Stressors, coping and symptoms of adjustment disorder in the course of the COVID-19 pandemic - study protocol of the European Society for Traumatic Stress Studies (ESTSS) pan-European study

A longitudinal study of risk and protective factors for symptoms of adjustment disorder during the COVID-19 pandemic

Background: The COVID-19 pandemic caused multiple stressors that may lead to symptoms of adjustment disorder.Objective: We longitudinally examined relationships between risk and protective factors, pandemic-related stressors and symptoms of adjustment disorder during the COVID-19 pandemic, as well as whether these relationships differed by the time of assessment.Method: The European Society for Traumatic Stress Studies (ESTSS) ADJUST Study included N = 15,169 participants aged 18 years and above. Participants from 11 European countries were recruited and screened three times at 6-month intervals from June 2020 to January 2022. Associations between risk and protective factors (e.g. gender), stressors (e.g. fear of infection), and symptoms of adjustment disorder (AjD, ADNM-8) and their interaction with time of assessment were examined using mixed linear regression.Results: The following predictors were significantly associated with higher AjD symptom levels: female or diverse gender; older age; pandemic-related news consumption >30 min a day; a current or previous mental health disorder; trauma exposure before or during the pandemic; a good, satisfactory or poor health status (vs. very good); burden related to governmental crisis management and communication; fear of infection; restricted social contact; work-related problems; restricted activity; and difficult housing conditions. The following predictors were associated with lower AjD levels: self-employment or retirement; working in healthcare; and face-to-face contact ≥ once a week with loved ones or friends. The effects of the following predictors on AjD symptoms differed by the time of assessment in the course of the pandemic: a current or previous mental disorder; burden related to governmental crisis management; income reduction; and a current trauma exposure.Conclusions: We identified risk factors and stressors predicting AjD symptom levels at different stages of the pandemic. For some predictors, the effects on mental health may change at different stages of a pandemic.

Savoring mediates the mental health benefits of positive coping processes: A prospective population-based analysis

Positive coping (e.g., self-efficacy and positive reappraisal) and savoring could bear mental health implications under large-scale disasters such as COVID-19. The integrative affect-regulation framework of psychological resilience proposes that evaluative efforts regulate affect, which then predicts positive short-term consequences and better mental health. This two-wave study was done during the prolonged, intensive COVID-19 control rules in Hong Kong and examined (1) the prospective associations of positive coping processes (i.e., self-efficacy and positive reappraisal) (T1, March-August 2021) with subsequent psychiatric symptoms (T2, September 2021-February 2022) and (2) the mediating effect of T2 savoring in the associations. Path analyses revealed that T1 self-efficacy and positive reappraisal were inversely related to T2 psychiatric symptoms. T2 savoring partially mediated the effect of T1 self-efficacy but fully mediated the effect of T1 positive reappraisal. Self-efficacy could have more sustainable direct positive associations with mental health, whereas the benefit of positive reappraisal might need to be catalyzed by savoring over time. Our study offered concrete illustrations of the conceptual tenets of the affect-regulation framework.

Trajectories of Adjustment Disorder and Well-Being in Austria and Croatia during 20 Months of the COVID-19 Pandemic

The present study aimed to investigate the trajectories of adjustment disorder (AD) symptoms and well-being over 20 months of the COVID-19 pandemic in Austria and Croatia. Further objectives of this study were to examine whether sociodemographic characteristics and the symptoms of anxiety and depression could predict these trajectories. As part of the pan-European ESTSS ADJUST study, N = 1144 individuals were recruited using convenience sampling and assessed four times between June 2020 and January 2022 through an online survey. Latent growth curve modelling was applied to estimate the trajectories of AD symptoms and well-being. Over time, the prevalence of probable AD varied between 9.8% and 15.1%. The symptoms of AD tended to increase, whereas well-being tended to decrease. According to the majority of the models tested, women, participants from Austria and those with lower income had higher initial AD symptoms, whereas older participants and those from Croatia had higher initial well-being. In all models and at all timepoints, anxiety and depression significantly predicted AD and well-being scores. Overall, our study points to several predictors of AD and well-being and indicates high variability in people's reactions to the pandemic. Psychosocial support for the general population is needed during pandemics and similar crises, with a special focus on vulnerable groups.

Interpersonal psychotherapy for traumatic grief following a loss due to COVID-19: a case report

Interpersonal psychotherapy (IPT) is a highly regarded evidence-based psychotherapy that aims to alleviate the suffering of clients and improve their interpersonal functioning. Research has demonstrated the effectiveness of IPT in depressive, bipolar and eating disorders. IPT also focuses on grief and loss as a problem area to help clients address and process their grief symptoms, leading them to reach a phase of finding meaning. However, traumatic grief which is characterized by someone who has both symptoms of trauma and grief can further complicate treatment. As for Posttraumatic Stress Disorder (PTSD), IPT can be a choice of treatment by addressing perceived isolation and emotional dysregulation through mobilizing adequate social support. This case study highlights the efficacy of IPT in treating complicated grief with traumatic experiences caused by the loss of a loved one during the COVID-19 pandemic, without undergoing exposure-based therapy. The treatment course consisted of 12 sessions scheduled twice weekly, and the client received antidepressant medication augmented with antipsychotic medication. After undergoing IPT, the client experienced an improvement in symptoms, gradual recovery of functional disability, and more meaningful interpersonal relationships. The case study presented provides evidence to suggest that IPT is a promising treatment approach for individuals struggling with trauma related to grief.

A predictive model of perceived stress during the first wave of the COVID-19 pandemic in university students Ecuadorians

Background and objectives

The situation caused by the confinement due to the COVID-19 pandemic and the mobility restriction implemented by governments worldwide had a significant impact on people's routines. Stressors are known to increase emotional imbalance, uncertainty, and frustration in the general population. This study explores the factors that predispose to the risk of perceived stress from COVID-19 and determines the underlying mediating mechanisms in the Ecuadorian population.

Method

The cross-sectional study an incidental non-probabilistic sample of n = 977 participating student volunteers from the four regions of the Republic of Ecuador (68.6% women and 31.4% men). Data on emotional regulation (ERQ), perceived stress (PSS), active procrastination (APS), diagnosis and symptoms related to COVID-19, social isolation, coexistence, and a sociodemographic questionnaire (biological sex, marital status, and age) were recruited. Statistical analysis was based on a structural equation model.

Results

The risk of suffering perceived stress in the COVID-19 pandemic was higher for single women who have lived longer in social isolation, have lived with more people, have poor emotional regulation and high rates of procrastination. This structural model is similar in all Ecuadorian regions χ² = 21.54 (p = 0.760), RMSEA = 0.001 (95%CI, 0.00-0.02), CFI = 0.998; TLI = 0.999; SRMR = 0.020.

Discussion

Although our findings are consistent and revealing for the scientific community, the lack of discrimination of the data due to strict isolation measures, taken at different periods by the Ecuadorian government against positive cases of COVID-19, is discussed. The research was applied to the university population, it would be representative to extend the study to schools and colleges.

Conclusion

We consider this work as a starting point for the creation of preventive models against perceived stress in the university environment in the event of health emergencies.

Networks of pandemic-specific stressors, risk factors, and clinical symptoms: A comparison between women and men during the early phase of the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, female gender was a robust factor associated with mental health problems. This study aimed to investigate associations between pandemic-related risk factors, stressors, and clinical symptoms, with special reference to gender and possible differential gender effects.

METHODS

Participants were recruited from June to September 2020 through an online survey (ESTSS ADJUST study). Women (N = 796) and men (N = 796) were matched on age, education, income, and living community. Symptoms of depression (PHQ-9), anxiety (PHQ-4), adjustment disorder (ADNM-8), and PTSD (PC-PTSD-5) and different risk factors including pandemic-specific stressors (PaSS) were assessed. Separate network analyses for men and women were conducted and compared followed by a joint network analysis including gender.

RESULTS

The networks of women and men did not differ in their structure (M = 0.14, p = .174) or strength of associations (S = 1.22, p = .126). Few relationships differed significantly between genders e.g., the connection between burden through work-related problems and anxiety was stronger in women. In the joint network, single factors were related to gender e.g., men felt more burdened through work-related problems and women through conflicts at home.

LIMITATIONS

We cannot imply causal relationships due to the cross-sectional data of our study. The findings cannot be generalized as the sample is not representative.

CONCLUSION

Men and women seem to show comparable networks of risk factors, stressors, and clinical symptoms, although differences in individual connections and in levels of clinical symptoms and burdens were found.

Psychometric properties of the Patient Health Questionnaire-4 (PHQ-4) in 9230 adults across seven European countries: Findings from the ESTSS ADJUST study

BACKGROUND

The four-item Patient Health Questionnaire-4 (PHQ-4) is a widely used screening measure for depression and anxiety.

OBJECTIVES

This study aimed to test factor structure and measurement invariance in an adult sample of the general population across seven European countries.

METHOD

A total sample of 9230 adults, 71.3 % female, M_age = 44.35 (SD = 14.11) from seven countries (Austria, Croatia, Georgia, Germany, Lithuania, Portugal, and Sweden) participated in the study. We applied confirmatory factor analysis (CFA) to examine the factor structure and measurement invariance testing to evaluate measurement equivalence across countries, gender, and age groups.

RESULTS

The CFA yielded that a two-factor PHQ-4 model with separate depression and anxiety factors had the best fit. Partial scalar measurement invariance was established across different groups based on gender, age, and country.

CONCLUSIONS

The PHQ-4 is a valid and reliable measure that can be applied to screen for depression and anxiety in the general population.

LIMITATIONS

The limitation of the study includes the sampling, which resulted in the sample structure with the majority of females, predominantly of high education and from urban communities.

Addressing psychosomatic issues after lifting the COVID-19 policy in China: A wake-up call

The Coronavirus has infected up to 900 million people as of 11 Jan 2023 in China Mainland, which is more than 60% of the population. The sudden and unprecedented nature of pandemic has resulted in a range of psychosomatic issues among the population. These issues can manifest in a variety of ways and it is important to address these issues as they can have serious consequences for individuals' mental and physical health. The lifting of lockdown measures in China presents an opportunity to address these issues and provide support to those who have been affected.

Profiles of risk factors for depressive and anxiety symptoms during the COVID-19 pandemic: A latent class analysis

The COVID-19 pandemic has caused a high burden in the general population. The exposure to an accumulation of risk factors, as opposed to a single risk, may have been associated with higher levels of depressive and anxiety symptoms during the pandemic. This study aimed to (1) identify subgroups of individuals with distinct constellations of risk factors during the COVID-19 pandemic and (2) investigate differences in levels of depressive and anxiety symptoms. German participants (N = 2245) were recruited between June-September 2020 through an online survey (ADJUST study). Latent class analysis (LCA) and multiple group analyses (Wald-tests) were conducted to identify profiles of risk factors and examine differences in symptoms of depression (PHQ-9) and anxiety (GAD-2). The LCA included 14 robust risk factors of different domains, for example, sociodemographic (e.g., age), health-related (e.g., trauma), and pandemic-related (e.g., reduced income) factors. The LCA identified three risk profiles: High sociodemographic risk (11.7%), high social and moderate health-related risk (18.0%), and low general risk (70.3%). Individuals with high sociodemographic risk reported significantly higher symptom levels of depression and anxiety than the remaining groups. A better understanding of risk factor profiles could help to develop targeted prevention and intervention programs during pandemics.

Relationship between Transition Shock, Professional Stressors, and Intent to Leave the Nursing Profession during the COVID-19 Pandemic

Background and Objectives: Moving nurses to a COVID-19 department may cause the phenomenon of transition shock, which occurs when already employed nurses change jobs. A set of confusing and uncertain feelings arise due to the unfamiliar work environment, which may lead to their intention to leave the nursing profession. The aim of this study was to examine transition shock and the contribution of both the respondents’ characteristics and the presence of stressors to the occurrence of transition shock in nurses assigned to work in COVID-19 departments. Materials and Methods: A cross-sectional study with 120 nurses employed in COVID-19 departments was conducted. Several linear regression models were used to assess the association between transition shock, personal and professional COVID-19 stressors, and the intention to leave the nursing profession. Results: Nurses who intended to leave the profession showed higher transition shock and higher personal and professional stressors (p < 0.001). Female nurses had lower transition shock (β = −0.16; p = 0.036) and higher personal COVID-19 stressors (β = 0.27; p < 0.001). University education contributes to the lowering of nurses’ transition shock (β = −0.16; p = 0.038). Nurses who did not intend to leave the nursing profession had lower personal COVID-19 stressors (β = −0.15; p = 0.044). Transition shock was associated with personal COVID-19 stressors (β = 0.39; p < 0.001) and professional COVID-19 stressors (β = 0.29; p < 0.001), and vice versa. Conclusions: The phenomenon of transition shock was present after nurses transitioned to working in COVID-19 departments. Transition shock may cause more nurses to leave the profession, which may have a strong impact on the health system in many countries that are already facing a shortage of nurses. Additional education on and preparation for adapting to new working conditions with psychological support could have an influence by lowering the level of nurses’ transition shock.

Shaped by the COVID-19 pandemic: Psychological responses from a subjective perspective-A longitudinal mixed-methods study across five European countries

BACKGROUND

Contextual factors are essential for understanding long-term adjustment to the COVID-19 pandemic. Therefore, the present study investigated changes in mental health outcomes and subjective pandemic-related experiences over time and across countries. The main objective was to explore how psychological responses vary in relation to individual and environmental factors.

METHODS

The sample consisted of N = 1070 participants from the general population of Austria, Croatia, Georgia, Greece, and Portugal. We applied a longitudinal mixed-methods approach, with baseline assessment in summer and autumn 2020 (T1) and follow-up assessment 12 months later (T2). Qualitative content analysis by Mayring was used to analyse open-ended questions about stressful events, positive and negative aspects of the pandemic, and recommendations on how to cope. Mental health outcomes were assessed with the Adjustment Disorder-New Module 8 (ADNM-8), the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), the Patient Health Questionnaire-2 (PHQ-2), and the 5-item World Health Organization Well-Being Index (WHO-5). The analyses were performed with SPSS Statistics Version 26 and MAXQDA 2022.

RESULTS

The mental health outcomes significantly differed over time and across countries, with e.g. Greek participants showing decrease in adjustment disorder symptoms (p = .007) between T1 and T2. Compared with other countries, we found better mental health outcomes in the Austrian and the Croatian sample at both timepoints (p < .05). Regarding qualitative data, some themes were equally represented at both timepoints (e.g. Restrictions and changes in daily life), while others were more prominent at T1 (e.g. Work and finances) or T2 (e.g. Vaccination issues).

CONCLUSIONS

Our findings indicate that people's reactions to the pandemic are largely shaped by the shifting context of the pandemic, country-specific factors, and individual characteristics and circumstances. Resource-oriented interventions focusing on psychological flexibility might promote resilience and mental health amidst the COVID-19 pandemic and other global crises.

The pandemic coping scale – validity and reliability of a brief measure of coping during a pandemic

This study assessed the validity and reliability of the Pandemic Coping Scale (PCS), a new brief measure of coping with pandemic-related stressors.

1000 Days: The "WeCare Generation" Program-The Ultimate Model for Improving Human Mental Health and Economics: The Study Protocol

INTRODUCTION

The COVID-19 pandemic stressed the necessity of a new resilience of the human population and health system. The "WeCare Generation" program is a new proposal of territorial intervention, with a new paradigm, on the diseases of the human body and mind.

BACKGROUND

In recent decades, the independent strands of investigation on brain plasticity and early trauma consequences have demonstrated that traumatic experiences in the period from pregnancy to the age of 3 years have an enormous impact on an individual's future development, and both physical and mental health. Research shows that adverse child experiences (ACEs) are associated with a strong risk of conditions such as: harmful alcohol use, smoking, illicit drug use, high body-mass index, depression, anxiety, interpersonal violence, cancer, type 2 diabetes, cardiovascular diseases, stroke respiratory diseases and, as a consequence, to a high financial cost in Italy and also across Europe (1-9% GDP) and the USA (total annual costs estimated to be USD 581 billion in Europe and USD 748 billion in North America). All this suggests that an early intervention on that traumatized-slice of population leads to multiplied savings.

METHODS

A multi-center, randomized, controlled trial was designed. The parents of the future neonatal population (from pregnancy to delivery) with trauma will be enrolled, and randomized to treatment, or control arm. The article describes in detail how the primary outpoint (cost to the national health system), and some secondary outpoints, will be collected.

DISCUSSION

An overall rate of return on investment (ROI) statistically significant 13.0% per annum with an associated benefit/cost ratio (BCR) of 6.3 is expected as the primary outcome of the "WeCare Generation" program. Our proposed model predicts a new medical paradigm aiming to empower new generations, with a strong return on economy and health.

Risk and protective factors for posttraumatic stress disorder in trauma-exposed individuals during the COVID-19 pandemic - findings from a pan-European study

HIGHLIGHTS

N =  4,607 trauma-exposed adult participants were recruited from the general population during the first year of the COVID-19 pandemic.The prevalence for probable posttraumatic stress disorder was 17.7%.We identified risk factors (e.g. poor health condition) and protective factors (e.g. social contact) associated with posttraumatic stress disorder.

Coping profiles and differences in well‐being during the COVID‐19 pandemic: A latent profile analysis

During the current COVID-19 pandemic, people need to cope with multiple stressors which may affect their well-being. This study aimed (1) to identify latent coping profiles in the German general population, and (2) to investigate differences between these profiles in well-being. In total, N = 2326 German participants were recruited as part of the European Society of Traumatic Stress Studies (ESTSS) ADJUST study from June to September 2020 using an online survey. Coping strategies were assessed using the Brief-COPE and the Pandemic Coping Scale; well-being was assessed using the WHO-5 Well-Being Index. Coping profiles were identified using latent profile analysis; differences between profiles were examined using the automatic BCH method and multiple group analyses. Five coping profiles were identified that included different types and numbers of coping strategies: (1) High functional coping (17.84%), (2) Moderate functional coping (40.63%), (3) High functional and religious coping (9.07%), (4) Low functional coping (22.06%), (5) Moderate functional and dysfunctional coping (10.40%). The identified profiles significantly differed in well-being (χ²  = 503.68, p <0.001). Coping profiles indicating high functional coping were associated with greater well-being compared to coping profiles indicating low (χ²  = 82.21, p <0.001) or primarily dysfunctional (χ²  = 354.33, p <0.001) coping. These results provide insight into how people differ in their coping strategies when dealing with stressors in an early phase of the COVID-19 pandemic. The study indicates higher levels of well-being in coping profiles with more frequent use of functional strategies. To promote well-being in the general population, it might be beneficial to train functional coping strategies in appropriate interventions that are associated with increased well-being.

Two Years of COVID-19 in Austria-Exploratory Longitudinal Study of Mental Health Outcomes and Coping Behaviors in the General Population

Since the long-term mental health impact of COVID-19 is not yet fully understood, the present study explored changes in mental health outcomes and pandemic-related coping behaviors across four pandemic stages. The main objective was to gain insights into the dynamics of mental health and coping, considering different pandemic features at different assessment waves. The final sample consisted of N = 243 adults from the Austrian general population. Data were collected at four timepoints (between June 2020 and December 2021) via LimeSurvey, an open-source online survey tool. Symptoms of posttraumatic stress disorder (PTSD), adjustment disorder (AD), anxiety, and depression were assessed using validated instruments: Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), AD-New Module 8 (ADNM-8), and Patient Health Questionnaire (PHQ4). We also administered the Pandemic Coping Scale (PCS) to address pandemic-related coping behaviors. Cochran’s Q test and repeated measures ANOVAs were applied to assess changes over time. The results indicated that prevalence rates of AD (χ2(2) = 16.88, p = 0.001), depression (χ2(3) = 18.69, p < 0.001), and anxiety (χ2(3) = 19.10, p < 0.001) significantly changed across four assessment waves. Changes in mean scores of the assessed mental health outcomes were also observed. For pandemic-related coping, we found differences in the subscales: healthy lifestyle: F(3, 651) = 5.11, prevention adherence: F(2.73, 592.35) = 21.88, and joyful activities: F(3, 651) = 5.03. Taken together, our study showed a higher mental health burden in wintertime than in summertime, indicating an increased need for psychosocial support in times of stricter measures, higher incidences, and higher death rates. Furthermore, the observed decrease in adaptive coping behaviors suggests that easy-to-implement coping strategies should be actively promoted in order to maintain mental health during and in the aftermath of pandemics.

Disentangling the associations between past childhood adversity and psychopathology during the COVID-19 pandemic: The mediating roles of specific pandemic stressors and coping strategies

BACKGROUND

Individuals with a history of adverse childhood experiences (ACEs) display heightened symptoms of psychopathology during the COVID-19 pandemic. Yet, no study has investigated what aspects of the pandemic are of particular concern for this population and ways in which strategies to coping with pandemic stressors may exacerbate their clinical symptomatology.

OBJECTIVE

This study explores what pandemic stressors and coping strategies are associated with ACEs, depression, and posttraumatic stress disorder (PTSD) during the COVID-19 pandemic, before investigating whether the identified chief stressors and coping styles mediate the effects of ACEs on depression and PTSD.

PARTICIPANTS AND SETTING

1107 Greek adults were sampled from the general population.

METHODS

Participants completed the Adverse Childhood Experiences Questionnaire, Patient Health Questionnaire, Primary Care PTSD Screen for DSM-5, Pandemic Stressor Scale, and Brief Cope Scale.

RESULTS

ACEs and depression were both predominantly associated with difficult housing conditions as a stressor (b = 0.079, p < .001 and b = 0.046, p < .001, respectively), whereas PTSD was mainly related to fear of contracting the COVID-19 virus (b = 0.065, p < .001). Self-blame was the main coping strategy associated with both ACEs (b = 0.046, p = .010), depression (b = 0.071, p < .0005), and PTSD (b = 0.088, p < .0005). Difficult housing conditions and self-blame further demonstrated a significant serial mediation effect in the relationship between ACEs with both depression (b = 0.105, 95% CI [0.0607, 0.158]) and PTSD (b = 0.019, 95% CI [0.011, 0.031]).

CONCLUSIONS

The findings indicate that policy makers should identify ways of ameliorating challenging housing conditions, and that service providers should target self-blame in the psychological treatment of adults with ACEs during the COVID-19 pandemic.

The potential impact of Covid-19 on CNS and psychiatric sequels

Due to its high prevalence and fatality, the current Severe Acute Respiratory Syndrome-coronavirus-2 (SARS-CoV-2) virus, which first emerged in China in 2019, quickly spread around the world and immediately became a serious global health concern. Although respiratory issues were initially the most prominent symptom of coronavirus disease 2019 (COVID-19), it became obvious rapidly that COVID-19, like many other coronavirus family members, could affect the central nervous system (CNS). During the pandemic, CNS involvement expressed itself in a variety of forms, including insomnia, anosmia, headaches, encephalopathies, encephalitis, cerebrovascular accidents, cognitive and memory impairment, and increased psychiatric disorders. Almost everyone who has been infected has at least one of these neurological symptoms, demonstrating that the virus has a high ability to impact the CNS. As the coronavirus pandemic passes its second year, the manifestations it can cause in the long run, such as its psychological sequels, have not yet been thoroughly studied. Given the high importance of this issue in today's society and due to the lack of reliable knowledge about the COVID-19 landscape on psychiatric disorders, we intend to investigate coronavirus's possible effect on mental illnesses based on available literature. Because the majority of the psychological effects of the coronavirus can continue for a long period after the pandemic ends, our research can give insight into potential psychiatric sequels associated with COVID-19.

Coping, Social Support and Loneliness during the COVID-19 Pandemic and Their Effect on Depression and Anxiety: Patients’ Experiences in Community Mental Health Centers in Norway

Background: Little is known about psychiatric patients’ experiences during the COVID-19 pandemic. The purpose of this study was to investigate associations of coping strategies, social support and loneliness with mental health symptoms among these patients. Methods: We recruited 164 patients from Community Mental Health Centers in June–July 2020. Participants responded to an online questionnaire on corona-related questions, Brief Coping Orientation to Problems Experience, Crisis Support Scale, a 3-item Loneliness Scale, and Hopkins Symptom Checklist-25. We used linear regression models to investigate associations between these and symptoms of depression and anxiety. Results: Almost 51% were aged 31–50 years and 77% were females. Forty-six (28%) participants reported worsened overall mental health due to the pandemic. The reported rates of clinical depression and anxiety were 84% and 76%, respectively. Maladaptive coping was independently associated with both depression and anxiety symptoms. Loneliness was independently associated with depression symptoms. Conclusions: Patients in Community Mental Health Centers in Norway reported high rates of depression and anxiety symptoms. Many of them reported worsening of their mental health due to the pandemic, even at a time when COVID-19 infections and restrictive measures were relatively low. Maladaptive coping strategies and loneliness may be possible explanations for more distress.

PTSD is not the emblematic disorder of the COVID-19 pandemic; adjustment disorder is

BACKGROUND

Posttraumatic stress disorder (PTSD) has been hailed by some as the emblematic mental disorder of the COVID-19 pandemic, assuming that PTSD's life-threat criterion was met de facto. More plausible outcomes like adjustment disorder (AD) have been overlooked.

METHODS

An online cross-sectional survey was launched in the initial stage of the pandemic using a convenience sample of 5 913 adults to compare the prevalence of COVID-related probable PTSD versus probable AD. The abridged Impact of Event Scale - Revised (IES-6) assessed the severity of trauma- and stressor-related symptoms over the previous week. Demographic and pandemic-related data (e.g., receiving a formal diagnosis of COVID-19, job loss, loss of loved one, confinement, material hardship) were collected. A Classification and Regression Tree analysis was conducted to uncover the pandemic experiences leading to clinical 'caseness'. Caseness was defined by a score > 9 on the IES-6 symptom measure and further characterized as PTSD or AD depending on whether the Peritraumatic Distress Inventory's life-threat item was endorsed or not.

RESULTS

The participants were predominantly Caucasian (72.8%), women (79.2%), with a university degree (85%), and a mean age of 42.22 (SD = 15.24) years; 3 647 participants (61.7%; 95%CI [60.4, 63.0]) met the threshold for caseness. However, when perceived life-threat was accounted for, only 6.7% (95%CI [6.1, 7.4]) were classified as PTSD cases, and 55% (95%CI [53.7, 56.2]) as AD cases. Among the AD cases, three distinct profiles emerged marked by the following: (i) a worst personal pandemic experience eliciting intense fear, helplessness or horror (in the absence, however, of any life-threat), (ii) a pandemic experience eliciting sadness/grief, and (iii) worrying intensely about the safety of significant others.

CONCLUSIONS

Studies considering the life-threat criterion as met de facto during the pandemic are confusing PTSD for AD on most counts. This misconception is obscuring the various AD-related idioms of distress that have emerged during the pandemic and the actual treatment needs.

The Pandemic Stressor Scale: factorial validity and reliability of a measure of stressors during a pandemic

BACKGROUND

This study aimed to assess the factorial validity and reliability of the Pandemic Stressor Scale (PaSS), a new measure to assess the severity of distress for different stressors relevant during a pandemic or epidemic.

METHODS

The PaSS was administered in N = 2760 German participants. Exploratory factor analysis was used to extract factors. The factor structure obtained in the German sample was examined in N = 1021 Austrian participants using confirmatory factor analysis. χ², RMSEA, SRMR, CFI, TLI were assessed as global goodness of fit indices for two models (Model 1: nine-factor model; Model 2: nine-factor model combined with a second-order general factor). We additionally assessed factor loadings, communalities, factor reliability, discriminant validity as local fit indices. Internal consistency, item discrimination, and item difficulty were assessed as additional test quality criteria.

RESULTS

The results of the exploratory factor analysis suggested a nine-factor solution with factor loadings accounting for 50.4% of the total variance (Factor 1 'Problems with Childcare', Factor 2 'Work-related Problems', Factor 3 'Restricted Face-to-Face Contact', Factor 4 'Burden of Infection ', Factor 5 'Crisis Management and Communication', Factor 6 'Difficult Housing Condition', Factor 7 'Fear of Infection', Factor 8 'Restricted Access to Resources', Factor 9 'Restricted Activity'). The confirmatory factor analysis showed a sufficient global fit for both tested models (Model 1: χ² (369, N = 1021) = 1443.28, p < .001, RMSEA = .053, SRMR = .055, CFI = .919, TLI = .904; Model 2: χ² (396, N = 1021) = 1948.51, p < .001, RMSEA = .062, SRMR = .074, CFI = .883, TLI = .871). The results of the chi-square difference test indicated a significantly better model-fit of Model 1 compared to Model 2 (∆χ² (27, N = 1021) = 505.23, p < .001). Local goodness of fit indices were comparable for both tested models. We found good factor reliabilities for all factors and moderate to large factor loadings of the items as indicators. In Model 2, four first-order factors showed small factor loadings on the second-order general factor.

CONCLUSION

The Pandemic Stressor Scale showed sufficient factorial validity for the nine measured domains of stressors during the current COVID-19 pandemic.

Measuring the Relation between Academic Performance and Emotional Intelligence at the University Level after the COVID-19 Pandemic Using TMMS-24

The outbreak of the global pandemic derived from COVID-19 in early 2020 has represented a huge loss of social contact for most young people. The extent of these effects is still unknown, so it is necessary to ask what the effect of this new, unforeseen, and prolonged situation on the management of emotional intelligence in university students is. This study aims to compare the academic performance, test anxiety (before and during the online exams), and emotional intelligence of 91 students in a university Master’s degree program after the outbreak of the COVID-19 pandemic. The emotional intelligence was measured by the TMMS-24, the academic performance was compiled in common subjects, and test anxiety was measured by self-assessment just after finishing each online exam. The comparisons between the variables were made through means difference contrasts using Mann–Whitney U, Kruskal–Wallis, and One-way ANOVA and Spearman’s rank correlation coefficient as a non-parametric test for correlational analysis. The results show that the COVID-19 pandemic has not modified how these three variables are related, so it can be concluded that the prolonged social isolation suffered by young people has not had negative repercussions on their emotional intelligence, anxiety before exams, and academic performance.

Associations of Depressive Symptoms, COVID-19-Related Stressors, and Coping Strategies. A Comparison Between Cities and Towns in Germany

BACKGROUND

The COVID-19 pandemic has led to a wide range of stressors related to depressive symptoms. Prevention measures like physical distancing have burdened the general population, especially in highly urbanized areas. However, little is known about the associations between pandemic-related stressors, coping strategies, and depressive symptoms in highly urbanized vs. less urbanized environments.

METHODS

Participants were recruited in a cross-sectional online survey in Germany. Propensity score matching yielded a matched sample of city (n = 453) and town (n = 453) inhabitants. Depressive symptoms, COVID-19-related stressors, and coping strategies were compared between cities and towns. Multiple regression analysis was performed to determine associations between pandemic-related stressors and depressive symptoms for the two groups separately.

RESULTS

City inhabitants showed significantly higher depression scores than town inhabitants (t = 2.11, df = 897.95, p = 0.035). Seven coping strategies were more often used by the city sample. Depressive symptoms were associated with "restricted physical social contact" and "difficult housing conditions" (adjusted R 2= 0.19, F [9,443] = 12.52, p < 0.001) in city inhabitants, and with "fear of infection" and "difficult housing conditions" (adjusted R 2= 0.20, F [9,443] = 13.50, p < 0.001) in town inhabitants.

LIMITATIONS

The data were collected at the end of the first wave and represent a snapshot without causal inferences. Pandemic-related stressors were measured with a newly developed scale.

CONCLUSION

Depressive symptoms, perceived stressors, and approach/avoidance coping strategies differed between city vs. town inhabitants. These differences should be considered in policy-making and mental health care.

Daily uplifts during the COVID-19 pandemic: what is considered helpful in everyday life?

Background

Knowledge of what is uplifting and helpful during pandemics could inform the design of sustainable pandemic recommendations in the future. We have explored individuals’ views on helpful and uplifting aspects of everyday life during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Participants answered a brief, daily survey via text messages during 14 consecutive days in July–August, 2020. The survey included the question: “During the past 24 hours, is there anything that has made you feel good or helped you in your life?” We used content analysis to compile responses from 693 participants, who provided 4,490 free-text answers, which resulted in 24 categories subsumed under 7 themes.

Results

Positive aspects during the COVID-19 pandemic primarily related to social interactions, in real life or digitally, with family, friends and others. Other important aspects concerning work, colleagues and maintaining everyday life routines. One theme concerning vacations, going on excursions and being in nature. Leisure and recreation activities, such as hobbies and physical exercise, also emerged as important, as did health-related factors. Bodily sensations, thoughts, feelings and activities that benefited well-being were mentioned frequently. Lastly, people commented on the government strategies for containing COVID-19, and whether to comply with restrictions.

Conclusions

To summarize, daily uplifts and helpful aspects of everyday life centered around social relationships. To comply with recommendations on physical distancing, people found creative ways to maintain social connections both digitally and face-to-face. Social interaction, maintenance of everyday life routines, hobbies and physical activity appeared to be important for well-being.

Predicting transitions between longitudinal classes of post-traumatic stress disorder, adjustment disorder and well-being during the COVID-19 pandemic: protocol of a latent transition model in a general Dutch sample

BACKGROUND

A growing body of literature shows profound effects of the COVID-19 pandemic on mental health, among which increased rates of post-traumatic stress disorder (PTSD) and adjustment disorder (AD). However, current research efforts have largely been unilateral, focusing on psychopathology and not including well-being, and are dominated by examining average psychopathology levels or on disorder absence/presence, thereby ignoring individual differences in mental health. Knowledge on individual differences, as depicted by latent subgroups, in the full spectrum of mental health may provide valuable insights in how individuals transition between health states and factors that predict transitioning from resilient to symptomatic classes. Our aim is to (1) identify longitudinal classes (ie, subgroups of individuals) based on indicators of PTSD, AD and well-being in response to the pandemic and (2) examine predictors of transitioning between these subgroups.

METHODS AND ANALYSIS

We will conduct a three-wave longitudinal online survey study of n≥2000 adults from the general Dutch population. The first measurement occasion takes place 6 months after the start of the pandemic, followed by two follow-up measurements with 6 months of intervals. Latent transition analysis will be used for data analysis.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from four Dutch universities. Longitudinal study designs are vital to monitor mental health (and predictors thereof) in the pandemic to develop preventive and curative mental health interventions. This study is carried out by researchers who are board members of the Dutch Society for Traumatic Stress Studies and is part of a pan-European study (initiated by the European Society for Traumatic Stress Studies) examining the impact of the pandemic in 11 countries. Results will be published in peer-reviewed journals and disseminated at conferences, via newsletters, and media appearance among (psychotrauma) professionals and the general public.

A Longitudinal Course of ICD-11 Adjustment Disorder Symptom Profiles: A 12-Month Follow-Up Study

INTRODUCTION

Adjustment disorder is frequently diagnosed in clinical practice; however, the course of adjustment disorder over time has not yet been studied extensively.

METHODS

This longitudinal study was one of the first that aimed to analyze trajectories of adjustment disorder symptoms in a 12-month follow-up among a high-risk community sample (n = 205) exposed to various stressors. Adjustment disorder symptoms were measured at baseline and 12-month follow-up with the Brief Adjustment Disorder New Module based on the definition of adjustment disorder provided in the 11th Edition of International Classification of Diseases (ICD-11) released in 2018 by the World Health Organization (WHO).

RESULTS

A latent transition analysis of adjustment symptoms identified four distinct trajectories: "high symptom," "recovery," "onset," and "low symptom." We found 46% of ICD-11 adjustment disorder at baseline, and 29% of the sample was classified as having a high-symptom adjustment symptom profile. The high-symptom profile was predicted by ongoing stressors, female gender, and higher education.

CONCLUSION

Study findings indicate that adjustment disorder among high-risk samples, in particular, those exposed to ongoing stressors, could have a high-symptom course over 12 months.

You can't do anything about it, but you can make the best of it: a qualitative analysis of pandemic-related experiences in six European countries

BACKGROUND

The complex system of stressors related to the coronavirus disease 2019 (COVID-19) pandemic has affected the global population, provoking a broad range of psychological reactions. Although numerous studies have investigated the mental health impact of COVID-19, qualitative research and cross-country comparisons are still rare.

OBJECTIVE

This qualitative study aimed to explore self-perceived challenges and opportunities related to COVID-19 across six European countries. The overall objective was to provide a differentiated picture of individual subjective experiences in the early stages of the pandemic.

METHOD

The present study included 7309 participants from Austria, Croatia, Georgia, Greece, Poland, and Portugal. We performed qualitative content analysis according to Mayring analyse open-ended questions regarding stressful events, positive and negative aspects of the pandemic, and recommendations to cope with the pandemic situation. MAXQDA software was used for data management and analysis.

RESULTS

Participants' accounts were moderately consistent across the countries. The most prominent themes regarding stressful and negative pandemic aspects included: Restrictions and changes in daily life, Emotional distress, and Work and finances. Answers about positive pandemic consequences were mainly centred around the themes Reflection and growth, Opportunity for meaningful/enjoyable activities, and Benefits on interpersonal level. Key themes identified from participants' recommendations to cope with the pandemic included Beneficial behavioural adjustment, Beneficial cognitive-emotional strategies, and Social support.

CONCLUSIONS

Participants experienced various challenges, but also shared several positive pandemic consequences and recommendations to cope with the pandemic. These first-hand data could inform mental health practices to promote well-being during COVID-19 and similar global challenges in the participating countries and possibly beyond.

HIGHLIGHTS

We examined COVID-19-related experiences in 7309 adults from six European countries.Besides challenges, participants identified many positive pandemic consequences.Participants' recommendations to cope with COVID-19 included behavioural and cognitive-emotional strategies.

Risk and protective factors, stressors, and symptoms of adjustment disorder during the COVID-19 pandemic - First results of the ESTSS COVID-19 pan-European ADJUST study

Background

The COVID-19 pandemic exposes individuals to multiple stressors, such as quarantine, physical distancing, job loss, risk of infection, and loss of loved ones. Such a complex array of stressors potentially lead to symptoms of adjustment disorder.

Objective

This cross-sectional exploratory study examined relationships between risk and protective factors, stressors, and symptoms of adjustment disorder during the first year of the COVID-19 pandemic.

Methods

Data from the first wave of the European Society of Traumatic Stress Studies (ESTSS) longitudinal ADJUST Study were used. N = 15,563 participants aged 18 years and above were recruited in eleven countries (Austria, Croatia, Georgia, Germany, Greece, Italy, Lithuania, the Netherlands, Poland, Portugal, and Sweden) from June to November 2020. Associations between risk and protective factors (e.g. gender, diagnosis of a mental health disorder), stressors (e.g. fear of infection, restricted face-to-face contact), and symptoms of adjustment disorder (ADNM-8) were examined using multivariate linear regression.

Results

The prevalence of self-reported probable adjustment disorder was 18.2%. Risk factors associated with higher levels of symptoms of adjustment disorder were female gender, older age, being at risk for severe COVID-19 illness, poorer general health status, current or previous trauma exposure, a current or previous mental health disorder, and longer exposure to COVID-19 news. Protective factors related to lower levels of symptoms of adjustment disorder were higher income, being retired, and having more face-to-face contact with loved ones or friends. Pandemic-related stressors associated with higher levels of symptoms of adjustment disorder included fear of infection, governmental crisis management, restricted social contact, work-related problems, restricted activity, and difficult housing conditions.

Conclusions

We identified stressors, risk, and protective factors that may help identify individuals at higher risk for adjustment disorder.

Factors Associated With Suicide Ideation in Lithuania and Poland Amid the COVID-19 Pandemic

Background: The COVID-19 pandemic had an impact on many risk and protective factors associated with suicide. Aims: The aim of this study was to identify pandemic-related factors associated with suicidal ideation in the two European countries, Lithuania and Poland, amid the COVID-19 pandemic. Method: The sample comprised 2,459 participants in both countries; 57.2% of the respondents were female. The M_age of the participants was 43.45 years (SD = 15.91). Pandemic-related stressors and adjustment problems were measured to assess associations with suicidal ideation. Results: High levels of adjustment problems, loneliness, and burden due to staying at home more during the COVID-19 pandemic were significantly associated with suicide ideation in both Lithuania and Poland. Limitations: This was a cross-sectional online study with different recruitment approaches in the two countries. Conclusion: Adjustment problems, loneliness, and stressors related to staying at home more could be important targets for suicide prevention amid the pandemic.

Confinement, Comfort and Health: Analysis of the Real Influence of Lockdown on University Students during the COVID-19 Pandemic

The COVID-19 pandemic forced the population worldwide into lockdown. The purpose of this study was to assess the impact of this measure on the health and comfort of university students and the role that the characteristics of the home may have played. It is essential to differentiate between the terms comfort and health both from the medical and architectural perspectives, as there are differences between the two concepts that are, nonetheless, shared by both disciplines. An online survey was fulfilled by 188 medicine and architecture undergraduate students at the University of Seville, Spain. In terms of health, 89% suffered neuropsychiatric disorders (56% anxiety and 49% depression), 38% gained weight and 59% reported alcohol consumption. In relation to comfort, the majority rated their home positively, comfortable in terms of room temperature and noise at night, and they had a good relationship with cohabitants. However, those who did not have a balcony or terrace would have liked to have open spaces They would have also liked to increase the size of their bedroom, where they spent most of their time and where they studied. A built-up environment gave them a sense of being imprisoned, while those who enjoyed open spaces found a sense of peace. The absence of open spaces in the house, the environment and the impossibility of making the most frequently used spaces more flexible may have had negative impacts on the health and comfort of university students during confinement.

A Self-Applied Multi-Component Psychological Online Intervention Based on UX, for the Prevention of Complicated Grief Disorder in the Mexican Population During the COVID-19 Outbreak: Protocol of a Randomized Clinical Trial

Background: COVID-19 has taken many lives worldwide and due to this, millions of persons are in grief. When the grief process lasts longer than 6 months, the person is in risk of developing Complicated Grief Disorder (CGD). The CGD is related to serious health consequences. To reduce the probability of developing CGD a preventive intervention could be applied. In developing countries like Mexico, the psychological services are scarce, self-applied interventions could provide support to solve this problem and reduce the health impact even after the pandemic has already finished.

Aims: To design and implement a self-applied intervention composed of 12 modules focused on the decrease of the risk of developing CGD, and increasing the life quality, and as a secondary objective to reduce the symptomatology of anxiety, depression, and increase of sleep quality. The Intervention Duelo COVID (Grief COVID) follows the principles of User Experience (UX) and is designed according to the needs and desires of a sample of the objective participants, to increase the adherence to the self-applied intervention, considered one of the main weaknesses of online interventions.

Methods: A Randomized Controlled Trial will be conducted from the 22nd of December of 2020 to the first of June 2021. The participants will be assigned to an intervention with elements of Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Mindfulness and Positive Psychology. The control group will be a wait-list condition, that will receive the intervention 1.5–2 months after the pre-measurement were taken. The Power Size Calculation conducted through G^*Power indicated the need for a total of 42 participants, which will be divided by 21 participants in each group. The platform will be delivered through responsive design assuring with this that the intervention will adapt to the screen size of cellphones, tablets, and computers.

Ethics and Dissemination: The study counts with the approval of the Research Ethics Committee of the Autonomous University of Ciudad Juárez, México, and it is registered in Clinical Trials (NCT04638842). The article is sent and registered in clinical trials before the recruitment started. The results will be reported in future conferences, scientific publications, and media.

Characteristics and outcomes of COVID-19 inpatients who underwent psychiatric consultations

Patients hospitalized with COVID-19 are at risk of developing many neuropsychiatric disorders, due to the effects of the disease on the brain and the psychosocial pressures of having the disease. The aim of the present study was to evaluate the characteristics and outcomes of patients who were hospitalized with a diagnosis of COVID-19, who underwent psychiatric consultations. The medical records of 892 patients hospitalized due to COVID-19 and the 89 among them who requested psychiatric consultations were analyzed retrospectively. After the psychiatric consultations, patients were most frequently diagnosed with delirium (38.2 %), adjustment disorder (27.0 %), depressive disorder (19.1 %) and anxiety disorder (11.2 %). Patients with delirium had longer hospital stays (p < 0.001), were transferred more frequently to intensive care units (p < 0.001), and had higher mortality rates during their hospital stays (p < 0.001), than all other patients. The need for oxygen (p < 0.001) and mechanical ventilation (p < 0.001) was also significantly higher in delirium patients, as well as in patients who received other psychiatric diagnoses. Neuropsychiatric disorders develop in patients receiving inpatient treatments in COVID-19 wards, and these disorders negatively affect the prognosis of COVID-19. Our findings suggest that the presence of neuropsychiatric disorders in in-patients with COVID-19 might be associated with the negative outcomes of the disease.

Emergency physician stressors, concerns, and behavioral changes during COVID-19: A longitudinal study

Objectives

The objective was to provide a longitudinal assessment of anxiety levels and work and home concerns of U.S. emergency physicians during the COVID‐19 pandemic.

Methods

We performed a longitudinal, cross‐sectional email survey of clinically active emergency physicians (attending, fellow, and resident) at seven academic emergency departments. Follow‐up surveys were sent 4 to 6 weeks after the initial survey and assessed the following: COVID‐19 patient exposure, availability of COVID‐19 testing, levels of home and workplace anxiety/stress, changes in behaviors, and performance on a primary care posttraumatic stress disorder screen (PC‐PTSD‐5). Logistic regression explored factors associated with a high PC‐PTSD‐5 scale score (≥3), indicating increased risk for PTSD.

Results

Of the 426 surveyed initial respondents, 262 (61.5%) completed the follow‐up survey. While 97.3% (255/262) reported treating suspected COVID‐19 patients, most physicians (162/262, 61.8%) had not received testing themselves. In follow‐up, respondents were most concerned about the relaxing of social distancing leading to a second wave (median score = 6, IQR = 4–7). Physicians reported a consistently high ability to order COVID‐19 tests for patients (median score = 6, IQR = 5–7) and access to personal protective equipment (median score = 6, IQR = 5–6). Women physicians were more likely to score ≥ 3 than men on the PC‐PTSD‐5 screener on the initial survey (43.3% vs. 22.5%; Δ 20.8%, 95% confidence interval [CI] = 9.3% to 31.5%), and despite decreases in overall proportions, this discrepancy remained in follow‐up (34.7% vs. 16.8%; Δ 17.9%, 95% CI = 7.1% to 28.1%). In examining the relationship between demographics, living situations, and institution location on having a PC‐PTSD‐5 score ≥ 3, only female sex was associated with a PC‐PTSD‐5 score ≥ 3 (adjusted odds ratio = 2.48, 95% CI = 1.28 to 4.79).

Conclusions

While exposure to suspected COVID‐19 patients was nearly universal, stress levels in emergency physicians decreased with time. At both initial and follow‐up assessments, women were more likely to test positive on the PC‐PTSD‐5 screener compared to men.

The Professional and Psycho-Emotional Impact of the COVID-19 Pandemic on Medical Care-A Romanian GPs' Perspective

The aim of this study was to assess the psycho-emotional impact and the adjustment degree of Romanian general practitioners (GPs) in the coronavirus disease 2019 (COVID-19) pandemic context. With a cross-sectional design, the study included 677 GPs to whom a validated questionnaire based on different items targeting three factors was sent: burden of prevention, presence of stress symptoms, and adjustment to pandemic. The burden of prevention and the adjustment effort to the pandemic were felt significantly more by female doctors and by GPs working in associated offices. The case definition quality, the support received, the professional life changes, and the stress symptoms proved to be the main predictors for the adjustment to pandemic. The adjustment measurement questionnaire can be used in further studies to identify the most supportive public health practices in difficult epidemiological contexts.

Mental health status and risk factors during Covid-19 pandemic in the Croatia's adult population

Background: The Covid-19 pandemic is associated with adverse mental health outcomes for people worldwide.Objective: The study aimed to assess mental health during the Covid-19 pandemic and the key risk factors from the human ecology perspective in Croatia's adult population.Method: An online panel survey with 1,201 adult participants (50.1% women) was done with a nationally representative sample in terms of gender, age, and country region four months after the nation lockdown began and two months after most of the restrictions were lifted. Indicators of mental health included symptoms of adjustment disorder (ADNM-8); depression, anxiety, and stress (DASS-21); symptoms of post-traumatic stress disorder (PC-PTSD-5); and well-being (WHO-5).Results: In the entire sample, 9.8% (95% confidence interval [CI]: 7.9%, 14.0%) of the participants were at risk of adjustment disorder, 7.7% (95% CI: 6.7%, 11.9%) were at risk of depression disorder, and 7.8% (95% CI: 5.3%, 10.3%) were at risk of anxiety disorder. In addition, 7.2% (95% CI: 5.3%, 10.2%) were experiencing high levels of stress. The average well-being score was 56.5 (SD = 21.91) on a scale from 0 to 100. Among the participants who have lifetime traumatic experience (n = 429), 14% (95% CI: 10.6%, 17.2%) were at risk for PTSD. Key risk factors for specific mental health outcomes differed, but the common ones included: current health status, previous mental health diagnosis, and psychological resilience. Being younger, having a below-average income, and excessively following news about Covid-19 were predictive for some of the mental health problems.Conclusions: Together, the key risk factors identified in this study indicate the need for public health interventions addressing the general population's mental health, but also for specific risk groups. Lower rates of mental health symptoms assessed soon after lifting quarantine measures that have been found in other studies may indicate human resilience capacity.

Adjustment disorder, traumatic stress, depression and anxiety in Poland during an early phase of the COVID-19 pandemic

Background: The current COVID-19 pandemic is associated with a variety of stressors. Preliminary research has demonstrated that general public are experiencing a range of psychological problems, including stress-related disturbances. However, to date, there is not much research on the prevalence of adjustment disorder during the current pandemic. Objectives: This study aimed to assess the prevalence and severity of symptoms of adjustment disorder compared to posttraumatic symptoms, depression and generalized anxiety in a large sample of adult Poles, in the first phase of the current pandemic. Method: Self-report data from a web-based sample (N = 1,742) was collected between March 25 and April 27, just after the introduction of nationwide quarantine measures in Poland. Results: The current COVID-19 pandemic was a highly stressful event for 75% of participants and the strongest predictor of adjustment disorder. Increased symptoms of adjustment disorder were reported by 49%, and they were associated with female gender and not having a full-time job. However, after exclusion of co-occurring symptomatology, 14% of the sample were finally qualified as meeting diagnostic criteria of adjustment disorder. A substantial proportion of the sample screened also positive for generalized anxiety (44%) and depression (26%); the rate for presumptive PTSD diagnosis was 2.4%. Conclusions: High rates of negative mental health outcomes were found in the Polish population in the first weeks into the COVID-19 pandemic and lockdown measures. They indicate the intense current stress-related symptoms in the early phase of the pandemic and warrant further monitoring on population's mental health.

Reduced physical activity and weight gain are associated with an increase of depressive symptoms during the COVID-19 pandemic. A general practitioners' prospective observational study

OBJECTIVES

We aimed to assess associations between depressive symptoms, lifestyle, and somatic symptoms during the COVID-19 pandemic.

DESIGN

A prospective, observational study using a self-designed questionnaire.

SETTING

Three general practitioners' (GP) offices in rural Germany.

PARTICIPANTS

271 adult patients without manifest cardiovascular or pulmonary disease with (n = 82) and without (n = 189) hypertension reporting to our GP offices.

MAIN OUTCOME MEASURES

The reported increase of depressive symptoms (loneliness, sleeplessness, joylessness, listlessness) prior to the first documented case in Germany on 27.01.2020 (t0) as opposed to patients' health perception during the Corona pandemic (t1) was the primary outcome measure. The secondary outcome measures were changes in physical activity (PA), dyspnea and angina in the two groups.

RESULTS

Out of 271 patients (50.8 ± 16.8 years, 55.1% females), 1.5% were tested positive for COVID-19. Overall, listlessness (8.5%, p = 0.001), sleeplessness (5.2%, p = 0.001) and joylessness (4.2%, p = 0.003) were increased. Dyspnea significantly increased (9.2%, p < 0.001) and employment status worsened (6.5%, p < 0.001). There were significant associations between the increase of depressive symptoms, weight increase (p = 0.017), and reduction in physical activity (p = 0.046). However, after adjusting for age, hypertensive patients did not show more depressive symptoms (p = 0.704), dyspnea (p = 0.063) or angina (p = 0.432), nor was there any difference in PA (p = 0.906) compared to healthy individuals.

CONCLUSIONS

We demonstrate an association between the deterioration of depressive symptoms, weight gain, and reduced physical activity during COVID-19, both in hypertensives and healthy controls. Hypertension is no driver of symptom deterioration during the pandemic. The trial was registered in the German Clinical Trials Registry (DRKS00022157).

Modeling pandemic depression and anxiety: The mediational role of core beliefs and meaning making

Background

Methods

Limitations

Conclusions