Stress overload in the spread of coronavirus

Stress mindset and nurses' sleep quality: mediating effects of stress overload and anxiety

BACKGROUND

Previous studies have shown that overall sleep quality among Chinese nurses is relatively low, with a sleep disorder prevalence rate of approximately 66.4%. Against the backdrop of healthcare reforms, China has been striving to improve the mental health and sleep quality of nurses. Stress mindset can influence how individuals respond to stress, but there is limited research on how stress mindset affects nurses' sleep quality. This study aims to explore the impact of stress mindset on sleep quality among nurses, as well as the mediating roles of stress overload and anxiety in this relationship.

METHODS

The study was conducted online using a questionnaire from February 18 to February 22, 2024. It utilized the Stress Mindset Measure (SMM), the Stress Overload Scale-Short (SOS-S), the Generalized Anxiety Disorder 7-item scale (GAD-7), and the Pittsburgh Sleep Quality Index (PSQI) to survey 441 nurses in three regions of China: Chongqing, Hunan, and Shandong (M = 34.39, SD = 7.82, 95.7% female). A chain mediation model was employed to examine the mediating roles of stress overload and anxiety in the relationship between stress mindset and sleep quality.

RESULTS

The participants' average sleep quality score was 7.18 ± 3.47. Nurses' stress mindset was significantly negatively correlated with both stress overload and anxiety, and significantly positively correlated with sleep quality. Stress overload was significantly positively correlated with anxiety and significantly negatively correlated with sleep quality. Anxiety was also significantly negatively correlated with sleep quality. The direct effect of nurses' stress mindset on sleep quality was significant (effect size = -0.10, 95% CI: -0.19 to -0.01), as were the indirect effects through stress overload (effect size = -0.05, 95% CI: -0.11 to -0.01) and anxiety (effect size = -0.09, 95% CI: -0.13 to -0.05), along with their chain mediation effect (effect size = -0.10, 95% CI: -0.14 to -0.06).

CONCLUSION

Our study demonstrates that a higher level of nurses' stress mindset is associated with better sleep quality, with stress overload and anxiety mediating this relationship. A positive stress mindset helps nurses cope more effectively with professional challenges and reduces anxiety, leading to improved sleep quality. Healthcare institutions should therefore prioritize fostering positive stress mindsets in nurses, encouraging regular psychological training and workshops to support the development of effective coping strategies.

Factors that influence happiness of nursing students according to COVID-19 infection status

BACKGROUND

Happiness is a cognitive and emotional evaluation of one's life, and the upward approach affects satisfaction and happiness throughout life. Because nursing students must experience medical settings closely related to COVID-19 infection through clinical practice, they are vulnerable to exposure to infection and academic stress, and are also sensitive to personal life satisfaction and happiness. In this study, Korean nursing students who experienced the COVID-19 pandemic during the COVID-19 endemic era were divided into nursing students infected with COVID-19 and non-infected nursing students. By identifying the effects of college life adaptation, leisure satisfaction from club activities, and family health on happiness, which are individual sub-factors of happiness, we intend to provide basic data for the development of intervention programs for promoting their happiness.

METHODS

Data were collected from October 4, 2023 to November 15, 2023. The subjects were 343 students enrolled in five nursing schools in four major cities (D, G, K, and Y) in Korea. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson's correlation coefficients.

RESULTS

For COVID+ students, happiness was significantly affected by adaptation to campus life and family strengths. This model had r2 = 0.401; i.e., it explained 40.1% of the variability in happiness. For COVID0 students, happiness was significantly affected by adaptation to campus life and subjective health status, with r2 = 0.346.

CONCLUSIONS

These results indicate the necessity of developing a happiness-promotion program for nursing students.

Promoting Women's Well-Being: A Systematic Review of Protective Factors for Work-Family Conflict

Work-family conflict is a prominent issue, especially in our society, where people are expected to fulfil many roles simultaneously. Work and family life demands significantly impact an individual's overall well-being, especially for women, since they typically balance caregiving for children and elderly relatives with careers. Therefore, highlighting which factors might protect women from experiencing work-family conflict is essential to enhance women's and their family's well-being. Thus, the main aim of the present study was to systematically review previous research on women's coping strategies and protective factors which can reduce the negative effects of work-family conflict. Following the PRISMA guidelines, we conducted a literature search of three databases (PubMed, PsycINFO, and Scopus). After the screening and the eligibility phases, we included a final set of 13 studies. Most of these studies adopted a cross-sectional design (N = 10), and a few adopted a longitudinal one (N = 3). Results highlighted the role of different personal (e.g., hardiness, self-esteem, locus of control) and relational factors (e.g., family and work support) that significantly reduce the negative effects of work-family conflict in women's lives. Findings, practical implications, and future research directions are discussed.

Stress overload, influencing factors, and psychological experiences of nurse managers during early stages of the COVID-19 pandemic: a sequential explanatory mixed method study

Background

Healthcare systems had an exceptionally difficult time during the early COVID-19 pandemic. Nurse managers in particular made enormous contributions to ensuring the safety of patients and front-line nurses while being under excessive psychological stress. However, little is known about their experiences during this time.

Objective

The aim of this study was thus to assess the level of stress overload and psychological feelings of nurse managers during the early COVID-19 pandemic.

Methods

A mixed methods sequential explanatory design study with non-random convenience sampling was performed, following the STROBE and COREQ checklists. The study was conducted at the Affiliated Dongyang Hospital, Wenzhou Medical University, with data collected from six provinces in southern China (Zhejiang, Hubei, Shanghai, Jiangsu, Hunan and Jiangxi) during March 2020 and June 2020. A total of 966 nurse managers completed the Stress Overload Scale and Work-Family Support Scale. In addition, a nested sample of nurse managers participated in semi-structured face-to-face interviews. The data were then analyzed using qualitative content analysis, Pearson correlation, and multiple linear regression.

Results

The quantitative results showed that nurse managers experienced a moderate level of stress load. There was a significant negative correlation between work-family support and stress load (r = -0.551, p < 0.01). Concerns about protecting front-line nurses and work-family support were the main factors affecting the stress load, which accounted for 34.0% of the total variation. Qualitative analysis identified four main thematic analyses that explained stress load: (1) great responsibility and great stress, (2) unprecedented stress-induced stress response, (3) invisible stress: the unknown was even more frightening, and (4) stress relief from love and support. Taken together these findings indicate that concern about protecting front-line nurses and negative work-family support of nurse managers were the main factors causing stress overload.

Conclusion

Implementing measures focused on individual psychological adjustment combined with community and family support and belongingness is one potential strategy to reduce psychological stress among nurse managers.

Work from home or office during the COVID-19 pandemic: The different chain mediation models of perceived organizational support to the job performance

With the coronavirus pandemic in 2019 (COVID-19), work from home (WFH) has become a frequent way of responding to outbreaks. Across two studies, we examined how perceived organizational support influences job performance when employees work in office or work from home. In study 1, we conducted a questionnaire survey of 162 employees who work in office. In study 2, we conducted a questionnaire survey of 180 employees who work from home. We found that perceived organizational support directly affected job performance when employees work in office. When employees work from home, perceived organizational support could not affect job performance directly. However, it could influence job performance indirectly through the separate mediating effects of job satisfaction and work engagement. These findings extend our understanding of the association of perceived organizational support and job performance and enlighten enterprises on improving employees' job performance during the COVID-19 pandemic.

Prevalence and risk factors of COVID-19-related generalized anxiety disorder among the general public in China: a cross-sectional study

Objective

This study aimed to estimate the prevalence of generalized anxiety disorder in China during the coronavirus disease 2019 (COVID-19) pandemic and identify its associated factors.

Methods

A cross-sectional study was conducted among the general population in China from March 16 to April 2, 2020. The participants were recruited using stratified random sampling. Data on demographic characteristics and COVID-19 related factors were obtained using self-administered questionnaires. The anxiety score was measured based on the Chinese version of the Generalized Anxiety Disorder 7-item Scale (GAD-7).

Results

The study comprised 10,824 participants, of which 37.69% had symptoms of anxiety. The risk factors for anxiety symptoms included poor self-reported health (OR = 1.672, p < 0.001), chronic diseases (OR = 1.389, p < 0.001), and quarantine (OR = 1.365, p < 0.001), while participants' perceptions that COVID-19 would be controlled was a protective factor (OR = 0.774, p < 0.001). The interactions between quarantine and self-reported health (p < 0.001), as well as between perceptions of COVID-19 and self-reported health (p < 0.001) were found to have a significant effect on GAD-7 scores.

Conclusions

Self-reported health status, chronic diseases, quarantine, and perceptions of COVID-19 were significantly associated with GAD-7 scores, indicating that mental health interventions are urgently needed during pandemics, especially for high-risk groups.

Marriage and health: exploring the role of stress overload

BACKGROUND AND OBJECTIVES

The association between marital status and health is well-established, but its causes remain unclear. This study was the first to examine stress overload, the pathogenic form of stress, as a possible explanation.

DESIGN

The study employed a cross-sectional design and convenience sample to explore relationships among stress overload, marital status, social support, and illness.

METHODS

A diverse sample (n = 455), recruited from community and social media sites, completed an anonymous online survey. Included were standardized measures of stress overload (SOS-S), perceived social support (MSPSS), and somatic symptoms (PHQ-15).

RESULTS

Married participants reported lower stress overload levels than those in any other type of relationship (single, in-a-relationship, or cohabiting). They did not differ from the unmarried in overall level of social support, nor did statistically controlling social support or income levels erase the stress overload differential. They also reported lower levels of symptomology than the unmarried. SEM analyses yielded a best-fitting model showing stress overload to partially mediate the link between marital status and symptoms.

CONCLUSIONS

Stress overload is one mechanism that explains the marital health disparity, albeit not the only one. This holds implications for future research and practice focused on personal relationships and well-being.

Factors Associated With Severity of COVID-19 Disease in a Multicenter Cohort of People With HIV in the United States, March-December 2020

BACKGROUND

Understanding the spectrum of COVID-19 in people with HIV (PWH) is critical to provide clinical guidance and risk reduction strategies.

SETTING

Centers for AIDS Research Network of Integrated Clinic System, a US multisite clinical cohort of PWH in care.

METHODS

We identified COVID-19 cases and severity (hospitalization, intensive care, and death) in a large, diverse HIV cohort during March 1, 2020-December 31, 2020. We determined predictors and relative risks of hospitalization among PWH with COVID-19, adjusted for disease risk scores.

RESULTS

Of 16,056 PWH in care, 649 were diagnosed with COVID-19 between March and December 2020. Case fatality was 2%; 106 (16.3%) were hospitalized, and 12 died. PWH with current CD4 count <350 cells/mm 3 [aRR 2.68; 95% confidence interval (CI): 1.93 to 3.71; P < 0.001] or lowest recorded CD4 count <200 cells/mm 3 (aRR 1.67; 95% CI: 1.18 to 2.36; P < 0.005) had greater risks of hospitalization. HIV viral load and antiretroviral therapy status were not associated with hospitalization, although most of the PWH were suppressed (86%). Black PWH were 51% more likely to be hospitalized with COVID-19 compared with other racial/ethnic groups (aRR 1.51; 95% CI: 1.04 to 2.19; P = 0.03). Chronic kidney disease, chronic obstructive pulmonary disease, diabetes, hypertension, obesity, and increased cardiovascular and hepatic fibrosis risk scores were associated with higher hospitalization risk. PWH who were older, not on antiretroviral therapy, and with current CD4 count <350 cells/mm 3 , diabetes, and chronic kidney disease were overrepresented among PWH who required intubation or died.

CONCLUSIONS

PWH with CD4 count <350 cells/mm 3 , and a history of CD4 count <200 cells/mm 3 , have a clear excess risk of severe COVID-19, accounting for comorbidities associated with severe outcomes. PWH with these risk factors should be prioritized for COVID-19 vaccination and early treatment and monitored closely for worsening illness.

Racial and ethnic disparities in coronavirus disease 2019 disease incidence independent of comorbidities, among people with HIV in the United States

OBJECTIVES

To define the incidence of clinically detected coronavirus disease 2019 (COVID-19) in people with HIV (PWH) in the United States and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19.

DESIGN

Observational study within the CFAR Network of Integrated Clinical Systems cohort in seven cities during 2020.

METHODS

We calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4+ cell count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores.

RESULTS

Among 16 056 PWH in care, of whom 44.5% were black, 12.5% were Hispanic, with a median age of 52 years (IQR 40-59), 18% had a current CD4+ cell count less than 350 cells/μl, including 7% less than 200; 95.5% were on antiretroviral therapy (ART), and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and black PWH respectively, than non-Hispanic white PWH. In adjusted analyses, factors associated with COVID-19 included female sex, Hispanic or black identity, lowest historical CD4+ cell count less than 350 cells/μl (proxy for CD4+ nadir), current low CD4+ : CD8+ ratio, diabetes, and obesity.

CONCLUSION

Our results suggest that the presence of structural racial inequities above and beyond medical comorbidities increased the risk of COVID-19 among PWH. PWH with immune exhaustion as evidenced by lowest historical CD4+ cell count or current low CD4+ : CD8+ ratio had greater risk of COVID-19.

The Association between Perceived Stress, Psychological Distress, and Job Performance During the COVID-19 Pandemic: the Buffering Role of Health-Promoting Management Practices

The first objective of the present study was to investigate the association between perceived stress, psychological distress, and job performance among workers during the first wave of the COVID-19 pandemic. As a second objective, this study sought to examine whether management practices aimed at promoting employees’ psychological health can moderate this relationship. A total of 435 workers answered a self-reported questionnaire assessing perceived stress, psychological distress, and job performance as well as health-promoting management practices adopted by their manager, which focused on establishing work structure, demonstrating consideration and showing support. Results indicated that perceived stress was negatively associated with job performance and this relation was mediated by psychological distress. Moderation analysis revealed that for low and average levels of health-promoting management practices, perceived stress was negatively associated with job performance. However, when workers perceived that their supervisor adopted several health-promoting management practices, the association between perceived stress and job performance became non-significant. Also, the association between perceived stress and psychological distress was positive and significant for all levels of health-promoting management practices, but its strength diminished as management practice increased. Finally, a moderated mediation analysis indicated that the indirect effect of perceived stress on job performance through psychological distress was moderated by health-promoting management practices. This study contributes to the advancement of knowledge by demonstrating that, in a context of a crisis which can cause considerable stress, such as the COVID-19 pandemic, health-promoting management practices can buffer the deleterious effect of perceived stress on psychological health and job performance.

Racial and ethnic disparities in COVID-19 disease incidence independent of comorbidities, among people with HIV in the US

OBJECTIVES

To define the incidence of clinically-detected COVID-19 in people with HIV (PWH) in the US and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19.

DESIGN

Observational study within the CFAR Network of Integrated Clinical Systems cohort in 7 cities during 2020.

METHODS

We calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4 count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores.

RESULTS

Among 16,056 PWH in care, of whom 44.5% were Black, 12.5% were Hispanic, with a median age of 52 years (IQR 40-59), 18% had a current CD4 count < 350, including 7% < 200; 95.5% were on antiretroviral therapy, and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and Black PWH respectively, than non-Hispanic White PWH. In adjusted analyses, factors associated with COVID-19 included female sex, Hispanic or Black identity, lowest historical CD4 count <350 (proxy for CD4 nadir), current low CD4/CD8 ratio, diabetes, and obesity.

CONCLUSIONS

Our results suggest that the presence of structural racial inequities above and beyond medical comorbidities increased the risk of COVID-19 among PWHPWH with immune exhaustion as evidenced by lowest historical CD4 or current low CD4:CD8 ratio had greater risk of COVID-19.

Stress research during the COVID-19 pandemic and beyond

The COVID-19 pandemic confronts stress researchers in psychology and neuroscience with unique challenges. Widely used experimental paradigms such as the Trier Social Stress Test feature physical social encounters to induce stress by means of social-evaluative threat. As lockdowns and contact restrictions currently prevent in-person meetings, established stress induction paradigms are often difficult to use. Despite these challenges, stress research is of pivotal importance as the pandemic will likely increase the prevalence of stress-related mental disorders. Therefore, we review recent research trends like virtual reality, pre-recordings and online adaptations regarding their usefulness for established stress induction paradigms. Such approaches are not only crucial for stress research during COVID-19 but will likely stimulate the field far beyond the pandemic. They may facilitate research in new contexts and in homebound or movement-restricted participant groups. Moreover, they allow for new experimental variations that may advance procedures as well as the conceptualization of stress itself. While posing challenges for stress researchers undeniably, the COVID-19 pandemic may evolve into a driving force for progress eventually.

Coping with COVID-19 stress: Associations with depression and anxiety in a diverse sample of U.S. adults

The COVID-19 pandemic has brought unprecedented levels of stress to individuals in the U.S. and throughout the world. These high stress levels place individuals at risk for symptoms of anxiety, depression, and other psychiatric disorders. The current study applies a control-based model of coping to contribute to the development of evidence-based interventions to promote resilience. Data were collected online from April 22 through July 12, 2020. Data from two samples of U. S. community adults who completed an online battery of standardized questionnaires were combined (N = 709). More than a quarter reported moderate to severe levels of depression symptoms, and more than one-fifth reported moderate to severe levels of anxiety symptoms; symptom levels were higher among adults who reported more COVID-19-related stress. As hypothesized, multiple regression analyses indicated that greater use of primary and secondary control coping was associated with lower symptom levels, whereas greater use of disengagement coping was associated with higher symptom levels, above and beyond the association of stress with symptoms. Race and ethnicity emerged as important moderators of these associations, indicating that what constitutes adaptive coping varies according to characteristics of the individual. Implications for public health policy and clinical practice are discussed.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-021-02444-6.

Factors associated with severity of COVID-19 disease in a multicenter cohort of people with HIV in the United States, March-December 2020

BACKGROUND

Understanding the spectrum of SARS-CoV-2 infection and COVID-19 disease in people with HIV (PWH) is critical to provide clinical guidance and implement risk-reduction strategies.

OBJECTIVE

To characterize COVID-19 in PWH in the United States and identify predictors of disease severity.

DESIGN

Observational cohort study.

SETTING

Geographically diverse clinical sites in the CFAR Network of Integrated Clinical Systems (CNICS).

PARTICIPANTS

Adults receiving HIV care through December 31, 2020.

MEASUREMENTS

COVID-19 cases and severity (hospitalization, intensive care, death).

RESULTS

Of 16,056 PWH in care, 649 were diagnosed with COVID-19 between March-December 2020. Case fatality was 2%; 106 (16.3%) were hospitalized and 12 died. PWH with current CD4 count <350 cells/mm ³ (aRR 2.68; 95%CI 1.93-3.71; P<.001) or lowest recorded CD4 count <200 (aRR 1.67; 95%CI 1.18-2.36; P<.005) had greater risk of hospitalization. HIV viral load suppression and antiretroviral therapy (ART) status were not associated with hospitalization, although the majority of PWH were suppressed (86%). Black PWH were 51% more likely to be hospitalized with COVID-19 compared to other racial/ethnic groups (aRR 1.51; 95%CI 1.04-2.19, P=.03). Chronic kidney disease (CKD), chronic obstructive pulmonary disease, diabetes, hypertension, obesity, and increased cardiovascular and hepatic fibrosis risk scores were associated with higher risk of hospitalization. PWH who were older, not on ART, with current CD4 <350, diabetes, and CKD were overrepresented amongst PWH who required intubation or died.

LIMITATIONS

Unable to compare directly to persons without HIV; underestimate of total COVID-19 cases.

CONCLUSIONS

PWH with CD4 <350 cells/mm ³ , low CD4/CD8 ratio, and history of CD4 <200, have a clear excess risk of severe COVID-19, after accounting for comorbidities also associated with severe outcomes. PWH with these risk factors should be prioritized for COVID-19 vaccination, early treatment, and monitored closely for worsening illness.

Differences in Stress and Coping During the COVID-19 Pandemic in Families With and Without Children With Developmental Disorders or Chronic Conditions

Objectives: To compare COVID-19-induced stress and coping in families with and without children diagnosed with developmental disorders or chronic conditions. Methods: In this mixed-method design study, an online survey collected information on parental stress levels before and during COVID-19, sources of stress, and coping strategies using open-ended questions. Qualitative answers were categorized thematically. Multiple linear regression models were built for the association between changes in stress levels (during-before COVID-19) and sources of stress for parents of children of both groups. Results: Answers of 1,827 parents were analyzed; of these, 186 (9.75%) had children with diagnosed problems. Changes in stress levels during vs. before COVID-19 were associated with the age of the parent, changes in working conditions, a total number of stressors, and distance learning of children. Stronger associations were found for parents of children with diagnoses. For example, for distance learning, the standardized beta (β) was 0.68 (95% confidence interval 0.37; 1.00) for parents of children without problems and β = 0.73 (0.43; 1.03) for those with problematic children. Conclusions: Parents of children with developmental disorders need specific attention in a pandemic.