Psychological interventions during COVID-19: Challenges for low and middle income countries

Psychological Distress Associated with Enforced Hospital Isolation Due to COVID-19 during the "Flatten the Curve" Phase in Morocco: A Single-Center Cross-Sectional Study

(1) Background: although much research has highlighted the mental health challenges faced by patients in hospital isolation during the COVID-19 pandemic, data from low-middle-income countries, including Morocco, are lacking. The main objective of this study was to assess the psychological distress of patients undergoing enforced hospital isolation during the initial phase of the COVID-19 pandemic in Morocco. (2) Methods: we conducted a cross-sectional study between 1 April and 1 May 2020, among patients hospitalized in isolation for suspected or confirmed COVID-19 at the Ibn Sina University Hospital of Rabat, Morocco. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Binary logistic regression was performed to identify variables associated with anxiety and depression, with a cutoff of ≥8 used for both scales to create dichotomous variables. (3) Results: among 200 patients, 42.5% and 43% scored above the cut-off points for anxiety and depression, respectively. Multiple logistic regression identified female gender, a higher education level, a longer duration of isolation, and a poor understanding of the reasons for isolation as significant factors associated with anxiety. Conversely, female gender, chronic disease, a longer duration of isolation, and a poor understanding of the reasons for isolation were factors significantly associated with depression. (4) Conclusions: our study underscores high rates of anxiety and depression among patients forced into hospital isolation during the initial phase of COVID-19 in Morocco. We identified several factors associated with patients experiencing psychological distress that may inform future discussions on mental health and psychiatric crisis management.

Assessing depression and anxiety among young adults after epidemics and pandemics: a cross-sectional study in Anyang, China

It has been well established that pandemics affect mental health, yet few studies have been conducted in China regarding this issue following COVID-19's gradual decline and the recent H1N1 influenza outbreak. In response to this research gap, this investigation explores the risk factors linked to depression and anxiety symptoms among young adults in this specific setting. Data were collected via an online cross-sectional survey of 385 young adults living in Anyang city, Henan Province, China, between June 15 and July 21, 2023. Respondents were assessed for anxiety and depression symptoms using the GAD-7 and PHQ-9 scales. Additionally, to examine the factors that influenced the study, we utilized an ordered logit regression model. Results revealed depression and anxiety prevalence rates of 33.3% and 21.6%, respectively. Several factors were found to increase the likelihood of depression and anxiety among young adults, including gender, age, education status, marital status, and attitudes towards epidemics. Participants' concerns about pandemics and viruses had a significant negative impact relationship on depression levels. Women report moderate to severe anxiety more frequently than men. An evident correlation can be observed between the educational attainment level and the influence of depression and anxiety.

Practitioners' perspectives on preparing for and delivering remote psychological support in Nepal, Perú and the United States during COVID-19

INTRODUCTION

The COVID-19 pandemic has propelled a global paradigm shift in how psychological support is delivered. Remote delivery, through phone and video calls, is now commonplace around the world. However, most adoption of remote delivery methods is occurring without any formal training to ensure safe and effective care.

OBJECTIVE

The purpose of this applied qualitative study was to determine practitioners' experiences of rapidly adapting to deliver psychological support remotely during COVID-19.

DESIGN

We used a pragmatic paradigm and applied approach to gain perspectives related to the feasibility and perceived usefulness of synchronous remote psychological support, including views on how practitioners can be prepared.

METHODS

Key informant interviews were conducted remotely with 27 specialist and non-specialist practitioners in Nepal, Perú and the USA. Interviewees were identified through purposeful sampling. Data were analysed using framework analysis.

RESULTS

Respondents revealed three key themes: (i) Remote delivery of psychological support raises unique safety concerns and interference with care, (ii) Remote delivery enhances skills and expands opportunities for delivery of psychological support to new populations, and (iii) New training approaches are needed to prepare specialist and non-specialist practitioners to deliver psychological support remotely.

CONCLUSIONS

Remote psychological support is feasible and useful for practitioners, including non-specialists, in diverse global settings. Simulated remote role plays may be a scalable method for ensuring competency in safe and effective remotely-delivered care.

Reduction of adverse events in a psychiatric inpatient eating disorder unit during the COVID-19 pandemic

TOPIC

Globally, the COVID-19 pandemic had impacted the health care delivery including inpatient psychiatric facilities. Within psychiatric settings, life of inpatients was profoundly altered.

PURPOSE

This paper aimed to understand if pandemic-related changes within an inpatient Eating Disorder Unit in a specialized psychiatric hospital in Ontario, Canada impacted incidence of aggression and use of coercive methods among adolescents.

SOURCE USED

An exploratory study design was used to examine incidence of aggression, self-harm, code whites, staff assist, restraints and seclusion, and nasogastric feeding (NGF) among adolescents with eating disorders before and after the modified service delivery within the inpatient unit. Descriptive analyses were conducted.

RESULTS

Analyses revealed a complete reduction in episodes of self-harm, aggression, staff assists, use of restraint and seclusion as well as an 80.14% reduction on average use of NGF.

CONCLUSION

Authors speculate that the change in environment and program delivery method, peer influence, and shift in power relations between patient and staff may have resulted in improved experiences. This report provides insights to adopt a recovery-oriented service delivery for adolescents with eating disorders in inpatient settings.

Depression and loneliness symptoms in Brazilian older people during the COVID-19 pandemic: a network approach

OBJECTIVES

Depression and loneliness in older people were a global challenge during the COVID-19 pandemic. Causal mechanisms to trigger depression might vary across different life events. We aimed to apply network analysis in a sample of Brazilian older people during the first wave of the COVID-19 pandemic, to investigate if loneliness and depression symptoms were connected within a psychological network. We explored how symptoms manifested and interacted, to discuss possible interventions that could mitigate late-life depression and loneliness symptoms in face of the COVID-19 pandemic.

METHOD

We collected data from 384 Brazilian older people who answered an online protocol to assess sociodemographic data, loneliness symptoms (assessed by the short version of UCLA-BR), and depression symptoms (assessed by the PHQ-2).

RESULTS

'Lack of companionship' was the bridge symptom connecting loneliness and depression communities. 'I feel shut out and excluded by others' and 'People are around me, but not with me' were the most predictable symptoms of loneliness.

CONCLUSION

Interventions aimed to promote older people's social participation and skills, combined with strategies to expand their sources of social support and combat ageism, might be relevant to mitigate symptoms of loneliness and depression in older people during a crisis like the COVID-19 pandemic.

Using ADAPT-ITT framework to tailor evidence-based interventions for addressing methamphetamine use among methadone patients in Vietnam

INTRODUCTION

Methamphetamine use threatens positive treatment outcomes in substance use and HIV, for people with opioid use disorders (POUD) in many countries. This paper describes the adaptation of four evidence-based interventions (EBI) (motivational interviewing, contingency management, Matrix group model and SMS text messaging) for treating methamphetamine use among POUD receiving methadone maintenance therapy in Vietnam.

METHODS

Following the ADAPT-ITT (Assessment-Decision-Administration-Production-Topical experts-Training-Testing) framework, we conducted 16 focus group discussions with POUD (n = 25) and providers (n = 22) at four methadone clinics in two largest cities (Hanoi in the North, Ho Chi Minh City in the South) to assess patterns of methamphetamine use and to get feedback on proposed EBIs. The proposed EBIs were properly adapted and used to train providers in two of the four methadone clinics. The revised EBIs were tested over 12 weeks among 42 POUD on methadone who use methamphetamine. Post-intervention feedback served to fine-tune the revised EBIs.

RESULTS

Insights about patterns of methamphetamine use suggested that EBIs should focus on different triggers to methamphetamine use among POUD receiving methadone treatment in the two cities. All EBIs should emphasise family-related topics to build a strong motivation for treatment. Participants suggested when, where and how each EBI should be delivered. Most participants were satisfied with the adapted EBIs. Limited human resources at methadone clinics might hinder implementation of the adapted EBIs.

DISCUSSION AND CONCLUSIONS

We successfully completed the adaptation of EBIs for POUD who use methamphetamine on methadone in Vietnam. The pilot testing of the adapted EBIs demonstrated feasibility and acceptability.

TRIAL REGISTRATION

NCT04706624. Registered 13 January 2021. https://clinicaltrials.gov/ct2/show/NCT04706624.

What Do Children in India Talk About? Personal Narratives of Typically Developing Hindi-Speaking Children

BACKGROUND

The recent development of the Global TALES Protocol provides a unique opportunity to conduct systematic cross-linguistic and cross-cultural comparisons of children's personal narratives. This protocol contains 6 scripted prompts to elicit personal narratives in school-age children about times when they experienced feeling happy/excited, worried, annoyed, proud, being in a problem situation, something important.

OBJECTIVES

The objectives of this study were to examine the topics of the children's narratives when they responded to the 6 prompts and draw comparisons with the topics of narratives spoken by children from 10 other countries speaking 8 other languages as described in the original feasibility paper.

METHODS

We translated the Global TALES Protocol into Hindi and collected personal narratives of thirty Hindi-speaking children (aged 6-9 years), residing in Varanasi, Uttar Pradesh, India. All personal narrative samples were elicited in person and audio recorded for manual coding of the topics.

RESULTS

Although we observed many similarities in the topics of children's personal narratives between this dataset and the dataset reported on in the initial feasibility study, we also documented some novel topics, such as "welcoming guests" in response to the "excited" prompt; "financial problems" in response to the "worried" prompt; "helping someone by actions or by advising someone morally" in response to the "problem" prompt; and "mishap/personal loss" and "exams" in response to the "important" prompt.

CONCLUSION

Some of these novel topics likely reflected the Indian culture. Because our study involved a group of children who are linguistically and culturally different from previous studies using the Global TALES protocol and, at ages 6-9 years, slightly younger than the 10-year-olds in prior studies, this study adds to the evidence that the Global TALES protocol can be used to elicit personal narratives of children from diverse languages and cultures, as young as age 6.

The COVID-19 pandemic and mental health in Kazakhstan

The COVID-19 pandemic had significant impacts on mental health. We examined factors associated with symptoms of depression and anxiety during the COVID-19 pandemic in Kazakhstan. We surveyed 991 adults in Kazakhstan in July 2021 using multistage stratified sampling. Depression and anxiety were measured with the Patient Health Questionnaire-4. We conducted logistic regression to assess associations between depression and anxiety and sociobehavioral factors. Overall, 12.01% reported depressive symptoms and 8.38% anxiety. Higher likelihood of depression was associated with being female (AOR: 1.64; 95% CI [1.05, 2.55]), having experience with COVID-19 in the social environment (AOR: 1.85; 95% CI [1.1-3.14]), experiencing food insecurity (AOR: 1.80; 95% CI [1.11-2.89]), increased family conflict (AOR: 2.43; 95% CI [1.32-4.48]) and impaired healthcare access (AOR: 2.41; 95% CI [1.32-4.41]). Higher likelihood of anxiety was associated with being female (AOR: 3.43; 95% CI [1.91-6.15]), increased family conflict (AOR: 2.22; 95% CI [1.11-4.44]) and impaired healthcare access (AOR: 2.63; 95% CI [1.36-5.12]). Multiple factors were associated with mental health in Kazakhstan during the COVID-19 pandemic. Further research is needed to determine the extent to which these factors and their associated mental health outcomes may persist.

Impact of COVID-19 pandemic on relapse of individuals with severe mental illness and their caregiver's burden

Background

The implementation of quarantine and social distancing measures to control the COVID-19 pandemic led to restrictions at the community level and most of in-person psychiatric services were discontinued. This situation could affect the psychopathology of the patients and the burden of their caregivers. The aim of this study was to investigate the effects of COVID-19 pandemic on people with severe mental illnesses (SMIs) and their caregivers' burden.

Method

The study sample consisted of 86 patients with severe mental illness and 86 caregivers. The mental status, relapse rate, and rehospitalization rate of the patients and the general health status and burden of caregivers were investigated in three waves, including before and 3 and 6 months after the COVID-19 pandemic.

Results

The relapse rate of the patients was 14%, 33.7%, and 43% (p = 0.000) and the rehospitalization rate was 4.7%, 7%, and 10.5% in waves 0, 1, and 2, respectively (p = 0.000). Most of the psychopathological scales increased in three waves (p = 0.000). The caregivers' burden and health condition worsened during the nine months of the study as well (p = 0.000).

Conclusion

The COVID-19 pandemic led to the exacerbation of symptoms and increased the relapse rate in people with SMIs. It also worsened the caregivers' condition. People with severe mental illnesses (SMIs) and their caregivers are one of the most vulnerable groups on which the COVID-19 pandemic had a marked negative effect.

COVID-19-Related Stressors and Clinical Mental Health Symptoms in a Northeast US Sample

Research has linked specific COVID-19-related stressors to the mental health burden, yet most previous studies have examined only a limited number of stressors and have paid little attention to their clinical significance. This study tested the hypothesis that individuals who reported greater COVID-19-related stressors would be more likely to have elevated levels of anxiety, posttraumatic stress symptoms, and serious psychological distress.

METHODS

An online survey was administered to a convenience sample from 18 June to 19 July 2020, in US states that were most affected by COVID-19 infections and deaths at the time. Individuals who were 18 or older and residents of five Northeast US states were eligible to participate (N = 1079). In preregistered analyses, we used logistic regression models to test the associations of COVID-19 stressors with symptoms on the Generalized Anxiety Disorder-7 (GAD-7), Impact of Event Scale-Revised, and K6, adjusting for sociodemographic covariates.

RESULTS

COVID-19-related stressors (i.e., essential worker status, worry about COVID-19 infection, knowing someone hospitalized by COVID-19, having children under 14 at home, loneliness, barriers to environmental rewards, food insecurity, loss of employment) were associated with meeting thresholds (i.e., positive screening) for anxiety, posttraumatic stress, and/or serious psychological distress. Loneliness and barriers to environmental rewards were associated with all mental health outcomes.

LIMITATIONS

We used a non-probability sample and cannot assume temporal precedence of stressors with regard to development of mental health symptoms.

CONCLUSIONS

These findings link specific stressors to the mental health burden of the COVID-19 pandemic.

The volatility of beef and lamb prices in Türkiye: The role of COVID-19, livestock imports, and energy prices

This study examines the volatility of beef and lamb prices in Türkiye, as food price inflation compromises the food security of low- and middle-income households. The inflation is the result of a rise in energy (gasoline) prices leading to an increase in production costs, together with a disruption of the supply chain by the COVID-19 pandemic. This study is the first to comprehensively explore the effects of multiple price series on meat prices in Türkiye. Using price records from April 2006 through February 2022, the study applies rigorous testing and selects the VAR(1)-asymmetric BEKK bivariate GARCH model for empirical analysis. The beef and lamb returns were affected by periods of livestock imports, energy prices, and the COVID-19 pandemic, but those factors influenced the short- and long-term uncertainties differently. Uncertainty was increased by the COVID-19 pandemic, but livestock imports offset some of the negative effects on meat prices. To improve price stability and assure access to beef and lamb, it is recommended that livestock farmers be supported through tax exemptions to control production costs, government assistance through the introduction of highly productive livestock breeds, and improving processing flexibility. Additionally, conducting livestock sales through the livestock exchange will create a price information source allowing stakeholders to follow price movements in a digital format and their decision-making.

Indirect social contact interventions to reduce mental health-related stigma in low- and middle-income countries: systematic review

AIMS

Mental health-related stigma and discrimination are a complex and widespread issue with negative effects on numerous aspects of life of people with lived experience of mental health conditions. Research shows that social contact is the best evidence-based intervention to reduce stigma. Within the context of a rapid development of remote technology, and COVID-19-related restrictions for face-to-face contact, the aim of this paper is to categorise, compare and define indirect social contact (ISC) interventions to reduce stigma and discrimination in mental health in low- and middle-income countries (LMICs).

METHODS

MEDLINE, Global Health, EMBASE, PsychINFO, Cochrane Central Register of Control Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using a strategy including terms related to 'stigma and discrimination', 'intervention', 'indirect social contact', 'mental health' and 'low- and middle-income countries'. Relevant information on ISC interventions was extracted from the included articles, and a quality assessment was conducted. Emerging themes were coded using a thematic synthesis method, and a narrative synthesis was undertaken to present the results.

RESULTS

Nine studies were included in the review overall. One study was ineffective; this was not considered for the categorisation of interventions, and it was considered separately for the comparison of interventions. Of the eight effective studies included in synthesis, interventions were categorised by content, combination of stigma-reducing strategies, medium of delivery, delivery agents, target condition and population, as well as by active or passive interaction and follow-up. Most of the interventions used education and ISC. Recovery and personal experience were important content components as all studies included either one or both. Cultural adaptation and local relevance were also important considerations.

CONCLUSIONS

ISC interventions were effective in overall terms for both the general public and healthcare providers, including medical students. A new definition of ISC interventions in LMICs is proposed. More research and better reporting of intervention details are needed to explore the effectiveness of ISC strategies in LMICs, especially in regions where little relevant research has been conducted.

The impact of COVID-19 on children and adolescents' mental health

Children and adolescents are more susceptible to the formation of mental health issues, since their brains are still developing. The coronavirus disease 19 (COVID-19) pandemic response measures have disrupted daily life and left individuals socially isolated, including children and adolescents. In view of this, this study aimed to give a narrative review of the literature on the pandemic's effects on children's and adolescents' mental health, associated risks, and successful intervention strategies. There are still issues to be resolved to give children and adolescents in many regions of the world with quality, rights-based, and culturally relevant mental health care. It is difficult to predict how the COVID-19 pandemic may affect children's and adolescents' mental health in the short- and long-term. To address the mental and social health needs of children and adolescents after the pandemic, it is urgently necessary to perform longitudinal and developmental studies and introduce evidence-centered action plans and interventions.

The relationship of probable clinical anxiety with attitude-behaviour, coping styles and social support in healthy pregnant women during the late period COVID-19 pandemic

The aim of the study is to investigate the prevalence of state and trait probable clinical anxiety and their relationship with socio-demographic factors, attitude-behaviour, coping styles and social support level in high-risk pregnant women in the late period of COVID-19 pandemic. The pregnant women followed up in the gynaecological outpatient clinic were evaluated during their admissions. About 191 healthy pregnant women were included in the study. Data were collected using the socio-demographic and pregnancy attitude-behaviour data form, STAI (Spielberger's State-Trait Anxiety Inventory), the Coping Styles Scale Brief Form (Brief-COPE) and the Multidimensional Scale of Perceived Social Support (MSPSS). Our study found that pregnant women had high anxiety levels (STAI-S:37.90 ± 8.88; STAI-T:42.46 ± 7.80) and probable clinical anxiety prevalences (STAI-S:81(42.4%); STAI-T:123(64.4%)) in the late period of the COVID-19 pandemic. The fact that COVID-19 determined the preference of the birth method and the level of knowledge about COVID-19 predicted state probable clinical anxiety. Educational status, concern for COVID-19 transmission to the baby during pregnancy/birth, behavioural disengagement, focussing on and venting emotions predicted trait probable clinical anxiety. Our results have emphasised the factors that should be taken into account and coping styles that may be functional to protect the mental well-being of healthy pregnants.IMPACT STATEMENTWhat is already known on this subject? The COVID-19 pandemic has been shown to increase the symptoms of stress, anxiety and depression of the general population and healthcare workers. There is limited studies about pregnant women.What do the results of this study add? According to our study, we can say that approximately half of the pregnant women in a pandemic need psychiatric evaluation due to probable clinical anxiety. The relationship between anxiety in the pandemic process and birth preference has been shown and coping styles in healthy pregnant women have been investigated for the first time, effective and ineffective coping styles have been shown. In addition, it has been found that the social support of pregnant women is effective in managing the pandemic process.What are the implications of these findings for clinical practice and/or further research? According to our current findings, a multidisciplinary approach in which pregnant women are screened with self-report psychiatry tests and appropriate pregnant women are consulted to psychiatry during pandemic processes will make it easier for obstetricians to manage the patient. Especially strengthening effective coping styles and social support will have a great effect in mental rehabilitation. In this respect, further studies on pregnant women are needed.

Uneven Implications of Lockdown Amid COVID-19 in India: From Harassment, Stigma, Crime, and Internally Displaced People to Stress and Coping Strategies in the Middle/Upper Class

A content analysis of an English Newspaper, The Times of India (the world's largest newspaper by circulation) during the first national lockdown amid the COVID-19 pandemic identified nine different categories culled out from a total of 129 news categories reporting unprecedented COVID-19 stories. Half of them portrayed two sides of a coin: from daily wagers and migrant workers, including internally displaced people (23/129), harassment and stigma (4/129), and crime (3/129) to stressors and coping strategies for middle/upper class individuals (39/129). Reports evidenced increased vulnerability in the lower layers of Indian stratified society. Yet, two years later, the uneven implications on physical and mental health are scarcely studied by scientific researchers.

Isolation insult during COVID-19 pandemic on the psychological status of medical students

Background

COVID‐19 is a newly discovered infectious disease that spread and caused a global health problem. Medical students, especially those in clinical stages are among groups exposed to the disease. The study aimed to show the impact of social distancing on the mental health of Iraqi medical students.

Method

A convenient sampling technique involved 105 participants was obtained through a questionnaire. The participants were from all stages of College Of Medicine. Questions were regarding the mental health status of the students, which included sleeping hours, nightmares, eating habits, weight problems, relationship with the family, starting to have bad habits, memory loss, attention problems, irritability, and study rank affect.

Results

Of about 105 participants, 64 (60.9%) of them were females and 41 (39.1%) were males. The mean age of the participants was (21.26 ± 1.065) ranging from 19 to 24 years. Feeling stressful when hearing news about COVID‐19″ found in 82 (78.1%) of the participants. A high statistical significant difference (p = 0.035) among feeling isolated. About 77 (73.3%) of the participants had become easily irritable and angry. About 82 (78.1%) student started for having calculation problems. The stress with sleeping hours (p = 0.019), sleeping disturbance (p = 0.022), eating habit (p = 0.015), weight problems (p = 0.002), fear of familiar places (p = 0.004), recent memory loss (p = 0.034) and being easily irritable or angry (p = 0.0001), revealed a statistical significant association, respectively.

Conclusion

COVID‐19 news and social distancing had made medical students more stressed and irritable, affecting their sleeping hours and pattern with a general tendency for weight gain and recent memory loss in stressful students.

The effect of influenza vaccine in reducing the severity of clinical outcomes in patients with COVID-19: a systematic review and meta-analysis

Recent evidence suggests that vaccination against influenza may reduce the clinical outcomes of COVID-19. This study looked at the link between influenza vaccination and the severity of COVID-19 infection. We searched five databases until August 2021. We included studies that reported the relationship between influenza vaccination and COVID-19 outcomes. We pooled the data as risk ratio (RR) or mean difference (MD), with 95% confidence intervals (CIs), the data pooled using fixed and random effects models according to the heterogeneity of results. Sixteen observational studies with 191,496 COVID-19 patients were included. In terms of mechanical ventilation, our analysis showed a significant favor for the influenza vaccinated group over the non-vaccinated group (RR = 0.72, 95% CI [0.54, 0.96], P = 0.03). However, the analysis indicated no statistically significant differences between vaccinated and non-vaccinated groups in the term of mortality rate (RR = 1.20, 95% CI [0.71, 2.04], P = 0.50), hospital admissions (RR = 1.04, 95% CI [0.84, 1.29], P = 0.75), intensive care admissions (RR = 0.84, 95% CI [0.44, 1.62], P = 0.60). There were no significant differences between those who had received the influenza vaccine and those who had not in COVID-19 clinical outcomes, except for mechanical ventilation which showed a significantly lower risk in the influenza vaccinated group compared to the non-vaccinated one. However, future research is encouraged as our data have limitations, and the influenza vaccine is regularly updated. Also, this does not exclude the importance of the influenza vaccine during the COVID-19 pandemic.

Lockdown Policies, Economic Support, and Mental Health: Evidence From the COVID-19 Pandemic in United States

During the COVID-19 pandemic, various lockdown policies were put in place by the governments in different countries and different levels, which effectively curbed the spread of the virus, but also cause substantial damage to the mental health of local residents. We use statistics provided by the Household Pulse Survey and OxCGRT between 23 April 2020 and 30 August 2021 to analyze the impact of lockdown on overall mental health levels in US states during the COVID-19 pandemic at the macro level. The results show that the lockdown policies implemented by the state governments lead to a deterioration in psychological conditions, and this relationship varies to some extent depending on the level of high-quality economic support, that the state governments implement to alleviate the symptoms of depression and anxiety associated with the lockdown. Therefore, we argue that although lockdown policies are necessary during the COVID-19 pandemic, further government efforts are needed to give high-quality economic and mental health support to mitigate the negative effects of lockdown on mental health.

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.

Anxiety, attitudes-behaviors, coping styles, and social support among high-risk pregnant women in the late period of the coronavirus disease 2019 pandemic

OBJECTIVE

The purpose of this study was to investigate the prevalence of anxiety among high-risk pregnant women in the late period of the coronavirus disease 2019 pandemic and to evaluate the relationship between anxiety levels, attitudes-behaviors, coping styles, and other psychometric parameters.

METHODS

Pregnant women who were followed up in our gynecology outpatient clinic were evaluated during their admissions between November 15, 2020 and February 15, 2021. This cross-sectional study analyzes prospectively collected data from a university hospital. Inclusion criteria were those being at risk of pregnancy and between the age of 18 and 45 years, while exclusion criteria were mental retardation and the presence of serious psychiatric illness. The study included 140 participants. Sociodemographic and pregnant attitudes-behaviors data form, State-Trait Anxiety Inventory, Coping Styles Scale Brief Form (Brief-COPE), and Multidimensional Scale of Perceived Social Support were used to collect data.

RESULTS

Participants had high anxiety levels (State-STAI: 40.32±9.88; Trait-STAI: 42.71±7.32) and high prevalence of probable clinical anxiety [State-STAI: 84 (60.0%); Trait-STAI: 92 (65.7%)]. The fact concerning the transmission of the coronavirus disease 2019 to the baby during pregnancy/birth, extent to which coronavirus disease 2019 pandemic prevents regular pregnancy checkups, and family subgroup-Multidimensional Scale of Perceived Social Support predicted state probable clinical anxiety. Use of disinfectants predicted trait probable clinical anxiety. Employment status predicted state/trait probable clinical anxiety. The existence of trait probable clinical anxiety was significantly associated with behavioral disengagement and substance use which are considered ineffective coping styles. Participants without trait probable clinical anxiety had significantly more adopted positive reinterpretation, one of emotion-focused coping styles.

CONCLUSION

Based on our results, the concern of the transmission of the coronavirus disease 2019 to the babies during pregnancy/birth may be the main factor influencing anxiety among high-risk pregnant women.

The role of covid‐19 anxiety and intolerance of uncertainty in predicting resilience

Resilience is one of the protective factors for mental health. The aim of this study is to reveal the role of COVID‐19 anxiety and intolerance of uncertainty in predicting resilience in adulthood. To this end, data were collected from 533 adults (359 women‐174 men). A hierarchical regression analysis was performed, controlling for the effects of gender and presence of a chronic disease on the prediction of resilience. Results showed that intolerance of uncertainty and COVID‐19 anxiety were statistically significant predictors of resilience. Gender and presence of a chronic disease were not statistically significant in predicting resilience. These results indicate that intolerance of uncertainty plays an important role in explaining resilience.

Mental wellbeing during the time of COVID-19 pandemic: A national pilot survey in Ethiopia

Introduction

The Coronavirus Disease 2019 (COVID-19) pandemic substantially disrupts population health and wellbeing globally, while little is known about the effect on mental wellbeing in developing countries. This study aimed to assess the impact of COVID-19 on mental wellbeing of individuals and households in Ethiopia.

Methods

A cross-sectional, national pilot survey was conducted through phone interviews from September to November 2021. Mental wellbeing and disability were assessed using a questionnaire adapted from the 5-item World Health Organization Wellbeing Index (WHO-5), the Oslo Social Support Scale (OSSS-3), and the WHO Disability Assessment Scale (WHODAS 2.0).

Results

A total of 614 adults completed the pilot survey. The mean age was 36 years (standard deviation 11) and 71.7% were male. Mental wellbeing was poor in 218 (35.5%) participants. The most important predictors for poor mental wellbeing were rural residence (Adjusted Odds Ratio [AOR] 1.89; 95% CI 1.14, 3.14; p=0.012), perceived COVID-19 risk (AOR 1.75; 95% CI 1.18, 2.60; p=0.005), household stress (AOR 2.09; 95% CI 1.31, 3.34; p=0.002), experience of symptom of COVID-19 in the household (AOR 2.14; 95% CI 1.13, 4.04; p=0.019), and poor social support (AOR 2.43; 95% CI 1.51, 3.91; p<0.001).

Conclusion

The study provides evidence that COVID-19 had a significant adverse impact on the mental wellbeing of individuals and households in Ethiopia. Further studies are needed to understand in detail the implications of the pandemic and interventions needed to keep mental wellbing of citizens.

Silver linings: Observed reductions in aggression and use of restraints and seclusion in psychiatric inpatient care during COVID-19

WHAT IS KNOWN ABOUT THE SUBJECT?: In a survey conducted by the World Health Organization (WHO) in the summer of 2020, 93% of countries worldwide acknowledged negative impacts on their mental health services. Previous research during the H1N1 pandemic in 2009 established an increase of patient aggression in psychiatric facilities. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Despite expected worsening of mental health, our hospital observed reductions in aggressive behaviour among inpatients and subsequent use of coercive interventions by staff in the months following Covid-19 pandemic restrictions being implemented. The downward trend in incidents observed during the pandemic has suggested that aggression in mental health hospitals may be more situation-specific and less so a factor of mental illness. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: We believe that the reduction in aggressive behaviour observed during the pandemic is related to changes in our organization that occurred in response to concerns about patient well-being; our co-design approach shifted trust, choice and power. Therefore, practices that support these constructs are needed to maintain the outcomes we experienced. Rather than return to normal in the wake of the pandemic, we are strongly encouraged to sustain the changes we made and continue to find better ways to support and work with the individuals who rely on or use our services. ABSTRACT: The global COVID-19 pandemic has dramatically changed the operation of health care such that many services were put on hold as patients were triaged differently, people delayed seeking care, and transition to virtual care was enacted, including in psychiatric facilities. Most of the media dialogue has been negative; however, there have been some silver linings observed. Coinciding with the pandemic has been a reduction in aggressive incidents at our psychiatric hospital, along with the decreased need to use restraints and seclusion to manage behaviour. In this paper, we are taking stock of the changes that have occurred in response to the pandemic in an attempt to share our learnings and offer suggestions so that health care does not necessarily return to "normal".

The Impact of COVID-19 on Psychological and Social Stigma for Indonesian Nurses: A Cross-Sectional Survey

INTRODUCTION

Nurses are on the front line and are at high risk of experiencing a mental health crisis during the pandemic due to the psychological impact and stigma. The aim of this study was to identify the role of psychological status and social stigma in anxiety, fear, depression, and mental health crises during the pandemic.

MATERIALS AND METHODS

A cross-sectional design during December 2020-August 2021. A total of 2,156 nurses who work in health facilities, either hospitals, or communities based on the criteria of nurses who interact directly with COVID-19 patients, work at least 3 months, age 20-54 years, are literate, have internet access, and have the ability to access the electronic form. The eligible participants filled in online questionnaires that were sent to them via WhatsApp. Data were analyzed using Spearman rho correlation test with statistically significant p value < 0.05.

RESULTS

A total of 2,156 respondents responded to the questionnaire, and the response rate was 100%. The psychological status of nurses was 78.4% moderate, 18.5% experienced social stigma, 44.0% showed an anxiety response, 53.5% fear, 64.5% depression in the very severe category, and 63.5% fell into a mental health crisis. The results of the inferential analysis showed that all P < 0.05 which indicated that psychological status and social stigma had a significant relationship with anxiety, fear, depression, and mental health crisis in nurses.

CONCLUSION

The psychological status and social stigma experienced by nurses during the COVID-19 pandemic indicate a bad situation and lead to a mental health emergency crisis.

COVID-19 Public Health Restrictions and Older Adults' Well-being in Uganda: Psychological Impacts and Coping Mechanisms

OBJECTIVES

Older adults across the globe have been particularly affected by the novel coronavirus due to their increased susceptibility to the virus. With limited existing research, the aim of this study was to explore the psychological effects of COVID-19 public health measures on older adults in Uganda and their coping mechanisms.

METHODS

Thirty semi-structured interviews were conducted with older Ugandans (aged 60+) in June 2020. Participants were asked about their experiences of public health measures, and their effects on the lives of older adults compared to pre-pandemic.

RESULTS

Three themes were identified: Impact on emotional well-being; Implications on physical well-being; and Coping mechanisms. Older adults experienced both psychological and physical effects, including upset, fear, and frustration about restrictions and the virus, as well as early signs of increased frailty, thus causing concerns for the long-term emotional and physical health of older Ugandans.

CONCLUSIONS

Public health measures need to be considerate of the potential long-term implications on the well-being of older adults in low-, middle-, and high-income countries, and ensure the possibility for continued physical exercise and social connection. This can be particularly challenging for people from more disadvantaged backgrounds who may not be able to afford a smartphone or laptop, with older adults further requiring support in using digital technologies.

CLINICAL IMPLICATIONS

Older adults need to receive adequate psychological support to cope with the mental health impacts of the pandemic.

Factors associated with anxiety and quality of life of the Wuhan populace during the COVID‐19 pandemic

In December 2019, COVID-19 broke out in Wuhan, China, affecting the mental health and quality of life (QoL) of its inhabitants. This study aimed at investigating the factors associated with anxiety and QoL in the Wuhan populace during the COVID-19 pandemic. An online questionnaire survey was carried out during July 6-10, 2020. The questionnaire collected information on demography, anxiety, QoL, and social-environmental support. The main statistical methods included descriptive statistics, independent-samples t-test, one-way analysis of variance, and multivariate regression analysis. In total, 226 participants were recruited. The findings showed that females, elderly, middle-income, poor health status, shortage of medical supplies, and insufficient basic commodities were associated with anxiety significantly. Multiple regression analysis indicated that social-environmental support was significantly related to anxiety. Higher social-environmental support was significantly associated with a higher QoL. Our findings showed that the social-environmental support may reduce anxiety and improve the QoL for those living in an area heavily affected by the pandemic.

Mental health interventions following COVID-19 and other coronavirus infections: a systematic review of current recommendations and meta-analysis of randomized controlled trials

OBJECTIVE

To review the most common mental health strategies aimed at alleviating and/or preventing mental health problems in individuals during the coronavirus disease 2019 (COVID-19) and other coronavirus pandemics.

METHODS

We conducted a systematic review of the literature assessing three databases (PubMed, SCOPUS, and PsycINFO). A meta-analysis was performed with data from randomized controlled trials (RCTs). For non-RCT studies, a critical description of recommendations was performed.

RESULTS

From a total of 2,825 articles, 125 were included. Of those, three RCTs were included in the meta-analysis. The meta-analysis revealed that the interventions promoted better overall mental health outcomes as compared to control groups (standardized mean difference [SMD] = 0.87 [95%CI 0.33-1.41], p < 0.001, I2 = 69.2%), but did not specifically improve anxiety (SMD = 0.98 [95%CI -0.17 to 2.13], p > 0.05; I2 = 36.8%). Concerning the systematic review, we found a large body of scientific literature proposing recommendations involving psychological/psychiatric interventions, self-care, education, governmental programs, and the use of technology and media.

CONCLUSIONS

We found a large body of expert recommendations that may help health practitioners, institutional and governmental leaders, and the general population cope with mental health issues during a pandemic or a crisis period. However, most articles had a low level of evidence, stressing the need for more studies with better design (especially RCTs) investigating potential mental health interventions during COVID-19.

PROSPERO REGISTRATION

CRD42020190212.

Impact on Mental Health of Families during Covid-19: A Cross-Sectional Survey

Background

The global pandemic of novel coronavirus outbreaks threatens the general public and health care workers' physical, social and mental well-being. Therefore, the current study is aimed to highlight the status of mental health of families suffering from the COVID-19 pandemic.

Methods

An online cross-sectional survey was conducted on 560 families through Google Form distributed via email, Whatsapp groups, Facebook, and LinkedIn from November 2020 to January 2021 during the pandemic period in Karachi through the snowball sampling technique. The status of COVID-19 patients was assessed through demographics information and contextual factors questions whereas impact on mental health was assessed through Depression Anxiety Stress Scale (DASS-21).

Results

A total number of 536 participated in the study. The prevalence of depression, anxiety and stress was found to be 38.99%, 26.67%, and 15.48% respectively included 31% of males and 69% where the highest number of respondents belonged to district Central (37.8%). Chi square estimation was found to be significant among both the gender and in between all the age group ranges from 20 to 60 years. Moreover, significant association among categorical division of demography and DASS-21 p<0.05 was observed.

Conclusion

The results of our study indicated high rate of depression and anxiety in majority of families; in particular females. Consistent with these symptoms, significant association was found between gender and age from high to low socioeconomic status.

Comparison of the Mental Health Impact of COVID-19 on Vulnerable and Non-Vulnerable Groups: A Systematic Review and Meta-Analysis of Observational Studies

Vulnerable populations may be more vulnerable to mental health problems posed by the coronavirus disease 2019 (COVID-19) pandemic. A systematic review was performed to compare the mental health impact of COVID-19 between vulnerable and non-vulnerable groups. Five electronic databases were searched for observational studies reporting the psychological outcomes of both vulnerable populations and healthy controls during the COVID-19 era. The primary outcomes are the severity of depression and anxiety, and secondary outcomes include other aspects of mental health such as stress or sleep disturbance. Meta-analysis was performed for the severity of mental health symptoms, and the results were presented as standardized mean difference and 95% confidence intervals. A total of 25 studies were included. According to the findings, the elderly generally experienced significantly lower levels of psychological symptoms including depression, anxiety, and perceived stress. Pregnant women, patients with chronic diseases, and patients with pre-existing severe mental disorders showed mixed results according to each mental health outcome. The results indicate that vulnerable groups have been affected differently in the COVID-19 era. Though the insufficient number and heterogeneity of included studies leave the results inconclusive, our findings may contribute to identifying priorities of mental health needs among various vulnerable populations and allocating health resources with efficiency.

Unpacking the Mental Health of Nurses during COVID-19: Evidence from Pakistan

The prime objective of the present study is to test the effect of COVID-19 fear on the mental condition of nurses in the public health sector of Pakistan. This study seeks to measure the psychological distress, anxiety, and psychological well-being of nurses due to fear of COVID-19 and exposure to COVID-19. This research further reveals the moderating role of “social support” in the link between COVID-19 fear, exposure and mental health. Through a convenient sampling technique, 250 sample contributors were chosen from 12 public hospitals. The results were obtained by applying multiple regression and moderation analysis by SPSS and the Hayes process. The outcomes indicated that fear of exposure to COVID-19 affects the mental health of nurses. The findings also discovered that social support is not very constructive in the pandemic. However, we suggested that social support is the best weapon to encourage nurses to relieve their fear and minimize negative emotions.

Psychological implications of the COVID-19 pandemic around the world: Introduction to the special issue

Although psychological researchers have long studied the implications of major crises, the outbreak and spread of the COVID‐19 pandemic have confronted the global community of psychologists and psychological researchers with new challenges. This special issue contributes to the growing empirical literature on the immediate psychological implications of the COVID‐19 pandemic. We present and discuss diverse work from authors that followed our call for papers in May 2020, shortly after the World Health Organisation declared COVID‐19 a global pandemic. The studies focus on the early phases of the pandemic by addressing (a) implications of the pandemic for psychological well‐being and mental health, (b) psychological effects of lockdown scenarios as well as (c) individual compliance with COVID‐19 prevention and intervention measures. We conclude by highlighting the need for new research efforts, with a special focus on low‐ and middle‐income regions, international research collaborations and cross‐cultural research designs.

Evaluating the Immediate Response of Country-Wide Health Systems to the Covid-19 Pandemic: Applying the Gray Incidence Analysis Model

The purpose of the study is to evaluate county-wide health systems using the data set of the first wave of the COVID-19 pandemic. The overall design of study comprises a literature review, secondary data, and a mathematical analysis. It is a cross-sectional quantitative study following a deductive approach. It uses the data of the first wave of the COVID-19 pandemic taken from the website of Worldometer as of April 8, 2020. The study uses a gray incidence analysis model (commonly known as Gray Relational Analysis, i.e., GRA) as its research methodology. On the basis of the results of GRA, a classification has been made under a predetermined scheme of ensigns: much better, better, somewhat better, fair, poor, somewhat worse, and worse health systems. There are a total 211 countries that have been divided into the seven aforementioned categories. Findings of the study show that Southern Africa Development Community (SADC) countries fall predominantly under the much better ensign, whereas Organization for Economic Co-operation and Development (OECD), Schengen Area (SA), and/or European Union (EU) countries fall under the worse ensign. Pakistan falls under the ensign of poor. It is an original attempt to evaluate the response of health systems based on real data using a scientific methodology. The study provides valuable information about the health systems of the countries for forming an informed opinion about the health systems herein. The study provides useful new information for stakeholders and a new framework for future research.

Needs, gaps and opportunities for standard and e-mental health care among at-risk populations in the Asia Pacific in the context of COVID-19: a rapid scoping review

Background

The COVID-19 pandemic is expected to have profound mental health impact, including in the Asia Pacific Economic Cooperation (APEC) region. Some populations might be at higher risk of experiencing negative mental health impacts and may encounter increased barriers to accessing mental health care. The pandemic and related restrictions have led to changes in care delivery, including a rapid shift to the use of e-mental health and digital technologies. It is therefore essential to consider needs and opportunities for equitable mental health care delivery to the most at-risk populations. This rapid scoping review: 1) identifies populations in the APEC region that are at higher risk of the negative mental health impacts of COVID-19, 2) identifies needs and gaps in access to standard and e-mental health care among these populations, and 3) explores the potential of e-mental health to address these needs.

Methods

We conducted a rapid scoping review following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched Medline, Embase and PsychInfo databases and Google Scholar using a search strategy developed in consultation with a biomedical librarian. We included records related to mental health or psychosocial risk factors and COVID-19 among at-risk groups; that referred to one or more APEC member economies or had a global, thus generalizable, scope; English language papers, and papers with full text available.

Results

A total of 132 records published between December 2019 and August 2020 were included in the final analysis. Several priority at-risk populations, risk factors, challenges and recommendations for standard and e-mental health care were identified. Results demonstrate that e-mental health care can be a viable option for care delivery but that specific accessibility and acceptability considerations must be considered. Options for in-person, hybrid or “low-tech” care must also remain available.

Conclusions

The COVID-19 pandemic has highlighted the urgent need for equitable standard and e-mental health care. It has also highlighted the persistent social and structural inequities that contribute to poor mental health. The APEC region is vast and diverse; findings from the region can guide policy and practice in the delivery of equitable mental health care in the region and beyond.

Role of Chinese government and Public–Private Partnership in combating COVID-19 in China

COVID-19 has been called a Global Health Emergency worldwide. According to their available resources, developed and developing countries' public and private sectors are fighting against this pandemic. This paper examines how effective the Public–Private Partnership (PPP) strategies under the Chinese government response to control this COVID-19. The study takes the Chinese government and private sector's collective efforts for analysis and discussion from January 01 to October 31, 2020. Applying linear regression revealed that public governance strategies have worked to control this pandemic's severity and frequency. The results also show that despite the negative COVID-19 graph, the Chinese government has remained consistent in health and stringency measures. Furthermore, in cooperation with private sectors, China's emergency management has built two makeshift hospitals in 12 days and 5G technology implementation; Health Code application and volunteer works illustrate sharing governance by PPP. The study advises that by keeping in mind the strategy of PPP in China, other countries should also involve private sectors to mitigate emergency issues like COVID-19 for fast and effective outcomes and ask for assistance from the Chinese government and follow their quarantine and prudent policies to control this contagious disease. It further suggests that governments should engage private sectors before draft effective emergency preparedness policies to fight against future calamities.

Government response moderates the mental health impact of COVID-19: A systematic review and meta-analysis of depression outcomes across countries

BACKGROUND

The COVID-19 pandemic represents a public health, economic and mental health crisis. We hypothesized that timely government implementation of stringent measures to reduce viral transmission would benefit mental health, as evidenced by reduced rates of depressive symptoms (i.e., Patient Health Questionnaire [PHQ]-9≥10, PHQ-2≥3).

METHODS

The systematic review herein (PROSPERO CRD42020200647) evaluated to what extent differences in government-imposed stringency and timeliness of response to COVID-19 moderate the prevalence of depressive symptoms across 33 countries (k=114, N=640,037). We included data from six lower-middle-income countries, nine upper-middle-income countries, and 18 higher-income countries. Government-imposed stringency and timeliness in response were operationalized using the Oxford COVID-19 Government Response ("Stringency") Index.

RESULTS

The overall proportion of study participants with clinically significant depressive symptoms was 21.39% (95% CI 19.37-23.47). The prevalence of clinically significant depressive symptoms was significantly lower in countries wherein governments implemented stringent policies promptly. The moderating effect of government response remained significant after including the national frequency of COVID cases at the time of study commencement, Healthcare Access and Quality index, and the inclusion of COVID patients in the study.

LIMITATIONS

Factors that may have confounded our results include, for example, differences in lockdown duration, lack of study participant and outcome assessor blinding, and retrospective assessment of depressive symptom severity.

CONCLUSIONS

Governments that enacted stringent measures to contain the spread of COVID-19 benefited not only the physical, but also the mental health of their population.

Social Inequality and Solidarity in Times of COVID-19

The enormous public health burdens of the COVID-19 pandemic are not distributed equally. Inequalities are noticeable along socio-economic and socio-cultural fault lines. These social determinants of health affect both the prevalence and severity of COVID-19 infections as well as the magnitude of negative impacts of the measures taken to slow the spread of the virus. This perspective paper summarizes key inequalities in who is affected by SARS-CoV-2 infection and in who is affected by COVID-19 prevention measures, based on evidence presented in state-of-the-art literature, and discusses the scope of challenges that these inequalities pose to solidarity and social justice. Key challenges for solidarity are highlighted across three areas: challenges to intergenerational solidarity, to global solidarity, and to intergroup solidarity.

Mental health policy and system preparedness to respond to COVID-19 and other health emergencies: a case study of four African countries

As a result of a long colonial history and subsequent developmental and economic challenges, many African countries have struggled to put in place adequate policies, systems, and associated infrastructures to address the health and social needs of their citizens. With the COVID-19 pandemic threatening human lives and livelihoods, concerns are raised about the preparedness and readiness of health policies and systems in African countries to deal with these kinds of health calamities. More particularly, questions can be asked about the preparedness or even existence of mental health policies and associated systems to help individuals and communities in Africa to deal with the consequences of COVID-19 and other health emergencies. In this article, we analyse the existing mental health policies of four African countries paying attention to the capacity of these legislative provisions to enable psychology professionals to deal with psychosocial problems brought about by COVID-19. We use Walt and Gilson's Policy Triangle Framework to frame our analysis of the existing mental health policies. In line with this conceptual framework, we review the role played by the different factors in shaping and influencing these mental health policies. We further explore the challenges and opportunities associated with existing legislation and mental health policies. We also reflect on the reports obtained from each of the four countries about the role that psychologists are playing to deal with the associated psychosocial problems. Based on our policy analysis and country reports, we highlight strengths and gaps in these policies and give recommendations on how mental health policies in these countries can be strengthened to respond to COVID-19 and future health emergencies.

Psychosocio-economic impacts of COVID-19 on gastroenterology and endoscopy practice

Beyond posing a major health crisis, the COVID-19 pandemic has inflicted profound psychological, social, and economic impacts on populations worldwide. Mass quarantines and social isolation have affected the mental health of the wider population, exacerbating other stressors, including fear of the virus and its repercussions, general uncertainty, and financial insecurity. The pandemic has challenged the broader delivery of healthcare--ranging from the need to triage limited hospital resources to balancing risk mitigation with maintaining medical care. Specific to gastroenterology, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not only been associated with complicating extant medical conditions of the gastrointestinal (GI) tract, but has also forced a shift in the practice of gastroenterology by patients, families, and healthcare providers alike. The gastroenterology field has been required to adapt its practices to minimize the possibility of viral spread while still upholding patient care. Healthcare practitioners in GI have helped to treat COVID-19 patients, stratified inpatient and outpatient visits and procedures, and shifted to telemedicine. Still, as is the case with much of the general population, healthcare providers working in GI practice or endoscopy have faced personal and professional stressors, mental health difficulties, social isolation, financial pressures, and familial burdens--all of which can take a toll on practitioners and, by extension, the provision of GI care overall. This article will highlight how the COVID-19 pandemic has affected the psychological wellbeing, social engagement, and economic conditions of the public, healthcare providers, and GI professionals specifically. Recommendations for strategies that can continue GI services while maintaining safety for both caregivers and patients are put forth to help uphold critical GI care during this worldwide crisis.

COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health

Most of the global population live in low-income and middle-income countries (LMICs), which have historically received a small fraction of global resources for mental health. The COVID-19 pandemic has spread rapidly in many of these countries. This Review examines the mental health implications of the COVID-19 pandemic in LMICs in four parts. First, we review the emerging literature on the impact of the pandemic on mental health, which shows high rates of psychological distress and early warning signs of an increase in mental health disorders. Second, we assess the responses in different countries, noting the swift and diverse responses to address mental health in some countries, particularly through the development of national COVID-19 response plans for mental health services, implementation of WHO guidance, and deployment of digital platforms, signifying a welcome recognition of the salience of mental health. Third, we consider the opportunity that the pandemic presents to reimagine global mental health, especially through shifting the balance of power from high-income countries to LMICs and from narrow biomedical approaches to community-oriented psychosocial perspectives, in setting priorities for interventions and research. Finally, we present a vision for the concept of building back better the mental health systems in LMICs with a focus on key strategies; notably, fully integrating mental health in plans for universal health coverage, enhancing access to psychosocial interventions through task sharing, leveraging digital technologies for various mental health tasks, eliminating coercion in mental health care, and addressing the needs of neglected populations, such as children and people with substance use disorders. Our recommendations are relevant for the mental health of populations and functioning of health systems in not only LMICs but also high-income countries impacted by the COVID-19 pandemic, with wide disparities in quality of and access to mental health care.

Psychological Health, Sleep Quality, Behavior, and Internet Use Among People During the COVID-19 Pandemic: A Cross-Sectional Study

Background: The COVID-19 pandemic has led to an increase in the risk of suicide, uncertainty, mental stress, terror, annoyance, weariness, financial issues, and frustration. We aim to determine the prevalence of insomnia, depressive and anxiety symptoms, and their associated factors among Libyan populations during the COVID-19 pandemic and the civil war. Methods: An online cross-sectional survey was conducted among the Libyan population between July 18 and August 23, 2020. The data collected included basic demographic characteristics, level of education, employment status, COVID-19-related questions, and questions about abuse and domestic violence. This study assessed the psychological status of participants who were screened for anxiety symptoms using the seven-item Generalized Anxiety Disorder scale (GAD-7). Depressive symptoms were also screened for using the two-item Patient Health Questionnaire (PHQ-2) and the Insomnia Severity Index (ISI). Binomial logistic regression was used to predict the probability of insomnia, anxiety and depressive symptoms. Results: A total of 10,296 responses were recorded. Among the participants, 4,756 (46.2%) obtained a cut-off score of ≥ 3 which indicated depressive symptoms. For anxiety, 1,952 participants (19%) obtained a cut-off score of ≥ 15, which indicated anxiety symptoms. For the ISI, the mean (SD) was 11.4 (6.1) for the following categories: no clinical insomnia (0-7) 3,132 (30.4%), sub-threshold insomnia (1-7) 3,747 (36.4%), moderate severity clinical insomnia (8-14) 2,929 (28.4%), and severe clinical insomnia (15-21) 488 (4.7%). Logistic regression analysis showed that depressive symptoms were statistically associated with age, marital status, education level, occupational category, financial problems during the COVID-19 pandemic, health status, having a COVID-19 infection, current health status, suicide ideation, abuse or domestic violence, and lockdown compliance (p < 0.05). The regression analysis revealed a statistically significant association between anxiety symptoms and age, education level, occupational status, financial problems during the COVID-19 pandemic, having a COVID-19 infection, health status, suicide ideation, abuse or domestic violence, and lockdown compliance (p < 0.05). The regression analysis revealed a statistically significant association between insomnia and all study variables with the exception of age, educational level, and occupational status (p < 0.05). Conclusion: Confronted with the COVID-19 outbreak, the Libyan population exhibited high levels of psychological stress manifested in the form of depressive and anxiety symptoms, while one-third of the Libyan population suffered from clinical insomnia. Policymakers need to promote effective measures to reduce mental health issues and improve people's quality of life during the civil war and the COVID-19 pandemic.

Living alone in lockdown: Impact on mental health and coping mechanisms among young working adults

In the wake of declaration of Covid-19 as a pandemic by the World Health Organization, the Prime Minister of India announced a nationwide lockdown to curb its spread. Subsequently, some groups of people found themselves away from their family or friends, and were unable to return to them. The aim of the research was to explore the lives of young adults who were living alone and working, during the lockdown in India. Focus was on their daily living, their relationships and their mental health. Twelve participants residing in various cities of India were included via the Internet. Focus group discussions were used to attain the objectives of the study. The data that emerged from the discussions, was analysed using thematic analysis. All participants had experienced different kinds of disruptions in their life due to the lockdown. This effect was mediated by their financial situation, their general comfort and preference for living alone, media, opportunities for non-virtual interactions and other kinds of recreation, quality of relationships and more. Though there were similarities in their coping methods, their perspective on the lockdown, the meaning they attributed to their current situation and their vision for their future was unique.

Health care provider's risk perception, and preparedness towards COVID-19 pandemic in North Central Ethiopia, 2020

BACKGROUND

Risk perception, positive emotions, and preparedness are important parameters in predicting pandemic protective behaviors. Though, health care providers are required with sufficient knowledge, skills, preparedness and best practices towards corona virus 2019, there are limited studies in Ethiopia.

AIM

This study aimed to assess health care providers' level of risk perception, preparedness and its associated factors among HCWs in North Central Ethiopia, 2020.

METHODS

An institutional-based cross-sectional survey was conducted among 217 health care providers working in South Gondar zone Hospitals from May 15-30, 2020. Data were collected using a self-administered questionnaire. Data were coded, entered, cleaned and checked using Epi data statistical software version 4.2.0.0 and taken in STATA Version 14 statistical software for analysis. Binary logistic regression was used for the analysis. Odds ratio along with 95% CI were estimated to measure the strength of the association. Descriptive statistics are presented in figures, text, and tables.

FINDINGS AND CONCLUSION

The level of high risk perception among frontline health care workers was 57.6% (95% CI: 56.9, 58.3). Almost half, 49.8% health care providers were prepared for corona virus pandemic and only 43.78% of health care providers had good knowledge regarding COVID -19. Having good knowledge (Adjusted Odd Ratio (AOR) = 2.83; 95% CI: 1.49, 5.34), training on COVID -19 (AOR = 2.16; 95% CI:1.07, 4.39), and avoiding meeting suspected/confirmed of COVID -19 (AOR = 2.67; 95% CI:1.05, 6.83) were significantly associated with risk perception. Risk perception, knowledge and preparedness for corona virus pandemic were low. Ensuring the improvement of knowledge, preparedness, and encouragement is important.

Psychological distress experienced by physicians and nurses at a tertiary care center in Lebanon during the COVID-19 outbreak

The COVID-19 outbreak has had a significant mental health toll on healthcare workers in Lebanon. We examined pandemic-related psychological distress among healthcare workers in a tertiary care medical center. One hundred and fifty participants completed an online questionnaire. About half showed a high risk of acute distress (58.7%) on the GHQ-28, while most (89.3%) scored low/moderate stress on the PSS-10. The IES-R revealed concern for post-traumatic stress in one-third of participants, significantly in nurses (p = 0.008) and those living with vulnerable individuals (p = 0.030). Mental health history did not increase the risk. Our findings highlight the need for early targeted interventions during the pandemic.