Stigma Over COVID-19; New Conception Beyond Individual Sense

Competing realities, uncertain diagnoses of infectious disease: Mass self-testing for COVID-19 and liminal bio-citizenship

Diagnoses of infectious diseases are being transformed as mass self-testing using rapid antigen tests (RATs) is increasingly integrated into public health. Widely used during the COVID-19 pandemic, RATs are claimed to have many advantages over 'gold-standard' polymerase chain reaction tests, especially their ease of use and production of quick results. Yet, while laboratory studies indicate the value of RATs in detecting the SARS-CoV-2 virus antigen, uncertainty surrounds their deployment and ultimate effectiveness in stemming infections. This article applies the analytic lens of biological citizenship (or bio-citizenship) to explore Australia's experience of implementing a RAT-based mass self-testing strategy to manage COVID-19. Drawing on Annemarie Mol's (1999, The Sociological Review, 47(1), 74-89) concept of ontological politics and analysing government statements, scientific articles and news media reporting published during a critical juncture of the strategy's implementation, we explore the kind of bio-citizenship implied by this strategy. Our analysis suggests the emergence of what we call liminal bio-citizenship, whereby citizens are made responsible for self-managing infection risk without the diagnostic certitude this demands. We discuss how the different realities of mass self-testing interact to reinforce this liminal citizenship and consider the implications for the sociology of diagnosis.

COVID-19 pandemic in the intensive care unit: Psychological implications and interventions, a systematic review

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic produced changes in intensive care units (ICUs) in patient care and health organizations. The pandemic event increased patients’ risk of developing psychological symptoms during and after hospitalisation. These consequences also affected those family members who could not access the hospital. In addition, the initial lack of knowledge about the virus and its management, the climate of fear and uncertainty, the increased workload and the risk of becoming infected and being contagious, had a strong impact on healthcare staff and organizations. This highlighted the importance of interventions aimed at providing psychological support to ICUs, involving patients, their relatives, and the staff; this might involve the reorganisation of the daily routine and rearrangement of ICU staff duties.

AIM

To conduct a systematic review of psychological issues in ICUs during the COVID-19 pandemic involving patients, their relatives, and ICU staff.

METHODS

We investigated the PubMed and the ClinicalTrials.gov databases and found 65 eligible articles, upon which we commented.

RESULTS

Our results point to increased perceived stress and psychological distress in staff, patients and their relatives and increased worry for being infected with severe acute respiratory syndrome coronavirus-2 in patients and relatives. Furthermore, promising results were obtained for some psychological programmes aiming at improving psychological measures in all ICU categories.

CONCLUSION

As the pandemic limited direct inter-individual interactions, the role of interventions using digital tools and virtual reality is becoming increasingly important. All considered, our results indicate an essential role for psychologists in ICUs.

COVID-19, stigma, and habituation: evidence from mobility data

BACKGROUND

The Japanese government has restricted people's going-out behavior by declaring a non-punitive state of emergency several times under COVID-19. This study aims to analyze how multiple policy interventions that impose non-legally binding restrictions on behavior associate with people's going-out.

THEORY

This study models the stigma model of self-restraint behavior under the pandemic with habituation effects. The theoretical result indicates that the state of emergency's self-restraint effects weaken with the number of times.

METHODS

The empirical analysis examines the impact of emergency declarations on going-out behavior using a prefecture-level daily panel dataset. The dataset includes Google's going-out behavior data, the Japanese government's policy interventions based on emergency declarations, and covariates that affect going-out behavior, such as weather and holidays.

RESULTS

First, for multiple emergency declarations from the beginning of the pandemic to 2021, the negative association between emergency declarations and mobility was confirmed in a model that did not distinguish the number of emergency declarations. Second, in the model that considers the number of declarations, the negative association was found to decrease with the number of declarations.

CONCLUSION

These empirical analyses are consistent with the results of theoretical analyses, which show that the negative association between people's going-out behavior and emergency declarations decreases in magnitude as the number of declarations increases.

Prevalence and Predictors of Anxiety among Stable Hospitalized COVID-19 Patients in Malaysia

The COVID-19 pandemic has created anxiety among hospitalized SARS-CoV-2 patients. Therefore, this study aimed to determine the prevalence of anxiety and its associated factors among stable inpatient COVID-19 patients in Malaysia. Method: A cross-sectional study was conducted using a web-based online survey involving 401 patients from Malaysia’s leading COVID-19 hospitals from 15th April until 30th June 2020, who were chosen using quota sampling. The General Anxiety Disorders 7 items (GAD-7) scale, the Coping Orientation to Problems Experienced Inventory (Brief-COPE) and a socio-demographic profile questionnaire were used. Descriptive analysis and multiple logistic regression were performed using SPSS v23 to determine the prevalence of anxiety and its associated factors. Result: The results showed that the prevalence of anxiety was 7.0%. Multiple logistic regression analysis revealed that female gender (p < 0.05), a fear of infection (p < 0.05), a lack of information (p < 0.05), a maladaptive coping mechanism of behavioral disengagement (p < 0.001) and self-blame (p < 0.001) were significantly associated with anxiety. Meanwhile, adaptive coping mechanisms via instrumental support (p < 0.001) were a significant protective predictor of anxiety. Conclusions: COVID-19 infection has had a significant influence on the mental health of patients. Findings in our study provide baseline data on the prevalence of anxiety among stabilized COVID-19 inpatients in Malaysia. Despite the relatively low prevalence, the data have the potential to improve the present mental health monitoring system and the deployment of suitable treatments in dealing with similar circumstances.

Status of stigma on the health care workers related to COVID-19 at the first wave of the pandemic in Iran: A qualitative study

Background

Stigma can be seen as a mark of disgrace that can lead to the separation of one person from another. In this qualitative study, we assess the status of stigma among in front-line health care workers (HCWs) during the first wave of the COVID-19 pandemic in Iran.

Subjects and methods

The participants were selected from frontline HCWs related to COVID-19 in Imam Ali and Imam Hossein referral hospitals in Alborz province, Iran. Study was conducted between May and June 2020. The 32-item checklist Consolidated Criteria for Reporting Qualitative Research (COREQ) was used to report this qualitative study. Interview questions were prepared based on the grounded theory method. The thematic approach was used to analyze the data content. Data analysis was based on open and axial coding and after implementing the codes in MAXQDA software.

Results

The results of this study included 4 themes, 8 categories and 33 sub-categories. Themes included extrinsic and intrinsic elements of stigma, perplexity and stigma removal requirements. Extrinsic elements included "creating blame and shame" and "discrimination" categories. Intrinsic elements included "the desire to be avoidance," "feeling depressed and frustrated" and "feeling anxious and scared" categories. Perplexity included "feeling loss" category. Stigma removal requirements included "factors causing stigma" and "protective agents against stigma" categories.

Conclusion

Low public awareness on COVID-19 and inadequate public care, limited personal protective equipment and inadequate facilities for HCWs along with lack of appreciation for their efforts, lack of proper psychiatric/psychological counseling to identify and treat symptoms associated with mental health and the limitations of training to maintain mental health skills are considered to be factors in the formation of stigma among HCWs related to COVID-19. Health policymakers should implement coherent strategies related to increasing public awareness and providing personal protection needs and counseling care for HCWs in relation to COVID-19.

What is the role of occupational physicians in the workplace during the COVID-19 pandemic in Japan? A qualitative interview study

Background

The coronavirus disease 2019 (COVID-19) pandemic has had various impacts on businesses and workers worldwide. The spread of infection has been reported through cluster outbreaks in the workplace, and World Health Organization has emphasized workplace infection control measures. Occupational physicians (OPs) are expected to actively support employers’ efforts to minimize the damage of the pandemic. However, there is little research on the role of these specialists during a pandemic. Clarification of the contributions of OPs to health and safety at the workplace in the COVID-19 pandemic would be beneficial to ensure that OPs can be effectively deployed in the next pandemic.

Methods

We employed semi-structured interviews and qualitative content analysis of the interview transcripts. Twenty OPs were selected as priority candidates from among 600 OPs certificated of the JSOH, and thirteen who met the eligibility criteria agreed to participate. The online interviews were conducted in November and December 2020 with thirteen OPs. We extracted meaning units (MUs) from interview transcripts according to the research question: “What was the role of OP in the COVID-19 pandemic?“ and condensed and abstracted them into codes and categorized them. Validity was confirmed by additional 5 OPs interviews.

Results

A total of 503 MUs were extracted from the transcripts. These were abstracted into 10 sub-categories and two categories. Categories 1 and 2 dealt with “Role in confronting the direct effects of the pandemic” and “Role in confronting the indirect effects of the pandemic” and accounted for 434 (86.3%) and 69 (13.7%) MUs, respectively. These results were validated by another 5 interviews.

Conclusion

This study identified the role of OPs in Japan in the COVID-19 pandemic. The results showed that they made a wide range of contributions to the direct and indirect effects of the pandemic. We hope our findings will help OPs during future pandemics or other long-term emergency situations.

Suicide, Stigma and COVID-19: A Call for Action From Low and Middle Income Countries

Suicide is a global health issue that needs to be addressed. The COVID-19 pandemic has resulted in an increased mental health burden. Stigma has obstructed efforts to prevent suicide as individuals who need urgent support do not seek appropriate help. The influence of stigma is likely to grow in tandem with the COVID-19 pandemic. The stigmatization of persons with mental illnesses is widespread worldwide, and it has substantial effects on both the individual and society. Our viewpoints aim to address the probable link between stigma and suicide in the wake of the current pandemic and propose ideas for reducing suicide-related stigma.

Worry from contracting COVID-19 infection and its stigma among Egyptian health care providers

BACKGROUNDS

Healthcare providers (HCPs) in COVID-19 epidemic face stressful workload of disease management, shortage of protective equipment and high risk of infection and mortality. These stressors affect greatly their mental health. The aim is to identify working conditions among Egyptian HCPs during COVID-19 epidemic as well as stigma and worry perceptions from contracting COVID-19 infection and their predictors.

METHODS

A cross-sectional study was conducted among 565 HCPs. Data was collected through Google online self-administered questionnaire comprised seven parts: demographics characteristics, knowledge and attitude of COVID-19, working condition, worry of contracting COVID-19 at work, discrimination intention at work for COVID-19 patients, stigma assessment using impact stigma, and internalized shame scales.

RESULTS

The vast majority of HCPs (94.7%) were worried from contracting COVID-19 at work. Risk factors for perceiving severe worry from contracting COVID-19 were expecting infection as a severe illness, believing that infection will not be successfully controlled, improbability to continue working during the pandemic even if in a well/fit health, high discrimination intention and impact stigma scales. Significantly high impact stigma scores were detected among those aged < 30 years, females, workers primarily in sites susceptible for contracting COVID-19 infection, those had severe worry from contracting infection at work, and high internalized shame scale. The risk factors for perceiving higher internalized shame scores were not having a previous experience in working during a pandemic, high discrimination intention towards COVID-19 patients and high impact stigma scale.

CONCLUSIONS

Considerable levels of worry and stigma were detected among Egyptian HCPs during COVID-19 outbreak. The psychological aspect of health care providers should not be overlooked during epidemic; appropriate institutional mental health support should be provided especially for young HCPs, those without previous work experience in epidemic and those who work in high-risk units. Raising the community awareness about contribution of HCPs in fighting the epidemic might decrease stigmatization action toward HCPs.

The untold story of the COVID-19 pandemic: perceptions and views towards social stigma and bullying in the shadow of COVID-19 illness in Jordan

Stigmatization towards COVID-19 patients can lead to negative outcomes like social exclusion and bullying, and it may hinder the willingness of people to undergo testing. This study aimed to measure and explore the perception of stigmatization and bullying towards COVID-19 patients in Jordan. This was a web-based cross-sectional survey. Participants were recruited from social media platforms employing a snowball convenience sampling. The perception of bullying, beliefs regarding social consequences of infection, views on measures towards violators of patients' privacy, and how to reduce the stigma were assessed by self-reported measures. 397 participants returned completed questionnaires. The majority of respondents believed that COVID-19 patients in Jordan are getting bullied (n = 255, 64.3%) and over 80% believed that people enjoy sharing identities, or news about COVID-19 patients. Although most respondents had adequate knowledge regarding transmission/prevention of COVID-19, they believed that all or some of the COVID-19 patients practiced something wrong to get infected (n = 358, 90.2%). Moreover, 86.9% of respondents reported that people in Jordan were crossing their lines with bullying behaviors towards COVID-19 patients. However, these negative views would not discourage most respondents to get tested and follow the government's instructions if they or any of their acquaintances were suspected to be infected. Our study sheds the light on a high degree of stigma and bullying of COVID-19 patients during the early stage of the pandemic in Jordan. Hence, there is a need to develop and implement effective anti-stigma/anti-bullying campaigns that refute the misperception, raise public knowledge about COVID-19, and spread encouraging messages.

Persistence of long COVID symptoms in COVID-19 survivors worldwide and its potential pathogenesis - A systematic review and meta-analysis

The study sought to determine the prevalence of persistent long COVID symptoms such as anxiety, depression, dizziness, chest pain, sleep difficulty, palpitations, weight loss, and hair loss among coronavirus disease 2019 (COVID-19) survivors worldwide and to discuss the potential pathogeneses. Potential studies were searched in three databases (PubMed, Scopus, and Web of Science) as of January 30, 2021. Data on study characteristics, patient characteristics during the follow-up, the number of patients with persistent long COVID symptoms and total COVID-19 survivors were collected according to PRISMA guidelines. To assess the quality of studies, the Newcastle-Ottawa scale was used. The estimated prevalence of each long COVID symptom and the association between COVID-19 severity and the occurrence of prolonged symptoms was assessed, if appropriate. The global prevalence of prolonged anxiety was 15.76% (95%CI: 6.36%, 25.15%). Chest pain persisted in 10.36% (239/3,224) of COVID-19 patients (95%CI: 4.92%, 15.80%). Prolonged depression was found in 24 of 548 COVID-19 survivors with an estimated prevalence of 4.32% (95%CI: 2.62%, 6.03%) and dizziness was presented in 4.83% (118/2,219, 95%CI: 1.50%, 8.16%) after recovery. Hair loss was complained by 527 of 2,251 recovered patients (cumulative prevalence of 24.76%, 95%CI: 19.60%, 29.91%), while weight loss was identified in 37 cases among 452 COVID-19 survivors (8.19%, 95%CI: 5.66%, 10.71%). Prolonged palpitation was experienced by 19.38% (211/1,926) survivors with 95%CI: 2.40%, 41.16%. Sleep difficulty was found in 541 of 2,622 COVID-19 survivors (17.87%, 95%CI: 7.55%, 28.20%). The association between COVID-19 severity and the occurrence of persistent long COVID symptoms was not analyzed due to the lack of data. In conclusion, persistent psychological symptoms are frequently reported among COVID-19 survivors. Follow-up studies with a longer duration and larger population are warranted to assess the extent of prolonged symptoms and the quality of life of COVID-19 survivors. Despite various potential pathogeneses that have been hypothesized, a definitive mechanism is yet to be addressed. PROSPERO registration: CRD42021247172.

Mental Health Status and Its Influencing Factors: The Case of Nurses Working in COVID-19 Hospitals in South Korea

The mental health of nurses participating in patient care is under threat amid the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to identify the mental health status (depression, anxiety, and stress) and its influencing factors on nurses who provided patient care at a specialized hospital for COVID-19 in South Korea. Of the 180 nurses who participated in this study, 30.6% had moderate or higher levels of depression, 41% had moderate or higher anxiety levels, and 19.4% had moderate or higher stress levels. In this study, stigma influenced nurses’ mental health, such that the higher the stigma, the higher the nurses’ depression, anxiety, and stress. Depression was higher in female nurses than in male nurses, and stress was higher in charge nurses than nurses in other job positions. Therefore, a management program should be designed to improve the mental health of nurses during the current pandemic. In particular, a solution to reduce stigma is required, and the mental health of female nurses and nurses in leadership roles requires special attention.

Mental Health Burden of the COVID-19 Pandemic in Healthcare Workers in Four Latin American Countries

The aim of the study was to assess the mental health burden of the COVID-19 pandemic in healthcare workers in four Latin American countries in 2020.An online survey was carried out with 1721 participants from Argentina, Chile, Colombia and Mexico in 2020. A non-probabilistic convenience sampling method was used to recruit voluntary participants. Post-traumatic stress symptoms were assessed with the SPRINT-E scale, Perceived Discrimination was assessed with a Spanish version of the scale developed by Molero, and anxiety toward death was assessed with the Spanish version of the Templer scale. All instruments were assessed for internal consistency.The overall frequency of post-traumatic stress symptoms was 23.9%. The frequency by countries was 26.4% in Argentina, 29.8% in Chile, 19.9 in Colombia, and 23.8% in Mexico. Post-traumatic stress symptoms were associated with individual subtle discrimination, anxiety toward the death of the elderly, lack of Personal Protective Equipment, and exposition to the death.The COVID-19 pandemic has imposed a mental health burden on health workers in the countries included in the study, not only due to the implications of the disease in the face of exposure to death, but also due to institutional conditions and in which they carry out their work.

Health Care Professionals' Perception of Stress During COVID-19 Pandemic in Iran: A Qualitative Study

BACKGROUND

The health care professionals have a unique role in controlling the pandemic of COVID-19 and decreasing its mortality and morbidity. The burden of care and psychological impact of working in this circumstance can be unfavorable for many caregivers. In this qualitative study, the health care professionals' perception of stress during COVID-19 pandemic in Iran was assessed and several implications were proposed.

MATERIALS AND METHODS

The participants were selected among staff who were providing medical services to patients with COVID-19 infection at the largest teaching hospital in Iran. Quota sampling was used to include physicians, nurses, and other paramedics. The grounded theory was selected to develop interview questions. Moreover, the thematic approach was applied to analyze the data content and data analysis was performed based on open and axial coding following the implementation of codes in MAQDA software.

RESULTS

A wide range of psychological reactions including anxiety, feelings of guilt, depression, and anger were detected in the staff. Uncertainty accompanied by the pandemic of COVID-19 and shortcomings in preparation for crisis management were recognized as the two main sources of stress among health care professionals.

CONCLUSION

Based on the findings of the study, it is important to identify and evaluate the mental health needs of healthcare professionals. To reduce stress among health staff at COVID-19 care centers, it seems that the optimal strategy is simultaneous improvement in equipment and crisis management.

Prevalence and severity of depression, anxiety, stress and perceived stress in hospitalized patients with COVID-19

PURPOSE

COVID-19, a disease that can be transmitted from person to person and with serious health problems, can be associated with mental health disorders. In this study, we evaluated the prevalence and severity of depression, anxiety, stress, and stress perception among a group of patients with COVID-19 who were hospitalized.

METHODS

In this cross-sectional study, 106 inpatients with COVID-19 who had stable clinical conditions were evaluated psychologically by two questionnaires: Depression, Anxiety and Stress Scales-21 (DASS-21) and Perceived Stress Scale (PSS-4).

RESULTS

More than one third of patients had underlying disease. Overall, 97.2% of patients with COVID-19 had some degree of depression. Severity of depression, according to the DASS questionnaire, was 85.8%. All patients (100%) had severe (0.9%) and very severe (99.1%) anxiety. Regarding to stress levels, 97.1% of patients had some degree of stress. In the severity of stress category, 84.9% of patients had severe and very severe stress. In terms of perceived stress, 73.6% of patients had high levels and 22.6% had moderate levels. A positive strong correlation was found between depression and perceived stress (Coefficient: 0.33, P-value: 0.001). Correlation between anxiety and perceived stress was statistically significant (Coefficient: 0.2, P-value: 0.04).

CONCLUSIONS

The existence of such a high prevalence and severity of psychiatric disorders among hospitalized patients with COVID-19 underscores the need for serious attention to the mental health status of these patients. It seems that health policymakers need to have coherent plans for screening cases and managing related situations.

Prevalence and Associated Factors of Posttraumatic Stress Symptoms and Stigma among Health Care Workers in Contact with COVID-19 Patients

Objective: The global spread of COVID-19 has caused great psychological stress in health care workers (HCWs). This study aims to assess the prevalence and associated factors of posttraumatic stress symptoms (PTSS) and stigma among health care workers (HCWs) who are involved in treating COVID-19 patients. This study was conducted as part of studies related to assessing the mental health status of HCWs in Iran during the COVID-19 pandemic. Method: Overall, in this cross sectional study, 894 HCWs working in 9 general hospitals in Alborz province, Iran, in the field of diagnostic and treatment care of patients with COVID-19 were selected using multistage sampling method. PTSS and its subscales, including intrusion, avoidance, and hyper vigilance were obtained based on the Posttraumatic Stress Disorder-8 Item validated questionnaire. Information on Stigma's perception among HCWs was also obtained based on a questionnaire adopted from the HIV Stigma Scale. Predictors of PTSS and Stigma's perception among HCWs were assessed using multivariate logistic regression analysis. Results: Overall, 71.4% of the participants were women and 46.9% were front line staff. The prevalence of intrusion, avoidance, and hyper vigilance symptoms was 44.2% (95% CI: 40.8-47.6), 31. 8% (95% CI: 28.8-35.0), and 37.7% (95% CI: 34.5-41.0), respectively. A strong and positive significant correlation was found between stigma score with PTSD total score (coefficient: 0.83) and its components. In multivariate logistic regression model, female gender was associated with intrusion (OR: 1.46, 95% CI: 1.03-2.06) and avoidance (OR: 1.66, 95% CI: 1.147-2.417) and working in frontline increased the odds of intrusion (OR: 1.45, 95% CI: 1.06-1.97) and hyper vigilance (OR: 1.41, 95% CI: 1.03-1.91). Conclusion: The prevalence of PTSS is high among HCWs during COVID-19 pandemic and it is associated with some demographic characteristics of HCWs. This situation should be considered by health policymakers so that while trying to control the disease, the mental health status of this group of personnel should be given much attention.

What mental health experts in Slovakia are learning from COVID-19 pandemic?

INTRODUCTION

The COVID-19 pandemic was confirmed to have spread to Slovakia on 6th March 2020. To date of paper submission, it has very favorable course. However, since the beginning healthcare workers have been working under increasing pressure, anxiety and fear.

AIM

Authors evaluated the psychosocial impact of COVID-19 pandemic on mental health experts and their clinical practice in Slovakia.

MATERIALS AND METHODS

A total of 157 mental health experts (79% women) submitted their responses via online questionnaire.

RESULTS

The most frequent occupation categories were 38.2% outpatient psychiatrists, 26.1% inpatient psychiatrists and 20.4% psychologists. The mental health experts felt maximum of stress during the peak of Slovak COVID-19 crisis, which was identified as the situation just after the declaring the state of emergency by Slovak government. The main sources of stress were statistical data, prognoses and other public presented information. Mental health experts felt mainly personal stress, then general and working stress. They identified also pathological effect of COVID-19 pandemic on the mental status of their patients, especially with anxiety and affective disorders and advantages of use of telemedicine.

CONCLUSION

Psychosocial support in Slovakia was newly organized in COVID-19 pandemic for medical professionals, patients and other inhabitants under high stress within a very short time. This unexpected situation has revealed to Slovakia the need for reform of the mental healthcare system.

Mental Health Care for Medical Staff in Iran during the COVID-19 Pandemic; Different Performance in Alborz Province

Objective: The mental health status of health care workers (HCWs) related to COVID-19 is of great importance. By designing cross sectional studies, we evaluated disorders related to the mental health of these health workers. Short-term and long-term diagnostic and treatment interventions are other components of this care protocol.

Method: This study includes a collection of studies and interventions in the form of analytical cross sectional study at the level of educational hospitals of Alborz University of Medical Sciences. In this study, HCWs were evaluated for mental health disorders in quantitative and qualitative studies. Depression, Anxiety and Stress Scales (DAS), Posttraumatic Stress Disorder (PTSD) questionnaires, and Stigma questionnaire in quantitative studies with thematic approach in qualitative study were used to evaluate and analyze the data.

Conclusion: A series of coherent measures have been taken to prevent, screen, and treat mental health disorders of the staff who provide services to patients with COVID-19. We hope the results of these measures will be used as a guide for other professionals and academic and hospital centers in similar conditions to effectively control the disease and improve the mental health of HCWs.

Mental Health of Medical Workers in COVID-19 Pandemic: Restrictions and Barriers

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