Differences in mental health and health-related quality of life between the Israeli and Italian population during a COVID-19 quarantine

Association between prolonged stress caused by COVID-19 pandemic and earthquakes and quality of life, anxiety, depression, psychoactive substances, and problematic alcohol use in adult Croatian population

Background

The prolonged stress experience caused by the COVID-19 pandemic and two earthquakes led to increased alcohol and psychoactive substance use (PSU) accompanied by a decrease in mental wellbeing and quality of life (QoL) in the Croatian population. Our aim was to determine the relationship between alcohol and PSU and mental health outcomes including anxiety and depression, and QoL.

Methods

A cross-sectional online survey conducted from September 30 to October 27, 2021, included 1,118 Croatian adults (220 men and 898 women; mean age, 35.1 ± 12.3 years) recruited through non-probabilistic convenience sampling. The survey consisted of a self-reported questionnaire on PSU, the CAGE Alcohol Questionnaire, the Hospital Anxiety Depression Scale, and the World Health Organization Quality of Life (WHOQoL)-BREF. Structural equation modeling was used to evaluate the association between PSU, problematic alcohol use (PAU), mental health outcomes, and QoL.

Results

The model demonstrated a good fit and indicated that PSU increase, PAU, and anxiety and depression symptoms significantly explained all QoL domains (p < 0.001 for all). Both PSU increase and PAU during prolonged stress were directly associated with decreased QoL. These relationships were also indirectly mediated through increased anxiety and depression symptoms.

Conclusion

These results showed the need to direct public health interventions and treatment interventions during and after long-term stress (pandemics and earthquakes) to reduce the negative impact on substance use and QoL by reducing depression and anxiety, which ultimately may contribute to better wellbeing and rapid recovery of individuals affected by prolonged stress.

Relationship between depression, anxiety, stress, and health-related quality of life in adults with and without chronic diseases: A cross-sectional study

Health-related quality of life (HRQoL) in patients with chronic diseases is an important tool to measure patient-reported health outcomes and evaluate the usefulness of treatment, management, and rehabilitation programs. Patients with chronic diseases are more likely than those without to experience psychological problems such as depression, anxiety, and stress, all of which can affect HRQoL. This study evaluated the impact of psychological problems such as depression, anxiety, and stress on HRQoL in people with and without chronic diseases in South Korea. The study's descriptive survey included 501 participants (191 with and 310 without chronic diseases). Data were collected using structured questionnaires between April and May 2021. The general characteristics, DASS-21, and HRQOL of this study were analyzed using descriptive statistics. Differences in DASS-21 and HRQoL based on general characteristics were analyzed using t tests and ANOVA. The study analyzed the factors influencing the participants' HRQoL using stepwise multiple regression analysis with SPSS Win 27.0. HRQoL was generally lower for patients with chronic diseases than for patients without. In patients with chronic diseases, the major variables affecting HRQoL were depression (β = -0.244, t = -3.582, P < .001), exercise (β = 0.201, t = 2.927, P = .004), and economic status (β = -0.150, t = -2.184, P = .030), of which depression was the most influential. These variables explained 12.5% of the variance in the regression model for total HRQoL. These results emphasize the need to explore intervention measures that can reduce depression in patients with chronic diseases and anxiety in patients without chronic diseases to improve their HRQoL. In addition, national efforts are needed to provide economic support, as economic status is an influential factor in HRQoL regardless of the presence of chronic disease. The study's limitations include the fact that neither did it consider disease severity among chronically ill patients nor did it examine all the variables affecting HRQoL.

A Contemporary Review of the Clubhouse Model of Psychosocial Rehabilitation: Past, Present, and Emerging Directions

Since the 1940s, the Clubhouse model of psychosocial rehabilitation has evolved towards a comprehensive practice of social theory and intervention. Despite the model's cost effectiveness and observational evidence of its efficacy, empirical research remains lacking. The current narrative review examines studies from recent years (2015-2021), not to assess study rigor, but to identify trends in research aims, findings, and methodology, as well as specify future research directions. A narrative review was conducted using PRISMA guidelines. Using the search term "Clubhouse," 194 articles were identified in online databases. 38 met criteria for inclusion. Most studies were qualitative (60.5%) and few utilized experimental or quasi-experimental designs (7.9%). Narrative synthesis revealed research aims and outcome variables falling into six key areas: social integration and connectedness, quality of life (QOL), recovery outcomes, relational dynamics, policy, and virtual adaptations of the model. Findings indicate that recent Clubhouse-related research trends have primarily involved studies of social connectedness, QOL, recovery, relationships, and policy, as well as studies examining the value of the virtual Clubhouse in maintaining well-being. However, heterogeneity of methodologies and measures present a critical limitation to assessing results across studies. Options for increasing experimental methodologies in this area are reviewed. Recommended future directions involve moving towards a biopsychosocial approach to clarifying the mechanisms through which the model promotes recovery-aims that may yield implications beyond the realm of serious mental illness.

Quality of Life During the First Three Waves of the COVID-19 Pandemic and Two Earthquakes in Croatia

ABSTRACT

In a cross-sectional study, we measured the impact of the first three COVID-19 pandemic waves and two earthquakes, occurring during the same period in Croatia, on the quality of life (QoL) of the general adult population. An online survey consisting of sociodemographic questions, questions related to COVID-19 and earthquake stressors, the World Health Organization Quality of Life (WHOQoL)-BREF scale, Impact of Event Scale, and Patient Health Questionnaire 4 was completed by 220 men and 898 women (mean age, 35.1 ± 12.3 years). In a series of regressions, we examined the association among five blocks of predictors and six dependent QoL variables, four domain scores, and two global scores. Both WHOQoL-BREF global and domain scores after the prolonged stress were significantly predicted by anxiety, depression, stress symptoms, and sociodemographic characteristics. COVID-19-related stressors predicted significantly physical and psychological health, social relationships, and environmental QoL, whereas earthquake-related stressors predicted health satisfaction, physical and psychological health, and environmental QoL.

Understanding the relationship between time spent outdoors, mental well-being and health-related behaviours in a Spanish sample: A real time smartphone-based study

INTRODUCTION

COVID-19 pandemic has affected our lifestyle and physical and mental well-being. We aimed to study the effect of being outdoors and mental well-being after the COVID-19 pandemic.

MATERIAL AND METHODS

We used smartphone based ecological momentary assessments (EMA) (Urban Mind app) to study the mental well-being of the Spanish general population. We collected socio-demographic data, past and current physical and mental health, and social and physical environment. Participants were recruited during 5 months (February to June 2021). Longitudinal associations between EMA and anxiety, depression, loneliness, tiredness, and happiness during the assessments were investigated using random intercept ordinal logistic regression models.

RESULTS

274 subjects downloaded the app and completed the baseline assessment. 66 participants completed at least 50 % of the assessments. Being outdoors was related to a lower likelihood of anxiety (OR: 0.48, 95 %CI 0.34-0.66), depression (OR: 0.40, 95 %CI 0.28-0.56), tiredness (OR: 0.47, 95 %CI 0.35-0.63), and loneliness (OR: 0.59, 95 %CI 0.42-0.84), and a higher likelihood of happiness (OR: 2.14, 95 %CI 1.57-2.93).

CONCLUSIONS

Being outdoors is related to better mental health in the general population independently of other factors (baseline mental well-being or socio-demographic characteristics). Public policies should include measurements to promote outdoor spaces in urban settings.

Fluctuations and individual differences in empathy interact with stress to predict mental health, parenting, and relationship outcomes

Introduction

Empathy is a complex, multifaceted ability allowing for the most basic forms of social communication and plays a prominent role in multiple aspects of everyday lives. In this intensive longitudinal study, we assessed how empathy interacts with stress to predict central domains of psychosocial functioning: mental health, romantic relationships, and parenting.

Methods

Fluctuations and individual differences in empathy were assessed across eight time points, where participants from the general population (N = 566) self-reported their empathy, stress, depressive symptoms, romantic satisfaction, and parental functioning.

Results

Both trait and state aspects of empathy were associated with all psychosocial outcomes, with state empathy showing a stronger effect. Additionally, empathy components interacted with stress-emotional empathy better-predicted outcomes under high stress, while cognitive empathy under low stress.

Discussion

Our findings advance the theoretical understanding of empathy, emphasizing the effects of state-dependent empathy fluctuations on our everyday mental and social lives.

Healthy Habits Factors and Stress Associated with Health-Related Quality of Life in a Peruvian Adult Population: A Cross-Sectional Study

Background

Healthy habits contribute to the prevention of diseases and, therefore, improve the health-related quality of life of people. However, stress is one of the main risk factors associated with serious health problems in the individual. Therefore, the literature suggests a relationship between healthy habits, stress, and health-related quality of life.

Objective

To assess the factors of healthy habits and stress associated with health-related quality of life in a Peruvian adult population.

Methods

A cross-sectional study was conducted with a sample of 540 Peruvian citizens aged between 18 and 60 years. A questionnaire was applied on the Google Forms platform to be completed online, using the "Healthy Lifestyle Questionnaire" and the PSS-4 to assess healthy habits and stress, respectively. Health-related quality of life was evaluated using the EuroQol-5D.

Results

In the multivariate analysis, stress was the most associated factor with quality of life. Physical activity, drug consumption, tobacco consumption, rest habits, and a balanced diet were healthy habits associated with quality of life.

Conclusion

Physical activity, rest habits, and a balanced diet improve health-related quality of life, while drug or tobacco consumption and stress are associated with a lower health-related quality of life.

Comparing the effects of reduced social contact on psychosocial wellbeing before and during the COVID-19 pandemic: a longitudinal survey from two Norwegian counties

PURPOSE

To determine changes to people's social contact during COVID-19, and whether reduced social contact was associated with changes to psychosocial wellbeing.

METHODS

Questionnaire data were collected from a sample of adult respondents (18 years or more) in two Norwegian counties participating pre-COVID-19 (September 2019-February 2020; n = 20,196) and at two time points during COVID-19 (June [Mid] and November/December [Late] 2020; n = 11,953 and n = 10,968, respectively). The main outcome measures were participants' self-reported changes to social contact, loneliness, psychological distress, and life satisfaction.

RESULTS

The proportion of respondents reporting less social contact due to COVID-19 decreased from 62% in Mid-2020 to 55% in Late-2020. Overall, reported psychological wellbeing remained unchanged or improved from pre-COVID-19 to Mid-2020. From Mid-2020 to Late-2020, however, a reduction in psychological wellbeing was observed. Poorer psychological wellbeing was found for those with less social contact during the pandemic compared with people reporting unchanged social contact. This effect increased over time and was observed for all age groups at Late-2020. At Mid-2020, the importance of change in social contact for change in psychological wellbeing was greatest among young adults (< 30 years), while no significant differences were found for the oldest age group.

CONCLUSION

The association between COVID-19-era changes to social contact and loneliness, psychological distress, and life satisfaction is complex and appears to be age-dependent. Future studies should consider the quality of social contact and cultural contexts in which social restrictions are imposed.

Responsiveness of the Patient-Reported Outcome Measure for Vascular Malformation Questionnaire in Patients with Low-Flow Vascular Malformations

PURPOSE

To assess the responsiveness, defined as the ability to detect change in a patient's health or function, of the Patient-Reported Outcome Measure for Vascular Malformation (PROVAM) questionnaire in a cohort of patients with low-flow vascular malformations (VMs).

MATERIALS AND METHODS

PROVAM was previously developed to assess symptoms, functional limitations, and social/emotional effects experienced by patients with VMs. This is a prospective cohort study of 56 patients with venous and lymphatic VMs who completed at least 2 PROVAM questionnaires, of whom 43 had undergone treatment with sclerotherapy in the interim between questionnaires. External responsiveness was assessed using a receiver operating characteristic (ROC) curve to ascertain whether a change in the total PROVAM score predicts whether patients reported symptom improvement and by correlating the change in the total PROVAM score and change in symptoms reported during clinic visit. Internal responsiveness was evaluated using Wilcoxon signed rank test, Cohen d effect size (ESp), and standard response mean difference (SRM).

RESULTS

The total PROVAM score demonstrated excellent discrimination for symptom improvement with an area under the ROC curve of 0.856. There was a statistically significant, moderate positive correlation between the change in the total PROVAM score and the change in patient symptoms as determined from clinical visits (Spearman correlation coefficient [r_s] = 0.67, P < .001). The total PROVAM score and all subdomain scores improved significantly after treatment (all P < .05). ESp and SRM were 0.80 and 0.83, respectively.

CONCLUSIONS

PROVAM is responsive to improvement after treatment and may be useful to assess health-related quality of life in patients treated for VMs.

Effect of a Multi-Strain Probiotic Supplementation to Manage Stress during the COVID-19 Pandemic: A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Clinical Trial

INTRODUCTION

The COVID-19 pandemic strongly affected every aspect of the modern society, from health to socioeconomics, leading people to experience high levels of stress.

METHODS

A double-blind, cross-over, placebo-controlled clinical study was performed to investigate the ability of a food supplement containing two probiotic strains, Limosilactobacillus reuteri PBS072 and Bifidobacterium breve BB077, in supporting 33 healthy adults, working at a university, in stress management. The efficacy of the tested strains in influencing the stress response, in terms of mood and sleep behavior, was assessed using the following validated questionnaires: Profile of Mood State (POMS) and Pittsburgh Sleep Quality Index (PSQI).

RESULTS

Outcomes of the POMS and the PSQI demonstrated a significant reduction of the questionnaire's scores both versus baseline and placebo after 30 days of probiotic intake.

CONCLUSIONS

According to the results, the probiotic food supplement investigated showed a remarkable effect on stress management by improving the quality of sleep and the mood.

Associations between psychological responses and quality of life at early and late time of quarantine among residents of a collective quarantine facility in central Taiwan

OBJECTIVES

Few countries required people living in collective facilities to undergo quarantine during the COVID-19 pandemic, which could lead to more psychological effects than quarantine at home or hotels. This study assessed the changes in depression, anxiety, and quality of life (QOL) among residents of a collective quarantine facility in central Taiwan.

METHODS

Between April and November 2020, 660 collective quarantine facility residents participated in the survey conducted on the first and last days of the 14-day quarantine period. Questionnaires of Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), and WHO quality of life (WHOQOL)-BREF were used to measure depression and anxiety symptoms, and QOL, respectively. Linear regression model with generalization estimation equation method was for estimating the differences in depression, anxiety, and QOL between two surveys and to test the changes of associations between them over time.

RESULTS

PHQ-9 and WHOQOL-BREF scores showed no significant changes, but GAD-7 score decreased during quarantine (p = 0.011, Cohen's d = -0.11). Both PHQ-9 and GAD-7 were negatively associated with overall and domain-specific WHOQOL-BREF scores on both the first and last days of quarantine. Such associations did not significantly vary with time, except for the association between PHQ-9 and environmental domain WHOQOL-BREF score, being stronger on the first day than on the last day of quarantine (p = 0.041, η2 = 0.0021).

CONCLUSION

A significant decrease in anxiety among quarantined individuals over a 14-day quarantine period was found. While depression was negatively associated with overall QOL, the strength of association between depression and environmental domain QOL decreased over the period.

Prevalence of anxiety during the COVID-19 pandemic: A systematic review and meta-analysis of over 2 million people

INTRODUCTION

Uncertainty, disruptions in daily routines, and concerns for the health and well-being during the COVID-19 pandemic are likely associated with increases in generalized anxiety. The present study aimed to systematically review the literature in order to identify the update prevalence of anxiety in the general population during the COVID-19 pandemic.

METHODS

A systematic review and meta-analysis. It included studies that assessed the prevalence of anxiety among the general population during the COVID-19 pandemic.

RESULTS

In total, we included 194 studies. The general prevalence of anxiety was 35.1 %, affecting approximately 851,000 participants. The prevalence in low and middle-income countries (35.1 %; 95%CI: 29.5 % to 41.0 %) was similar compared to high-income countries (34.7 %; 95%CI: 29.6 % to 40.1 %). In studies that provided the proportion of cases in each level of anxiety disorder, mild-to-moderate anxiety affected one quarter of the participants. One in ten cases with anxiety during the COVID-19 may be living with severe or extremely anxiety disorder. Most instruments estimated similar prevalence of anxiety disorders with notable difference in the prevalence estimated by the Generalized Anxiety Disorder 2-item (GAD-2), Zung Self-Rating Anxiety Scale (SAS), and State-Trait Anxiety Inventory (STAI).

CONCLUSION

One in three adults were living with anxiety disorder during the COVID-19 pandemic worldwide.

Vulnerable populations during COVID-19 response: Health-related quality of life among Chinese population and its influence due to socio-demographic factors and loneliness

Background

Infection control policy affected people's wellbeing during the COVID-19 pandemic, especially those vulnerable populations. This study aimed to compare the health-related quality of life (HRQoL) of the Hong Kong (HK) Chinese population under the pandemic with the normative profiles and explore its influencing factors, including socio-demographic characteristics, loneliness, and the interaction between them.

Methods

A cross-sectional questionnaire survey (301 online and 202 in-person) was conducted between June and December 2020 among the adult Chinese population during the 2nd wave of COVID-19 in HK. HRQoL was measured by a Hong Kong validated EQ-5D-5L instrument (EQ-5D-5L HK). Loneliness was measured by a single-item question regarding the frequency of the participants reporting feeling lonely and their subjective social status was measured by the MacArthur Scale of Subjective Social Status. A series of Tobit regressions was conducted. The interaction terms between socio-demographics and loneliness were also examined to decide their association with HRQoL.

Results

A total of 503 responses were collected. The level of HRQoL of the respondents was significantly lower than the referred norms profile among the local general population. The findings identified that younger age, single, a higher subjective social status, and a lower level of loneliness were significantly associated with better HRQoL. Moreover, age and marital status were significant moderators in the relationship between loneliness and HRQoL.

Conclusion

The present study found that some population groups face additional vulnerabilities during the pandemic in terms of declined HRQoL. In addition, reducing loneliness can protect the HRQoL during the pandemic, especially among older people. This article provides useful information for policy-makers to design and promote effective services or provide education to improve the connection of people and recover from the global pandemic.

The Role of Science-Based Knowledge on the SARS-CoV-2 Virus in Reducing COVID-19-Induced Anxiety among Nurses

The COVID-19 infection has generated not only a risk of morbidity and mortality but also resulted in an enormous psychological impact on healthcare providers and the general public. This study aimed to evaluate the prevalence of anxiety and identify the role of protective factors. A two-part cross-sectional study was conducted, by means of an online questionnaire. Part 1 investigated 562 registered nurses, nursing students, and the general public. Participants were assessed for anxiety symptoms with the State-Trait-Anxiety Inventory. A one-way ANCOVA analysis revealed that nurses had the highest level of anxiety compared to the general public and students, with 26% of them reporting severe anxiety. To identify how anxiety can be mitigated, the Part 2 study was focused on registered nurses from Part 1. Multiple regression revealed that a higher level of science-based knowledge of COVID-19 and professional experience were associated with a lower level of anxiety among nurses. The findings suggest that nurses are a vulnerable population prone to anxiety symptoms resulting from the COVID-19 pandemic. Having a deeper science-based understanding of COVID-19 may protect nurses from anxiety. This study underlines the importance of deep evidence-based knowledge for health providers, which may be generalized to a possible future emergency disaster.

The mediating role of psychological distress on the link between socio-ecological factors and quality of life of Filipino adults during COVID-19 crisis

Anchored on the Ecological Systems Theory, this study aimed to determine how psychological distress operates as an underlying mechanism in the impact of socio-ecological factors on the quality of life of Filipino adults during coronavirus disease 2019 (COVID-19) crisis. A cross-sectional online survey was conducted to assess perceptions of 401 adults on socio-ecological factors (i.e., safety at home, trust in public institutions, and financial difficulties), psychological distress, and quality of life during the early phase of COVID-19 community quarantine in the Philippines. Using latent variable path analysis, all three socio-ecological factors have significant direct effects on both psychological distress and quality of life. More importantly, the proposed model was confirmed in terms of a significant partial mediation of psychological distress on the impact of safety at home, trust in public institutions, and financial difficulties on the quality of life of Filipino adults. The study offers novel insights into the role of psychological distress as an underlying mechanism that operates on the influence of socio-ecological factors on the quality of life of adults during a global health crisis. Implications on psychological interventions and policies in preventing mental health problems vis-à-vis improving Filipinos' quality of life during the COVID-19 pandemic are discussed.

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.

Health-related quality of life following percutaneous coronary intervention during the COVID-19 pandemic

Purpose

During the COVID-19 pandemic, widespread public health measures were implemented to control community transmission. The association between these measures and health-related quality of life (HRQOL) among patients following percutaneous coronary intervention has not been studied.

Methods

We included consecutive patients undergoing percutaneous coronary intervention (PCI) in the state-wide Victorian Cardiac Outcomes Registry between 1/3/2020 and 30/9/2020 (COVID-19 period; n = 5024), with a historical control group from the identical period one year prior (control period; n = 5041). HRQOL assessment was performed via telephone follow-up 30 days following PCI using the 3-level EQ-5D questionnaire and Australian-specific index values.

Results

Baseline characteristics were similar between groups, but during the COVID-19 period indication for PCI was more common for acute coronary syndromes. No patients undergoing PCI were infected with COVID-19 at the time of their procedure. EQ-5D visual analogue score (VAS), index score, and individual components were higher at 30 days following PCI during the COVID-19 period (all P < 0.01). In multivariable analysis, the COVID-19 period was independently associated with higher VAS and index scores. No differences were observed between regions or stage of restrictions in categorical analysis. Similarly, in subgroup analysis, no significant interactions were observed.

Conclusion

Measures of HRQOL following PCI were higher during the COVID-19 pandemic compared to the previous year. These data suggest that challenging community circumstances may not always be associated with poor patient quality of life.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-03056-0.

International psychological research addressing the early phase of the COVID-19 pandemic: A rapid scoping review and implications for global psychology

In March 2020, the World Health Organization (WHO) declared COVID-19 a global pandemic. Given that keeping abreast of international perspectives and research results is of particular importance for such massive global emergencies, we employed a scoping review methodology to rapidly map the field of international psychological research addressing this important early phase of the pandemic. We included a total of 79 studies, with data mostly collected between March and June 2020. This review aimed to systematically identify and map the nature and scope of international studies examining psychological aspects of the unfolding COVID-19 pandemic. We mapped key research themes, subfields of psychology, the nature and extent of international research collaboration, data methods employed, and challenges and enablers faced by psychological researchers in the early stages of the pandemic. Among the wide range of themes covered, mental health and social behaviours were the key themes. Most studies were in clinical/health psychology and social psychology. Network analyses revealed how authors collaborated and to what extent the studies were international. Europe and the United States were often at the centre of international collaboration. The predominant study design was cross-sectional and online with quantitative analyses. We also summarised author reported critical challenges and enablers for international psychological research during the COVID pandemic, and conclude with implications for the field of psychology.

Power(ful) myths: misconceptions regarding sample size in quality of life research

PURPOSE

Carefully selecting the sample size for a research study is one of the most fundamental ways to utilize resources in an ethical manner, maximize impact and replicability, and minimize research waste when investigating questions relevant to health-related quality of life (HRQOL). Despite an increased focus on sample size in the methodological literature, the topic has received limited attention in the HRQOL field, and there are still misconceptions that can weaken even well-intentioned sample size planning. This article aims to highlight common misconceptions, provide accessible and non-technical corrections to these misconceptions, and show how HRQOL researchers can benefit from a more nuanced understanding of sample size planning.

METHOD

Misconceptions were identified broadly through examples within the health, psychology, and HRQOL literatures. In examining these misconceptions, study-level (e.g., missing data, multilevel designs, multiple reported outcomes) and field-level (e.g., publication bias, replicability) issues relevant to HRQOL research were considered.

RESULTS

Misconceptions include: (a) researchers should use rules of thumb or the largest sample size possible, (b) sample size planning should always focus on power, (c) planned power = actual power, (d) there is only one level of power per study, and (e) power is only relevant for the individual researcher. Throughout the article, major themes linked to these misconceptions are mapped onto recent HRQOL studies to make the connections more tangible.

CONCLUSION

By clarifying several challenges and misconceptions regarding sample size planning and statistical power, HRQOL researchers will have the tools needed to augment the research literature in effective and meaningful ways.

Life in a time of COVID: a mixed method study of the changes in lifestyle, mental and psychosocial health during and after lockdown in Western Australians

BACKGROUND

Since the beginning of the COVID-19 pandemic, the Western Australian government imposed multiple restrictions that impacted daily life activities and the social life. The aim of this study was to examine the effects of COVID-19 lockdown on the community's physical, mental and psychosocial health.

METHODS

Approximately 2 months after a three-month lockdown, a cross-sectional study was opened to Western Australian adults for an 8-week period (25th August - 21 October 2020). Participants competed a 25-min questionnaire adapted from the Western Australia Health and Wellbeing Surveillance system. Participants provided information on their socio-demographic status, lifestyle behaviours, mental health, and psychosocial health during and post-lockdown. Open-ended questions explored key issues in greater detail. Changes between the lockdown and post-lockdown period were assessed using Wilcoxon signed rank test and One-Sample Kolmogorov-Smirnov Normal tests as appropriate. Sex differences were examined using the Mann-Whitney U test. A content analysis approach examined responses to the open-ended questions with frequencies and variations in responses determined using Chi-Square tests.

RESULTS

A total of 547 complete responses were obtained. Compared to post-lockdown period, lockdown was associated with a significantly lower levels of physical activity, poorer mental well-being and sense of control over one's life, and a higher level of loneliness. Similarly, during lockdown, there was a significantly higher consumption of junk food, soft drinks and alcoholic drinks but no change in fruit and vegetable intake. Participants recalled health campaigns on hand washing and social distancing and there was a retrospective view that more timely and informative campaigns on physical activity, nutrition and mental well-being should have been available during lockdown.

CONCLUSIONS

While advice on infection control measures were appropriately provided, there is a need for concurrent health promotional information to help combat the changes in physical, mental and psychosocial well-being observed during quarantine to prevent negative health consequences in the community even if there are minimal effects of the pandemic itself.

Accessibility of Vaccination Centers in COVID-19 Outbreak Control: A GIS-Based Multi-Criteria Decision Making Approach

The most important protective measure in the pandemic process is a vaccine. The logistics and administration of the vaccine are as important as its production. The increasing diffusion of electronic devices containing geo-referenced information generates a large production of spatial data that are essential for risk management and impact mitigation, especially in the case of disasters and pandemics. Given that vaccines will be administered to the majority of people, it is inevitable to establish vaccination centres outside hospitals. Site selection of vaccination centres is a major challenge for the health sector in metropolitan cities due to the dense population and high number of daily cases. A poor site selection process can cause many problems for the health sector, workforce, health workers, and patients. To overcome this, a three-step solution approach is proposed: (i) determining eight criteria using from the experience of the advisory committee, (ii) calculating criterion weights using Analytic Hierarchy Process (AHP), and performing spatial analysis of criteria using Geographic Information System (GIS), (iii) assigning potential vaccination centres by obtaining a suitability map and determining service areas. A case study is performed for Bağcılar, Istanbul district, using the proposed methodology. The results show that the suitable areas are grouped in three different areas of the district. The proposed methodology provides an opportunity to execute a scientific and strategic vaccination programme and to create a map of suitable vaccination centres for the countries.

Active Coping and Anxiety Symptoms during the COVID-19 Pandemic in Spanish Adults

The features of the COVID-19 pandemic and the social operations to contain the spread of the virus might have limited or altered coping, including healthy habits such as exercise, this contributing to a myriad of negative consequences for the mental health of the global population. We explored the contribution of coping and physical activity to the management of anxiety in Spanish adults during an active phase of the epidemic, as well as the relationship between these strategies. A total of 200 young and adult individuals (70% women) voluntarily completed an anxiety inventory, a coping skills self-report and a personal data section including exercise practice. The participants reported in average a mild yet existing level of anxiety symptoms; a third reported noticeable symptoms. At the time of the study, the participants used more adaptive than maladaptive coping styles. Participants' anxiety was inversely correlated with an active coping style, and positively with an avoidant style; physical activity correlated positively with an active coping style, and regular exercisers used more frequently active coping. Controlling for confounders, active coping, avoidant coping and exercise during the pandemic predicted anxiety symptoms. Other findings indicated that exercise was used as a coping strategy for dealing with emotional distress. Our results highlight the positive impact of functional coping and exercise for the management of negative states such as anxiety during the pandemic, and underline the importance of developing interventions aimed at enhancing coping skills for promoting physical and mental well-being of the population during health and social crises.