["Now You're Talking!"]

Ethics of Nudging in the COVID-19 Crisis and the Necessary Return to the Principles of Shared Decision Making: A Critical Review

Nudging, a controversial technique for modifying people's behavior in a predictable way, is claimed to preserve freedom of choice while simultaneously influencing it. Nudging had been largely confined to situations such as promoting healthy eating choices but has been employed in the coronavirus disease 2019 (COVID-19) crisis in a shift towards measures that involve significantly less choice, such as shoves and behavioral prods. Shared decision making (SDM), a method for direct involvement and autonomy, is an alternative approach to communicate risk. Predominantly peer-reviewed scientific publications from standard literature databases like PubMed, PsycInfo, and Psyndex were evaluated in a narrative review. The so-called fear nudges, as well as the dissemination of strongly emotionalizing or moralizing messages can lead to intense psycho-physical stress. The use of these nudges by specialized units during the COVID-19 pandemic generated a societal atmosphere of fear that precipitated a deterioration of the mental and physical health of the population. Major recommendations of the German COVID-19 Snapshot Monitoring (COSMO) study, which are based on elements of nudging and coercive measures, do not comply with ethical principles, basic psychological principles, or evidence-based data. SDM was misused in the COVID-19 crisis, which helped to achieve one-sided goals of governments. The emphasis on utilitarian thinking is criticized and the unethical behavior of decision makers is explained by both using the concept of moral disengagement and the maturity level of coping strategies. There should be a return to an open-ended, democratic, and pluralistic scientific debate without using nudges. It is therefore necessary to return to the origins of SDM.

Säuglings‑, Kinder- und Jugendlichen- (SKJ) Psychotherapien während der Covid-19 Pandemie: Ergebnisse einer Studie unter psychodynamischen Psychotherapeut*innen in Österreich

Fragestellung

Diese explorative Studie untersucht die Situation der Säuglings‑, Kinder- und Jugendlichen- (SKJ) Psychotherapien während der Covid-19 Pandemie in Österreich.

Methodik

23 psychodynamisch arbeitende Psychotherapeut*innen nahmen an einer Online-Umfrage teil, die quantitative und qualitative Daten generierte. Offene Fragen zu subjektiv wahrgenommenen Veränderungen wurden mithilfe der qualitativen Inhaltsanalyse ausgewertet.

Ergebnisse

Insgesamt sank die Anzahl an Psychotherapien insbesondere bei den Säuglings- und Kleinkind-Psychotherapien. Die Zahl der Kinder und Jugendlichen-Psychotherapien nahm zunächst ab, stieg nach dem ersten Lockdown aber an. Große Nachfrage wurde zuletzt vor allem bei Jugendlichenpsychotherapien wahrgenommen. Anpassungsleistungen an sich ändernde Bedingungen und Settings erforderten große Flexibilität der Psychotherapeut*innen, die mit Fortschreiten der Pandemie zunehmend an ihre Belastungsgrenzen kamen. Befragte beobachteten eine Zunahme an Symptomen sowie einen gestiegenen Bedarf an Eltern- und Vernetzungsarbeit mit Institutionen.

Schlussfolgerungen

Tele-Psychotherapie kann vor allem mit jüngeren Kindern Präsenztherapie nicht ersetzen. Ergebnisse deuten auf eine Unterversorgung dieser Zielgruppe hin. Dies, sowie die beobachtete Zunahme an Symptomen bei älteren Kindern und Jugendlichen, ist gesellschaftspolitisch und gesundheitsökonomisch ein großes Thema und erfordert dringend einen weiteren Ausbau der Versorgungsnetzwerke.

Self-reported changes in sleep patterns and behavior in children and adolescents during COVID-19

The COVID-19 pandemic and lockdowns worldwide forced children and adolescents to change and adapt their lives to an unprecedented situation. Using an online survey, we investigated whether they showed changes in sleep quality and other related factors due to this event. Between February 21st, 2021 and April 19th, 2021, a total of 2,290 Austrian children and adolescents (6-18 years) reported their sleep habits and quality of sleep as well as physical activity, daylight exposure and usage of media devices during and, retrospectively, before the pandemic. Results showed an overall delay of sleep and wake times. Almost twice as many respondents reported having sleeping problems during the pandemic as compared to before, with insomnia, nightmares and daytime sleepiness being the most prevalent problems. Furthermore, sleeping problems and poor quality of sleep correlated positively with COVID-19 related anxiety. Lastly, results showed a change from regular to irregular bedtimes during COVID-19, higher napping rates, a strong to very strong decrease in physical activity and daylight exposure, as well as a high to very high increase in media consumption. We conclude that the increase in sleeping problems in children and adolescent during COVID-19 is concerning. Thus, health promoting measures and programs should be implemented and enforced.

Burdens and psychosocial consequences of the COVID-19 pandemic for Austrian children and adolescents

OBJECTIVES

The negative psychosocial effects of the COVID-19 pandemic are becoming increasingly apparent. Children and adolescents in particular, were affected and torn away from their daily life routines. The aim of our survey is to evaluate the psychosocial burden and impairments of children and adolescents in Austria during the COVID-19 pandemic by using cross-sectional analysis.

SETTING

An Austrian-wide online survey was conducted from 21 February to 19 April 2021 for children and adolescents. The questionnaire was distributed widely using the national press agency and public media.

PARTICIPANTS

Using an online questionnaire, 5,483 children and adolescents between 6 and 18 years of age were sampled.

OUTCOME MEASURE

Quantitative responses to questions regarding the children's feelings, worries, and needs concerning the COVID-19 pandemic were measured. Furthermore, the children were sampled for subjective risk perception as well as their sleep quality.

RESULTS

Most children reported a high degree of fear due to the pandemic, especially female (48.1%) participants being under more emotional strain than their male (35.9%) counterparts. Associated with this, we found a strong overestimation of COVID-19-associated hospitalization likelihood (>100-fold) across all age groups. In addition, an alarming lack of positive perspective during the ongoing pandemic is evident across all age groups, including the youngest participants aged 6-10 years. Feelings of anger and annoyance (58.2%), loneliness (46%), and sadness (42.7%) are reported much more frequently than before the pandemic. On the other hand, only 15.6% reported feeling well (or even better; 2%) since the COVID-19 pandemic. Last but not least, our study shows an alarming 37% of children and adolescents who now report poorer sleep quality than before the pandemic.

CONCLUSION

The results of this survey indicate the high burden and emotional strain for children and adolescents during the pandemic. Personal contact with friends and family is mentioned as the most protective factor for their mental health. The study results underscore the need for immediate action to limit the collateral damage that has already occurred on a psychosocial and developmental level among younger generations worldwide.

[Associations between students' social background, mode of instruction and learning outcomes during the pandemic]

The COVID-19 pandemic has led to widespread school closures, which have been associated with massive changes in teaching and learning and student learning outcomes. While initial performance studies have examined learning losses due to the school closures, there are few findings to date that provide evidence on key predictors of the development of other student outcomes (stress experience, learning gain, learning time) during the school closures. This study approaches these questions by retrospectively predicting student self-assessments in these student outcomes for the periods before and during school closures by social background (academic household, language spoken at home) and instructional design (open vs. traditional). The multilevel regression models presented are motivated by theories of educational inequality and concepts of open instruction. In addition, the hypotheses tested are based on recent survey studies on COVID-19 and school. Results calculated on the basis of data from N = 1566 upper secondary school students show higher values in the retrospectively assessed stress experience of students without German as their native language than for children with German as their native language during school closures. With regard to the retrospectively self-assessed learning gain and learning time, however, there are no correlations with social background (beyond the differences in the baseline values before COVID). With respect to the relations between open instruction and student outcomes, it appears that students from traditional instruction report statistically significant higher learning time during school closures than students in open instruction. Students in open instruction, however, do not rate their learning gain to be lower than traditionally taught students despite less learning time.

The coronavirus pandemic: Psychosocial burden, risk-perception, and attitudes in the Austrian population and its relation to media consumption

Objective

The aim was to assess the psychosocial burden, risk-perception and attitudes regarding the coronavirus pandemic among the Austrian population after the second infection wave in Austria.

Methods

A self-designed questionnaire was available online from 17th January to 19th February 2021. Knowledge, attitudes, fears, and psychosocial burdens were collected in a comprehensive convenience sample of 3,848 adults from the Austrian general population.

Results

67.2% reported their greatest fear was that a close relative could be infected; the fear of dying from COVID-19 oneself, however, was mentioned least frequently (15.2%). Isolation from family and friends (78%), homeschooling for parents (68.4%), and economic consequences (67.7%) were perceived as most stressful factors during the pandemic. Personal risk for COVID-19-associated (ICU) hospitalization was overestimated 3- to 97-fold depending on age group. Depending on the media mainly consumed, the sample could be divided into two subsamples whose estimates were remarkably opposite to each other, with regular public media users overestimating hospitalization risk substantially more.

Conclusion

The results show a high degree of psychosocial burden in the Austrian population and emphasize the need for more objective risk communication in order to counteract individually perceived risk and consequently anxiety. Altogether data call for a stronger focus and immediate action for supporting mental well-being and general health in the aftermath of the coronavirus pandemic.

Health Behaviors in Austrian Apprentices and School Students during the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic has disrupted our daily lives, which in turn has impacted health behaviors. Young people have been particularly affected. This study aimed to assess health behaviors in Austrian apprentices and high school students during the COVID-19 pandemic and whether vaccination willingness is affected by health behaviors.

METHODS

Two online surveys were conducted via REDCap with 1442 apprentices (female: 53.5%, male: 45.4%) from 29 March to 18 May 2021 and 563 school students (female: 79.6%, male: 18.6%) from 19 June to 2 July 2021. The two samples were matched to account for sociodemographic differences and analyses were run on the matched sample. Besides the health behaviors, namely, smoking, alcohol consumption, cannabis consumption, and exercise, health status and vaccination willingness were also assessed.

RESULTS

Health behaviors were affected by both education group and gender. Apprentices reported significantly more smoking than high school students and this difference was more pronounced in women (all p < 0.01). Alcohol consumption was higher in apprentices than school students, but only in women (p < 0.01). There was a trend for the two education groups to differ in their cannabis use as well (p = 0.05). Apprentices took part in more weekly exercise (p < 0.0001), but high school students reported better average health status (p < 0.001). When included in the same model, health behaviors did not affect vaccine willingness, but education group did, with high school students showing a higher willingness to receive the COVD-19 vaccine than apprentices.

CONCLUSIONS

These findings support the argument that education type is an important factor for health behaviors, but this is also mediated by gender. Appropriate interventions for adolescents are needed to prevent adverse health behavior changes following the COVID-19 pandemic.

The Psychological and Biological Impact of "In-Person" vs. "Virtual" Choir Singing in Children and Adolescents: A Pilot Study Before and After the Acute Phase of the COVID-19 Outbreak in Austria

Psychobiological responses to music have been examined previously in various naturalistic settings in adults. Choir singing seems to be associated with positive psychobiological outcomes in adults. However, evidence on the effectiveness of singing in children and adolescents is sparse. The COVID-19 outbreak is significantly affecting society now and in the future, including how individuals engage with music. The COVID-19 pandemic is occurring at a time when virtual participation in musical experiences such as singing in a virtual choir has become more prevalent. However, it remains unclear whether virtual singing leads to different responses in comparison with in-person singing. We evaluated the psychobiological effects of in-person choral singing (7 weeks, from January to March 2020, before the COVID-19 outbreak) in comparison with the effects of virtual choral singing (7 weeks, from May to July 2020, after schools partly re-opened in Austria) in a naturalistic pilot within-subject study. A group of children and young adolescents (N = 5, age range 10-13, female = 2) from a school in Salzburg, Austria were recruited to take part in the study. Subjective measures (momentary mood, stress) were taken pre- and post-singing sessions once a week. Additionally, salivary biomarkers (cortisol and alpha-amylase) and quantity of social contacts were assessed pre- and post-singing sessions every second week. Psychological stability, self-esteem, emotional competences, and chronic stress levels were measured at the beginning of in-person singing as well as at the beginning and the end of the virtual singing. We observed a positive impact on mood after both in-person and virtual singing. Over time, in-person singing showed a pre-post decrease in salivary cortisol, while virtual singing showed a moderate increase. Moreover, a greater reduction in stress, positive change in calmness, and higher values of social contacts could be observed for the in-person setting compared to the virtual one. In addition, we observed positive changes in psychological stability, maladaptive emotional competences, chronic stress levels, hair cortisol, self-contingency and quality of life. Our preliminary findings suggest that group singing may provide benefits for children and adolescents. In-person singing in particular seems to have a stronger psychobiological effect.