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Ma MZ, Chen SX, Wang X. Looking beyond vaccines: Cultural tightness-looseness moderates the relationship between immunization coverage and disease prevention vigilance. Appl Psychol Health Well Being 2024; 16:1046-1072. [PMID: 38105555 DOI: 10.1111/aphw.12519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
Advancements in vaccination technologies mitigate disease transmission risks but may inadvertently suppress the behavioral immune system, an evolved disease avoidance mechanism. Applying behavioral immune system theory and utilizing robust big data analytics, we examined associations between rising vaccination coverage and government policies, public mobility, and online information seeking regarding disease precautions. We tested whether cultural tightness-looseness moderates the relationship between mass immunization and disease prevention vigilance. Comprehensive time series analyses were conducted using American data (Study 1) and international data (Study 2), employing transfer function modeling, cross-correlation function analysis, and meta-regression analysis. Across both the US and global analyses, as vaccination rates rose over time, government COVID-19 restrictions significantly relaxed, community mobility increased, and online searches for prevention information declined. The relationship between higher vaccination rates and lower disease prevention vigilance was stronger in culturally looser contexts. Results provide initial evidence that mass immunization may be associated with attenuated sensitivity and enhanced flexibility of disease avoidance psychology and actions. However, cultural tightness-looseness significantly moderates this relationship, with tighter cultures displaying sustained vigilance amidst immunization upticks. These findings offer valuable perspectives to inform nuanced policymaking and public health strategies that balance prudent precautions against undue alarm when expanding vaccine coverage worldwide.
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Affiliation(s)
- Mac Zewei Ma
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Sylvia Xiaohua Chen
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Xijing Wang
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
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Shi R, Wang Y, Chen Y, Yang Z, Jing F, Shang H, Chen E, Zhou Y. Age-specific disparity in insomnia among COVID-19 patients in Fangcang shelter hospitals: a population-based study in Shanghai, China. Front Neurol 2024; 15:1420898. [PMID: 39131047 PMCID: PMC11310121 DOI: 10.3389/fneur.2024.1420898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/05/2024] [Indexed: 08/13/2024] Open
Abstract
Background Fangcang shelter hospitals are quarantine facilities offering primary medical treatment for mild and asymptomatic SARS-CoV-2 cases. Little is known about the age-specific prevalence of insomnia among patients in Fangcang shelter hospitals, particularly in older age groups. Methods This cross-sectional study was conducted in the three largest Fangcang shelter hospitals during the lockdown period, from March to May 2022, in Shanghai. The patients' demographic and medical information was recorded. Insomnia was defined according to the prescriptions for zolpidem and estazolam. The overall and age-specific prevalence and the risk factors of insomnia were investigated through regression models. Results A total of 2,39,448 patients were included in this study (59.09% of the patients were male, the median age was 42, and 73.41% of the patients were asymptomatic), with the prevalence of insomnia being 3.1%. The prevalence of insomnia varied across different age groups (<18 years: 0.23%, 18-64 years: 2.64%, and ≥65 years: 10.36%). SARS-CoV-2 vaccine, regardless of the number of doses, was significantly associated with a decreased risk of insomnia for the group aged ≥65 years. Three doses of the vaccine reduced the risk of insomnia for patients aged 18-64 years. An extra day in the hospital significantly increased the risk of insomnia by approximately 10% for all age groups. Mild symptoms were significantly associated with a higher risk of insomnia among patients aged <65 years old, while being male and residing in the surrounding area were negatively associated with insomnia for all adults. Conclusion This study observed that older patients were a high-risk population for developing insomnia in Fangcang shelter hospitals. SARS-CoV-2 vaccination might decrease the risk of insomnia in adults, especially the older adult, which indicates the benefits of vaccination for reducing insomnia among infected patients.
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Affiliation(s)
- Ruizi Shi
- Shanghai Institute of Aviation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yihui Wang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhitao Yang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Division of Medical Affairs, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Jing
- Nursing Department, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hanbing Shang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Neurosurgery, Ruijin-Hainan Hospital, Shanghai Jiao Tong University School of Medicine, Haikou, China
| | - Erzhen Chen
- Shanghai Institute of Aviation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Zhou
- Shanghai Institute of Aviation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Cheslack-Postava K, Forthal S, Musa GJ, Ryan M, Bresnahan M, Sapigao RG, Lin S, Fan B, Svob C, Geronazzo-Alman L, Hsu YJ, Skokauskas N, Hoven CW. Persistence of anxiety among Asian Americans: racial and ethnic heterogeneity in the longitudinal trends in mental well-being during the COVID-19 pandemic. Soc Psychiatry Psychiatr Epidemiol 2024; 59:599-609. [PMID: 37624465 DOI: 10.1007/s00127-023-02553-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE To examine within-individual time trends in mental well-being and factors influencing heterogeneity of these trends. METHODS Longitudinal telephone survey of adults over 3 waves from the New York City (NYC) Metropolitan area during the COVID-19 Pandemic. Participants reported depression using the Patient Health Questionnaire (PHQ)-8, anxiety using the Generalized Anxiety Disorder (GAD)-7, and past 30-day increases in tobacco or alcohol use at each wave. Adjusted mixed effects logistic regression models assessed time trends in mental well-being. RESULTS There were 1227 respondents. Over 3 study waves, there were statistically significant decreasing time trends in the odds of each outcome (adjusted OR (95% CI) 0.47 (0.37, 0.60); p < 0.001 for depression; aOR (95% CI) 0.55 (0.45, 0.66); p < 0.001 for anxiety; aOR (95% CI) 0.50 (0.35, 0.71); p < 0.001 for past 30-day increased tobacco use; aOR (95% CI) 0.31 (0.24, 0.40); p < 0.001 for past 30-day increased alcohol use). Time trends for anxiety varied by race and ethnicity (p value for interaction = 0.05, 4 df); anxiety declined over time among white, Black, Hispanic, and Other race and ethnicity but not among Asian participants. CONCLUSIONS In a demographically varied population from the NYC Metropolitan area, depression, anxiety and increased substance use were common during the first months of the pandemic, but decreased over the following year. While this was consistently the case across most demographic groups, the odds of anxiety among Asian participants did not decrease over time.
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Affiliation(s)
- Keely Cheslack-Postava
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA.
| | - Sarah Forthal
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - George J Musa
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Megan Ryan
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
| | - Michaeline Bresnahan
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Rosemarie G Sapigao
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
- CUNY Graduate School of Public Health and Health Policy, New York, USA
| | - Susan Lin
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
| | - Bin Fan
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
| | - Connie Svob
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lupo Geronazzo-Alman
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
| | - Yi-Ju Hsu
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
| | - Norbert Skokauskas
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Christina W Hoven
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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Adzrago D, Walker TJ, Williams F. Reliability and validity of the Patient Health Questionnaire-4 scale and its subscales of depression and anxiety among US adults based on nativity. BMC Psychiatry 2024; 24:213. [PMID: 38500115 PMCID: PMC10949792 DOI: 10.1186/s12888-024-05665-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 03/06/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The burdens of anxiety and depression symptoms have significantly increased in the general US population, especially during this COVID-19 epidemiological crisis. The first step in an effective treatment for anxiety and depression disorders is screening. The Patient Health Questionnaire-4 (PHQ-4, a 4-item measure of anxiety/depression) and its subscales (PHQ-2 [a 2-item measure of depression] and Generalized Anxiety Disorder [GAD-2, a 2-item measure of anxiety]) are brief but effective mass screening instruments for anxiety and depression symptoms in general populations. However, little to no study examined the psychometric properties (i.e., reliability and validity) of the PHQ-4 and its subscales (PHQ-2 and GAD-2) in the general US adult population or based on US nativity (i.e., foreign-born vs. the US-born). We evaluated the psychometric properties of the PHQ-4 and its subscales in US adults, as well as the psychometric equivalence of the PHQ-4 scale based on nativity. METHODS We conducted a cross-sectional survey of 5,140 adults aged ≥ 18 years. We examined the factorial validity and dimensionality of the PHQ-4 with confirmatory factor analysis (CFA). A multiple-group confirmatory factor analysis (MCFA) was used to evaluate the comparability of the PHQ-4 across nativity groups. Reliability indices were assessed. Also, the scales' construct validities were assessed by examining the associations of both the PHQ-4 and its subscales' scores with the sociodemographic characteristics and the 3-item UCLA Loneliness scale. RESULTS The internal consistencies were high for the PHQ-4 scale (α = 0.92) and its subscales of PHQ-2 (α = 0.86) and GAD-2 (α = 0.90). The CFA fit indices showed evidence for the two-factor structure of the PHQ-4. The two factors (i.e., anxiety and depression) were significantly correlated (r = 0.92). The MCFA demonstrated measurement invariance of the PHQ-4 across the nativity groups, but the model fits the data better in the foreign-born group. There were significant associations of the PHQ-4 scale and its subscales' scores with the sociodemographic characteristics and the UCLA Loneliness scale (all p < 0.001). CONCLUSIONS The PHQ-4 and its subscales are reliable and valid measures to screen anxiety and depression symptoms in the general US adult population, especially in foreign-born individuals during the COVID-19 pandemic.
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Affiliation(s)
- David Adzrago
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 11545 Rockville Pike, 20852, Rockville, MD, USA.
| | - Timothy J Walker
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 11545 Rockville Pike, 20852, Rockville, MD, USA.
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Hinson-Enslin AM, Espinoza LE. The mental health symptoms of individuals with sensory disabilities and the reasons that lead to COVID-19 vaccine refusal and hesitancy. Vaccine 2024; 42:1220-1229. [PMID: 38199922 DOI: 10.1016/j.vaccine.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/08/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
The relationship between the reasons for COVID-19 vaccine hesitancy or refusal among people with sensory disabilities and mental health conditions (MHCs) are unclear. Data from the Census Bureau's Household Pulse Survey were analyzed to examine reasons for COVID-19 vaccination refusal among persons with sensory disabilities. Multivariable logistic and polytomous regression were used to examine the relationships among sensory disability status, MHC, and reasons for vaccine refusal and hesitancy. Individuals with sensory disabilities had higher proportion of anxiety and depression than those without a sensory disability. Individuals with a sensory disability and MHCs were less likely to obtain a vaccine and have a general distrust in the COVID-19 vaccine and the government than those without a disability or a MHC. These findings can assist in tailoring messages and developing programs to increase COVID-19 vaccination trust and uptake among individuals with disabilities and MHCs.
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Affiliation(s)
- Amanda M Hinson-Enslin
- Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA.
| | - Luis Enrique Espinoza
- College of Nursing and Health Sciences, Texas A&M University-Corpus Christi, Corpus Christi, TX, USA.
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Huang N, Liu X, Liu Q, Zhang J, Fu Y, Zhu Z, Guo J, Li X, Yang L. Does COVID-19 vaccination affect post-traumatic stress symptoms via risk perception? A large cross-sectional study among the Chinese population. Public Health 2024; 226:107-113. [PMID: 38052112 DOI: 10.1016/j.puhe.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/07/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVES Although infection rates may increase after relaxation of the zero COVID strategy, the extensive vaccination campaign in China could potentially curb the spread of COVID-19, which may be associated with a low level of risk perception and post-traumatic stress symptoms (PTSS). However, the relationship between vaccination, risk perception and PTSS has not been studied extensively. This study aims to examine the associations between the number of COVID-19 vaccine doses, consistency in the type of each dose and time since vaccination with PTSS, and the mediating role of risk perception on such relationships in China. STUDY DESIGN Cross-sectional sampling with a self-report questionnaire was used to measure vaccination, PTSS and risk perception. METHODS The survey was conducted in Beijing, China, from 13 January to 9 February 2023. Linear regression analyses were conducted to test the relationship between vaccination, risk perception and PTSS. RESULTS The analysis included 55,803 individuals. In total, 72.86 % of participants received two doses of the COVID-19 vaccine. Regression results indicated that people with two doses of the COVID-19 vaccine had a lower level of PTSS (β = -1.232, 95 % confidence interval [CI]: -1.930, -0.534) than those who had not received any doses of the COVID-19 vaccine. Only the negative relationship between two-dose vaccination and PTSS was mediated by risk perception, while the negative relationship between the time since vaccination and PTSS was suppressed by risk perception. CONCLUSIONS This study showed that receiving the COVID-19 vaccine reduced PTSS by decreasing perceived risk. Vaccination time was negatively associated with PTSS, but this relationship was suppressed by risk perception.
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Affiliation(s)
- N Huang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, PR China
| | - X Liu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, PR China
| | - Q Liu
- Department of General Practice, Second Outpatient Section, Peking University Third Hospital, Beijing, PR China
| | - J Zhang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, PR China
| | - Y Fu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, PR China
| | - Z Zhu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, PR China
| | - J Guo
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, PR China.
| | - X Li
- Department of Infectious Diseases, Peking University Third Hospital, Beijing, PR China.
| | - L Yang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, PR China.
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Zhang X, Yue Q, Li M, Wu C, Zhou L, Cai Y, Xu J. SARS-CoV-2 vaccination may improve anxious, insomnia and depressive symptoms among Chinese population aged 18-75 years during the COVID-19 pandemic. Sci Rep 2023; 13:22029. [PMID: 38087031 PMCID: PMC10716261 DOI: 10.1038/s41598-023-48977-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
Previous studies have reported significant decreases in the incidence of mental health problems following SARS-CoV-2 vaccination. However, less relevant studies are published in China. We conducted a cross-sectional study involving Chinese adults aged 18-75 years with no known psychiatric diseases. The study used data from mental health of SARS-CoV-2 vaccinated and unvaccinated participants from May 2020 to July 2021.Three standardized scales, namely, the Generalized Anxiety Disorder-7 (GAD-7) for anxious symptoms, Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms and Athens Insomnia Score-8 (AIS-8) for insomnia symptoms, as well as basic demographic questions were used. The hierarchical regression method was used for multivariate logistic regression analysis to explore the effects of SARS-CoV-2 vaccination on anxious, insomnia, and depressive symptoms. The results confirmed first that vaccinated participants experienced significantly lower anxious, insomnia, and depressive symptoms scores (P < 0.001) compared with unvaccinated participants. Second that vaccinated participants had a lower prevalence of anxious, insomnia, and depressive symptoms (P < 0.001). Third, after adjusting for potential confounders, we still observed a good correlation between vaccination and a reduced risk of anxious, insomnia, and depressive symptoms. The current study showed that SARS-CoV-2 vaccination may be helpful in improving anxious, insomnia, and depressive symptoms.
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Affiliation(s)
- Xiaobo Zhang
- Department of Neurology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City), 818 Renmin Road, Changde, 415000, Hunan, China
| | - Qiang Yue
- Department of Neurology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City), 818 Renmin Road, Changde, 415000, Hunan, China
| | - Mingxia Li
- Department of NeurosurgeryChangde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City), 818 Renmin Road, Changde, 415000, Hunan, China
| | - Chaoping Wu
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Lu Zhou
- The Outpatient DepartmentChangde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City), 818 Renmin Road, Changde, 415000, Hunan, China
| | - Yang Cai
- Department of Infectious Diseases, Changde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City), 818 Renmin Road, Changde, 415000, Hunan, China.
| | - Jian Xu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China.
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d'Arqom A, Akram M, Azzahranisa NS, Nasution MZ, Surjaningrum ER, Yusof J. Societal influence and psychological distress among Indonesian adults in Java on the early Omicron wave of COVID-19. Future Sci OA 2023; 9:FSO894. [PMID: 37753359 PMCID: PMC10518838 DOI: 10.2144/fsoa-2023-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/02/2023] [Indexed: 09/28/2023] Open
Abstract
Aim Changes during the COVID-19 pandemic might create pressure on different people, thus this study aimed to measure respondents' psychological distress during the early phase of the Omicron wave in Java Island. Methods A web-based survey on societal influence and COVID-19-related psychological distress was distributed through social media in November-December 2021, and received 396 responses. Results This study showed that almost 50% of respondents faced psychological distress during the early phase of the Omicron variant, especially concerning hypervigilance and avoidance. Several sociodemographic factors might contribute to the incidence of psychological distress including comorbidity, age and education. Conclusion Taken together, the incidence of COVID-19-related psychological distress was still found in the early phase of the Omicron variant, especially among young adults.
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Affiliation(s)
- Annette d'Arqom
- Division of Pharmacology & Therapy, Department of Anatomy, Histology, & Pharmacology, Faculty of Medicine, Universitas Airlangga, 60131, Indonesia
- Airlangga Research Group for Translational Medicine & Therapeutic, Universitas Airlangga, 60131, Indonesia
| | - Muh Akram
- Faculty of Medicine, Universitas Airlangga, Surabaya, 60131, Indonesia
| | | | | | | | - Junaidah Yusof
- School of Human Resource Development & Psychology, Faculty of Social Sciences & Humanities, Universiti Teknologi Malaysia, Johor Bahru, 81310, Malaysia
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Wang S, Luo G, Zhang X, Jing Y, Zaimina, Yao C, Li M, Chen H, Li J. Prevalence and influencing factors of sleep disturbance among medical students under the COVID-19 pandemic. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01707-6. [PMID: 38007404 DOI: 10.1007/s00406-023-01707-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/15/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Medical students may feel severe psychological stress during COVID-19, which might impair their ability to sleep. This research aimed to look at the risk factors for sleep disturbance and the prevalence of sleep disturbance among medical students. METHODS 538 medical students in total were recruited for this research. Anxiety, depression, and sleep disturbance were assessed using the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI). To evaluate the possible risk variables, we computed descriptive statistics for each assessment item and ran univariate and logistic regression analyses. RESULTS Medical students had a 63.6% prevalence of sleep disturbance (n = 342). According to logistic regression, introverted students are 1.77 times more likely than extroverted students to have sleep disturbance (OR = 1.77, 95% CI 1.08-2.91). Medical students with depression had a 5.6-times higher risk of sleep disturbance than those without depression (OR = 5.60, 95% CI 3.43-9.15). Additionally, medical students with anxiety were 3.95 times more likely than those without anxiety to have sleep disturbance (OR = 3.95, 95% CI 2.04-7.64). CONCLUSIONS According to this research, the COVID-19 pandemic caused significant sleep disturbance among medical students. Additionally, among medical students, introversion, anxiety, and depression were risk factors for sleep disturbance.
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Affiliation(s)
- Shuo Wang
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China
| | - Guoshuai Luo
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China
| | - Xue Zhang
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China
| | - Yifan Jing
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China
| | - Zaimina
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China
| | - Cong Yao
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China
| | - Meijuan Li
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China
| | - Hongli Chen
- State Key Laboratory of Separation Membrane and Membrane Process, Tiangong University, Tianjin, 300387, China
| | - Jie Li
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China.
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Radomyslsky Z, Kivity S, Lidar S, Bentur N, Korn L, Nissanholtz-Gannot R, Sternberg S, Halevi Hochwald I, Reges O, Alon Y, Saban M. Association between COVID-19 vaccination and critical outcomes among older adults with dementia: a comparative cohort study. Front Public Health 2023; 11:1281266. [PMID: 37849724 PMCID: PMC10578450 DOI: 10.3389/fpubh.2023.1281266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Background As COVID-19 vaccines became available, understanding their potential benefits in vulnerable populations has gained significance. This study explored the advantages of COVID-19 vaccination in individuals with cognitive disorders by analyzing health-related variables and outcomes. Methods A prospective cohort study analyzed electronic medical records of 25,733 older adults with cognitive disorders and 65,544 older adults without cognitive disorders from March 2020 to February 2022. COVID-19 vaccination status was the primary exposure variable, categorized as fully vaccinated or unvaccinated. The primary outcomes measured were all-cause mortality and hospitalization rates within 14 and 400 days post-vaccination. Data on vaccination status, demographics, comorbidities, testing history, and clinical outcomes were collected from electronic health records. The study was ethically approved by the relevant medical facility's Institutional Review Board (0075-22-MHS). Results Vaccinated individuals had significantly lower mortality rates in both groups. In the research group, the mortality rate was 52% (n = 1852) for unvaccinated individuals and 7% (n = 1,241) for vaccinated individuals (p < 0.001). Similarly, in the control group, the mortality rate was 13.58% (n = 1,508) for unvaccinated individuals and 1.85% (n = 936) for vaccinated individuals (p < 0.001), despite higher COVID-19 positivity rates. In the research group, 30.26% (n = 1,072) of unvaccinated individuals tested positive for COVID-19, compared to 37.16% (n = 6,492) of vaccinated individuals (p < 0.001). In the control group, 17.31% (n = 1922) of unvaccinated individuals were COVID-19 positive, while 37.25% (n = 18,873) of vaccinated individuals tested positive (p < 0.001). Vaccination also showed potential benefits in mental health support. The usage of antipsychotic drugs was lower in vaccinated individuals (28.43%, n = 4,967) compared to unvaccinated individuals (37.48%, n = 1,328; 95% CI [0.92-1.28], p < 0.001). Moreover, vaccinated individuals had lower antipsychotic drug prescription rates (23.88%, n = 4,171) compared to unvaccinated individuals (27.83%, n = 968; 95% CI [-1.02 to -0.63], p < 0.001). Vaccination appeared to have a positive impact on managing conditions like diabetes, with 38.63% (n = 6,748) of vaccinated individuals having diabetes compared to 41.55% (n = 1,472) of unvaccinated individuals (95% CI [0.24, 0.48], p < 0.001). Discussion The findings highlight the importance of vaccination in safeguarding vulnerable populations during the pandemic and call for further research to optimize healthcare strategies for individuals with cognitive disorders.
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Affiliation(s)
| | - Sara Kivity
- Department of Health System Management, Ariel University, Ariel, Israel
| | - Shira Lidar
- Department of Health System Management, Ariel University, Ariel, Israel
| | - Netta Bentur
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Korn
- Department of Health System Management, Ariel University, Ariel, Israel
| | - Rachel Nissanholtz-Gannot
- Department of Health System Management, Ariel University, Ariel, Israel
- Mayers-JDC-Brookdale Institute, Jerusalem, Israel
| | - Shelley Sternberg
- Department of Health System Management, Ariel University, Ariel, Israel
| | | | - Orna Reges
- Department of Health System Management, Ariel University, Ariel, Israel
| | - Yaniv Alon
- Nursing Department, School of Health Sciences, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mor Saban
- Nursing Department, School of Health Sciences, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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da Graca B, Bennett MM, Gottlieb RL, Douglas ME, Powers MB, Warren AM. Associations of Mental Health and Experience of the COVID-19 Pandemic with United States Adults' Intentions to Be Vaccinated. Popul Health Manag 2023; 26:317-324. [PMID: 37643305 DOI: 10.1089/pop.2023.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
COVID-19 vaccine uptake in the United States has proved challenging. A deeper characterization extending beyond demographics and political ideologies of those hesitating or resisting is needed to guide ongoing conversations. This study examined associations between US adults' vaccination intentions and mental health history, experience of the COVID-19 pandemic, and mental health outcomes. An online population-based cross-sectional survey was administered nationwide during January 4-7, 2021. Participants were questioned about past and current mental health, and completed the Patient Health Questionnaire 8 (PHQ-8), Generalized Anxiety Disorder 7-item (GAD-7), and Posttraumatic Diagnostic Scale (PDS)-5 (to capture symptoms of depression, anxiety, and traumatic stress, respectively). Experience of the pandemic included cumulative county-level COVID case and death rates, self-reported COVID-19 testing/exposure/diagnosis, and self-reported impact on routines, resources, and relationships. Of 936 respondents, 66% intended to be vaccinated, 14.7% responded "maybe," and 19.6% "no." Past diagnosis of obsessive compulsive disorder, less impact on routines or social supports, not having been screened or tested for COVID-19, not knowing someone who tested positive, and not self-isolating were associated with less intention to vaccinate. After controlling for demographic and pandemic experience factors, symptoms of traumatic stress, but not other mental health outcomes, were associated with less intention to vaccinate. The apparent contradiction between less negative impact of the pandemic and symptoms of traumatic stress being associated with less intention to be vaccinated indicates the complex nature of barriers to vaccine uptake. Results from this study contribute to the evidence base needed to improve ongoing and future communications about, and strategies to increase uptake of, vaccination.
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Affiliation(s)
| | | | | | | | - Mark B Powers
- Baylor Scott & White Research Institute, Dallas, Texas, USA
- Baylor University Medical Center, Dallas, Texas, USA
| | - Ann Marie Warren
- Baylor Scott & White Research Institute, Dallas, Texas, USA
- Baylor University Medical Center, Dallas, Texas, USA
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12
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Ryu S, Kim JW, Lee JY, Kang YS, Shin HY, Jung SI, Kim JM, Kim SW. Psychological and Personality Characteristics Associated With COVID-19 Vaccination Behavior in Korean General Population. J Korean Med Sci 2023; 38:e234. [PMID: 37527911 PMCID: PMC10396430 DOI: 10.3346/jkms.2023.38.e234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/30/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND This study characterized coronavirus disease 2019 (COVID-19) vaccination behavior in the Korean general population using cluster analysis and explored related psychological factors. METHODS We categorized 1,500 individuals based on their attitudes toward COVID-19 vaccination using hierarchical clustering and identified their level of vaccine acceptance. We examined the associations between vaccine acceptance and behavioral and psychological characteristics. RESULTS Clustering revealed three groups according to vaccine acceptance: 'totally accepting' (n = 354, 23.6%), 'somewhat accepting' (n = 523, 34.9%), and 'reluctant' (n = 623, 41.5%). Approximately 60% of all participants who belonged to the 'totally accepting' and 'somewhat accepting' groups were willing to receive a COVID-19 vaccine despite concerns about its side effects. High vaccine acceptance was associated with older age, regular influenza vaccination, and trust in formal sources of information. Participants with high vaccine acceptance had higher levels of gratitude, extraversion, agreeableness, and conscientiousness, and lower levels of depression, anxiety, and neuroticism. CONCLUSIONS People weighed the benefits of COVID-19 vaccination against the risk of side effects when deciding to receive the COVID-19 vaccine. Our findings also indicate that this vaccination behavior may be affected by coping mechanisms and psychological factors.
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Affiliation(s)
- Seunghyong Ryu
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Shin Kang
- Department of Psychology, Chonnam National University, Gwangju, Korea
| | - Hee-Young Shin
- Department of Biomedical Science, Chonnam National University Medical School, Gwangju, Korea
| | - Sook-In Jung
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Korea.
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13
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Honsky J, Edguer MN, Click ER, Rusnak S, Burgess Van Aken B, Salerno MA, Berg KA. Mindfulness matters in the classroom: A pilot study of a university-wide classroom-based brief mindfulness program. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-10. [PMID: 37490524 DOI: 10.1080/07448481.2023.2237596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 05/22/2023] [Accepted: 07/09/2023] [Indexed: 07/27/2023]
Abstract
Objective: The aims of this pilot study were: first, to assess the impact of a brief classroom-based mindfulness program on students' reported levels of mindfulness, well-being, and stress; and, second, to understand students' experiences of participating in the program.Participants: Students at a private midwestern research-intensive university, 133 (16%) students completed either the study's pretest or post-test survey.Methods: The study had an observational design using pre- and post-test survey responses from students taking courses from faculty who were trained to facilitate brief classroom-based mindfulness activities.Results: Students who participated in the semester-long program reported reduced levels of stress and increased mindfulness. Qualitative data indicate that students found the program to be beneficial.Conclusions: Brief classroom-based mindfulness activities led by faculty may have benefits for students in higher education settings. More research is recommended to better understand the impact of mindfulness in the classroom on students and faculty.
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Affiliation(s)
- Jesse Honsky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Marjorie N Edguer
- Jack, Joseph, and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Elizabeth R Click
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | - Matthew A Salerno
- School of Law, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kristen A Berg
- Center for Health Care Research and Policy, Population Health Research Institute, MetroHealth Medical Center, Cleveland, Ohio, USA
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14
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Ryu S, Kang H, Jung HR, Yun H, Kang SH, Kim TS, Choi S, Kim JW, Lee JY, Kim JM, Jung SI, Yoon BH, Kim SW. COVID-19 vaccine acceptance and related behavioral and psychological characteristics in individuals with mental disorders in Korea. Front Psychiatry 2023; 14:1195103. [PMID: 37260761 PMCID: PMC10228693 DOI: 10.3389/fpsyt.2023.1195103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/02/2023] [Indexed: 06/02/2023] Open
Abstract
Objective This study aimed to investigate COVID-19 vaccine acceptance and related factors in individuals with mental disorders in Korea. Methods We surveyed 572 individuals with mental disorders about their attitudes toward COVID-19 vaccination using a 7-item self-rating questionnaire on vaccine acceptance and hesitancy. We categorized the respondents into groups based on their level of vaccine acceptance using hierarchical clustering. In addition, we evaluated the respondents' vaccination status and trust in sources of information regarding COVID-19 vaccines, and assessed their psychological characteristics using the Patient Health Questionnaire-9, Gratitude Questionnaire-6, and Big Five Inventory-10. Results Clustering revealed three groups according to vaccine acceptance: 'totally accepting' (n= 246, 43.0%), 'somewhat accepting' (n= 184, 32.2%), and 'hesitant' (n= 142, 24.8%) groups. Three quarters of all participants, who belonged to the 'totally accepting' or 'somewhat accepting' groups, were willing to receive a COVID-19 vaccine despite concerns about its side effects. Individuals in the high vaccine acceptance group were older (F= 12.52, p< 0.001), more likely to receive the influenza vaccine regularly, and more likely to trust formal information sources. Additionally, they had higher levels of gratitude (F= 21.00, p< 0.001) and agreeableness (F= 4.50, p= 0.011), and lower levels of depression (χ2= 11.81, p= 0.003) and neuroticism (F= 3.71, p= 0.025). Conclusion The present study demonstrated that individuals with mental disorders were generally willing to receive COVID-19 vaccination. However, they weighed its need and effectiveness against potential side effects before coming to a decision. It is important to understand the behavioral and psychological characteristics associated with vaccine acceptance, to effectively communicate its importance to individuals with mental disorders.
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Affiliation(s)
- Seunghyong Ryu
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hangoeunbi Kang
- Department of Psychiatry, Naju National Hospital, Naju, Republic of Korea
| | - Ha-Ran Jung
- Department of Psychiatry, Naju National Hospital, Naju, Republic of Korea
| | - Hyunju Yun
- Department of Psychiatry, Naju National Hospital, Naju, Republic of Korea
- Gokseonggun Mental Health Center, Gokseong, Republic of Korea
| | - Shi-Hyun Kang
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
| | - Tae-Suk Kim
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Seunggi Choi
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sook-In Jung
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Bo-Hyun Yoon
- Department of Psychiatry, Naju National Hospital, Naju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Republic of Korea
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15
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Alotaibi KA, Balay-Odao EM, Cruz JP, Alotaibi JS, Bajet JB, Alquwez N, Mesde J, Almansour AM, Almoghairi A, Albougami AS. Influence of the Psychological Effect of COVID-19 on Saudi Student Nurses' Attitudes toward Nursing and Their Future Career Plans. J Pers Med 2023; 13:jpm13040672. [PMID: 37109058 PMCID: PMC10141600 DOI: 10.3390/jpm13040672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/06/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The effects of COVID-19 on the attitude of student nurses toward the nursing profession remain unclear because few studies have been conducted on this topic. Thus, this study examines the influence of the psychological effects of COVID-19 on student nurses' attitudes toward the nursing profession and their desire to become nurses. METHOD The study utilised a quantitative, cross-sectional, and observational design. It surveyed a convenience sample of 726 student nurses in Saudi Arabia during the first semester of the 2021-2022 academic year. RESULTS The students reported low levels of COVID-19 fear, anxiety, stress, phobia, and obsession. The students reported positive attitudes toward the nursing profession and 86.0% highlighted their desire to continue with nursing as their future profession. Gender, knowing someone infected with COVID-19, confidence in the government's pandemic response, fear, anxiety, and phobia were significant predictors of the nurses' attitudes. Community, family members in the profession, "COVID-19-related anxiety", and "preference for the nursing profession" were significant predictors of the student's desire to continue nursing. CONCLUSIONS Living in a rural community, having family members in the nursing profession, having low levels of COVID-19-related anxiety, and having positive attitudes toward nursing increased the likelihood of nursing students continuing their nursing careers during the COVID-19 pandemic.
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Affiliation(s)
- Khalaf Aied Alotaibi
- Department of Nursing, College of Applied Medical Sciences, Shaqra University, Dawadmi 11961, Saudi Arabia
| | - Ejercito Mangawa Balay-Odao
- Department of Medicine, School of Medicine, Nazarbayev University, Kerey and Zhanibek Khans St 5/1, Nur-Sultan 010000, Kazakhstan
- School of Advanced Studies, Saint Louis University, Baguio City 2600, Philippines
| | - Jonas Preposi Cruz
- Department of Medicine, School of Medicine, Nazarbayev University, Kerey and Zhanibek Khans St 5/1, Nur-Sultan 010000, Kazakhstan
| | - Jazi Shaydied Alotaibi
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al-Majmaah 11952, Saudi Arabia
| | - Junel Bryan Bajet
- Department of Nursing, College of Applied Medical Sciences, Shaqra University, Dawadmi 11961, Saudi Arabia
| | - Nahed Alquwez
- Department of Nursing, College of Applied Medical Sciences, Shaqra University, Dawadmi 11961, Saudi Arabia
| | - Jennifer Mesde
- Department of Nursing, College of Applied Medical Sciences, Shaqra University, Dawadmi 11961, Saudi Arabia
| | - Ahmed Mansour Almansour
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al-Majmaah 11952, Saudi Arabia
| | - Ahmed Almoghairi
- Department of Nursing, College of Applied Medical Sciences, Shaqra University, Dawadmi 11961, Saudi Arabia
| | - Abdulrhman Saad Albougami
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al-Majmaah 11952, Saudi Arabia
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16
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Tancredi S, Ulytė A, Wagner C, Keidel D, Witzig M, Imboden M, Probst-Hensch N, Amati R, Albanese E, Levati S, Crivelli L, Kohler P, Cusini A, Kahlert C, Harju E, Michel G, Lüdi C, Ortega N, Baggio S, Chocano-Bedoya P, Rodondi N, Ballouz T, Frei A, Kaufmann M, Von Wyl V, Lorthe E, Baysson H, Stringhini S, Schneider V, Kaufmann L, Wieber F, Volken T, Zysset A, Dratva J, Cullati S. Changes in socioeconomic resources and mental health after the second COVID-19 wave (2020-2021): a longitudinal study in Switzerland. Int J Equity Health 2023; 22:51. [PMID: 36959642 PMCID: PMC10035489 DOI: 10.1186/s12939-023-01853-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/25/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND During the 2020/2021 winter, the labour market was under the impact of the COVID-19 pandemic. Changes in socioeconomic resources during this period could have influenced individual mental health. This association may have been mitigated or exacerbated by subjective risk perceptions, such as perceived risk of getting infected with SARS-CoV-2 or perception of the national economic situation. Therefore, we aimed to determine if changes in financial resources and employment situation during and after the second COVID-19 wave were prospectively associated with depression, anxiety and stress, and whether perceptions of the national economic situation and of the risk of getting infected modified this association. METHODS One thousand seven hundred fifty nine participants from a nation-wide population-based eCohort in Switzerland were followed between November 2020 and September 2021. Financial resources and employment status were assessed twice (Nov2020-Mar2021, May-Jul 2021). Mental health was assessed after the second measurement of financial resources and employment status, using the Depression, Anxiety and Stress Scale (DASS-21). We modelled DASS-21 scores with linear regression, adjusting for demographics, health status, social relationships and changes in workload, and tested interactions with subjective risk perceptions. RESULTS We observed scores above thresholds for normal levels for 16% (95%CI = 15-18) of participants for depression, 8% (95%CI = 7-10) for anxiety, and 10% (95%CI = 9-12) for stress. Compared to continuously comfortable or sufficient financial resources, continuously precarious or insufficient resources were associated with worse scores for all outcomes. Increased financial resources were associated with higher anxiety. In the working-age group, shifting from full to part-time employment was associated with higher stress and anxiety. Perceiving the Swiss economic situation as worrisome was associated with higher anxiety in participants who lost financial resources or had continuously precarious or insufficient resources. CONCLUSION This study confirms the association of economic stressors and mental health during the COVID-19 pandemic and highlights the exacerbating role of subjective risk perception on this association.
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Affiliation(s)
- Stefano Tancredi
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.
| | - Agnė Ulytė
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Cornelia Wagner
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Dirk Keidel
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Melissa Witzig
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Medea Imboden
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Rebecca Amati
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Emiliano Albanese
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Sara Levati
- Department of Business Economics, Health and Social Care at the University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Luca Crivelli
- Department of Business Economics, Health and Social Care at the University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St Gallen, St-Gallen, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Alexia Cusini
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St Gallen, St-Gallen, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Christian Kahlert
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St Gallen, St-Gallen, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Erika Harju
- Department Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Gisela Michel
- Department Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Chantal Lüdi
- Department Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Natalia Ortega
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Division of Prison Health, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
| | - Patricia Chocano-Bedoya
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco Kaufmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Viktor Von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Elsa Lorthe
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Hélène Baysson
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Valentine Schneider
- Cantonal Public Health Service of the Canton of Neuchâtel, Neuchâtel, Switzerland
| | - Laurent Kaufmann
- Cantonal Public Health Service of the Canton of Neuchâtel, Neuchâtel, Switzerland
| | - Frank Wieber
- Zurich University of Applied Sciences, Institute of Public Health, Winterthur, Switzerland
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Thomas Volken
- Zurich University of Applied Sciences, Institute of Public Health, Winterthur, Switzerland
| | - Annina Zysset
- Zurich University of Applied Sciences, Institute of Public Health, Winterthur, Switzerland
| | - Julia Dratva
- University of Basel, Basel, Switzerland
- Zurich University of Applied Sciences, Institute of Public Health, Winterthur, Switzerland
| | - Stéphane Cullati
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
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Xiao Y, Brown TT, Snowden LR, Chow JCC, Mann JJ. COVID-19 Policies, Pandemic Disruptions, and Changes in Child Mental Health and Sleep in the United States. JAMA Netw Open 2023; 6:e232716. [PMID: 36912834 DOI: 10.1001/jamanetworkopen.2023.2716] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
IMPORTANCE The adverse effects of COVID-19 containment policies disrupting child mental health and sleep have been debated. However, few current estimates correct biases of these potential effects. OBJECTIVES To determine whether financial and school disruptions related to COVID-19 containment policies and unemployment rates were separately associated with perceived stress, sadness, positive affect, COVID-19-related worry, and sleep. DESIGN, SETTING, AND PARTICIPANTS This cohort study was based on the Adolescent Brain Cognitive Development Study COVID-19 Rapid Response Release and used data collected 5 times between May and December 2020. Indexes of state-level COVID-19 policies (restrictive, supportive) and county-level unemployment rates were used to plausibly address confounding biases through 2-stage limited information maximum likelihood instrumental variables analyses. Data from 6030 US children aged 10 to 13 years were included. Data analysis was conducted from May 2021 to January 2023. EXPOSURES Policy-induced financial disruptions (lost wages or work due to COVID-19 economic impact); policy-induced school disruptions (switches to online or partial in-person schooling). MAIN OUTCOMES AND MEASURES Perceived stress scale, National Institutes of Health (NIH)-Toolbox sadness, NIH-Toolbox positive affect, COVID-19-related worry, and sleep (latency, inertia, duration). RESULTS In this study, 6030 children were included in the mental health sample (weighted median [IQR] age, 13 [12-13] years; 2947 [48.9%] females, 273 [4.5%] Asian children, 461 [7.6%] Black children, 1167 [19.4%] Hispanic children, 3783 [62.7%] White children, 347 [5.7%] children of other or multiracial ethnicity). After imputing missing data, experiencing financial disruption was associated with a 205.2% [95% CI, 52.9%-509.0%] increase in stress, a 112.1% [95% CI, 22.2%-268.1%] increase in sadness, 32.9% [95% CI, 3.5%-53.4%] decrease in positive affect, and a 73.9 [95% CI, 13.2-134.7] percentage-point increase in moderate-to-extreme COVID-19-related worry. There was no association between school disruption and mental health. Neither school disruption nor financial disruption were associated with sleep. CONCLUSIONS AND RELEVANCE To our knowledge, this study presents the first bias-corrected estimates linking COVID-19 policy-related financial disruptions with child mental health outcomes. School disruptions did not affect indices of children's mental health. These findings suggest public policy should consider the economic impact on families due to pandemic containment measures, in part to protect child mental health until vaccines and antiviral drugs become available.
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Affiliation(s)
- Yunyu Xiao
- Weill Cornell Medicine, NewYork Presbyterian, Department of Population Health Sciences, New York
| | | | | | | | - J John Mann
- Departments of Psychiatry and Radiology, Columbia University Irving Medical Center, Columbia University, New York
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York
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18
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Chourpiliadis C, Lovik A, Kähler AK, Valdimarsdóttir UA, Frans EM, Nyberg F, Sullivan PF, Fang F. Short-term improvement of mental health after a COVID-19 vaccination. PLoS One 2023; 18:e0280587. [PMID: 36791070 PMCID: PMC9931115 DOI: 10.1371/journal.pone.0280587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/03/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION The role of COVID-19 vaccination on the mental health of the general population remains poorly understood. This study aims to assess the short-term change in depressive and anxiety symptoms in relation to COVID-19 vaccination among Swedish adults. METHODS A prospective study of 7,925 individuals recruited from ongoing cohort studies at the Karolinska Institutet, Stockholm, Sweden, or through social media campaigns, with monthly data collections on self-reported depressive and anxiety symptoms from December 2020 to October 2021 and COVID-19 vaccination from July to October 2021. Prevalence of depressive and anxiety symptoms (defined as a self-reported total score of ≥10 in PHQ-9 and GAD-7, respectively) was calculated one month before, one month after the first dose, and, if applicable, one month after the second dose. For individuals not vaccinated or choosing not to report vaccination status (unvaccinated individuals), we selected three monthly measures of PHQ-9 and GAD-7 with 2-month intervals in-between based on data availability. RESULTS 5,079 (64.1%) individuals received two doses of COVID-19 vaccine, 1,977 (24.9%) received one dose, 305 (3.9%) were not vaccinated, and 564 (7.1%) chose not to report vaccination status. There was a lower prevalence of depressive and anxiety symptoms among vaccinated, compared to unvaccinated individuals, especially after the second dose. Among individuals receiving two doses of vaccine, the prevalence of depressive and anxiety symptoms was lower after both first (aRR = 0.82, 95%CI 0.76-0.88 for depression; aRR = 0.81, 95%CI 0.73-0.89 for anxiety) and second (aRR = 0.79, 95%CI 0.73-0.85 for depression; aRR = 0.73, 95%CI 0.66-0.81 for anxiety) dose, compared to before vaccination. Similar results were observed among individuals receiving only one dose (aRR = 0.76, 95%CI 0.68-0.84 for depression; aRR = 0.82, 95%CI 0.72-0.94 for anxiety), comparing after first dose to before vaccination. CONCLUSIONS We observed a short-term improvement in depressive and anxiety symptoms among adults receiving COVID-19 vaccines in the current pandemic. Our findings provide new evidence to support outreach campaigns targeting hesitant groups.
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Affiliation(s)
| | - Anikó Lovik
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna K. Kähler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Unnur A. Valdimarsdóttir
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Emma M. Frans
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Patrick F. Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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19
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Cylus J, Walters J, McKee M, Cowley P. Consumption and tax gains attributable to Covid-19 vaccinations in 12 EU countries with low vaccination rates. Eur J Public Health 2023; 33:228-234. [PMID: 36780609 PMCID: PMC10066489 DOI: 10.1093/eurpub/ckad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The Covid-19 pandemic is an economic and a health crisis. Households reduced consumption expenditures as large-scale physical distancing measures, lower disposable incomes and fear of infection when engaging in many types of economic activity took hold. This, in turn, reduced domestic tax revenues at a time when governments were facing increased financial pressures to strengthen and sustain welfare states. METHODS We developed a simulation model, the Covid-19 Taxination Simulator, to estimate potential economic gains and tax revenues attributable to vaccine rollouts. We apply the model to 12 European Union countries which had low vaccination rates at the beginning of 2022. RESULTS The highest growth in aggregate personal consumption expenditure attributable to Covid-19 vaccines administered as of January 2022 is in Greece (10.8%), Slovenia (8.6%) and Czechia (8.6%), while the lowest is in Bulgaria (2.2%) and Slovakia (2.1%). If countries had vaccinated 85% of their adult population, the largest gains in consumption tax revenues would be expected in Romania (830 million Euros) and Poland (738 million Euros). Consumption tax revenues generated by meeting the 85% of the adult population target would, on their own, be large enough to fully cover the costs of expanding the vaccine rollout itself in Estonia, Latvia, Slovenia, Croatia, Czechia, Hungary and Greece. CONCLUSION Covid-19 vaccination rollouts not only save lives and relieve pressures on health systems, they also support economic growth and generate additional tax revenues. These revenues can partially offset the costs of vaccines programmes themselves.
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Affiliation(s)
- Jonathan Cylus
- European Observatory on Health Systems and Policies, London, UK.,LSE Health, Department of Health Policy, London School of Economics and Political Science, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,WHO Barcelona Office for Health Systems Financing, World Health Organization Regional Office for Europe, Barcelona, Spain.,Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.,Brown University School of Public Health, Providence, USA
| | - Jessica Walters
- European Observatory on Health Systems and Policies, London, UK
| | - Martin McKee
- European Observatory on Health Systems and Policies, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Cowley
- Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
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20
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Hromatko I, Mikac U, Tadinac M. Intention to Vaccinate against COVID-19 among Young Adults: The Role of Conspiratorial Thinking. Vaccines (Basel) 2023; 11:vaccines11020321. [PMID: 36851199 PMCID: PMC9965982 DOI: 10.3390/vaccines11020321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
The anti-scientific and anti-vaccine movements gained momentum amidst the health and socio-economic crisis brought about by the COVID-19 pandemic. These widespread pseudoscientific beliefs and the endorsement of conspiracy theories likely contributed to the COVID-19 vaccine hesitancy. The aim of this study was to explore which variables best differentiated between groups of vaccinated (n = 289), vaccine-hesitant (n = 106), and vaccine-refusing (n = 146) young adults. The study was conducted online at the beginning of the mass vaccination campaign in Croatia when the vaccine just became available for younger and non-vulnerable members of the general population. The demographic variables, COVID-19 anxiety, and conspiratorial thinking regarding COVID-19 were entered into the discriminant analysis. The function explaining 89.2% of the group differences, mostly between the vaccinated and vaccine-refusing, was largely defined by conspiratorial thinking regarding COVID-19 (0.852), followed by variables with substantially less discriminative power, including COVID-19 anxiety (0.423; lower in the vaccine-refusing group), political orientation (0.486; vaccine-refusing leaning less to the left), financial and educational status (0.435 and 0.304, respectively; both lower in the vaccine-refusing group), and religiosity (0.301; higher in the vaccine-refusing group). These results confirm that among young adults, the decision to vaccinate against COVID-19 might be heavily influenced by one's proclivity to engage in conspiratorial thinking.
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21
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Lee SE, Shim SR, Youn JH, Han HW. COVID-19 Vaccination Is Not Associated with Psychiatric Adverse Events: A Meta-Analysis. Vaccines (Basel) 2023; 11:vaccines11010194. [PMID: 36680038 PMCID: PMC9861090 DOI: 10.3390/vaccines11010194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has been a global health problem since December 2019. Vaccination has been widely considered the best way to prevent COVID-19 pandemic, but public concerns about the safety of vaccines remain. There have been many studies reporting adverse events in the vaccinated. However, to date, no meta-analysis of the association of COVID-19 vaccination with psychiatric adverse events has been conducted yet. In this meta-analysis, studies on depression, anxiety and distress after COVID-19 vaccination were searched in the PubMed, Cochrane and Embase from January 2020 to April 2022. The OR of depression in four studies with a total sample size of 462,406 is obtained as 0.88 (95% CI; 0.75, 1.03), and the OR of anxiety as 0.86 (95% CI; 0.71, 1.05). However, there were no statistically significant differences between the groups. The mean difference of distress in two studies was −0.04 (95%CI; −0.05, −0.02; p < 0.0001). As a result of the moderator analysis, married people experienced less depression and anxiety after vaccination, and in White people, depression after vaccination was lower than others. We also found that people with a history of COVID-19 infection were more depressed and anxious after vaccination. We suggest that COVID-19 vaccination was not associated with a worsening of depression and anxiety.
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Affiliation(s)
- Sang-Eun Lee
- Graduate School of Clinical Counseling Psychology, CHA University, Seongnam 13488, Republic of Korea
| | - Sung-Ryul Shim
- Department of Health and Medical Informatics, Kyungnam University, College of Health Sciences, Changwon 51767, Republic of Korea
- Evidence Based Research Center, Kyungnam University, Changwon 51767, Republic of Korea
| | - Jung-Hae Youn
- Graduate School of Clinical Counseling Psychology, CHA University, Seongnam 13488, Republic of Korea
- Correspondence: (J.-H.Y.); (H.-W.H.)
| | - Hyun-Wook Han
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam 13488, Republic of Korea
- Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam 13488, Republic of Korea
- Institute for Biomedical Informatics, School of Medicine, CHA University, Seongnam 13488, Republic of Korea
- Healthcare Big-Data Center, Bundang CHA Hospital, Seongnam 13488, Republic of Korea
- Correspondence: (J.-H.Y.); (H.-W.H.)
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22
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Workneh F, Worku A, Assefa N, Berhane Y. Change in depression during the COVID-19 pandemic among healthcare providers in Addis Ababa, Ethiopia. PeerJ 2023; 11:e15053. [PMID: 37065689 PMCID: PMC10100826 DOI: 10.7717/peerj.15053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/21/2023] [Indexed: 04/18/2023] Open
Abstract
Background The COVID-19 pandemic has increased mental health problems among healthcare workers globally. However, studies from low- and middle-income countries on this matter were minimal. This study assessed the change in depression prevalence during the first year of the COVID-19 pandemic and associated factors among healthcare providers in Addis Ababa, Ethiopia. Methods We conducted surveys among healthcare workers in Addis Ababa at two-time points, September 2020 and October 2021. A total of 577 study participants were randomly selected based on registers obtained from professional associations. Computer-assisted telephone interviewing technique was used for data collection. The Patient Health Questionnaire (PHQ-9) was used to screen for depression. Multivariable logistic regression analysis was performed to identify potential factors associated with depression. Result The prevalence of depression among healthcare workers was 2.3% (95% CI [1.1-4.8]) in Time 1 and 6.5% (95% CI [4.1-10.1]) in Time 2; nearly a three-fold increase in Time 2 compared to Time 1. The most frequently reported symptoms at both times based on the PHQ-9 item were having poor energy, sleep problem, and anhedonia, while reported suicidal ideation was less than 5%. Depression showed a positive and significant association with a positive COVID-19 test result (AOR 7.25 95% CI [1.32-39.4]) in Time 1, and with being a female healthcare provider (AOR 3.96 95% CI [1.08-14.51]) and lack of COVID-19 related policy or guidelines at the workplace (AOR 3.22 95% CI [1.11-9.35]) in Time 2. Conclusion The prevalence of depression among healthcare workers tripled during the first year of the COVID-19 pandemic. Panic reaction to positive COVID-19 test result seems to have a negative effect at the beginning while lack of disease-specific prevention guidelines and comprehensive psychological interventions for healthcare providers had an adverse effect on the mental health of health workers.
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Affiliation(s)
- Firehiwot Workneh
- Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yemane Berhane
- Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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23
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Paul JN, Mbalawata IS, Mirau SS, Masandawa L. Mathematical modeling of vaccination as a control measure of stress to fight COVID-19 infections. CHAOS, SOLITONS, AND FRACTALS 2023; 166:112920. [PMID: 36440088 PMCID: PMC9678855 DOI: 10.1016/j.chaos.2022.112920] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/29/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
The world experienced the life-threatening COVID-19 disease worldwide since its inversion. The whole world experienced difficult moments during the COVID-19 period, whereby most individual lives were affected by the disease socially and economically. The disease caused millions of illnesses and hundreds of thousands of deaths worldwide. To fight and control the COVID-19 disease intensity, mathematical modeling was an essential tool used to determine the potentiality and seriousness of the disease. Due to the effects of the COVID-19 disease, scientists observed that vaccination was the main option to fight against the disease for the betterment of human lives and the world economy. Unvaccinated individuals are more stressed with the disease, hence their body's immune system are affected by the disease. In this study, the S V E I H R deterministic model of COVID-19 with six compartments was proposed and analyzed. Analytically, the next-generation matrix method was used to determine the basic reproduction number ( R 0 ). Detailed stability analysis of the no-disease equilibrium ( E 0 ) of the proposed model to observe the dynamics of the system was carried out and the results showed that E 0 is stable if R 0 < 1 and unstable when R 0 > 1 . The Bayesian Markov Chain Monte Carlo (MCMC) method for the parameter identifiability was discussed. Moreover, the sensitivity analysis of R 0 showed that vaccination was an essential method to control the disease. With the presence of a vaccine in our S V E I H R model, the results showed that R 0 = 0 . 208 , which means COVID-19 is fading out of the community and hence minimizes the transmission. Moreover, in the absence of a vaccine in our model, R 0 = 1 . 7214 , which means the disease is in the community and spread very fast. The numerical simulations demonstrated the importance of the proposed model because the numerical results agree with the sensitivity results of the system. The numerical simulations also focused on preventing the disease to spread in the community.
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Affiliation(s)
- James Nicodemus Paul
- School of Computational and Communication Science and Engineering, The Nelson Mandela African Institution of Science and Technology, P.O Box 447, Arusha, Tanzania
| | - Isambi Sailon Mbalawata
- African Institute for Mathematical Sciences, NEI Global Secretariat, Rue KG590 ST, Kigali, Rwanda
| | - Silas Steven Mirau
- School of Computational and Communication Science and Engineering, The Nelson Mandela African Institution of Science and Technology, P.O Box 447, Arusha, Tanzania
| | - Lemjini Masandawa
- School of Computational and Communication Science and Engineering, The Nelson Mandela African Institution of Science and Technology, P.O Box 447, Arusha, Tanzania
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24
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Ausserhofer D, Mahlknecht A, Engl A, Piccoliori G, Pfitscher G, Silbernagl P, Giacomoni F, Pycha R, Lombardo S, Gärtner T, Mian M, Meier H, Wiedermann CJ, Keim R. Relationship between depression, anxiety, stress, and SARS-CoV-2 infection: a longitudinal study. Front Psychol 2023; 14:1116566. [PMID: 37213392 PMCID: PMC10197902 DOI: 10.3389/fpsyg.2023.1116566] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/06/2023] [Indexed: 05/23/2023] Open
Abstract
Objectives We aimed to (1) describe the course of the emotional burden (i.e., depression, anxiety, and stress) in a general population sample during the coronavirus pandemic in 2020 and 2021 and (2) explore the association between emotional burden and a serologically proven infection with SARS-CoV-2. Study design This longitudinal study involved a sample of community-dwelling persons aged ≥14 years from the general population of South Tyrol (Province of Bolzano-Bozen, Northern Italy). Data were collected at two stages over a 1-year period in 2020 and 2021. Methods Persons were invited to participate in a survey on socio-demographic, health-related and psychosocial variables (e.g., age, chronic diseases, Depression Anxiety Stress Scale, DASS-21), as well as in the serological testing for of SARS-CoV-2-specific immunoglobulins. Results In 2020, 855 (23.8%) out of 3,600 persons participated; in 2021, 305 (35.7%) out of 855 were tested again. We observed a statistically significant decrease in mean DASS-21 scores for depression, stress, and total scores between 2020 and 2021, yet not for anxiety. Persons with a confirmed SARS-CoV-2-infection between the first and second data collection exhibited increased emotional burden compared to those without SARS-CoV-2-infection. The odds of participants with a self-reported diagnosis of mental disorder for future infection with SARS-CoV-2 was almost four times higher than that of participants without mental disorders (OR:3.75; 95%CI:1.79-7.83). Conclusion Our findings support to the hypothesis of a psycho-neuroendocrine-immune interplay in COVID-19. Further research is necessary to explore the mechanisms underlying the interplay between mental health and SARS-CoV-2 infections.
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Affiliation(s)
- Dietmar Ausserhofer
- Institute of General Practice and Public Health, College of Health Care-Professions Claudiana, Bolzano-Bozen, Italy
- Claudiana Research, College of Health Care-Professions Claudiana, Bolzano-Bozen, Italy
| | - Angelika Mahlknecht
- Institute of General Practice and Public Health, College of Health Care-Professions Claudiana, Bolzano-Bozen, Italy
| | - Adolf Engl
- Institute of General Practice and Public Health, College of Health Care-Professions Claudiana, Bolzano-Bozen, Italy
| | - Giuliano Piccoliori
- Institute of General Practice and Public Health, College of Health Care-Professions Claudiana, Bolzano-Bozen, Italy
| | - Gernot Pfitscher
- Hospital of Bressanone-Brixen (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bressanone-Brixen, Italy
| | - Philipp Silbernagl
- Hospital of Bressanone-Brixen (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bressanone-Brixen, Italy
| | - Francesca Giacomoni
- Hospital of Bressanone-Brixen (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bressanone-Brixen, Italy
| | - Roger Pycha
- Hospital of Bressanone-Brixen (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bressanone-Brixen, Italy
| | - Stefano Lombardo
- Statistical Institute of the Province of Bolzano (ASTAT), Bolzano-Bozen, Italy
| | - Timon Gärtner
- Statistical Institute of the Province of Bolzano (ASTAT), Bolzano-Bozen, Italy
| | - Michael Mian
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano-Bozen, Italy
| | - Horand Meier
- Clinical Governance Unit, Administration of the Autonomous Province of Bolzano-Bozen, Bolzano-Bozen, Italy
| | - Christian J. Wiedermann
- Institute of General Practice and Public Health, College of Health Care-Professions Claudiana, Bolzano-Bozen, Italy
- Department of Public Health, Medical Decision Making and Health Technology Assessment, University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Roland Keim
- Hospital of Bressanone-Brixen (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bressanone-Brixen, Italy
- *Correspondence: Roland Keim,
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25
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Ma D, Kuang Y, Lan Z, Zeng S, Li Y, Shang M, Zhang RY, Zhao B, Li W. The rapid change in mental health among college students after introduction of on-campus quarantine during the 2022 Shanghai COVID-19 lockdown. Front Public Health 2023; 11:1132575. [PMID: 37213647 PMCID: PMC10196357 DOI: 10.3389/fpubh.2023.1132575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/03/2023] [Indexed: 05/23/2023] Open
Abstract
Objectives Among the various impacts of disasters in terms of emotions, quarantine has been proven to result in significant increases in mental health problems. Studies of psychological resilience during outbreaks of epidemics tend to focus on long-term social quarantine. In contrast, insufficient studies have been conducted examining how rapidly negative mental health outcomes occur and how these outcomes change over time. We evaluated the time course of psychological resilience (over three different phases of quarantine) among students at Shanghai Jiao Tong University to investigate the influence of unexpected changes on college students. Methods An online survey was conducted from 5 to 7 April 2022. A structured online questionnaire was administered using a retrospective cohort trial design. Before 9 March (Period 1), individuals engaged in their usual activities without restrictions. From 9 to 23 March (Period 2), the majority of students were asked to remain in their dormitories on campus. From 24 March to early April (Period 3), restrictions were relaxed, and students were gradually allowed to participate in essential activities on campus. We quantified dynamic changes in the severity of students' depressive symptoms over the course of these three periods. The survey consisted of five sets of self-reported questions: demographic information, lifestyle/activity restrictions, a brief mental health history, COVID-19-related background, and the Beck Depression Inventory, second edition. Results A total of 274 college students aged 18-42 years (mean = 22.34; SE = 0.24) participated in the study (58.39% undergraduate students, 41.61% graduate students; 40.51% male, 59.49% female). The proportion of students with depressive symptoms was 9.1% in Period 1, 36.1% in Period 2, and 34.67% in Period 3. Depressive symptoms increased notably with the introduction of the quarantine in Periods 2 and 3. Lower satisfaction with the food supplied and a longer duration of physical exercise per day were found to be positively associated with changes in depression severity in Periods 2 and 3. Quarantine-related psychological distress was more evident in students who were in a romantic relationship than in students who were single. Conclusion Depressive symptoms in university students rapidly increased after 2 weeks of quarantine and no perceptible reversal was observed over time. Concerning students in a relationship, ways to take physical exercise and to relax should be provided and the food supplied should be improved when young people are quarantined.
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Affiliation(s)
- Dongni Ma
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, and Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
- Institute of Psychology and Behavioral Science, Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China
- WLA Laboratories, World Laureates Association, Shanghai, China
| | - Yifang Kuang
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, and Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
- Institute of Psychology and Behavioral Science, Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China
- WLA Laboratories, World Laureates Association, Shanghai, China
- Correspondence: Yifang Kuang, ; Binglei Zhao, ; Weidong Li,
| | - Zhaohui Lan
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, and Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
- Institute of Psychology and Behavioral Science, Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China
- WLA Laboratories, World Laureates Association, Shanghai, China
| | - Suhua Zeng
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, and Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
- Institute of Psychology and Behavioral Science, Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China
- WLA Laboratories, World Laureates Association, Shanghai, China
| | - Yi Li
- SJTU Paris Elite Institute of Technology, Shanghai Jiao Tong University, Shanghai, China
| | - Mengnan Shang
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, and Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
- Institute of Psychology and Behavioral Science, Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China
- WLA Laboratories, World Laureates Association, Shanghai, China
| | - Ru-Yuan Zhang
- Institute of Psychology and Behavioral Science, Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Binglei Zhao
- Institute of Psychology and Behavioral Science, Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China
- Correspondence: Yifang Kuang, ; Binglei Zhao, ; Weidong Li,
| | - Weidong Li
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, and Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
- Institute of Psychology and Behavioral Science, Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China
- WLA Laboratories, World Laureates Association, Shanghai, China
- Global Institute of Future Technology, Shanghai Jiao Tong University, Shanghai, China
- Correspondence: Yifang Kuang, ; Binglei Zhao, ; Weidong Li,
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Becerra-García JA, Barbeito S, Calvo A, Sanchez-Gutierrez T. Vaccination against SARS-CoV-2 and its relationship with public interest in mental health: a study between 2020-2022 in Spain. PSYCHOL HEALTH MED 2022:1-10. [DOI: 10.1080/13548506.2022.2159049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | - Sara Barbeito
- Health Sciences Faculty, Universidad Internacional de La Rioja (UNIR), La Rioja, Spain
| | - Ana Calvo
- Department of Personality, Assessment and Clinical Psychology, School of Psychology, Universidad Complutense de Madrid, Madrid, Spain
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Chiang C, Morita S, Hirakawa Y, Priya FT, Matsumoto Y, Ota A, Yatsuya H, Tabuchi T. Possible contribution of COVID-19 vaccination to the subsequent mental well-being in Japan. Sci Rep 2022; 12:21195. [PMID: 36477701 PMCID: PMC9729563 DOI: 10.1038/s41598-022-25357-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had a severe impact on mental well-being. Vaccination may have played a pivotal role in enduring this mental health crisis. The present study aimed to longitudinally investigate the association between COVID-19 vaccination and mental health status among Japanese population in 2021. Longitudinal data of 17,089 individuals aged 15-79 years who participated in a nationwide online study were analyzed. Baseline and follow-up mental health statuses were assessed using the Kessler Psychological Distress Scale (K6). General linear and multivariable logistic regression models adjusted for baseline levels of mental distress were used to examine the association between vaccine receipt and follow-up levels of mental health. Mean K6 scores were lower in the vaccinated than in the non-vaccinated participants. Those who had received one or two doses of COVID-19 vaccines were associated with improved mental health at follow-up in subjects with psychological distress at baseline (odds ratio [OR] 1.31 and 1.35, respectively) and were inversely associated with deteriorated mental health status at follow-up in subjects without psychological distress at baseline (OR 0.66 and 0.70, respectively) compared with no vaccination groups, respectively. The present study would indicate that one or two doses of COVID-19 vaccinations contributed to mental well-being in Japan. This finding might provide evidence for promoting vaccination against COVID-19 and emerging infectious diseases in the future.
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Affiliation(s)
- Chifa Chiang
- grid.27476.300000 0001 0943 978XDepartment of Public Health and Health Systems, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya, Aichi 466-8550 Japan
| | - Shuhei Morita
- grid.27476.300000 0001 0943 978XNagoya University School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya, Aichi 466-8550 Japan
| | - Yoshihisa Hirakawa
- grid.27476.300000 0001 0943 978XDepartment of Public Health and Health Systems, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya, Aichi 466-8550 Japan
| | - Farzana Tanzin Priya
- grid.27476.300000 0001 0943 978XDepartment of Public Health and Health Systems, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya, Aichi 466-8550 Japan
| | - Yuka Matsumoto
- grid.27476.300000 0001 0943 978XNagoya University School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya, Aichi 466-8550 Japan
| | - Atsuhiko Ota
- grid.256115.40000 0004 1761 798XDepartment of Public Health, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192 Japan
| | - Hiroshi Yatsuya
- grid.27476.300000 0001 0943 978XDepartment of Public Health and Health Systems, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya, Aichi 466-8550 Japan
| | - Takahiro Tabuchi
- grid.489169.b0000 0004 8511 4444Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka-shi, Osaka 541-8567 Japan
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Montero-López E, Peralta-Ramírez MI, Ortego-Centeno N, Callejas-Rubio JL, Ríos-Fernández R, Santos-Ruiz A. Psychological and quality of life effects of vaccination against COVID-19 in patients with systemic autoimmune diseases. Lupus 2022; 31:1808-1815. [PMID: 36355914 PMCID: PMC9659700 DOI: 10.1177/09612033221134203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
To verify the psychological and quality of life benefits of vaccination against COVID-19 in patients with systemic autoimmune diseases. In this study, levels of psychological stress, psychopathological symptoms, quality of life, and satisfaction with life were compared in patients with systemic autoimmune diseases vaccinated against COVID-19 (n = 132) versus unvaccinated patients (n = 254). To this end, we used the Perceived Stress Scale (PSS), Symptom Checklist-90-Revised (SCL-90-R), EUROQoL-5Q health questionnaire, and Satisfaction with Life Scale (SWLS), respectively. Statistically significant differences were found with better scores in the vaccinated group in the following quality of life dimensions: mobility (p ≤ 0.010), domestic activities (p ≤ 0.004), pain/discomfort (p ≤ 0.001), and anxiety/depression (p≤ 0.005). The scores were also significantly higher in the vaccinated group for the total values of quality of life (p ≤ 0.001), health status self-assessment on the EUROQoL-5Q (p ≤ 0.043), and satisfaction with life (p ≤ 0.015). In addition, the unvaccinated group presented higher scores with clinically pathological levels in depression and psychoticism for somatizations (p ≤ 0.006), depression (p ≤ 0.015), anxiety (p ≤ 0.003), and phobic anxiety (p ≤ 0.001). Finally, participants vaccinated with the complete regimen showed better levels of psychological well-being than those who were not vaccinated or those that had not completed the vaccination regimen. Our results reflect and confirm the positive effects reported elsewhere of the COVID-19 vaccine in autoimmune patients with systemic diseases, both in terms of quality and satisfaction with life as well as psychopathological symptoms and perceived stress. These benefits increased as the patients completed their vaccination schedule.
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Affiliation(s)
- Eva Montero-López
- Department of Developmental and
Educational Psychology, University of Granada, Granada, Spain
| | - María Isabel Peralta-Ramírez
- Department of Clinical Psychology, University of Granada, Granada, Spain
- Mind, Brain, Behavior Research Center
(CIMCYC), Granada, Spain
| | - Norberto Ortego-Centeno
- Department of Medicine, University of Granada, Granada, Spain
- Systemic Autoimmune Diseases Unit, San Cecilio Clinical
Hospital, Granada, Spain
- Biohealth Research Institute
(IBS), Granada, Spain
| | - José Luis Callejas-Rubio
- Systemic Autoimmune Diseases Unit, San Cecilio Clinical
Hospital, Granada, Spain
- Biohealth Research Institute
(IBS), Granada, Spain
| | - Raquel Ríos-Fernández
- Systemic Autoimmune Diseases Unit, San Cecilio Clinical
Hospital, Granada, Spain
- Biohealth Research Institute
(IBS), Granada, Spain
| | - Ana Santos-Ruiz
- Department of of Health Psychology, University of Alicante, Alicante, Spain
- Institute for Health and Biomedical
Research (ISABIAL), Alicante, Spain
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Erdoğan S, Can AA, Abiç A, Yilmaz DV. Examination of individuals' depression, anxiety, and stress levels during the COVID-19 pandemic in Turkey. Arch Psychiatr Nurs 2022; 41:96-102. [PMID: 36428081 PMCID: PMC9307468 DOI: 10.1016/j.apnu.2022.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/31/2022] [Accepted: 07/10/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE This research was conducted to determine the depression, anxiety, and stress levels of individuals during the COVID-19 epidemic. In addition, the compatibility of the Depression-Anxiety-Stress Scale (DASS-21) scale results with the participants' feeling depressed, anxious, and stressed were examined. DESIGN AND METHODS The sample of the study consisted of 870 individuals over the age of 18 between May-August 2021. The data of the study were collected online, using the personal information form and DASS-21. RESULTS In our study, it was observed that 22.3 % of the participants were severely depressed, 19.0 % were highly anxious and 14.3 % were highly stressed. In addition, a relationship was determined between many sociodemographic variables and depression, anxiety, and stress levels. It was found that individuals who were not vaccinated, did not receive health care, and were not satisfied with health care were more depressed, anxious, and stressed. The agreement between all DASS-21 sub-dimensions and participants' feeling is poor in terms of Cohen's kappa. The agreement is poor in the anxiety sub dimension, but moderate in the other sub-dimensions in terms of Gwet's AC1. PRACTICE IMPLICATIONS It is recommended that nurses develop new care and evaluation strategies for the psychosocial field in order to protect and maintain the health of individuals during the COVID-19 pandemic process, as well as more practices promoting the COVID-19 vaccine in our country.
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Affiliation(s)
- Semra Erdoğan
- Department of Biostatistics and Medical Informatics, Mersin University Faculty of Medicine, 33343 Mersin, Turkey.
| | - Ahu Aksoy Can
- Department of Obstetrics and Gynecology Nursing, Mersin University Faculty of Nursing, 33343 Mersin, Turkey
| | - Arzu Abiç
- Department of Nursing, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, North Cyprus, via Mersin 10, Turkey.
| | - Duygu Vefikuluçay Yilmaz
- Department of Obstetrics and Gynecology Nursing, Mersin University Faculty of Nursing, 33343 Mersin, Turkey; Department of Obstetrics and Gynecology Nursing, Mersin University Faculty of Nursing, Mersin, 33343 Mersin, Turkey
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Trajectories of resilience and mental distress to global major disruptions. Trends Cogn Sci 2022; 26:1171-1189. [PMID: 36302711 PMCID: PMC9595401 DOI: 10.1016/j.tics.2022.09.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/20/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
The COVID-19 pandemic has resulted in a major societal disruption, raising the question of how people can maintain or quickly regain their mental health (i.e., be resilient) during such times. Researchers have used the pandemic as a use case for studying resilience in response to a global, synchronously starting, and chronic set of stressors on the individual and societal level. Our review of this recent literature reveals that mental distress trajectories during the pandemic largely resemble mental distress responses to individual-level macro-stressors, except for a lower prevalence of recovery trajectories. Results suggest more resilient responses in older adults, but trajectories are less consistent for younger and older ages compared with middle-aged adults. We call for more research integrating state-of-the-art operationalizations of resilience and using these to study resilience over the lifespan.
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Andhavarapu S, Yardi I, Bzhilyanskaya V, Lurie T, Bhinder M, Patel P, Pourmand A, Tran QK. Post-traumatic stress in healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry Res 2022; 317:114890. [PMID: 36260970 PMCID: PMC9573911 DOI: 10.1016/j.psychres.2022.114890] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 10/02/2022] [Accepted: 10/06/2022] [Indexed: 01/05/2023]
Abstract
The SARS-CoV-2 (COVID-19) pandemic has increased healthcare worker (HCW) susceptibility to mental illness. We conducted a meta-analysis to investigate the prevalence and possible factors associated with post-traumatic stress disorder (PTSD) symptoms among HCW during the COVID-19 pandemic. We searched PubMed, SCOPUS and EMBASE databases up to May 4th, 2022. We performed random effects meta-analysis and moderator analyses for the prevalence of PTSD-relevant symptoms and severe PTSD symptoms. We identified 1276 studies, reviewed 209 full-text articles, and included 119 studies (117,143 participants) with a total of 121 data points in our final analysis. 34 studies (24,541 participants) reported prevalence of severe PTSD symptoms. Approximately 25.2% of participants were physicians, 42.8% nurses, 12.4% allied health professionals, 8.9% auxiliary health professionals, and 10.8% "other". The pooled prevalence of PTSD symptoms among HCWs was 34% (95% CI, 0.30-0.39, I2 >90%), and 14% for severe PTSD (95% CI, 0.11 - 0.17, I2 >90%). The introduction of COVID vaccines was associated with a sharp decline in the prevalence of PTSD, and new virus variants were associated with small increases in PTSD rates. It is important that policies work towards allocating adequate resources towards protecting the well-being of healthcare workers to minimize adverse consequences of PTSD.
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Affiliation(s)
- Sanketh Andhavarapu
- The Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Isha Yardi
- The Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Vera Bzhilyanskaya
- The Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Tucker Lurie
- The Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Mujtaba Bhinder
- The Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Priya Patel
- The Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, 22 South Greene Street, Suite T3N45, Baltimore, MD 21043, United States; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States.
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Long D, Bonsel GJ, Lubetkin EI, Yfantopoulos JN, Janssen MF, Haagsma JA. Health-Related Quality of Life and Mental Well-Being during the COVID-19 Pandemic in Five Countries: A One-Year Longitudinal Study. J Clin Med 2022; 11:6467. [PMID: 36362694 PMCID: PMC9654255 DOI: 10.3390/jcm11216467] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 10/02/2023] Open
Abstract
This study aimed to investigate socioeconomic and health-related determinants and recent life events and their relation to changes in health-related quality of life (HRQoL) and mental well-being during the first year of the COVID-19 pandemic. A web-based survey was administered repeatedly to participants from Greece, Italy, the Netherlands, the United Kingdom, and the United States. Primary outcome measures were HRQoL (measured by EQ-5D-5L) and mental well-being (measured by WHO-5). Linear regression analyses were performed to estimate the impact of determinants on HRQoL and well-being. In total, 6765 respondents completed the questionnaire at T1 (April-May 2020) and T2 (May-June 2021). Regarding results, 33% showed improved HRQoL at T2, whereas 31% deteriorated. In terms of mental well-being, 44% improved and 41% deteriorated. The greatest deterioration in HRQoL and mental well-being from T1 to T2 was observed with an increasing number of chronic conditions. The effect of negative life events on HRQoL and mental well-being was larger than the effect of positive life events. We conclude that slightly more respondents showed improved rather than deteriorated HRQoL and mental well-being, with some variation by outcome measure and country.
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Affiliation(s)
- Di Long
- Department of Public Health, Erasmus MC, 3000 CA Rotterdam, The Netherlands
| | - Gouke J. Bonsel
- EuroQol Research Foundation, 3068 AV Rotterdam, The Netherlands
| | - Erica I. Lubetkin
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY 10031, USA
| | - John N. Yfantopoulos
- Health Department of Economics, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Mathieu F. Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, 3000 CA Rotterdam, The Netherlands
| | - Juanita A. Haagsma
- Department of Public Health, Erasmus MC, 3000 CA Rotterdam, The Netherlands
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Qin Y, Zhao Z, Teng Z, Xu B, Wang X, Guo J, Huang J, Wu H. COVID-19 vaccination coverage among patients with psychiatric disorders in China during the pandemic: a cross-sectional study. BMC Psychiatry 2022; 22:659. [PMID: 36289487 PMCID: PMC9597954 DOI: 10.1186/s12888-022-04271-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the Coronavirus Disease 2019 (COVID-19) vaccination coverage and the influential factors of vaccination among patients with mental disorders, we conducted a cross-sectional study in China. METHOD The anonymous questionnaires including demographic data, vaccination status, intention to be vaccinated and its reasons were collected in the Second Xiangya Hospital, one of the biggest four psychiatric centers in China. Mental health of these participants were measured by the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder-7 items (GAD-7). The influential factors associated with vaccination status were analyzed by Fisher exact tests and binary logistical analysis. RESULT 1328 patients and 922 family members completed the survey. The vaccination rate of patients included was 69.4%, whereas 85.5% patients were willing to be vaccinated. Being hospitalized (aOR 0.41, 95% CI:0.27-0.60), suffering from schizophrenia (aOR 0.38, 95% CI: 0.19-0.75) and secondary school educational background (aOR 0.58, 95% CI: 0.37-0.93) were significantly associated with less likelihood to get vaccinated. Uptaking vaccines could reduce depressive (aOR 0.63, 95% CI: 0.41-0.98) or anxious symptoms (aOR 0.40, 95% CI: 0.25-0.63) in these patients for a short period. CONCLUSION Further COVID-19 immunization programme should prioritize hospitalized psychiatric patients and schizophrenic patients since their demands for vaccination had been partly ignored during the current inoculation.
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Affiliation(s)
- Yue Qin
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China
| | - Ziru Zhao
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China
| | - Ziwei Teng
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China
| | - Baoyan Xu
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China
| | - Xianghe Wang
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China
| | - Jingyi Guo
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China
| | - Jing Huang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China.
| | - Haishan Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China.
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Wadasadawala T, Kumar A, Laskar SG, Mokal S, Kapoor R, Das A, Pradhan S, Pujari L, Mahantshetty U, Vadgaonkar R, Agarwal JP. A Longitudinal Study to Reexamine the Mental Health Impact on Radiation Oncology Health Care Workers with the Launch of COVID-19 Vaccination Strategies in India. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1755547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Introduction The novel coronavirus disease 2019 (COVID-19) catastrophe caused significant mental threats to health care workers (HCW), especially during the first wave of the pandemic. India successfully implemented vaccination strategies in January 2021 that is likely to ameliorate the mental health impact of HCWs. The current survey aims to identify the change in impact following vaccination and address the issues affecting mental health.
Objective The primary objective is to reevaluate the stress levels of radiation oncology HCWs with vaccine implementation and compare it with the mental health status at the onset of the pandemic. The secondary objective is to identify the current causative factors influencing mental health.
Materials and Methods Health care workers who participated in the initial mental health impact survey at the outset of the COVID-19 pandemic from May to July 2020 were included in this study. Two hundred eligible HCWs were reassessed of the total 363 initial assessments. The 7-item Generalised Anxiety Disorder (GAD-7), 9-item Patient Health Questionnaire (PHQ-9), and 22-item Impact of Events Scale-revised (IES-R) was again served for assessing anxiety, depression, and posttraumatic stress disorder. The Mc Nemar test was used to evaluate the change and significance of the mental health impact. Univariate and multivariate analyses were done to identify the causative factors affecting mental health.
Results The cohort's median age was 30 years (interquartile range [IQR]: 27–33). The incidence of moderate-to-severe level anxiety, depression, and stress significantly declined to 6.5% (p = 0.031), 9% (p = 0.01), and 19% (p < 0.001) compared with 39.5, 40.5, and 30.5% during the pandemic onset. On further analysis, HCWs with affected family members had higher levels of stress (p = 0.002). The rest of the parameters did not have significant impact on mental health outcomes.
Conclusion With public education, awareness, and vaccination strategies, the second follow-up survey conducted after vaccine implementation demonstrated a significant number of HCWs in the radiation oncology community, exhibiting a decline in the incidence of anxiety, depression, and stress levels compared with the initial wave of the pandemic.
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Affiliation(s)
- Tabassum Wadasadawala
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anuj Kumar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sarbani G. Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Smruti Mokal
- Department of Biostatistics, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rakesh Kapoor
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Abhijit Das
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Satyajit Pradhan
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital, Varanasi, Uttar Pradesh, India
| | - Lincoln Pujari
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital, Varanasi, Uttar Pradesh, India
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, Andhra Pradesh, India
| | - Rohit Vadgaonkar
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, Andhra Pradesh, India
| | - Jai P. Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Sleep Quality Worsens While Perceived Stress Improves in Healthcare Workers over Two Years during the COVID-19 Pandemic: Results of a Longitudinal Study. Healthcare (Basel) 2022; 10:healthcare10081588. [PMID: 36011245 PMCID: PMC9408655 DOI: 10.3390/healthcare10081588] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/09/2022] [Accepted: 08/19/2022] [Indexed: 11/25/2022] Open
Abstract
The purpose of the study was to measure changes in sleep quality and perceived stress and their interrelationships in a sample of healthcare workers two years post the COVID-19 pandemic. Using a cohort design, data were collected from frontline healthcare workers (FLHCW, n = 70) and non-frontline healthcare workers (NFLHCW, n = 74) in April 2020 (T1) and in February 2022 (T2). The Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS-10) were administered at both time points. There were no differences in sleep quality or perceived stress between FLHCW and NFLHCW at either timepoint. For the entire sample, the PSQI scores at T2 were significantly higher than at T1 (7.56 ± 3.26 and 7.25 ± 3.29, respectively) (p = 0.03, Cohen’s d = 0.18). PSS-10 scores at T2 were significantly lower than at T1 (19.85 ± 7.73 and 21.13 ± 7.41, respectively) (p = 0.001, Cohen’s d = 0.78). Baseline sleep quality PSQI (T1) was a significant predictor for changes in sleep quality. During the initial months of the outbreak of the COVID-19 pandemic, poor sleep quality and perceived stress were common for healthcare workers. Two years into the pandemic, the perceived stress was reduced, but sleep quality worsened.
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Rogowska AM, Chilicka K, Ochnik D, Paradowska M, Nowicka D, Bojarski D, Tomasiewicz M, Filipowicz Z, Grabarczyk M, Babińska Z. Network Analysis of Well-Being Dimensions in Vaccinated and Unvaccinated Samples of University Students from Poland during the Fourth Wave of the COVID-19 Pandemic. Vaccines (Basel) 2022; 10:vaccines10081334. [PMID: 36016222 PMCID: PMC9414629 DOI: 10.3390/vaccines10081334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 01/07/2023] Open
Abstract
Although numerous studies investigated the predictors of vaccination intention and decision, little is known about the relationship between vaccination and well-being. This study compares the physical and mental health dimensions among vaccinated and unvaccinated people. In a cross-sectional online survey, 706 university students from Poland (mean age of 23 years, 76% of women) participated in this study during the fourth pandemic wave (November–December 2021). Standardized questionnaires with a Likert response scale were included in the survey to measure spirituality, exposure to the COVID-19 pandemic, perceived physical health, stress, coronavirus-related PTSD, fear of COVID-19, anxiety, depression, and life satisfaction. Consistent with the fuzzy-trace theory, the unvaccinated sample was younger and scored significantly lower than the vaccinated group in exposure to COVID-19, perceived physical health, stress, coronavirus-related PTSD, fear of COVID-19, and depression, while higher in life satisfaction. The network analysis showed that mental health plays a crucial role in both groups, with the central influence of anxiety and stress on depression and life satisfaction. The message on vaccination to university students should focus on the benefits of vaccination in maintaining the status quo of good health and well-being. Campus prevention programs should primarily aim to reduce anxiety, stress, and negative emotions by teaching students coping strategies, relaxation techniques, and mindfulness.
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Affiliation(s)
| | - Karolina Chilicka
- Department of Health Sciences, University of Opole, 45-040 Opole, Poland
| | - Dominika Ochnik
- Faculty of Medicine, University of Technology, 40-555 Katowice, Poland
| | - Maria Paradowska
- Faculty of Psychology and Cognitive Studies, Adam Mickiewicz University in Poznan, 60-568 Poznan, Poland
| | - Dominika Nowicka
- Faculty of Sociology, University of Warsaw, 00-927 Warsaw, Poland
| | - Dawid Bojarski
- Faculty of Psychology and Cognitive Studies, Adam Mickiewicz University in Poznan, 60-568 Poznan, Poland
| | | | - Zuzanna Filipowicz
- Department of Pharmacology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | | | - Zuzanna Babińska
- Institute of the Middle and the Far East, Faculty of International and Political Studies, Jagiellonian University, 30-063 Krakov, Poland
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Affiliation(s)
- Bhramar Mukherjee
- Bhramar Mukherjee is Professor of Biostatistics, Epidemiology and Global Public Health at the University of Michigan, Ann Arbor, Michigan 48109-2029, USA
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Sasaki N, Kuroda R, Tsuno K, Imamura K, Kawakami N. COVID-19 vaccination did not improve employee mental health: A prospective study in an early phase of vaccination in Japan. Neuropsychopharmacol Rep 2022; 42:230-232. [PMID: 35411665 PMCID: PMC9216361 DOI: 10.1002/npr2.12250] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives This study aimed to examine the effectiveness of vaccination to improve mental health among employees in Japan based on a prospective study. Methods The data were retrieved from the Employee Cohort Study conducted during the COVID‐19 pandemic in Japan (E‐ COCO‐J) at T1 (4–10 February 2021) and T2 (22–29 June 2021). Psychological distress was measured by using an 18‐item scale of the Brief Job Stress Questionnaire (BJSQ). The analytic sample was limited to individuals employed at both T1 and T2 without missing covariates. Vaccination status was measured at T2. Statistical analysis was conducted to test the differential change in the psychological distress at T1 and T2 with the time × group interactions by using repeated ANOVA, adjusting for the covariates (gender, age, marital status, education, chronic disease, company size, industry, and occupation). Results Of the total sample (N = 948), 105 (11.1%) were vaccinated at least once at T2. The crude mean scores of psychological distress at T1 and T2 were 41.8 and 42.0 for vaccinated participants and 41.2 and 41.2 for nonvaccinated participants, respectively, with no significant effect of having been vaccinated (Cohen's d = 0.02, P = 0.833). After adjusting the covariates, there was no significance (P = 0.446). Conclusions The COVID‐19 vaccination was supposed to have a limited effect on mental health among Japanese employees in an early phase of vaccination. To keep providing mental health care for employees is important even after starting the vaccination program.
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Affiliation(s)
- Natsu Sasaki
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Reiko Kuroda
- Division for Environment, Health, and Safety, The University of Tokyo, Tokyo, Japan
| | - Kanami Tsuno
- School of Health Innovation, Kanagawa University of Human Services, Yokosuka, Japan
| | - Kotaro Imamura
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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