REACH for mental health in the COVID19 pandemic: an urgent call for public health action

Mental health, stress, and well-being measured before (2019) and during (2020) COVID-19: a Swedish socioeconomic population-based study

OBJECTIVES

Compare mental health, stress, and well-being in the Swedish population as measured before and during the COVID-19 pandemic.

METHODS

Repeated cross-sectional design using data measured before (Jan-2019; n = 2791) and during (Oct/Nov-2020; n = 2926) COVID-19 pandemic in Swedish population-representative cohorts. Following constructs were measured: anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory-II), stress (Perceived Stress Scale-10 items), health-related quality of life (HRQOL[Functional Assessment of Cancer Therapy-General Population]) and self-rated health (SRH) was assessed with a single-item question.

RESULTS

When adjusting for age, sex, education, and income there were significantly higher levels of anxiety (M̂ = 9.15 vs. 8.48, p < 0.01) and depression (M̂ = 3.64 vs. 3.30, p = 0.03), lower levels of stress (M̂ = 14.06 vs. 14.91, p < 0.001), but worsened HRQOL (M̂ = 76.40 vs. 77.92, p < 0.01) and SRH (M̂ = 6.91 vs. 7.20, p < 0.001), observed in 2020 compared to 2019. For the negative effects seen in anxiety, depression, HRQOL, and SRH, higher income and education had a protective effect. The decrease in stress was also correlated with higher income.

CONCLUSIONS

The COVID-19 pandemic led to a small but significant worsening in mental health and well-being in the general Swedish population, where higher socioeconomic status seemed to have a protective effect.

Text Messages for Depression, Anxiety and Alcohol Abuse Therapy-Are Construction Guidelines Needed?

Despite the effectiveness of text messaging therapy in improving mental health conditions, limited attention has been paid to how the text messages are constructed. Thus, this study questions whether there is a need to develop a model of text message construction for mental health therapy. In this backdrop, this study reviews how a text message for mental health therapy is constructed, specifically focused on the process and guidelines. This study also aims to identify the research gap regarding the guideline of text message construction for mental health therapy and to identify mental health professionals' practices in text messaging therapy. In addition, the opinions of mental health professionals on the need to develop a text message construction guideline were also gathered. The findings from the literature review confirmed that there are still limited guidelines explaining the process of constructing text messages for mental health therapy. Meanwhile, results from the online survey found that mental health professionals expressed a high need to explore and develop a model of text message construction for mental health therapy. With this research gap addressed, this study proposes further research into the development of a text message construction model for mental health therapy.

Analyzing the research trends of COVID-19 using topic modeling approach

Purpose

The COVID-19 pandemic has impacted 222 countries across the globe, with millions of people losing their lives. The threat from the virus may be assessed from the fact that most countries across the world have been forced to order partial or complete shutdown of their economies for a period of time to contain the spread of the virus. The fallout of this action manifested in loss of livelihood, migration of the labor force and severe impact on mental health due to the long duration of confinement to homes or residences.

Design/methodology/approach

The current study identifies the focus areas of the research conducted on the COVID-19 pandemic. Abstracts of papers on the subject were collated from the SCOPUS database for the period December 2019 to June 2020. The collected sample data (after preprocessing) was analyzed using Topic Modeling with Latent Dirichlet Allocation.

Findings

Based on the research papers published within the mentioned timeframe, the study identifies the 10 most prominent topics that formed the area of interest for the COVID-19 pandemic research.

Originality/value

While similar studies exist, no other work has used topic modeling to comprehensively analyze the COVID-19 literature by considering diverse fields and domains.

Understanding the mental health impacts of COVID-19 through a trauma lens

This special issue of the European Journal of Psychotraumatology (EJPT) presents the first studies published by EJPT on COVID-19. We present 26 qualitative and quantitative studies assessing the prevalence of trauma-related symptoms and psychopathology within specific vulnerable populations such as health-care workers, students, children, and managers, or more broadly at a country level with a diverse set of outcomes including post-traumatic stress, moral injury, grief and post-traumatic growth. Intervention studies focus on whether telehealth delivery of mental health therapy in the pandemic environment was useful and effective. It is clear that the pandemic has brought with it a rise in trauma exposure and consequently impacted on trauma-related mental health. While for many individuals, COVID-19-related events met criteria for a DSM-5 Criterion A event, challenges remain in disentangling trauma exposure from stress, anxiety, and other phenomena. It is important to determine the contexts in which a trauma lens makes a useful contribution to understanding the mental health impacts of COVID-19 and the ways in which this may facilitate recovery. The papers included in this Special Issue provide an important and much-needed evidence-based foundation for developing trauma-informed understanding and responses to the pandemic.

Impact of COVID-19 on mental health according to prior depression status: A mental health survey of community prospective cohort data

OBJECTIVE

We aimed to investigate the mental health impact of COVID-19 on a demographically well-characterized population cohort by gender and previous depression status.

METHODS

Among people who participated in a community cohort study between 2013 and 2018 with previous depression measurement, a total of 1928 people without quarantine experience (680 men and 1249 women) were included after responding to an online survey in March 2020. In the 2020 survey, people were queried about daily needs supply, social support, risk perception, change during the COVID-19 pandemic, as well as mental health indices measuring loneliness, anxiety symptoms, post-traumatic stress disorder (PTSD), and depression. Separate analyses by gender were conducted to assess the association between COVID-19-related experiences and each mental health index, using multivariable logistic regressions with additional adjustment and stratification with pre-existing depression status.

RESULTS

We could not observe significant gender differences for depression, anxiety, PTSD, and loneliness at 55 days after the start of the COVID-19 outbreak. Most external support, including daily needs supply and social support, protected men and women from experiencing severe anxiety (for life supply, OR = 0.92 (95%CI 0.88-0.97) (men) and OR = 0.95 (95% CI 0.91-0.99) (women); for social support, OR = 0.92(both for men and women, p < 0.01)). The results were similar for depression and PTSD. External support showed a larger reduction in the likelihoods for anxiety and depression during the COVID-19 pandemic among people with pre-existing depression compared to previously healthy people, and it was more prominent in men.

CONCLUSION

COVID-19 significantly affected the mental health of both men and women in the early period of the pandemic. Having enough supply of daily needs and social support seems important, especially for people with previous depression.

Selection of Production Mix in the Agricultural Machinery Industry Considering Sustainability in Decision Making

Competition among companies is growing globally, with the need to increase productivity and efficiency in the product sector. However, there is also a growing concern about global warming and the depletion of natural resources, as well as their effects on human health. In this context, all human activities that involve intense usage of resources must take into account sustainability as one of the decision criteria. This work presents the application of decision-making methods to define the best product mix in the agricultural machinery industry. With this objective, the current schedule of the production line was identified, along with the production flow, by performing an inventory analysis and an environmental impact study (endpoint). A total of seven alternatives for the production mix of grain trailers were defined, considering different materials and production processes. The selection of the best schedule according to the different criteria was performed through the analytic hierarchy process (AHP) and data envelopment analysis (DEA) to evaluate the managerial implications for decision making. The results obtained through AHP identified a single alternative as being the best, which facilitates the decision making. The DEA method identified two alternatives as the most efficient, and in this case the manager can choose between a product mix that generates lesser environmental impact or greater profitability. Although applied to agricultural industry, the presented methodology can be easily adapted to other activities related to the built environment, such as construction industry.

The interplay between anxiety, fear, protective behaviors, compassion, and resilience among older adults during a COVID-19 lockdown: a structural equation modeling study

The implementation of lockdown measures to curb the transmission of Coronavirus disease-2019 (COVID-19) has brought about significant psychological impacts and older adults have been identified as one of the vulnerable groups. In the current COVID-19 context among older adults in the community, the fear of COVID-19, anxiety symptoms, compassion, resilience, and the practice of protective behaviors are possibly related to each other in several ways. How these factors relate to each other would have important implications in managing the spread of the disease and its mental health consequences. To this end, we modeled their interrelationships using a structural equation model. Older adults (N = 421), aged 60 and above completed various questionnairesCOVID-19 Fear Inventory, Short form of the Geriatric Anxiety Inventory, COVID-19 Risky and Protective Behaviours, Resilience Appraisals Scale, and Compassion Scale during a COVID-19 lockdown. The relationships between these variables were assessed within a structural equation model. The findings showed that older adults who are more compassionate engage in protective behaviors more frequently. Additionally, frequent practice of protective behaviors and greater resilience predicted lower anxiety among older adults. Greater fear predicted higher anxiety levels but did not significantly influence an individuals engagement in protective behaviors. Mental health services are crucial in fostering resilience and supporting older adults psychologically. Social services are also necessary in maintaining and enhancing social support for older adults. Importantly, these findings suggest that public health communications could promote compassion and avoid using a fear-based approach to increase engagement in protective behaviors.

This study focused on the interrelations between various psychosocial factors (i.e., fear of COVID-19, compassion, and resilience) and the behavioral (i.e., engagement in protective health behaviors) and psychological responses (i.e., anxiety) to COVID-19 among community-dwelling older adults. The study analyzed self-reported data from 421 older adults who are aged 60 and above. The findings showed that older adults who are more compassionate engage in protective behaviors more frequently. Additionally, older adults who showed greater resilience and engage in protective health behaviors more frequently reported lower anxiety levels. Lastly, greater fear of COVID-19 predicted greater anxiety among older adults but did not significantly influence their engagement in protective health behaviors.

The Experience of Patients with COVID-19 in China: An Interpretative Phenomenological Analysis

Aim

The present study examined the experiences of patients diagnosed with COVID-19 to better understand their concerns and inspiration and provide better care.

Methods

Semistructured interviews were performed with 10 COVID-19 patients from the Optical Valley Branch of Maternity and Child Healthcare Hospital of Hubei Province. Interviews were recorded on audiotape and transcribed verbatim. Transcripts were analysed using an interpretative phenomenological analysis.

Results

Four superordinate themes emerged: psychological distress caused by COVID-19 uncertainty, ethical dilemmas that will be faced after returning to the family and society, resources to cope with COVID-19, and event-related growth experience.

Conclusion

Patients with COVID-19 were generally at high risk of having mental and social health challenges. Although the epidemic obviously affected their overall health, which led to their negative emotions or concerns, it also had a positive effect, such as viewing their relationship with families or others more positively and having more thoughts and outlooks on life. The study prompted medical staff to take their time listening to patients and pay more attention to specific psychological and social health problems in future care.

Psychosocial Aspects During the First Wave of COVID-19 Infection in South Africa

Background: In South Africa, as in many countries, the nationwide spread of COVID-19 caused a public health emergency that resulted in the government implementing necessary restrictive measures such as the nationwide lockdown as a way of containing the pandemic. Such restrictive measure, while necessary, can disrupt many aspects of people's lives resulting in unprecedented psychosocial distress. Aim: The present study aims to describe the psychosocial health and situational factors associated with the novel coronavirus (COVID-19) in South Africa during the first wave of infection. Methods: This cross-sectional survey, recruited a total of 203 participants through convenience sampling via online platforms-WhatsApp, Facebook, emails, etc.-during COVID-19 lockdown in the country. Through the snowball technique, participants from across South Africa completed the online survey that assessed socio-demographic information, risk perception, history of mental health, COVID-19-related stress, and fears during the lockdown (first wave). Results: The majority of the participants who completed the survey were young, Black African, and female. Participants reported feelings of stress and anxiety (61.2%); stress about finances (39.5%); and feelings of sadness, anger, and/or frustration (31.6%) during the lockdown. Females compared to males were more likely to perceive COVID-19 as a risk to their household,X ( 20 ) 2 = 45,844, p < 0.001 and community,X ( 20 ) 2 = 40,047, p = 0.005. COVID-19 differentially impacted the mental health of participants with and without mental health diagnosis,X ( 4 ) 2 = 16.596, p = 0.002. Participants with a prior mental health diagnosis reported significant extra stress during lockdown (p < 0.05). Conclusion: The findings may be of significance to assist in the development of targeted psychosocial interventions to help people during and after the pandemic.

Prevalence and Determinants of Immediate and Long-Term PTSD Consequences of Coronavirus-Related (CoV-1 and CoV-2) Pandemics among Healthcare Professionals: A Systematic Review and Meta-Analysis

Background: The COVID-19 pandemic continues to rise. In order to control the COVID-19 pandemic, healthcare professionals have been subjected to increased exposure to work stress. In this systematic review, we aimed at investigating the prevalence and determinants of immediate and long-term post-traumatic stress disorder (PTSD) effects on healthcare professionals by the COVID-19 (SARS CoV-2) and SARS-2003 (SARS CoV-1) pandemics. Methods: This systematic review was conducted according to the recommendations of the Protocols for Systemic Review and Meta-Analysis (PRISMA) statement. Only studies reporting the prevalence of PTSD (frequency, percentage) and related risk factors (adjusted odds ratio (OR)) in healthcare professionals (HCPs) during the SARS CoV-2 and SARS CoV-1 pandemics were included. The following databases were screened: Medline, Embase, PsychINFO, and Health Psychosocial Instrument (HaPI). Results: Six of eight studies reported PTSD symptoms among healthcare professionals during the COVID-19 pandemic in China (three), Singapore (one), India (one), and the United States of America (USA) (two), while two studies reported symptoms during the SARS-2003 pandemic in China (one) and Singapore (one). Sample sizes ranged from 263 to 5062 with a combined total of 10,074 participants. All of the studies self-reported the level of exposure to coronaviruses (CoV-1 and CoV-2) and severity of PTSD. Seven studies reported the prevalence of immediate PTSD and determinants, while one study reported delayed-onset PTSD (3 years after CoV-1 pandemic). Determinants of immediate PTSD were reported for the CoV-2 pandemic, while those for long-term PTSD were reported for the CoV-1 pandemic. Conclusions: A comprehensive understanding of the prevalence and determinants of immediate or long-term pandemic PTSD for healthcare workers can improve prevention, diagnosis, and management. Rigorous research measuring the prevalence of PTSD and its associated risk factors (adjusted OR) for the CoV-2 pandemic are envisaged. Although strategies to resolve immediate PTSD are key, long-term PTSD must not be overlooked.

Mental health responses to COVID-19 around the world

Background: The mental health impact of the COVID-19 crisis may differ from previously studied stressful events in terms of psychological reactions, specific risk factors, and symptom severity across geographic regions worldwide. Objective: To assess the impact of COVID-19 on a wide range of mental health symptoms, to identify relevant risk factors, to identify the effect of COVID-19 country impact on mental health, and to evaluate regional differences in psychological responses to COVID-19 compared to other stressful events. Method: 7034 respondents (74% female) participated in the worldwide Global Psychotrauma Screen - Cross-Cultural responses to COVID-19 study (GPS-CCC), reporting on mental health symptoms related to COVID-19 (n = 1838) or other stressful events (n = 5196) from April to November 2020. Results: Events related to COVID-19 were associated with more mental health symptoms compared to other stressful events, especially symptoms of PTSD, anxiety, depression, insomnia, and dissociation. Lack of social support, psychiatric history, childhood trauma, additional stressful events in the past month, and low resilience predicted more mental health problems for COVID-19 and other stressful events. Higher COVID-19 country impact was associated with increased mental health impact of both COVID-19 and other stressful events. Analysis of differences across geographic regions revealed that in Latin America more mental health symptoms were reported for COVID-19 related events versus other stressful events, while the opposite pattern was seen in North America. Conclusions: The mental health impact of COVID-19-related stressors covers a wide range of symptoms and is more severe than that of other stressful events. This difference was especially apparent in Latin America. The findings underscore the need for global screening for a wide range of mental health problems as part of a public health approach, allowing for targeted prevention and intervention programs.

To share or not to share - 10 years of European Journal of Psychotraumatology

The European Journal of Psychotraumatology, owned by the European Society for Traumatic Stress Studies (ESTSS), launched as one of the first full Open Access 'specialist' journals in its field. Has this Open Access model worked in how the Journal has performed? With the European Journal of Psychotraumatology celebrating its ten-year anniversary we look back at the past decade of sharing our research with the world and with how the journal sits with the broader movement beyond Open Access to Open Research and we present new policies we have adopted to move the field of psychotraumatology to the next level of Open Research. While we as researchers now make our publications more often freely available to all, how often do we share our protocols, our statistical analysis plans, or our data? We all gain from more transparency and reproducibility, and big steps are being made in this direction. The journal's decennial performance as well as the exciting new Open Research developments are presented in this editorial. The journal is no longer in its infancy and eager to step into the next decade of Open Research.

Trauma-informed responses in addressing public mental health consequences of the COVID-19 pandemic: position paper of the European Society for Traumatic Stress Studies (ESTSS)

The COVID-19 pandemic has changed life in Europe and globally. The pandemic affects both individuals and the broader society across many domains, including physical and psychological health, the economy and general welfare. The measures taken to counteract the pandemic have significantly altered daily life and, along with the threat of contracting the coronavirus and uncertainties surrounding future developments, created a complex system of stressors with a negative impact on public mental health. This paper aims to outline the ESTSS strategy to address mental health issues related to COVID-19 and focuses on (1) trauma-informed policies, (2) capacity building, (3) collaborative research and (4) knowledge-exchange. To facilitate implementation of a trauma-informed approach and appropriate measures, ESTSS has developed a toolkit of recommendations on mental health and psychosocial assistance to be provided during the different phases of crisis and its aftermath. To promote capacity building, ESTSS offers a certification programme based on a curriculum in psychotraumatology and corresponding on-line training to the European community of mental health professionals. To assure evidence-based approaches and methods tailored to current circumstances, ESTSS has initiated a pan-European research project with international cooperation aimed at studying the mental health consequences of the pandemic, with a focus on psychological trauma and other stress-related reactions. To foster knowledge-exchange, the European Journal of Psychotraumatology (EJPT), the official journal of ESTSS, is publishing a special issue on COVID-19.