenge to raise the public coronavirus disease 2019 (COVID-19) related health literacy (CRHL) in impoverished regions due to the limits of poor infrastructure, large proportion of vulnerable groups, etc. However, those limits cannot be solved in the short term. Therefore, this study chose Liangshan Yi Autonomous Prefecture, one of the poorest areas in China, as a pilot, to reveal the quantitative relationships among different dimensions under the COVID-19 health education framework, clarify the key points for health promotion, and provide specific suggestions for COVID-19 health education strategy in impoverished regions.

Methods

A cross-sectional questionnaire survey was conducted in five regions of Liangshan Yi Autonomous Prefecture in 2020. There were 2,100 individuals sampled by multi-stage method. This survey mainly measured the four dimensions: CRHL, COVID-19 related tense psychological reactions (CRTPR), COVID-19 related information report acquisition (CRIRA), and general health literacy (GHL). The multivariate logistic regression was used to explore the influence of demographic characteristics on each dimension. Furthermore, to quantify the relationships among different dimensions, this study employed the structural equation model (SEM), and analyzed the mediating effects of CRHL and CRIRA as well as the moderating effects of regional characteristic variables.

Results

The CRHL played an important role in promoting COVID-19 health education, reaching 52.5% in Liangshan Yi Autonomous Prefecture. The GHL (β = 0.336) and age (β = 0.136) had statistically positive impacts on CRHL. The CRHL affected CRTPR negatively (β = − 0.198) and CRIRA positively (β = 0.052). The CRHL played significant mediating roles among the four dimensions (P < 0.05). Effectiveness of government prevention and control as well as the ethnicity moderated not only the relationships between CRHL and other dimensions, but also the mediating effect of CRHL (P < 0.05). People with lower income and education levels had lower GHL (β = 0.286, 1.292). The youth were more likely to show CRTPR (β = − 0.080).

Conclusions

By proposing and verifying the theoretical framework, this study put forward specific suggestions on how to improve COVID-19 health education strategies in impoverished regions via implementation methods, key groups and effect evaluation, which also provided references about future public health emergencies for other impoverished regions of the world.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-022-00963-3.

Health anxiety model of cyberchondria, fears, obsessions, sleep quality, and negative affect during COVID-19

The aim of the study was to explore the relationships among cyberchondria, fear of COVID-19, health anxiety, obsessions, sleep quality, and negative affect in a national community sample of Turkish participants. A sample of 8,276 volunteers, aged between 18 and 65, were recruited via an online platform. The Perceived Vulnerability about Diseases Questionnaire, Fear of COVID-19 Scale, Cyberchondria Severity Scale, Short Health Anxiety Inventory, Depression Stress Anxiety Scale-21, Obsessive-Compulsive Inventory-Revised, and Pittsburgh Sleep Quality Index were completed by participants. Data were analyzed using mixture structural equation modelling approach. Results revealed that perceived vulnerability to disease was found to be positively related with cyberchondria, poor sleep quality, health anxiety, and obsessive-compulsive symptoms. Negative affect was positively associated with obsessive-compulsive symptoms, fears of COVID-19, cyberchondria severity, and poor sleep quality. Additionally, fear of COVID-19 was positively related to health anxiety. Also, cyberchondria severity was found to be positively associated with poor sleep quality and obsessive-compulsive symptoms. Mixture analysis classified participants into six latent classes: 1) Risk-Aversive Healthy Group, 2) Incautious Healthy Group, 3) Infection Obsessions Group, 4) Health Anxiety Group, 5) Negative Affect Group, and 6) General Psychopathology Group. The national survey data showed that perceived vulnerability to diseases, negative affect, fear of COVID-19, cyberchondria, health anxiety, obsessive-compulsive symptoms, and sleep quality appeared to be at the center of pandemic health anxiety.

Prevalence of depressive and anxiety symptoms among Chinese older adults during the COVID-19 pandemic: A systematic review and meta-analysis

Background: Estimating the prevalence of depressive and anxiety symptoms among older adults with different health conditions can inform mental health services for this population during the corona virus disease-2019 (COVID-19) pandemic. Method: A search of 12 scientific databases identified 17 studies with 11,237 Chinese older adults who were infected by COVID-19, were generally healthy, or had chronic illnesses. Meta-analysis was used to estimate the overall prevalence of depressive and anxiety symptoms in these three groups. Assessment criteria, region, and time phase of the pandemic were tested as sources of heterogeneity. Results: With an average risk of bias score of 6.71 (range = 6-8), the majority of included studies employed appropriate statistical methods, used validated measurement tools, and had adequate response rates; however, they might have deficiencies in sample frame, sampling method, and sample size. Within the COVID-19, general, and chronic illness groups, the prevalence of depressive symptoms was 27%, 26%, and 61%, respectively, and the prevalence of anxiety symptoms was 14%, 23%, and 85%, respectively. Among generally healthy older adults, anxiety was more prevalent during the Phase 2 (March-April 2020) of the pandemic compared with other time phases. Conclusions: The results have implications for addressing the mental health problems of Chinese older adults, especially those with chronic illnesses, during the COVID-19 pandemic.

Anxiety Linked to COVID-19: A Systematic Review Comparing Anxiety Rates in Different Populations

The COVID-19 pandemic has incited a rise in anxiety, with uncertainty regarding the specific impacts and risk factors across multiple populations. A qualitative systematic review was conducted to investigate the prevalence and associations of anxiety in different sample populations in relation to the COVID-19 pandemic. Four databases were utilised in the search (Medline, EMBASE, CINAHL, and PsycINFO). The review period commenced in April 2021 and was finalised on 5 July 2021. A total of 3537 studies were identified of which 87 were included in the review (sample size: 755,180). Healthcare workers had the highest prevalence of anxiety (36%), followed by university students (34.7%), the general population (34%), teachers (27.2%), parents (23.3%), pregnant women (19.5%), and police (8.79%). Risk factors such as being female, having pre-existing mental conditions, lower socioeconomic status, increased exposure to infection, and being younger all contributed to worsened anxiety. The review included studies published before July 2021; due to the ongoing nature of the COVID-19 pandemic, this may have excluded relevant papers. Restriction to only English papers and a sample size > 1000 may have also limited the range of papers included. These findings identify groups who are most vulnerable to developing anxiety in a pandemic and what specific risk factors are most common across multiple populations.

Demographics Associated With Stress, Severe Mental Distress, and Anxiety Symptoms During the COVID-19 Pandemic in Japan: Nationwide Cross-sectional Web-Based Survey

Background

With the spread of COVID-19, the deterioration of public mental health has become a major global and social problem.

Objective

The purpose of this study was to elucidate the relationship between the 3 mental health problems associated with COVID-19, that is, perceived stress, severe mental distress, and anxiety symptoms, and the various demographic factors, including occupation.

Methods

A nationwide web-based questionnaire survey was conducted in Japan from August 4 to 31, 2020. In addition to sociodemographic data, the degrees of perceived stress, severe mental distress, and anxiety symptoms associated with COVID-19 were measured. After performing a descriptive statistical analysis, factors related to stress, severe mental distress, and anxiety symptoms were analyzed using logistic regression analysis.

Results

A total of 8203 respondents submitted survey responses, among whom 34.9% (2861/8203) felt intense stress associated with COVID-19, 17.1% (1403/8203) were depressed, and 13.5% (1110/8203) had severe anxiety symptoms. The logistic regression analysis showed that each of the 3 mental health problems were prevalent in females, nonbinary gender, people in their 50s, 60s and older, respondents who visited psychiatrists, and those currently in psychiatric care. Severe mental distress and anxiety symptoms were associated with the number of effective lifestyle coping strategies during the lockdown period. Severe mental distress was only prevalent in teenagers and respondents in their 20s, as students tended to develop stress and severe mental distress. With regard to occupation, working in nursing care and welfare, education and research, and medical and health sectors was associated with stress; however, working in these occupations was not associated with severe mental distress and anxiety symptoms. Unemployment was associated with severe mental distress and anxiety symptoms. All 3 mental health problems were prevalent in part-time workers and those working in entertainment and arts sectors.

Conclusions

Gender, age, occupation, history of psychiatric visits, and stress coping mechanisms were associated with mental health during the COVID-19 pandemic, but their associations with stress, severe mental distress, and anxiety symptoms differed. In addition, the actual state of mental health varied according to the respondents’ occupation. It is necessary to consider the impact of the COVID-19 pandemic on mental health not only at the individual level but also at the occupational level.

Loneliness and mental health among the elderly in Poland during the COVID-19 pandemic

Background

The unexpected changes caused by the COVID-19 pandemic related to the fear of developing the disease, and the need for social distancing and isolation have had an effect on people’s mental health. These drastic changes can result in the development of anxiety, depressive symptoms and sense of loneliness. Elderly and chronically ill individuals are at a particularly high risk of developing COVID-19, suffering severe illness and dying as a result of it.

Aim of the study

The aim of the study was to assess the prevalence of anxiety, depressive symptoms, irritability and loneliness in the elderly aged 60 years and older as a group exposed to the negative impact of the COVID-19 pandemic, and to analyze the relationships between loneliness and mental health of the respondents and sociodemographic variables and chronic diseases.

Materials and methods

The study was conducted in Poland among 221 individuals aged 60+. The study material was collected using a sociodemographic questionnaire, Hospital Anxiety and Depression Scale (HADS-M) and a revised University of California Los Angeles loneliness scale (R-UCLA). Women accounted for 47.51% and men for 52.49% of study participants; the mean age was 65.18 (SD = 4.06).

Results

In total, according to HADS-M, depressive symptoms were present in 19.15% of the participants and borderline states in 14.18% of them. Based on R-UCLA, moderate and moderately high sense of loneliness was present in 58.83% of the participants. Sense of loneliness was significantly correlated with the prevalence of depressive symptoms (p < 0.001).

Conclusions

In this study, one in five participants experienced anxiety and depressive symptoms. Two out of three participants experienced a moderate sense of loneliness. Individuals who displayed a higher level of loneliness also had a higher severity of anxiety level depressive symptoms and irritability. Elderly individuals should be under special care due to their high risk of experiencing physical and mental effects of the COVID-19 pandemic.

Loneliness and Depression among Women in Poland during the COVID-19 Pandemic

Background: The COVID-19 pandemic has forced many changes in the functioning of people all over the world in a short period of time. According to a WHO report (2020), it is women who are at a particular risk of the negative effects of the pandemic, especially in terms of mental health. Aim of study: The aim of the study was to assess the prevalence of anxiety, depression, irritability, and loneliness among adult women during the COVID-19 pandemic. Materials and methods: The study was conducted on a representative sample of women in Poland (n = 452). The data were collected using the HADS-M scale and the R-UCLA scale. Results: A low level of loneliness was found in 37.3% of the women, moderate in 38.9%, moderately high in 22.3% and very high in 1.3% of women. Self-rating of physical and mental health was significantly positively correlated with anxiety, depression, and irritability in HADS-M, and loneliness in R-UCLA. As the severity of loneliness increased, so did Hospital Anxiety and Depression Scale scores on all subscales (p < 0.001). Conclusions: The study group presented with mental well-being disorders in the form of anxiety and depression. Two in three women experienced loneliness.

Dynamic monitor on psychological problems of medical aid teams in the context of corona virus disease 2019: a multi-stage and multi-factor quantitative study

Background

To explore the psychological status and vulnerability characteristics of medical staff with the progress of the epidemic.

Methods

This study investigated the prevalence of mental problems of 2748 medical staff in four stages. The PHQ-9 (Patient Health Questionnaire), GAD-7 (Generalized Anxiety Disorder questionnaire), SSS (Somatization Symptom Checklist), Pittsburgh sleep quality index, and PCL-C (Self-rating scale for post-traumatic stress disorder) were used for the psychological evaluation, and univariate logistic standardised analysis, and multivariate logistic regression for data analysis.

Results

The prevalence of mental problems showed a statistically significant difference. In Stage 1, mild anxiety and mild depression reached the highest value of 41.4 and 40.72% respectively. Between 4 and 17 March that of mild depression rose from 16.07 to 26.7%, and between 17 and 26 March the prevalence of mild anxiety increased from 17.28 to 20.02%. Female, unmarried, and working in Wuhan are the risk factors of mental health of medical staff (P < 0.05).

Conclusion

The psychological status of the medical staff has changed dynamically. Stage 1 and the latter period of Stages 2 and 3 are the high-risk stages. Female and unmarried are the dangerous characteristics of psychological vulnerability.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11479-0.

Profiling COVID-related experiences in the United States with the Epidemic-Pandemic Impacts Inventory: Linkages to psychosocial functioning

The COVID-19 pandemic has had a profound impact on the lives of individuals, families, and communities around the world with constraints on multiple aspects of daily life. The purpose of the present study was to identify specific profiles of pandemic-related experiences and their relation to psychosocial functioning using the 92-item Epidemic-Pandemic Impacts Inventory (EPII). Data were collected as part of a cross-sectional, online survey of adults (18+) residing in the Northeast region of the United States (N = 652) and recruited via online advertisements. Person-centered latent class analysis (LCA) was applied to 38 pandemic-related experiences that showed a significant bivariate correlation with perceived stress. Measures of psychosocial risk were also obtained. Results revealed five unique profiles of respondents based on patterns of pandemic-related experiences. Three profiles representing about 64% of the sample were characterized by moderate to high exposure to adverse experiences during the pandemic and were more likely to screen positive for depression, anxiety, and posttraumatic stress. These profiles were differentiated by sociodemographic differences, including age, caregiving, and employment status. Two profiles differentiated by age and caregiver status represented about 36% of the sample and were characterized by relatively low exposure to adverse experiences and lower risk for psychosocial impairment. Findings support the EPII as an instrument for measuring tangible and meaningful experiences in the context of an unprecedented pandemic disaster. This research may serve to identify high-risk subpopulations toward developing public health strategies for supporting families and communities in the context of public health emergencies such as the COVID-19 pandemic.

Factors associated with serious psychological distress during the COVID-19 pandemic in Japan: a nationwide cross-sectional internet-based study

OBJECTIVE

To investigate the factors associated with serious psychological distress (SPD) during the COVID-19 pandemic in Japan.

DESIGN

Nationwide cross-sectional study using survey data.

SETTING

Internet survey using sampling weights for national estimates conducted between 25 August and 30 September 2020 in Japan.

EXPOSURES

Demographics (age, gender), socioeconomic status (income level, employment type, educational attainment, marital status, family composition and caregiving burden); the experience of domestic violence (DV), the state of emergency and fear of and stigma related to COVID-19.

MAIN OUTCOME MEASURES

Prevalence of SPD, defined as Kessler 6 Scale score ≥13.

RESULTS

Among 25 482 respondents, 10.0% met the criteria of SPD. Overall, women (adjusted OR (aOR) 1.59; 95% CI 1.17 to 2.16; p=0.003), ages 15-29 (aOR 2.35 compared with ages 45-59 years; 95% CI 1.64 to 3.38; p<0.001), low-income level (aOR 1.70 compared with intermediate income; 95% CI 1.16 to 2.49; p=0.007), providing caregiving to family members (aOR 5.48; 95% CI 3.51 to 8.56; p<0.001), experiencing DV (aOR 5.72; 95% CI 3.81 to 8.59; p<0.001) and fear of COVID-19 (aOR 1.96; 95% CI 1.55 to 2.48; p<0.001) were associated with SPD. Among women aged 15-29 years, who have a higher risk of suicide during the COVID-19 pandemic in Japan, caregiving, DV, fear of COVID-19 and COVID-19-related stigma were associated with SPD.

CONCLUSIONS

Economic situation, caregiving burden, DV and fear of COVID-19 were independently associated with SPD during the COVID-19 pandemic. Among young women, similar factors, except economic situation, were associated with SPD. Targeted interventions based on age and gender may be more effective in mitigating the negative impact of the COVID-19 pandemic on the population's mental health.

Depression and anxiety symptoms to COVID-19 outbreak among the public, medical staff and patients during the initial phase of the pandemic: an online questionnaire survey by a WeChat Mini Program

OBJECTIVES

To survey anxiety and depression symptoms to COVID-19 outbreak in the public, medical staff and patients during the initial phase of the pandemic.

DESIGN

Cross-sectional online survey administered through WeChat Mini Program using Chinese versions of Zung Self-rating Depression Scale and Zung Self-rating Anxiety Scale.

SETTING

Guangzhou, China.

PARTICIPANTS

47 378 public, 1512 medical staff and 125 patients with COVID-19.

RESULTS

Higher rates of depression (47.8%) and anxiety symptoms (48.7%) were shown by patients who were screened positive compared with those of the public (35.6%, 25.7%) or medical staff (15.4%, 13.3%). The professional identity of a nurse, conditions of 'with an infected family member' and 'working at the frontline' were risk factors to depression or anxiety symptoms for the medical staff. Younger age, lower educational level, female and not having adequate masks were the risk factors for the public.

CONCLUSION

The COVID-19 outbreak increased people's depression or anxiety emotion responses, which varied extensively among the patients, public and medical staff.

Impact of COVID-19 on Healthcare Workers in Brazil between August and November 2020: A Cross-Sectional Survey

During the COVID-19 pandemic, healthcare workers (HCW) have been subjected to greater workloads. We conducted a cross-sectional online survey to assess the impact of the COVID-19 pandemic on Brazilian HCW. Data were collected between 11 August and 1 November 2020. Of the 295 respondents, 95 (32.2%) were medical doctors, 82 (27.8%) administrative staff, 53 (18.0%) nurses, 27 (9.2%) laboratory staff, and 38 (12.9%) were other staff. COVID-19-related restructuring at the health facilities was reported by 207 (70.2%) respondents, and 69 (23.4%) had their tasks changed. Preventive measures were well respected when seeing suspected patients. Overall, 167 (56.6%) HCW screened positive for anxiety and 137 (46.4%) for depression; 109 (36.9%) screened positive for both conditions. Of the 217 (73.6%) HCW who had been tested for COVID-19, at least one positive result was reported in 49 (22.6%). Following a positive COVID-19 test, 45/49 (91.8%) stopped working and stayed home. In conclusion, we found a high incidence of COVID-19 infection among Brazilian HCW with high rates of anxiety and depression despite a good self-reported adherence to COVID-19 preventive measures. As such, our study highlights the urgent need for interventions to mitigate the psychosocial risks HCW in Brazil encounter during the COVID-19 pandemic.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

DISCUSSION

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

The Prevalence of Psychological Status During the COVID-19 Epidemic in China: A Systemic Review and Meta-Analysis

The COVID-19 is creating panic among people around the world and is causing a huge public mental health crisis. Large numbers of observational studies focused on the prevalence of psychological problems during the COVID-19 pandemic were published. It is essential to conduct a meta-analysis of the prevalence of different psychological statuses to insight the psychological reactions of general population during the COVID-19 epidemic in China. Sixty six observational studies about the psychological statuses of people during the COVID-19 were included, searching up to 1 December 2020. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used to evaluate the quality of the included studies. OpenMeta[Analyst] was used for the data analysis. High prevalence of acute stress and fear symptoms were observed in the early period of the epidemic. Additionally, anxiety and depression symptoms continued at a high prevalence rate during the epidemic. It should alert the lasting mental health problems and the risk of post-traumatic stress disorder and other mental disorders. Systematic Review Registration: PROSPERO CRD 42020171485.

Factors Associated with Serious Psychological Distress during the COVID-19 Pandemic in Japan

Importance:

The coronavirus disease 2019 (COVID-19) pandemic may have a negative impact on mental health of the population, leading to higher suicide rates, in many countries. However, little is known about risk factors associated with worsened mental health during the COVID-19 pandemic.

Objective:

To investigate the factors associated with serious psychological distress (SPD) during the COVID-19 pandemic in Japan.

Design, Setting, and Participants:

A cross-sectional study using a large-scale internet survey conducted between August 25 and September 30, 2020, in Japan.

Exposures:

Demographics (age, gender, marital status, family composition, and caregiving burden), socio-economic status (income level, employment type, educational attainment), the experience of domestic violence (DV), the state of emergency, fear of COVID-19, and stigma related to COVID-19.

Main Outcomes and Measures:

Prevalence of SPD, defined as Kessler 6 scale score ≥13.

Results:

Among 25,482 individuals included in this study, 2,556 (10%) met the criteria of SPD. Overall, women (adjusted odds ratio [aOR] 1.59; 95%CI, 1.17–2.16; P=0.003), ages 15–29 (aOR compared with ages 45–59, 2.35; 95%CI, 1.64–3.38; P<0.001), low income (aOR compared with intermediate income, 1.70; 95%CI, 1.16–2.49; P=0.007), providing caregiving to family members (aOR, 5.48; 95%CI, 3.51–8.56; P<0.001), experiencing DV (aOR, 5.72; 95%CI, 3.81–8.59; P<0.001), and fear of COVID-19 (aOR, 1.96; 95%CI, 1.55–2.48; P<0.001) were associated with a higher rate of SPD. Among women aged 15–29 years, who experienced the highest rate of SPD, caregiving, DV, fear of COVID-19, and COVID-19-related stigma were associated with a higher rate of SPD; whereas economic situation (income level and employment type) and social isolation (marital status) were not associated with the prevalence of SPD.

Conclusions and Relevance:

Economic situation, caregiving burden, DV, and fear of COVID-19 were independently associated with SPD during the COVID-19 pandemic. Among young women—who have a higher risk of suicide during the COVID-19 pandemic in Japan—similar factors, except economic situation, were associated with a higher rate of SPD. Targeted interventions based on age and gender may be more effective in mitigating the negative impact of the COVID-19 pandemic on the population’s mental health.

The Impact of Poor Nutrient Intakes and Food Insecurity on the Psychological Distress among Community-Dwelling Middle-Aged and Older Adults during the COVID-19 Pandemic

This study aimed to investigate the impact of food insecurity and poor nutrient intake on the psychological health of middle-aged and older adults during the COVID-19 pandemic. A sub-sample of 535 individuals aged 52 years and above, from the earlier cohort and interventional studies (n = 4) from four selected states in Peninsular Malaysia, were recruited during the COVID-19 outbreak (April to June 2020). Telephone interviews were conducted by trained interviewers with a health sciences background to obtain participants' information on health status, physical activity, food security, and psychological health (General Health Questionnaire-12; normal and psychological distress). Univariate analyses were performed for each variable, followed by a logistic regression analysis using SPSS Statistics version 25.0. Results revealed food insecurity (OR = 17.06, 95% CI: 8.24-35.32, p < 0.001), low protein (OR = 0.981, 95% CI: 0.965-0.998, p < 0.05), and fiber intakes (OR = 0.822, 95% CI: 0.695-0.972, p < 0.05) were found to be significant factors associated with the psychological distress group after adjusting for confounding factors. The findings suggested that food insecurity and insufficiencies of protein and fiber intakes heightened the psychological distress during the COVID-19 pandemic. Optimal nutrition is vital to ensure the physical and psychological health of the older population, specifically during the current pandemic.

A nationwide evaluation of the prevalence of and risk factors associated with anxiety, depression and insomnia symptoms during the return-to-work period of coronavirus disease 2019 in China

PURPOSE

To evaluate the prevalence of and risk factors associated with anxiety, depression, and insomnia symptoms during the return-to-work period of coronavirus disease 2019 in China.

METHODS

The authors conducted a large-scale, nationwide, multicenter, cross-sectional study in China. A population-based quota and snowball sampling were designed to recruit a representative sample. Online questionnaires and telephone reviews were used to collect characteristics and assess psychological and sleep problems. Anxiety, depression, and insomnia symptoms were measured by the generalized anxiety disorder-7, patient health questionnaire-9, and insomnia severity index tools.

RESULTS

A total of 42,000 participants were recruited from 15 centers, and 36,795 valid questionnaires were received. Generally, 18.3, 14.9, and 17.9% of the participants had anxiety, depression, and insomnia symptoms, respectively, and 2.2-2.7% had severe symptoms. Engaging in outside activity once in ≥ 30 days (OR = 2.719, OR = 2.074, OR = 2.225) and age 50-64 years (OR = 2.431, OR = 1.936, OR = 2.036) were common risk factors for anxiety, depression and insomnia symptoms. Living in Hubei Province (OR = 1.304, OR = 1.242) was a common risk factor for anxiety and insomnia symptoms. Working as frontline medical staff (OR = 2.150) was another risk factor for anxiety symptoms. The health education rate of the samples reached 98.9%. However, the psychological intervention rate was only 16.2%, and 2.5% received targeted interventions.

CONCLUSIONS

An increasing number of people might have psychological and sleep problems. However, the current psychological interventions are not sufficient. Efforts should be made to strengthen interventions for high-risk populations.

Prevalence and risk factors of mental distress in China during the outbreak of COVID-19: A national cross-sectional survey

OBJECTIVE

As a result of the pandemic of COVID-19, the public have been experiencing psychological distress. However, the prevalence of psychological distress during the COVID-19 pandemic remains unknown. Our objective was to evaluate the prevalence of psychological distress during COVID-19 outbreak and their risk factors, especially their internal paths and causality.

METHODS

A nationwide cross-sectional survey of the prevalence of mental disorders was conducted. We used Hospital Anxiety and Depression Scale (HADS) to estimate the prevalence of anxiety and depression. The internal paths and the causality of the psychological health were analyzed using a structural equation modeling (SEM) approach.

RESULTS

A total of 24,789 respondents completed the survey. We found that the overall prevalence of anxiety, depression, combination of anxiety, and depression were 51.6% (95% CI: 51.0-52.2), 47.5% (95% CI: 46.9-48.1), and 24.5% (95% CI: 24.0-25.0), respectively. The risk of psychological disorders in men was higher than that in women. The status of psychological health was different across different age groups, education levels, occupations, and income levels. The SEM analysis revealed that inadequate material supplies, low income, low education, lack of knowledge or confidence of the epidemic, and lack of exercise are major risk factors for psychological distress.

CONCLUSIONS

The evidence from this survey poses serious challenges related to the high prevalence of psychological distress, but also offers strategies to deal with the mental health problems caused by the COVID-19 pandemic.