The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: A critical review across waves

The impact of the COVID-19 pandemic on the socioeconomic gradient of hypertension

The COVID-19 pandemic has brought into sharp focus the impact of socioeconomic factors on hypertension outcomes. This review examines the implications of the pandemic on the socioeconomic gradient of hypertension and explores the physiological and pathophysiological processes underlying this relationship. Changes in socioeconomic factors have disproportionately affected individuals with lower socioeconomic status, leading to adverse hypertension outcomes. The pandemic-related stressors, coupled with social isolation and disrupted daily routines, have contributed to elevated stress levels among individuals, particularly those with lower socioeconomic status. Equitable access to healthcare, enhancing health literacy and patient empowerment, and addressing social determinants of health are essential components of hypertension management strategies. By recognizing the specific challenges faced by individuals with lower socioeconomic status and implementing targeted interventions, public health efforts can help reduce the socioeconomic gradient of hypertension.

Mitigating the effect of COVID-19 in a postemergency phase: The role of sense of community and individual resilience

To identify and confirm patterns of relationships connecting sense of community (SOC) and individual resilience with psychological well-being, via the mediation of coronavirus disease 2019 (COVID-19) impacts on life domains. An online survey was conducted with a sample of adults (n = 650) 1 year after the COVID-19 outbreak in Italy and the United States (April-December 2021). Utilizing a Structural Equation Model, we tested a mediation model (n = 563) to identify the associations between SOC and individual resilience and the perceived impacts of the emergency situation and psychological well-being. Results revealed that during the crisis, SOC had an influence on psychological well-being, but only by mediating the effects of COVID-19 impacts on life domains. Independently, individual resilience had a direct influence on psychological well-being. The findings support the importance of the interaction of individual and collective variables that played different roles at different phases of the pandemic. The findings suggest for possible interventions to enhance well-being during crises.

COVID-19 and psychiatric disorders among young people: a cross-sectional study

During the COVID-19 pandemic, a significant rise in mental health issues was observed. Particularly, children and adolescents have shown a higher risk of developing mental disorders than adults. This study aimed to describe the evolving features of the requests for psychiatric emergency interventions during the COVID-19 pandemic in young people. We conducted a cross-sectional study comparing the number, characteristics, and symptoms of people aged between 12 and 18 years old attending one Emergency Department (ED) for psychiatric issues, considering three different periods: T0 (8 March 2019-7 March 2020), T1 (8 March 2020-7 March 2021), and T2 (8 March 2021-7 March 2022). Total admissions were 220: 99 (45%) during T0, 40 (18.1%) for T1, and 81 (36.8%) for T2 ( P  < 0.001). A significant decrease in the mean age from T0 to T1 was found ( P  < 0.01). Admissions for psychomotor agitation decreased, while admission due to anxiety disorder and nonsuicidal self-injury raised significantly ( P  < 0.05), as for first psychiatric presentation ( P  < 0.01). Regarding substance use, a significant reduction was observed ( P  < 0.05). The rates of eating disorders ( P  < 0.001) and early insomnia ( P  < 0.01) increased from T0. These findings highlight the worsening of psychiatric symptoms in the young population during the COVID-19 pandemic.

Has Covid-19 left an imprint on our levels of life satisfaction? Empirical evidence from the Netherlands

Many papers have investigated the effects of Covid-19 on people's well-being shortly after the epidemic's outbreak. In this article, we use the joint World Values Survey (WVS) and European Value Study (EVS) 2017-2022 dataset and employ OLS (Ordinary Least Squares) regressions and Coarsened Exact Matching, to evaluate the possible existence of a persistent effect on life satisfaction, two years after the start of the pandemic. We have chosen to focus on the Netherlands -a country which appears among the happiest in the world and for which we have available data- to assess the impact of the Covid-19 pandemic at this later stage. The results of our analysis seem to indicate that the pandemic has contributed to reducing the levels of life satisfaction significantly, particularly among the younger generation. These findings show that specific intervention programmes should be created focusing on different age groups.

Bloody stressed! A systematic review of the associations between adulthood psychological stress and menstrual cycle irregularity

Regular menstruation is a key indicator of general health and irregular menstrual parameters have been associated with elevated risk of adverse health outcomes. While psychological stress is believed to contribute to abnormal menstruation, little is known of the effects of discrete psychological stressors, including the COVID-19 pandemic, on menstrual function. A systematic database search was performed and studies investigating the relation between psychological stress and menstrual cycle irregularity in otherwise healthy adults were included. Two independent investigators completed abstract and full-text screening, data extraction, and risk of bias assessment. In the 41 included studies, a variety of stressors were assessed, namely COVID-19 pandemic stress, academic stress, and occupational stress. Our review found most studies report an association between psychological stress and menstrual dysfunction, with the most common disruptions being irregular menstruation and abnormal menstrual flow. Our findings also underlined notable discrepancies in the operational definitions used in the study of menstrual disorders. These observations emphasize the importance of psychological stress as a modifiable risk factor associated with irregular menstruation.

Were fewer boys born in the United States during the early months of the COVID-19 pandemic? A test of the Trivers-Willard hypothesis

The Trivers-Willard hypothesis predicts that mammalian parents in poor environmental conditions will favor the offspring sex with more reliable chance of reproductive success, which in humans is females. Three months following the onset of the COVID-19 pandemic in South Africa, England, and Wales, there were significant decreases in the sex ratio at birth (SRB) (male births/total live births). We analyzed this ratio with a seasonal autoregressive moving average model, and a logistic regression, using nationwide natality data for all singleton births in the United States from 2015 to 2021 (n = 25,201,620 total births). We identified no significant change in the sex ratio in either analysis. Rather, we observed marked differences in the sex ratio by maternal characteristics of race/ethnicity, age, and education, with more vulnerable groups having lower sex ratios. These findings suggest the SRB may be an important marker of reproductive vulnerability for disadvantaged groups in the United States.

Development and validation of the Environmental Confinement Stressors Scale (ECSS-20)

The COVID-19 pandemic has generated a global crisis with severe consequences for public health. There have been negative impacts on people's quality of life and mental health due to various stressors arising in this context, such as physical, social, economic, and psychological challenges. Noteworthy among these are the indirect effects of health measures, especially social distancing and confinement, which have significantly altered people's daily lives and social activities, producing high levels of anxiety, depression, and stress. This study proposes developing and validating a cross-sectional scale called the "Environmental Stressors Scale (ECSS-20)" to address the need to measure the impact of environmental stressors during confinement. The scale, which has been validated following ethical and methodological guidelines, consists of four dimensions: economic stressors (EE), social activities (SA), habitability (H), and exposure to virtual media (EMV). A pilot study (n = 113) and a main study (n = 314) were applied. The results showed that the instrument has a reliable and valid structure, with satisfactory internal consistency and factorial validity. Likewise, gender invariance tests supported its suitability for its applicability to women and men. Overall, the ECSS-20 is a valuable instrument for assessing the impact of confinement and improving the understanding of people's subjective experiences in this situation. Future research could further develop its applicability in different contexts and populations to better understand its usefulness and psychometric properties.

Adapting Minds: Exploring Cognition to Threatened Stimuli in the Post-COVID-19 Landscape Comparing Old and New Concerns about Pandemic

The global population has been significantly affected by the pandemic in terms of physical and mental health. According to transactional theory, individuals have undergone an adaptation process influenced by cognitive control abilities. Emotional responses to COVID-19-related stimuli may interfere with top-down attentional processes, thereby hindering adaptation. This study aimed to investigate the impact of COVID-19-related stimuli on attentional processing and to determine whether psychological factors could modulate these effects. A sample of 96 healthy undergraduate students participated in an emotional Stroop task in which they were presented with a series of stimuli, including both neutral and negative COVID-19-related as well as non-COVID-19 stimuli. COVID-19-related PTSD, as an index of distress (PTSS), and trait anxiety were evaluated. Results showed that participants were more accurate in identifying COVID-19-related stimuli compared to non-COVID-19 stimuli. Being female and having higher retrospective PTSS scores related to COVID-19 were predictive of faster reaction times for both neutral and negative COVID-19-related stimuli. This heightened attentional bias toward COVID-19-related stimuli suggests that individuals may be more sensitive to stimuli associated with the pandemic. The results suggest that the association between COVID-19 stimuli and attentional biases extends beyond emotional valence, being retrospectively influenced by mental health, suggesting potential pathways to future mental health challenges.

Using health belief model constructs to understand the role of perceived disease threat and resilience in responding to COVID-19 among people who use drugs: a cluster analysis

Introduction

The Health Belief Model (HBM) has been successfully applied to understanding adherence to COVID-19 prevention practices. It has not, however, been used to understand behavior in people who use drugs (PWUD). The aim of this study was to use the HBM to better understand COVID-19 perceptions among PWUD and understand how resiliency affects those perceptions.

Materials and methods

A cross-sectional survey was completed from September to December 2021 with PWUD (n = 75) who utilize services at a large harm reduction organization in Philadelphia. Segmentation analysis was done using a k-means clustering approach. Two clusters emerged based on perceived COVID-19 personal impact and resiliency (Less COVID impact/High resilience (NoCOV/HR) and High COVID impact/Low resilience (COV/LR). Differences in responses by cluster to perceptions of COVID-19 and individual pandemic response grouped by HBM constructs were assessed using Student's t-test and chi squares.

Results

Significant differences in HBM constructs were seen between clusters. Those in the COV/LR cluster were more likely to think they were susceptible to getting COVID-19 and less likely to believe they knew how to protect themselves. The NoCOV/HR cluster believed they were able to protect themselves from COVID-19 and that they were able to easily understand messages about protecting themselves.

Conclusion

Understanding how PWUD conceptualize disease threat and using HBM can better inform interventions to improve future pandemic response. Findings suggest that resilience is key to protecting PWUD from future infectious disease outbreaks. Interventions aimed at increasing resiliency among PWUD may improve preventative behavior and decrease disease burden in this vulnerable population.

Writing about a stressful experience can impair visual working memory

Acute stress has been well-established to impair working memory. However, less is known about how writing about an unresolved stressor may influence working memory or working memory processes. We addressed these issues in the present study (N = 282) by randomly assigning participants to write about an unresolved stressful experience (stressful writing condition or the events of the previous day). We then both measured performance on a change detection task and used computational modeling to estimate the processes underlying performance: attention, capacity, and guessing bias. We found that, relative to the control condition, writing about a stressful experience impaired change detection task performance and significantly impaired task attention. These results show that the effects of writing about an unresolved stressor may mimic the effects of acute stress on working memory, rather than conforming to expectations from mood-as-information theory.

Impact of 2 years of COVID-19 pandemic on preterm birth: Experience from a tertiary center of obstetrics in western Germany

OBJECTIVE

To compare preterm birth rates and reasons before and during the COVID-19-pandemic using a monocentric, retrospective study.

METHODS

Univariate analysis identified differences in rates and reasons for preterm birth and neonatal outcomes between the pre-pandemic period (January 1, 2018 to December 31, 2019) and during the pandemic (January 1, 2020 to December 31, 2021) among all births at our tertiary obstetrical center, the University Hospital of Essen.

RESULTS

The cohort consisted of 6086 deliveries with 593 liveborn preterm singletons. During the pandemic, the incidence of preterm birth decreased (10.7% vs. 8.6%; odds ratio [OR] 0.79; 95% confidence interval [CI] 0.66-0.93). Spontaneous preterm birth (43.2% vs. 52.3%; OR 1.47; 95% CI 1.05-2.03), and placenta accreta spectrum disorder (3.7% vs. 8.2%; OR 2.36; 95% CI 1.15-4.84) were more common reasons for preterm birth. Placental dysfunction was a less common reason (34.1% vs. 24.3%; OR 0.62; 95% CI 0.43-0.90). Incidences of preterm premature rupture of membranes (28.13% vs. 40.25%; OR 1.72; 95% CI 1.12-2.43) and oligo-/anhydramnios (3.98% vs. 7.88%; OR 2.06; 95% CI 1.02-4.21) increased. Iatrogenic preterm birth decreased (54.5% vs. 49.5%; OR 0.81; 95% CI 0.58-1.13). Stillbirth rates did not change significantly. Among term births, there were fewer spontaneous deliveries (71.0% vs. 65.8%; OR 0.78; 95% CI 0.69-0.88), and more elective (12.3% vs. 15.1%; OR 1.26; 95% CI 1.07-1.50) and unplanned (9.3% vs. 10.9%; OR 1.19; 95% CI 0.98-1.45) cesarean sections. During the pandemic, more term newborns were admitted to neonatal intensive care (1.4% vs. 2.5%; OR 1.86; 95% CI 1.20-2.88).

CONCLUSION

Our results, in line with data from other high-income countries, suggest that the likely reason for the decreased preterm birth rates is the underdiagnosis of pregnancy complications.

Waning waves of mood: The declining trend of hospitalized patients with affective disorders in Germany

INTRODUCTION

Affective disorders profoundly affect individuals' emotional well-being and quality of life. This study investigates the epidemiology of affective disorders in Germany from 2011 to 2021, focusing on incidence rates, age- and sex-standardized rates, and developmental trends.

METHODS

Using nationwide data of ICD-10 diagnosis codes from 2011 to 2021, this cross-sectional study analyzed inpatient cases of affective disorders in individuals aged 20 years or older. Age- and sex-standardized incidence rates were calculated based on the population size of each birth cohort in the 16 German federal states. Incidence rate ratios (IRRs) for 2011 to 2021 and 2019 to 2021 were compared with a two-sample z-test.

RESULTS

Between 2011 and 2021, F30 (manic episode) showed a decline of 42.8 % to an incidence of 4.9 per 100,000 inhabitants, even though not statistically significant (p = 0.322). F31 (bipolar affective disorder) remained relatively stable with a reduction of 15.3 % to an incidence of 13.6 per 100,000 inhabitants in 2021 (p = 0.653). F32 (depressive episode) decreased statistically significant by 25.7 % to an incidence of 64.1 per 100,000 inhabitants (p = 0.072). F33 (recurrent depressive disorder) slightly increased by 18.3 % to an incidence of 94.6 per 100,000 inhabitants (p = 0.267). No statistically significant differences were found when comparing the COVID-19 pandemic year 2021 to 2019 incidences (p ≥ 0.529).

CONCLUSION

The study provides valuable insights into the changing landscape of affective disorders in Germany over the past decade. The observed decline in incidence rates underscores the importance of continued efforts to promote mental health awareness and access to care.

Innovative behavior and organizational innovation climate among the Chinese clinical first-line nurses during the Omicron pandemic: The mediating roles of self-transcendence

BACKGROUND

During the Omicron pandemic, clinical first-line nurses played a crucial role in healthcare. Their innovative behavior enhanced the quality of nursing and served as a vital factor in driving the sustainable development of the nursing discipline and healthcare industry. Many previous studies have confirmed the significance of nurses' innovative behavior worldwide. However, the correlations among innovative behaviors, organizational innovation climate, self-transcendence, and their mediating roles in Chinese clinical first-line nurses need further research.

METHODS

A cross-sectional study was conducted, and the quality reporting conformed to the STROBE Checklist. From March 2022 to February 2023, a convenience sample of 1,058 Chinese clinical first-line nurses was recruited from seven tertiary grade-A hospitals of Tianjin city in Northern China. The Demographic Characteristics Questionnaire, Nurse Innovative Behavior Scale (NIBS), Nurse Organizational Innovation Climate Scale, and the Self-Transcendence Scale were used. The data was analyzed using descriptive statistics, correlation, and process plug-in mediation effect analyses.

RESULTS

The total scores of innovative behavior, organizational innovation climate, and self-transcendence were 33.19 ± 6.71, 68.88 ± 12.76, and 41.25 ± 7.83, respectively. Innovative behavior was positively correlated with the organizational innovation climate (r = 0.583, p < 0.01) and self-transcendence (r = 0.635, p < 0.01). Self-transcendence partially mediated mediating role between innovative behavior and organizational innovation climate, accounting for 41.7%.

CONCLUSION

The innovative behavior, organizational innovation climate, and self-transcendence among the first-line nurses during the Omicron pandemic were relatively moderate, which needs improving. Organizational innovation climate can directly affect the innovative behavior among Chinese clinical first-line nurses and indirectly through the mediating role of self-transcendence. It is recommended that nursing managers adjust their management strategies and techniques based on the unique characteristics of nurses during the pandemic. This includes fostering a positive and inclusive environment for organizational innovation, nurturing nurses' motivation and awareness for innovation, enhancing their ability to gather information effectively, overcoming negative emotions resulting from the pandemic, and promoting personal growth. These efforts will ultimately enhance nursing quality and satisfaction during the Omicron pandemic.

Follow-up of telemedicine mental health interventions amid COVID-19 pandemic

The initiation of the program Mental Health Support Program for Coronavirus Infection addressed the increased demand for mental health services in the province of Salamanca, resulting from the COVID-19 pandemic. The psychiatry service provided care for COVID-19 patients, their families, and healthcare workers who treated them, as these groups were identified as being at risk. This study aims to describe the assistance provided, including personnel and resources utilized, types of interventions carried out, and to assess the demand for mental health care and predominant symptoms and emotions experienced by patients. Billboards and the complex's intranet publicized the program. Specific clinical approach using telemedicine were provide from March 2020 to December 2021 to COVID-19 patients, their relatives, and healthcare workers. 216 patients were included with a mean age of 53.2 years, with women comprising 77.3% of this group. All the groups received treatment in similar proportions. Over a period of 730 h, a total of 1376 interventions were performed, with an average duration of 31.8 min per intervention. The program could treat 79.6% of these patients without requiring referrals to other services. When the program concluded, only 21 participants (9.7%) were discharged to the local mental health network to continue their mental health treatment. The program effectively reduced the burden on regular mental health services due to its ability to treat most patients without requiring referrals. The program was able to attend to most mental health requests with minimal involvement of the regular mental health service.

Exploration of the COVID-19 mental health implications in elite disabled athletes

The COVID-19 pandemic influenced the way individuals conducted their lives, with consequences relating to mental health deterioration. Whilst researchers explored this outcome in the general population and athletic populations, less focus was on athletes with disabilities. The aim of this study was to investigate how the pandemic influenced the mental health of elite para-athletes in the United Kingdom. Nine elite-level athletes with disabilities participated in semi-structured interviews. Three broad themes were interpreted from the data using reflexive thematic analysis, two themes reflected the negative impact of COVID-19 on mental health and one theme reflected positive outcomes of the pandemic. Athletes explained that losing face-to-face interactions and delays in major sporting events were significant factors in their mental health decline. This population group reported different challenges to able-bodied communities. Differences included increased susceptibility to contract the virus, difficulties in communication where face masks and online interactions became necessary and perceptions of vulnerability relating to shielding protocols. Finally, positive outcomes related to the additional time to recover, to prepare for major events and time to reassess their values. Exploring experiences of a pandemic on this population group warrants further exploration to enhance the effectiveness of mental health support services in para-sporting organisations.

Longitudinal associations of depression, anxiety, and stress among healthcare workers assisting patients with end-stage cancer during the COVID-19 pandemic: the moderator role of emotional exhaustion

BACKGROUND

This study aimed to analyze the moderating role of emotional exhaustion in the relationships between longitudinal associations of depression, anxiety, and stress among healthcare workers assisting end-of-life cancer patients during the COVID-19 pandemic.

METHODS

A longitudinal study involving a final sample of 122 healthcare workers (61.5% females, mean age = 39.09 ± 11.04 years) was conducted. These participants completed the Maslach Burnout Inventory (MBI) and the Depression Anxiety Stress Scales-21 (DASS-21).

RESULTS

Results of correlation analysis showed that emotional exhaustion was correlated with both T1 and T2 measures of depression, anxiety, and stress. Results of the moderation analysis indicated that emotional exhaustion moderated the relationships between consecutive measures of depression and anxiety. Each of the moderation models explained about half of the variance for depression and anxiety. When considering stress, results did not show a moderating role for emotional exhaustion.

CONCLUSIONS

Overall, the results of this study highlight that emotional exhaustion moderated depression and anxiety over time. Psychological interventions to promote psychological mental health among healthcare workers assisting patients with end-stage cancer should carefully consider these findings.

The Use of Non-Person-First Language in Consecutive General Ophthalmology Referrals

PURPOSE

To investigate the prevalence of non-person-first language (PFL) in consecutive general ophthalmology referrals to a single tertiary ophthalmology clinic.

DESIGN

Retrospective cross-sectional study.

METHODS

Participants included Ophthalmology patients seen for their initial visit to a single tertiary ophthalmology clinic from July 2018 to December 2022. Ten randomly selected referrals from each day were screened for non-PFL as per the American Medical Association and American Psychological Association guidelines. Non-PFL was further categorized into general, diabetes, stigma, obesity, or ageism subcategories. The Chi-square test was used to evaluate associations between non-PFL use and referring provider gender and specialty, length of referral, and patient age and gender.

RESULTS

A total of 2625 referrals were included in the study and 136 (5.2%) used non-PFL, such as referring to a person with diabetes as a "diabetic". Error types included Diabetes (38.2%), Stigma (30.9%), General (23.5%), Disability (8.8%), and Obesity (4.4%). Year of referral was predictive of non-PFL (P = .0016), with most occurring in 2020 (9.5%). Non-PFL was significantly more likely to occur in long length referrals compared to medium and short length referrals (16.2% vs. 5.1% vs. 3.5%, P < .001). Referring provider specialty was also predictive of non-PFL (P < .001) with most received by Family Medicine (8.3%), Optometry (4.4%), Emergency Medicine (0.62%), Ophthalmology (4.2%), Others (2.9%). Patient gender (P = .5563), patient age (P = .3466), and referring provider gender (P = .9057) were not predictive of non-PFL.

CONCLUSIONS

Non-PFL use was most prevalent in 2020, with the most common referral sources being Family Medicine and Optometry. The highest proportions of non-PFL errors made were diabetes and stigma errors. Increased use of PFL in physician-physician communication can decrease intersectional stigma and promote inclusive patient care for ophthalmology patients.

Efficacy of a program in increasing coping strategies in firefighters: randomized clinical trial

OBJECTIVE

to evaluate the effectiveness of a program in increasing coping strategies focused on military firefighters' problems and emotions.

METHOD

randomized, parallel, single-masked clinical trial. The sample consisted of 51 participants in the intervention group and 49 in the control group. The intervention group received the intervention program including coping strategies based on the Nursing Interventions Classification, lasting six consecutive weeks, one day a week. The control group followed the Service Unit routine. Descriptive statistics, Student's T test with Welch's correction and the Mann-Whitney test were used for the analyses. The magnitude of the intervention effect was calculated using Cohen's d index. A p-value of ≤0.05% was considered.

RESULTS

in the analysis of the mean difference between the scores in the groups, the means of the intervention group increased significantly for the coping strategies: social support (p = 0.009), acceptance of responsibility (p = 0.03), problem solving (p = 0.05) and positive reappraisal (p = 0.05). The impact of the intervention was moderate in magnitude for social support (d = 0.54).

CONCLUSION

the intervention program enabled the increase of coping strategies focused on military firefighters' problems and emotions. ReBEC: RBR-8dmbzc. (1) The intervention program increases coping strategies. (2) The study included military firefighters. (3) Social support was the main strategy of the study. (4) Intervention group presented better results than the control group. (5) The use of the Nursing Intervention Classification was effective.

The COVID-19 pandemic and wellbeing in Switzerland-worse for young people?

BACKGROUND

The key objective of our study was to describe the population-average trajectories of wellbeing, spanning the period of 2017-2022, comparing young people with other age groups. Moreover, we aimed to identify subgroups of young people who experienced disproportionate changes in wellbeing.

METHODS

We used longitudinal data from six waves (2017-2022) of the Swiss Household Panel. Participants were at least 14 years old in 2017 and had at least one valid composite measure of wellbeing between 2017 and 2022 (n individuals = 11,224; n observations = 49,032). The data were typically collected with telephone or web interviewing. The age of participants ranged from 14 to 102, with a roughly equal distribution of men (51.1%) and women (48.9%). We conceptualized wellbeing as positive affect and life satisfaction, negative affect, stress and psychosomatic symptoms. We described the trajectories of wellbeing using piecewise growth curve analysis. We included sociodemographic characteristics to further describe wellbeing trajectories across subgroups of young people. These comprised (1) gender, (2) migration status, (3) partnership status, (4) living with parents, (5) education/employment status, (6) household income.

RESULTS

Young people (age 14-25) experienced a steady decline in positive affect and life satisfaction throughout the entire period, with the greatest change occurring before the pandemic (2017-2019). The trajectories in this outcome were largely stable in other age groups. Moreover, young individuals showed a more pronounced increase in negative affect, particularly in the pre-pandemic years, compared to older groups. Negative affect increased during the pandemic, followed by a subsequent decline post-pandemic, observed similarly across all age groups. Among young people specifically, the trajectory of stress was similar to the one of negative affect. However, issues such as sleep problems, weakness, weariness, and headaches continued to increase in this population from 2017 to 2022. We also found evidence for a greater increase in negative affect during the pandemic in young women and those not in employment or education.

CONCLUSIONS

Given the fact that the decline in young people's wellbeing in Switzerland started two years before the pandemic, our study emphasises the importance of consideing their wellbeing within a broader systemic context beyond pandemic-related changes.

Influence of the COVID-19 pandemic on births and induced abortions in Southern Sweden: a register-based study

BACKGROUND

Pandemics are linked with declining birth rates, but little is known about how the COVID-19 pandemic has influenced childbearing decisions. We aimed to investigate the associations between the COVID-19 pandemic and reproductive decisions, specifically to identify potential changes in the frequency of deliveries and induced abortions in Skåne, Sweden.

METHODS

Using the Skåne Healthcare Register, we identified women aged 15-45 years who had at least one pregnancy-related care visit registered between 1 January 2013 and 11 November 11 2021. Deliveries and induced abortions were identified, and changes in weekly delivery and abortion counts were assessed using an interrupted time series design. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated from a Poisson regression model.

RESULTS

During the study period we identified 129 131 deliveries and 38 591 abortions. Compared with the counterfactual (exposed interval assuming COVID-19 had not occurred), pandemic exposure was associated with fewer deliveries (RR 0.93; 95% CI 0.89 to 0.98). For abortions, pandemic exposure appeared to be associated with fewer abortions (RR 0.95; 95% CI 0.90 to 1.00); however, age-related differences were found. Among women aged 25 years and over, pandemic exposure was more strongly associated with fewer abortions. Contrastingly, among women aged under 25 years, abortions appeared to increase.

CONCLUSIONS

The COVID-19 pandemic seemed to have contributed to a decline in births in Southern Sweden. During the same period, abortions declined in women in the older age range, but contrastingly increased among younger women.

The impact of COVID-19 trauma on healthcare workers: Examining the relationship between stress and growth through the lens of memory

The COVID-19 pandemic constituted tremendous traumatic stress among the frontline healthcare workers. In the present study, we investigated relationships of two types of rumination, namely brooding and reflection, with traumatic stress and post-traumatic growth and the mediating role of recollective experience in these relationships. A total of 88 healthcare workers (75% female, Mage = 54.91) actively providing service to COVID-19 patients reported two memories of events that impacted them the most at the first peak of the pandemic and rated their recollective experience (i.e., phenomenological characteristics of memories). We used structural equation modelling to test whether recollective experience mediated the link of brooding and reflection with post-trauma reactions of stress and growth. The findings showed that brooding and reflection were associated with higher levels of traumatic stress and post-traumatic growth. Importantly, recollective experience mediated the relationship of rumination with traumatic stress but this differed for the type of rumination. Higher brooding was associated with greater traumatic stress and that relationship was independent of how well the memories were recollected, while for reflection, high reflection was associated with stronger recollective experience, which predicted higher traumatic stress and post-traumatic growth. The present study shows the functional dimensions of reflective rumination and presents novel findings that demonstrates the discrete mnemonic mechanisms underlying the association between brooding, reflection, and post-trauma reactions.

Caregiver and Child Mental Health During 3 Years of the COVID-19 Pandemic

BACKGROUND AND OBJECTIVES

Coronavirus disease 2019 (COVID-19) lockdowns (stay-at-home orders) had significant mental health consequences in 2020 to 2021 for caregivers and children. Little is known about "postlockdown" periods in 2022 to 2023. We investigated the mental health experiences of Australian families throughout the 3 years of the COVID-19 pandemic (2020-2023), by demographic characteristics and lockdown length.

METHODS

A total N = 12 408 caregivers (N = 20 339 children, aged 0-17 years) completed Australia's only representative, repeated, cross-sectional, National Child Health Poll across 6 waves (June 2020-April 2023). Caregivers reported mental health for themselves (Kessler-6, poor versus not) and each child (self-rated mental health, poor/fair versus good/very good/excellent), and perceived impacts of the pandemic on own/child mental health (negative versus none/positive). Binary logistic models were fitted to predict marginal probabilities of each mental health measure by state/territory group (proxy for lockdown length), over time, adjusted for potential demographic confounders.

RESULTS

Poor caregiver Kessler-6 was similar between genders but more common for sole caregivers, and those with a home language other than English and lower education. Poor/fair child self-rated mental health was similar between genders and increased with child age. Perceived negative impacts were more common for females and socially advantaged caregivers. Overall, negative mental health experiences increased with lockdown length, peaking with the height of lockdown in July 2021, before declining.

CONCLUSIONS

Negative mental health experiences of Australian caregivers and children decreased during postlockdown periods of 2022-2023; however, social gradients persisted. These data can inform more precise mental health policies that enable better use of limited mental health infrastructure.

Psychopathological risk stability and change in a sample of mothers and preschool children before, during and after the peak of COVID-19 pandemic

Numerous studies have found that the COVID-19 epidemic and the measures to stop it have had a substantial impact on the mental health of the general population. Nevertheless, the majority of this research only looked at the variations in the degree of psychopathological symptoms in individuals before and after the first wave of the pandemic. In a sample of N = 380 preschoolers and their mothers assessed through the Symptom Check-List/90-R and of the Child Behaviour Check-List, the present study aimed at exploring psychopathological risk in mothers and their offspring's dysregulation levels before (T1), during (T2) and after (T3) the peak of COVID-19 pandemic. Our main results showed that mothers' relational distress increased from T1 to T2 and then increased again from T2 to T3. Moreover, maternal aggressiveness, hostility, and anxiety scores significantly decreased from T1 to T2 but slightly increased from T2 to T3. In children, dysregulation levels increased from T1 to T2 but decreased from T2 to T3. Children of mothers with clinical scores at the SCL-90/R showed significantly higher dysregulation problems at T1, T2 and T3 than children of mothers with scores below the clinical threshold. This study adds to previous literature in that it evaluates stability or change in maternal and offspring scores not only in the pre-pandemic period and during the first wave of the pandemic, but it also considers the subsequent months, focusing on a broad range of maternal symptoms, rather than assessing depressive and anxiety symptoms as most of previous research did.

A Comparative Study of the Impact of the Covid-19 Pandemic on Mental Health, Healthcare Access, and Pain Levels of Patients with Chronic Pain from Spring 2020 to Spring 2021

Purpose

The short-term impact of the Covid-19 pandemic on patients with chronic pain has been under the microscope since the beginning of the pandemic. This time-lag design study aimed to track changes in pain levels, access to care, mental health, and well-being of Greek chronic pain patients within the first year of the Covid-19 pandemic.

Patients and Methods

101 and 100 chronic pain patients were contacted during the Spring of 2020 and 2021, respectively. A customized questionnaire was used to evaluate the perceived impact of the pandemic on pain levels and healthcare access. Psychological responses, personality characteristics, and overall well-being were evaluated using the Depression, Anxiety, and Stress Scale (DASS-42), the Ten-Item Personality Index (TIPI) and the Personal Wellbeing Index (PWI).

Results

The perceived effect of the pandemic and the Covid-related restrictions affected significantly access to healthcare, pain levels and quality of life. Differences were detected in the PWI sub-scales regarding Personal Safety, Sense of Community-Connectedness, Future Security, Spirituality-Religiousness, and General Life Satisfaction. Marital status, parenthood, education and place of residence were associated with differences in pain levels, emotional and psychological responses.

Conclusion

Changes in chronic pain levels, emotional responses, and overall well-being took place throughout the year. Also, an evident shift took place in the care delivery system. Both tendencies disclose an ongoing adaptation process of chronic pain patients and healthcare services that needs further monitoring.

Mental well-being and sleep quality among vocational college students in Sichuan, China during standardized COVID-19 management measures

Purpose

This research investigated the impact of the COVID-19 pandemic on the mental well-being and sleep quality of students in higher vocational colleges in Sichuan, China, identifying key factors influencing their psychological health during this period.

Methods

Between January and February 2022, a comprehensive survey was conducted among students from several higher vocational colleges in Sichuan, utilizing a randomized selection approach to involve 3,300 participants. Data were collected through direct interviews executed by skilled interviewers.

Results

Out of 3,049 valid responses, a significant number reported experiencing symptoms of poor mental health, anxiety, depression, and insomnia, with prevalence rates of 21.2%, 9.7%, 14.1%, and 81.9%, respectively. Factors contributing positively to mental health and sleep included a higher family economic status, reduced stress from the pandemic, and decreased online activity. Conversely, lack of physical activity post-pandemic, disruptions to education and employment, and deteriorating relationships emerged as negative influencers. Interestingly, a lack of pre-pandemic mental health knowledge acted as a protective factor against insomnia.

Conclusion

The ongoing management of COVID-19 has notably influenced the psychological and sleep health of vocational college students, driven by economic, emotional, lifestyle, and educational factors. The findings underscore the necessity for targeted interventions to address these challenges effectively.

Long COVID-19 Enigma: Unmasking the Role of Distinctive Personality Profiles as Risk Factors

Background: The COVID-19 (Coronavirus disease 2019) pandemic has prompted extensive research into lingering effects, especially in 'Long COVID' patients. Despite exploration, contributing factors remain elusive; Objective: This study explores the potential link between distinctive personality profiles, particularly type D personality, and an increased risk of Long COVID; Methods: A retrospective cross-sectional study at Tel-Aviv Sourasky Medical Center's Post-COVID clinic analyzed data from 373 Long COVID patients through comprehensive questionnaires covering Long COVID syndrome, Fibromyalgia criteria, personality assessments, social support, and subjective evaluations of cognitive decline, health and life quality. In total, 116 out of 373 patients completed the questionnaire, yielding a 31% participation rate; Results: Cluster analysis revealed two groups, with Cluster 1 (N = 58) exhibiting Type D personality traits while Cluster 2 (N = 56) not meeting criteria for Type D personality. In comparison to Cluster 2, Cluster 1 patients reported heightened anxiety, depression, reduced social support, increased pain symptoms, manifestations of fibromyalgia, cognitive decline, and poor sleep quality, contributing to a diminished quality-of-life perception; Conclusions: findings highlight diverse personality profiles among Long COVID patients, emphasizing the need for tailored care. This approach shows potential for improving Long COVID patient care, aligning with the evolving personalized medicine paradigm.

Personality dimensions, resilience, and depression during COVID-19 pandemic: A one-year longitudinal study

BACKGROUND

The onset of the COVID-19 pandemic has brought to light a significant surge in depression across diverse populations. While a considerable body of research has linked this upswing to lockdowns and restrictive measures, it is crucial to recognize that lockdowns alone cannot fully elucidate the observed increase in mental health disorders, given the vast array of individual psychological responses.

OBJECTIVE

This study aims to test e whether personality dimensions (Extroversion, Neuroticism, and Psychoticism) and resilience play a role in shielding individuals from developing depression during the COVID-19 pandemic, as observed in a sample of Brazilian adults.

METHODS

This research employed a one-year longitudinal naturalistic study involving the general population. It utilized a web-based questionnaire administered in three waves during the COVID-19 pandemic: April 2020, September 2020, and May 2021. The research protocol contains the Patient Health Questionnaire-9 - PHQ-9, the Connor-Davidson Resilience Scale - CD-RISC, and the Eysenck Personality Questionnaire Revised-Abbreviated - EPQR-A.

RESULTS

Our study encompassed 455 participants, of which 35.6 % met the criteria for depression in the first wave, and this figure decreased to 18.5 % in the second and third waves (p = 0.001). Resilience levels in the non-depressed group (consistently exhibited higher means across all three waves when compared to the depressed group (first wave: x¯= 27.98; second wave: x¯= 37.26; third wave: x¯= 36.67; p = 0.001). Furthermore, resilience exhibited an overall protective effect against depression in all waves (PR = 0.93, p = 0.000). Neuroticism and Psychoticism emerged as predictors of depression across all waves (PR = 1.346; p = 0.0001 and PR = 1.157; p = 0.030), while the Extroversion dimension showed no significant effect.

CONCLUSION

The decline in depression rates during the first year of the COVID-19 pandemic was influenced by levels of resilience, which acted as a protective factor against the development of depressive symptoms. Notably, Neuroticism and Psychoticism predicted the risk of developing depressive symptoms. Implications for practical intervention in future crisis scenarios suggest the need for public health policy programs featuring personalized interventions that prioritize enhancing resilience.

National trends in counseling for stress and depression and COVID-19 pandemic-related factors among adults, 2009-2022: A nationwide study in South Korea: Stress, depression, and pandemic

To investigate the long-term trends in counseling for stress and depression using data from a nationwide survey in South Korea. We conducted a nationwide serial, large-scale, cross-sectional, survey-based study using data from 2,903,887 Korean adults from the Korea Community Health Survey, 2009-2022. Our study investigated the trends and risk factors for counseling for stress and depression during the pre-pandemic (2009-2019) and pandemic era (2020-2022). The prevalence of counseling for stress and depression increased across pre-pandemic (counseling for stress: β, 0.217 [95 % CI, 0.194 to 0.241]; counseling for depression: β, 0.136 [0.118 to 0.154]) and pandemic periods (β, 0.324 [0.287 to 0.360]; β, 0.210 [0.182 to 0.239], respectively). The prevalence of counseling for stress and depression showed steeper slopes for increasing trends after the outbreak. In addition, subgroups with female sex, urban residence, lower household income, lower self-rated health, shorter sleep time, and higher worries about contracting COVID-19 were the risk factors associated with the increased prevalence of counseling for stress and depression. Our study analyzed the trends in counseling for stress and depression among over two million South Korean adults in 2009-2022, revealing a significant escalation during the pandemic. These findings emphasize the need for mental health policies to support vulnerable groups during the pandemic.

Six-month psychopathological symptom trajectories following the COVID-19 outbreak: Contrasting mental health outcomes between nurses and the general population

The COVID-19 pandemic prompted a social, economic and health crisis that had a major impact on the mental health of the global community, particularly nurses. The objective of the current study is to conduct a longitudinal evaluation of the trajectory of depressive, anxiety, trauma, and fear of COVID-19 symptoms, comparing self-reports of nurses and the general population over a six-month period. Self-report questionnaires were administered online to a sample of 180 nurses and 158 individuals from the general population for the baseline assessment (T1) and follow-up at 6 months (T2). Levels of symptoms reported by nurses were generally greater and tended to worsen over time, as opposed to the levels of symptoms reported by the general population that tended to improve. Levels of depressive, anxiety, and trauma symptoms were significantly different between nurses and the general population over time. Levels of fear of COVID-19 declined significantly from T1 to T2 in both groups. These results suggest that it is crucial to monitor the longer-term effects of COVID-19 and to develop resilience-promoting interventions tailored to the unique needs of this vulnerable group.

Relationship Between Severity and Length of Exposure to COVID-19 Parameters and Resulting Government Responses and the Suicide Crisis Syndrome (SCS)

OBJECTIVE

The COVID-19 pandemic has had a globally devastating psychosocial impact. A detailed understanding of the mental health implications of this worldwide crisis is critical for successful mitigation of and preparation for future pandemics. Using a large international sample, we investigated in the present study the relationship between multiple COVID-19 parameters (both disease characteristics and government responses) and the incidence of the suicide crisis syndrome (SCS), an acute negative affect state associated with near-term suicidal behavior.

METHODS

Data were collected from 5528 adults across 10 different countries in an anonymous web-based survey between June 2020 and January 2021.

RESULTS

Individuals scoring above the SCS cut-off lived in countries with higher peak daily cases and deaths during the first wave of the pandemic. Additionally, the longer participants had been exposed to markers of pandemic severity (eg, lockdowns), the more likely they were to screen positive for the SCS. Findings reflected both country-to-country comparisons and individual variation within the pooled sample.

CONCLUSION

Both the pandemic itself and the government interventions utilized to contain the spread appear to be associated with suicide risk. Public policy should include efforts to mitigate the mental health impact of current and future global disasters.

Predictors of stress resilience in Parkinson's disease and associations with symptom progression

People with Parkinson's disease (PD) are sensitive to effects of long-term stress, but might differ in stress resilience, i.e. the ability to maintain mental health despite adversity. It is unclear whether stress resilience in PD is predominantly determined by dopamine deficiency, psychosocial factors, or both. In PD animal models, chronic stressors accelerate disease progression, but evidence in humans is lacking. Our objectives were to (1) distinguish stressor-reactive from resilient PD patients, (2) identify resilience factors, and (3) compare symptom progression between stressor-reactive and resilient patients. We conducted a longitudinal survey in Personalized Parkinson Project participants (N = 350 PD). We used the COVID-19 pandemic as a model of a stressor, aligned in time for the entire cohort. COVID-19-related stressors, perceived stress, and PD symptoms were assessed at 11 timepoints (April-October 2020). Both pre-COVID and in-COVID clinical assessments were available. We quantified stressor-reactivity as the residual between actual and predicted perceived stress relative to COVID-19-related stressors, and modeled trajectories of stressor-reactivity across timepoints. We explored pre-COVID predictors of 6-month average stressor-reactivity, and tested whether stressor-reactivity was prospectively associated with one-year clinical progression rates. Latent class trajectory models distinguished patients with high (N = 123) or low (N = 227) stressor-reactivity. Pre-existing anxiety, rumination and non-motor symptom severity predicted high stressor-reactivity (risk factors), whereas quality of life, social support, positive appraisal style and cognitive abilities predicted low stressor-reactivity (resilience factors). PD-specific factors, e.g. disease duration, motor severity, and levodopa use, did not predict stressor-reactivity. The COVID-19 pandemic did not accelerate disease progression, but worsened depressive symptoms in stressor-reactive PD patients.

The relationship between gender, psychosocial factors, pain, health literacy and health-related quality of life in parents of Norwegian adolescents one year into the COVID-19 pandemic

BACKGROUND

Stress impacts healthy behaviours and may influence life and health-related quality of life (HRQOL). A stressful event occurred when the COVID-19 pandemic hit in March 2020. The present study aims to explore possible gender differences in stress, psychosocial factors (self-efficacy, self-esteem, loneliness), pain, HL, and HRQOL in parents of adolescents one year into the COVID-19 pandemic, and to explore possible associations between gender, demographic and psychosocial factors, pain, HL, and HRQOL.

METHODS

Parents of adolescents aged 16-17 took part in the study from January to February 2021, when the COVID-19 pandemic was ongoing. Data on socio-demographics, stress, self-efficacy, self-esteem, pain, HL, loneliness, and HRQOL were collected. HRQOL was assessed using RAND-36.

RESULTS

Among the 320 parents from the general population, the mean age was 47.6 (standard deviation (SD) = 4.6) years, 81% were mothers, 79% were married or cohabiting, 81% had a university degree, and the majority worked full time (78%) or part time (13%). The average pain score was low, 0.48 (95% CI [0.43-0.54]). However, 50% of the parents reported persistent pain and more mothers reported persistent pain compared to fathers (53% vs. 37%). The parents' mean (SD) score for RAND-36 was 52.1 (95% CI [51.2-53.0]) for the physical component summary (PCS) score and 51.0 (95% CI [50.0-52.1]) for the mental component summary (MCS) score. Mothers reported significantly lower scores for all the eight RAND-36 domains and the PCS and MCS scores. Adjusting for gender, age, living condition, education, pain, HL, self-efficacy and loneliness, we revealed no associations between stress and RAND-36-PCS. University education of four years or more was positively associated (B = 3.29, 95% CI: [0.78-5.80]) with RAND-36-PCS, while persistent pain was negatively associated (B = -7.13, CI: [-9.20- -5.06]). We identified a strong negative association between RAND-36-MCS and stress (B = -43.11, CI: [-48.83- -37.38]) and a positive association with older age (B = 0.21, CI: [ 0.04, 0.39)].

CONCLUSION

One year into the COVID-19 pandemic, we identified a strong negative association between stress and mental HRQOL, while pain was strongly negatively associated with physical HRQOL.

Impact of COVID-19 on the development of major mental disorders in patients visiting a university hospital: a retrospective observational study

BACKGROUND

This study aimed to investigate the impact of coronavirus disease 2019 (COVID-19) on the development of major mental disorders in patients visiting a university hospital.

METHODS

The study participants were patients with COVID-19 (n=5,006) and those without COVID-19 (n=367,162) registered in the database of Keimyung University Dongsan Hospital and standardized with the Observational Medical Outcomes Partnership Common Data Model. Data on major mental disorders that developed in both groups over the 5-year follow-up period were extracted using the FeederNet computer program. A multivariate Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for the incidence of major mental disorders.

RESULTS

The incidences of dementia and sleep, anxiety, and depressive disorders were significantly higher in the COVID-19 group than in the control group. The incidence rates per 1,000 patient-years in the COVID-19 group vs. the control group were 12.71 vs. 3.76 for dementia, 17.42 vs. 7.91 for sleep disorders, 6.15 vs. 3.41 for anxiety disorders, and 8.30 vs. 5.78 for depressive disorders. There was no significant difference in the incidence of schizophrenia or bipolar disorder between the two groups. COVID-19 infection increased the risk of mental disorders in the following order: dementia (HR, 3.49; 95% CI, 2.45-4.98), sleep disorders (HR, 2.27; 95% CI, 1.76-2.91), anxiety disorders (HR, 1.90; 95% CI, 1.25-2.84), and depressive disorders (HR, 1.54; 95% CI, 1.09-2.15).

CONCLUSION

This study showed that the major mental disorders associated with COVID-19 were dementia and sleep, anxiety, and depressive disorders.

When time worsens framing: a longitudinal analysis of the psychological effects of the COVID-19 pandemic in women with an eating disorder and their healthy sisters

The COVID-19 pandemic has profoundly affected individuals with eating disorders (ED), leading to an exacerbation of symptoms worldwide in 2020. However, there is a lack of longitudinal analyses of the psychological burdens experienced by this population. This study aims to longitudinally assess the psychological effects of the COVID-19 pandemic in people with ED and their healthy sisters (HS) 1 and 2 years after the onset of the crisis. A sample of 148 individuals, consisting of 73 with ED and 45 HS, was evaluated in spring 2021 and spring 2022 regarding their current psychological and behavioral states. Participants were also asked to reflect on their feelings and behaviors during the 2020 lockdown. General psychopathology, eating disorders, and trauma-related symptoms were evaluated using validated questionnaires. Both groups showed an overall improvement in psychopathological symptoms with time. Individuals with ED exhibited greater improvement compared to their HS, which may be attributed to their initially higher burden. Individuals with ED reported a negative reframe, characterized by internalizing negative emotions and behaviors related to the 2020 lockdown. This longitudinal evaluation revealed two distinct and contrasting effects. Both ED patients and their HS demonstrated psychological improvement over time. However, people with ED experienced a negative reframe that affected their memory of specific life events, subsequently affecting their psychological well-being. These findings shed light on the clinical severity observed in people with ED during these pandemic years.

Mental health improvement after the COVID-19 pandemic in individuals with psychological distress

The COVID-19 pandemic and associated countermeasures had an immensely disruptive impact on people's lives. Due to the lack of systematic pre-pandemic data, however, it is still unclear how individuals' psychological health has been affected across this incisive event. In this study, we analyze longitudinal data from two healthy samples (N = 307) to provide quasi-longitudinal insight into the full trajectory of psychological burden before (baseline), during the first peak, and at a relative downturn of the COVID-19 pandemic. Our data indicated a medium rise in psychological strain from baseline to the first peak of the pandemic (d = 0.40). Surprisingly, this was overcompensated by a large decrease of perceived burden until downturn (d =  - 0.93), resulting in a positive overall effect of the COVID-19 pandemic on mental health (d = 0.44). Accounting for this paradoxical positive effect, our results reveal that the post-pandemic increase in mental health is driven by individuals that were already facing psychological challenges before the pandemic. These findings suggest that coping with acute challenges such as the COVID-19 pandemic can stabilize previously impaired mental health through reframing processes.

Chiropractic students' perception of remote learning during the COVID-19 pandemic

OBJECTIVE

To investigate chiropractic students' preferences and perceptions of remote learning with a secondary aim of comparing individuals with and without learning challenges.

METHODS

Following the mandatory period of remote education, a 33-question, mixed-methods, anonymous online survey was distributed from March to September 2021 to a single-campus chiropractic student body with an estimated sample study population of N = 1375. Demographic variables, self-reported learning challenges, technology skills, and perceptions of remote and on-ground learning delivery modalities were gathered. Percentages, measures of central tendency, and chi-square tests were performed on the data.

RESULTS

There were 117 participants (8.5%), of whom 63.2% were female (n = 74) and 87.2% (n = 102) were aged 18-34 years. Self-identified learning challenges were present in 33.3% (n = 39) of participants, of whom 28 stated they had attention-deficit/hyperactivity disorder or attention-deficit disorder. More than 85.5% (n = 100) of participants agreed they were proficient with the necessary technology. For basic science classes with a lecture and lab component, 61.5% (n = 72) preferred on-ground labs and remote lectures. Participants agreed that remote lectures and on-ground labs were a good use of time (75.2% [n = 88] and 79.5% [n = 93], respectively). There was a significant χ2 between individuals with and without learning challenges for the perception of "stimulating and interesting" (p = .044) and "attention" (p = .001) for on-ground lectures.

CONCLUSION

Chiropractic students preferred remote and on-ground education differentially for labs and lectures. On-ground labs provided greater perceived educational benefits; perceived benefits of remote lecture courses were only modestly supported. Students with self-identified learning challenges presented with some differences related to perception of on-ground lectures.

Age-related impact of social isolation in mice: Young vs middle-aged

Social isolation is a chronic mild stressor and a significant risk factor for mental health disorders. Herein we explored the impact of social isolation on depression- and anxiety-like behaviours, as well as spatial memory impairments, in middle-aged male mice compared to post-weaning mice. We aimed to quantify and correlate social isolation-induced behaviour discrepancies with changes in hippocampal glial cell reactivity and pro-inflammatory cytokine levels. Post-weaning and middle-aged C57BL7/J6 male mice were socially isolated for a 3-week period and behavioural tests were performed on the last five days of isolation. We found that 3 weeks of social isolation led to depressive-like behaviour in the forced swim test, anxiety-like behaviour in the open field test, and spatial memory impairment in the Morris water maze paradigm in middle-aged male mice. These behavioural alterations were not observed in male mice after post-weaning social isolation, indicating resilience to isolation-mediated stress. Increased Iba-1 expression and NLRP3 priming were both observed in the hippocampus of socially isolated middle-aged mice, suggesting a role for microglia and NLRP3 pathway in the detrimental effects of social isolation on cognition and behaviour. Young socially isolated mice also demonstrated elevated NLRP3 priming compared to controls, but no differences in Iba-1 levels and no significant changes in behaviour. Ageing-induced microglia activation and enhancement of IL-1β, TNF-α and IL-6 proinflammatory cytokines, known signs of a chronic low-grade inflammatory state, were also detected. Altogether, data suggest that social isolation, in addition to inflammaging, contributes to stress-related cognitive impairment in middle-aged mice.

Reporting of auditory symptoms over time: (in)consistencies, expectations and the nocebo effect

Objective: Consistent symptom reporting for conditions like tinnitus that do not have an associated sign is critical for evaluating severity and intervention effectiveness, and for interpreting research findings. There is little research examining reporting of tinnitus and hearing difficulty over time. We address this here by comparing reported hearing difficulty and tinnitus at two time-points.Design: A cross-sectional study comparing symptom reporting in March 2019 and August/September 2021 using data from two online surveys of the same cohort. Although each survey was designed to address a different question, both asked about symptoms of tinnitus and hearing difficulties and enabled this exploratory analysis.Study sample: 6881 members of the UK general public aged 18+ years.Results: Inconsistent reporting was evident - many participants who reported experiencing tinnitus and/or hearing difficulties in 2019, said in 2021 that they had never had such symptoms before. Additionally, reports of new tinnitus/hearing difficulties in 2021 were unexpectedly high, equating to 18-month incidence rates of 13.6% and 11.7%, respectively.Conclusions: Psychosocial factors, expectations and context impact symptom reporting. This should be considered when treating patients and interpreting research findings. Using real-time data collection methods could thus provide a better understanding of experiences of tinnitus and hearing.

Online case-based learning for medical students as a teaching method for biochemistry at King Abdulaziz University amid COVID-19 pandemic (a study conducted in 2021)

Online case-based learning (CBL) is a method used by King Abdulaziz University to teach medical students in their preclinical years. The use of CBL in basic sciences is important for enabling medical students to correlate basic sciences with future clinical practice. This study implemented online CBL for biochemistry teaching as part of the medical genetic module for 3rd-year preclinical students. Teaching during the study was completely online because of restricted precautions caused by the COVID-19 pandemic, except for practical sessions that were held on campus. The case was presented to the students involved in prenatal screening and diagnosis. Students were guided to learn and discuss the biochemical tests used for prenatal screening and diagnosis and their clinical importance. They were divided into two groups: the control group was given an online lecture and the intervention group was given an online CBL session before the lecture. The online lecture was given to both groups simultaneously by the same instructor, and then 10 MCQs tests were distributed to both groups after the lecture, and their test scores were compared. A 10-question survey was administered to the intervention group to assess their perception of the online CBL session after the test. A significant difference was found between the intervention and control groups regarding test scores (p < 0.001), and most students found the online CBL session enjoyable and motivating.

Prevalence of depression, stress and suicide tendency among individuals with long COVID and determinants: a protocol of a systematic review and meta-analysis

BACKGROUND

It is well known that the COVID-19 pandemic has had a devastating impact on mental health, especially among individuals with long COVID. This systematic review and meta-analysis aims to investigate the prevalence of depression, stress and suicide tendencies among individuals with long COVID, as well as to explore the factors that contribute to these conditions.

METHODS AND ANALYSIS

A comprehensive review of literature will be conducted in various databases of including PubMed, including Medline, Embase, PsycINFO, CINAHL and Cochrane Library. The studies to be included in this review will be published in the English language, and the time frame of included studies will be from the date of inception of COVID-19 until 30 December 2023. Two independent reviewers will identify studies for inclusion based on a screening questionnaire, and the JBI standardised critical appraisal checklist for studies reporting prevalence data will be used to assess the methodological quality. The strength of the body of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. To analyse the data, a robust Bayesian approach will be applied using the STATA software package (V.14; STATA) and JASP software. The findings of this systematic review and meta-analysis will provide valuable insights into the prevalence of depression, stress and suicide tendencies among individuals with long COVID, as well as the factors that contribute to these conditions.

ETHICS AND DISSEMINATION

There is no research ethics board approval required. The dissemination plan is to publish results in a peer-reviewed academic journal.

PROSPERO REGISTRATION NUMBER

CRD42022346858.

Physical Activity, Heart Rate Variability, and Ventricular Arrhythmia During the COVID-19 Lockdown: Retrospective Cohort Study

BACKGROUND

Ventricular arrhythmias (VAs) increase with stress and national disasters. Prior research has reported that VA did not increase during the onset of the COVID-19 lockdown in March 2020, and the mechanism for this is unknown.

OBJECTIVE

This study aimed to report the presence of VA and changes in 2 factors associated with VA (physical activity and heart rate variability [HRV]) at the onset of COVID-19 lockdown measures in Ontario, Canada.

METHODS

Patients with implantable cardioverter defibrillator (ICD) followed at a regional cardiac center in Ontario, Canada with data available for both HRV and physical activity between March 1 and 31, 2020, were included. HRV, physical activity, and the presence of VA were determined during the pre- (March 1-10, 2020) and immediate postlockdown (March 11-31) period. When available, these data were determined for the same period in 2019.

RESULTS

In total, 68 patients had complete data for 2020, and 40 patients had complete data for 2019. Three (7.5%) patients had VA in March 2019, whereas none had VA in March 2020 (P=.048). Physical activity was reduced during the postlockdown period (mean 2.3, SD 1.6 hours vs mean 2.1, SD 1.6 hours; P=.003). HRV was unchanged during the pre- and postlockdown period (mean 91, SD 30 ms vs mean 92, SD 28 ms; P=.84).

CONCLUSIONS

VA was infrequent during the COVID-19 pandemic. A reduction in physical activity with lockdown maneuvers may explain this observation.

A Longitudinal Study of the Influence of the COVID-19 Pandemic on Anxiety and Stress among Medical University Students

(1) Background: The COVID-19 pandemic was declared an international health emergency by the World Health Organization. The dramatic, widespread transmission of the virus, high mortality, and lack of specific drugs caused the development of panic attacks and anxiety. Healthcare professionals, including medical students, were challenged to provide medical care to patients in need, often exposing themselves to the virus. (2) Methods: This study aimed to assess anxiety and stress levels in medical students, both at the beginning and after the end of the COVID-19 pandemic. The STAI and PSS-10 questionnaires were used. (3) Results: This study showed a decrease in anxiety levels among medical students after the end of the COVID-19 pandemic. In both 2020 and 2022, female students were found to experience higher stress levels than male students. Anxiety levels were similar among students of different medical-related faculties. (4) Conclusions: The COVID-19 pandemic caused stress and anxiety among medical students, which decreased throughout the duration of the pandemic.

Regular use of acupressure mats reduces perceived stress at subjective but not psychophysiological levels: Insights from a three-week relaxation training

Acupressure mats are promoted as stress management tools for easy and effective self-application, promising reduced stress and increased well-being. However, the scientific evidence for these effects is based on few experimental studies and lacks the examination of acupressure mats as a solitary relaxation tool. Our study aimed to examine which changes in stress and well-being can be expected from the use of acupressure mats by healthy young people on the subjective and psychophysiological level. Unexperienced participants practiced relaxation for three weeks either with an acupressure mat or without any tools (active control group [CG]). As a results, subjective well-being and stress decreased, while sleep quality and concentration endurance increased across groups. Blood pressure (BP), heart rate (HR), pain threshold and pain tolerance did not change significantly from pre- to post-training measurements. Most importantly, no significant differences were found between groups, indicating that training with an acupressure mat yielded no superior effects compared with an active control condition in healthy young students. As a conclusion, taking time to relax has some but limited beneficial effects on the subjective levels independent of the specific method for healthy students. Potential beneficial effects of acupressure mats might be bound to specific impairments, such as tension pain.

Pregnant individuals with uncomplicated pregnancies display pro-inflammatory immune changes when exposed to the COVID-19 pandemic

PROBLEM

The COVID-19 pandemic has been shown to have a detrimental impact on the mental health of pregnant individuals, and chronic stress can alter the immune profile. However, the effects of the COVID-19 pandemic on the immune system in pregnancy are still poorly understood. We aimed to evaluate the impact of pandemic exposure on the maternal immune profile in uncomplicated pregnancies.

METHOD OF STUDY

We collected blood and placenta samples from pregnant individuals exposed and unexposed to the pandemic to compare their immune and inflammatory profiles. We performed co-culture with circulating maternal immune cells and endothelial cells to assess endothelial activation. Statistical analysis was performed using unpaired t-test, Mann-Whitney, or Fisher's exact test as appropriate.

RESULTS

In exposed individuals, we observed a decreased proportion of Th2 cells (p < .0001) and Treg/Th17 ratio (p < .05), as well as an increased Th1/Th2 ratio (p < .0001). Levels of IL-1β (p < .01) and IL-18 (p < .01) were increased in the circulation of exposed participants, whilst other mediators were significantly decreased (IFNγ, IL-8, MCP-1, amongst others). Furthermore, we observed increased production of ICAM, hallmark of endothelial activation, when we co-cultured endothelial cells with immune cells from exposed individuals. Vaccination status impacted the cellular profile with increased proportions of Th1 and B cells in vaccinated participants.

CONCLUSION

Overall, we observed a pro-inflammatory bias in the circulation of pregnant individuals exposed to the COVID-19 pandemic, with otherwise uncomplicated pregnancies. Our work also supports an association between the increased risk of endothelial activation/hypertension and SARS-CoV2 infection, which might be driven in part by exposure to the pandemic and associated stressors.

Writing about a stressful experience improves semantic clustering of memory in men, not women

Writing about negative experiences can produce multiple benefits, including improvements in mental and emotional health. However, writing about negative experiences potentially be detrimental, as reliving and reexperiencing a negative memory can be painful. Although the emotional effects of writing about negative experiences are well established, the cognitive effects are less heavily explored, and no work to date has examined how writing about a stressful experience might influence episodic memory. We addressed this issue in the present study (N = 520) by having participants encode a list of 16 words that were organised around four semantic clusters, randomly assigning participants to write about an unresolved stressful experience (n = 263) or the events of the previous day (n = 257), and assessing their memory in a free recall task. Writing about a stressful experience did not influence overall memory performance; however, the stressful writing manipulation increased semantic clustering of information within memory for men, whereas the stressful writing manipulation did not influence semantic clustering of information within memory in women. Additionally, writing with more positive sentiment improved semantic clustering and reduced serial recall. These results provide evidence for unique sex differences in writing about stressful experiences and the role of sentiment in the effects of expressive writing.

[Influence of the Corona pandemic on cardiovascular risk factors - Data from 1775 participants of the ELITE study before and during the Corona pandemic]

BACKGROUND

 The COVID-19 pandemic and its interventions have led to a deficit in medical care and changes in people's lifestyles, which has consequently changed cardio- and cerebrovascular primary and secondary prevention. The existing data are mainly based on surveys. In addition to the problem of the accuracy of self-assessments, the pandemic per se and the massive public reporting may have biased the data.Only a few publications have compared data collected before the pandemic with results during the pandemic. The ELITE study has regularly monitored risk factors (RF) and psychosocial parameters (stress, depression, well-being, diet, brain performance, exercise) in over 5000 participants for years. From this study, data were analyzed from 1775 individuals collected before the onset and again during the pandemic (06/05/2020-25/01/2022). Thus, baseline values were unaffected by the pandemic.

RESULTS

 As expected, both improvements and worsening of the collected parameters were found. Blood pressure and depressive symptoms worsened significantly more often, with women more frequently affected. Weight and stress levels also increased more often than they improved. Only physical activity showed a slight increase. 24.1 % showed only deteriorations and no improvements in these parameters. In contrast, 19.6 % showed improvements exclusively. In the group with only worsening, there was a significant increase in individuals with the risk factors (RF) hypertension, obesity, elevated LDL cholesterol, nicotine, and diabetes mellitus. This resulted in an increase in individuals with 2 or more RF. In contrast, the number of individuals with 2 and more RF decreased in the group with only improvements. Strikingly, individuals with risk factors improved more frequently.

CONCLUSION

 A not insignificant part of the population experienced significant worsening of RF during the pandemic. This particularly affected blood pressure and depressive symptoms, and more often women.

How Did Breast Cancer Patients Fare during Different Phases of the COVID-19 Pandemic in Norway Compared to Age-Matched Controls?

Little is known about how health-related quality of life (HRQoL) in breast cancer cases differed from that of controls during and after the COVID-19 pandemic. This study used data from an ongoing, nationwide HRQoL survey of 4279 newly diagnosed breast cancer cases and 2911 controls to investigate how breast cancer patients fared during different phases of the pandemic compared to controls. Responders during 2020-2022 were categorized into three COVID-19-related phases: the social restrictions phase, the high infection rate phase, and the post-pandemic phase. Across phases, breast cancer cases had significantly worse scores in most HRQoL domains compared to controls. Apart from slightly more insomnia in the high infection rate phase for both cases and controls, and better social functioning for young cases in the post-COVID-19 phase, the case-control differences in HRQoL remained consistent across phases. When the phases were assessed as one period, young women and those living with children <18 years of age fared the worst among breast cancer cases, while single women fared the worst among controls. In contrast, controls living with children <18 years of age exhibited better HRQoL than controls without children. In summary, women with breast cancer did not appear to fare differently than controls in terms of HRQoL across COVID-19 phases. However, breast cancer cases with young children fared worse in their HRQoL than other breast cancer cases.

College Students' Day-to-Day Maladaptive Drinking Responses to Stress Severity and Stressor-Related Guilt and Anger

BACKGROUND

Stress is a common part of college students' daily lives that may influence their physical activity (PA) and alcohol use. Understanding features of daily stress processes that predict health behaviors could help identify targets for just-in-time interventions.

PURPOSE

This study used intensive longitudinal data to examine whether prior day stress processes predict current day PA or alcohol use.

METHODS

Participants (N=58, Mage=20.5, 59% women, 70% White) were 18-to-25-year-old students who engaged in binge drinking at least twice monthly and used cannabis or tobacco in the past year. They wore activity (activPAL4) and alcohol (Secure Continuous Remote Alcohol Monitor) monitors for 11 days to assess daily PA (e.g., step counts) and alcohol use (e.g., drinking day), and completed daily surveys about yesterday's stress, including number of stressors (i.e., frequency), stressor intensity (i.e., severity), and frequency of affective states (e.g., guilt). Multilevel models examined prior day stress predicting current day PA or alcohol use.

RESULTS

Participants had higher odds of current day drinking (odds ratio=1.21) and greater area under the curve (B=0.08) when they experienced greater than usual stress severity the prior day. Participants had higher current day peak transdermal alcohol concentration (B=0.12) and area under the curve (B=0.11) when they more frequently experienced guilt due to stressors the prior day.

CONCLUSIONS

College students' unhealthy response of increasing alcohol use due to stress could adversely impact health outcomes. There is a critical need for interventions addressing students' ability to effectively manage and respond to the stress-inducing, daily demands of student life.

How adolescents' lives were disrupted over the course of the COVID-19 pandemic: A longitudinal investigation in 12 cultural groups in 9 nations from March 2020 to July 2022

It is unclear how much adolescents' lives were disrupted throughout the COVID-19 pandemic or what risk factors predicted such disruption. To answer these questions, 1,080 adolescents in 9 nations were surveyed 5 times from March 2020 to July 2022. Rates of adolescent COVID-19 life disruption were stable and high. Adolescents who, compared to their peers, lived in nations with higher national COVID-19 death rates, lived in nations with less stringent COVID-19 mitigation strategies, had less confidence in their government's response to COVID-19, complied at higher rates with COVID-19 control measures, experienced the death of someone they knew due to COVID-19, or experienced more internalizing, externalizing, and smoking problems reported more life disruption due to COVID-19 during part or all of the pandemic. Additionally, when, compared to their typical levels of functioning, adolescents experienced spikes in national death rates, experienced less stringent COVID-19 mitigation measures, experienced less confidence in government response to the COVID-19 pandemic, complied at higher rates with COVID-19 control measures, experienced more internalizing problems, or smoked more at various periods during the pandemic, they also experienced more COVID-19 life disruption. Collectively, these findings provide new insights that policymakers can use to prevent the disruption of adolescents' lives in future pandemics.

COVID-19-related stress response among adult females: Relevance of sociodemographics, health-related behaviors and COVID-19 contact

Women were more affected than men during the COVID-19 pandemic. This study aimed to investigate COVID-19-related stress response in adult women and its association with the relevant socioeconomic, lifestyle and COVID-19-related factors. This research was carried out in eight randomly chosen cities from September 2020 to October 2021. To examine stress, we distributed the COVID Stress Scales (CSS) and the Perceived Stress Scale (PSS). Women also fulfilled a general socio-epidemiologic questionnaire. The study included 1,264 women. Most women were healthy, highly educated, employed, married, nonsmokers who consumed alcohol. The average total CSS score suggested a relatively low COVID-19 related stress), while 1.7% of women had CSS ≥ 100. The mean PSS was around the mid-point value of the scale. Older women, who were not in a relationship, didn't smoke, didn't drink alcohol, but used immune boosters, had chronic illnesses and reported losing money during the pandemic had higher CSS scores. A higher level of stress was also experienced by women exposed to the intense reporting about COVID-19, had contact with COVID-19 positive people or took care of COVID-19 positive family members. In this sample of predominantly highly educated women few women experienced very high stress level, probably due to the study timing (after the initial wave) when the pandemic saw attenuated stress levels. To relieve women from stress, structural organization and planning in terms of health care delivery, offsetting economic losses, controlled information dissemination and psychological support for women are needed.