Social factors and worry associated with COVID-19: Evidence from a large survey in China

Impact of the COVID-19 Pandemic on Physical Activity among Mostly Older, Overweight Black Women Living in the Rural Alabama Black Belt

Despite well-documented global declines in physical activity (PA) during the COVID-19 pandemic, little is known regarding the specific impact among underserved, rural Alabama counties. This is concerning as this region was already disproportionately burdened by inactivity and related chronic diseases and was among the hardest hit by COVID-19. Thus, the current study examined the effect of COVID-19 on PA in four rural Alabama counties. An ancillary survey was administered between March 2020 and August 2021 to the first cohort (N = 171) of participants enrolled in a larger PA trial. Main outcomes of this survey included the perceived impact of COVID-19 on PA, leisure-time PA, and social cognitive theory (SCT) constructs at 3 months. Almost half of the participants reported being less active during the pandemic (49.7%) and endorsed that COVID-19 made PA more difficult (47.4%), citing concerns such as getting sick from exercising outside of the home (70.4%) and discomfort wearing a face mask while exercising (58%). Perceived COVID-19 impact on PA was significantly associated with education, household dependents, and gender (p's < 0.05). More women, parents, and college graduates reported that the COVID-19 pandemic made PA more difficult. Overall, there were no significant associations between PA, SCT constructs, or perceived COVID-19 impact on PA scores at 3 months. While the pandemic made PA difficult for many participants, these barriers were not associated with leisure-time PA levels or related theoretical mechanisms of action, which bodes well for the success of our ongoing intervention efforts and the resiliency of these communities.

Manifestations and Outcomes of Intracerebral Hemorrhage During the COVID-19 Pandemic in China: Multicenter, Longitudinal Cohort Study

BACKGROUND

The COVID-19 pandemic has inevitably affected the distribution of medical resources, and epidemic lockdowns have had a significant impact on the nursing and treatment of patients with other acute diseases, including intracerebral hemorrhage (ICH).

OBJECTIVE

This study aimed to investigate how the COVID-19 pandemic affected the manifestations and outcomes of patients with ICH.

METHODS

Patients with acute ICH before (December 1, 2018-November 30, 2019) and during (December 1, 2019-November 30, 2020) the COVID-19 pandemic at 31 centers in China from the Chinese Cerebral Hemorrhage: Mechanism and Intervention (CHEERY) study were entered into the analysis. Demographic information and clinical manifestations and outcomes were collected and compared between the 2 groups.

RESULTS

From December 1, 2018, to November 30, 2020, a total of 3460 patients with ICH from the CHEERY study were enrolled and eventually analyzed. The results showed that during the COVID-19 pandemic, patients with ICH were more likely to be older (P<.001) with a history of ischemic stroke (P=.04), shorter time from onset to admission (P<.001), higher blood pressure (P<.001), higher fasting blood glucose (P=.003), larger hematoma volume (P<.001), and more common deep ICH (P=.01) and intraventricular hemorrhage (P=.02). These patients required more intensive care unit treatment (P<.001) and preferred to go to the hospital directly rather than call an ambulance (P<.001). In addition, the COVID-19 pandemic was associated with an increased risk of pulmonary infection during hospitalization (adjusted risk ratio [RRadjusted] 1.267, 95% CI 1.065-1.509), lower probability of a 3-month good outcome (RRadjusted 0.975, 95% CI 0.956-0.995), and a higher probability of in-hospital (RRadjusted 3.103, 95% CI 2.156-4.465), 1-month (RRadjusted 1.064, 95% CI 1.042-1.087), and 3-month (RRadjusted 1.069, 95% CI 1.045-1.093) mortality.

CONCLUSIONS

Our study indicated that the cloud of COVID-19 has adversely impacted the presentation and outcomes of ICH. Medical workers may pay more attention to patients with ICH, while the public should pay more attention to hypertension control and ICH prevention.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR1900020872; https://www.chictr.org.cn/showprojEN.html?proj=33817.

Symptomatic SARS-CoV-2 Episodes and Health-Related Quality of Life

BACKGROUND

Understanding the physical and mental health needs of the population through evidence-based research is a priority for informing health policy. During the COVID-19 pandemic, population wellbeing dramatically dropped. The relationship between experiences of symptomatic illness episodes and health-related quality of life has been less documented.

OBJECTIVE

This study analysed the association between symptomatic COVID-19 illness and health-related quality of life.

METHODS

The analyses drew from a cross-sectional analysis of data from a national digital symptoms' surveillance survey conducted in the UK in 2020. We identified illness episodes using symptoms and test results data and we analysed validated health-related quality of life outcomes including health utility scores (indexed on a 0-1 cardinal scale) and visual analogue scale (VAS) scores (0-100 scale) generated by the EuroQoL's EQ-5D-5L measure. The econometric model controlled for respondents' demographic and socioeconomic characteristics, comorbidities, social isolation measures, and regional and time fixed effects.

RESULTS

The results showed that the experience of common SARS-CoV-2 symptoms was significantly associated with poorer health-related quality of life across all EQ-5D-5L dimensions of mobility, self-care, usual activities, pain/discomfort and anxiety/depression, a decrement in utility score of - 0.13 and a decrement in the EQ-VAS score of - 15. The findings were robust to sensitivity analyses and restrictive test results-based definitions.

CONCLUSION

This evidence-based study highlights the need for targeting of interventions and services towards those experiencing symptomatic episodes during future waves of the pandemic and helps to quantify the benefits of SARS-CoV-2 treatment in terms of health-related quality of life.

Organization of psychosocial factors associated with worry about acquiring SARS-CoV-2 among women undergoing cancer treatment: an empirical network comparison approach

OBJECTIVES

Pandemic-induced anxiety can have adverse mental and somatic health consequences on cancer patients (CP). This study aimed to (1) explore the intricate relationships between worry related to potential SARS-CoV-2 infection, COVID-19 perception, sociodemographic factors, and the perceived effectiveness of lockdown measures and (2) investigate if these relationships differ between cancer patients and individuals without a history of cancer (IWHC).

METHODS

We conducted a cross-sectional quantitative study in France between December 1 and 14, 2020. Network analysis was employed on a sample of 1889 women, including 282 cancer patients and 1607 noncancer individuals.

RESULTS

Our findings indicate that CP were 20% more likely to express worry than IWHC. Anxiety is embedded within a complex network involving sociodemographic, cognitive, and emotional factors. The emotional components related to COVID-19 perception were found to play a crucial role. The networks for both groups were observed to be identical.

CONCLUSIONS

Our study underscores the heightened vulnerability of cancer patients to pandemic-induced anxiety, emphasizing the crucial role of emotional components related to COVID-19 perception. The observed similarities in the anxiety network between cancer patients and those without a history of cancer suggest that universal approaches might be effective across groups.

IMPLICATIONS

Utilizing the Causal Attitude Network Model, we propose potential methods for managing and reducing individual anxiety levels.

An interaction and feedback mechanism-based group decision-making for emergency medical supplies supplier selection using T-spherical fuzzy information

Selecting a supplier for emergency medical supplies during disasters can be considered a typical multiple attribute group decision-making (MAGDM) problem. MAGDM is an intriguing common problem that is rife with ambiguity and uncertainty. It becomes much more challenging when governments and medical care enterprises adjust their priorities in response to the escalating problems and the effectiveness of the actions taken in different countries. As decision-making problems become increasingly complicated nowadays, a growing number of experts are likely to use T-spherical fuzzy sets (T-SFSs) rather than exact numbers. T-SFS is a novel extension of fuzzy sets that can fully convey ambiguous and complicated information in MAGDM. The objective of this paper is to propose a MAGDM methodology based on interaction and feedback mechanism (IFM) and T-SFS theory. In it, we first introduce T-SF partitioned Bonferroni mean (T-SFPBM) and T-SF weighted partitioned Bonferroni mean (T-SFWPBM) operators to fuse the evaluation information provided by experts. Then, an IFM is designed to achieve a consensus between multiple experts. In the meantime, we also find the weights of experts by using T-SF information. Furthermore, in light of the combination of IFM and T-SFWPBM operator, an MAGDM algorithm is designed. Finally, an example of supplier selection for emergency medical supplies is provided to demonstrate the viability of the suggested approach. The influence of parameters on decision results and comparative analysis with the existing methods confirmed the reliability and accuracy of the suggested approach.

Subjective social status and health among older adults in China: the longitudinal mediating role of social trust

BACKGROUND

From a developmental perspective, this study explored the interplays between subjective social status (SSS), social trust (ST), and health status measured by self-rated health (SRH) among older adults in the context of China. It also tested the longitudinal mediation of ST between SSS and SRH.

METHODS

After excluding samples with missing values, we analyzed 4,877 individual responses from those aged 60 years or older, extracted from the China Family Panel Studies (CFPS) data in 2014, 2016, and 2018. We used latent growth modeling to test the hypothesized relationships among their SSS, ST, and SRH.

RESULTS

Latent growth modeling based on bootstrapping showed that the SSS, ST, and SRH of older adults all increased linearly and that the mechanism of SSS acted on the SRH as follows: the initial level of SSS indirectly influenced the initial level and the growth rate of the SRH, respectively, through the initial level of ST, and the initial level and growth rate of SSS played an indirect role in the growth rate of the SRH through the growth rate of ST.

CONCLUSION

The findings have practical implications for promoting health for older adults and realizing active aging in China. Therefore, we recommend establishing a family-centered and community-supported social support system for those with lower social status among older adults and a friendly community environment with various social, cultural, and recreational activities to improve the ST among older adults, thereby improving their health.

Sooner, later, or never: Changing fertility intentions due to Covid-19 in China's Covid-19 epicentre

Using survey data collected from Hubei province, China's Covid-19 epicentre, in August 2020, this study examines how fertility intentions of Chinese citizens changed during the Covid-19 pandemic. We consider not only whether people changed their fertility plans due to Covid-19 but also distinguish three types of change: bringing forward ('sooner'), postponing ('later'), and abandoning ('never') planned fertility. Over half of those who planned to have a child intended to change their fertility plans due to Covid-19. Younger individuals, those of non-Han ethnicities, urban residents, those with one child already, and those with ever-infected family members were more likely to change their fertility plans. While the effects of some characteristics seem to be short term, other characteristics such as age and number of children show more consequential influences. Older individuals and those planning their second child were particularly prone to abandoning their childbearing plans due to Covid-19. The pandemic may thus complicate China's latest efforts to boost its low fertility.

The impact of the COVID-19 pandemic and related policy responses on non-COVID-19 healthcare utilization in China

We investigate the impact of the COVID-19 pandemic and related policy responses on non-COVID-19 healthcare utilization (i.e., different types of outpatient care) up to October 2020 in China. Using an administrative database from a large prefecture-level city, we find that both direct exposure to the COVID-19 pandemic and the strict containment policy responses led to reductions in outpatient care utilization. The largest decline during the lockdown was observed in preventive care visits, which nevertheless recovered to pre-pandemic levels 2 months after the lockdown. The disruptions in prenatal care visits could not be offset by the recovery later on. Chronic care and emergency department visits had not returned to pre-pandemic levels as of October 2020, which may be driven by extended days' supply of prescription medication, increased use of telemedicine, and improved health-protective behaviors. In the reopening period, there were increases in visits for mental and sleep disorders, especially among children, and for medical abortion. Among health facilities at all levels, primary care facilities saw the least reductions in total outpatient visits. Our results emphasize the need for strategies to ensure access to urgent or essential care services when managing the current epidemiologic transition and future crises.

Perceptions and worries about monkeypox, and attitudes towards monkeypox vaccination among medical workers in China: A cross-sectional survey

BACKGROUND

The World Health Organization (WHO) declared monkeypox a "public health emergency of international concern" on 23 June 2022. However, there is a lack of data on monkeypox perceptions among medical workers. The purposes of this study were to evaluate perceptions, worries about monkeypox, attitudes towards monkeypox vaccination and their correlates among medical workers in China.

METHODS

Data were collected from medical practitioners using an online survey questionnaire between September 1 and September 30, 2022 in China. All the subjects completed an online questionnaire including general characteristics, perceptions/knowledge/worries about monkeypox, and attitudes towards monkeypox vaccination. Logistic regression was employed to examine the correlates of perceptions, worries about monkeypox, and attitudes toward monkeypox vaccination.

RESULTS

In total, this study sample included 639 medical workers. The mean age was 37.9 ± 9.4 years old. Approximately 71.8% of individuals reported perceptions of monkeypox, 56.7% worried about monkeypox, and 64.9% supported the promotion of monkeypox vaccination. Medical workers who were older than 50 years (aOR 3.73, 95%CI 1.01-13.85), worked in the Infectious Diseases/Dermatology/Venereal Diseases departments (3.09, 1.61-5.91), and provided correct answer to monkeypox transmission route (10.19, 5.42-19.17) were more likely to know about monkeypox/monkeypox virus before investigation. 30.7% reported that they were more worried about monkeypox than the coronavirus (COVID-19). Participants reported that the key population most in need of monkeypox vaccination were health practitioners (78.2%) and people with immunodeficiency (74.3%), followed by children (65.4%) and older adults (63.2%).

CONCLUSION

Awareness of monkeypox was high and attitude towards the promotion of monkeypox vaccination was positive among medical staff in China. Further targeted dissemination of monkeypox common knowledge among health care providers might improve their precaution measures and improve the promotion of monkeypox vaccination among key populations.

Evaluation of the knowledge, attitudes and concerns of the mothers of children who applied to the hospital during the COVID-19 pandemic

Aim: Families had to adapt to difficulties such as the use of masks, maintaining social distance, and the isolation process in their daily lives to stop the spread of the COVID-19 virus. It was also necessary to reveal how children with acute/chronic diseases affect primary caregivers in this challenging and stressful process. Methods: In this context, 315 children aged 1-17 years and their mothers who applied to the Inonu University Pediatrics Outpatient Clinic between January 2021 and June 2021 were included in our study. Sociodemographic information, attitudes and knowledge levels about prevention of the disease towards COVID-19 were learned and the 'Stait-Trait Anxiety Inventory' was applied. Results: The overall mean score of the COVID-19 disease knowledge level of the mothers is 4.888±1.428 (max=8). The low educational level of the father, the father's unemployed status, the diagnosis of chronic disease in the family, the diagnosis of chronic disease in their children increased the stait-trait anxiety scores of the mothers. Conclusion: While the pandemic is still in effect, it is understood that it is necessary to develop interventions to improve the mental health of parents who have chronic diseases in their children and families.

Public awareness, specific knowledge, and worry about mpox (monkeypox): A preliminary community-based study in Shenzhen, China

Background

The mpox (monkeypox) outbreak has been declared to be a public health emergency of international concern by the Director-General of World Health Organization in July 2022. However, evidence regarding the awareness, knowledge, and worry about mpox in the general population remains scant.

Methods

A community-based survey targeting community residents was preliminarily conducted in Shenzhen, China in August 2022 by using a convenience sampling method. Information on mpox-related awareness, knowledge, and worry was collected from each participant. Binary logistic regression analyses with the stepwise procedure were applied to explore the factors associated with awareness, knowledge, and worry about mpox.

Results

A total of 1028 community residents were included in the analysis (mean age: 34.70 years). Among these participants, 77.9% had ever heard of mpox, and 65.3% were aware of the global outbreak of mpox. However, only about half of them had a high level of knowledge regarding mpox (56.5%) and related symptoms (49.7%). More than one-third of them (37.1%) expressed a high level of worry about mpox. Having high knowledge levels of mpox and related symptoms were positively associated with a high level of worry (OR: 1.79, 95%CI: 1.22~2.63 for a single high knowledge level; OR: 1.98, 95%CI: 1.47~2.66 for both high knowledge levels).

Conclusions

This study identified the gaps in public awareness and specific knowledge of mpox in Chinese people, providing scientific evidence for the prevention and control network of mpox at the community level. Targeted health education programs are of urgent need, which should be implemented along with psychological interventions to release public worry if necessary.

The predictive role of parental attitudes toward COVID-19 vaccines and child vulnerability: A multi-country study on the relationship between parental vaccine hesitancy and financial well-being

Background and purpose

Recent new mutations and increases in transmission of COVID-19 among adolescents and children highlight the importance of identifying which factors influence parental decisions regarding vaccinating their children. The current study aims to explore whether child vulnerability and parents' attitudes toward vaccines mediate the association between perceived financial well-being and vaccine hesitancy among parents.

Method

A predictive, cross-sectional, multi-country online questionnaire was administered with a convenience sample of 6,073 parents (Australia, 2,734; Iran, 2,447; China, 523; Turkey, 369). Participants completed the Parent Attitude About Child Vaccines (PACV), the Child Vulnerability Scale (CVS), a Financial Well-being (FWB) measure, and Parental Vaccine Hesitancy (PVH) questionnaire.

Results

The current study revealed that perceived financial well-being had significant and negative associations with parents' attitudes toward COVID-19 vaccines and child vulnerability among the Australian sample. Contrary to the Australian findings, results from Chinese participants indicated that financial well-being had significant and positive predictive effects on parent attitudes toward vaccines, child vulnerability, and parental vaccine hesitancy. The results of the Iranian sample revealed that parents' attitudes toward vaccines and child vulnerability significantly and negatively predicted parental vaccine hesitancy.

Conclusion

The current study revealed that a parents' perceived financial well-being had a significant and negative relationship with parental attitudes about vaccines and child vulnerability; however, it did not significantly predict parental vaccine hesitancy among Turkish parents as it did for parents in Australia, Iran, and China. Findings of the study have policy implications for how certain countries may tailor their vaccine-related health messages to parents with low financial wellbeing and parents with vulnerable children.

Spatiotemporal dynamics and potential ecological drivers of acute respiratory infectious diseases: an example of scarlet fever in Sichuan Province

OBJECT

Scarlet fever is an acute respiratory infectious disease that endangers public health and imposes a huge economic burden. In this paper, we systematically studied its spatial and temporal evolution and explore its potential ecological drivers. The goal of this research is to provide a reference for analysis based on surveillance data of scarlet fever and other acute respiratory infectious illnesses, and offer suggestions for prevention and control.

METHOD

This research is based on a spatiotemporal multivariate model (Endemic-Epidemic model). Firstly, we described the epidemiology status of the scarlet fever epidemic in Sichuan Province from 2016 to 2019. Secondly, we used spatial autocorrelation analysis to understand the spatial pattern. Thirdly, we applied the endemic-epidemic model to analyze the spatiotemporal dynamics by quantitatively decomposing cases into endemic, autoregressive, and spatiotemporal components. Finally, we explored potential ecological drivers that could influence the spread of scarlet fever.

RESULTS

From 2016 to 2019, the incidence of scarlet fever in Sichuan Province varied much among cities. In terms of temporal distribution, there were 1-2 epidemic peaks per year, and they were mainly concentrated from April to June and October to December. In terms of transmission, the endemic and temporal spread were predominant. Our findings imply that the school holiday could help to reduce the spread of scarlet fever, and a standard increase in Gross Domestic Product (GDP) was associated with 2.6 folds contributions to the epidemic among cities.

CONCLUSION

Scarlet fever outbreaks are more susceptible to previous cases, as temporal spread accounted for major transmission in many areas in Sichuan Province. The school holidays and GDP can influence the spread of infectious diseases. Given that covariates could not fully explain heterogeneity, adding random effects was essential to improve accuracy. Paying attention to critical populations and hotspots, as well as understanding potential drivers, is recommended for acute respiratory infections such as scarlet fever. For example, our study reveals GDP is positively associated with spatial spread, indicating we should consider GDP as an important factor when analyzing the potential drivers of acute infectious disease.

How do Chinese tourists negotiate the constraints of engaging in post-COVID-19 domestic travel?

Post-COVID-19 domestic travel, a valuable component of tourism recovery, has been initiated. However, verified and detailed knowledge regarding epidemic-induced travel behaviour changes from an emic perspective is lacking. Focusing on actual behaviour based on a field investigation of Chinese domestic travellers, this study provides detailed knowledge of the travel constraint-negotiation interaction process between travellers and the epidemic. The findings suggest that the effects of COVID-19 involve various constraints including intrapersonal, interpersonal and structural factors at both the context and system levels. Both cognitive and behavioural strategies are synergistically used in an interlinking manner and depend not only on individual preference and self-efficacy but also, more importantly, on the temporality and socioculture of COVID-19 created by anti-epidemic practices.

Race-related differences in the economic, healthcare-access, and psychological impact of COVID-19: personal resources associated with resilience

Background

The impact of the coronavirus disease 2019 (COVID) is worse among those with fewer financial resources, in jobs not amenable to remote work, and in denser living conditions. People of color are more likely to be among these vulnerable groups. Although race itself is a social construction and not based on underlying genetic/biological differences, this study investigated race/ethnicity differences in the negative repercussions of COVID and in the benefits of psychological and social resources.

Methods

This cross-sectional, web-based study (n = 4817) was administered to a heterogeneous United States sample in Spring/Summer 2020. Information was gathered on the following COVID-specific variables: Infection Status, Coping with Lockdown, Social Support, Post-traumatic Growth, Interpersonal Conflict, Worry about Self, Financial Impact on Family, Lack of Money, Inadequate Access to Healthcare, and Housing Instability. Resilience was operationalized as the ability to maintain a sense of wellness in the face of the pandemic, using the DeltaQuest Wellness measure. Multivariate linear regression (adjusting for demographics) and propensity-matched cohort analysis (matched on demographics) evaluated the impact of COVID-specific variables on Wellness in separate models for Whites and Non-Whites.

Findings

Both sets of models retained the same COVID-specific variables and explained about half of the variance in wellness. Coping with Lockdown, Social Support, and Post-traumatic Growth were associated with higher levels of Wellness in both Whites and Non-Whites, while Interpersonal Conflict and Worry about Self were associated with lower levels of Wellness. While these associations are similar, Non-Whites reported worse levels of some positive resources (e.g., social support) and more challenging levels of negative stressors (e.g., interpersonal, worry, financial). Non-Whites also reported much higher levels of post-traumatic growth.

Conclusion

COVID was a source of worry and even conflict, but also unlocked people’s resources in use of health-enhancing behavioral strategies, social support, and renewed gratitude for sources of personal meaning and value. The similar relationships between Whites and Non-Whites on wellness and COVID-specific stressors across racial groups underscore that race is a social construction, not a biological fact. Focusing on a renewed appreciation for sources of personal meaning, and particularly faith, seemed to buffer much of the COVID-related stress for Non-Whites.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-022-00514-2.

COVID-19-related stigma and its impact on psychological distress: A cross-sectional study in Wuhan, China

Background and Aims

Health-related stigma arises from the perceived association between a person or group of certain characteristics and a specific disease. Coronavirus disease 2019 (COVID-19) has brought about stigma targeted at individuals and groups who are perceived to be connected with the virus. Wuhan of China was not only the locale where the first COVID-19 cases were detected in the world but was also the hardest hit across China.

Methods

Using new data (N = 1153) from a survey conducted in Wuhan in August 2020, this cross-sectional study aims to reveal the stigma experienced by residents in Wuhan during the COVID-19 pandemic and the impact of this experienced stigma on psychological distress, specifically posttraumatic stress disorder.

Results

69.47% (95% confidence interval (CI): 66.81%─72.13%) of the surveyed Wuhan residents have experienced some forms of stigma related to COVID-19. The average posttraumatic stress disorder score based on the impact of event scale-revised is 20.28 (95% CI: 19.096─21.468) out of 88. In particular, 27.75% (95% CI: 25.17%─30.34%) of the respondents display clinically significant distress symptoms. Moreover, this stigma not only aggravates individuals' posttraumatic stress disorder score by 10.652 (95% CI: 8.163─13.141) but also elevates the chance of developing clinically significant distress symptoms. Specifically, the probability of clinical distress is significantly higher (p < 0.001) among those who have experienced stigma (33.66%) than those who have no such experiences (12.62%).

Conclusion

The public should be aware of the distress-inducing impact of stigma related to COVID-19 and prevent it from causing more harm to certain individuals and groups.

Location matters: Regional variation in association of community burden of COVID-19 with caregiver and youth worry

Our study characterized associations between three indicators of COVID-19's community-level impact in 20 geographically diverse metropolitan regions and how worried youth and their caregivers in the Adolescent Brain Cognitive Development℠ Study have been about COVID-19. County-level COVID-19 case/death rates and monthly unemployment rates were geocoded to participants' addresses. Caregivers' (vs. youths') COVID-19-related worry was more strongly associated with COVID-19's community impact, independent of sociodemographics and pre-pandemic anxiety levels, with these associations varying by location. Public-health agencies and healthcare providers should avoid adopting uniform "one-size-fits-all" approaches to addressing COVID-19-related emotional distress and must consider specific communities' needs, challenges, and strengths.

COVID-19 lockdown impact on familial relationships and mental health in a large representative sample of Italian adults

PURPOSE

Benefits of national-level stay-at-home order imposed in Italy to prevent SARS-CoV-2 transmission need to be carefully weighed against its impact on citizens' health. In a country with a strong familial culture and where welfare relies on households, confinement drastically decreased support provided by elder relatives, which may have resulted in mental health worsening.

METHODS

A web-based cross-sectional study (LOST in Italy) was conducted on a representative sample of Italian adults during lockdown (27th of April-3rd of May 2020). We asked 3156 subjects to report on reduced help in housework and childcare from retired parents to assess the impact of confinement on mental health, through validated scales before and during lockdown.

RESULTS

Overall, 1484 (47.0%) subjects reported reduced housework help from parents, and 769 (64.0%, of the 1202 subjects with children) diminished babysitting support. Subjects reporting reduced housework help had worsened sleep quality (multivariate odds ratio, OR = 1.74, 95% confidence interval, CI 1.49-2.03) and quantity (OR = 1.50, 95% CI 1.28-1.76), depressive (OR = 1.32, 95% CI 1.14-1.53) and anxiety symptoms (OR = 1.53, 95% CI 1.32-1.78), compared to those reporting unreduced help. Worsening in sleep quality (OR = 2.32, 95% CI 1.76-3.05), and quantity (OR = 1.80, 95% CI 1.36-2.37), depressive (OR = 1.79, 95% CI 1.39-2.31) and anxiety symptoms (OR = 1.90, 95% CI 1.48-2.46) was also associated with reduced babysitting help. Mental health outcomes were worse in subjects with poorer housing and teleworking during lockdown.

CONCLUSION

Confinement came along with reduced familial support from parents, negatively impacting household members' mental health. Our findings might inform evidence-based family and welfare policies to promote population health within and beyond pandemic times.

A National Study of Racial-Ethnic Differences in COVID-19 Concerns Among Older Americans: Evidence From the Health and Retirement Study

OBJECTIVES

Concerns about coronavirus disease 2019 (COVID-19) are an important emotional reaction to the pandemic and represent a key pandemic-related mental health outcome. We provide the first population-based evidence of racial-ethnic differences in COVID-19 concerns among older Americans during the COVID-19 outbreak.

METHODS

We analyzed data from the 2020 Health and Retirement Study COVID-19 project. The sample included 2,879 respondents (aged 50 and older) who were interviewed from June to September 2020 and had completed measures on COVID-19 concerns and other key covariates. Ordinary least squares regression models were estimated to assess racial-ethnic differences in COVID-19 concerns. Formal mediation analysis was conducted to test potential mediating roles of exposures to COVID-19 risks, preexisting health status, and socioeconomic resources in accounting for racial-ethnic differences in COVID-19 concerns.

RESULTS

Non-Hispanic Black and Hispanic Americans showed significantly greater concerns about the COVID-19 pandemic than non-Hispanic White Americans. Racial-ethnic minority older adults also had higher proportions of knowing someone who had contracted or died from COVID-19 than White older adults. Unequal exposures to COVID-19 risks by race-ethnicity and, to a lesser degree, preexisting health inequalities accounted for only part of the racial-ethnic differences in COVID-19 concerns.

DISCUSSION

Our findings call for more research and policy interventions to lessen the disproportionate burden of COVID-19 experienced by older adults of racial-ethnic minority groups.

What kinds of social networks protect older adults' health during a pandemic? The tradeoff between preventing infection and promoting mental health

When the coronavirus emerged in early 2020, older adults were at heightened risk of contracting the virus, and of suffering mental health consequences from the pandemic and from the precautions designed to mitigate it. In this paper, we examine how social networks prior to the pandemic helped to shape health beliefs, behaviors, and outcomes among older adults during its onset, focusing on (1) perceived risk of COVID-19, (2) preventative health behaviors, and (3) mental health, including loneliness, perceived stress, depression, and anxiety. Drawing on the longitudinal Social Networks in Alzheimer Disease study, we find that networks high in bridging social capital predict greater perceived risk and more precautions taken, but worse mental health. In contrast, networks high in bonding social capital predict less perceived risk and fewer precautions taken, but better mental health. We discuss this apparent tradeoff between physical and mental health.

A post-lockdown study of burnout risk amongst New Zealand essential workers

BACKGROUND AND RATIONALE

Job burnout is an essential topic for researchers and a pressing issue for employers and employees. However, the most popular tool has become widely critiqued, and a new measure of burnout - the Burnout Assessment Tool (BAT) - is used here. The BAT is helpful because it provides a cut-off threshold score representing high burnout risk. This study provides one of the first BAT studies post Covid-19 pandemic and focuses on comparing high burnout risk rates between essential and non-essential workers after the first lockdown in New Zealand (May 2020).

METHODS AND RESULTS

Using representative data from 955 employees across a wide range of occupations, sectors, and industries, we calculate an overall burnout risk of 11.1%, with essential workers higher (14%) than non-essential workers (9%). The odds ratios of burnout risk and having high levels of mental health complaints were 10-20 times higher for burnout risk workers. For essential workers, they were significantly higher for high job depression risk (35 times). Building on these results, to develop a deeper understanding of the factors contributing to burnout risk, we report on a qualitative analysis of comments (n = 213) provided by essential workers on their lockdown work experiences.

CONCLUSIONS

Findings provide evidence that while a range of (1) health-related concerns (i.e., increased risk of getting and spreading covid) and (2) employee- and employer-specific pressures related to challenging lockdown work practices contribute to essential worker burnout risk, an unwavering sense of pride and purpose in the value of their essential work serves to reduce this risk. We discuss the implications, highlighting the unique issues facing essential workers.

Artificial intelligence against the first wave of COVID-19: evidence from China

BACKGROUND

The COVID-19 pandemic unexpectedly broke out at the end of 2019. Due to the highly contagious, widespread, and risky nature of this disease, the pandemic prevention and control has been a tremendous challenge worldwide. One potentially powerful tool against the COVID-19 pandemic is artificial intelligence (AI). This study systematically assessed the effectiveness of AI in infection prevention and control during the first wave of COVID-19 in China.  METHODS: To better evaluate the role of AI in a pandemic emergency, we focused on the first-wave COVID-19 in the period from the early December 2019 to the end of April 2020 across 304 cities in China. We employed three sets of dependent variables to capture various dimensions of the effect of AI: (1) the time to the peak of cumulative confirmed cases, (2) the case fatality rate and whether there were severe cases, and (3) the number of local policies for work and production resumption and the time span to having the first such policy. The main explanatory variable was the local AI development measured by the number of AI patents. To fit the features of different dependent variables, we employed a variety of estimation methods, including the OLS, Tobit, Probit, and Poisson estimations. We included a large set of control variables and added interaction terms to test the mechanisms through which AI took an effect.

RESULTS

Our results showed that AI had highly significant effects on (1) screening and detecting the disease, and (2) monitoring and evaluating the epidemic evolution. Specifically, AI was useful to screen and detect the COVID-19 in cities with high cross-city mobility. Also, AI played an important role for production resumption in cities with high risk to reopen. However, there was limited evidence supporting the effectiveness of AI in the diagnosis and treatment of the disease.

CONCLUSIONS

These results suggested that AI can play an important role against the pandemic.

Predictive Factors of the Burnout Syndrome Occurrence in the Healthcare Workers During the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic is probably the most critical epidemiological situation that human civilization has faced in the last few decades. In this context, of all the professional categories involved in the management of patients with COVID-19 are the most likely to develop burnout syndrome. The main objective of this study is to analyze specific predictive factors of the occurrence and development of the burnout syndrome in the healthcare workers involved in the diagnosis and treatment of patients with COVID-19. The study focused on determining factors of the occurrence, development and maintaining the specific burnout syndrome related to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic infection. The study was conducted on a sample of 959 participants, medical personnel from all the public medical entities in Romania(including 5 hospitals): 122 male and 755 female (82 participants did not declare their gender), with a mean age of 42.29 years (SD = 9.97). The sample included 219 doctors, 477 nurses, 214 auxiliary medical personnel and 49 other types of hospital workers. A cross-sectional design was used. Three predictors of the burnout syndrome were identified: Work conditions, Fear of the consequences (including death) determined by the COVID-19 and Need for emotional support. Meaning of work had a moderating role. Several moderated mediation models were tested. The indirect relationship of Work conditions with burnout via Fear of infection was statistically significant; in addition, the indirect effect of Work conditions on burnout through both fear of infection and need for support was statistically significant. The moderation analysis showed that Meaning of work buffer the relationship between Work conditions and Fear of infection. The variance explained by the model including the moderator (30%) was higher than the variance explained by Model 1 (27%), showing that adding the moderating effect of Meaning of work to the relationship of Work conditions with burnout was relevant. The results could be used to design specific interventions to reduce the occurrence of the burnout syndrome in healthcare workers, the implementation of a strategy to motivate employees by highlighting and recognizing the high significance of the work of those in the frontline of the fight against COVID-19.

How Can We Increase Pro-environmental Behavior During COVID-19 Pandemic? Focusing on the Altruistic (vs. Egoistic) Concerns

Would the life-threatening pandemic impact pro-environmental behavior? This study demonstrates the effects of coronavirus disease 2019 (COVID-19) on pro-environmental product consumption. Two experimental studies manipulated individuals' COVID-19 concerns and the presence/absence of pro-environmental prompts. In study 1, we found that consumers indicated lower purchase intention for a product with the environmental prompts when recalling COVID-19 concerns compared to normal situations. In study 2, we disentangled egoistic COVID-19 concerns (e.g., concerns about disadvantages to individuals' work and finances) from altruistic COVID-19 concerns (e.g., concerns about damage to the country's economy) and investigated the effects of both these concerns on pro-environmental product consumption. The results of study 2 revealed that consumers reported an increased purchase intention toward the e-prompt products, which manipulated altruistic COVID-19 concerns. However, the presence/absence of e-prompt products did not affect consumers' purchase intentions when recalling egoistic COVID-19 concerns. Concerns regarding environmental, social, and corporate governance (ESG) issues mediated the interaction effect between the type of COVID-19 concerns and the presence/absence of e-prompts for the products.

Intersecting Stigma and HIV/AIDS Community Participation Among Young Chinese Men Who Have Sex with Men Living with HIV

Community participation is vital for the recovery and empowerment of men who have sex with men (MSM) living with HIV. Intersectionality also provides an important lens that inequalities operate in an intersectional manner and pose compound challenges to the lives of minority individuals. However, the association between intersecting stigma toward HIV-positive MSM and their community participation is underexplored. The study drew on a sample of young Chinese MSM living with HIV from a community-based online survey that recruited respondents using nonprobability purposive sampling (n = 1004). Structural equation modeling was performed to investigate the associations among perceived stigma against sexual minorities and people living with HIV, HIV-related self-stigma, and HIV/AIDS community participation. The indirect effect of self-stigma and the statistical interaction between perceived homosexual stigma and perceived HIV-related stigma were further examined. Results show that total direct effect was significant [B (SE) = 0.859 (0.233); confidence interval (95% CI) = 0.402-1.316]. Perceived HIV-related stigma was positively correlated with HIV/AIDS community participation, while HIV-related self-stigma was negatively correlated. The mediating role of HIV-related self-stigma was significant in both types of perceived stigma [total indirect effect: B (SE) = -0.935 (0.175); 95% CI = -1.277 to -0.593]. The interaction effect was also significant and negative [B (SE) = -0.117 (0.056), p < 0.001], showing that perceived homosexual stigma could offset the effect of perceived HIV-related stigma on HIV-related self-stigma. The findings illustrate how intersecting stigma is involved in HIV-related self-stigma and community participation and highlight the importance of applying an intersectionality perspective to investigate stigma toward MSM living with HIV and their community participation.

Stress and Turnover Intentions Within Healthcare Teams: The Mediating Role of Psychological Safety, and the Moderating Effect of COVID-19 Worry and Supervisor Support

Employees at healthcare organizations are experiencing more stress than ever given the current COVID-19 pandemic. Different types of stress are affecting diverse organizational outcomes, including the employees' voluntary turnover. This is the case of cognitive stress, a type of stress that affects how individuals process information, which can influence employees' turnover intentions. In this study, we look at the mechanisms that can reduce the adverse effects of cognitive stress on turnover intentions, particularly the role of employees' perceived psychological safety (i.e., how safe they perceive the interactions with their colleagues are). We hypothesize that psychological safety mediates the relationship between cognitive stress and turnover intentions, and COVID-19 worry and supervisor support moderate the relationship between cognitive stress and psychological safety. To test our hypothesis, we invited two public health care organizations in Chile to join this study. In total, we obtained a sample of 146 employees in 21 different teams. Using a multilevel model, we found that psychological safety prevents the harmful effects of cognitive stress on employees' turnover intentions. In addition, while COVID-19 worry can worsen the relationship between cognitive stress and psychological safety, supervisor support only directly affects psychological safety. This study contributes to expanding the stress and psychological safety literature and informs practitioners in healthcare organizations about how to deal with cognitive stress in the "new normality" that the pandemic has brought.

How Does Social Class Affect Need for Structure during the COVID-19 Pandemic? A Moderated Mediating Model Analysis

The COVID-19 pandemic is profoundly affecting the minds and behaviors of people worldwide. This study investigated the differences in the need for structure among people from different social classes and the psychological mechanisms underlying this need, as well as the moderating effect of the threat posed by the pandemic. Using data collected from non-student adults in China, we found that the lower an individual's social class, the lower their need for structure, and this effect was based on the mediating role of perceived control. However, the mediating effect was moderated by pandemic threat, and the above relationship existed only when this threat was low. When the level of pandemic threat was higher, neither the effect of social class nor of perceived control on the need for structure were significant. Specifically, in higher-threat situations, the need for structure among individuals from higher social classes and who had a higher sense of control increased significantly, meaning the mediating effect was no longer significant. This finding showed that under the threat of a pandemic, individuals who have a lower need for structure will still pursue and prefer structure and order. The theoretical and practical implications of the research are also discussed.

Do government responses impact the relationship between age, gender and psychological distress during the COVID-19 pandemic? A comparison across 27 European countries

RATIONALE

Governments around the world have developed a range of responses to deal with the COVID-19 pandemic, including containment and closure, health system and economic policies. Despite their ubiquity, little is known regarding how government policies interact with age and gender to predict individual-level psychological outcomes.

OBJECTIVE

This study examines how three types of national-level government responses to the COVID-19 pandemic moderate the relationship between age and psychological distress as well as gender and psychological distress.

METHOD

We use a multilevel model to assess how government policies moderate the relationship between age as well as gender and psychological distress. Individual-level data are based on the SHARE COVID-19 Survey (n = 51,467 from 27 countries). Government policies are assessed using data from the Oxford COVID-19 Government Response Tracker.

RESULTS

Results show that containment and closure policies increase psychological distress more for women compared to men. Health system policies increase psychological distress more for women compared to men and more for older individuals compared to younger individuals. Economic policies do not interact with age or gender to predict psychological distress.

CONCLUSIONS

While containment and closure policies and health system policies interact with age and gender to predict psychological distress, their overall effect is comparably modest.

Exploring the Longitudinal Relationship Between Lockdown Policy Stringency and Public Negative Emotions Among 120 Countries During the COVID-19 Pandemic: Mediating Role of Population Mobility

BACKGROUND

To limit the spread of COVID-19, governments worldwide have implemented a series of lockdown policies to restrict the social activities of people. Although scholars suggest that such policies may produce negative effects on public emotions, the existing research is limited because it only provides a cross-sectional snapshot of the effect of lockdown policies in small and local samples. Using large-scale longitudinal cross-country data, the current study aims to gain a better understanding of the dynamic effect of lockdown policies on public emotions and their underlying mechanisms.

METHODS

Drawing on a large-scale longitudinal data from multiple sources, the study employs fixed-effects models to analyze the association between lagged lockdown policy stringency and public negative emotions among 120 countries from February to July 2020 (N = 9,141 country-day observations). The bootstrapping mediation test is used to examine the mediation effects of increased population mobility in residential areas.

RESULTS

The results show a statistically significant and positive association between lagged lockdown policy stringency and general public negative emotion (standardized coefficient = 0.32, CI = 0.30-0.35, p < 0.001). This pattern remains similar to other specific negative emotions, such as depression, anxiety, hopelessness, and helplessness. Moreover, the negative health effects of lockdown policy stringency are significantly mediated by increased mobility in residential areas (51-74% points, p < 0.001).

CONCLUSION

The findings confirm that stringent lockdown policies have a negative effect on public emotions via confining population mobility residential areas. To tackle the COVID-19, future public health policies should pay more attention to the unintended negative consequences of lockdown measures on public emotions.

Impact of the COVID-19 pandemic on daily life and worry among mothers in Bhaktapur, Nepal

The COVID-19 pandemic has affected many aspects of daily life worldwide, but the impact may be higher for impoverished populations. The main aim of this study is to describe the impact of the COVID-19 pandemic on different aspects of daily life in mothers in Nepal. We included 493 mothers of children aged 54-71 months participating in a randomized controlled trial on vitamin B12 supplementation. Mothers answered questions regarding the exposure and impact of the pandemic on their daily lives, and pandemic-related worries and sleep problems. We examined the extent to which worry, and sleep problems differed between mothers according to their exposure to COVID-19, socioeconomic status, and previous symptoms of depression. The mean age (SD) of the mothers was 32.3 (4.6) years and 54% had education below the secondary level. Of the mothers, 5.4% had either been exposed to someone who had tested positive or who had a family member with COVID-19. One-third of the participants responded that the pandemic had affected their economic situation, employment, and family life to a great deal. Both mothers and fathers with educational levels above 10 years or households with higher socioeconomic status had significantly higher average worry scores (maternal p = 0.020 and paternal p = 0.005). Mothers with a history of symptoms of depression had significantly more worry-related sleep problems during the pandemic (p = 0.020) than those without a history of depressive symptoms. Our study underlines the negative impact of the COVID-19 pandemic on diverse aspects of everyday life of mothers in Nepal.

Socioeconomic inequality in mental well-being associated with COVID-19 containment measures in a low-incidence Asian globalized city

The COVID-19 pandemic exposes and amplifies pre-existing inequalities even in places with relatively well-controlled outbreaks such as Hong Kong. This study aimed to explore whether the socioeconomically disadvantaged fare worse via various types of worry in terms of their mental health and well-being. Between September and October 2020, 1067 adults in Hong Kong were recruited via a cross-sectional population-wide telephone survey. The inter-relationship between deprivation, types of worry, mental health disorders, and subjective well-being was assessed using structural equation modelling. Results showed significant total effects of deprivation on worries about being infected (p = 0.002), economic activities and livelihood (p < 0.001), and personal savings (p < 0.001), as well as mental health disorders (p < 0.001) and subjective well-being (p < 0.001). Specifically, worry about economic activities and livelihood partly mediated the total effect of deprivation on mental health disorders (p = 0.004), whereas worry about personal savings and worry about economic activities and livelihood partially mediated the total effect of deprivation on subjective well-being (p = 0.007 and 0.002, respectively). Socioeconomic inequality, particularly in mental health and well-being, could be exacerbated via people's economic concerns during the pandemic, which was largely induced by the COVID-19 containment measures rather than the pandemic per se given the relatively low COVID-19 incidence in Hong Kong.

Sustained Effects of Government Response on the COVID-19 Infection Rate in China: A Multiple Mediation Analysis

Many scholars have considered the relationship between the government response to COVID-19, an important social intervention strategy, and the COVID-19 infection rate. However, few have examined the sustained impact of an early government response on the COVID-19 infection rate. The current paper fills this gap by investigating a national survey performed in February 2020 and infection data from Chinese cities surveyed 1.5 years after the outbreak of COVID-19. The results suggest that the Chinese government's early response to COVID-19 significantly and sustainedly reduced China's COVID-19 infection rate, and that this impact worked through risk perception, the adoption of protective action recommendations (PARs), and the chain-mediating effects of risk perception and the adoption of PARs, respectively. These findings have important practical value. In demonstrating how government response and infection rate at the macro level are connected to the behaviour of individuals at the micro level, they suggest feasible directions for curbing the spread of diseases such as COVID-19. When facing such public health emergencies, the focus should be on increasing the public's risk perception and adoption of PARs.

Daily fluctuations in occupation with and worry about COVID-19

In the first week after the first COVID-19 patient was reported in the Netherlands, we conducted a pre-registered momentary assessment study (7 surveys per day, 50 participants, 7 days) to study the dynamic relationship between individuals' occupation with and worries about COVID-19 in daily life, and the moderating role of neuroticism in this relationship. At the group level, higher scores on occupation and worry co-occurred, and occupation predicted worry 1 h later, but not vice versa. There were substantial individual differences in the magnitudes and directions of the effects. For instance, occupation with COVID-19 was related to increases in worry for some but decreases in worry for others. Neuroticism did not predict any of these individual differences in the links between worry and occupation. This study suggests that it is important to go beyond group-level analyses and to account for individual differences in responses to COVID-19.

Behavioral Correlates of COVID-19 Worry: Stigma, Knowledge, and News Source

Non-adherence to COVID-19 guidelines may be attributable to low levels of worry. This study assessed whether endorsing COVID-19-stigmatizing restrictions, COVID-19 knowledge, and preferred news source were associated with being 'very worried' versus 'not at all' or 'somewhat' worried about contracting COVID-19. Survey data were collected in July-August 2020 from N = 547 New York State (NYS) and N = 504 national Amazon MTurk workers. Respondents who endorsed COVID-19 stigmatizing restrictions (NYS OR 1.96; 95% CI 1.31, 2.92; national OR 1.80; 95% CI 1.06, 3.08) and consumed commercial news (NYS OR 1.89; 95% CI 1.21, 2.96; national OR 1.93; 95% CI 1.24, 3.00) were more likely to be very worried. National respondents who consumed The New York Times (OR 1.52; 95% CI 1.00, 2.29) were more likely to be very worried, while those with little knowledge (OR 0.24; 95% CI 0.13, 0.43) were less likely to be very worried. NYS (OR 2.66; 95% CI 1.77, 4.00) and national (OR 3.17; 95% CI 1.95, 5.16) respondents with probable depression were also more likely to be very worried. These characteristics can help identify those requiring intervention to maximize perceived threat to COVID-19 and encourage uptake of protective behaviors while protecting psychological wellbeing.