Prevalence of psychological morbidities among general population, healthcare workers and COVID-19 patients amidst the COVID-19 pandemic: A systematic review and meta-analysis

Changes in the contributions of risk factors to under-five mortality in low- and lower-middle-income countries (1997-2022): an analysis of Demographic and Health Survey data

BACKGROUND

Under-five mortality (U5M) is a critical public health challenge in low- and lower-middle-income countries (LLMICs), where over 90% of global deaths occur. Despite progress, the changing contributions of risk factors to U5M in LLMICs remain unexplored.

METHODS

We analysed Demographic and Health Survey (DHS) data from 24 LLMICs across two periods: 1997-2005 and 2016-2022. We included 139,890 live births in 1997-2005 and 319,034 in 2016-2022. A mixed-effects robust Poisson regression model with a log link function was employed to identify risk factors of U5M in each period. Population-attributable fractions (PAFs) were calculated and compared to investigate changes in the contributions of risk factors over time.

RESULTS

U5M attributable to never having been breastfed increased by 15.5 percentage points (95% CI 8.6, 22.9), early maternal age at birth (< 20 years) by 5.4 percentage points (95% CI 3.1, 5.7), and plural births by 1.2 percentage points (95% CI 0.4, 1.8). U5M reductions attributable to maternal secondary education were increased by 5.5 percentage points (95% CI 0.4, 11.0) and tertiary education increased by 2.6 percentage points (95% CI 1.6, 4.2). However, U5M reductions associated with 1-3 antenatal care (ANC) visits decreased by 7.2 percentage points (95% CI 2.4, 11.7).

CONCLUSIONS

The main contributors of U5M in LLMICs were never breastfeeding, short birth intervals (<33 months), ANC uptake, higher maternal education (secondary and tertiary), advanced maternal age at birth (≥35 years),  early maternal age at birth (<20 years), very small infants at birth, male sex, plurality, and single motherhood. The contributions of risk factors to U5M have changed over time. Interventions need to prioritise promoting breastfeeding, enhancing maternal education and increasing ANC uptake, and addressing other significant contributors to U5M.

Digital Psychological Interventions for Adults in the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

This study evaluates the effect of digital psychological interventions on anxiety, depression, and stress symptoms in adults affected by the pandemic. A systematic search across five digital databases, from 1 January 2020 to 6 March 2024, identified 36 studies encompassing 8,662 participants. Compared with all control conditions, random-effects meta-analyses indicated that digital psychological interventions significantly reduced anxiety (g = -0.374; 95% CI, -0.529 to -0.218), depression (g = -0.568; 95% CI, -0.776 to -0.360), and stress (g = -0.452; 95% CI, -0.608 to -0.295). Smaller effect sizes were observed when compared with active controls than with inactive controls. Notable heterogeneity across three outcomes was observed. Publication bias was noted in depression symptoms. Several moderators were identified compared with inactive controls, including participant type for anxiety (psubgroup = 0.005), and region for depression symptoms (psubgroup = 0.000). Larger sample sizes (b = 0.0004; p = 0.028) related to stronger effects on depression symptoms. Publication year positively correlated with effects on stress (b = 0.1573; p = 0.032). This study supports the efficacy of digital psychological interventions in alleviating anxiety, depression, and stress symptoms for adults during the pandemic, offering insights for developing targeted mental health strategies in future public health crises.

An umbrella review and meta-analysis of 87 meta-analyses examining healthcare workers' mental health during the COVID-19 pandemic

During the COVID-19 pandemic, healthcare workers (HCWs) experienced several changes in their work (e.g., longer hours, new policies) that affected their mental health. In this study, an umbrella review and meta-analysis of meta-analyses was conducted to examine the prevalence of various mental health problems experienced by HCWs during the COVID-19 pandemic. We conducted a systematic review searching PubMed, EMBASE, PsycINFO, Cochrane Library, and Scopus databases (PROSPERO: CRD42022304823). We performed a meta-analysis to summarize prevalence of different mental health problems and examined whether these differed as a function of job category, sex/gender, sociodemographic index (SDI), and across time. Eighty-seven meta-analyses were included in the umbrella review and meta-analysis, including 1846 non-overlapping articles and 9,400,962 participants. The overall prevalence ratio for the different mental health outcomes ranged from 0.20 for PTSD (95 % CI: 0.16-0.25) to 0.44 for burnout (95 % CI: 0.32-0.56), with ratios for depressive symptoms, anxiety symptoms, psychological distress, perceived stress, sleep problems, and insomnia symptoms falling between these ranges. Follow-up analyses revealed little variation in outcomes across job category, and sex. Prevalence of mental health problems in HCWs was high during the pandemic. Administrators and policymakers worldwide need to address these growing problems through institutional policies and wellness programming.

Prevalence and Associated Factors of Mental Health Outcomes in Peruvian Healthcare Workers During the COVID-19 Pandemic: The FRONTLINE Study

Background: The COVID-19 pandemic impacted global health, particularly the mental health of healthcare workers in low-resource countries like Peru. Aim: To determine the prevalence of depressive, anxiety, and post-traumatic stress symptoms among health workers in Peru throughout the COVID-19 pandemic between December 2021 and August 2022. Methodology: Cross-sectional study on health workers (physicians, nurses, midwives, medical technologists, and healthcare technicians) from Peru selected by non-probabilistic sampling adjusted by post-stratification weights and the Raking method. We evaluate depressive, anxiety, and post-traumatic stress symptoms with Patient Health Questionnaire 9, General Anxiety Disorder 7, and Post-traumatic Stress Disorder Checklist for DSM-5. Results: We evaluated 2,122 participants, of which 72% were women, and the average age was 38 years. The prevalence of depressive symptoms was 18.6% (95%CI 16.6%-20.8%), anxious symptoms were 12.2% (95%CI 10.6%-13.9%), and post-traumatic stress symptoms were 9.3% (95%CI 7.9%-10.9%). Age, sex, and type of health facility were associated with anxiety and depression symptoms, and for post-traumatic stress symptoms, age, and marital status. Conclusion: Our study provides more updated evidence on the mental health situation of healthcare workers. It reveals a significant proportion of workers with evidence of depressive, anxious, or post-traumatic stress problems.

Workers' Psychological Distress During the Early Months of the COVID-19 Pandemic in Brazil: A Cross-Sectional Study

The COVID-19 pandemic significantly impacted the mental health of workers. This study aimed to assess the prevalence of psychological distress among Brazilian workers during the early months of the pandemic and explore its associated factors. A cross-sectional study was conducted using an online questionnaire administered to 2903 Brazilian workers, including 1752 non-healthcare workers (NHCWs) and 1151 healthcare workers (HCWs), between April and May 2020. Snowball sampling was employed for participant recruitment, and the research questionnaire was adapted for use with the Brazilian population through a process of translation and cultural adaptation, based on an instrument initially created and validated for use in Spain. Differences between NHCWs and HCWs were tested using the chi-square or Fisher's Exact test and Mann-Whitney test followed by effect size measurement. Multiple linear regression models were used to analyze the association between psychological distress and the predictor variables. Psychological distress was observed in 72.6% (95% CI 70.1-74.2%) of the participants, with no significant difference observed between NHCWs and HCWs. Although 32 variables showed statistically significant differences between NHCWs and HCWs, only 7 demonstrated clinical-epidemiological relevance, primarily related to occupational factors. Work-related stress was positively associated with psychological distress, but this relationship diminished in the absence of family members infected with COVID-19. Conversely, a higher sense of coherence was protective against psychological distress, although this effect weakened in the absence of family members infected with COVID-19. The study highlights the high prevalence of psychological distress among Brazilian workers during the pandemic's early months. Work stress played a significant role, while sense of coherence appeared to mitigate mental health challenges. These findings highlight the need for targeted mental health interventions, particularly for workers facing both professional and family-related stressors during crises.

The Moderated Mediating Effects of Social Media Identity and Loneliness on the Relationship Between Problematic Internet Use and Mental Health in China: Nationwide Cross-Sectional Questionnaire Study

BACKGROUND

Mental health disorders are a major public health challenge, and problematic internet use (PIU) may play an important role in this issue. However, the underlying mechanisms of PIU and its effects on mental health have not yet been elucidated.

OBJECTIVE

This study examines the mediating effect of loneliness on the relationship between PIU and mental health, as well as the moderating effect of social media identity on the relationships among PIU, loneliness, and mental health.

METHODS

A cross-sectional questionnaire survey was conducted on 21,292 participants recruited using a multistage stratified sampling strategy from 31 provinces/regions in mainland China from June 20 to August 31, 2022. This study assesses PIU (PIU questionnaire-short form-6), depression (9-item Patient Health Questionnaire [PHQ-9]), anxiety (7-item Generalized Anxiety Disorder scale [GAD-7]), loneliness (3-item loneliness scale), and social media identity (identity bubble reinforcement scale). Additionally, we collected the sociodemographic characteristics of the participants. Participants whose total score of PHQ-9≥15 or total score of GAD-7≥10 were considered to have moderate or severe symptoms of depression or anxiety, respectively. A moderated mediation model was established to examine the mediating effect of loneliness on the association between PIU and mental health outcomes (depression and anxiety), moderated by social media identity.

RESULTS

Approximately 22.80% (4854/21,292) and 14.20% (3023/21,292) of the respondents reported moderate or severe symptoms of depression and anxiety, respectively. Loneliness significantly mediated the association between PIU and mental health outcomes, explaining 42.53% and 45.48% of the total effect of PIU on depression and anxiety, respectively. Social media identity significantly moderated the associations between PIU and depression (β=0.002, 95% CI 0.001-0.002), PIU and anxiety (β=0.001, 95% CI 0.000-0.002), loneliness and depression (β=0.010, 95% CI 0.007-0.013), and loneliness and anxiety (β=0.007, 95% CI 0.004-0.010), but not between PIU and loneliness (β=0.000, 95% CI -0.003 to 0.003). Higher levels of social media identity were significantly associated with lower levels of loneliness (β=-0.018, 95% CI -0.020 to -0.016).

CONCLUSIONS

Addressing loneliness may serve as a valuable approach to mitigate the impact of PIU on mental health outcomes. However, social media identity poses a significant challenge in addressing health issues linked to PIU.

Perceived coercion amongst healthcare workers during the COVID-19 pandemic

Direct and prolonged exposure to stress and uncertainty among healthcare workers (HCWs) during the COVID-19 pandemic likely had a significant negative impact on their mental health and general wellbeing. Although the contributors to such distress remain to be fully understood, the construct of perceived coercion appears to be relevant. Among HCWs, perceived coercion is conceptualised as appraisals about lack of control/'freedom to choose' and pressure to perform patient-care duties in the context of unprecedented threat of contagion from patients. To improve our understanding of perceived coercion amongst HCWs, we developed a 10-item scale-the Pandemic-specific Perceived Coercion Scale for Healthcare Workers (PPCS-HCW) scale-designed to be adaptable and applicable for use in future mass-contagion emergencies. A preliminary (exploratory) factor analysis (N = 546) showed that relevant items coalesced around three factors-'internal pressure', 'external pressure' and 'perceived coercion', that partly overlap with previous conceptualisations of perceived coercion. The exploratory conceptual and psychometric structure was confirmed in a separate sample of HCWs from the UK and Norway (N = 483). On average, across the three PPCS-HCW scale factors, HCWs showed low levels of perceived coercion (M = 0.22 (95% CI [0.11, 0.33] on a - 3 to + 3 scale). However, cluster analysis identified three groups: low (- 1.09 (95% CI [- 1.20, - 0.99]), moderate (0.17 (95% CI [0.08, 0.25]) and high scoring (1.57 (95% CI [1.47, 1.67]) PPCS-HCW clusters. High scoring participants showed higher levels of psychological distress, avoidance coping and compassion fatigue. In summary, our findings suggest that perceived coercion is a relevant construct in understanding the adverse psychological impact of large-scale contagion emergencies on HCWs.

From Anxiety to Hopelessness: Examining Influential Psychological Processes Affecting Mental Health Status of Spanish Nurses During the COVID-19 Pandemic

Background and Objective: to test a model aimed at delving into the psychological processes that lead to hopelessness in Spanish nurses two years after a stressful work situation. The model proposed starts with the anxiety experienced at the beginning of the COVID-19 pandemic and includes cognitive fusion and emotional exhaustion, evaluated six months after the end of the confinement, as possible contributing factors to development of hopelessness. Design: prospective study with three data collection periods, May to June 2020 (period 1), January to April 2021 (period 2), April to July 2022 (period 3). Materials and Methods: The sample (n = 131 Spanish nurses) was selected by non-probabilistic convenience sampling. The inclusion criteria were as follows: being female, over 18 years of age, and working as a nurse in direct contact with COVID-19 patients. Results: The model proposed was statistically significant (B = 0.34, SE = 0.07, t = 5.15, p < 0.001, 95% CI = [0.21, 0.47]), contributing to the explanation of 28% of the variance of hopelessness, finding that the direct anxiety-hopelessness effect was equally significant (B = 0.19, SE = 0.08, t = 2.46, p = 0.014, 95% CI = [0.04, 0.34]). An effect of anxiety on cognitive fusion and on emotional exhaustion was observed. In turn, cognitive fusion had a significant effect on emotional exhaustion but not on hopelessness. Finally, emotional exhaustion had a significant effect on hopelessness. In this final model, years of experience had a significant effect (p = 0.004) on hopelessness. Conclusions: Cognitive fusion and emotional exhaustion are shown to be relevant psychological processes upon which to intervene to contribute to the improvement of the mental health of nurses regarding the COVID-19 pandemic.

Characteristics and Associated Factors of Insomnia Among the General Population in the Post-Pandemic Era of COVID-19 in Zhejiang, China: A Cross-Sectional Study

Objective

This study aimed to analyze the changes in insomnia characteristics among the general population and explore associated factors during the COVID-19 pandemic and post-pandemic periods.

Methods

A cross-sectional study was conducted using an anonymous online survey. Questionnaires were administered at two-time points (T1: March 1-31, 2022; T2: March 1-31, 2023), which included an Insomnia Severity Index (ISI) and questions related to sleep risk factors, including the COVID-19 pandemic, familial influences, work and study conditions, social activities, physical health, use of electronic devices before sleep, sleep environment, food intake and exercise before sleep, etc. Insomnia characteristics were compared at two points, with logistic regression testing associations with sociodemographic covariates and risk factors. Six machine learning models were employed to develop a predictive model for insomnia, namely logistic regression, random forest, neural network, support vector machine, CatBoost, and gradient boosting decision tree.

Results

The study obtained 2769 and 1161 valid responses in T1 and T2, respectively. The prevalence of insomnia increased from 23.4% in T1 to 34.83% in T2. Univariate analyses indicated the factors of the COVID-19 pandemic, familial influences, social activity, physical health, food intake, and exercise before sleep significantly differed in T1 (p<0.05) between insomnia and non-insomnia groups. In T2, significant differences (p<0.05) were observed between the two groups, including the factors of the COVID-19 pandemic, family structure, work and study conditions, social activity, and physical health status. The random forest model had the highest prediction accuracy (90.92% correct and 86.59% correct in T1 and T2, respectively), while the pandemic was the most critical variable at both time points.

Conclusion

The prevalence and severity of insomnia have worsened in the post-pandemic period, highlighting an urgent need for effective interventions. Notably, the COVID-19 pandemic and physical health status were identified as significant risk factors for insomnia.

Evolution of Well-Being and Associated Factors during the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic was a global public health crisis with an unparalleled impact worldwide, presenting a significant challenge for both physical and mental health. The main objective of this study was to analyze the risk of depression during the COVID-19 pandemic and how this was affected by sociodemographic factors, pandemic fatigue, risk perception, trust in institutions, and perceived self-efficacy.

METHODS

A cross-sectional study was conducted in the Region of Murcia through two online surveys completed by 1000 people in June 2021 (Round 1) and March 2022 (Round 2). Risk of depression was measured using the 5-item World Health Organization Well-Being Index (WHO-5) questionnaire, and descriptive, bivariate, and multivariate regression analyses were performed to identify factors associated with the risk of depression.

RESULTS

In Round 1, 35.2% of the sample presented a risk of depression, which increased to 39.1% in Round 2. Those at greater risk were women, individuals with lower socioeconomic status, those with less family support, lower trust in institutions, higher perceived risk of contracting the disease, and higher levels of pandemic fatigue.

CONCLUSIONS

Identifying vulnerable populations facing mental health issues can help the authorities and institutions that are responsible for managing public health crises to develop and implement inclusive strategies and interventions tailored to the population's needs.

Understanding the impact of COVID-19 on quality of life using surveys and Mendelian randomization

The COVID-19 pandemic has significantly impacted the quality of life (QoL) of individuals in China, affecting both their physical and mental well-being. This study aims to comprehensively analyze the factors influencing QoL in China during the pandemic. In 2022, we collected data using a self-developed questionnaire (dataset 2) and obtained dataset 1 from the 2021 China General Social Survey (CGSS). After confirming the scale's reliability and validity, we employed a random forest algorithm to prioritize the factors. Subsequently, Mendelian randomization analyses were conducted using data from the MRC IEU OpenGWAS data infrastructure. By comparing data from two periods with low and high infection rates, the results showed that among the various influences brought about by the prevalence of COVID-19, sleep disorders have a significant and widespread impact on the quality of life, especially for the elderly. Through the inclusion of Mendelian randomization analysis, we found that COVID-19 have a relative increase in the risk of developing insomnia by approximately 26.7% (OR = 1.267). These findings can inform the development of targeted interventions and strategies to improve overall well-being.

An umbrella review of the prevalence of depression during the COVID-19 pandemic: Call to action for post-COVID-19 at the global level

BACKGROUND

Pandemics can lead to mental health problems such as depression. This meta-analysis of meta-analyses aimed to estimate the precise prevalence of depression during the COVID-19 pandemic.

METHODS

Web of Science, PubMed, Scopus, and Embase were searched for published meta-analyses using relevant keywords, such as depression, prevalence, COVID-19, and meta-analysis up to March 18, 2024 according to the PRISMA guidelines. Relevant journals as well as the search engine Google Scholar were manually searched to discover more articles. The AMSTAR tool was used for quality assessment. A random-effects model was used for the analysis. All analyses were conducted using the STATA 17 software.

RESULTS

Of 535 records, 82 meta-analyses were included. The results showed that the overall prevalence of depression was 30% [95% CI: 29-32] with a high heterogeneity (I2: 90.98%). The highest prevalence of depression according to population group was found in medical students (40% [30-49]), specific groups (40% [3-78]), and patients (36% [27-45]). The results of meta-regression based on the different times between the start of COVID-19 and the last date of search in the articles (week) and the prevalence of depression, showed that each past week of Covid-19 increases the prevalence of depression by almost 0.00021% [95% CI: -0.00025, 0.00068], P-value: 0.36, but "time" is not a significant predictor of an increase in depression.

CONCLUSIONS

The results showed that the prevalence of depression was high during the COVID-19 pandemic, particularly among medical students. Policy makers should pay more attention to these groups and those who are at greater risk. Primary mental health interventions and policies are necessary to support the mental health of these individuals during the pandemic.

Study protocol: A national cross-sectional study on psychology and behavior investigation of Chinese residents in 2023

Introduction

This study protocol specifies the primary research line and theoretical framework of the 2023 Survey of the Psychology and Behavior of the Chinese Population. It aims to establish a consistent database of Chinese residents' psychological and behavioral surveys through multi-center and large-sample cross-sectional surveys to provide robust data support for developing research in related fields. It will track the public's physical and psychological health more comprehensively and systematically.

Methods

The study was conducted from June 20, 2023 to August 31, 2023, using stratified and quota sampling methods. A total of 150 cities across 800 communities/villages were surveyed, selected from China (Despite extensive coordination, we have been unable to contact our counterparts in the Taiwan region of China to obtain relevant statistical data). The questionnaires were distributed to the public one-on-one and face-to-face by trained surveyors. The questionnaires included basic information about the individual, personal health status, basic information about the family, the social environment in which the individual lives, psychological condition scales, behavioral level scales, other scales, and attitudes towards topical social issues. Supervisors conducted quality control during the distribution process and returned questionnaires, logically checked and cleaned for data analysis.

Discussion

Data collection has been finished, and scientific outputs based on this data will support the development of health promotion strategies in China and globally. In the aftermath of the pandemic, it will guide policymakers and healthcare organizations to improve their existing policies and services to maximize the physical and mental health of the Chinese population.

Trial Registration

This study was filed in the National Health Security Information Platform (Record No.: MR-37-23-017876) and officially registered in the China Clinical Trials Registry (Registration No.: ChiCTR2300072573).

Burnout components, perceived stress and hair cortisol in healthcare professionals during the second wave of COVID 19 pandemic

This study evaluates the impact of the COVID-19 pandemic on healthcare workers in Argentina, during the second wave in 2021. The aim is to assess stress and burnout, incorporating the assessment of hair cortisol levels as a biomarker of chronic stress. A total of 496 healthcare workers from three different hospitals were included in this study. Two of these hospitals depend on the Buenos Aires City Ministry of Health and the third hospital belongs to Buenos Aires University. Hair samples were obtained using scissors from the posterior vertex, as close to the scalp as possible. Each sample was weighed, and cortisol was extracted and then measured using an automated chemiluminescent method. Notably, 10% of the population exhibited hair cortisol levels above 128 pg/mg. Associations were found between high hair cortisol levels and age, workload, emotional exhaustion, and depersonalization. In addition, burnout, identified in 11% of participants, correlated with higher perceived stress and lower social support. Binary logistic regression revealed associations between burnout and perceived stress, and age. Finally, mediation analysis showed depersonalization as a mediating variable in the relationship between hair cortisol concentration and emotional exhaustion. In conclusion, this study highlights the complex relationships between stress, cortisol levels, and burnout. Prioritizing interventions and research is essential to support the well-being of frontline healthcare professionals, ensuring their resilience during challenging times.

Depressive and anxiety symptoms amid COVID-19 pandemic among healthcare workers in a low-resource setting: a systematic review and meta-analysis from Ethiopia

Background

Coronavirus disease 2019 (COVID-19) outbreak is one of the public health problems that pose a serious mental health concern due to its high morbidity and mortality rate. The healthcare workers are at risk of developing mental health symptoms like depression and anxiety because they are the first point of contact in the diagnosis, treatment, and care of patients with COVID-19. This study aimed to systematically review the prevalence and the associated factors of depression and anxiety disorders among healthcare workers amid COVID-19 pandemic in Ethiopia.

Method

A systematic review and meta-analysis study was conducted. Different primary studies that assessed the depressive and anxiety disorders during amid COVID-19 pandemic in the Ethiopian healthcare workers were extracted by Microsoft Excel and exported to STATA version 11 for further analysis. Random-effects model meta-analysis was used to the estimate pooled effect size and the effect of each study with their 95% confidence interval. Funnel plot analysis and Egger regression tests were conducted to detect the presence of publication bias. Subgroup analysis and sensitivity analysis were conducted.

Results

Thirteen studies with 5,174 participants were included in this systematic review and meta-analysis study. The pooled prevalence of depression and anxiety disorders was 40.39% (95% CI: 28.54, 52.24) and 44.93% (95% CI: 31.39, 58.46), respectively. Being a woman, being married, working in the frontline, and having high perceived susceptibility were significantly associated with depression among the Ethiopian healthcare workers. Similarly, being a woman, being older in age, working in the frontline, and having high perceived susceptibility were the factors associated with anxiety disorder among the Ethiopian healthcare workers during the COVID-19 pandemic.

Conclusion

The prevalence of depression and anxiety disorders in the Ethiopian healthcare workers was high. The timely detection and appropriate management of mental health problems is essential for the quality of healthcare services, and proactive support methods for the female, married, and older-age healthcare professionals could result in these outcomes.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022299074.

Estimation of the prevalence of anxiety during the COVID-19 pandemic: A meta-analysis of meta-analyses

BACKGROUND

Pandemics such as COVID-19, can lead to psychiatric symptoms like anxiety. It seems that meta-analysis of meta-analysis studies can provide more comprehensive information regarding the needs for post-COVID-19 services. Therefore, this umbrella review and meta-analysis of meta-analyses aimed to estimate the precise prevalence of anxiety during the COVID-19 pandemic.

METHODS

PubMed, Scopus, and Web of Science were searched for published meta-analyses using relevant keywords, such as Anxiety, Prevalence, COVID-19, and Meta-analysis up to November 1, 2023. Google Scholar, reference check, citation check, and grey literature were manually searched. A random-effect model was used for the analysis. All analyses were conducted using STATA: 17.

RESULTS

Out of the 4263 records, Finally, 75 meta-analyses were included. The overall prevalence of anxiety was 30.4% [95% CI: 29-31.8] with a high heterogeneity (I2: 86.76%). The highest prevalence of anxiety according to population type was 41.3% in patients and then in students (30.8), pregnant women (30.6%), and health care workers (30.5%). The Result of meta-regression showed that "Time" (based on the time between the start of COVID-19 and the last search date in articles) was not a significant predictor of the prevalence of anxiety (R Coefficient = 0.000149, P = 0.61).

CONCLUSIONS

Considering the prevalence of anxiety among patients, students, pregnant women, and healthcare workers, special attention should be paid to these groups in case of the re-occurrence of COVID-19 or occurrence of other pandemics. As quarantine due to pandemics causes reduced social interactions, reduced income, and increased worry about severe illness and death, there is a need for large-scale mobilization of political measures.

Acute Sarcopenia: Mechanisms and Management

BACKGROUND

Acute sarcopenia refers to the swift decline in muscle function and mass following acute events such as illness, surgery, trauma, or burns that presents significant challenges in hospitalized older adults.

METHODS

narrative review to describe the mechanisms and management of acute sarcopenia.

RESULTS

The prevalence of acute sarcopenia ranges from 28% to 69%, likely underdiagnosed due to the absence of muscle mass and function assessments in most clinical settings. Systemic inflammation, immune-endocrine dysregulation, and anabolic resistance are identified as key pathophysiological factors. Interventions include early mobilization, resistance exercise, neuromuscular electrical stimulation, and nutritional strategies such as protein supplementation, leucine, β-hydroxy-β-methyl-butyrate, omega-3 fatty acids, and creatine monohydrate. Pharmaceuticals show variable efficacy.

CONCLUSIONS

Future research should prioritize serial monitoring of muscle parameters, identification of predictive biomarkers, and the involvement of multidisciplinary teams from hospital admission to address sarcopenia. Early and targeted interventions are crucial to improve outcomes and prevent long-term disability associated with acute sarcopenia.

Psychological responses and factors associated with depression and anxiety in entry personnel under quarantine during pandemic in China

Background

The global COVID-19 pandemic has highlighted critical concerns surrounding mental health. Social isolation measures, such as the quarantine of incoming travelers, are essential public health strategies for the prevention and control of infectious diseases. However, quarantine can lead to adverse psychological outcomes, including feelings of confinement, boredom, perceived scarcity of supplies and information, financial hardship, and social stigma. This study aims to assess the mental states of quarantined individuals, investigate the factors affecting their mental well-being, and examine their coping mechanisms, with the objective of providing recommendations to enhance mental health in anticipation of future outbreaks, such as Disease X.

Methods

We surveyed 327 individuals in quarantine from September 22, 2020 to January 9, 2021, collecting general demographic data and information related to COVID-19. Depression and anxiety were assessed using the PHQ-9 and GAD-7 scales, respectively, while stress coping was evaluated with a simplified version of the Cope scale. We analyzed the relationships between independent variables and mental health outcomes.

Results

Among the individuals undergoing entry quarantine, 27.8% reported symptoms of depression, and 20.5% reported symptoms of anxiety. Students were more likely to experience depression compared to those with permanent jobs or no occupation. Significant risk factors for both depression and anxiety included pre-existing health conditions, lack of medical insurance, concerns about shortages of daily necessities during quarantine, and high scores for "guilt and self-blame." Additionally, participants who worried about the impact of the epidemic on their studies or work, and those with high scores for "denial," were more likely to exhibit depressive symptoms. On the other hand, participants who were concerned about potential rejection or discrimination from the outside world after quarantine were more prone to anxiety symptoms.

Conclusion

Attention should be paid to the negative psychological reactions of the entry quarantined personnel, especially those with pre-existing health conditions, those without medical insurance, and students studying abroad. Accurate and effective epidemic dynamic information and preventive and control measures can be provided to the public to prevent fear and stigma against quarantined personnel.

The roles of the kynurenine pathway in COVID-19 neuropathogenesis

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the highly contagious respiratory disease Corona Virus Disease 2019 (COVID-19) that may lead to various neurological and psychological disorders that can be acute, lasting days to weeks or months and possibly longer. The latter is known as long-COVID or more recently post-acute sequelae of COVID (PASC). During acute COVID-19 infection, a strong inflammatory response, known as the cytokine storm, occurs in some patients. The levels of interferon-γ (IFN-γ), interferon-β (IFN-β), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α) are particularly increased. These cytokines are known to activate the enzyme indoleamine 2,3-dioxygenase 1 (IDO-1), catalysing the first step of tryptophan (Trp) catabolism through the kynurenine pathway (KP) leading to the production of several neurotoxic and immunosuppressive metabolites. There is already data showing elevation in KP metabolites both acutely and in PASC, especially regarding cognitive impairment. Thus, it is likely that KP involvement is significant in SARS-CoV-2 pathogenesis especially neurologically.

Impact of COVID-19 on Healthcare Professionals at a Midwestern Quaternary Academic Urban Health Center

BACKGROUND

Prior pandemic research has focused on physicians and nurses who provide direct patient care. Literature on the experiences of nonnurse/physician clinicians and nonclinical health care professionals is sparse.

METHODS

An observational, cross-sectional study was conducted over threetime points to examine the impact of COVID-19 on clinical and nonclinical healthcare professionals (n = 464).

FINDINGS

There were no significant differences in distress across survey waves, except for anger (p = .046). No significant differences in distress scores were found between job types. Multiple linear regression results varied. Both the threat and interrupted plans scores were significant predictors of distress. Resources available to healthcare providers (HCPs) were underutilized in all three waves.

CONCLUSIONS

Healthcare professionals' distress increases with exposure. Integrating self-care resources for staff may mitigate the impact and maintain a healthy work environment.

APPLICATION TO PRACTICE

Occupational health providers should incorporate these findings when developing opportunities to address the needs of health care professionals in the workplace.

The Prevalence and Determinants of Mental Health Problems in Lebanon: A Meta-Analytic Study of 3957 Healthcare Workers

OBJECTIVE

Healthcare workers are continuously exposed to challenging environments, making them liable for poor mental health. The COVID-19 pandemic exacerbated this problem, however available data in Lebanon is scarce. We conducted this investigation to provide comprehensive evidence on the mental health of Lebanese healthcare workers.

METHODS

In this systematic review, we analyzed 3957 workers reported in 15 cross-sectional studies (10 during and five before the pandemic), identified after searching four databases. Examined mental health problems included depression, anxiety, stress, posttraumatic stress disorder (PTSD), and poor sleep quality. STATA software was used to pool the prevalence across studies. Subgroup analyses were performed based on the pandemic status, severity of mental health problems, and healthcare worker type. Gender and marital status were analyzed as potential risk factors. The methodological quality of all included studies was good as per the National Institute of Health risk of bias tool.

RESULTS

Anxiety, depression, stress, PTSD, insomnia, and poor sleep quality were reported in 50%, 52%, 50%, 35%, 45%, and 41% of the population, respectively. Most cases had mild anxiety (40%), mild depression (45%), but severe stress (27%). Depression and anxiety were highest among pharmacists (69% and 56%) and nurses (49% and 45%), respectively. Compared to the pre-pandemic period, depression (36% vs. 62%) and anxiety (30% vs. 56%) rates were higher during the pandemic, while stress levels were lower (62% vs. 45%). Both gender and marital status were insignificant predictors of depression, anxiety, stress, or PTSD.

CONCLUSIONS

Depression, anxiety, posttraumatic stress, insomnia, and poor sleep quality are experienced by approximately one in every two Lebanese healthcare workers. The rate of depression and anxiety almost doubled during the pandemic with higher rates among pharmacists and nurses than physicians and residents. Both gender and marital status were deemed insignificant predictors of reported mental health problems.

We Have Spent Time, Money, and Effort Making Self-Help Digital Mental Health Interventions: Is Anyone Going to Come to the Party?

Although efficacious psychotherapies exist, a limited number of mental health care providers and significant demand make their accessibility a fundamental problem. Clinical researchers, funders, and investors alike have converged on self-help digital mental health interventions (self-help DMHIs) as a low-cost, low-burden, and broadly scalable solution to the global mental health burden. Consequently, exorbitant financial and time-based resources have been invested in developing, testing, and disseminating these interventions. However, the public's assumed desirability for self-help DMHIs by experts has largely proceeded without question. This commentary critically evaluates whether self-help DMHIs can, and will, reach their purported potential as a solution to the public burden of mental illness, with an emphasis on evaluating their real-world desirability. Our review finds that self-help DMHIs are often perceived as less desirable and credible than in-person treatments, with lower usage rates and, perhaps accordingly, clinical trials testing self-help DMHIs suffering from widespread recruitment challenges. We highlight two fundamental challenges that may be interfering with the desirability of, and engagement in, self-help DMHIs: (1) difficulty competing with technology companies that have advantages in resources, marketing, and user experience design (but may not be delivering evidence-based interventions) and (2) difficulty retaining (vs initially attracting) users. We discuss a range of potential solutions, including highlighting self-help DMHIs in public mental health awareness campaigns; public education about evidence-based interventions that can guide consumers to appropriate self-help DMHI selection; increased financial and expert support to clinical researchers for marketing, design, and user experience in self-help DMHI development; increased involvement of stakeholders in the design of self-help DMHIs; and investing in more research on ways to improve retention (versus initial engagement). We suggest that, through these efforts, self-help DMHIs may fully realize their promise for reducing the global burden of mental illness.

Psychological treatments for mental health symptoms associated with COVID-19 infection: A scoping review

The aim of this scoping review was to synthesize published studies and ongoing clinical trials of psychological interventions for mental health problems associated with COVID-19 infection. The study protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. We conducted systematic searches for studies published or registered between January 2020 and October 2022 using eight scientific databases and clinical trial registries, which identified 40 complete published studies and 53 ongoing clinical trials. We found that most studies were randomized controlled trials (74%) while the remaining used study designs of lower methodological quality. Most studies investigated interventions for acute COVID-19 patients (74%) and others explored post-COVID conditions (PCC) or recovered patients. Cognitive and behavioral therapies were the main intervention approaches (31%), followed by multidisciplinary programs (21%) and mindfulness (17%). The most frequently evaluated outcomes were anxiety (33%), depression (26%), quality of life (13%), and insomnia (10%). No studies on youths, older people, or marginalized communities were found. These findings summarize the burgeoning research on a range of psychological interventions for individuals infected with COVID-19. However, the field is in its infancy and further research to develop an evidence base for targeted care is necessary. The gaps identified in the current study also highlight the need for more research on youths, older people, and members of marginalized communities, and PCC patients. It is important to ascertain interventions and delivery strategies that are not only effective and affordable but also allow high scalability and accessibility.

Gut microbiota: a potential influencer of insomnia occurring after COVID-19 infection

The prevalence of insomnia has increased in recent years, significantly affecting the lives of many individuals. Coronavirus disease 2019 (COVID-19) infection has been found to have a substantial impact on the human gut microbiota (GM). Clinical studies have shown that the high prevalence, prolonged duration, and refractory treatment of insomnia symptoms following the COVID-19 pandemic may be related to the effect of COVID-19 infection on the GM. Therefore, the GM may be a potential target for the treatment of insomnia following COVID-19 infection. However, relevant studies have not been well-documented, and the GM has not been sufficiently analyzed in the context of insomnia treatment. Herein, we review the interaction between sleep and the GM, summarize the characteristics of COVID-19-induced abnormal changes in the GM and metabolites in patients with insomnia, and discuss potential mechanisms, including metabolic, immune, and neural pathways, by which these abnormal changes in the GM cause insomnia as well as the factors affecting the GM. Finally, we discuss the prospect of modulating the host GM community for the effective treatment of insomnia after COVID-19 infection and the need for further clinical studies.

Can Occupational Safety and Health Preventive Measures Taken by the Employer Influence Sleep Disturbances in Teleworkers? Results from the Quantitative Study on Working Life with COVID-19 in Latvia

This research on sleep disturbances emerged during the COVID-19 pandemic. Our study investigated the association between self-reported sleep disturbances among teleworkers and the preventive measures employers took to improve their working environment. Answers obtained via a web survey gathered from 1086 teleworkers (517 in the spring of 2021 and 569 in the spring of 2022) were analysed. The odds of self-reported sleep disturbances were significantly higher for all preventive measures in the group of respondents reporting a lack of a particular measure. The highest odds ratios were observed for the statement "My employer identified conditions where I am teleworking" (adjusted OR = 2.98, 95% CI 2.10-4.23) and "Online team-building events were organised" (adjusted OR = 2.85, 95% CI 1.88-4.35). The results of our study have revealed that workplace interventions that serve as a mediator for sleep disorders, even if they are not directly targeted at managing sleep disturbances or stress, can reduce the number of teleworkers reporting sleep disturbances. According to our knowledge, this is the first study reporting the effectiveness of employer interventions that help teleworkers manage their sleep disturbances.

Faris M, G. Albalushi A, Alsaedi F, Khan SA, Khan MA. Sleep disruptions and associated risk factors among Iranians during Ramadan amid COVID-19 pandemic: A nationwide cross-sectional study

The global COVID-19 pandemic has disrupted daily routines and heightened stress levels worldwide, impacting various aspects of health, including sleep. This cross-sectional study conducted in Iran aimed to investigate the impact of Ramadan Intermittent Fasting (RIF) during the pandemic on sleep disturbances and associated risk factors in adults aged ≥ 18 years. Data was collected from Iranian participants observing RIF. A structured electronic questionnaire, translated into Persian, gathered information on sociodemographics, dietary habits, sleep parameters, physical activity, and more. The study assessed sleep quality, duration, and disturbances and conducted a thorough analysis to identify risk factors associated with sleep disruptions. The study revealed that 48% of the participants experienced sleep disturbances during RIF, with 21% reporting poor sleep quality and 46% having unusual sleep duration. Various factors were associated with an elevated risk of sleep disruptions, including body mass index, place of residence, income levels, cohabitation status, family history of obesity, hypertension, diabetes, heart disease, personal history of obesity, weight fluctuations, Shisha smoking, and unemployment. The results highlight the critical importance of health promotion strategies tailored to cultural contexts. This study advocates for enhanced health education initiatives focusing on sleep hygiene and stress management, especially during periods of significant lifestyle alterations like Ramadan amid a global pandemic. Such initiatives are vital in mitigating sleep disturbances and promoting overall well-being in populations facing unique health challenges.

Role of self-esteem and personal mastery on the association between social support and resilience among COVID-19 long haulers

Although the COVID-19 mortality rate is declining, the number of individuals dealing with persistent COVID-19 symptoms is increasing worldwide, making long COVID a global public health concern. People with long COVID (long haulers) often deal with physical and mental stressors. Long haulers' psychological resilience could play a key role in coping with these stressors in intercorrelation with psychosocial resources. The current study aims to test a hypothesized relationship between social support and its functions (i.e., instrumental and emotional) and the resilience of long haulers through serial mediation by personal mastery and self-esteem. A cross-sectional and self-administered online survey was conducted among 460 individuals with long COVID recruited from COVID-19 Facebook support groups in the United States. Analyzing data indicated a positive correlation between social support and the resilience of long haulers. Structural equation modeling suggested that self-esteem and personal mastery fully mediated the association between social (instrumental) support and resilience. Personal mastery also mediated the association between self-esteem and resilience in social (instrumental) support models. However, in the emotional support model, the indirect effect was non-significant for the mediation by personal mastery and self-esteem. Findings suggest that social support, mainly instrumental support, may protect long haulers by promoting their resilience through self-esteem and personal mastery. This study emphasizes the importance of including social support services in designing programs for COVID-19 long haulers.

The effect of job and personal demands and resources on healthcare workers' wellbeing: A cross-sectional study

The COVID-19 pandemic presented many psychological stressors which affected healthcare worker wellbeing. The aim of this study was to understand the factors that affect the wellbeing of healthcare professionals in the Kingdom of Saudi Arabia using Job-Demand and Resource (JD-R) Model. The proposal model consisted of demand factors (Work load-job demand, loneliness-personal demand), support factors (organizational support-job resource, and resilience-personal resource), mediators (burnout and work engagement), and outcome (wellbeing) A cross-sectional, descriptive study was conducted across 276 healthcare workers from hospitals and primary healthcare centers, including healthcare professionals, health associate professionals, personal care workers, health management and support personnel, and health service providers, and others between February-March 2022. The proposed model was tested using partial least squares structural equation modeling. Among the respondents, the majority were female (198, 71,7%), married (180, 65.2%), healthcare professionals (206, 74.6%), being more than 10 years in the profession (149, 51.6%), and non-Saudi nationality (171, 62.0%). Burnout accounted for a significant effect on wellbeing. Of the demands (workload and loneliness) and the resources (organizational support and resilience), workload had the greatest impact on burnout. Healthcare organizations should invest in reducing workloads and promoting resilience to reduce burnout and increase healthcare worker wellbeing.

Mapping the needs of healthcare workers caring for COVID-19 patients using the socio-ecological framework: a rapid scoping review

Undoubtedly, the mental health of healthcare workers (HCWs) was negatively affected because of caring for patients during the COVID-19 pandemic. However, literature is limited on mapping the challenges and needs of HCWs during COVID-19 pandemic. A widely used framework in public health for mapping evidence includes the socio-ecological models, suggesting behavior can be influenced by individual, interpersonal, organizational, and community factors. The aim of this rapid scoping review was to use the socio-ecological model to map and compile lessons learnt from the literature regarding primarily the challenges and needs and secondly available psychological interventions for HCWs caring for COVID-19 patients. PubMed, CINAHL and Scopus databases were searched, with 21 studies finally included examining challenges and needs of HCWs and 18 studies presenting psychological interventions. Organizational-level challenges and needs such as inadequate staff preparation and supplies of protective equipment, flexible work policies and paid rest periods were the most reported. Individual-level challenges and needs included COVID-19-related fears and reduced mental health, whereas interpersonal-related needs included support provision. Community-level challenges included societal stigma. Certain psychological interventions were found to be promising for HCWs, but these were utilized to address only individual-level challenges and needs. Given that well-being entails an interaction of factors, multi-level interventions addressing multiple socio-ecological levels (interpersonal, organizational, community) and that place HCWs in their social context should be administrated to increase and maintain intervention' effects long-term and possibly aid in better coping with future pandemics.

Factors influencing uptake of protective behaviours by healthcare workers in England during the COVID-19 pandemic: A theory-based mixed-methods study

BACKGROUND

Hospital infection control policies protect patients and healthcare workers (HCWs) and limit the spread of pathogens, but adherence to COVID-19 guidance varies. We examined hospital HCWs' enactment of social distancing and use of personal protective equipment (PPE) during the COVID-19 pandemic, factors influencing these behaviours, and acceptability and feasibility of strategies to increase social distancing.

METHODS

An online, cross-sectional survey (n = 86) and semi-structured interviews (n = 22) with HCWs in two English hospitals during the first wave of the COVID-19 pandemic (May-December 2020). The Capability, Opportunity, Motivation (COM-B) model of behaviour change underpinned survey and topic guide questions. Spearman Rho correlations examined associations between COM-B domains and behaviours. Interviews were analysed using inductive and deductive thematic analysis. Potential strategies to improve social distancing were selected using the Behaviour Change Wheel and discussed in a stakeholder workshop (n = 8 participants).

RESULTS

Social distancing enactment was low, with 85% of participants reporting very frequently or always being in close contact with others in communal areas. PPE use was high (88% very frequently or always using PPE in typical working day). Social distancing was associated with Physical Opportunity (e.g., size of physical space), Psychological Capability (e.g., clarity of guidance), and Social Opportunity (e.g., support from managers). Use of PPE was associated with Psychological Capability (e.g., training), Physical Opportunity (e.g., availability), Social Opportunity (e.g., impact on interactions with patients), and Reflective Motivation (e.g., beliefs that PPE is effective). Local champions and team competition were viewed as feasible strategies to improve social distancing.

CONCLUSIONS

It is valuable to understand and compare the drivers of individual protective behaviours; when faced with the same level of perceived threat, PPE use was high whereas social distancing was rarely enacted. Identified influences represent targets for intervention strategies in response to future infectious disease outbreaks.

Stress, anxiety, depression and sleep disturbance among healthcare professional during the COVID-19 pandemic: An umbrella review of 72 meta-analyses

The outbreak of SARS-CoV-2, which causes COVID-19, has significantly impacted the psychological and physical health of a wide range of individuals, including healthcare professionals (HCPs). This umbrella review aims provide a quantitative summary of meta-analyses that have investigated the prevalence of stress, anxiety, depression, and sleep disturbance among HCPs during the COVID-19 pandemic. An umbrella review of systematic reviews and meta-analyses reviews was conducted. The search was performed using the EMBASE, PubMed, CINAHL, MEDLINE, PsycINFO, and Google Scholar databases from 01st January 2020 to 15th January 2024. A random-effects model was then used to estimate prevalence with a 95% confidence interval. Subgroup analysis and sensitivity analyses were then conducted to explore the heterogeneity of the sample. Seventy-two meta-analyses involved 2,308 primary studies were included after a full-text review. The umbrella review revealed that the pooled prevalence of stress, anxiety, depression, and sleep disturbance among HCPs during the COVID-19 pandemic was 37% (95% CI 32.87-41.22), 31.8% (95% CI 29.2-34.61) 29.4% (95% CI 27.13-31.84) 36.9% (95% CI 33.78-40.05) respectively. In subgroup analyses the prevalence of anxiety and depression was higher among nurses than among physicians. Evidence from this umbrella review suggested that a significant proportion of HCPs experienced stress, anxiety, depression, and sleep disturbance during the COVID-19 pandemic. This information will support authorities when implementing specific interventions that address mental health problems among HCPs during future pandemics or any other health crises. Such interventions may include the provision of mental health support services, such as counseling and peer support programs, as well as the implementation of organizational strategies to reduce workplace stressors.

Post-traumatic stress in older, community-dwelling adults with hypertension during the COVID-19 pandemic: An investigation of pre-pandemic sociodemographic, health, and vascular and inflammatory biomarker predictors

COVID-19 pandemic-related traumatic stress (PRTS) symptoms are reported in various populations, but risk factors in older adults with chronic medical conditions, remain understudied. We therefore examined correlates and pre-pandemic predictors of PRTS in older adults with hypertension during COVID-19. Participants in California, aged 61-92 years (n = 95), participated in a pre-pandemic healthy aging trial and later completed a COVID-19 assessment (May to September 2020). Those experiencing ⩾1 PRTS symptom (n = 40), and those without PRTS symptoms (n = 55), were compared. The PRTS+ group had poorer mental and general health and greater impairment in instrumental activities of daily living. Pre-pandemic biomarkers of vascular inflammation did not predict increased odds of PRTS; however, greater pre-pandemic anxiety and female gender did predict PRTS during COVID-19. Our findings highlight PRTS as a threat to healthy aging in older adults with hypertension; targeted approaches are needed to mitigate this burden, particularly for females and those with pre-existing anxiety.

Sleep quality and job satisfaction in Spanish nurses: the consequences of COVID-19

Introduction

Sleep is fundamental to the quality of life and can affect individuals' well-being and mental health.

Objective

This study analyzed sleep quality and job satisfaction among Spanish nurses following the COVID-19 pandemic.

Materials and Methods

A cross-sectional study was conducted using the Pittsburgh Sleep Quality Index (PSQI), Font Roja Job Satisfaction Questionnaire, and sociodemographic and work- related variables. A "snowball" sampling method was employed through social media dissemination.

Results

The mean PSQI score was 9.75 ± 4.36 points. The poorest sleep quality was identified in participants without dependents (p=0.031; p=3.329; 95% CI=0.035-6.354) and those with dependents other than children (p=0.022; p=4.121; 95% CI=0.575- 7.667). However, having a Ph.D degree (p=0.001; p=-3.406; 95% CI=-5.503- 1.309) or specialist degree (p=0.021; p=-1.639; 95% CI=-3.031- -0.247) was associated with better sleep quality. Higher job satisfaction was found among women (p=0.034; p=0.104; 95% CI=0.007-0.201) who did not work with COVID-19 patients (p=0.049; p=-0.085; 95% CI=-0.174- -0.003).

Discussion

Improving working conditions, such as the nurse-to-patient ratio and distribution of work shifts, is crucial to enhancing nurses' sleep quality.

Conclusions

Spanish nurses reported poor sleep quality. Not having dependents or having dependents other than children were risk factors for poor sleep quality. Job satisfaction was higher among women who did not work with COVID-19 patients. No relationship was found between job satisfaction and sleep quality.

A comparative analysis of stress, anxiety, and social well-being of working mothers and stay-at-home mothers during the covid pandemic

BACKGROUND

The role of mental health is crucial in maintaining the dynamism and productivity of any given society. In contemporary times, a significant proportion of the workforce is comprised of women and mothers. Working in healthcare facilities, where exposure to pathogenic agents is an everyday nuisance, can have detrimental effects on mothers' stress and anxiety levels. Furthermore, such exposure can also endanger the health of both the family and society. Conversely, the employment of mothers could positively impact their social well-being. The primary objective of this study is to assess and compare the stress, anxiety, and social well-being scores of mothers employed in healthcare facilities and stay-at-home mothers during the COVID pandemic.

MATERIALS AND METHODS

This study is a cross-sectional analysis of 246 mothers, equally divided into two groups: Mothers who work in health centers and stay-at-home mothers (123 individuals in each group). The study was conducted from 2021 to 2022, a multistage sampling method was utilized and two questionnaires were administered: The DASS 21 (21 questions) and the social well-being questionnaire (48 questions). The data were analyzed using SPSS 18, and descriptive and analytical tests (Independent Samples T-Test, Mann-Whitney) were employed.

RESULTS

The mean age was 35.7 ± 7.1 for working mothers and 34.3 ± 6.3 for stay-at-home mothers. The average stress score for employed mothers was 5.72 ± 4.7, and for stay-at-home mothers, it was 7.16 ± 4.3, which indicates a statistically significant difference in stress levels between the two groups (P = 0.04). However, the two groups had no significant difference in the mean anxiety score (P = 0.08). The mean score for social well-being was 165.5 ± 18.4 for working mothers and 162.17 ± 21.2 for stay-at-home mothers. This difference was not statistically significant (P = 0.18). Except for the social acceptance dimension (P = 0.003), no statistically significant differences were observed in the social well-being dimension between the two groups.

CONCLUSION

The social acceptance of working mothers appears to be greater than that of stay-at-home mothers. Higher social acceptance suggests that they hold a more positive outlook on people and are at ease in social situations, which may have helped to alleviate their stress and anxiety.

A cross-sectional study of university students' mental health and lifestyle practices amidst the COVID-19 pandemic

OBJECTIVES

University students are regarded as the backbone of society, and their mental health during a pandemic may have a substantial impact on their performance and life outcomes. The purpose of this study was to assess university students' mental health, specifically depression, anxiety, and stress, during Lebanon's extended COVID-19 pandemic, as well as the sociodemographic factors and lifestyle practices associated with it.

METHODS

An online anonymous survey assessed the rates of mental health problems during COVID-19, controlling for socio-demographics and other lifestyle practices, in 329 undergraduate and graduate university students. Instruments utilized were the Patient Health Questionnaire (PHQ-9) for depression, the Beck Anxiety Inventory (21-BAI) for anxiety, and the Perceived Stress Scale (PSS-10) for stress. The study employed descriptive statistics and multiple logistic regression models to analyze the association between depression, anxiety, and stress with sociodemographic and lifestyle factors. Results were evaluated using adjusted odds ratios and confidence intervals, with a significance level of 0.05.

RESULTS

Moderate to severe rates of depression, anxiety and stress among students were reported by 75.9%, 72.2%, and 89.3%, respectively. The odds of anxiety and stress were higher among women compared to men. Students who used private counseling services had higher odds of anxiety and stress than those who did not. Overall rated health was a major predictor of depression and anxiety, with the "poor" and "fair" overall-reported health groups having higher odds than the "Excellent" group. When compared to those who did not smoke, students who increased their smoking intake had higher odds of depression, anxiety and stress. Students who reduced their alcohol consumption had lower odds of anxiety compared to those who did not consume alcohol. Students who reduced their physical activity had higher odds than those who increased it. Finally, students who slept fewer than seven hours daily had higher odds of depression than those who slept seven to nine hours.

CONCLUSION

Our findings indicate a national student mental health crisis, with exceptionally high rates of moderate to severe depression, anxiety, and stress. Factors such as gender, university program, overall rated health, importance of religion in daily decisions, private counseling, smoking cigarettes, alcohol consumption, physical activity, and sleeping, were all found to have an impact on mental health outcomes. Our study highlights the need for university administrators and mental health professionals to consider targeted mental health programming for students, particularly for women and those with poor or fair overall perceived health.

The impact of catastrophic events on the sex ratio at birth: A systematic review

OBJECTIVE

The impact of maternal stress on birth outcomes is well established in the scientific research. The sex ratio at birth (SRB), namely the ratio of male to female live births, shows significant alteration when mothers experience acute stress conditions, as proposed by the Trivers-Willard Hypothesis. We aimed to synthetize the literature on the relationship between two exogenous and catastrophic stressful events (natural disasters and epidemics) and SRB.

METHODS

A systematic search was run in Scopus, PubMed, Web of Science, and Cochrane Library, until March 9, 2023. The search produced 1336 articles and 25 articles met the inclusion criteria. We found seven case-control studies and 18 observational studies. Most of studies investigated the impact of earthquakes and other natural disasters. Only seven studies examined the effect of epidemics or pandemics.

RESULTS

The results of the studies seem inconsistent, as 16 studies found a decline in SRB, three found a rise, four did not record any change and two studies gave contradictory results. The period and population analyzed, the source of information, the method of variance analysis in the SRB, and the failure to assess confounding variables may have influenced the incongruence of the results.

CONCLUSION

Our findings contribute to improve the knowledge about the relationship between socio-ecological factors and SRB. Future studies should investigate the mechanisms by which this relationship impacts public health, in particular the health of pregnant women and their newborn, through an accurate and consistent methodology that also includes confounding factors.

Description of a telehealth mental health programme in the framework of the COVID-19 pandemic in Colombia

BACKGROUND

A telehealth mental health programme was designed at the LivingLab of the Faculty of Medicine of the Universidad de Antioquia [University of Antioquia].

OBJECTIVES

To describe the development and operation of the programme and evaluate the satisfaction of the patients treated during the COVID-19 pandemic in 2020 and 2021.

METHODS

Descriptive study that details the development of the programme. Data were extracted from medical records to describe the patients who were treated. A satisfaction scale was applied to a random sample and the data were summarised with descriptive statistics.

RESULTS

In March 2020 and August 2021, 10,229 patients were treated, with 20,276 treated by telepsychology and 4,164 by psychiatry, 1,808 by telepsychiatry and 2,356 by tele-expertise, with a total of 6,312 visits. The most frequent diagnoses were depressive (36.8%), anxiety (12.0%), and psychotic (10.7%) disorders. Respondents were satisfied to the point that more than 93% would recommend it to another person.

CONCLUSIONS

The LivingLab telehealth mental health programme allowed for the care of patients with mental health problems and disorders in Antioquia during the first two years of the COVID-19 pandemic, and there was a high degree of satisfaction among the beneficiaries. Therefore it could be adopted in mental health care.

An examination of psychosocial and professional effects of the COVID-19 pandemic on genetic counselors

For healthcare workers, recognized professional challenges associated with the COVID-19 pandemic include changes to service delivery models, increased burnout, furlough, and loss of income. The main goal of this study was to more clearly define the impact on mental health and quality of life of genetic counselors during the COVID-19 pandemic in the contexts of their personal, professional, and social lives. Eligible genetic counselors (GCs) (n = 283) responded to an online survey that incorporated validated instruments: Patient Health Questionnaire, Generalized Anxiety Disorder, Professional Quality of Life, and the In Charge Financial Distress/Financial Well-Being Scale. Additionally, original questions were developed from previous qualitative research on COVID-19 challenges for healthcare workers. Results showed 62% of respondents felt their mental health was impacted for the worse, 45% found it more difficult to achieve work/life balance, 16.8% scored within moderate-to-severe depression severity, 19.2% scored within moderate-to-severe anxiety, 26.3% reported high burnout, and 7% had high financial distress. GCs reported generally lower levels of anxiety and depression compared to healthcare workers and the general population. Thematic analysis identified feelings of isolation and difficulties balancing professional/personal responsibilities with more remote work. However, some participants reported greater flexibility in their schedule and more time with family. Self-care activities increased, with 93% engaging in more meditation and 54% began exercising. There were similar themes reported in this survey compared to other healthcare workers' experiences. There is also a dichotomy in positive and negative impacts with some GCs appreciating the flexibility of working from home but others reporting this blurs the line between personal and professional responsibilities. These results suggest consequences of the COVID-19 pandemic will continue to impact the field of genetic counseling and understanding these changes will be instrumental in addressing the needs of GCs to practice effectively.

The Multi-faceted Effects of COVID-19 on Female Reproductive Health: An Updated Narrative Review

Concerns about the SARS-CoV-2 pandemic's possible impact on sexual and reproductive health have grown significantly. In this narrative review, the latest research on the effects of SARS-CoV-2 infection on several facets of sexual and reproductive health is reviewed. The review starts initially by going through the possible consequences of SARS-CoV-2 on female menstrual cycles. The virus may interfere with the menstrual cycle, which could affect hormone synthesis and endometrial reactions, according to newly available evidence. Menstrual blood loss may be impacted by COVID-19's potential to influence endothelial cell function and systemic hemostasis. Hypothalamic amenorrhea may be brought on by severe COVID-19 disease. There is little research on this subject, although most women resume their regular menstrual cycles after 1-2 months of recuperation. The review also examines how SARS-CoV-2 infection may affect assisted reproductive technology (ART) treatments. There are few clinical data, although some research points to potential effects on embryo quality. Overall, ART results, however, did not materially change from the time before the epidemic. Obstetric problems are more likely when SARS-CoV-2 infection occurs during pregnancy, especially in the third trimester. Even though the maternal death rate is still low, pregnant women, especially those with comorbidities, are more likely to experience serious sickness. The review emphasizes how the COVID-19 vaccine affects menstrual cycles, showing brief, modest modifications without serious health hazards. Also included are the psychological effects of family planning choices during the pandemic. In conclusion, this narrative review offers a thorough assessment of the complicated and changing effects of SARS-CoV-2 on sexual and reproductive health. The different requirements of people and couples during and after the pandemic are highlighted, underscoring the necessity for ongoing study and specialized healthcare practices.

Association of COVID-19 preventive behavior and job-related stress with the sleep quality of healthcare workers one year into the COVID-19 outbreak: a Japanese cross-sectional survey

BACKGROUND

This study aimed to evaluate the association of COVID-19 preventive behavior and job-related stress with sleep quality among healthcare workers (HCWs). We conducted a cross-sectional survey using a questionnaire at the National Center of Neurology and Psychiatry, Tokyo, Japan.

METHODS

A total of 586 participants who completed the questionnaire were eligible for the study. The Pittsburgh Sleep Quality Index was used to evaluate sleep quality. We examined the level of engagement between poor sleep and COVID-19-related infection preventive behaviors, such as avoiding closed spaces, crowded places, and close contact (three Cs), a distance of at least one meter from others, wearing a face mask regularly, washing hands regularly, and working remotely, as well as job-related stress in the work environment, exposure to patients, potential risk of infection, fear of infecting others, need for social confinement, and financial instability. We conducted a hierarchical logistic regression analysis to examine the relationship between poor sleep and COVID-19 preventive behavior, job-related stress, and other covariates, including age, sex, and the Kessler Psychological Distress Scale (K6), which was used to measure non-specific psychological distress.

RESULTS

Poor sleep was observed in 223 (38.1%) participants. Adherence to COVID-19 preventive measures was relatively high: 84.1% of participants answered "always" for wearing a face mask regularly and 83.4% for washing hands regularly. In the multivariate logistic regression analysis, stress in the work environment (odds ratio [OR] = 2.09, 95% confidence interval [CI], 1.37-3.20; p < 0.001), financial instability (OR = 1.73, 95% CI, 1.12-2.67; p < 0.05), and low adherence to working remotely (OR = 1.65, 95% CI, 1.06-2.57; p < 0.05) were independently and significantly associated with poor sleep after controlling for the covariates.

CONCLUSIONS

One year into the COVID-19 pandemic, the poor sleep rates of HCWs remained high. These results emphasize the need to protect HCWs from work environment stress and financial concerns.

Influence of loneliness and social isolation before and during the COVID-19 pandemic on mood, cognition and sleep

BACKGROUND

Social isolation and loneliness are public health problems and are related to poor physical and mental health in older persons, especially during the COVID-19 pandemic. We investigated the influences of social isolation and loneliness on mood, cognition and sleep quality in older persons.

METHODS

This study evaluated 82 older persons, with a median age of 69.16 years (range: 60.00-85.97). The older persons were assessed before and during the period of the COVID-19 pandemic. Cognition was assessed using the Montreal Cognitive Assessment, symptoms of depression using the Beck Depression Inventory II, symptoms of anxiety using the Beck Anxiety Inventory, quality of sleep by the Pittsburgh Sleep Quality Index, daytime sleepiness by the Epworth Sleepiness Scale, isolation by the Duke Social Support Index and three-item UCLA Loneliness Scale.

RESULTS

Our results revealed that loneliness is related to worsening anxiety symptoms (P = 0.008), and sleep quality (P = 0.011). Isolation is related to worsening sleep quality (P = 0.011). On the other hand, participants who did not isolate themselves during the pandemic felt more anxious (P = 0.021). In addition, older persons who were not isolated (P = 0.035) and had no loneliness (P = 0.007), have higher cognitive performance over time.

CONCLUSION

Loneliness is related to worsening symptoms of anxiety and sleep quality. Our results showed that social isolation is related to worsening sleep quality. On the other hand, high social support during the COVID-19 pandemic increased anxiety. Furthermore, better cognitive performance is related to non-isolated and non-lonely participants.

Global burden of sleep disturbances among older adults and the disparities by geographical regions and pandemic periods

Sleep disturbances are highly prevalent during the COVID-19 pandemic, especially among older adults. We aimed to evaluate sleep heath during COVID-19 pandemic and assess the differences among geographical regions and pandemic periods. We searched three databases (PubMed, Embase, Web of Science) to find articles up to March 12, 2023. We included observational studies that reported the prevalence of sleep disturbances among adults aged 60 years or older in any setting. Two researchers independently reviewed the literature and retrieved the data. We used Der Simonian-Laird random effects meta-analyses to pool the data, followed by subgroup analysis, sensitivity analysis, and meta-regression. A total of 64 studies with 181,224 older adults during the pandemic were included. The prevalence of poor sleep quality, short sleep duration, long sleep duration, and insomnia symptoms were 47.12% (95% CI: 25.97%, 68.27%), 40.81% (95% CI: 18.49%, 63.12%), 31.61% (95% CI: 24.83%, 38.38%), and 21.15% (95% CI: 15.30%, 27.00%), respectively. The prevalence of sleep problems reported by self-constructed items was 26.97% (95% CI: 20.73%, 33.22%). When compared to America (64.13%), Europe (20.23%) and the Western Pacific (21.31%) showed a lower prevalence of sleep problems (all P < 0.0001). The prevalence of worsened sleep problems was 27.88% (95% CI: 11.94%, 43.82%). Compared to 2020 (15.14%), it increased to 47.42% in 2021 (P < 0.05). Eight studies on sleep disturbances among 672 older COVID-19 patients were included. The prevalence of sleep problems and insomnia symptoms among older COVID-19 patients were 41.58% (95% CI: 21.97%, 61.20%) and 41.56% (95% CI: 28.11%, 58.02%), respectively. A significant burden related to poor sleep has been observed among older adults worldwide over the past three years, with variations across different regions and time periods. It is important to make more efforts in prevention and intervention to identify the risk factors, treatment, and rehabilitation of sleep disturbances for healthy aging.

Perceived risk of COVID-19 hurts mental health: the mediating role of fear of COVID-19 and the moderating role of resilience

BACKGROUND

Depression and anxiety have been found prevalent during all phases of the COVID-19 pandemic. In late December 2022, almost all COVID-19 control measures were lifted in China, leading to a surge in COVID-19 infections. The public's perceived risk and fear of COVID-19 would be increased. This study aims to examine the prevalence of depression and anxiety in the Chinese general population and explores the mediating role of fear of COVID-19 between COVID-19 perceived risk and depression/anxiety and the moderating role of resilience between fear of COVID-19 and depression/anxiety.

METHODS

A cross-sectional online survey was conducted in Wenzhou, China, immediately following almost all COVID-19 control measures lifted. The 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), the COVID-19 Risk Perception Scale, the Fear of COVID-19 Scale, and the Connor-Davidson Resilience Scale (CD-RISC) were used to evaluate depression, anxiety, COVID-19 perceived risk, fear of COVID-19, and resilience, respectively. Structural Equation Modeling (SEM) with Maximum Likelihood (ML) estimator and adjusted for significant background factors was performed to test the moderated mediation. Data obtained from 935 participants were analyzed.

RESULTS

The prevalence of moderate to severe depression and anxiety was 23.7% and 9.5%, respectively. The present study revealed positive associations among COVID-19 perceived risk, fear of COVID-19 and depression/anxiety, and negative associations between resilience and fear of COVID-19/depression/anxiety. Fear of COVID-19 partially mediated the association between COVID-19 perceived risk and depression/anxiety. Furthermore, resilience significantly moderated the association between fear of COVID-19 and depression/anxiety. Two moderated mediation models were constructed.

CONCLUSION

Depression and anxiety were prevalent among Chinese adults during the final phase of the pandemic in China. The significant mediation role of fear of COVID-19 implies that reducing fear of COVID-19 may effectively alleviate depression and anxiety symptoms. Moreover, enhancing public resilience during an epidemic crisis is crucial for promoting mental health.

Mental health status and related factors influencing healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

The mental health of healthcare workers during the coronavirus-2019 pandemic was seriously affected, and the risk of mental health problems was high. The present study sought to systematically evaluate the mental health problems of healthcare workers worldwide during the pandemic and to determine the latest global frequency of COVID-19 associated mental health problems.

METHODS

Data in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Elsevier, MEDLINE, PubMed, PsycINFO and the Web of Science before November 11, 2022, were systematically searched. Cohort, case-control and cross-sectional studies were included. The meta-analysis used a random effects model to synthesize the comprehensive prevalence rate of mental health problems. Subgroup analyses were performed based on time of data collection; whether the country was or was not developed; continent; doctors and nurses; doctors/nurses vs. other healthcare workers; and psychological evaluation scale.

RESULTS

A total of 161 studies were included, including 341,014 healthcare workers worldwide, with women accounting for 82.8%. Occupationally, 16.2% of the healthcare workers were doctors, 63.6% were nurses and 13.3% were other medical staff. During the pandemic, 47% (95% confidence interval [CI], 35-60%) of healthcare workers reported job burnout, 38% (95% CI, 35-41%) experienced anxiety, 34% (95% CI 30-38%) reported depression, 30% (95% CI, 29-31%) had acute stress disorder, and 26% (95% CI, 21-31%) had post-traumatic stress disorder.

CONCLUSIONS

The study found that there were common mental health problems among health care workers during the COVID-19 pandemic. The most common was job burnout, followed by anxiety, depression, acute stress and post-traumatic stress disorder. Although the global pandemic has been brought under control, its long-term impact on the mental health of healthcare workers cannot be ignored. Additional research is required to develop measures to prevent, monitor and treat psychological disorders among healthcare workers.

A narrative systematic review of changes in mental health symptoms from before to during the COVID-19 pandemic

The onset of the COVID-19 pandemic raised concerns regarding population-wide impacts on mental health. Existing work on the psychological impacts of disaster has identified the potential for multiple response trajectories, with resilience as likely as the development of chronic psychopathology. Early reviews of mental health during the pandemic suggested elevated prevalence rates of multiple forms of psychopathology, but were limited by largely cross-sectional approaches. We conducted a systematic review of studies that prospectively assessed pre- to peri-pandemic changes in symptoms of psychopathology to investigate potential mental health changes associated with the onset of the pandemic (PROSPERO #CRD42021255042). A total of 97 studies were included, covering symptom clusters including obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), fear, anxiety, depression, and general distress. Changes in psychopathology symptoms varied by symptom dimension and sample characteristics. OCD, anxiety, depression, and general distress symptoms tended to increase from pre- to peri-pandemic. An increase in fear was limited to medically vulnerable participants, and findings for PTSD were mixed. Pre-existing mental health diagnoses unexpectedly were not associated with symptom exacerbation, except in the case of OCD. Young people generally showed the most marked symptom increases, although this pattern was reversed in some samples. Women in middle adulthood in particular demonstrated a considerable increase in anxiety and depression. We conclude that mental health responding during the pandemic varied as a function of both symptom cluster and sample characteristics. Variability in responding should therefore be a key consideration guiding future research and intervention.

Shinrin-Yoku (Forest Bathing): A Scoping Review of the Global Research on the Effects of Spending Time in Nature

Background

This Scoping review (ScR) builds upon the 2017 review conducted by Hansen et al which contributed to evidence base shinrin-yoku (SY), also known as forest bathing (FB), has many positive health effects and is becoming a prescribed dose (specific time spent in nature) by health care providers. Practice and research regarding SY, has been historically based in Asian countries with a recent increase in Europe. The need and call for more research worldwide continues to further the evidence of SY as a health promotion modality. Through this ScR the authors identified programmatic components, health information monitored and screened, time spent in nature, geographical regions, trends, and themes in SY research worldwide.

Methods

Following PRISMA-ScR guidelines we searched across 7 electronic databases for SY or FB research articles from 2017 through 2022. PubMed, CINAHL, PsycInfo, ScienceDirect, SCOPUS, Embase, JSTOR were included due to the interdisciplinary nature of SY or FB research. Each database provided unique strengths ensuring a capture of a wide range of articles. The resulting articles were screened and extracted through Covidence.

Results

Database searches returned 241 results, with 110 references removed during the deduplication process, 131 were initially screened in the title and abstract review stage. Resulting in 82 unique results deemed relevant and screened in full text. During the final stage of the review, 63 articles met all inclusion criteria and were extracted for data.

Conclusions

The practice of SY has physiological (PHYS) and psychological (PSYCH) benefits across age groups. Research findings indicate either the natural or the virtual environment (VW) has significant health benefits. Continued research is encouraged globally for short- and long-term health outcomes for all individuals. The connection with nature benefits the mind, body and soul and is supported by Henry David Thoreau's philosophy: "Our livesneed the relief of where the pine flourishes and the jay still scream."

Predictive Machine Learning Models for Assessing Lebanese University Students' Depression, Anxiety, and Stress During COVID-19

University students are experiencing a mental health crisis. COVID-19 has exacerbated this situation. We have surveyed students in 2 universities in Lebanon to gauge their mental health challenges. We have constructed a machine learning (ML) approach to predict symptoms of depression, anxiety, and stress based on demographics and self-rated health measures. Our approach involved developing 8 ML predictive models, including Logistic Regression (LR), multi-layer perceptron (MLP) neural network, support vector machine (SVM), random forest (RF) and XGBoost, AdaBoost, Naïve Bayes (NB), and K-Nearest neighbors (KNN). Following their construction, we compared their respective performances. Our evaluation shows that RF (AUC = 78.27%), NB (AUC = 76.37%), and AdaBoost (AUC = 72.96%) have provided the highest-performing AUC scores for depression, anxiety, and stress, respectively. Self-rated health is found to be the top feature in predicting depression, while age was the top feature in predicting anxiety and stress, followed by self-rated health. Future work will focus on using data augmentation approaches and extending to multi-class anxiety predictions.

Prevalence and network structure of post-traumatic stress symptoms and their association with suicidality among Chinese mental health professionals immediately following the end of China's Dynamic Zero-COVID Policy: a national survey

Studies on post-traumatic stress symptoms (PTSS) among mental health professionals (MHPs) are limited, particularly since restrictions due to coronavirus disease (COVID-19) have been lifted such as the recent termination of China's Dynamic Zero-COVID Policy. The current study filled this gap by exploring the prevalence, correlates, and network structure of PTSS as well as its association with suicidality from a network analysis perspective. A cross-sectional, national survey was conducted using a convenience sampling method on MHPs between January 22 and February 10, 2023. PTSS were assessed using the Post-Traumatic Stress Disorder Checklist-Civilian version, while suicidality was assessed using standardized questions related to ideation, plans, and attempts. Univariate and multivariate analyses examined correlates of PTSS. Network analysis explored the structure of PTSS and suicidality. The centrality index of "Expected influence" was used to identify the most central symptoms in the network, reflecting the relative importance of each node in the network. The "flow" function was adopted to identify specific symptoms that were directly associated with suicidality. A total of 10,647 MHPs were included. The overall rates of PTSS and suicidality were 6.7% (n = 715; 95% CI = 6.2-7.2%) and 7.7% (n = 821; 95% CI = 7.2-8.2%), respectively. Being married (OR = 1.523; P < 0.001), quarantine experience (OR = 1.288; P < 0.001), suicidality (OR = 3.750; P < 0.001) and more severe depressive symptoms (OR = 1.229; P < 0.001) were correlates of more PTSS. Additionally, higher economic status (e.g., good vs. poor: OR = 0.324; P = 0.001) and health status (e.g., good vs. poor: OR = 0.456; P < 0.001) were correlates of reduced PTSS. PCL6 ("Avoiding thoughts"; EI = 1.189), PCL7 ("Avoiding reminders"; EI = 1.157), and PCL11 ("Feeling emotionally numb"; EI = 1.074) had the highest centrality, while PCL12 ("Negative belief"), PCL 16 ("Hypervigilance") and PCL 14 ("Irritability") had the strongest direct, positive associations with suicidality. A high prevalence of lingering PTSS was found among MHPs immediately after China's "Dynamic Zero-COVID Policy" was terminated. Avoidance and hyper-arousal symptoms should be monitored among at-risk MHPs after the COVID-19 pandemic and serve as potential targets for the prevention and treatment of PTSS in this population.

Experiences and perspectives of nurses infected with COVID-19: A qualitative systematic review and meta-synthesis

This qualitative systematic review aims to comprehensively understand the experiences and perspectives of nurses infected with COVID-19, addressing a significant gap in the current literature. Following the JBI meta-synthesis approach, a rigorous search was conducted across nine electronic databases and references until January 16, 2023. Seventeen eligible studies underwent quality assessment using the JBI critical checklist. Data were synthesized using standardized tools, and the ConQual tool evaluated confidence in the findings. Seven key findings emerged, providing valuable insights into emotional experiences, adaptation to COVID-19 challenges, influence of support systems, coping strategies, posttraumatic growth perceptions, and effects on professional identity and career advancement. The findings highlight emotional toll, adaptive strategies, and professional implications for nurses. Moreover, they emphasize the importance of support systems, coping mechanisms, and posttraumatic growth in promoting nurses' well-being and resilience. These insights have practical implications for targeted interventions and support mechanisms to enhance infected nurses' well-being and improve healthcare outcomes.

Trauma Shaping the Psychopathological Correlates of Patients with Long-COVID: A 6-Months Longitudinal Study with Repeated Measures Mixed Models

This research aimed at investigating how the experience of trauma can influence the psychological correlates of long-COVID over time in a clinical sample of patients hospitalized because of COVID-19. Through a longitudinal research design, 70 post-acute patients with COVID-19 were followed-up after hospital discharge in 3-time points up to 6 months and completed the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) and the Symptoms Checklist-90-Revised (SCL-90 R). Repeated measures mixed models with random intercept were used to evaluate the effect of trauma (yes/no) over time (T1, T2, T3) on the SCL-90-R scales. Results showed that patients with trauma display significantly worse psychological outcomes in all the SCL-90-R dimensions [all padj < .05 for the principal effects of trauma(y)], especially in symptoms of depression [time 2 vs time 1*trauma(y): b = -3.86, 95%CI (-7.18, -0.53), padj = .035; time 3 vs time 1*trauma(y): b = -4.77, 95%CI (-8.10, -1.45), padj = .011], anxiety [time 3 vs time 1*trauma(y): b = -4.54, 95%CI (-7.72, -1.37), padj = .011], and obsessive-compulsive difficulties [time 3 vs time 1*trauma(y): b = -4.03, 95%CI (-7.20, -0.86), padj = .027]. These findings shed light on the long-term psychological consequences of COVID-19 among hospitalized patients and highlight the key role of trauma, suggesting its assessment to tailor psychological interventions.