The emergence of the novel H1N1 virus: implications for global mental health

"The emotions were like a roller-coaster": a qualitative analysis of e-diary data on healthcare worker resilience and adaptation during the COVID-19 outbreak in Singapore

BACKGROUND

Uncertainties related to COVID-19 have strained the mental health of healthcare workers (HCWs) worldwide. Gaining the ability to adapt and thrive under pressure will be key to addressing this. We explore what characterises risk, vulnerability and resilient responses of HCWs during the early stages of the outbreak in Singapore.

METHODS

We undertook qualitative theory-guided thematic analysis of e-diary entries from HCWs who navigated the outbreak from June-August 2020. Data were extracted from a subset of an online survey of n = 3616 participants collected across 9 institutions, including restructured hospitals, hospices and affiliated primary care partners.

RESULTS

N = 663 or 18% submitted qualitative journal entries included for analyses. All professional cadres, local as well as foreign HCWs participated. Themes are reported according to the Loads-Levers-Lifts model of resilience and highlighted in italics. The model assumes that resilience is a dynamic process. Key factors threatening mental health (loading) risk included a notable rise in anxiety, the effects of being separated from loved ones, and experiencing heightened emotions and emotional overload. Bad situations were made worse, prompting vulnerable outcomes when HCWs experienced stigma in the community and effects of "public paranoia"; or under conditions where HCWs ended up feeling like a prisoner with little control or choice when either confined to staff accommodation or placed on quarantine/Stay Home Notices. Those with strife in their place of residence also described already difficult situations at work being aggravated by home life. Protection (lifts) came from being able to muster a sense of optimism about the future or feeling grateful for the pace of life slowing down and having the space to reprioritise. In contrast, when risk factors were present, balancing these in the direction of resilient outcomes was achieved by choosing to re-direct stress into positive narratives, drawing on inner agency, uptake of therapeutic activities, social support as well as faith and prayer and drawing comfort from religious community among other factors.

CONCLUSION

The Loads-Levers-Lifts model is used to guide analysis to inform intervention designs. Levers promoting resilience through targeting therapies, workplace policies and awareness campaigns accounting for identified loads are proposed.

Who Is at Risk of Poor Mental Health Following Coronavirus Disease-19 Outpatient Management?

Background

Coronavirus Disease-19 (COVID-19) convalescents are at risk of developing a de novo mental health disorder or worsening of a pre-existing one. COVID-19 outpatients have been less well characterized than their hospitalized counterparts. The objectives of our study were to identify indicators for poor mental health following COVID-19 outpatient management and to identify high-risk individuals.

Methods

We conducted a binational online survey study with adult non-hospitalized COVID-19 convalescents (Austria/AT: n = 1,157, Italy/IT: n = 893). Primary endpoints were positive screening for depression and anxiety (Patient Health Questionnaire; PHQ-4) and self-perceived overall mental health (OMH) and quality of life (QoL) rated with 4 point Likert scales. Psychosocial stress was surveyed with a modified PHQ stress module. Associations of the mental health and QoL with socio-demographic, COVID-19 course, and recovery variables were assessed by multi-parameter Random Forest and Poisson modeling. Mental health risk subsets were defined by self-organizing maps (SOMs) and hierarchical clustering algorithms. The survey analyses are publicly available (https://im2-ibk.shinyapps.io/mental_health_dashboard/).

Results

Depression and/or anxiety before infection was reported by 4.6% (IT)/6% (AT) of participants. At a median of 79 days (AT)/96 days (IT) post-COVID-19 onset, 12.4% (AT)/19.3% (IT) of subjects were screened positive for anxiety and 17.3% (AT)/23.2% (IT) for depression. Over one-fifth of the respondents rated their OMH (AT: 21.8%, IT: 24.1%) or QoL (AT: 20.3%, IT: 25.9%) as fair or poor. Psychosocial stress, physical performance loss, high numbers of acute and sub-acute COVID-19 complaints, and the presence of acute and sub-acute neurocognitive symptoms (impaired concentration, confusion, and forgetfulness) were the strongest correlates of deteriorating mental health and poor QoL. In clustering analysis, these variables defined subsets with a particularly high propensity of post-COVID-19 mental health impairment and decreased QoL. Pre-existing depression or anxiety (DA) was associated with an increased symptom burden during acute COVID-19 and recovery.

Conclusion

Our study revealed a bidirectional relationship between COVID-19 symptoms and mental health. We put forward specific acute symptoms of the disease as "red flags" of mental health deterioration, which should prompt general practitioners to identify non-hospitalized COVID-19 patients who may benefit from early psychological and psychiatric intervention.

Clinical Trial Registration

[ClinicalTrials.gov], identifier [NCT04661462].

COVID-19: the perfect vector for a mental health epidemic

In times of crisis, people have historically had to band together to overcome. What happens when they cannot? This article examines the reality of people forced to isolate from one another during one of the most turbulent events of their lives: the COVID-19 pandemic. Connecting the dots of topics including fear, social stigmas, global public response and previous disease outbreaks, this article discusses the negative mental health effects that individuals and communities will likely suffer as the result of social distancing, isolation and physical infection.

The influence and enlightenment of five public health emergencies on public psychology since new century: A systematic review

BACKGROUND

Since the 21st century, humans have experienced five public health emergencies: the severe acute respiratory syndrome (SARS), type A H1N1 influenza (H1N1), Middle East respiratory syndrome (MERS), Ebola virus disease (EVD), and the new coronavirus pneumonia (COVID-19). They caused a large number of casualties and a wider psychological crisis, which might cause severe consequences such as post-traumatic stress disorder and suicide.

AIMS

To reveal the law of formation of public psychological crisis in public health emergencies, and draw lessons from it. To provide ideas for effectively deal with these psychological crisis problems and fundamentally curbing the occurrence of public health emergencies.

METHOD

Through the method of literature research, 'public health incidents', 'psychological crisis', 'mental health', 'psychological intervention', 'SARS', 'H1N1', 'MERS', 'EVD', and 'COVID-19' were used to search literatures in the databases such as PubMed, Springer, and Sciencedirect, and the literatures were summarized, sorted, and studied.

RESULTS

(1) The public health emergencies caused a universal psychological crisis. The main manifestations were depression, compulsion, despair, etc. The people involved mainly include patients, suspected isolated patients, medical staff, and the general public in the epidemic situation. (2) People's psychological state often experienced stress stage, shock stage, acceptance, and reorganization. Only some susceptible individuals couldn't complete effective psychological reconstruction, resulting in serious psychological disorders. Individual susceptibility is related to genetic factors, adversity, and traumatic stimuli experienced in early life.

CONCLUSION

To reduce these psychological crisis problems, we should establish and improve the psychological crisis intervention or rescue system of public health emergencies, it was still necessary to live in harmony with nature, get rid of the inappropriate habit of preying on wild animals, in order to prevent the cross-species transmission of the virus between wild animals and humans, and to fundamentally avoid the occurrence of major infectious diseases.

The impact of viral epidemics and pandemics on acute mental health service use: an integrative review

The aim of this integrative review was to examine the impact of past viral epidemics on mental health, with a specific focus on changes in numbers of acute mental health presentations and mental health service recommendations in response to this, in the context of the COVID-19 pandemic. Following PRISMA methodology, databases were searched for relevant publications. A total of 83 articles with a range of methodologies were included to ensure broad coverage of this rapidly emerging research area. The literature supports an initial increase in mental health concerns which generally do not reach the threshold for diagnosis with a mental illness, but present to frontline telephone services. There is a potential delay before community and hospital-based mental health services see an increase in new or relapsing mental illness presentations. However vulnerable populations, such as people with pre-existing mental illness, are at increased risk of mental health issues during such public health crises. Many of the general recommendations distilled from the literature are closely aligned with existing strategic frameworks for mental health service provision. However, in review of these frameworks, gaps in the literature become more apparent, such as a failure to include people with lived experience, peer workers, and First Nations People in the COVID-19 mental health response.

Use of EMDR-Derived Self-Help Intervention in Children in the Period of COVID-19: A Randomized-Controlled Study

Self-help treatments are an important intervention tool, with high accessibility and ease of application. To our knowledge, no research has previously been conducted on any self-help intervention derived from eye movement desensitization and reprocessing (EMDR) therapy. In this study, we evaluated the mental health status of children not directly affected by the pandemic and investigated the effects of using an EMDR-derived self-help intervention in children as a low-intensity treatment. The mental health status of 178 children was evaluated online via the State-Trait Anxiety Inventory for Children (STAIC) and Childhood Posttraumatic Stress Reaction Index (CPTS-RI). Then, children were randomly assigned to intervention and waitlist. A booklet containing EMDR-derived techniques was sent via the school online portal and the intervention was conducted. Posttests were administered 4 weeks later. The attrition rate was 45.5%, with 97 children completing the trial (intervention: 52; waitlist: 45). At baseline, 76.4% of children showed posttraumatic stress symptoms (PTSS) above threshold. Results showed a statistically significant decrease in the posttest PTSS scores for the intervention group compared to waitlist. The intervention group had significant pre–post improvement on all but one subscale, while the waitlist group showed a significant increase in state anxiety on the STAIC. In conclusion, posttraumatic stress was found to be high in children during the COVID-19 outbreak period, and EMDR-derived self-help intervention appeared to be an effective psychosocial intervention tool.