Mental disorders following COVID-19 and other epidemics: a systematic review and meta-analysis

COVID-19 hardship and mental health in Chilean parents: the role of disaster exposure and family resilience

Background: The negative mental health effects of the pandemic on families are well documented, while factors that buffer or increase such effects still need further investigation. Previous exposure to adversity might increase the negative impact of pandemic experiences. On the other hand, family resilience may protect against these negative effects, and may also be regarded as a mediator explaining the negative association between pandemic hardship and mental health.Objective: The current study focused on the effects of COVID-19-related hardship on parental mental health. We evaluated the impact of the individual experiences with the COVID-19 pandemic on mental health among Chilean parents from a community sample, who were exposed in varying levels to a destructive earthquake and tsunami approximately 10 years earlier.Method: Participants (N = 219) completed online measures of pandemic hardship, mental health, disaster hardship related to the past earthquake, and family resilience. We examined the moderating role of disaster exposure and the moderating and mediating role of family resilience on the current impact of the pandemic on mental health.Results: Individual exposure levels of COVID-19 hardship were associated with mental health complaints. Both previous disaster hardship and family resilience were associated with mental health complaints. However, previous disaster hardship did not moderate the relationship between pandemic hardship and mental health complaints, nor did family resilience moderate or mediate it.Conclusions: These results align with the evidence of the negative emotional impact of pandemic-related stressors, and propose family resilience and past disaster exposure as relevant predictors of mental health during the sanitary emergency. Findings are discussed in the broader social context in Chile and warrant adjusting public policies towards those underserved groups heavily affected by the pandemic.

Comparing psychiatric symptom networks between individuals in resilience and non-resilience trajectories of adaptation amid the global pandemic

OBJECTIVE

The current study compared symptom networks between individuals exhibiting resilience and non-resilience trajectories of adaptation two years after the COVID-19 outbreak.

METHOD

A population-representative sample (N = 906) reported symptoms of anxiety and depression in February-July 2020 (T1), March-August 2021 (T2), and September 2021-February 2022 (T3), as well as symptoms of post-traumatic stress disorder (PTSD) and adjustment disorder (AD) at T3. After differentiating between individuals with resilience and non-resilience trajectories using growth mixture modeling, network analyses were conducted to investigate group differences in T3 network symptoms (undirected and directed).

RESULTS

Despite non-significant group differences (M = 0.184, p = .380; S = 0.096, p = .681), distinctive qualitative characteristics were observed between networks. Difficulty relaxing was identified as the single root cause in the more diffused resilience network, with anxiety and depressive symptoms as additional starting points in the non-resilience network, which was more interconnected into clusters with clear-cut diagnostic boundaries. Sad mood demonstrated a transdiagnostic communicative role across common mental disorders.

CONCLUSION

Our results contribute to the understanding of anxiety-depression-PTSD-AD symptom networks in resilient and non-resilient individuals by highlighting the consequences of heterogeneity in adaptation capacity in the development of pandemic-related psychopathology.

A social identity approach to crisis leadership

This paper discusses the importance of a social identity approach to crisis leadership in the context of global crises such as the Covid-19 pandemic and emphasizes the interconnected relationships between leaders and followers. I highlight the role of leaders in fostering unity and shaping citizens' responses especially during crises. I discuss the nature of crises and the significant role of political leaders in guiding societal responses and suggest that crisis leadership extends beyond individual competencies and behaviours and involves a shift from individual to collective responses. With this, I introduce the social identity approach to leadership that views leadership as a social influence process and emphasizes the importance of creating a sense of 'we-ness' among followers. Following from that, crisis leadership involves leaders constructing defining features of collective identity and efficacy to address crises appropriately. However, the value of this approach depends on the careful definition of shared identity boundaries, consideration of diverse experiences within society, the evolving nature of crisis leadership over time and potential consequences of crisis leadership. The sustainability of identity leadership, the dynamics of intergroup and subgroup processes, and the complexities of various crises are identified as areas requiring further research.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Multiple material need insecurities and severity of psychological distress during the COVID-19 pandemic among women who use drugs

BACKGROUND

The COVID-19 pandemic highlighted the salience of material needs and financial precarity on mental health and distress. Women who use drugs (WWUD) experienced significant mental distress and multiple material need insecurities before the pandemic. However, research is limited on the nature of these insecurities during the pandemic despite both material scarcity and mental distress placing WWUD at greater risk of drug-related harms such as overdose. We aim to characterize material need insecurities and their associations with level of mental distress among a sample of WWUD in the United States during the COVID pandemic.

METHODS

N = 227 WWUD (i.e., non-medical use of opioids, crack or powdered cocaine at least three times in the past three months) were recruited in Baltimore, Maryland between August 2021-December 2022. We assessed participants' challenges (i.e., none, minor, major challenge) in accessing five critical material needs during the pandemic: housing; food security; clean, potable water; transportation; and bathroom facilities. The number of major challenges was summed and dichotomized as minimal (0-1) challenges vs. multiple (2+) challenges. The outcome was severity of mental distress, measured by the Kessler-6 and categorized into no/mild, moderate, or severe distress based on validated cut-points. Multinomial logistic regression models were used to explore differences between mental distress severity groups.

RESULTS

36% of the sample reported symptoms of moderate psychological distress and 39% severe distress. Nearly half (43%) reported multiple material need insecurities during COVID. Compared to those who reported minimal material need insecurities, participants with multiple insecurities were 3.25 (95% CI = 1.42-7.45) and 1.96 (95% CI = 0.97-3.95) times more likely to report severe psychological distress compared to no/mild distress or moderate distress, respectively. Unmet mental health needs increased risk of severe distress compared to no/mild 3.44 (95% CI = 1.48-7.97) or moderate 3.62 (95% CI = 1.75-7.49) distress.

CONCLUSIONS

WWUD experienced a substantial burden of multiple material needs during the pandemic which were associated with elevated levels of mental distress. Results speak to the need to advance mental health equity by addressing access to material needs and mental healthcare for marginalized populations, particularly during health emergencies that threaten already-precarious social safety nets and healthcare infrastructure.

The burden of diseases, injuries, and risk factors by state in the USA, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides a comprehensive assessment of health and risk factor trends at global, regional, national, and subnational levels. This study aims to examine the burden of diseases, injuries, and risk factors in the USA and highlight the disparities in health outcomes across different states.

METHODS

GBD 2021 analysed trends in mortality, morbidity, and disability for 371 diseases and injuries and 88 risk factors in the USA between 1990 and 2021. We used several metrics to report sources of health and health loss related to specific diseases, injuries, and risk factors. GBD 2021 methods accounted for differences in data sources and biases. The analysis of levels and trends for causes and risk factors within the same computational framework enabled comparisons across states, years, age groups, and sex. GBD 2021 estimated years lived with disability (YLDs) and disability-adjusted life-years (DALYs; the sum of years of life lost to premature mortality and YLDs) for 371 diseases and injuries, years of life lost (YLLs) and mortality for 288 causes of death, and life expectancy and healthy life expectancy (HALE). We provided estimates for 88 risk factors in relation to 155 health outcomes for 631 risk-outcome pairs and produced risk-specific estimates of summary exposure value, relative health risk, population attributable fraction, and risk-attributable burden measured in DALYs and deaths. Estimates were produced by sex (male and female), age (25 age groups from birth to ≥95 years), and year (annually between 1990 and 2021). 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws (ie, 500 random samples from the estimate's distribution). Uncertainty was propagated at each step of the estimation process.

FINDINGS

We found disparities in health outcomes and risk factors across US states. Our analysis of GBD 2021 highlighted the relative decline in life expectancy and HALE compared with other countries, as well as the impact of COVID-19 during the first 2 years of the pandemic. We found a decline in the USA's ranking of life expectancy from 1990 to 2021: in 1990, the USA ranked 35th of 204 countries and territories for males and 19th for females, but dropped to 46th for males and 47th for females in 2021. When comparing life expectancy in the best-performing and worst-performing US states against all 203 other countries and territories (excluding the USA as a whole), Hawaii (the best-ranked state in 1990 and 2021) dropped from sixth-highest life expectancy in the world for males and fourth for females in 1990 to 28th for males and 22nd for females in 2021. The worst-ranked state in 2021 ranked 107th for males (Mississippi) and 99th for females (West Virginia). 14 US states lost life expectancy over the study period, with West Virginia experiencing the greatest loss (2·7 years between 1990 and 2021). HALE ranking declines were even greater; in 1990, the USA was ranked 42nd for males and 32nd for females but dropped to 69th for males and 76th for females in 2021. When comparing HALE in the best-performing and worst-performing US states against all 203 other countries and territories, Hawaii ranked 14th highest HALE for males and fifth for females in 1990, dropping to 39th for males and 34th for females in 2021. In 2021, West Virginia-the lowest-ranked state that year-ranked 141st for males and 137th for females. Nationally, age-standardised mortality rates declined between 1990 and 2021 for many leading causes of death, most notably for ischaemic heart disease (56·1% [95% UI 55·1-57·2] decline), lung cancer (41·9% [39·7-44·6]), and breast cancer (40·9% [38·7-43·7]). Over the same period, age-standardised mortality rates increased for other causes, particularly drug use disorders (878·0% [770·1-1015·5]), chronic kidney disease (158·3% [149·6-167·9]), and falls (89·7% [79·8-95·8]). We found substantial variation in mortality rates between states, with Hawaii having the lowest age-standardised mortality rate (433·2 per 100 000 [380·6-493·4]) in 2021 and Mississippi having the highest (867·5 per 100 000 [772·6-975·7]). Hawaii had the lowest age-standardised mortality rates throughout the study period, whereas Washington, DC, experienced the most improvement (a 40·7% decline [33·2-47·3]). Only six countries had age-standardised rates of YLDs higher than the USA in 2021: Afghanistan, Lesotho, Liberia, Mozambique, South Africa, and the Central African Republic, largely because the impact of musculoskeletal disorders, mental disorders, and substance use disorders on age-standardised disability rates in the USA is so large. At the state level, eight US states had higher age-standardised YLD rates than any country in the world: West Virginia, Kentucky, Oklahoma, Pennsylvania, New Mexico, Ohio, Tennessee, and Arizona. Low back pain was the leading cause of YLDs in the USA in 1990 and 2021, although the age-standardised rate declined by 7·9% (1·8-13·0) from 1990. Depressive disorders (56·0% increase [48·2-64·3]) and drug use disorders (287·6% [247·9-329·8]) were the second-leading and third-leading causes of age-standardised YLDs in 2021. For females, mental health disorders had the highest age-standardised YLD rate, with an increase of 59·8% (50·6-68·5) between 1990 and 2021. Hawaii had the lowest age-standardised rates of YLDs for all sexes combined (12 085·3 per 100 000 [9090·8-15 557·1]), whereas West Virginia had the highest (14 832·9 per 100 000 [11 226·9-18 882·5]). At the national level, the leading GBD Level 2 risk factors for death for all sexes combined in 2021 were high systolic blood pressure, high fasting plasma glucose, and tobacco use. From 1990 to 2021, the age-standardised mortality rates attributable to high systolic blood pressure decreased by 47·8% (43·4-52·5) and for tobacco use by 5·1% (48·3%-54·1%), but rates increased for high fasting plasma glucose by 9·3% (0·4-18·7). The burden attributable to risk factors varied by age and sex. For example, for ages 15-49 years, the leading risk factors for death were drug use, high alcohol use, and dietary risks. By comparison, for ages 50-69 years, tobacco was the leading risk factor for death, followed by dietary risks and high BMI.

INTERPRETATION

GBD 2021 provides valuable information for policy makers, health-care professionals, and researchers in the USA at the national and state levels to prioritise interventions, allocate resources effectively, and assess the effects of health policies and programmes. By addressing socioeconomic determinants, risk behaviours, environmental influences, and health disparities among minority populations, the USA can work towards improving health outcomes so that people can live longer and healthier lives.

FUNDING

Bill & Melinda Gates Foundation.

The relationship between physical inactivity, excessive screen time, and health indicators among teachers working from home during the COVID-19 pandemic: A cross-sectional study

Background: The literature has demonstrated that teachers were susceptible to psychological issues such as anxiety, depression, and stress during the COVID-19 pandemic. However, there is a need to explore the underlying factors contributing to these psychological burdens. Objective: To investigate the independent and joint association of physical inactivity and excessive screen time with self-perceived health, quality of life, anxiety, and sadness among teachers working from home during the COVID-19 pandemic. Methods: This online cross-sectional study was conducted with 14,979 teachers from public schools in Minas Gerais, Brazil. Physical activity, TV viewing time, and computer/tablet use were self-reported. Health outcomes were assessed using a Likert scale. Adjusted logistic regression models examined the associations. Results: Approximately 80% of the teachers were physically inactive (<150 min/week), while 10% and 80% spent more than 5 h/day watching TV and using a computer/tablet, respectively. Physical inactivity was associated with poor health, low quality of life, sadness, and anxiety. Excessive screen time was associated with low quality of life, sadness, and anxiety. Longer TV viewing time was associated with an increased frequency of sadness and anxiety. Interaction effects between physical inactivity and excessive screen time heightened the likelihood of adverse outcomes. Conclusion: Physical inactivity and excessive screen time independently contributed to the investigated health outcomes. The combination of physical inactivity and prolonged screen time increased the risk of poor self-perceived health among teachers during the pandemic.

The SARS-CoV-2 pandemic causes a dysfunctional dietary behavior: A German cross-sectional study

Background: Since the COVID-19 pandemic has been affected our daily lives, the global population has been exposed to permanent concerns and thus might suffer from the psychological burden. It is well known that psychological burdens can affect dietary behavior. Aim: The impact of a psychological burden on people, and in particular on their dietary patterns was investigated in this nationawide cross-sectional study. Methods: 7525 participants responded to the questionnaire regarding the psychological burden concerning the COVID-19 pandemic and their current dietary structure with changes in the pattern and food amount (between November 2020 and March 2021). Results: A pandemic-related dysfunction of dietary behavior was found. Some participants reported restrictive (conscious) food intake and as well impulsive food intake, which can be described as dysfunctional eating behaviors. In particular, younger persons and individuals who claimed an increased psychological burden reported dysfunctional dietary behavior. Data clearly show that psychological burdens affect an individual's dietary behavior. Conclusion: Public health strategies have to be developed to support individuals at risk to improve coping strategies. The long-term aim should be avoiding the maintenance of dysfunctional dietary behavior.

Is There such a Thing as Post-Viral Depression?: Implications for Precision Medicine

Viral infections are increasingly recognized as triggers for depressive disorders, particularly following the SARS-CoV-2 pandemic and the rise of long COVID. Viruses such as Herpes Simplex Virus (HSV), Epstein-Barr Virus (EBV), Cytomegalovirus (CMV), and Human Immunodeficiency Virus (HIV) are linked to depression through complex neurobiological mechanisms. These include immune system dysregulation, chronic inflammation, and neurotransmitter imbalances that affect brain function and mood regulation. Viral activation of the immune system leads to the release of pro-inflammatory cytokines, resulting in neuroinflammation and associated depressive symptoms. Furthermore, specific viruses can disrupt neurotransmitter systems, including serotonin, dopamine, and glutamate, all of which are essential for mood stabilization. The unique interactions of different viruses with these systems underscore the need for virus-specific therapeutic approaches. Current broad-spectrum treatments often overlook the precise neurobiological pathways involved in post-viral depression, reducing their efficacy. This review emphasizes the need to understand these virus-specific interactions to create tailored interventions that directly address the neurobiological effects induced by each type of virus. These interventions may include immunomodulatory treatments that target persistent inflammation, antiviral therapies to reduce the viral load, or neuroprotective strategies that restore neurotransmitter balance. Precision medicine offers promising avenues for the effective management of virus-induced depression, providing patient-specific approaches that address the specific biological mechanisms involved. By focusing on the development of these targeted treatments, this review aims to pave the way for a new era in psychiatric care that fully addresses the root causes of depression induced by viral infections.

Study of the immune disorder and metabolic dysregulation underlying mental abnormalities caused by exposure to narrow confined spaces

Prolonged confinement in cramped spaces can lead to derangements in brain function/structure, yet the underlying mechanisms remain unclear. To investigate, we subjected mice to restraint stress to simulate long-term narrow and enclosed space confinement, assessing their mental state through behavioral tests. Stressed mice showed reduced center travel and dwell time in the Open Field Test and increased immobility in the Tail Suspension Test. We measured lower hippocampal brain-derived neurotrophic factor levels and cortical monoamine neurotransmitters (5-HT and NE) in the stressed group. Further examination of the body's immune levels and serum metabolism revealed immune dysregulation and metabolic imbalance in the stressed group. The results of the metabolic network regulation analysis indicate that the targets affected by these differential metabolites are involved in several metabolic pathways that the metabolites themselves participate in, such as the "long-term depression" and "purine metabolism" pathways. Additionally, these targets are also associated with numerous immune-related pathways, such as the TNF, NF-κB, and IL-17 signaling pathways, and these findings were validated using GEO dataset analysis. Molecular docking results suggest that differential metabolites may regulate specific immune factors such as TNF-α, IL-1β, and IL-6, and these results were confirmed in experiments. Our research findings suggest that long-term exposure to confined and narrow spaces can lead to the development of psychopathologies, possibly mediated by immune system dysregulation and metabolic disruption.

Perinatal depression and its associated risk factors during the COVID-19 pandemic in low- and middle-income countries: a systematic review and meta-analysis

PURPOSE

Perinatal depression significantly impacts maternal and child health, with further complexities arising during the COVID-19 pandemic. This review is the first to comprehensively synthesize evidence on the prevalence of perinatal depression and its associated risk factors in Low- and Middle-Income Countries (LMICs) during the pandemic period.

METHODS

The study protocol was registered in PROSPERO (CRD42022326991). This review followed the Joanna Briggs Institute (JBI) guideline for prevalence studies. A comprehensive literature search was conducted in six databases: PubMed, Scopus, Web of Science, PsycInfo, CINAHL, and ProQuest. Pooled prevalence estimates were computed for both prenatal and postnatal depression. Identified risk factors were summarized narratively.

RESULTS

A total of 5169 studies were screened, out of which 58 were included in the narrative review and 48 [prenatal (n = 36) and postnatal (n = 17)] were included in the meta-analysis. The pooled depression prevalence for prenatal women was 23% (95% CI: 19-27%), and for the postnatal women was 23% (95% CI: 18-30%). Maternal age, education, perceived fear of COVID-19 infection, week of pregnancy, pregnancy complications, and social and family support were identified as associated risk factors for depression.

CONCLUSIONS

Our review demonstrates an increased prevalence of perinatal depression during the COVID-19 pandemic in LMICs. It sheds light on the significant burden faced by pregnant and postnatal women and emphasizes the necessity for targeted interventions during the ongoing and potential future crisis.

The Presence of a Pet Dog Is Associated with a More Balanced Response to a Social Stressor

Acute and chronic stress each have physical manifestations in the human body that can lead to many negative health impacts. Today, reported stress levels worldwide are at an all-time high, spurring the search for non-pharmaceutical interventions to maintain healthy stress levels. In this study, we examined whether a pet dog’s presence influences healthy adults’ acute stress responses as assessed through self-reports, heart rate, plasma cortisol, and salivary alpha-amylase. Participating pet dog owners were randomly assigned to undergo the Trier Social Stress Test either with their pet dog or alone. While there was no group difference in perceived anxiety levels, participants undergoing the acute psychological stressor with their pet dogs present had significantly lower heart rates, lower plasma cortisol responses, and higher salivary alpha-amylase responses than people without their dogs. Those who participated without their dogs had a statistically flat alpha-amylase response, which is typically associated with extreme or pathological stress. These findings extend the potential effects of pet dogs beyond merely lowering their owner’s stress levels to maintaining a healthier, balanced response across the sympathoadrenal medullary axis and hypothalamic–pituitary-adrenal axis.

Overcoming times of crisis: unveiling coping strategies and mental health in a transnational general population sample during and after the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has had an unparalleled impact, precipitating not only direct threats to physical health but also widespread economic and psychological challenges. This study aims to explore the dynamics of coping behaviour and psychological distress (PD) across different phases of the pandemic within an adult general population sample, spanning Austria and Italy.

METHODS

An online questionnaire-based panel study was conducted between 2020 and 2023 including three measurements. We collected data on sociodemographic variables, coping responses (Brief COPE), and PD (Brief-Symptom-Checklist). Statistical analyses were conducted within a linear-mixed-model framework. Multiple imputation and sensitivity analysis were applied to validate the results obtained by complete case analysis.

RESULTS

The study follows 824 participants and reveals a marginal decrease in overall PD from the first to the second follow-up, particularly in clinically relevant phobic anxiety (35.6% and 34.5% to 25.4%). Most coping behaviours exhibited stable mean-levels with intra-individual variability across the study period. Maladaptive coping strategies were consistently linked to increased PD, whereas adaptive strategies were associated with decreased PD.

CONCLUSION

Our findings underscore the complex nature of coping behaviours and PD during and after the pandemic, suggesting that while mean-levels of PD and coping responses remained relatively stable, most coping strategies were subject to intra-individual change. Maladaptive strategies were associated with increased PD, pinpointing to the need for interventions that establish the foundation for adaptive coping mechanisms and promote their application. Further research should explore the reciprocal influences of mental health on coping behaviour, incorporating interventional designs to unravel the nuances of these relationships.

Depression during the COVID pandemic in La Manouba Governorate, Tunisia: A community survey

BACKGROUND

It is difficult to quantify the impact of the COVID-19 pandemic on mental health as many community surveys have limited quality, rely on screening tests to measure mental health conditions and distress, and often use convenience samples. Moreover, robust surveys come mainly from high-income countries.

AIM

To measure the prevalence of depressive disorders with onset during the pandemic in a community of a Lower-Middle-income country (LMIC)-Tunisia.

METHODS

Clinical semi-structured face-to-face interviews were carried out during the pandemic (September-December 2021) by medical doctors among a representative sample of the general population in the governorate of La Manouba, Tunisia. Psychiatric diagnoses were established according to DSM-IV.

RESULTS

The prevalence of Major Depressive Disorder (MDD) started or recurred after the pandemic was 5.66%. The factors associated with MDD were loss of job and considerably diminished income due to the pandemic (OR = 2.1, 95% CI [1.5, 2.9]) and the perception of having the family's financial situation below the Tunisian average (OR = 2.3, 95% CI [1.7, 3.2]). Female sex, marital status as separated/divorced, and having a COVID-19 infection were associated with MDD only in the overall sample and urban areas, but not in rural areas. Age and having loved ones who passed away due to COVID-19 were not associated with MDD.

CONCLUSION

In Tunisia, the pandemic seems to have increased the risk of depression in people experiencing a precarious financial situation, also due to the pre-existing economic crisis. Specific local level factors, such as not establishing a rigid lockdown for an extended period, may have protected young people and allowed for better mourning in families suffering the loss of a loved one.

Hyperactivity and Risk for Dysregulation of Mood, Energy, and Social Rhythms Syndrome (DYMERS): Standardization of a Simple One-Item Screener versus the Mood Disorder Questionnaire (MDQ)

Background: This study aims to verify the accuracy of item 10 on the energy level of the Short-Form Health Survey (SF-12) in an item screening according to Mood Disorder Questionnaire (MDQ) results, providing a measure of hyper-energy. Methods: Regression techniques were employed in a dataset comprising 4093 records of respondents to test both linear and nonlinear relationships between predictor and outcome variables (energy level and symptoms considered in the MDQ). We examined the relationship of energy level with cases identified using MDQ with a cut-off of 7. Results: Levels of energy, as rated on item 10 of the SF-12, were related to the MDQ score with sensitivity = 0.72 and specificity = 0.70. In linear regression, the associations were stronger with MDQ items on excessive energy or activity, showing a medium effect size and an explained variance of 10% or higher. A greater association was observed for items on excessive energy and activity, as expected, as well as for items concerning self-confidence, sociability, and talkativeness. Conclusions: This result may have implications for the research on risk factors and the pathogenesis of the dysregulation of mood, energy, and social rhythms syndrome (DYMERS), a syndrome that is hypothesized to occur in stressful conditions like those shown under the COVID-19 pandemic.

Prior Engagement in Physical Activity Correlates with Enhanced Quality of Life Perceptions among Older Adults during COVID-19 Lockdown

BACKGROUND

This longitudinal study aimed to evaluate whether prior engagement in a physical exercise program correlated with enhanced perceptions of quality-of-life components among older adults during the COVID-19 lockdown period.

METHODS

The cohort comprised elderly individuals (aged ≥ 65 years) who had previously partaken in a 12-week randomized controlled trial investigating the effects of a mixed aerobic-anaerobic, moderate-intensity exercise program. Participants' health-related quality of life was assessed using the Short Form Health Survey-12 item (SF-12) at the beginning of the initial trial and, again, one year later during the COVID-19 lockdown. In the exercise group, 44 participants were included, while the control group consisted of 49 participants, with computer-based, double-blind randomization conducted in Cagliari, Italy. The differences in scores for each SF-12 item between the two groups from T0 to T1 were compared using one-way ANOVA with Bonferroni corrections. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 27.

RESULTS

No statistically significant differences were observed on average by age (exercise group vs. control group 72.20 ± 4.78 vs. 72.91 ± 4.77; F = 0.513, p = 0.476). A decrease from T0 to T1 towards a better score on the SF-12 was observed in the exercise group compared to the control group in item 1 (F = 67.463, p < 0.0001); in item 5 (F = 4.319, p = 0.041); item 8 (F = 4.269, p = 0.041); item 9 (F = 10.761, p = 0.001); item 10 (F = 170.433, p < 0.001); and item 11 (F = 4.075, p = 0.046).

CONCLUSIONS

The results suggest that participation in a moderate physical exercise program one year prior may have equipped older adults with better coping mechanisms to navigate the stress and isolation imposed by the COVID-19 lockdown, as reflected by their enhanced scores on quality-of-life components pertaining to mental well-being. Exercise may confer a protective effect against the adverse psychological impacts of stressful events like the pandemic, even among older adults with chronic conditions. This study underscores the potential benefits of exercise interventions for promoting quality of life and preventing mood disorders in the elderly population.

The burden and its determinants of mental health distress among adolescents dwelling in Africa: a systematic review and meta-analysis

BACKGROUND

Adolescent mental health issues are emerging as a significant public health concern across many low- and middle-income countries, particularly in Africa. This study aims to evaluate the aggregated prevalence and contributing risk factors of mental health distress among adolescents in Africa.

METHODOLOGY

A comprehensive search of PubMed, PsycINFO, Web of Science, Google Scholar, and HINARI databases was conducted to identify relevant articles on the prevalence and risk factors associated with mental health distress among African adolescents, published up to December 2023. The quality of the selected studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Heterogeneity among the studies was evaluated using the I² statistical test. Potential publication bias was assessed through a funnel plot and Egger's statistical test. This systematic review was registered with PROSPERO under reference number CRD42023494665.

RESULTS

Eighteen studies encompassing data from 37,016 adolescents were included in the analysis. The overall prevalence of mental health distress among adolescents in Africa was found to be 27.34% (95% CI: 23.18-31.50). The occurrence of mental health distress is observed in older adolescents at a prevalence of 29.44% (95% CI: 23.26-35.66) and in younger adolescents at 24.73% (95% CI: 11.96-37.51). Significant risk factors identified included bullying victimization, with an odds ratio (POR) of 1.30 (95% CI: 1.16, 1.46), and experiencing hunger, with an odds ratio (POR) of 2.10 (95% CI: 1.13, 3.91).

CONCLUSION

The findings indicate a high prevalence of mental health distress among adolescents in Africa, highlighting the widespread impact on this demographic. These results underscore the urgent need for targeted interventions to prevent and address mental health distress among adolescents. Further research on a global scale is essential to develop effective prevention and treatment strategies tailored to this age group.

Adapting Minds: Exploring Cognition to Threatened Stimuli in the Post-COVID-19 Landscape Comparing Old and New Concerns about Pandemic

The global population has been significantly affected by the pandemic in terms of physical and mental health. According to transactional theory, individuals have undergone an adaptation process influenced by cognitive control abilities. Emotional responses to COVID-19-related stimuli may interfere with top-down attentional processes, thereby hindering adaptation. This study aimed to investigate the impact of COVID-19-related stimuli on attentional processing and to determine whether psychological factors could modulate these effects. A sample of 96 healthy undergraduate students participated in an emotional Stroop task in which they were presented with a series of stimuli, including both neutral and negative COVID-19-related as well as non-COVID-19 stimuli. COVID-19-related PTSD, as an index of distress (PTSS), and trait anxiety were evaluated. Results showed that participants were more accurate in identifying COVID-19-related stimuli compared to non-COVID-19 stimuli. Being female and having higher retrospective PTSS scores related to COVID-19 were predictive of faster reaction times for both neutral and negative COVID-19-related stimuli. This heightened attentional bias toward COVID-19-related stimuli suggests that individuals may be more sensitive to stimuli associated with the pandemic. The results suggest that the association between COVID-19 stimuli and attentional biases extends beyond emotional valence, being retrospectively influenced by mental health, suggesting potential pathways to future mental health challenges.

Global climate change: Effects of future temperatures on emergency department visits for mental disorders in Beijing, China

Rising temperatures can increase the risk of mental disorders. As climate change intensifies, the future disease burden due to mental disorders may be underestimated. Using data on the number of daily emergency department visits for mental disorders at 30 hospitals in Beijing, China during 2016-2018, the relationship between daily mean temperature and such visits was assessed using a quasi-Poisson model integrated with a distributed lag nonlinear model. Emergency department visits for mental disorders attributed to temperature changes were projected using 26 general circulation models under four climate change scenarios. Stratification analyses were then conducted by disease subtype, sex, and age. The results indicate that the temperature-related health burden from mental disorders was projected to increase consistently throughout the 21st century, mainly driven by high temperatures. The future temperature-related health burden was higher for patients with mental disorders due to the use of psychoactive substances and schizophrenia as well as for women and those aged <65 years. These findings enhance our knowledge of how climate change could affect mental well-being and can be used to advance and refine targeted approaches to mitigating and adapting to climate change with a view on addressing mental disorders.

SIR+ models: accounting for interaction-dependent disease susceptibility in the planning of public health interventions

Avoiding physical contact is regarded as one of the safest and most advisable strategies to follow to reduce pathogen spread. The flip side of this approach is that a lack of social interactions may negatively affect other dimensions of health, like induction of immunosuppressive anxiety and depression or preventing interactions of importance with a diversity of microbes, which may be necessary to train our immune system or to maintain its normal levels of activity. These may in turn negatively affect a population's susceptibility to infection and the incidence of severe disease. We suggest that future pandemic modelling may benefit from relying on 'SIR+ models': epidemiological models extended to account for the benefits of social interactions that affect immune resilience. We develop an SIR+ model and discuss which specific interventions may be more effective in balancing the trade-off between minimizing pathogen spread and maximizing other interaction-dependent health benefits. Our SIR+ model reflects the idea that health is not just the mere absence of disease, but rather a state of physical, mental and social well-being that can also be dependent on the same social connections that allow pathogen spread, and the modelling of public health interventions for future pandemics should account for this multidimensionality.

Mental health and insomnia problems in healthcare workers after the COVID-19 pandemic: A multicenter cross-sectional study

BACKGROUND

Healthcare workers (HCWs) are at increased risk of contracting coronavirus disease 2019 (COVID-19) as well as worsening mental health problems and insomnia. These problems can persist for a long period, even after the pandemic. However, less is known about this topic.

AIM

To analyze mental health, insomnia problems, and their influencing factors in HCWs after the COVID-19 pandemic.

METHODS

This multicenter cross-sectional, hospital-based study was conducted from June 1, 2023 to June 30, 2023, which was a half-year after the end of the COVID-19 emergency. Region-stratified population-based cluster sampling was applied at the provincial level for Chinese HCWs. Symptoms such as anxiety, depression, and insomnia were evaluated by the Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Insomnia Severity Index. Factors influencing the symptoms were identified by multivariable logistic regression.

RESULTS

A total of 2000 participants were invited, for a response rate of 70.6%. A total of 1412 HCWs [618 (43.8%) doctors, 583 (41.3%) nurses and 211 (14.9%) nonfrontline], 254 (18.0%), 231 (16.4%), and 289 (20.5%) had symptoms of anxiety, depression, and insomnia, respectively; severe symptoms were found in 58 (4.1%), 49 (3.5%), and 111 (7.9%) of the participants. Nurses, female sex, and hospitalization for COVID-19 were risk factors for anxiety, depression, and insomnia symptoms; moreover, death from family or friends was a risk factor for insomnia symptoms. During the COVID-19 outbreak, most [1086 (76.9%)] of the participating HCWs received psychological interventions, while nearly all [994 (70.4%)] of them had received public psychological education. Only 102 (7.2%) of the HCWs received individual counseling from COVID-19.

CONCLUSION

Although the mental health and sleep problems of HCWs were relieved after the COVID-19 pandemic, they still faced challenges and greater risks than did the general population. Identifying risk factors would help in providing targeted interventions. In addition, although a major proportion of HCWs have received public psychological education, individual interventions are still insufficient.

Large environmental changes reduce valence-dependent belief updating

When updating beliefs, humans tend to integrate more desirable information than undesirable information. In stable environments (low uncertainty and high predictability), this asymmetry favors motivation towards action and perceived self-efficacy. However, in changing environments (high uncertainty and low predictability), this process can lead to risk underestimation and increase unwanted costs. Here, we examine how people (n = 388) integrate threatening information during an abrupt environmental change (mandatory quarantine during the COVID-19 pandemic). Given that anxiety levels are associated with the magnitude of the updating belief asymmetry; we explore its relationship during this particular context. We report a significant reduction in asymmetrical belief updating during a large environmental change as individuals integrated desirable and undesirable information to the same extent. Moreover, this result was supported by computational modeling of the belief update task. However, we found that the reduction in asymmetrical belief updating was not homogeneous among people with different levels of Trait-anxiety. Individuals with higher levels of Trait-anxiety maintained a valence-dependent updating, as it occurs in stable environments. On the other hand, updating behavior was not associated with acute anxiety (State-Anxiety), health concerns (Health-Anxiety), or having positive expectations (Trait-Optimism). These results suggest that highly uncertain environments can generate adaptive changes in information integration. At the same time, it reveals the vulnerabilities of individuals with higher levels of anxiety to adapt the way they learn.

[A Continuous Literature Review for Mental Health Surveillance during the Covid-19 Pandemic in Germany - Method, Selected Results and Lessons Learned]

In order to provide an up-to-date overview on changes in population's mental health during the COVID-19 pandemic, a continuous literature review was conducted. Building on a rapid review, systematic and hand searches were conducted monthly until December 31, 2022. Studies were assessed for observation periods, risk of bias and outcomes. Trends in depressive symptoms in adults were summarized by vote counting. 102 publications were included from 62 studies in the adult population. Studies declined over the course of the pandemic. Overall, 37% of the studies and 56% of the publications can assess trends in the population reliably. Among evidence for changes in depressive symptoms deteriorations predominated at last. The heterogeneity of results published by the end of 2022 limits evidence syntheses. Evidence of deterioration requires further surveillance. A continuous review can indicate evidence gaps at an early stage.

Impact of the COVID-19 pandemic on the work of clinical psychologists in Austria: results of a mixed-methods study

Introduction

Clinical psychologists in Austria shouldered a large part of the massive increase in demand for mental health services caused by the COVID-19 pandemic. This study aimed to find out how the pandemic affected their work and to gather information on how best to support the profession in the event of a crisis.

Methods

N = 172 Austrian clinical psychologists participated in a cross-sectional online survey between 11 April 2022 and 31 May 2022, including both closed and open-ended questions about their work. Open-ended questions were analyzed using qualitative content analysis. A mixed-methods analysis was conducted to test correlations between the categories derived from the qualitative analysis and professional variables.

Results

The analyses revealed that clinical psychologists, especially those with more years of experience, perceived an increased need for clinical psychological treatment, especially for children and adolescents, a lack of coverage for clinical psychological treatment by health insurance, a change to remote treatment formats, and a number of burdens associated with complying with COVID-19 measures.

Discussion

Clinical psychologists reported an urgent need to increase resources in both outpatient and inpatient settings and to promote health insurance coverage. To support the clinical psychology profession in providing high-quality work in times of crisis, there is a need to facilitate more opportunities for team and peer exchange, as well as financial support in the event of loss of income.

"Compliant Supporters," "Anxious Skeptics," and "Defiant Deniers": A Latent Profile Analysis of People's Responses to COVID-19 Communications

This study investigates whether people's responses to official communications about COVID-19 could be "profiled" with respect to socio-economic-demographic and behavioral characteristics. Such profiles could enhance the effectiveness of future crisis management through the use of profile-adapted communications that maximize message comprehension. A representative web panel survey (742 respondents) was conducted across Switzerland in February 2022 to assess the population's reaction to COVID-19 communications during the pandemic. Latent profile analysis was conducted to explore if distinct profiles of reactions to the communications would emerge, and how each of them relate to conspiracy mentality and SED measures. The analyses revealed three latent profiles: "Compliant supporters" (54%), "defiant deniers" (23.6%), and "anxious skeptics" (22.4%). Respondents with high conspiracy mentality were more likely to belong to "defiant deniers" or "anxious skeptics." Each profile was characterized by distinct SED and behavioral features (discussed in the paper). The COVID-19 pandemic demonstrated that one communication does not work for all people. Our study evidenced three different types of respondent profiles that require profile-adapted communications for more effective crisis control. Our study is the first to profile people's responses to COVID-19 communications in a systematic, person-centered way. The results can be used for more effective future crisis management that delivers to each profile's communicative needs.

Assets and depression in U.S. adults during the COVID-19 pandemic: a systematic review

PURPOSE

Mental health is shaped by social and economic contexts, which were altered during the COVID-19 pandemic. No study has systematically reviewed the literature on the relation between different assets and depression during the COVID-19 pandemic.

METHODS

We conducted a systematic review of the literature on financial (e.g. income/savings), physical (e.g., home ownership), and social (e.g., marital status, educational attainment) assets and depression in U.S. adults. For each asset type, we created binary comparisons to report on the direction of the relationship and described if each study reported insignificant, positive, negative, or mixed associations.

RESULTS

Among the 41 articles identified, we found that income was the most studied asset (n=34), followed by education (n=25), marital status (n=18), home ownership (n=5), and savings (n=4). 88%, 100%, and 100% of articles reported a significant association of higher income, home ownership, and higher savings, respectively, with less depression. The association between marital status and education with depression was more nuanced: 72% (13 of 18) studies showed that unmarried persons had greater risk of depression than married or cohabitating persons and 52% (13 of 25) of studies reported no significant difference in depression across educational groups.

CONCLUSION

This work adds to the literature a deeper understanding of how different assets relate to depression. In the context of largescale traumatic events, policies that maintain and protect access to social, physical, and financial assets may help to protect mental health.

Impact of Benzodiazepines and Illness Duration on Obsessive-Compulsive Disorder during COVID-19 in Italy: Exploring Symptoms' Evolutionary Benefits

Obsessive-compulsive disorder (OCD) is believed to follow a waxing and waning course, often according to environmental stressors. During the COVID-19 pandemic, pre-existing OCD symptoms were reported to increase and to change from checking to washing behaviors, while new-onset symptoms were predominantly of the hoarding type. In the present study, we followed the evolution of OCD symptoms, anxiety, depression, and insights of illness in forty-six OCD patients throughout the pandemic. Clinical measures were collected at four different time points before and during the COVID-19 pandemic in Italy. Within-subject comparisons were used to compare clinical scale scores across time, and correlations were examined between patients' baseline characteristics and changes in clinical scores. We found that all clinical measures increased during the first Italian lockdown with respect to the pre-pandemic values. Anxiety decreased during the temporary elimination of restriction provisions, whereas the severity of OCD symptoms and insight returned to pre-pandemic values during the second mandatory lockdown. These results were observed only in two sub-groups of patients: those taking benzodiazepines and those with shorter illness duration. Our findings suggest the need for additional clinical attention to these specific sub-groups of OCD patients in case of particularly distressing circumstances while pointing to a possible adaptive role of their OCD symptoms when the environment requires a higher care of hygiene and an extraordinary supply of essential resources.

The impact of COVID-19 on medical students

Objective

The outbreak of COVID-19 has disrupted social order and placed a heavy burden on the healthcare system. The pandemic also has an unprecedented impact on medical students.

Methods

We searched PubMed for articles related to COVID-19 and medical students from January 2020 to December 2022. A total of 5358 studies were retrieved and after screening, 176 studies were finally included in this review.

Results

The impact of COVID-19 on medical students is widespread and profound. First reflected in the transformation of educational models. In the early days, education model quickly shifted from offline to online. In terms of clinical exposure, most students have been suspended from internships, while in some areas with staff shortages they have the opportunity to continue clinical work. Scientific research of medical students is also difficult to carry out due to COVID-19. The epidemic has also seriously damaged students' mental health, and this impact won't simply disappear with the improvement of the epidemic situation. The career intentions of medical students may also become firmer or change due to COVID-19. International medical electives have also been negatively affected by COVID-19 due to travel restriction. Even in the postpandemic era, with the gradual resumption of work, production and school, medical students are still affected in some ways by COVID-19.

Conclusion

The COVID-19 pandemic has had a profound impact on both the education of medical students and their personal development. Through COVID-19, we should reflect on what models of medical education should be developed in the future. Based on the experiences learned from COVID-19, we believe that a more flexible blended education model may be the most promising.

The association between the sense of control and depression during the COVID-19 pandemic: a systematic review and meta-analysis

Introduction

High levels of depression and low sense of control have been reported during the COVID-19 pandemic. The removal of typical freedoms through public health restrictions may have played an important role. The aim of this review was to examine data collected during the pandemic and (1) estimate the strength of the association between sense of control and depression, (2) examine whether the different types of control measures affected the strength of the association, and (3) whether this changed as a function of pandemic indicators.

Methods

We conducted a systematic review and meta-analysis of studies published in English between December 2019 and November 2022. A total of 993 articles were identified, of which 20 were included in the review and 16 in the meta-analysis after conducting a quality assessment using the standard NIH tool.

Results

The control-depression association gave a bias-independent pooled effect size of r = .41, and grew stronger over the 130 weeks covered by this review but did not change as a function of local COVID incidence rates. Subgroup analyses showed that external and overall control were more strongly related to depression than internal control.

Discussion

These findings emphasize that external factors are important to the sense of control and the importance of preserving the sense of control in situations where the removal of personal freedoms is necessary, such as public health emergencies.

Trajectories of mental health outcomes following COVID-19 infection: a prospective longitudinal study

BACKGROUND

The COVID-19 pandemic has triggered a global mental health crisis. Yet, we know little about the lasting effects of COVID-19 infection on mental health. This prospective longitudinal study aimed to investigate the trajectories of mental health changes in individuals infected with COVID-19 and to identify potential predictors that may influence these changes.

METHODS

A web-survey that targeted individuals that had been infected with COVID-19 was used at three time-points: T0 (baseline), T1 (six months), and T2 (twelve months). The survey included demographics, questions related to COVID-19 status, previous psychiatric diagnosis, post-COVID impairments, fatigue, and standardized measures of depression, anxiety, insomnia. Linear mixed models were used to examine changes in depression, anxiety, and insomnia over time and identify factors that impacted trajectories of mental health outcomes.

RESULTS

A total of 236 individuals completed assessments and was included in the longitudinal sample. The participants' age ranged between 19 and 81 years old (M = 48.71, SD = 10.74). The results revealed notable changes in mental health outcomes over time. The trajectory of depression showed significant improvement over time while the trends in anxiety and insomnia did not exhibit significant changes over time. Younger participants and individuals who experienced severe COVID-19 infection in the acute phase were identified as high-risk groups with worst mental ill-health. The main predictors of the changes in the mental health outcomes were fatigue and post-COVID impairments.

CONCLUSIONS

The findings of our study suggest that mental health outcomes following COVID-19 infection exhibit a dynamic pattern over time. The study provides valuable insights into the mental health trajectory following COVID-19 infection, emphasizing the need for ongoing assessment, support, and interventions tailored to the evolving mental health needs of this population.

Post-covid-19 conditions in adults: systematic review and meta-analysis of health outcomes in controlled studies

Objective

To assess the impact of post-covid-19 conditions among adults.

Design

Systematic review and meta-analysis of health outcomes in controlled studies.

Data sources

Two sources were searched from database inception to 20 October 2022: Cochrane covid-19 study register (comprising Cochrane Central Register of Controlled Trials, Medline, Embase, clinicalTrials.gov, World Health Organization's International Clinical Trials Registry Platform, medRxiv) and WHO's covid-19 research database.

Eligibility criteria

Cohort studies recruiting more than 100 participants with a control group and a follow-up of at least 12 weeks were included. Adults who were documented to have SARS-CoV-2 infection based on clinical, imaging, or laboratory criteria were included.

Data extraction and synthesis

Two independent reviewers extracted data. The main outcomes included quality of life, functionality in daily activities, use of resources, recovery rates (cluster of symptoms), and the incidence of new medical diagnoses. Data were pooled using a random effects model. The risk of bias was assessed with the Joanna Briggs Institute critical appraisal tool for cohort studies.

Results

We included 63 controlled cohort studies, encompassing more than 96 million participants. Based on five studies, we found a reduction in overall quality of life between individuals with confirmed SARS-CoV-2 infection versus controls at six to 24 months follow-up, although heterogeneity was very high (mean difference in EQ-5D scale -5.28 (95% confidence interval -7.88 to 2.68; I2=93.81%). Evidence from ten studies, which could not be pooled in a meta-analysis, indicated that an increased rate of functional impairment associated with SARS-CoV-2 infection. Use of care increased compared with controls at six to 24 months follow-up at intensive care units (risk ratio 2.00 (95% confidence interval 0.69 to 5.80), five studies, I2=91.96%) and in outpatient care (1.12 (1.01 to 1.24), seven studies, I2=99.51%). Regarding persistent symptoms, individuals with documented SARS-CoV-2 infection had an increased risk of having two or more persistent symptoms at follow-up, especially those related to neurological clusters (ie, risk ratio 1.51 (95% confidence interval 1.17 to 1.93), I2=98.91%). Evidence also showed an increased incidence of a wide variety of metabolic, cardiovascular, neurological, respiratory, haematological and other incident diagnoses.

Conclusion

Evidence suggests functional impairment after SARS-CoV-2 infection, in addition to a higher use of resources and a higher incidence of widely varying medical diagnoses. These results should be interpreted with caution, considering the high heterogeneity across studies and study limitations related to outcome measurement and attrition of participants.

Systematic review registration

Open Science Framework, osf.io/drm39.

Pattern of adult psychiatric emergencies at a tertiary care center before and after the onset of the COVID-19 pandemic

A gap exists in published data on psychiatric emergencies presenting to Indian centers over the entire pandemic. We assessed 2,048 consecutive adult psychiatric emergencies for the period April 2019-September 2021 to compare 18 months following the onset of the pandemic, with the pre pandemic year as the control. Mean age was 33.8 ± 13.6 years, with 55% females. The proportion with ICD-10 schizophrenia and related psychotic disorders (18.9% vs 15.3%; P = 0.031), mood disorders (21.8% vs 18.1%; P = 0.038), and personality disorders (3.8% vs 2%; P = 0.018) showed a significant increase during a pandemic, while those with no diagnosable illness reduced (28.6% vs 34.3%; P = 0.006). Suicidality was the reason for referral in 43%, comparable to pre pandemic year. Those with stay ≥24 hours increased (14% vs 11%; P = 0.034). Benzodiazepines remained the commonly prescribed medication, but a notable rise was seen in mood stabilizer prescriptions.

Trajectories of self-kindness, common humanity, and mindfulness during the COVID-19 pandemic: A person-oriented multi-trajectory approach

The COVID-19 pandemic has produced unprecedented changes in the lives of many people. Although research has documented associations between concerns related to COVID-19 and poor mental health indicators, fewer studies have focused on positive factors that could help people better cope with this stressful social context. To fill this gap, the present research investigated the trajectories of self-compassion facets in times of dramatic social change. Using a longitudinal research design, we described the trajectories of self-kindness, common humanity, and mindfulness during the first eight months of the COVID-19 pandemic, in a representative sample of Canadian adults (N = 3617). Relying on a multi-trajectory group-based approach, we identified clusters of individuals following persistently low (4.0%), moderate-low (39.3%), moderate-high (46.7%), and high (10.0%) levels of self-kindness, common humanity, and mindfulness. Interestingly, we found that compassionate self-responding trajectories were mainly stable over time with minor fluctuations for some groups of individuals, in line with the epidemiological situation. In terms of covariates, we observed that older women were more likely to follow trajectories of high compassionate self-responding, as compared to the other age and gender groups. In terms of mental health indicators, we demonstrated that trajectory groups with high levels of compassionate self-responding were associated with greater life satisfaction, more happiness, better sleep quality, higher sleep quantity, and fewer negative emotions, as compared to lower trajectory groups. The results supported the idea that self-compassion during the COVID-19 pandemic could have favored better mental health indicators and could possibly be promoted as a psychological intervention in the general population.

Effects of auriculotherapy on anxiety and biomarkers in Primary Health Care: a clinical trial

OBJECTIVE

to assess the effects of auriculotherapy on anxiety and brain-derived neurotrophic factor (BDNF), neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B) serum levels in adults assisted in Primary Health Care.

METHODS

a pre-experimental pilot clinical trial. Information was obtained from 19 patients using the State-Trait Anxiety Inventory (STAI) and analysis of BDNF, NSE and S100B serum levels.

RESULTS

the pre-intervention anxiety score in the IDATE-Trait was 52.11±6.691 (CV 12.84%) and the assessment after auriculotherapy was significantly lower (43.72±8.141; CV 18.62%; P=0.0007). S100B levels were significantly reduced after auriculotherapy (from 64.03±72.18 to 54.03±68.53 pg/mL; CV 126.8%; P=0.0023).

CONCLUSION

auriculotherapy effectively reduced anxiety levels. It proved to be safe and easy to apply, allowing nurses to perform this technique autonomously. A reduction of S100B was also evidenced, demonstrating possible prevention of neuronal damage.

Factors associated with prolonged viral shedding of SARS-CoV-2 Omicron variant infection in Shanghai: A multicenter, retrospective, observational study

Shanghai has faced an unprecedented COVID-19 pandemic with the BA.2.2 strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron infection. Comprehensive insights into its epidemiology, clinical manifestations, and viral shedding dynamics are currently limited. This study encompasses 208373 COVID-19 patients that were infected with the Omicron BA.2.2 sub-lineage in Shanghai, China. Demographic information, clinical symptoms, vaccination status, isolation status, as well as viral shedding time (VST) were recorded. Among the COVID-19 patients included in this study, 187124 were asymptomatic and 21249 exhibited mild symptoms. The median VST was 8.3 days. The common clinical symptoms included fever, persistent cough, phlegm, sore throat, and gastrointestinal symptoms. Factors such as advanced age, presence of comorbidities, mild symptomatology, and delayed isolation correlated with extended VST. Conversely, female gender and administration of two or three vaccine doses correlated with a reduction in VST. This investigation offers an in-depth characterization and analytical perspective on Shanghai's recent COVID-19 surge. Prolonged viral shedding of SARS-CoV-2 was observed in elderly, male, symptomatic patients, and those with comorbidity. Female, individuals with two or three vaccine doses, as well as those isolated early, shows an effective reduced VST.

Prevalence of sleep disturbances in patients with long COVID assessed by standardised questionnaires and diagnostic criteria: A systematic review and meta-analysis

OBJECTIVE

We aimed to study the prevalence of sleep disturbances in patients with long COVID-19.

METHODS

We conducted a systematic review and meta-analysis of the pooled prevalence of sleep disturbances in patients post COVID-19. We systematically searched relevant studies from three databases, including Medline, Embase and Scopus. Original articles were included based on specific criteria: peer-reviewed, observational studies involving adults (18 or older) with confirmed post COVID-19 status through PCR testing and focused on sleep in the context of post COVID-19. Exclusion criteria included non-English articles, studies with insufficient data, and narrative/systematic reviews. The search was performed from 31st July 2023 to 15th August 2023. We identified 35 eligible papers; however, we excluded 6 studies which did not describe the sleep assessment. We used a random-effects meta-analysis model to estimate the pooled prevalence of sleep disturbances.

RESULTS

29 studies involved 13,935 long COVID-19 patients; approximately 39% of participants were male aged 18 to 97 years. The overall pooled prevalence of sleep disturbance was 46% (95% CI: 38-54%). Subgroup analyses revealed that the pooled prevalence of poor sleep quality was 56% (95% CI: 47-65%). The pooled prevalence of insomnia was 38% (95% CI: 28-48%). Finally, the pooled prevalence of excessive daytime sleepiness was 14% (95% CI: 0-29%).

CONCLUSION

Sleep disturbances are common in long COVID-19 patients. The healthcare sector should recognise these sleep issues and provide an early, effective treatment to prevent long-term sequelae of sleep problems.

Effectiveness of a scalable, remotely delivered stepped-care intervention to reduce symptoms of psychological distress among Polish migrant workers in the Netherlands: study protocol for the RESPOND randomised controlled trial

BACKGROUND

The COVID-19 pandemic has negatively affected the mental health of international migrant workers (IMWs). IMWs experience multiple barriers to accessing mental health care. Two scalable interventions developed by the World Health Organization (WHO) were adapted to address some of these barriers: Doing What Matters in times of stress (DWM), a guided self-help web application, and Problem Management Plus (PM +), a brief facilitator-led program to enhance coping skills. This study examines whether DWM and PM + remotely delivered as a stepped-care programme (DWM/PM +) is effective and cost-effective in reducing psychological distress, among Polish migrant workers with psychological distress living in the Netherlands.

METHODS

The stepped-care DWM/PM + intervention will be tested in a two-arm, parallel-group, randomized controlled trial (RCT) among adult Polish migrant workers with self-reported psychological distress (Kessler Psychological Distress Scale; K10 > 15.9). Participants (n = 212) will be randomized into either the intervention group that receives DWM/PM + with psychological first aid (PFA) and care-as-usual (enhanced care-as-usual or eCAU), or into the control group that receives PFA and eCAU-only (1:1 allocation ratio). Baseline, 1-week post-DWM (week 7), 1-week post-PM + (week 13), and follow-up (week 21) self-reported assessments will be conducted. The primary outcome is psychological distress, assessed with the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). Secondary outcomes are self-reported symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), resilience, quality of life, and cost-effectiveness. In a process evaluation, stakeholders' views on barriers and facilitators to the implementation of DWM/PM + will be evaluated.

DISCUSSION

To our knowledge, this is one of the first RCTs that combines two scalable, psychosocial WHO interventions into a stepped-care programme for migrant populations. If proven to be effective, this may bridge the mental health treatment gap IMWs experience.

TRIAL REGISTRATION

Dutch trial register NL9630, 20/07/2021, https://www.onderzoekmetmensen.nl/en/trial/27052.

The Risk of Suicide in the Post-COVID-19 Emergency Era: Psychological and Forensic Implications

The emergence of the coronavirus disease 2019 (COVID-19) pandemic brought numerous challenges, including the management of psychological and psychiatric disorders, leading to an increased risk of suicide. At the end of the COVID-19 emergency, we wonder what the impact of the pandemic has been, and still is, on the state of public mental health with respect to the phenomenon of suicide. Therefore, this review aims to explore the psychological and forensic aspects of suicide in the post-COVID-19 emergency era. The paper will delve into the various psychiatric disorders associated in the literature with COVID-19, the risk factors for suicide during the pandemic, and measures that can be taken to prevent suicide in the post-COVID-19 era. Additionally, the paper will look at how forensic experts investigate suicide cases due to COVID-19 and the legal implications of suicide due to the pandemic. The findings of this study will provide insights into the psychological and forensic aspects of suicide in the post-COVID era, and emphasize interventions and policy development to address this growing public health concern.

Loneliness Is Associated With Lower Self- and Clinician-Rated Levels of Personality Functioning

Personality disorders (PDs) are associated with interpersonal dysfunction, loneliness, and reduced social embeddedness. This study investigates loneliness and social network size in association with self- and clinician-rated personality functioning regarding the DSM-5's Alternative Model for Personality Disorders (AMPD). Eighty psychiatric inpatients including participants with and without PDs completed the Semi-structured Interview for Personality Functioning, the Level of Personality Functioning Scale - Brief Form, the UCLA Loneliness Scale, and the Social Network Index. Patients with PDs reported more loneliness and personality dysfunctioning than patients without PDs. Social network size did not differ between patient groups and showed lower correlations with personality functioning compared to loneliness. Loneliness was further associated with deficits in personality functioning. Deficits in distinct AMPD domains and loneliness may constitute transdiagnostically relevant factors that are related and mutually reinforcing. This could be important for identifying patients beyond PD diagnoses who are at risk of poor psychosocial functioning and require tailored psychotherapy.

Depression and stress levels in patients with different psychiatric disorders during concurrent early-phase COVID-19 pandemic and earthquake in Croatia

BACKGROUND

While Croatia shared COVID-19 pandemic with other countries, its capital area was also hit by a 5.6 magnitude earthquake. The simultaneous impact of these two disasters on psychiatric patients is largely unknown, and we addressed those knowledge gaps.

METHODS

The cross-sectional study was conducted during the pandemic's first peak, in the aftermath of earthquake, by telephonic survey. Measurements included the Patient Health Questionnaire-9, the Perceived Stress Scale and the semi-structured interview to evaluate the impact of pandemic stress and earthquake. Overall 396 patients with depression and/or anxiety disorders (DAD), 229 participants with schizophrenia spectrum disorders (SSD) and 205 healthy controls were enrolled.

RESULTS

Both patient groups had higher depression and stress levels than controls, independent of sex, age and the presence of somatic comorbidity. After controlling for the same covariates, patient groups had higher COVID-19- and earthquake-related fears than controls. In patients with DAD, both fears were greater than among SSD patients. When comparing the two fears, the fear from earthquake was higher in DAD and control groups, whereas in SSD patients there was no such difference.

CONCLUSIONS

Patients with DAD were the most vulnerable group during disasters, while earthquake seems to be associated with more fear than the pandemics, at least in DAD patients and healthy individuals. Future longitudinal studies should determine if early psychological support might alleviate stress levels after disasters and prevent further worsening of mental health, particularly among DAD patients.

Diurnal fluctuations in steroid hormones tied to variation in intrinsic functional connectivity in a densely sampled male

Most of mammalian physiology is under the control of biological rhythms, including the endocrine system with time-varying hormone secretion. Precision neuroimaging studies provide unique insights into the means through which our endocrine system regulates dynamic properties of the human brain. Recently, we established estrogen's ability to drive widespread patterns of connectivity and enhance the functional efficiency of large-scale brain networks in a woman sampled every 24h across 30 consecutive days, capturing a complete menstrual cycle. Steroid hormone production also follows a pronounced sinusoidal pattern, with a peak in testosterone between 6-7am and nadir between 7-8pm. To capture the brain's response to diurnal changes in hormone production, we carried out a companion precision imaging study of a healthy adult man who completed MRI and venipuncture every 12-24 hours across 30 consecutive days. Results confirmed robust diurnal fluctuations in testosterone, cortisol, and estradiol. Standardized regression analyses revealed predominantly positive associations between testosterone, cortisol, and estradiol concentrations and whole-brain patterns of coherence. In particular, functional connectivity in Dorsal Attention and Salience/Ventral Attention Networks were coupled with diurnally fluctuating hormones. Further, comparing dense-sampling datasets between a man and naturally-cycling woman revealed that fluctuations in sex hormones are tied to patterns of whole-brain coherence to a comparable degree in both sexes. Together, these findings enhance our understanding of steroid hormones as rapid neuromodulators and provide evidence that diurnal changes in steroid hormones are tied to patterns of whole-brain functional connectivity.

Anxiety symptoms before and during the COVID-19 pandemic: A longitudinal examination of Canadian young adults

The COVID-19 pandemic has resulted in many changes that may impact anxiety symptoms (i.e., general anxiety and somatization), particularly for young adults who were at higher risk for anxiety than older adults. We examined anxiety symptoms before (age 19, 20, 21, and 22) and during the pandemic (age 23 and 24) in a cohort of Canadian young adults (n = 396). Latent growth curve models were performed for general anxiety and somatization and the pandemic time points were estimated as structured residuals to quantify the change from participants' expected trajectories. We also examined whether fear of COVID-19 predicted the changes in anxiety symptoms during the pandemic. Results indicated that a history of general anxiety and somatization positively predicted fear of COVID-19 during the pandemic and negatively predicted pandemic change from predicted values for both general anxiety and somatization. Increased COVID-19 fear was related within time to increases in general anxiety at ages 23 and 24 and increases in somatization at age 24. We also found that the proportion of individuals in the subclinical/clinical range of somatization was higher from age 23-24, but not from age 22-23 and there were no differences for general anxiety. Results highlight the need to consider within-person change and development in evaluating anxiety symptom changes and predictors of changes in anxiety symptoms.

The prevalence of anxiety and depression symptoms (ADS), persistent and chronic ADS among the adult general population and specific subgroups before and during the COVID-19 pandemic until December 2021

BACKGROUND

It is unclear to what extent the prevalence of moderate and severe anxiety and depression symptoms (ADS) is higher during the first 20 months after the COVID-19 outbreak than before the outbreak. The same holds for persistent and chronic ADS among the adult general population and subgroups (such as employed, minorities, young adults, work disabled).

METHODS

Data were extracted from six surveys conducted with the Dutch longitudinal LISS panel, based on a traditional probability sample (N = 3493). Biographic characteristics and ADS (MHI-5 scores) were assessed in March-April 2019, November-December 2019, March-April 2020, November-December 2020, March-April 2021, and November-December 2021. Generalized estimating equations were conducted to examine differences in the prevalence of post-outbreak ADS, persistent and chronic ADS compared to the pre-outbreak prevalence in similar periods. The Benjamini-Hochberg correction for multiple testing was applied.

RESULTS

Among the general population chronic moderate ADS increased significantly but slightly in the period March-April 2020 to March-April 2021 compared to a similar period before the pandemic (11.9 % versus 10.9 %, Odds Ratio = 1.11). In the same period a somewhat larger significant increase in chronic moderate ADS was observed among 19-24 years old respondents (21.4 % versus 16.7 %, Odds Ratio = 1.35). After the Benjamini-Hochberg correction several other differences were no longer significant.

LIMITATIONS

No other mental health problems were assessed.

CONCLUSIONS

The Dutch general population and most of the assessed subgroups were relatively resilient given the limited increase or absence of increases in (persistent and chronic) ADS. However, young adults suffered from an increase of chronic ADS.

Resilience and Psychological Well-Being of Polish Women in the Perinatal Period during the COVID-19 Pandemic

PURPOSE

The COVID-19 pandemic, with its multidimensional consequences, is the most serious threat of the 21st century affecting the mental health of women in the perinatal period around the world. Resilience, which assumes the flexible use of an individual's resources in facing adversity, is an important, protective factor influencing mental well-being. The presented study aimed to determine to what extent psychological resilience, mitigates the relationship between adverse consequences of the COVID-19 pandemic and symptoms of depression and anxiety in women in the perinatal period.

METHODS

We recruited pregnant women from 17 February to 13 October 2021, using social media, the parenting portal, and the snowball method. To assess mental well-being, we used: The Edinburgh Postnatal Depression Scale (EPDS), The Beck Depression Inventory (BDI-2), Self-report Labour Anxiety Questionnaire-LAQ and the self-developed COVID-19 Pandemic Anxiety Questionnaire (CRAQ). Resilience was measured usingthe Resilience Measure Questionnaire (KOP26). Multiple Correspondence Analysis (MCA), an independent t-test, and a Pearson correlation analysis were performed.

RESULTS

Low resilience was significantly associated with depressive symptoms (r = -0.46; p < 0.05) and anxiety related to childbirth (r = -0.21; p < 0.05). No associations were found for resilience and pandemic-related stress. Very high and high perinatal anxiety along with the lowest level of resilience clustered with EPDS and BDI-2 scores indicating depression.

CONCLUSIONS

Our study provides evidence that lower levels of resilience during pregnancy may be a significant predictor of increased severity of depressive symptoms and higher levels of anxiety related to childbirth among the perinatal population.

An Ethical Analysis Regarding the COVID-19 Pandemic Impact on Oral Healthcare in Patients with Mental Disorders

During the COVID-19 pandemic, restrictive measures were imposed that significantly impacted the healthcare system in general, and the dental healthcare system in particular. The literature cites a possible association between mental and oral health, as psychiatric patients have decreased awareness of their oral health and, therefore, poor dental status. Moreover, several studies have found a positive association between SARS-CoV-2 infection and oral health conditions, as well as between SARS-CoV-2 infection and mental health status. This context generated multiple ethical dilemmas in the case of persons with mental health disorders who require dental treatment because they are more vulnerable in this respect. This article aims to analyze the ethical issues in dental care for patients with mental disorders concerning the COVID-19 restrictive measures. The ethical aspects involved here are the basic principles of bioethics and the related elements of accessibility, equity, consent, and confidentiality.

Relationship between self-esteem and suicidal ideation before and during COVID-19 in a non-clinical sample: mediating effects of psychological distress and hopelessness

Introduction

Several studies have highlighted the impact of the novel coronavirus disease (COVID-19) pandemic on suicide. Accordingly, investigating the risk factors of suicide during this crisis is important. Based on the escape theory of suicide, the current study examined the serial mediating roles of psychological distress and hopelessness in the relationship between self-esteem and suicidal ideation. It also aimed to explore whether or not the COVID-19 pandemic changed the mediation effect in any way.

Methods

Data were collected from 645 university students before and during the pandemic. The study employed mediation and multi-group analyses to test the hypotheses.

Results

The results demonstrated that individuals with low self-esteem reported high psychological distress, which further lead to hopelessness and eventually heightened suicidal ideation. Multi-group analysis revealed that psychological distress exerted a greater impact on suicidal ideation during COVID-19.

Discussion

The finding suggested that self-esteem, hopelessness, and psychological distress could help elucidate the development of suicidal ideation. Clinicians may target these factors in suicide prevention programs, particularly in the settings of the COVID-19 pandemic or future crisis.