Intolerance of uncertainty as a factor linking obsessive-compulsive symptoms, health anxiety and concerns about the spread of the novel coronavirus (COVID-19) in the United States

Intolerance of Uncertainty as a Situational Vulnerability Factor in the Context of the Pandemic: A Systematic Review and Meta-Analysis of COVID-19-Related Psychological Impacts

BACKGROUND

Intolerance of uncertainty (IU) is widely accepted as a transdiagnostic vulnerability factor for a range of mental health problems. It is considered a transsituational vulnerability factor associated with a range of responses to different stressful life situations. The aim of this systematic review and meta-analysis is to examine the association between IU and specific psychological responses to the COVID-19 pandemic and the moderators of this relationship drawn from IU research and other studies on COVID-19.

METHOD

The studies included were as follows: (i) English-language articles published in peer-reviewed journals or thesis/dissertations; (ii) reporting specific psychological impacts of COVID-19; (c) reporting IU; (iii) case-control studies, prospective cohort studies, experimental studies and cross-sectional studies of large populations and (iv) reporting correlation coefficients between the variables of interest. Studies on participants with a diagnosis of neurological and/or organic impairment were excluded. The databases searched were Google Scholar, PubMed, ScienceDirect, and ProQuest, up until 31 December 2022. The risk of bias was assessed using the Risk of Bias Utilized for Surveys Tool (ROBUST, Nudelman et al., 2020). Sensitivity analysis was conducted using the one-study remove method, and studentized residuals and Cook's distance were examined. A random effects model was used.

RESULTS

We examined the association between IU and COVID-19-related psychological impacts across 85 studies from 22 countries (N = 69,997; 64.95% female; mean sample age, 32.90 ± 9.70). There was no evidence of publication bias. We found a medium and positive association between IU and COVID-19-related psychological impacts (N = 69,562, r = 0.35, k = 89, 95% CI [0.32, 0.37]), which was independent of the IU measure used or whether the psychological impact was measured in relation to the virus alone or broader aspects of the pandemic. It was also independent of severity, publication year, sample type and size, study quality, age and sample levels of anxiety, depressive symptoms, stress, mental well-being and social support. However, the observed association varied significantly between countries and country income levels (stronger among low-incomes) and across genders (stronger among males) and was stronger for measures with greater reliability and more items, but lower among samples with more people who had been exposed to COVID-19.

CONCLUSIONS

The findings support that IU is a higher order transsituational vulnerability factor related to cognitive, behavioural and distress responses during the pandemic. Limitations include English-language-only sources, reliance on a wide range of measures that were coded using a novel system and variable risk of bias across studies. The implications are considered in relation to the management of psychological consequences of major situational stressors experienced at a global scale, but the variations at a national and socioeconomic level also have implications for different or localized stressors at a regional or community level.

Intolerance of Uncertainty, Job Satisfaction and Work Performance in Turkish Healthcare Professionals: Mediating Role of Psychological Capital

Objective: Psychological capital refers to internal resources including self-efficacy, hope, optimism and resilience to overcome adverse life events. The current study sought to examine the mediating role of psychological capital in the relationship between intolerance of uncertainty and job satisfaction and work performance in healthcare professionals. Methods: Participants were 302 healthcare professionals [48% females; M(SD) age = 34.0 (7.5)] and completed measures of intolerance of uncertainty, psychological capital, work performance, and job satisfaction. Results: The findings indicated that intolerance of uncertainty was negatively correlated with psychological capital, work performance, and job satisfaction, whereas psychological capital was positively correlated with job satisfaction and work performance. More importantly, the findings revealed that these relationships were mediated by psychological capital. Conclusion: The results provide several contributions that help to understand the role of psychological capital in the relationship between intolerance to uncertainty and job satisfaction and work performance.

Fear of COVID-19, Health Anxiety and Work-Family Conflict in Nurses Working in the COVID-19 Ward

Background

COVID-19 is an example of an epidemic and sudden crisis that has affected many aspects of life and work and identifying the factors that contribute to its impact can help prevent similar crises in the future. The purpose of this study was to investigate fear of COVID-19, health anxiety, and work-family conflict in nurses working in COVID-19 wards in hospitals affiliated with the Tehran University of Medical Sciences (TUMS).

Materials and Methods

This descriptive-analytical study used a census method to survey 226 nurses working in eight hospitals affiliated with TUMS. Demographics information and three questionnaires including; the Fear of COVID-19 Scale, Short Health Anxiety Inventory, and Work-Family Conflict Scale were completed online. Data were analyzed using descriptive statistics and analytical statistics, and a significance level of p < 0.05 was considered.

Results

Structural equation modeling test showed that work-family conflict had an effect on health anxiety, and health anxiety had an effect on fear of COVID-19 (p < 0.05). The severity of the effect of work-family conflict on health anxiety was 0.73, and the severity of the effect of health anxiety on fear of COVID-19 was 0.46. Work-family conflict had an indirect effect on fear of COVID-19 mediated only by health anxiety (p < 0.05) and the severity of the indirect effect was 0.33.

Conclusions

Health anxiety plays a mediating role in the relationship between work-family conflict and fear of COVID-19. Workplaces should provide more support to their employees during a crisis such as the COVID-19 pandemic, and prevention programs should be implemented to decrease anxiety.

Prevalence of obsessive-compulsive symptoms and their psychosocial correlates among medical students during COVID-19 pandemic

This study aimed to assess the prevalence of obsessive-compulsive symptoms (OCS) among medical students during COVID-19 pandemic and to evaluate their association with related sociodemographic features and other psychological symptoms. In this cross-sectional study, students from Mashhad University of Medical Sciences with no major exam in the preceding or following month were surveyed during April to August 2021 through stratified available sampling. Data were collected by a structured online questionnaire distributed through social media platforms. OCS were assessed using Obsessive-Compulsive Inventory-Revised (OCI-R) and COVID-related stress was evaluated using COVID Stress Scale (CSS). Overall, 347 students with a mean age of 22.67 ± 2.56 years were included in this study, of whom 30.3% had probable obsessive-compulsive disorder (OCD; OCI-R score ≥21). Mean CSS scores in students with and without probable OCD were 38.64 ± 19.82 and 26.72 ± 16.63, respectively ( P  < 0.005). Total CSS score was significantly correlated with OCI-R score ( r  = 0.38, P  = 0.001). Around one-third of the medical students reported significant OCS during COVID-19 pandemic, which was associated with higher COVID-19-related stress. Further research provides insight into management of OCD and related disorders during the COVID-19 pandemic.

COVID-19 anxiety and its relation to anxiety-related disorder symptoms and mechanisms

The COVID-19 pandemic had a significant impact on the mental health of individuals, particularly in the area of anxiety-related disorders. Anxiety regarding COVID-19 has been associated with health anxiety, panic disorder, and obsessive-compulsive disorder symptoms. Additionally, COVID-19 anxiety has been associated with anxiety sensitivity, disgust, maladaptive metacognitions, and intolerance of uncertainty. While researchers have established that anxiety disorders and anxiety-related mechanisms were associated with COVID-19 anxiety, which specific anxiety-related symptoms and mechanisms are primarily associated with COVID-19 anxiety needs to be more extensively explored. The current study sought to further this area by examining which particular anxiety-related disorder symptoms and mechanisms were uniquely associated with COVID-19 anxiety. A non-clinical sample of 593 Canadian undergraduate participants (Mage = 21.13 years; 67.7 % female) completed this cross-sectional study between September 2020 and February 2021. Participants completed online questionaries assessing anxiety-related disorder symptoms and mechanisms in addition to multiple scales of COVID-19 anxiety. When examining symptoms, health anxiety (prs = 0.17-0.29) and obsessive-compulsive disorder (prs = 0.16-0.35) symptoms had the strongest unique associations with COVID-19 anxiety. Among the anxiety-related mechanisms, disgust sensitivity (prs = 0.14-0.16) and health anxiety-specific intolerance of uncertainty (prs = 0.12-0.30) had the strongest unique associations with COVID-19 anxiety. Individuals experiencing these disorders and anxiety-related mechanisms may be at a heightened vulnerability to experiencing heightened anxiety during future pandemics. Mental health professionals should discuss COVID-19 anxiety with individuals experiencing health anxiety or obsessive-compulsive disorder symptoms. Lastly, the study highlights the significance of considering a variety of specific anxiety-related disorder symptoms and mechanisms when working to understand pandemic anxiety.

Too much of a good thing? Hand hygiene and the long-term course of contamination-related obsessive-compulsive symptoms

Increased hygiene behavior may be a factor in the development of contamination-related obsessive-compulsive symptoms (C-OCS). We aimed at investigating (1) the course of C-OCS over 1 year after the start of the COVID-19 pandemic and (2) the effects of changes in hand hygiene (i.e., duration and frequency of handwashing) and related distress regulation on the long-term course of C-OCS. In a longitudinal study, we assessed 1,220 individuals from the German general population at the start of the COVID-19 pandemic (t1), 3 months later (t2), and 12 months later (t3). Pre-pandemic data were available in a subsample from 2014 (n = 430). A decrease in C-OCS over the first year of the pandemic emerged with a small effect size. Thirty-six percent of the participants scored above the clinical cut-off score at t1, 31% at t2, and 27% at t3. In 2014, only 11% scored above the clinical cut-off score. Hierarchical regression showed that C-OCS at t1 was the strongest predictor of a long-term increase in C-OCS. With small effect sizes, change in the duration (not frequency) of handwashing from t1 to t2, as well as the distress-reducing effect of handwashing served as additional predictors. Implications for information on hand hygiene guidelines are discussed.

Intolerance of Uncertainty and Worry Prospectively Predict COVID-19 Anxiety and Distress: A 4-Year Longitudinal Study

The COVID-19 pandemic precipitated an uptick in poor mental health outcomes, including coronavirus-related anxiety and distress. Preliminary research has shown that intolerance of uncertainty (IU) and worry proneness, two transdiagnostic risk factors for anxiety and related disorders, are associated cross-sectionally with pandemic-related fear and distress. However, the extent to which IU and worry proneness prospectively predict coronavirus-related anxiety and distress is unclear. Whether IU and worry may also interact in prospectively predicting coronavirus-related anxiety and distress is also unknown. To address this knowledge gap, the present study examined IU and trait worry as prospective predictors of the level and trajectory of coronavirus anxiety and COVID stress syndrome over time, as well as the extent to which worry moderated the relation between IU and pandemic-related outcomes. Participants (n = 310) who completed self-report measures of IU and trait worry in 2016 were contacted following the onset of COVID-19 in 2020 and completed biweekly measures of coronavirus anxiety and COVID stress syndrome for 30 weeks. Multilevel models revealed that IU assessed in 2016 significantly predicted the severity of both coronavirus anxiety and COVID stress syndrome throughout the study period in 2020. Worry also moderated the link between IU and coronavirus anxiety, such that individuals with high levels of trait worry and high IU in 2016 experienced the most coronavirus anxiety in 2020. Results suggest that IU and worry functioned as independent and interactive vulnerability factors for subsequent adverse psychological reactions to COVID-19. Clinical implications and future directions are discussed.

Psychological effects of the COVID-19 pandemic on primary healthcare professionals in Turkey: One year into the pandemic

AIM AND OBJECTIVES

This study aimed to determine the psychological effects of the COVID-19 pandemic on healthcare professionals working in primary care settings in the first year of the pandemic.

BACKGROUND

The healthcare industry has faced an unprecedented burden in the COVID-19 pandemic. Primary care professionals experienced the high level of psychological problems.

DESIGN AND METHODS

A total of 793 healthcare professionals from different regions of Turkey participated in this cross-sectional study. The STROBE (Strengthening the reporting of observational studies in epidemiology) checklist was used in the study. Data were collected online.

RESULTS

It has been found that more than half of healthcare professionals experienced severe depression, three-quarters experienced anxiety, and almost half experienced stress. It was also found that about half of the participants experienced a high degree of acute and chronic fatigue, and one-fifth experienced low inter-shift recovery.

CONCLUSION

The effects of the COVID-19 pandemic on the mental health of primary care professionals, especially nurses and midwives, are alarming. The problems that arise from the flawed healthcare delivery models and gender inequality, which worsen the usual psychological effects of the pandemic on primary care professionals, should be addressed urgently.

RELEVANCE TO CLINICAL PRACTICE

Psychological support and rehabilitative services should be expanded to eliminate the short- and long-term psychological effects of the pandemic on healthcare professionals.

Intention to receive the monkeypox vaccine and its psychological and sociodemographic predictors: a cross-sectional survey in the general population of Peru

OBJECTIVE

The objective of this study was to identify predictors of intention to be vaccinated against Monkeypox (Mpox) in a sample of Peruvian citizens.  METHODS: A set of sociodemographic and psychological predictors were used, such as sex, sexual orientation, educational level, previous diagnosis of COVID-19, marital status, complete vaccination against COVID-19, employment status, living with vulnerable people, presence of chronic disease, area of residence, perceived usefulness of COVID-19 vaccines, fear of Mpox, conspiracy beliefs about Mpox, among others. A total of 472 Peruvian adults participated, selected by non-probabilistic snowball convenience sampling. A sociodemographic survey, the Mpox Fear Scale, was used. Conspiracy Beliefs about Mpox was assessed using three questions created specifically for this study. For inferential purposes, simple ordinal regressions ("crude models") were performed between each factor and the outcome.  RESULTS: Regarding their intention to be vaccinated against Mpox, more than 60% expressed clear approval. Being non-heterosexual, having greater emotional fear of Mpox, and perceiving some potential for this disease to become the next pandemic were related to greater intention to vaccinate. On the other hand, being older, having low perceived usefulness of COVID-19 vaccines, and having higher conspiracy beliefs about Mpox were associated with lower intention to vaccinate.  CONCLUSION: The study provides initial information for future research seeking to better analyze Mpox vaccination intention. In addition, cross-sectional data are provided that can be used to develop public health policies that target subgroups with low prevalence of intention to vaccinate against Mpox.

Mind-Wandering and Its Relationship With Psychological Wellbeing and Obsessive-Compulsive Symptomatology in the Context of Covid-19

Mind-wandering (MW) as a research topic has received considerable attention over the last several decades. The recent differentiation between spontaneous and deliberate MW has suggested a particular effect of the former on psychopathology; in that increased spontaneous MW may precede mental illness. The present study sought to explore MW as a potential contributing factor to poor mental health in the context of the Covid-19 pandemic. More specifically, we sought to determine firstly, whether the effects of MW frequency, type and content on subjective psychological wellbeing was consistent with previous findings after controlling for the impacts of Covid-related stress. Secondly, previous research has demonstrated an effect of both Covid-stress and spontaneous MW on the experience of obsessive-compulsive symptomatology (OCS), and so the present study explored this relationship further by assessing whether Covid-stress mediated the relationship between spontaneous MW and OCS. Participants completed measures of MW, OCS and psychological wellbeing through an online questionnaire. The results indicated that increased spontaneous MW was indicative of both poorer subjective psychological wellbeing and OCS, with Covid-stress partially mediating the relationship between spontaneous MW and OCS. Our findings provide further support for the adverse effect of unintentional MW on psychological wellbeing, as well as for the differentiation between both forms of the cognitive phenomenon. Additionally, they provide an important insight into one of the factors that may have preceded poor mental health among the Irish population during Covid-19. Future research may build upon the present study by exploring similar relationships among clinical populations.

Two Years after the Beginning of COVID-19: Comparing Families Who Had or Did not Have Patients with COVID-19 on Health Beliefs and Obsessive-Compulsive Symptoms

Objective: This study aimed to compare health beliefs and obsessive-compulsive symptoms (OCS) in families with (FIM+) or without an infected member (FIM-) two years after the beginning of COVID-19. Additionally, this research intended to predict a decrease in OCS from baseline (T1) to 40 days later (T2) based on health beliefs. Method : In a longitudinal survey, 227 participants in two groups, including FIM+ (n = 98; M = 30.44; SD = 5.39) and FIM- (n = 129; M = 29.24; SD = 4.93), were selected through purposive sampling. They responded to measurements consisting of demographic characteristics, the Obsessive-Compulsive Inventory-Revised (OCI-R), Patient Health Questionnaire (PHQ-9), Impact of Event Scale-Revised (IES-R), and COVID-19 Health Belief Questionnaire (COVID-19-HBQ) at the final assessment phase (T2). To investigate differences between the two groups and predict OCS changes from T1 to T2, data were analyzed using Chi-squared, t-tests, U-Mann-Whitney, Kruskal-Wallis, Pearson correlations, and linear regression analyses. Results: At T1, FIM+ demonstrated significantly greater OCS, health beliefs, posttraumatic stress symptoms (PTS), and depressive symptoms than FIM-. Furthermore, FIM+ showed a decrease in OCS from T1 to T2 after its infected member recovered from COVID-19 (P < 0.001). A decrease in OCS was correlated with a decrease in perceived susceptibility, severity, and barriers. Lack of a vulnerable family member, lower educational attainment, and being a primary caregiver were associated with a greater decrease in OCS. Changes in perceived severity and self-efficacy accounted for 17% of variation in OCS. Conclusion: Even two years after the onset of the pandemic, COVID-19 not only impacts the life of patients with COVID-19 but family members who care for such patients respond to the disease by engaging in excessive health behaviors in the form of OCS.

COVID-19 related stress and fears of contamination: the impact of feared self-perceptions

Specific concerns have been raised for those suffering from obsessive-compulsive disorder (OCD) during the COVID-19 pandemic, particularly those suffering from contamination fear. Investigation in non-clinical and OCD samples have reported an increase in contamination symptoms in association with the severity of the COVID-19 pandemic. In particular, stress related to COVID-19 has been found to be a major predictor of an increase in contamination symptoms. It has also been suggested that these effects may be accounted for by feared-self perceptions, that renders certain individuals more vulnerable to COVID-related stress and its effect on contamination-related symptomatology. We hypothesized that feared self-perceptions would predict COVID-19-related stress and that both feared self-perceptions and COVID-19-related stress would predict contamination symptoms while controlling for age, education and sex. To test this hypothesis, 1137 community participants completed online questionnaires. Path analysis confirmed our hypotheses highlighting the importance of feared self-perceptions during the COVID-19 pandemic in its effect on stress and ensuing symptomatology. Further, women scored higher on questionnaires, but the relationship between feared self-perceptions, COVID-19-related stress and contamination symptoms remained similar. Implications for theory and research are discussed.

Intolerance of uncertainty, fear of contamination and perceived social support as predictors of psychological distress in NHS healthcare workers during the COVID-19 pandemic

Psychological distress has been repeatedly quantified over the course of the pandemic, however this has not always included broader healthcare workers, and has mostly focused on prevalence and occupational factors. This study investigated intolerance of uncertainty (IOU), fear of contamination and perceived social support as key predictors of psychological distress in healthcare professionals, between the 10^th and 23 June 2020, during the first wave of the COVID-19 pandemic. This study was a cross-sectional, online survey design. Opportunity sampling was used to recruit to the study, primarily using social media sites and snowballing techniques. The final sample included 342 National Health Service (NHS) healthcare workers. IU (p < .001), gender (p < .001), fear of contamination (p = .007), perceived social support (p = .012), and age (p = .017) significantly predicted psychological distress in the sample and accounted for 36.2% of variance in psychological distress scores. IOU accounted for 28.2% of this variance. A two-way post hoc ANOVA, looking at gender and profession, showed a significant main effect of gender on psychological distress scores (F(1,218) = 7.156, p = .008, η_p² = .032), with females reporting significantly higher psychological distress scores compared to males. In conclusion, higher levels of intolerance of uncertainty, fear of contamination and lower levels of perceived social support significantly influenced higher scores of psychological distress. These factors should be considered when adapting and delivering evidence-based interventions to healthcare staff during this crisis.

Psychological Correlates of Health anxiety in Response to the Coronavirus (COVID-19) Pandemic: a Cross-Sectional Online Study in Iran

Current models suggest health anxiety as a fundamental variable associated with fear and anxiety related to COVID-19. The investigation was carried out in separate two studies on the Iranian population. The first study aims to test the COVID-19 Anxiety Inventory (N = 202). The findings indicate a two-factor structure of the scale. Participants (N = 1638) completed the online survey anonymously in the second study, including the COVID-19 Anxiety Inventory, Short Health Anxiety Inventory, The Intolerance of Uncertainty Scale, Anxiety Sensitivity Index-3, Body Vigilance Scale, Depression Anxiety Stress Scales 21, and Contamination Cognitions Scale. Results showed that health anxiety, anxiety sensitivity, and body vigilance would significantly contribute to fears of contracting COVID-19. Moreover, the findings support a central role of intolerance of uncertainty in predicting COVID-19 anxiety. The study results provided both theoretical and practical implications for understanding psychosocial predictors during the COVID-19 pandemic.

Relationships between stress appraisals and intolerance of uncertainty with psychological health during early COVID-19 in the USA

BACKGROUND AND OBJECTIVES

The COVID-19 pandemic has caused increased psychological distress and decreased quality of life (QoL), but limited research has evaluated cognitive appraisals of COVID-19. This study aimed to examine the role of three stress appraisals of the COVID-19 pandemic - threat appraisal, harm/loss appraisal, and challenge appraisal - and the interaction between these appraisals and intolerance of uncertainty (IU) on psychological distress and QoL.

DESIGN

This was a cross-sectional survey study using Amazon's Mechanical Turk.

METHODS

A sample of 327 adults living in the U.S. completed a series of questionnaires investigating IU, appraisal of the pandemic, psychological distress, and QoL in May 2020 during the first wave of the COVID-19 pandemic.

RESULTS

Controlling for demographic variables, IU and harm/loss appraisal positively related to psychological distress and negatively related to QoL. Challenge appraisals negatively related to distress and positively related to QoL. Moderation analyses revealed that higher levels of IU led to stronger positive relationships between threat appraisal and psychological distress.

CONCLUSIONS

Cognitive appraisals of COVID-19 are associated with psychological health, though the relationship between threat appraisal and psychological distress are strongest for those with difficulty tolerating uncertainty. Theoretical and practical implications are discussed.

Intolerance of uncertainty, anxiety sensitivity, and health anxiety during the COVID-19 pandemic: Exploring temporal relationships using cross-lag analysis

Intolerance of uncertainty (IU) and anxiety sensitivity (AS) have been widely discussed and explored as factors that may contribute to health anxiety. We propose that IU and AS are salient issues for many during the COVID-19 pandemic, and may play a role in the development or exacerbation of health anxiety during the pandemic. Studies have examined links between IU and AS with health anxiety during the pandemic, but these relationships have not been tested together using a longitudinal study design. In the present study, measures of IU, AS, and health anxiety were collected from 301 adults at two time points 6 months apart during (early stages of) the COVID-19 pandemic using an online survey platform. Cross-lagged analysis was utilized to simultaneously estimate cross-sectional and longitudinal associations between these three variables. Robust cross-sectional associations were observed, and IU prospectively predicted changes in both health anxiety and AS. No other statistically significant prospective associations emerged. Present findings support the putative role of IU in health anxiety, suggesting that some observed links between AS and health anxiety could be driven by shared variance with IU. IU may be an important factor to monitor and target in health anxiety interventions during the pandemic.

Obsessive-Compulsive Disorder During the COVID-19 Pandemic Process: A Narrative Review

This study aimed to review all empirical contributions published between March 2020 and June 2022, addressing the impact of the COVID-19 pandemic on obsessive-compulsive disorder in adults. We searched the literature in PubMed, Google Scholar, and Web of Science. A total of 543 articles were scanned and 73 full-text articles were identified. Reviews, comments, letters to the editor, and case reports (except case series) were excluded. It was determined that 42 articles met the inclusion criteria, 6 studies involving only children and adolescents were excluded, and 36 were decided on their suitability for our study. The analysis determined that COVID-19 had an impact on obsessive-compulsive disorder. Characteristics such as liability for harm and unacceptable thoughts influenced the symptoms as well as contamination and washing. Some studies showed an increase in the severity of obsessive-compulsive symptoms, while some reported no worsening but improvement with treatment and follow-up. While some reported variations in outcomes related to sociodemographic characteristics and subtypes, some focused on the risk of suicide. There were also studies conducted on special groups such as pregnant women or healthcare workers. The results were controversial. While available data contain more information on worsening obsessive-compulsive disorder symptoms, data on the status of patients under treatment were scarce. There were not enough studies evaluating follow-up results. Influencing factors such as sociodemographic characteristics, subtypes, comorbid conditions, treatment, and support did not seem to have been adequately addressed.

The Relationship between Intolerance of Uncertainty and Problematic Social Media Use during the COVID-19 Pandemic: A Serial Mediation Model

The COVID-19 pandemic has brought significant interruptions to life certainty, and there has been a lack of research on the influence of uncertainty. The present research aimed to explore how intolerance of uncertainty, maladaptive coping strategies, and fear of missing out affect social media use in a Chinese community sample (N = 311) during the pandemic. Serial mediation analysis was applied, integrating the mediating role of maladaptive coping strategy and fear of missing out. Intolerance of uncertainty, maladaptive coping strategies, and fear of missing out was positively related to PSMU. Based on the mediation analysis, when age and gender were controlled, the direct effect of intolerance of uncertainty on PSMU was significant. The total indirect effect was also significant. The effect of intolerance of uncertainty on PSMU was mediated by maladaptive coping strategies and fear of missing out. Taken together, maladaptive coping strategies and fear of missing out played a serial mediating role between intolerance of uncertainty and PSMU. The findings imply that strategies to improve the tolerance of uncertainty, reduce fear of missing out, and relevant coping strategies could be potentially helpful in mitigating problematic social media use, especially during the COVID-19 pandemic.

Association between COVID-19 stress, coping mechanisms and stress-related oral conditions among Egyptian adults: a cross-sectional study

The present study investigated the association between COVID-19 stresses and oral conditions including gingivitis, oral hygiene, oral ulcers, and dry mouth. This was a cross-sectional study that collected data from adults in community settings in Alexandria, Egypt, between October 2021, and February 2022. Gingival condition and oral hygiene were assessed using the gingival and plaque indices. Participants were asked if they experienced oral ulcers during the past week and dry mouth during the past year. COVID-19 fears and coping were assessed using the COVID Stress Scale (CSS), and the Brief Resilience Coping Scale (BRCS), respectively. Oral health behaviors were assessed using the World Health Organization questionnaire. Regression analyses were used to assess the association between the dependent variables (clinically assessed gingival and plaque indices, reported presence of oral ulcers, and dry mouth) and explanatory variables (CSS and BRCS) after adjusting for confounders (COVID-19 status, oral health behaviors, smoking, age in years, sex, and highest educational level). The response rate was 88.8% (373/420). The mean (SD) age = 39.26 (11.45) with 74.3% females and 49.3% reporting completing high school or higher education. The mean (SD) plaque and gingival indices were 1.59 (0.66) and 1.39 (0.59), respectively. Only 20.1% reported the presence of oral ulcers and 41.6% reported xerostomia. Lower plaque score was associated with higher COVID-19 contamination fears (B = - 0.03, 95% CI - 0.05, - 0.02) and higher compulsive checking and reassurance-seeking (B = - 0.02, 95% CI - 0.03, - 0.009). Lower gingival score was associated with higher COVID-19 contamination fears (B = - 0.02, 95% CI - 0.03, - 0.002). Higher odds of reporting dry mouth were associated with greater fear of COVID-19 socioeconomic consequences (AOR = 1.05, 95% CI 1.001, 1.09), and lower coping scores (AOR = 0.93, 95% CI 0.88, 0.99). The findings suggest an association between COVID-19 specific stresses and stress-related oral conditions and shed light on the possible link between mental and oral health, emphasizing the importance of integrated planning of care services.

Interoceptive anxiety-related processes: Importance for understanding COVID-19 and future pandemic mental health and addictive behaviors and their comorbidity

The COVID-19 pandemic is associated with an increased prevalence of mental health problems and addictive behaviors. There is a growing theoretical and empirical evidence that individual differences in interoceptive anxiety-related processes are a one set of vulnerability factors that are important in understanding the impact of pandemic-related mental health problems and addictive behavior. However, there has not been a comprehensive effort to explore this rapidly growing body of research and its implications for public health. In this paper, we discuss why interoceptive anxiety-related processes are relevant to understanding mental health and addictive behaviors during the COVID-19 pandemic. We then provide a narrative review of the available COVID-19 literature linking interoceptive fear and anxiety-related processes (e.g., anxiety sensitivity, health anxiety, and COVID-19 anxiety, fear, and worry) to mental health and addictive behaviors. We then propose a novel transdiagnostic theoretical model that highlights the role of interoceptive anxiety-related processes in mental health and addictive behavior in the context of the present and future pandemics. In the final section, we utilize this conceptualization to underscore clinical implications and provide guidance for future research initiatives in the management of COVID-19 mental health and addictive behaviors and inform the public health field for future pandemics.

Does COVID-19 related symptomatology indicate a transdiagnostic neuropsychiatric disorder? - Multidisciplinary implications

The clinical presentation that emerges from the extensive coronavirus disease 2019 (COVID-19) mental health literature suggests high correlations among many conventional psychiatric diagnoses. Arguments against the use of multiple comorbidities for a single patient have been published long before the pandemic. Concurrently, diagnostic recommendations for use of transdiagnostic considerations for improved treatment have been also published in recent years. In this review, we pose the question of whether a transdiagnostic mental health disease, including psychiatric and neuropsychiatric symptomology, has emerged since the onset of the pandemic. There are many attempts to identify a syndrome related to the pandemic, but none of the validated scales is able to capture the entire psychiatric and neuropsychiatric clinical presentation in infected and non-infected individuals. These scales also only marginally touch the issue of etiology and prevalence. We suggest a working hypothesis termed Complex Stress Reaction Syndrome (CSRS) representing a global psychiatric reaction to the pandemic situation in the general population (Type A) and a neuropsychiatric reaction in infected individuals (Type B) which relates to neurocognitive and psychiatric features which are part (excluding systemic and metabolic dysfunctions) of the syndrome termed in the literature as long COVID. We base our propositions on multidisciplinary scientific data regarding mental health during the global pandemic situation and the effects of viral infection reviewed from Google Scholar and PubMed between February 1, 2022 and March 10, 2022. Search in-clusion criteria were "mental health", "COVID-19" and "Long COVID", English language and human studies only. We suggest that this more comprehensive way of understanding COVID-19 complex mental health reactions may promote better prevention and treatment and serve to guide implementation of recommended administrative regulations that were recently published by the World Psychiatric Association. This review may serve as a call for an international investigation of our working hypothesis.

Worrying But Not Acting: The Role of Intolerance of Uncertainty in Explaining the Discrepancy in COVID-19-Related Responses

Research indicates that Intolerance of Uncertainty (IU) is associated with COVID-19 emotional responses, but not necessarily with engaging in COVID-19 preventative behaviors. The current study was designed to further evaluate this discrepancy. Participants (N = 454) completed self-report forms about COVID-19 emotional responses (i.e., fear, worry, sensitivity to symptoms) and COVID-19 behavioral interference/responses (i.e., interference in daily activities, interference due to worry, and engagement in preventative behaviors). IU was positively associated with COVID-19-related emotional responses as well as two of the COVID-19-related behavioral interference/responses (i.e., interference in daily activities and interference due to worry), but negatively predicted engagement in COVID-19 preventative behaviors. Exploratory analyses revealed a significant indirect effect of IU on lower engagement in preventative behaviors through lower belief in the effectiveness of such behaviors. Thus, we further document the role of IU in statistically predicting higher distress but lower levels of adaptive health behaviors. Furthermore, we provide preliminary support for the hypothesis that these relationships may be explained by associations between IU and lower belief in the efficacy of health behaviors. Because some current analyses indicate small effect sizes, future studies should investigate IU alongside other potentially important markers.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-022-10321-0.

Hand Washing: When Ritual Behavior Protects! Obsessive-Compulsive Symptoms in Young People during the COVID-19 Pandemic: A Narrative Review

The Coronavirus Disease 2019 (COVID-19) pandemic had a profound impact on the lifestyles and mental health of young people. It has been hypothesized that the focus on hygiene and the fear of contamination/infection during the pandemic may have exacerbated obsessive–compulsive (OC) symptoms in this population. OC symptoms are widespread in the general population, with varying degrees of intensity. At their most extreme, they manifest in obsessive–compulsive disorder (OCD), which is characterized by obsessive thoughts and compulsive behaviors. The present narrative review aimed at evaluating the relationship between the COVID-19 pandemic and OCD and OC symptoms in young people, especially children and adolescents with and without OCD, focusing on vulnerability and risk factors and the impact of lockdown measures. Of the six studies identified, four examined clinical samples diagnosed with OCD and two looked at community-based adolescent samples. Five of the six studies found that OC symptoms increased during the pandemic. Additionally, vulnerability to anxiety may constitute a risk condition and the lockdown measures and personal stressful life events can constitute potential triggers of OC symptoms, while ongoing treatment for OCD had a protective effect. The results suggest that, during the COVID-19 pandemic, obsessive and compulsive behavior (e.g., hand washing) in young people at the greatest risk should be monitored, and the intervention of mental health services should be maintained. More research is needed in this area.

Relationship between COVID-19 anxiety and fear of death: the mediating role of intolerance of uncertainty among a Turkish sample

The Coronavirus Disease 2019 (COVID-19) pandemic has increased the salience of death in our lives. The aim of this study is to uncover potential mechanisms underlying fear of death during the pandemic. A sample of 478 volunteers (312 females and 166 males) aged 18 years and older participated voluntarily in this study. Coronavirus Anxiety Scale, Multidimensional Mortality Awareness Measure, Intolerance of Uncertainty Scale, and Personal Information Form were used for data collection. The mediating role of intolerance of uncertainty in the relationship between COVID-19 anxiety and fear of death was determined using the bootstrapping method. COVID-19 anxiety was associated with increased intolerance of uncertainty, and fear of death. Intolerance of uncertainty was associated with increased fear of death. Furthermore, intolerance of uncertainty partially mediated the relationship between COVID-19 anxiety and fear of death. Results suggest that intolerance of uncertainty is a critical variable in the relationship between COVID-19 anxiety and fear of death. The current research adds to our knowledge of fear of death by investigating COVID-19 anxiety and intolerance of uncertainty. Additionally, this study underlies and contributes to the consideration of psychological health of individuals during the pandemic process. The results are discussed within the context of the COVID-19 pandemic.

Subjective social status, COVID-19 health worries, and mental health symptoms in perinatal women

Pregnant women and those who have recently given birth are considered an at-risk population during the COVID-19 pandemic with regards to the impact of both general stress and pandemic-related stressors. The extent to which subjective social status (SSS), one's perception of relative standing compared to others in a social hierarchy, might mitigate the effects of COVID-19-related health worries on mental health has not yet been reported, despite SSS often outperforming socioeconomic status as a predictor of various health outcomes including depression. This cross-sectional survey study tested the moderating effect of SSS on association between COVID-19- related health worries and mental health symptoms (depressive and generalized anxiety) among a sample of 1,637 perinatal women from the United States who took part in the Perinatal Experiences and COVID-19 Effects (PEACE) Study between May 2020 and June 2021. We found that high subjective social status was protective against depressive symptoms when self-reported COVID-19-related worry was low. When COVID-19-related worry was high, subjective social status was no longer influential. Higher levels of COVID-19-related health worries were associated with more anxiety symptoms, and higher subjective social status did not moderate anxiety symptomatology at either level of COVID-19-related worry. Although higher SSS has historically been protective against mental health decline, in the context of the COVID-19 pandemic it may not be sufficiently protective against anxiety, or against depression for those who experience high levels of worry regarding the effects of COVID-19 on health.

Using what we know about threat reactivity models to understand mental health during the COVID-19 pandemic

The COVID-19 pandemic has been accompanied by unprecedented levels of stress and threats in a variety of domains (e.g., health, livelihood). Individual differences in threat reactivity may explain why some individuals are at elevated risk for the development or maintenance of psychopathology during the COVID-19 pandemic. This article describes several prominent models, mechanisms, and components of threat reactivity (e.g., appraisals, intolerance of uncertainty, avoidance) and discusses how they might help improve understanding of changes in psychopathology during and following the COVID-19 pandemic.

Relationships between fear of COVID ‐19, cyberchondria, intolerance of uncertainty, and obsessional probabilistic inferences: A structural equation model

The study was set out to explore the structural relationships between fear of COVID‐19, cyberchondria, intolerance of uncertainty, and obsessional probabilistic inferences. The data were recruited online from a community population (n = 1,049) subjected to a confirmatory factor analytic procedure. The structural model specified according to the previous findings in the literature showed that a general tendency to negative expectations in terms of probabilistic thinking was significantly associated with both COVID‐19‐related‐fear and intolerance of uncertainty. Fear of COVID‐19 was significantly associated with cyberchondria. Probabilistic thinking style and intolerance of uncertainty contributed to cyberchondria through fear of COVID‐19 as well. We concluded that a tendency to engage in a probabilistic thinking style and intolerance of uncertainty seems to play role in the etiology of fear of infection and cyberchondria.

Uncertainty, Stress, and Resilience During the COVID-19 Pandemic in Greece

ABSTRACT

The COVID-19 outbreak imposed stress worldwide, as daily routine changed almost overnight, with no time to prepare. A pandemic like this may trigger a chain reaction starting out as surprise, continuing to uncertainty and ending up either in adaptation or in symptoms of fear, anxiety, and/or depression. Resilience on the other hand could lessen anxiety and prove to be a prophylactic coping mechanism against distress. This study explored peritraumatic distress, intolerance of uncertainty (IU), and resilient coping in a sample of 2717 adults who voluntarily and anonymously participated in an online survey conducted in April 2020, in Greece.Results indicated a moderate pandemic-related mental burden and medium resilient coping and designated IU as a significant positive predictor of peritraumatic distress; resilient coping proved to be a significant moderator that alters the strength of the association between IU and distress reactions.

Unrealistic pessimism and obsessive-compulsive symptoms during the COVID-19 pandemic: Two longitudinal studies

Objective

Unrealistic pessimism (UP) is an aspect of overestimation of threat (OET) that has been associated with obsessive‐compulsive disorder/symptoms (OCD/OCS). During the COVID‐19 pandemic, UP may have played an important role in the course of OCD. To investigate the relationship, we conducted two longitudinal studies assuming that higher UP predicts an increase in OCS.

Method

In Study 1, we investigated UP in the general population (N = 1,184) at the start of the pandemic asking about overall vulnerability to infection with SARS‐CoV‐2 and UP regarding infection and outcome of severe illness. Further, OCS status (OCS+/−) was assessed at the start of the pandemic and 3 months later. In Study 2, we investigated UP in individuals with OCD (N = 268) regarding the likelihood of getting infected, recovering, or dying from an infection with SARS‐CoV‐2 at the start of the pandemic and re‐assessed OCS 3 months later.

Results

In Study 1, UP was higher in the OCS+ compared to the OCS− group, and estimates of a higher overall vulnerability for an infection predicted a decrease in OCS over time. UP regarding severe illness predicted an increase in symptoms over time. In Study 2, UP was found for a recovery and death after an infection with SARS‐CoV‐2, but not for infection itself.

Conclusions

Exaggeration of one’s personal vulnerability rather than OET per se seems pivotal in OCD, with UP being associated with OCD/OCS+ as well as a more negative course of symptomatology over the pandemic in a nonclinical sample.

Practitioner points

Unrealistic optimism, a bias common in healthy individuals, is thought to be a coping mechanism promoting well‐being in the face of danger or uncertainty.

The current study extends findings that its inversion, unrealistic pessimism, may play an important role in obsessive‐compulsive disorder and may also be involved in the development of the disorder.

This study highlights the importance that prevention programs during a pandemic should include targeting unrealistic pessimism.

Obsessive-compulsive symptoms and the Covid-19 pandemic: A rapid scoping review

BACKGROUND

There has been much speculation about untoward effects of the Covid-19 pandemic on psychological symptoms. OCD may be expected to be especially impacted. Our aim was to distil the current evidence base on relationships between the pandemic and obsessive-compulsive symptoms, in patients, and general population samples.

METHODS

We conducted a rapid scoping review, in the form of a systematic literature search, coupled with narrative review. 32 relevant papers were identified.

RESULTS AND INTERPRETATION

(1) A sizable proportion of people with OCD (but not all) experienced/reported symptom worsening during the pandemic, especially during initial restrictions (approximately 20-65 % of cases in longitudinal studies); (2) contamination/washing symptoms appeared particularly susceptible; and (3) OCD symptoms in general population samples were associated with trait compulsivity and pandemic-related-stress. The literature was heterogeneous with various methodological issues being commonplace.

FUTURE DIRECTIONS

The review identified important unaddressed issues: how should exposure based therapy be adapted during pandemics? How can we minimise harm from exacerbation of OCD in vulnerable individuals arising from public health messaging? Why do some but not all OCD patients experience worsening? And does Covid-19 infection affect (or lead to) OCD symptoms?

How are OCD patients and their families coping with the COVID-19 pandemic? A qualitative study

Patients with obsessive-compulsive disorder (OCD) are likely to be affected by the COVID-19 crisis since fear of contamination is highly prevalent in this illness and disease reminders are omnipresent during this crisis. The current study aimed to investigate the impact of the pandemic and the lockdown on the mental health, well-being and coping abilities of OCD patients and their families in order to increase our understanding of the underlying mechanisms of the disorder. Twenty-two patients and 13 family members were interviewed one-to-one about their experiences and challenges caused by the pandemic and home-confinement directives. Verbatim transcripts of the interviews were analyzed using inductive thematic analysis. Five overarching themes were identified: (1) changing point of reference: confusion and legitimization of OCD behavior, (2) coping strategies were challenged: too much or too little exposure to obsessional concerns, (3) distress but also relief in some areas, (4) developing a new equilibrium within the family, (5) changes in accessibility and nature of therapy: perils and merits of online treatment. These findings make clear the importance of the accessibility of mental health services during this pandemic through direct patient contacts or in a remote format. In therapy therapists should focus on challenging the changing point of reference, providing practical advice on coping, stimulating to engage in exposure and encouraging patients to seek social support. Furthermore, it is important to involve family members in therapy to support and coach them to be validating, supportive and encouraging, without accommodating to the OCD behaviour.

Obsessive-Compulsive Disorder During the COVID-19 Pandemic-A Systematic Review

BACKGROUND

The COVID-19 pandemic and its associated restrictions may contribute to a deterioration in mental health; individuals with obsessive-compulsive disorder (OCD) may be particularly affected. This systematic review aimed to investigate the effects of the current pandemic on people diagnosed with OCD, and whether pandemics may affect the development of OCD symptoms.

METHODS

We conducted a systematic search using NCBI PubMed, SCOPUS, and Google Scholar on February 9, 2021. Research articles related to OCD and COVID-19 or other pandemics were attempted to be identified using pre-defined search terms. Case reports, clinical guidelines, letters, and clinical research articles including ≥100 participants were included; reviews were excluded. The systematic review adheres to PRISMA guidelines and the Newcastle-Ottawa Scale was used to assess the quality of the included clinical research articles.

RESULTS

A total of 79 articles were included in the full-text assessment. Of these, 59 were clinical research articles, two were clinical guidelines, six were case reports, and 12 were letters. The research articles examined OCD symptoms in adult patients with diagnosed OCD, the general population, pregnant women, healthcare workers, students, and young adults, children, and adolescents. Only one study on OCD in previous pandemics was identified.

CONCLUSION

This systematic review found that people both with and without diagnosed OCD prior to the pandemic generally experienced a worsened landscape of symptoms of OCD during the COVID-19 pandemic. However, the responses are heterogeneous and many factors other than the pandemic seemed to affect the development of OCD symptoms. To prevent the impairment of symptoms and the development of new cases, close monitoring of patients with OCD and education of the general public is essential. Literature is still limited; thus, multinational and cross-cultural, longitudinal studies are warranted to gain further insights on this topic.

The effect of the COVID-19 pandemic on health anxiety and cyberchondria levels of university students

OBJECTIVE

Our study hypothesizes that the fear and panic of COVID-19 triggers cyberchondria (CYB) in students thus increasing health anxiety. In this way, we aim to determine the effect of the belief of previously having had and not having had COVID-19 on health anxiety and CYB levels of the university students.

METHODS

Our study is a descriptive cross-sectional study. The target population of our study consisted of 950 students who were continuing their education in the Vocational School of Health Services, an associate degree program of a university, and the samples consisted of 794 students (85.5%) who filled out our questionnaire (n = 794). The questionnaire form included the information regarding sociodemographic characteristics and the symptoms of COVID-19, and the obtained data were electronically collected altogether with Cyberchondria Scale (CS) and Health Anxiety Inventory.

FINDINGS

Health anxiety mean scores were significantly higher in people who lived alone, had a chronic disease, searched for symptoms online, and took herbal supplements against COVID-19 (p < 0.05). The mean total scores of Health Anxiety Inventory, CS, Anxiety-Increasing Factors Subscale of the students who believe they have had COVID-19 were significantly lower compared to the scores of those who believe they have not had COVID-19. Nevertheless, women and people living alone and in cities had significantly high CS scores (p < 0.05).

CONCLUSION

The increase in infodemia can be prevented with the services offered by specialists through mental health helpline or websites to people with high health anxiety or CYB levels, especially to women, and to people living alone and in urban areas.

Managing life during the pandemic: communication strategies, mental health, and the ultimate toll of the COVID-19

Background/aim

The purpose of this review was to present the ultimate toll of the COVID-19 pandemic by focusing on the communication strategies and mental health.

Materials and methods

We unsystematically reviewed the studies published between 2020 and 2021 from databases such as Google Scholar, Web of Science and ScienceDirect. Firstly, “new-normal” life challenges during the pandemic were discussed along with the public risk communication strategies. Later, mental health problems, posttraumatic growth, and protective factors were reviewed.

Results

Literature highlighted that individuals mainly experience COVID-19 related fear, anxiety, stress, negative emotions and sleep problems. Furthermore, the rates of clinically significant depression, anxiety, obsessive compulsive disorder, and posttraumatic stress disorder suggest an increase. Specifically, COVID-19 stress syndrome, loneliness, and sleep problems were associated with mental health problems in the pandemic. However, some individuals seem to be resilient to the COVID-19 trauma and experience posttraumatic growth. Brief online intervention studies are promising for reducing the emotional toll of the COVID-19 as well as for making individuals more resilient.

Conclusion

To conclude, the negative conditions of the pandemic seem to make some people, but not all, vulnerable to mental illness. In addition, framing the public warnings in an optimal emotional tone seems to be more effective to comply with the precautions.

Playful Metaphors for Narrative-Driven E-Learning

A team of e-learning specialists was assigned the mission to design and develop seven short e-learning modules for young learners on popular topics with a prime focus on social-emotional learning. However, these courses had to be produced on a limited budget, hosted in a Moodle platform, and be delivered for free in asynchronous only mode. Hence, a playful method of meaningful storyfication was applied in e-learning to captivate attention and spark interest. In each module, a fictional story or metaphorical challenge with playful elements was introduced where learners were invited to assist the story’s protagonists or become the heroes themselves by engaging with content. As the role of teachers is vital for the adoption of technology-based solutions in education, a mixed method evaluation was undertaken to assess the effectiveness of the method. Forty-two educators reviewed the courses, answered a questionnaire and participated in interviews. Results indicated that participants highly appreciated the narrative aspects, visual, and auditory elements rendering the e-learning courses effective for the target audience. This article can assist educators, distance education designers and developers to adopt a playful mindset and learn how to integrate practically storytelling elements into their classroom-based and online teaching.

How are OCD Patients and Family Members Dealing with the Waxing and Waning Pattern of the COVID-19 Pandemic? Results of a Longitudinal Observational Study

The current study aimed to investigate the impact of the COVID-19 pandemic on the mental health of people with OCD and the degree of family accommodation (FA) by live-in family members across phases of the lockdown measures imposed by the Belgian government. Forty-nine OCD patients and 26 live-in family members participated in the study. We assessed OCD symptom severity and FA of the live-in family members, as well as depressive symptoms, anxiety and stress levels and COVID-19 related psychological distress of patients and family members at four different timepoints: one month after the start of the lockdown (T₁), during the gradual relaxation (T₂), between the two waves (T₃) and during the second wave (T₄). Results showed that although COVID-19 related stress increased and decreased in accordance with the waxing and waning pattern of the pandemic, OCD symptoms showed an initial slight increase followed by a decrease at T₃ and again at T₄. Changes in family members' accommodation of symptoms followed the same course as the OCD symptoms. Furthermore, OCD symptoms correlated with depressive symptoms, anxiety and stress levels and COVID-19 related distress at all timepoints. It is important to involve family members in the treatment of OCD even during a pandemic. Clinicians should also pay attention to symptoms of depression, anxiety and stress during OCD treatment. Further research is necessary to entangle the causal relationship between OCD symptoms, FA and symptoms of depression, anxiety and stress.

Intolerance of uncertainty predicts fear of healthcare settings but not desire for testing during the novel coronavirus pandemic

The novel coronavirus (COVID-19) pandemic has caused unprecedented uncertainty, and differences in how people cope with this uncertainty will influence the cost of viral pandemics to both individuals and society. The personality trait of intolerance of uncertainty (IU), defined as a dispositional fear of the unknown, has been linked to higher health anxiety and fear of the virus. Although IU may increase the desire for medical information and treatment, during pandemics, this might be weighed against the risk of becoming infected while in a healthcare setting. We examined whether people with higher IU report greater fear of healthcare settings, and show more desire to be tested for the virus. Residents of the United States (n = 149) were surveyed in early May 2020, while most states had active stay-at-home orders. Higher prospective but not inhibitory IU predicted more fear of healthcare settings. The largest effect size, however, was for fear of leaving the home, indicating a general tendency toward fear and avoidance. Fear of leaving the home, perceiving the virus as dangerous, access to testing, and having symptoms were significant predictors of desire for testing.

When a nightmare comes true: Change in obsessive-compulsive disorder over the first months of the COVID-19 pandemic

The outbreak of the COVID-19 pandemic has particularly affected people with obsessive-compulsive disorder (OCD). Exacerbation of obsessive-compulsive symptoms (OCS) has been suspected for those with contamination-related OCD (C-OCD). However, the course of OCS over the ongoing pandemic remains unclear. We assessed 268 participants with OCD (n = 184 with C-OCD) in an online survey at the beginning of the pandemic in Germany, reassessing 179 participants (66.8%, 104 C-OCD) three months later. We assessed severity of OCD (OCI-R), depression (PHQ-9), experiential avoidance, as well as functional and dysfunctional beliefs. Overall, OCS and depressive symptoms did not substantially change over time. However, when people with and without C-OCD were compared, symptoms improved in patients without C-OCD (nC-OCD) but remained stable in patients with C-OCD over time. Symptom improvement was associated with male gender, higher initial OCI-R, and nC-OCD. Experiential avoidance and beliefs at the beginning of the pandemic did not generally predict change in OCS. People with OCD, particularly those with nC-OCD, showed tentative signs for signs of adapting, whereas distress in those with C-OCD remained at a high level, underlining the burden for these patients. Clinicians should be informed about how to maintain effective treatment for C-OCD during a pandemic.

Self-Reported Obsession Toward COVID-19 Preventive Measures Among Undergraduate Medical Students During the Early Phase of Pandemic in Jordan

Background: Coronavirus disease 2019 (COVID-19) pandemic and its associated precautionary measures have substantial impacts not only on the medical, economic, and social context but also on psychological health. This study aimed to assess the obsession toward COVID-19 preventive measures among undergraduate medical students during the early phase of the pandemic in Jordan.

Methods: Online questionnaires were distributed between March 16, 2020 and March 19, 2020. Socio-demographic characteristics were collected, and self-reported obsession toward COVID-19 preventive measures was assessed using a single question.COVID-19 knowledge, risk perception, and precautionary measures were evaluated using scales. Using the chi-square test, Student t-test, and one-way ANOVA, we assessed the differences in the obsession of students with socio-demographic characteristics and scores of the scales.

Results: A total of 1,404 participants (60% were female participants) completed the survey with a participation rate of 15.6%. Obsession with preventive measures was reported by 6.8%. Obsession was significantly more common among women (9.2%) than men (3.3%) and students who attended COVID-19 lectures (9.5%) than those who did not attend such lectures (5.8%) (p < 0.001 and p = 0.015, respectively). Obsessed participants reported significantly higher levels of COVID-19 knowledge (p = 0.012) and precautionary measures (p < 0.001). COVID-19 risk perception had a mild effect size difference but with no statistical significance (p = 0.075). There were no significant differences in the academic levels of participants (p = 0.791) and universities (p = 0.807) between students who were obsessed and those who were not.

Conclusions: Obsession is one of the significant but unspoken psychological effects of COVID-19 precautionary measures among undergraduate medical students. Medical schools should be equipped with means to handle pandemic psychological effects.

The associations of obsessive-compulsive symptom dimensions and general severity with suicidal ideation in patients with obsessive-compulsive disorder: The role of specific stress responses to COVID-19

Suicidal ideation is prevalent in patients with obsessive-compulsive disorder (OCD); but, during COVID-19, it may be increased. The present study aimed to examine the effects of obsessive-compulsive (OC) symptom dimensions and OCD severity on suicidal ideation by considering the role of stress responses in reaction to COVID-19 in a clinical sample of patients with OCD. In a cross-sectional study, 304 patients with OCD completed measures of OC symptom dimensions, OCD severity, general mental health (depression and anxiety), and COVID-19-related stress. Results showed that after controlling for depression, anxiety, comorbidity, and lifetime suicide attempts, the OC symptom dimensions of responsibility for harm and unacceptable obsessional thoughts as well as general severity had indirect effects on suicidal ideation through the specific stress responses to COVID-19, including traumatic stress and compulsive checking. The study shows that OCD patients with specific OC symptom dimensions and severe OCD are more likely to have suicidal ideation during the pandemic. Further, the specific stress responses to COVID-19 may be an underlying mechanism. Clinicians should carefully assess suicidal ideation in patients with OCD who experience responsibility for harm and unacceptable thoughts, particularly during the pandemic.

Obsessive-compulsive disorder during the SARS-CoV-2 pandemic (case report)

The novel coronavirus 2019 (COVID-19) pandemic has affected not only the somatic health of people but also their mental health and the organization of mental health care. Self-isolation, quarantine, extensive media coverage of the situation, a large amount of inaccurate information, and conflicting recommendations – all this has led to an increase in admission of patients who have not previously had mental illness to psychiatrists. As a confirmation of the influence of the above factors on the population's mental health, we present a case report of a 25-year-old patient who first came to a psychiatric clinic due to the obsessive-compulsive disorder that developed due to the pandemic.

Obsessive-Compulsive Disorder During the COVID-19 Pandemic: a Systematic Review

PURPOSE OF REVIEW

This systematic review evaluated the impact of the COVID-19 pandemic on obsessive-compulsive symptoms.

RECENT FINDINGS

Most studies showed that obsessive-compulsive symptoms worsened during the early stages of the pandemic, particularly for individuals with contamination-related obsessive-compulsive disorder (OCD), though other symptoms dimensions were found to worsen as well. Many patients and individuals in the general population experienced new obsessive-compulsive-like symptoms centered on COVID-19. Self-reported rates of symptom exacerbation and COVID-19-focused symptoms were consistently lower in studies that recruited patients from specialty clinics (compared to online samples). Most studies were conducted in Spring/Summer, 2020. The COVID-19 pandemic has been an enormous stressor for individuals with OCD, especially for those with contamination symptoms. Regardless, there is strong reason to believe gold standard treatment approaches for OCD have maintained strong efficacy. Disseminating and effectively delivering evidence-based treatments for OCD is an urgent public health priority.

Predicting COVID-19-related anxiety: The role of obsessive-compulsive symptom dimensions, anxiety sensitivity, and body vigilance

The novel coronavirus disease (COVID-19), first detected in December of 2019 and declared a global pandemic in March of 2020, continues to pose a serious threat to public health and safety worldwide. Many individuals report anxiety in response to this threat, and at high levels, such anxiety can result in adverse mental health outcomes and maladaptive behavioral responses that have consequences for the health of communities more broadly. Predictors of excessive anxiety in response to COVID-19 are understudied. Accordingly, the present study examined psychological factors that predict more intense COVID-19-related anxiety. 438 community members completed measures assessing COVID-19-related anxiety as well as psychological variables hypothesized to predict anxious responding to the threat of COVID-19. As expected, obsessive-compulsive symptoms related to contamination, the fear of arousal-related body sensations (i.e., anxiety sensitivity), and body vigilance each predicted more severe anxiety related to the pandemic. Obsessive-compulsive symptoms related to responsibility for causing harm also emerged as a predictor. Study limitations and implications are discussed.

Non-suicidal self-injury and suicidal behavior during the COVID-19 pandemic in Brazil

This study sought to determine the explanatory variables behind suicidal behavior and non-suicidal self-injury during the early months of the COVID-19 pandemic in Brazil. The sample comprised 4797 adults, who filled out a series of standardized instruments and additional questions on COVID-19 exposure (self and others), self-injury, and suicidal behavior. One in 10 participants reported self-injury, and three in 10 had considered or attempted suicide. The factors associated with self-injury and suicidal behavior were lower educational level, younger age, chronic diseases, and anxiety. The factors associated with suicidal behavior were regular employment, living alone, and Black ethnicity.

Facing the "new normal": How adjusting to the easing of COVID-19 lockdown restrictions exposes mental health inequalities

BACKGROUND

Re-establishing societal norms in the wake of the COVID-19 pandemic will be important for restoring public mental health and psychosocial wellbeing as well as economic recovery. We investigated the impact on post-pandemic adjustment of a history of mental disorder, with particular reference to obsessive-compulsive (OC) symptoms or traits.

METHODS

The study was pre-registered (Open Science Framework; https://osf.io/gs8j2/). Adult members of the public (n = 514) were surveyed between July and November 2020, to identify the extent to which they reported difficulties re-adjusting as lockdown conditions eased. All were assessed using validated scales to determine which demographic and mental health-related factors impacted adjustment. An exploratory analysis of a subgroup on an objective online test of cognitive inflexibility was also performed.

RESULTS

Adjustment was related to a history of mental disorder and the presence of OC symptoms and traits, all acting indirectly and statistically-mediated via depression, anxiety and stress; and in the case of OC symptoms, also via COVID-related anxiety (all p < 0.001). One hundred and twenty-eight (25%) participants reported significant adjustment difficulties and were compared with those self-identifying as "good adjusters" (n = 231). This comparison revealed over-representation of those with a history or family history of mental disorder in the poor adjustment category (all p < 0.05). 'Poor-adjusters' additionally reported higher COVID-related anxiety, depression, anxiety and stress and OC symptoms and traits (all p < 0.05). Furthermore, history of mental disorder directly statistically mediated adjustment status (p < 0.01), whereas OC symptoms (not OC traits) acted indirectly via COVID-related anxiety (p < 0.001). Poor-adjusters also showed evidence of greater cognitive inflexibility on the intra-extra-dimensional set-shift task.

CONCLUSION

Individuals with a history of mental disorder, OC symptoms and OC traits experienced greater difficulties adjusting after lockdown-release, largely statistically mediated by increased depression, anxiety, including COVID-related anxiety, and stress. The implications for clinical and public health policies and interventions are discussed.

Investigating the Association Between Obsessive-Compulsive Disorder Symptom Subtypes and Health Anxiety as Impacted by the COVID-19 Pandemic: A Cross-Sectional Study

Background

Since the COVID-19 outbreak was declared a global pandemic, public health messages have emphasised the importance of frequent handwashing in limiting the transmission of the virus. Whilst crucial in controlling transmission, such messaging may have an adverse effect on individuals with OCD.

Methods

A cross-sectional study was conducted, with a total of 332 participants recruited. Participants who scored above the optimal cut-off score on the Obsessive-Compulsive Inventory Revised edition (OCI-R) were included in the analysis (n = 254). Scores on the six subscales of the OCI-R were correlated with responses to a COVID-19 Impact measure.

Results

Factor analysis of the COVID-19 Impact measure revealed that items loaded on two components of the measure (handwashing and distress-avoidance). Canonical correlation analyses revealed significant associations between the OCI-R subscales and COVID-19 Impact measure, F (12, 490) = 8.14, p = 0.001, and the SHAI subscales with the COVID-19 Impact Measure, F (4, 498) = 8.18, p = 0.001). Specifically, washing and checking OCI-R subscales correlated with both components of the COVID-19 Impact measure, as did the health anxiety and beliefs SHAI subscales. Content analysis revealed disruption to treatment delivery and worsening symptom severity in participants with contamination-related OCD.

Discussion

Contamination and checking OCD subtypes have been associated with increased hand-washing behaviour and avoidance of distress-inducing cues. Consideration should be given to targeted support tailored to patients with these subtypes of OCD.

Coping Strategies, Anxiety and Depression in OCD and Schizophrenia: Changes during COVID-19

BACKGROUND

The main aim was to examine changes in coping strategies, anxiety and depression in obsessive-compulsive and schizophrenia patients during COVID-19, in addition to controlling the influence of intolerance to uncertainty and experiential avoidance.

METHOD

The first time, the study comprised (15-30 April 2020) 293 patients, 113 of whom were diagnosed with obsessive-compulsive disorder, 61 with schizophrenia and 119 healthy controls, aged 13-77 years (M = 37.89, SD = 12.65). The second time (15-30 November), the study comprised 195 participants (85 obsessive-compulsive patients, 42 schizophrenic patiens and 77 healthy controls participants). The evaluation was carried out through an online survey.

RESULTS

The clinical groups worsened over time in cognitive coping, anxiety and depression, while the control group only worsened in depression. Intergroup differences in anxiety, depression and coping strategies were maintained, highlighting the use of some maladaptive strategies (avoidance, spiritual) in clinical groups. Experiential avoidance and tolerance for uncertainty mainly affected coping.

CONCLUSIONS

The duration of COVID-19 not only produced changes in anxiety and depression in clinical groups but also in coping strategies to face this pandemic and its consequences.

Anxiety Sensitivity Mediates Relations Between Mental Distress Symptoms and Medical Care Utilization During COVID-19 Pandemic

Anxiety and uncertainty are common during pandemics. The present study extended previous pandemic research by investigating the role of two transdiagnostic risk factors — anxiety sensitivity (AS: fear of physiological anxiety or “fear of fear”; Reiss & McNally, 1985) and intolerance of uncertainty (IU; Buhr & Dugas, 2009) — in explaining relations between mental distress symptoms and behavioural responding during the COVID-19 pandemic. Student and community-based participants (N=457; 87.6% female) were recruited between May and July 2020 to complete measures of anxiety (health, panic, general), depression, and stress. Anxiety and related symptoms were found to be higher than in previous studies. Parallel mediation analyses showed that clinically meaningful levels of mental distress symptoms directly influenced safety behaviours and medical care utilization but also indirectly influenced the latter (vs. former) through AS-physical concerns (vs. IU). CBT interventions, targeting AS-physical concerns, may reduce mental distress symptoms during pandemic and prevent overuse of healthcare.

Using Fear and Anxiety Related to COVID-19 to Predict Cyberchondria: Cross-sectional Survey Study

BACKGROUND

Studies have highlighted that fear and anxiety generated by COVID-19 are important psychological factors that affect all populations. There currently remains a lack of research on specific amplification factors regarding fear and anxiety in the context of the COVID-19 pandemic. Despite established associations between anxiety sensitivity, intolerance of uncertainty, and cyberchondria, empirical data investigating the associations between these three variables, particularly in the context of the COVID-19 pandemic, are currently lacking. Urgent research is needed to better understand the role of repeated media consumption concerning COVID-19 in amplifying fear and anxiety related to COVID-19.

OBJECTIVE

This study investigated the associations between fear of COVID-19, COVID-19 anxiety, and cyberchondria.

METHODS

Convenience sampling was used to recruit respondents to participate in an online survey. The survey, which was distributed via social media and academic forums, comprised the Cyberchondria Severity Scale, Fear of COVID-19 Scale, Coronavirus Anxiety Scale, Anxiety Sensitivity Index, and Intolerance of Uncertainty Scale. Multiple mediation analyses were conducted using structural equation modeling.

RESULTS

A total of 694 respondents (males: n=343, females: n=351) completed the online survey. The results showed that fear and anxiety generated by COVID-19 predicted cyberchondria (fear: β=.39, SE 0.04, P<.001, t=11.16, 95% CI 0.31-0.45; anxiety: β=.25, SE 0.03, P<.001, t=7.67, 95% CI 0.19-0.32). In addition, intolerance of uncertainty and anxiety sensitivity mediated the relationship between fear and anxiety generated by COVID-19 with cyberchondria. In a reciprocal model, the standardized total effects of cyberchondria on fear of COVID-19 (β=.45, SE 0.04, P<.001, t=15.31, 95% CI 0.39-0.51) and COVID-19 anxiety (β=.36, SE 0.03, P<.001, t=11.29, 95% CI 0.30-0.41) were statistically significant, with moderate effect sizes. Compared to males, females obtained significantly higher scores for cyberchondria (t_1,692=-2.85, P=.004, Cohen d=0.22), COVID-19 anxiety (t_1,692=-3.32, P<.001, Cohen d=0.26), and anxiety sensitivity (t_1,692=-3.69, P<.001, Cohen d=0.29).

CONCLUSIONS

The findings provide a better understanding of the role of COVID-19 in amplifying cyberchondria. Based on these results, cyberchondria must be viewed as a significant public health issue. Importantly, increasing awareness about cyberchondria and online behavior at both the individual and collective levels must be prioritized to enhance preparedness and to reduce the adverse effects of current and future medical crises.