Psychiatric symptoms and behavioral adjustment during the COVID-19 pandemic: evidence from two population-representative cohorts

Temporal dynamics of socioeconomic inequalities in depressive and anxiety symptoms during the COVID-19 pandemic: a scoping review

Background

The existence of socioeconomic inequalities in the prevalence of symptoms of depression and anxiety is widely acknowledged, and individuals from lower socioeconomic backgrounds tend to exhibit higher rates of symptoms. However, the direction in which the COVID-19 pandemic has influenced these disparities remains uncertain. We therefore aimed to systematically outline the available evidence on the temporal dynamics of socioeconomic inequalities in symptoms related to depression and anxiety during the COVID-19 pandemic across high-income countries.

Methods

A scoping review was conducted by searching the databases Embase, Scopus and PsycINFO. According to pre-defined eligibility criteria, two reviewers independently screened titles and abstracts as well as full texts of the compiled records. Data from the included studies were extracted using a standardised data-extraction form and analysed numerically and narratively. The scoping review followed the PRISMA-ScR guidelines.

Results

A total of 49 studies comprising 149 analyses of socioeconomic indicators in relation to symptoms of depression and anxiety were included. Despite heterogeneous study designs and results, there was a tendency of increasing (40.9%; n = 61) or persistent (38.2%; n = 57) inequality trends to the detriment of those in socially more disadvantaged positions. Increasing inequalities were most pronounced when income was used as a socioeconomic indicator. Groups with lower socioeconomic status appeared most vulnerable in the initial phase of the COVID-19 pandemic. Throughout the pandemic, dynamics were diverse, with persistent trends most frequently reported.

Conclusion

Overall, to the detriment of those with lower socioeconomic status, mental-health inequalities persisted or increased in most analyses. Continually monitoring socioeconomic inequalities over time is crucial, since this makes it possible to adapt prevention and intervention strategies to specific pandemic phases. Interventions targeting job security, income security and educational attainment could reduce mental-health inequalities. The results can contribute to preparedness plans for future pandemics and crises.

Greater within- and between-day instability is associated with worse anxiety and depression symptoms

BACKGROUND

Depression and anxiety affect hundreds of millions of people worldwide, and their prevalence increased during the COVID-19 pandemic as social schedules were disrupted. This study explores the associations between anxiety and depression and within- and between-day instability of affective, somatic, and cognitive symptoms during the early pandemic stages.

METHODS

Participants (n = 153, ages 18-77, 72 % female) reported daily levels of affective (anxiety/sadness), somatic (appetite/sleepiness), and cognitive (concentration/energy) symptoms for 14-44 days at five timepoints: 0, 3, 6, 9, and 12 h after awakening. At the end of the study, participants completed validated scales for anxiety (GAD-7) and depression (PHQ-9). Symptom instability was assessed using the Absolute Real Variability (ARV) index. Regression models examined within-day instability (WD-I) and between-day instability (BD-I) with GAD-7 and PHQ-9 scores as outcomes.

RESULTS

Greater instability (both WD-I and BD-I) of affective symptoms correlated with elevated GAD-7 and PHQ-9 scores. For somatic and cognitive symptoms, greater BD-I was associated with higher scores.

LIMITATIONS

The study used retrospective daily data, which could benefit from real-time assessments for improved accuracy.

CONCLUSIONS

This study provides empirical evidence of a connection between greater anxiety and depression severity and increased instability in daily mood and physiological symptoms. The findings underscore the importance of consistent symptom monitoring to understand overall mental health trajectories. Additionally, it highlights the role of daily routines in stabilizing the circadian system, potentially regulating physiological and psychological processes and reducing symptom instability.

A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain

BACKGROUND

Covid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)-a multifaceted construct that measures a person's socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders.

METHODS

Following PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into 'actual versus perceived' and 'static versus fluid' classes to explore their differential effects on emotional health.

RESULTS

Out of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed 'expected' results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst.

CONCLUSIONS

This review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.

Routine regularity during a global pandemic: Impact on mental health outcomes and influence of chronotype

Among the public health recommendations for supporting mental health during the COVID-19 pandemic, many strategies had an impact on biological rhythms, like sleep hygiene, physical exercise and healthy eating habits. Considering the known relationship between circadian organization and mental health, our aim was to test the association between behavioral regularity and mental health, and its interaction with chronotype, in a large sample surveyed in Brazil. We collected longitudinal data using online questionnaires that assessed sociodemographic characteristics, behavioral routines, mental health (PHQ-9, GAD-7, WHO-5 scales), and chronotype estimation based on midpoint of sleep on free days - MSF (μMCTQ), in a sample of 1390 participants (81% females). We computed a Routine Regularity Score (RRS) that reflects regularity across four behaviors: sleep, eating, working, exercising. There was a strong negative association between RRS and the severity of anxiety and depressive symptoms (GAD-7 and PHQ-9 scores), which was weaker among participants with late MSF, and a strong positive association with well-being (WHO-5 scores). RRS was a mediator of the MSF-mental health association and a predictor of mental health states. This study provides empirical evidence that maintaining behavioral routines during times of hardship may serve as tools to alleviate the negative impact on mental health.

Daily routine disruptions and psychiatric symptoms amid COVID-19: a systematic review and meta-analysis of data from 0.9 million individuals in 32 countries

BACKGROUND

There is currently a deficit of knowledge about how to define, quantify, and measure different aspects of daily routine disruptions amid large-scale disasters like COVID-19, and which psychiatric symptoms were more related to the disruptions. This study aims to conduct a systematic review and meta-analysis on the probable positive associations between daily routine disruptions and mental disorders amid the COVID-19 pandemic and factors that moderated the associations.

METHODS

PsycINFO, Web of Science, PubMed, and MEDLINE were systematically searched up to April 2023 (PROSPERO: CRD42023356846). Independent variables included regularity, change in frequency, and change in capability of different daily routines (i.e., physical activity, diet, sleep, social activities, leisure activities, work and studies, home activities, smoking, alcohol, combined multiple routines, unspecified generic routines). Dependent variables included symptoms and/or diagnoses of mental disorders (i.e., depression, anxiety, post-traumatic stress disorder, and general psychological distress).

RESULTS

Fifty-three eligible studies (51 independent samples, 910,503 respondents) were conducted in five continents. Daily routine disruptions were positively associated with depressive symptoms (r = 0.13, 95% CI = [0.06; 0.20], p < 0.001), anxiety symptoms (r = 0.12, 95% CI = [0.06; 0.17], p < 0.001), and general psychological distress (r = 0.09, 95% CI = [0.02; 0.16], p = 0.02). The routine-symptom associations were significant for physical activity, eating, sleep, and smoking (i.e., type), routines that were defined and assessed on regularity and change in capability (i.e., definition and assessment), and routines that were not internet-based. While the positive associations remained consistent across different sociodemographics, they were stronger in geo-temporal contexts with greater pandemic severity, lower governmental economic support, and when the routine-symptom link was examined prospectively.

CONCLUSIONS

This is one of the first meta-analytic evidence to show the positive association between daily routine disruptions and symptoms of mental disorders among large populations as COVID-19 dynamically unfolded across different geo-temporal contexts. Our findings highlight the priority of behavioral adjustment for enhancing population mental health in future large-scale disasters like COVID-19.

Investigating the reciprocity between cognition and behavior in adaptation to large-scale disasters

Cognition and behavior could reciprocally impact each other and together determine mental health amid large-scale disasters such as COVID-19. This study reports a six-month cohort study of a population-representative sample of Hong Kong residents (N = 906) from March-August 2021 (T1) to September 2021-February 2022 (T2). Cross-lagged panel analyses reveal that T1 poor behavioral functioning as indicated by high daily routine disruptions is inversely associated with T2 cognitive adaptation as indicated by self-efficacy and meaning-making but not vice versa. T1 routine disruptions but not cognitive adaptation are positively associated with T2 probable depression/anxiety. The positive link between T1 routine disruptions and T2 probable disorders is mediated by poor cognitive adaptation at T2. The present findings suggest that upholding daily behavioral functioning relative to positive states of mind could have a more pivotal role in mental health amid large-scale disasters. Future studies can test interventions that enhance the sustainment of regular daily routines.

Everyday life experiences for evaluating post-traumatic stress disorder symptoms

Background: Previous research has highlighted the importance of regularizing daily routines for maintaining mental health. Little is known about whether and how regularity of daily routines is associated with reduced post-traumatic stress disorder (PTSD) symptoms.Objective: We aimed to examine the associations between regularity of daily routines and PTSD symptoms in two studies (N = 796).Method: In Study 1, prospective data were analysed with the latent change score model to investigate the association between sustainment of regular daily routines and change in PTSD symptoms over time amid massive civil unrest in Hong Kong in 2019. Study 2 used vignette as a quasi-experimental method to assess the ability of maintaining regular daily routines in face of a major stressor, and tested its associations with PTSD symptoms.Results: In Study 1, increased regularity of diverse daily routines was inversely associated with increased PTSD symptoms amid the civil unrest in Hong Kong (β = -.427 to -.224, 95% confidence intervals [-.543 to -.359, -.310 to -.090], p values < .01). In Study 2, a greater ability to maintain regular daily routines during stress was associated with lower levels of PTSD symptoms (β = -.285 to -.096, 95% confidence intervals [-.379 to -.189, -.190 to -.003], p values < .05).Conclusions: Our findings suggest the benefit of considering diverse everyday activities in evaluating PTSD symptoms in both clinical and subclinical populations. Interventions with the direct focus on the role of daily living could promote psychological resilience during and after potentially traumatic events.

Poor mental health is associated with loneliness and boredom during Covid-19-related restriction periods in patients with pre-existing depression

BACKGROUND

In 2020-2021, many European countries put in place temporary lockdown measures due to the increase in COVID-19 cases, although such measures have negative psychological effects. As pre-existing mental disorders are a risk factor of negative psychological consequences during pandemics, it is important to identify specific predictors of psychological distress caused by restrictive measures in patients with history of depressive episodes. The aims of this study were i) to determine whether depressive, anxious symptomatology and suicidal ideation (i.e. mental health outcomes) were influenced by stay-at-home orders, and ii) to identify the psychosocial dimensions that influenced these mental health outcomes in patients with pre-existing depression during/after COVID-19-related restrictions.

METHODS

This study concerned 296 psychiatric patients with history of depressive episode in the 2 years before the COVID-19 outbreak. Participants received a computerized form to self-measure depression, suicidal ideation, and anxiety (5 times during 2020-2021, two lockdown periods and three non- lockdown periods). Loneliness, boredom, habits, substance consumption, and access to psychiatric care also were self-reported.

RESULTS

Loneliness and boredom were independent risk factors of anxiety and depression, and their changes dynamically affected the psychological state. Suicidal ideation was mostly driven by depressive symptomatology.

CONCLUSIONS

Our results highlight the need to target these dimensions in the most vulnerable patients in order to prevent the psychological consequences of the repeated COVID-19-related restrictions.

The Occurrence and Co-Occurrence of Harsh Parenting and Family Conflict in Hong Kong

The violation of children's right to a safe home environment is a major public health problem in need of serious attention. Evidence has been limited about the family characteristics that go with the co-occurrence of harsh parenting and family conflict. By using a representative community sample of Hong Kong families, this study aims to examine the prevalence and risk factors of harsh parenting and family conflict. This study was conducted using a secondary analysis obtained from the 2017 Hong Kong Family Survey with a sample size of 1926 respondents who have children. Results showed that participants' ages are negatively related to the occurrence and co-occurrence of harsh parenting and/or family conflict. Married mothers reported less family conflict. Fathers with lower education levels reported more experiences of family violence. Mothers reporting a higher level of family satisfaction were less associated with harsh parenting. This study provides insights into the unique and shared familial elements that prevent harsh parenting and family conflict and help facilitate the development of effective intervention strategies for family violence co-occurrence. Family-based prevention for family violence may screen for the presence of harsh parenting and family conflict and take into consideration these signals to better support families in need.

Prevalence of anxiety during the COVID-19 pandemic: A systematic review and meta-analysis of over 2 million people

INTRODUCTION

Uncertainty, disruptions in daily routines, and concerns for the health and well-being during the COVID-19 pandemic are likely associated with increases in generalized anxiety. The present study aimed to systematically review the literature in order to identify the update prevalence of anxiety in the general population during the COVID-19 pandemic.

METHODS

A systematic review and meta-analysis. It included studies that assessed the prevalence of anxiety among the general population during the COVID-19 pandemic.

RESULTS

In total, we included 194 studies. The general prevalence of anxiety was 35.1 %, affecting approximately 851,000 participants. The prevalence in low and middle-income countries (35.1 %; 95%CI: 29.5 % to 41.0 %) was similar compared to high-income countries (34.7 %; 95%CI: 29.6 % to 40.1 %). In studies that provided the proportion of cases in each level of anxiety disorder, mild-to-moderate anxiety affected one quarter of the participants. One in ten cases with anxiety during the COVID-19 may be living with severe or extremely anxiety disorder. Most instruments estimated similar prevalence of anxiety disorders with notable difference in the prevalence estimated by the Generalized Anxiety Disorder 2-item (GAD-2), Zung Self-Rating Anxiety Scale (SAS), and State-Trait Anxiety Inventory (STAI).

CONCLUSION

One in three adults were living with anxiety disorder during the COVID-19 pandemic worldwide.

Low assets predict persistent depression through living difficulties amid large-scale disasters: A cohort study

BACKGROUND

In face of large-scale disasters, persons with fewer assets are at greater risk of persistent poorer mental health than persons with more assets. Everyday daily routine disruptions and financial hardship could mediate this association.

METHODS

This prospective population-representative study in Hong Kong aimed to investigate the relation between assets during the acute phase of COVID-19 (February-August 2020, T1) and persistent probable depression from T1 to March-August 2021 (T2), as well as the mediating effects of daily routine disruptions and financial hardship on the assets-depression association.

RESULTS

Low assets at T1 prospectively related to persistent probable depression from T1 to T2. Primary routine disruptions (i.e., healthy eating and sleep) at T1 and financial hardship at T2 were found to fully mediate the association between T1 assets and persistent probable depression.

LIMITATIONS

Persistent probable depression reported on the PHQ-9 should be further verified with clinical diagnoses/interviews.

CONCLUSIONS

The COVID-19 pandemic was accompanied by a global economic downturn. Persons who have fewer assets could be at greater risk of depression during this period. Our findings suggest a need to provide behavioral and financial assistance to persons with fewer assets in the short run and a need to ensure that everyone has adequate assets to mitigate the mental health consequences of the COVID-19 pandemic in the long run.

Disrupted daily routines mediate the socioeconomic gradient of depression amid public health crises: A repeated cross-sectional study

OBJECTIVE

There is a socioeconomic gradient to depression risks, with more pronounced inequality amid macroenvironmental potential traumatic events. Between mid-2019 and mid-2020, the Hong Kong population experienced drastic societal changes, including the escalating civil unrest and the COVID-19 pandemic. We examined the change of the socioeconomic gradient in depression and the potential intermediary role of daily routine disruptions.

METHOD

We conducted repeated territory-wide telephone surveys in July 2019 and July 2020 with 1112 and 2034 population-representative Cantonese-speaking Hong Kong citizens above 15 years old, respectively. Stratified by year, we examined the association between socioeconomic indicators (education attainment, household income, employment status and marital status) and probable depression (nine-item Patient Health Questionnaire [PHQ-9] ⩾ 10) using logistic regression. Differences in the socioeconomic gradient between 2019 and 2020 were tested. Finally, we performed a path analysis to test for the mediating role of daily routine disruptions.

RESULTS

Logistic regression showed that higher education attainment in 2019 and being married in 2020 were protective against probable depression. Interaction analysis showed that the inverse association of higher education attainment with probable depression attenuated in 2020 but that of being married increased. Path analysis showed that the mediated effects through daily routine disruptions accounted for 95.9% of the socioeconomic gradient of probable depression in 2020, compared with 13.1% in 2019.

CONCLUSION

From July 2019 to July 2020, the mediating role of daily routine disruptions in the socioeconomic gradient of depression in Hong Kong increased. It is thus implied that infection control measures should consider the relevant potential mental health impacts accordingly.

Coping resources mediate the prospective associations between disrupted daily routines and persistent psychiatric symptoms: A population-based cohort study

This study examined the mediating effects of coping resources in the prospective associations between daily routine disruptions in the acute phase of COVID-19 and persistent probable anxiety and depression. A prospective, population-representative cohort of 1318 Hong Kong Chinese respondents completed a baseline survey between February and July 2020 (T1) and a 1-year follow-up survey between March and August 2021 (T2). Respondents reported demographics and disruptions to primary and secondary daily routines at T1, coping resources (i.e., self-efficacy and meaning making) at T2, and anxiety and depressive symptoms at T1 and T2. We found that 8.1% and 10.0% of respondents reached cutoff scores for probable anxiety and depression respectively at both T1 and T2. Logistic regression showed that T1 daily routine disruptions were positively associated with heightened risk of persistent probable anxiety and depression amid COVID-19. Path analysis showed that 15.3% and 13.1% of the associations of daily routine disruptions with persistent probable anxiety and depression were explained by coping resources, respectively, while the direct routine-outcome associations remained significant. Daily routine disruptions predict higher odds of persistent probable anxiety and depression directly and partially through reducing coping resources. Sustainment of regular daily routines should be advocated and fostered to enhance coping resources and reduce the risk of poorer adjustment among the affected populations amid public health crises.

Second Wave of COVID-19 Pandemic in Argentinian Population: Vaccination Is Associated With a Decrease in Depressive Symptoms

Background

Since the irruption of the coronavirus disease 2019 (COVID-19) the planet has submerged in a time of concern and uncertainty, with a direct impact on people's mental health. Moreover, the recurrent outbreaks that periodically harry different regions of the world constantly refocus people's concerns to the pandemic. Yet, each new wave heats the diverse countries in different situations, including the advances in their vaccination campaigns. In this research, we studied the levels of the general anxiety disorder (GAD) and depression in the Argentine population across the first and second waves of infections that occurred in our country.

Methods

We conducted an on-line survey, within each peak of the pandemic. People were asked to self-report GAD and depression symptoms using the GAD-7 and PHQ-9 questioners, inform their vaccination status, the frequency they performed physical activity as well as working condition and modality. Here, we identified the more vulnerable groups and evaluated factors that could mitigate the rise of these mental disorders, focusing on vaccination.

Results

Our data shows that reported GAD and depression levels were higher during the second wave than during the first one. More importantly, vaccinated people were less depressed than non-vaccinated people, while GAD levels remained equivalent in both groups. Other factors directly associated with lower GAD and depression levels were performing frequent physical activity and being employed, regardless of the employment modality. These observations were replicated in different age ranges and genders.

Conclusion

This work evidences GAD and depression in different pandemic waves in Argentina, as well the factors that may contribute to reducing the magnitude of these disorders, including vaccination.

Prevalence and determinants of probable depression and anxiety during the COVID-19 pandemic in seven countries: Longitudinal evidence from the European COvid Survey (ECOS)

BACKGROUND

Our aim was to present data on the prevalence of probable depression and anxiety and to determine their correlates during the COVID-19 pandemic in seven European countries using a longitudinal approach.

METHODS

Longitudinal data (wave 4 in November 2020: n = 7,115; wave 5 in January 2021: n = 7,068; wave 6 in April 2021: n = 7,204) were taken from the European COvid Survey (ECOS), a representative sample of non-institutionalized inhabitants from Germany, United Kingdom, Denmark, Netherlands, France, Portugal and Italy aged 18+. Probable depression and anxiety were quantified using the established and validated PHQ-4 (2-item depression scale, PHQ-2 / 2-item anxiety scale, GAD-2).

RESULTS

In wave 4 (wave 5; wave 6), 26.6% (25.5%; 23.8%) of all respondents had probable depression and 25.7% (23.6%; 22.1%) had probable anxiety. Prevalence rates for probable depression and probable anxiety differed significantly between countries. Among all countries and waves, particularly high prevalence rates were found among individuals aged 18 to 29 years. Longitudinal analysis showed that the likelihood of probable depression was positively associated with increasing age, great income difficulties and lower health-related quality of life. The likelihood of probable anxiety was positively associated with income difficulties, and lower health-related quality of life.

LIMITATIONS

Screening tool was used to quantify the outcomes.

CONCLUSION

The magnitude of probable depression and anxiety during the COVID-19 pandemic in European countries was highlighted. Moreover, determining the factors associated with probable depression or anxiety (e.g., income difficulties, worse health-related quality of life) may assist in identifying individuals at increased risk.

Family socio-economic status and Chinese Preschoolers' anxious symptoms during the COVID-19 pandemic: the roles of parental investment, parenting style, home quarantine length, and regional pandemic risk

Using data from 16,161 families with target child of 3-6 years old in Hubei, China during COVID-19 pandemic, this study examined the association between family socio-economic status (SES) and preschoolers' anxious symptoms (PAS). Parental investment and parenting style were tested as mediators for this association. Home quarantine length was tested as a moderator for this direct association and for the associations between family SES and parenting processes, whereas regional pandemic risk was tested as a moderator for the entire model. Results support the utility of Family Stress and Family Investment Models in a Chinese context by identifying unique roles of parental investment and parenting style in mediating the link between family SES and PAS. Quarantine length moderated the link between family SES and authoritarian parenting: Strength of this negative association was stronger for families with longer quarantine than for those with shorter quarantine. Further, family SES was negatively associated with PAS through its negative association with authoritarian parenting, regardless of the quarantine length. Model comparison analyses between high-risk region versus low/medium-risk region groups indicated that the pandemic risk for living regions did not alter any pathway in the model. Such findings inform the designs of targeted interventions to help families cope with pandemic-related challenges. Promoting parental investment and adaptive patenting style represents an avenue to diminish consequences of family economic hardship for young children's mental health, regardless of macrolevel pandemic risk. Interventions should attend to home quarantine duration, as it contextualizes the links among family SES, parenting, and child well-being.

The impact of COVID-19 perceived threat and restrictive measures on mental health in Italy, Spain, New York, and Hong Kong: An international multisite study

In the early stages of the COVID-19 pandemic, Italy, Spain, New York, and Hong Kong stood out for the ir high rates of infections. Given this scenario, a web-based international multisite and cross-sectional study was conducted between April and May 2020 to investigate the psychological impact of the pandemic and the restrictions imposed by the governments in these countries. We expected similar patterns in European countries, and no significant differences in terms of psychological impairment between Hong Kong (with a previous experience related to SARS, but subjected to restrictions for a longer time) and the other areas. Participants were 1955 adults from the above-mentioned areas. We assessed anxiety (GAD-7), depression (PHQ-9), COVID-19-related threats, and perceived burden of restrictive measures. Two-explorative factor analyses (EFAs) with Promax rotation identified COVID-19-related factors: personal physical threat, personal economic threat, global economic threat, and restriction-related burden. ANOVAs studied locations' differences and two-separate hierarchical multiple regression analyses by location determined whether and how COVID-19-related variables were associated with anxiety and depression, adjusting for age and sex. Italy and Hong Kong showed higher anxiety than Spain (p < 0.05); Hong Kong scored higher on depression than Italy and Spain (p < 0.001), which highlighted the lowest mean-score. New York participants showed the poorest mental health conditions. Anxiety was predicted by restriction-related burden (β_NY = 0.242; β_HK = 0.116) and personal economic threat (β_NY = 0.246; β_HK = 0.145) in New York (Adj.R ² = 0.125) and Hong Kong (Adj.R ² = 0.079); by global economic threat (β = 0.199) and restriction-related burden (β = 0.124) in Italy (Adj.R ² = 0.108); and by personal physical threat (β = 0.144) in Spain (Adj.R ² = 0.049). Depression was predicted by restriction-related burden (β_NY = 0.313; β_HK = 0.120) and personal economic threat (β_NY = 0.229; β_HK = 0.204) in New York (Adj.R ² = 0.161) and Hong Kong (Adj.R ² = 0.089); by global economic threat (β = 0.209) in Italy (Adj.R ² = 0.149); and no predictors emerged in Spain. Findings could contribute to understanding the specific impact of the pandemic on people's psychological health in each area, along with the factors that impacted mental health. This information may be useful to implementing prevention interventions in case of restrictions.

The Prevalence and Correlates of Probable Major Depressive Disorder and Probable Generalized Anxiety Disorder during the COVID-19 Pandemic. Results of a Nationally Representative Survey in Germany

The aim was to clarify the prevalence and correlates of probable major depressive disorder and probable generalized anxiety disorder in the general adult population during the COVID-19 pandemic. Data were derived from a nationally representative survey (August and September 2021). In total, n = 3075 individuals took part. To quantify probable generalized anxiety disorder, the established Generalized Anxiety Disorder-7 (GAD-7; cutoff of 10) was used. Moreover, the Patient Health Questionnaire-9 (PHQ-9; cutoff of 10) was used to quantify probable major depressive disorder. The prevalence of probable major depressive disorder was 20.0% and the prevalence of probable generalized anxiety disorder was 13.4%. Particularly high prevalence rates were observed for younger individuals, individuals with migration background and individuals with at least one chronic disease. The likelihood of probable major depressive disorder was positively associated with younger age, being unmarried, having a migration background, smoking, daily alcohol intake, the presence of chronic diseases and lower self-rated health. Similarly, the likelihood of probable generalized anxiety disorder was positively associated with younger age, being unmarried, smoking, the presence of chronic diseases and lower self-rated health. In conclusion, the magnitude of probable major depressive disorder and probable generalized anxiety disorder in Germany in late summer of 2021 was highlighted. Identifying the correlates of them may help to tackle individuals at higher risk.

Alcohol Consumption Pre and Post COVID-19. Implications for Health, Underlying Pathologies, Risks and Its Management

Research indicates that individuals who experience increased levels of stress often report increased alcohol consumption and consequently misuse [...]

The moderated associations of self-compassion with physiological and psychological stress responses: Comparisons between cancer caregivers and non-caregivers

Self-compassion has been shown to be protective against stress. Whether its stress buffering effect differs between cancer caregivers and non-caregivers is unknown. This study examined the moderating effect of self-compassion among cancer caregivers relative to non-caregivers by recruiting cancer caregivers from the hospital and a community sample matching on sex and age. Participants completed a questionnaire which comprised the self-reported anxiety (STAI-6) and self-compassion (SCS-SF) measures, and administered cortisol sample collections with Salivette tubes at home. Whereas caregivers experienced higher diurnal cortisol level, the differential protective effects of self-compassion were only present against anxiety symptoms but not physiological stress.

Psychometric evaluation of the Adjustment Disorder New Module-20 (ADNM-20): A multi-study analysis

The Adjustment Disorder New Module (ADNM) is a self-report instrument for assessing Adjustment disorder (AjD), but uncertainties remain in evaluating factor structure and psychometric properties of ADNM in previous studies. Three studies were conducted to examine the factor structure, psychometrics properties, and clinical utility of the 20-item version of ADNM (ADNM-20) and 4-item version (ADNM-4) among samples of Hong Kong Chinese (N = 1,415). Confirmatory factor analysis demonstrated good model fitness with a bifactor model. Statistical indices indicated unidimensionality of AjD. The model-based reliability showed that the total score of ADNM-20 should be used in scoring and interpretation for capturing the construct of AjD. ADNM-4 model demonstrated full invariance between women and men and partial invariance between age groups. Receiver operating characteristic analysis revealed a cutoff score of 10 for probable AjD. The prevalence of probable AjD was 20.5 % excluding cases with probable depression among a population-representative sample of Hong Kong Chinese amid civil unrest in Hong Kong in July 2019. Cutoff scores of ADNM-20 (49) and ADNM-4 (9) were established for clinically significant common psychiatric conditions, namely PTSD, depression, and anxiety. Both ADNM-20 and ADNM-4 were reliable and valid to assess probable AjD. Implications for clinical research and practice are discussed.