Changing trends of mental and behavioral responses and associations during the COVID-19 epidemic in China: a panel study

Longitudinal influence of quarantine and COVID-19 surge after quarantine was released on behavioral and mental problems among Chinese university students

OBJECTIVE

This study examines the longitudinal influence of quarantine and the COVID-19 surge after quarantine was released on behavioral and mental problems among the Chinese university students.

METHODS

A longitudinal observation design was utilized. There were 10 waves of surveys including the pre-quarantine period, the quarantine period, and the quarantine releasing period. The non-parametric linear mixed-effects model and generalized estimating equations were used to examine the association between the dependent and independent variables.

RESULTS

Two-hundred and two (88.21%) participants completed 10 waves of the survey. The COVID-19 surge was positively associated with perceived severity for COVID-19 infection (β: 0.2162, p < 0.01), the quarantine period was negatively associated with perceived risk (β: -0.3632, p < 0.01). The quarantine was negatively associated with both behavior belief (β: -0.6164, p < 0.01) and outcome belief for lockdown (β: -0.0976, p < 0.01). The COVID-19 surge was only positively associated with behavior belief for the lockdown (β: 0.1073, p < 0.01). Both the COVID-19 surge and the quarantine periods were positively associated with mental disorders, and the standard β values were 0.2611 and 0.3846. The quarantine also had an influence on short sleep duration (β: 0.2681, p < 0.05).

CONCLUSION

This study yielded new information about the influence of the COVID-19 surge, the quarantine period and the period after quarantine was released on the behavioral and mental problems among Chinese university students. Policy changes and health education are essential for minimizing the adverse health effects of these responses. This may have important implications for policies and disease prevention strategies targeted at controlling COVID-19.

Changing trends of suicidal ideation, and impact of social trust and social communication during transition from quarantine to non-quarantine in the COVID-19 epidemic in China

BACKGROUND

In order to curb the rapid spread of COVID-19, many countries have implemented lockdown or quarantine requirements, but little is known about how this impacts suicide ideation. The purpose of this study is to examine changing trends of suicidal ideation, social trust, and social communication from the quarantine to non-quarantine period during the COVID-19 epidemic in China and the effects of quarantine on suicidal ideation.

METHODS

A prospective longitudinal observation design was utilized. There were six waves of interviews from the quarantine to the non-quarantine period. Two hundred and twenty-one participants completed all observation points and were included in the study. For the continuing variables, the Mann-Kendall test was used to assess changing trends across the six observation points. For categorical variables, the Cochran-Armitage test was used to examine their changing trends. A generalized estimating equation was used to examine the association between several independent variables and suicide ideation.

RESULTS

The prevalence of suicide ideation was 16.7, 14.5 %, and 14.5 %, respectively, in the quarantine period, and 13.8, 10.9 %, and 10.0 %, respectively in the non-quarantine period, which there was a significant downward trend (T: -4.06, p < 0.01) across the total observation period. Negative behavioral belief, negative social trust, and low levels of social communications were positively associated with suicide ideation, with a β of 0.0310 (P < 0.01), 0.0541 (P < 0.01), and 0.0245 (P < 0.05) respectively. The positive attitude toward lockdown was negatively associated with suicide ideation, with a β of -0.0137 (P < 0.01) among guaranteed classmates and it was -0.0121 (P < 0.01) among unguaranteed classmates.

CONCLUSIONS

This study yielded new information and may have important policy implications to design effective intervention strategies to reduce future new infectious diseases while maintaining positive mental health and reducing suicide ideation.

Temporal changes in mental response and prevention patterns, and their impact from uncertainty stress during the transition in China from the COVID-19 epidemic to sporadic infection

An epidemic of a highly lethal disease can overwhelm people emotionally and physically. Little is known about how public mental and preventive patterns changed during the transition from the COVID-19 epidemic to sporadic infection. This study examined changing trends of metal response and behavioral variables, and their impact from uncertainty stress in this process in China. A prospective longitudinal observation design was utilized. There were 7 waves of surveys from COVID-19 epidemic status to the sporadic infection period. Sixty-two participants completed all observation points and were included in the study. The Mann-Kendall Test was used to assess changing trends across the seven observation points. The nonparametric linear mixed effects model was used to examine the association between uncertainty stress and mental and behavioral responses. The mean uncertainty stress did not change significantly over the observation period (Z: -0.911, p > 0.05). This trend was also true for perceived risk, perceived severity, self-efficacy for prevention, and prevention behavior. There was a statistically significant downward trend in irrational beliefs about prevention (Z: -4.993, p < 0.01), sleep (Z: -2.499, p < 0.05), emotions (Z: -5.650, p < 0.01), and lifestyle (Z: -5.978, p < 0.01). The results showed that uncertainty stress was positively associated with irrational beliefs (β: 0.16298, p < 0.01), their sleep (β: 0.02070, p < 0.05), emotions (β: 0.03462, p < 0.01), and lifestyle (β: 0.02056, p < 0.05). High levels of uncertainty stress were negatively associated with self-efficacy for prevention and prevention behavior, β was -1.33210 (p < 0.01) and -0.82742 (p < 0.01). These results may have important policy and disease prevention in post-epidemic times.

A 'health message' on sustainable physical and mental health for the prolonged COVID-19 and other pandemics

The world has been living with another pandemic physical inactivity (PI) and sedentary behavior (SB) and of other nature for years. As social measures to prevent the spread of COVID-19 have been strengthened, the physical activity (PA) barrier has been hit and the PI/SB pandemic has been exacerbated, and in the current situation, triggered by its prolonged period, it is emerging as a problem to be considered in order to combat the PI/SB pandemic through PA and to maintain continuous physical and mental health. This review aims to summarize existing and recent studies on the effects of PA/SB on physical and mental health in preparation for the context of prolonged COVID-19 and provides an easy and fun way to motivate, access PA, and PA recommendations for maintaining physical and mental health. We performed search strategies on PubMed, Medline, Scopus, and Google Scholar databases, and used a literature review of the current available literature on the COVID-19 and the effects of PI, SB, and PA on physical and mental health. The clinical relevance of this review shows that integrating PA into daily life and reducing prolonged sitting time is an important strategy for continuing a healthy life physically and mentally. As a result, for those who have not yet incorporated exercise as part of their daily routine, fun and easy access to PA suggests that in the long run, may be an opportunity to implement newer habits. In addition, in an emergency such as the COVID-19 quarantine period or other pandemics, it is essential for one to maintain health through PA at home, and underscore the 'health message' of the current review that reducing SB, progressively increasing PA, and doing more PA regularly in the current context prolonged COVID-19 can bring significant benefits to long-term habits and physical and mental health.

Exploring the impact of shielding advice on the wellbeing of individuals identified as clinically extremely vulnerable amid the COVID-19 pandemic: a mixed-methods evaluation

BACKGROUND

The national shielding programme was introduced by UK Government at the beginning of the COVID-19 pandemic, with individuals identified as clinically extremely vulnerable (CEV) offered advice and support to stay at home and avoid all non-essential contact. This study aimed to explore the impact and responses of "shielding" on the health and wellbeing of CEV individuals in Southwest England during the first COVID-19 lockdown.

METHODS

A two-stage mixed methods study, including a structured survey (7 August-23 October 2020) and semi-structured telephone interviews (26 August-30 September 2020) with a sample of individuals who had been identified as CEV and advised to "shield" by Bristol, North Somerset & South Gloucestershire (BNSSG) Clinical Commissioning Group (CCG).

RESULTS

The survey was completed by 203 people (57% female, 54% > 69 years, 94% White British, 64% retired) in Southwest England identified as CEV by BNSSG CCG. Thirteen survey respondents participated in follow-up interviews (53% female, 40% > 69 years, 100% White British, 61% retired). Receipt of 'official' communication from NHS England or General Practitioner (GP) was considered by participants as the legitimate start of shielding. 80% of survey responders felt they received all relevant advice needed to shield, yet interviewees criticised the timing of advice and often sought supplementary information. Shielding behaviours were nuanced, adapted to suit personal circumstances, and waned over time. Few interviewees received community support, although food boxes and informal social support were obtained by some. Worrying about COVID-19 was common for survey responders (90%). Since shielding had begun, physical and mental health reportedly worsened for 35% and 42% of survey responders respectively. 21% of survey responders scored ≥ 10 on the PHQ-9 questionnaire indicating possible depression and 15% scored ≥ 10 on the GAD-7 questionnaire indicating possible anxiety.

CONCLUSIONS

This research highlights the difficulties in providing generic messaging that is applicable and appropriate given the diversity of individuals identified as CEV and the importance of sharing tailored and timely advice to inform shielding decisions. Providing messages that reinforce self-determined action and assistance from support services could reduce the negative impact of shielding on mental health and feelings of social isolation.

Geriatric Health Care During the COVID-19 Pandemic: Managing the Health Crisis

COVID-19 pandemic significantly threatens the health and well-being of older adults. Aging-related changes, including multimorbidity, weakened immunity and frailty, may make older people more susceptible to severe infection and place them at higher risk of morbidity and mortality from COVID-19. Various quarantine measures have been implemented to control the spread of COVID-19. Nevertheless, such social distancing has disrupted routine health care practices, such as accessibility of medical services and long-term continuous care services. The medical management of older adults with multimorbidity is significantly afflicted by COVID-19. Older persons with frailty or multiple chronic disease may poorly adapt to the altered health care system, having detrimental consequences on their physical and mental health. COVID-19 pandemic has posed great challenges to the health of older adults. We highlighted the difficulties and obstacles of older adults during this unprecedented time. Also, we provided potential strategies and recommendations for actions to mitigate the COVID-19 pandemic threats. Certain strategies like community primary health care, medication delivery and home care support are adopted by many health facilities and caregivers, whereas other services such as internet hospital and virtual medical care are promoted to be accessible in many regions. However, guidelines and policies based on high-quality data are still needed for better health promotion of older groups with increasing resilience during the COVID-19 pandemic.

Differences in Multi-Faceted Lifestyles in Response to the COVID-19 Pandemic and Their Association with Depression and Quality of Life of Older Adults in South Korea: A Cross-Sectional Study

BACKGROUND

The World Health Organization declared COVID-19 a global pandemic on 11 March 2020, due to the number of newly reported confirmed cases and the rapid increase in deaths. Therefore, countries around the world limited their population to policies such as "social distancing" or "staying at home" to prevent the spread of the virus. The purpose of this study was to evaluate differences in lifestyle pre and post the outbreak COVID-19 among older adults in South Korea and to identify the impact of lifestyle differences on depression and quality of life.

METHODS

An online single questionnaire covering sociodemographic data, lifestyle details, depression status, and quality of life level was distributed using mailing lists and social media. To assess lifestyles differences in older people pre and post the outbreak of COVID-19 pandemic, the online single questionnaire was used post COVID-19 pandemic. Based on the participants' memories, they responded lifestyles at two time points (pre and post COVID-19 pandemic).

RESULTS

The results showed that there was a significant decrease in physical activity and activity participation during the pandemic. In terms of nutrition, there was no statistically significant change pre and post the outbreak COVID-19, except for the intake of protein, fat, and vitamins. Additionally, the results showed that the resulting lifestyle differences seem to have had a negative impact on depression and quality of life among older adults in South Korea.

CONCLUSION

There was a significant difference the lifestyle patterns among the participants in South Korea between the current period and pre COVID-19 pandemic. Additionally, it is observed that these differenced lifestyles were associated with depression and quality of life among the participants. Our findings may help to develop public health programs that support healthy lifestyles in pandemic conditions.

Will Nothing Be the Same Again?: Changes in Lifestyle during COVID-19 Pandemic and Consequences on Mental Health

Social isolation caused by the COVID-19 pandemic has drastically affected lifestyles: from sedentary behaviors to reduced physical activity, from disrupted sleep patterns to altered dietary habits. As a consequence, serious mental and emotional responses have been registered. There was a significant decline in physical and other meaningful activities of daily living, leisure, social activity, and education. In children, collateral effects of the pandemic include inadequate nutrition with a risk of both overweight and underweight, addiction to screens, lack of schooling, and psychosocial difficulties. Older adults are frequently unable to adapt to lockdown measures and suffer from depression and cognitive complaints. Recent studies focusing on changes in lifestyle during the Covid-19 pandemic and consequences on mental health have been identified in PubMed/Medline, Scopus, Embase, and ScienceDirect. All the available literature has been retrospectively reviewed. The results of the present narrative review suggest that mental distress caused by social isolation seems to be linked not only to personality characteristics but also to several lifestyle components (sleep disruption, altered eating habits, reduced physical activity). This review aims to explore major changes in the lifestyle and quality of life and the impact of these changes on mental health, and to inform clinicians and policymakers about elements that may reduce the negative psychological effects of the quarantine period imposed during this worldwide crisis. There is an urgent need for tailored preventive, diagnostic, and therapeutic mental health interventions for the general population and for higher risk groups.