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Duan S. Immediate shock and residual stress: Unmasking the dual dynamics of covid-19 on the mental health of health professionals in China. Health Psychol Res 2024; 12:117201. [PMID: 39257415 PMCID: PMC11386716 DOI: 10.52965/001c.117201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/05/2024] [Indexed: 09/12/2024] Open
Abstract
Background The pandemic of 2019 has created large scale disruption around the globe. It has posed extraordinary hurdles for Chinese health workers, affecting their mental health with respect to situations in the present as well as the future. Recognising the dynamic features of these mental health issues among health professionals is critical for developing effective support systems. Objectives This study aims to explore the dual impact of COVID-19 on the mental health of health professionals in China, both during and after the pandemic; to explore the probable underlying factors causing these mental health issues; to identify both adaptive and maladaptive coping behaviours employed by the health personnel; and to assess the organisational and social support to mitigate the effect of the pandemic on the mental health of the Chinese health professionals. Method To address these objectives an explorative qualitative research design has been adopted involving analysis of previous researches in the relevant field. Results The study confirms anxiety, depression, sleep disorders, PTSD, and burnout among medical personnel as immediate shock and residual stress, along with its demographic variations. Few maladaptive coping behaviours have been identified that can lead to delayed psychological effects even after a pandemic. Conclusion The key findings underscore the complicated interaction of immediate and delayed mental health challenges among health professionals, advocating for the deployment of tailored treatments and policy modifications to address the ever changing needs of this vital workforce.
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Ma HY, Chiang NT, Kao RH, Lee CY. Health Workers' Mindfulness-Based Stress Reduction and Resilience During COVID-19 Pandemic. J Multidiscip Healthc 2024; 17:3691-3713. [PMID: 39114858 PMCID: PMC11303674 DOI: 10.2147/jmdh.s464285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/25/2024] [Indexed: 08/10/2024] Open
Abstract
Background Research indicates that a significant number of healthcare workers accounted for all confirmed Coronavirus disease 2019 (COVID-19) cases, and many of the infected healthcare workers were asymptomatic. During the COVID-19 outbreak, a considerable number of people in Taiwan contracted the disease. Therefore, health workers in Taiwan often experienced lack of medical resources, and this problem is worse for outer island areas. In terms of stress and mental health, this study investigated the effect of poor healthcare capacity and high workload on health workers during the COVID-19 pandemic. This study also explored mindfulness-based stress reduction and resilience in health workers. Methods This study conducted an in-depth interview to investigate stress perceived by health workers in a hospital located on an outer island of Taiwan as well as their mental health and stress relieving strategies. Results It was found that during the COVID-19 outbreak, some common sources of stress for health workers included exposure to infectious diseases, heavy workloads, facing ethical dilemma in clinical decision-making, and unfamiliar problems from the pandemic. These types of stress cause worries, anxiety, and depression in health workers, which affects their mental and physical health as well as their patient-care performance. Conclusion This study proposed that mindfulness-based stress reduction and protecting mental health are important for health workers.
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Affiliation(s)
- Hsiang-Yu Ma
- Department of Ocean and Border Management, National Quemoy University, Kinmen, Taiwan
| | - Nein-Tsu Chiang
- Department of Ocean and Border Management, National Quemoy University, Kinmen, Taiwan
| | - Rui-Hsin Kao
- Department of Ocean and Border Management, National Quemoy University, Kinmen, Taiwan
| | - Chih-Ying Lee
- Department of Ocean and Border Management, National Quemoy University, Kinmen, Taiwan
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Chen MY, Chen P, An FR, Sha S, Feng Y, Su Z, Cheung T, Ungvari GS, Ng CH, Zhang L, Xiang YT. Depression, anxiety and suicidality among Chinese mental health professionals immediately after China's dynamic zero-COVID policy: A network perspective. J Affect Disord 2024; 352:153-162. [PMID: 38316260 DOI: 10.1016/j.jad.2024.01.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Using network analysis, the interactions between mental health problems at the symptom level can be explored in depth. This study examined the network structure of depressive and anxiety symptoms and suicidality among mental health professionals after the end of China's Dynamic Zero-COVID Policy. METHODS A total of 10,647 mental health professionals were recruited nationwide from January to February 2023. Depression and anxiety were assessed using the 9-item Patient Health Questionnaire (PHQ-9) and 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively, while suicidality was defined by a 'yes' response to any of the standard questions regarding suicidal ideation (SI), suicide plan (SP) and suicide attempt (SA). Expected Influence (EI) and Bridge Expected Influence (bEI) were used as centrality indices in the symptom network to characterize the structure of the symptoms. RESULTS The prevalence of depression, anxiety, and suicidality were 45.99 %, 28.40 %, and 7.71 %, respectively. The network analysis identified GAD5 ("Restlessness") as the most central symptom, followed by PHQ4 ("Fatigue") and GAD7 ("Feeling afraid"). Additionally, PHQ6 ("Guilt"), GAD5 ("Restlessness"), and PHQ8 ("Motor disturbance") were bridge nodes linking depressive and anxiety symptoms with suicidality. The flow network indicated that the strongest connections of S ("Suicidality") was with PHQ6 ("Guilt"), GAD7 ("Feeling afraid"), and PHQ2 ("Sad mood"). CONCLUSIONS Depression, anxiety, and suicidality among mental health professionals were highly prevalent after China's Dynamic Zero-COVID Policy ended. Effective measures should target central and bridge symptoms identified in this network model to address the mental health problems in those at-risk.
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Affiliation(s)
- Meng-Yi Chen
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
| | - Pan Chen
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
| | - Feng-Rong An
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Sha Sha
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuan Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Gabor S Ungvari
- Psychiatry Section, University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia.
| | - Ling Zhang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
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Zhang Y, Wu C, Ma J, Liu F, Shen C, Sun J, Ma Z, Hu W, Lang H. Relationship between depression and burnout among nurses in Intensive Care units at the late stage of COVID-19: a network analysis. BMC Nurs 2024; 23:224. [PMID: 38561758 PMCID: PMC10983623 DOI: 10.1186/s12912-024-01867-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Mental health problems are critical and common in medical staff working in Intensive Care Units (ICU) even at the late stage of COVID-19, particularly for nurses. There is little research to explore the inner relationships between common syndromes, such as depression and burnout. Network analysis (NA) was a novel approach to quantified the correlations between mental variables from the perspective of mathematics. This study was to investigate the interactions between burnout and depression symptoms through NA among ICU nurses. METHOD A cross-sectional study with a total of 616 Chinese nurses in ICU were carried out by convenience sampling from December 19, 2022 to January19, 2023 via online survey. Burnout symptoms were measured by Maslach Burnout Inventory-General Survey (MBI-GS) (Chinese version), and depressive symptoms were assessed by the 9-item Patient Health Questionnaire (PHQ-9). NA was applied to build interactions between burnout and depression symptoms. We identified central and bridge symptoms by R package qgraph in the network model. R package bootnet was used to examined the stability of network structure. RESULTS The prevalence of burnout and depressive symptoms were 48.2% and 64.1%, respectively. Within depression-burnout network, PHQ4(Fatigue)-MBI2(Used up) and PHQ4(Fatigue)-MBI5(Breakdown) showed stronger associations. MBI2(Used up) had the strongest expected influence central symptoms, followed by MBI4(Stressed) and MBI7 (Less enthusiastic). For bridge symptoms. PHQ4(Fatigue), MBI5(Breakdown) and MBI2(Used up) weighed highest. Both correlation stability coefficients of central and bridge symptoms in the network structure were 0.68, showing a high excellent level of stability. CONCLUSION The symptom of PHQ4(Fatigue) was the bridge to connect the emotion exhaustion and depression. Targeting this symptom will be effective to detect mental disorders and relieve mental syndromes of ICU nurses at the late stage of COVID-19 pandemic.
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Affiliation(s)
- Yinjuan Zhang
- Department of Nursing, Air Force Medical University, No. 169 Changle West Road, 710032, Xi'an, Shaanxi, China
- Department of Nursing, Shaanxi University of Chinese Medicine, Shiji Avenue, 712046, Xianyang, Shaanxi, China
| | - Chao Wu
- Department of Nursing, Air Force Medical University, No. 169 Changle West Road, 710032, Xi'an, Shaanxi, China
| | - Jin Ma
- Department of Aerospace Medicine, Air Force Medical University, No. 169 Changle West Road, 710032, Xi'an, Shaanxi, China
| | - Fang Liu
- Department of Nursing, Shaanxi University of Chinese Medicine, Shiji Avenue, 712046, Xianyang, Shaanxi, China
| | - Chao Shen
- Department of Computer Science and Engineering, Xi'an Technological University, No. 4 Jinhua North Road, 710021, Xi'an, Shaanxi, China
| | - Jicheng Sun
- Department of Aerospace Medicine, Air Force Medical University, No. 169 Changle West Road, 710032, Xi'an, Shaanxi, China
| | - Zhujing Ma
- Department of Military Medical Psychology, Air Force Medical University, No. 169 Changle West Road, 710032, Xi'an, Shaanxi, China
| | - Wendong Hu
- Department of Aerospace Medicine, Air Force Medical University, No. 169 Changle West Road, 710032, Xi'an, Shaanxi, China.
| | - Hongjuan Lang
- Department of Nursing, Air Force Medical University, No. 169 Changle West Road, 710032, Xi'an, Shaanxi, China.
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Fronteira I, Mathews V, Dos Santos RLB, Matsumoto K, Amde W, Pereira A, de Oliveira APC, Craveiro I, Chança R, Boniol M, Ferrinho P, Poz MRD. Impacts for health and care workers of Covid-19 and other public health emergencies of international concern: living systematic review, meta-analysis and policy recommendations. HUMAN RESOURCES FOR HEALTH 2024; 22:10. [PMID: 38273317 PMCID: PMC10809470 DOI: 10.1186/s12960-024-00892-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Health and care workers (HCW) faced the double burden of the SARS-CoV-2 pandemic: as members of a society affected by a public health emergency and as HWC who experienced fear of becoming infected and of infecting others, stigma, violence, increased workloads, changes in scope of practice, among others. To understand the short and long-term impacts in terms of the COVID-19 pandemic and other public health emergencies of international concern (PHEICs) on HCW and relevant interventions to address them, we designed and conducted a living systematic review (LSR). METHODS We reviewed literature retrieved from MEDLINE-PubMed, Embase, SCOPUS, LILACS, the World Health Organization COVID-19 database, the ClinicalTrials.org and the ILO database, published from January 2000 until December 2021. We included quantitative observational studies, experimental studies, quasi-experimental, mixed methods or qualitative studies; addressing mental, physical health and well-being and quality of life. The review targeted HCW; and interventions and exposures, implemented during the COVID-19 pandemic or other PHEICs. To assess the risk of bias of included studies, we used the Johanna Briggs Institute (JBI) Critical Appraisal Tools. Data were qualitatively synthetized using meta-aggregation and meta-analysis was performed to estimate pooled prevalence of some of the outcomes. RESULTS The 1013 studies included in the review were mainly quantitative research, cross-sectional, with medium risk of bias/quality, addressing at least one of the following: mental health issue, violence, physical health and well-being, and quality of life. Additionally, interventions to address short- and long-term impact of PHEICs on HCW included in the review, although scarce, were mainly behavioral and individual oriented, aimed at improving mental health through the development of individual interventions. A lack of interventions addressing organizational or systemic bottlenecks was noted. DISCUSSION PHEICs impacted the mental and physical health of HCW with the greatest toll on mental health. The impact PHEICs are intricate and complex. The review revealed the consequences for health and care service delivery, with increased unplanned absenteeism, service disruption and occupation turnover that subvert the capacity to answer to the PHEICs, specifically challenging the resilience of health systems.
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Affiliation(s)
- Inês Fronteira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal.
- National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University of Lisbon, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.
| | - Verona Mathews
- School of Public, Health University of the Western Cape, South Africa, Private Bag X17, Bellville, 7535, Republic of South Africa
| | - Ranailla Lima Bandeira Dos Santos
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Osvaldo Cruz, Rua Leopoldo Bulhões, 1480 - Manguinhos, Rio de Janeiro, Brazil
| | - Karen Matsumoto
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524 - 7º andar, Blocos D e E - Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
| | - Woldekidan Amde
- School of Public, Health University of the Western Cape, South Africa, Private Bag X17, Bellville, 7535, Republic of South Africa
| | - Alessandra Pereira
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524 - 7º andar, Blocos D e E - Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
| | - Ana Paula Cavalcante de Oliveira
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524 - 7º andar, Blocos D e E - Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
| | - Isabel Craveiro
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal
| | - Raphael Chança
- Instituto Nacional de Cancer, Ministério da Saúde, Rua Marquês de Pombal, 125, Centro, Rio de Janeiro, RJ, 20230240, Brazil
| | - Mathieu Boniol
- Health Workforce Department, World Health Organization, Av. Appia 20, 1202, Geneva, Switzerland
| | - Paulo Ferrinho
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal
| | - Mario Roberto Dal Poz
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524 - 7º andar, Blocos D e E - Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
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Huang J, Huang ZT, Sun XC, Chen TT, Wu XT. Mental health status and related factors influencing healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. PLoS One 2024; 19:e0289454. [PMID: 38241316 PMCID: PMC10798549 DOI: 10.1371/journal.pone.0289454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The mental health of healthcare workers during the coronavirus-2019 pandemic was seriously affected, and the risk of mental health problems was high. The present study sought to systematically evaluate the mental health problems of healthcare workers worldwide during the pandemic and to determine the latest global frequency of COVID-19 associated mental health problems. METHODS Data in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Elsevier, MEDLINE, PubMed, PsycINFO and the Web of Science before November 11, 2022, were systematically searched. Cohort, case-control and cross-sectional studies were included. The meta-analysis used a random effects model to synthesize the comprehensive prevalence rate of mental health problems. Subgroup analyses were performed based on time of data collection; whether the country was or was not developed; continent; doctors and nurses; doctors/nurses vs. other healthcare workers; and psychological evaluation scale. RESULTS A total of 161 studies were included, including 341,014 healthcare workers worldwide, with women accounting for 82.8%. Occupationally, 16.2% of the healthcare workers were doctors, 63.6% were nurses and 13.3% were other medical staff. During the pandemic, 47% (95% confidence interval [CI], 35-60%) of healthcare workers reported job burnout, 38% (95% CI, 35-41%) experienced anxiety, 34% (95% CI 30-38%) reported depression, 30% (95% CI, 29-31%) had acute stress disorder, and 26% (95% CI, 21-31%) had post-traumatic stress disorder. CONCLUSIONS The study found that there were common mental health problems among health care workers during the COVID-19 pandemic. The most common was job burnout, followed by anxiety, depression, acute stress and post-traumatic stress disorder. Although the global pandemic has been brought under control, its long-term impact on the mental health of healthcare workers cannot be ignored. Additional research is required to develop measures to prevent, monitor and treat psychological disorders among healthcare workers.
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Affiliation(s)
- Jia Huang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Zhu-Tang Huang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Xin-Ce Sun
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Ting-Ting Chen
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Xiao-Tian Wu
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
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Bin X, Qu KY, Wang YH, Chen L, Xiong YJ, Wen JF, Wei HB, Bing T, Dan CY, Zhu JQ. Prevalence of depression, anxiety in China during the COVID-19 pandemic: an updated systematic review and meta-analysis. Front Public Health 2024; 11:1267764. [PMID: 38249392 PMCID: PMC10796455 DOI: 10.3389/fpubh.2023.1267764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/01/2023] [Indexed: 01/23/2024] Open
Abstract
Background Mental health risks associated with the aftermath of the COVID-19 pandemic are often overlooked by the public. The aim of this study was to investigate the effects of the COVID-19 pandemic on depression and anxiety disorders in China. Methods Studies were analyzed and extracted in accordance with the PRISMA 2020 flowchart. The studies were screened and extracted using electronic databases including PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov according to the predefined eligibility criteria. The Cochrane Review Manager software 5.3.1 was used for data analysis and the risk of bias assessment. Results As of 2023, a total of 9,212,751 Chinese have been diagnosed with COVID-19 infection. A total of 913,036 participants in 44 studies were selected following the eligibility criteria, the statistical information of which was collected for meta-analysis. The pooled prevalence of depression and anxiety were 0.31 (95% CI: 0.28, 0.35; I2 = 100.0%, p < 0.001) and 0.29 (95% CI: 0.23, 0.36; I2 = 100.0%, p < 0.001), respectively. After performing a subgroup analysis, the prevalence of depression among women, healthcare workers, students, and adolescents was 0.31 (95% CI: 0.22, 0.41), 0.33 (95% CI: 0.26, 0.44), 0.32 (95% CI: 0.26, 0.39), and 0.37 (95% CI: 0.31, 0.44), respectively. Conclusion The prevalence of depression and anxiety among the Chinese was overall high. Monitoring and surveillance of the mental health status of the population during crises such as sudden global pandemics are imperative. Systematic review registration https://clinicaltrials.gov/, identifier [CRD42023402190].
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Affiliation(s)
- Xiang Bin
- Department of Otolaryngology, Fengdu County People's Hospital, Chongqing, China
| | - Ke-Yi Qu
- Department of Stomatology, Fengdu County People's Hospital, Chongqing, China
| | - Yu-Hao Wang
- Shandong Academy of Medical Sciences, Shandong First Medical University, Shandong, China
| | - Li Chen
- Department of Pharmacy, Fengdu County People's Hospital, Chongqing, China
| | - Yan-Jie Xiong
- Department of Pharmacy, Fengdu County People's Hospital, Chongqing, China
| | - Jin Fu Wen
- Institute of Cardiovascular Endocrinology of Shandong First Medical University, Shandong Academy of Medical Sciences, Shandong, China
| | - Hua-Bo Wei
- Department of Pharmacy, Fengdu County People's Hospital, Chongqing, China
| | - Tan Bing
- Department of Pharmacy, Fengdu County People's Hospital, Chongqing, China
| | - Chun-Yan Dan
- Department of Human Resources, Fengdu County People's Hospital, Chongqing, China
| | - Jia-Quan Zhu
- Department of Pharmacy, Fengdu County People's Hospital, Chongqing, China
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Sun HL, Zhao YJ, Sha S, Li XH, Si TL, Liu YF, Su Z, Cheung T, Chang A, Liu ZM, Li X, Ng CH, An FR, Xiang YT. Depression and anxiety among caregivers of psychiatric patients during the late stage of the COVID-19 pandemic: A perspective from network analysis. J Affect Disord 2024; 344:33-40. [PMID: 37793475 DOI: 10.1016/j.jad.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 09/17/2023] [Accepted: 09/30/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Depressive and anxiety symptoms (depression and anxiety hereafter) are common among psychiatric patients and their caregivers during the COVID-19 pandemic. Network analysis is a novel method to assess the associations between psychiatric syndromes/disorders at the symptom level. This study examined depression and anxiety among caregivers of psychiatric inpatients during the late stage of the COVID-19 pandemic from the perspective of network analysis. METHODS A total of 1101 caregivers of psychiatric inpatients were included in this study. The severity of depression was assessed using the nine-item Patient Health Questionnaire (PHQ-9), while anxiety was assessed with the seven-item Generalized Anxiety Disorder Scale (GAD-7). The expected index (EI) and bridge EI index were used to identify the central and bridge symptoms, respectively. The stability of the network was evaluated via a case-dropping bootstrap procedure. RESULTS The prevalence of depression and anxiety were 32.4 % (95%CI: 29.7 %-35.3 %) and 28.0 % (95%CI: 25.4 %-30.7 %), respectively while the prevalence of comorbid depression and anxiety was 24.9 % (95%CI: 22.4 %-27.6 %). The most central symptom was "Fatigue", followed by "Trouble Relaxing" and "Restlessness". The highest bridge symptom was "Restlessness", followed by "Uncontrollable worry" and "Suicide ideation". The bootstrap test indicated that the whole network model was stable, and no network difference was detected between genders and between different education levels. CONCLUSIONS Depression, anxiety, and comorbid depression and anxiety were common among caregivers of psychiatric inpatients during the late stage of the COVID-19 pandemic. Central and bridge symptoms identified in this network analysis should be considered key target symptoms to address in caregivers of patients.
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Affiliation(s)
- He-Li Sun
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
| | - Yan-Jie Zhao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Sha Sha
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xiao-Hong Li
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Tong Leong Si
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Yu-Fei Liu
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Angela Chang
- Department of Communication, Faculty of Social Sciences, University of Macau, Macau SAR, China
| | - Zhao-Min Liu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xinyue Li
- School of Data Science, City University of Hong Kong, Hong Kong SAR, China
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia.
| | - Feng-Rong An
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
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Bai W, Gui Z, Chen MY, Zhang Q, Lam MI, Si TL, Zheng WY, Liu YF, Su Z, Cheung T, Jackson T, Li XH, Xiang YT. Global prevalence of poor sleep quality in military personnel and veterans: A systematic review and meta-analysis of epidemiological studies. Sleep Med Rev 2023; 71:101840. [PMID: 37647751 DOI: 10.1016/j.smrv.2023.101840] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
Poor sleep quality is prevalent among members of the military but rates of poor sleep quality vary between studies. This study examined the global prevalence of poor sleep quality in military personnel and veterans as well as possible moderators of prevalence differences between studies. PubMed, EMBASE, Web of Science, and PsycINFO were systematically searched from their inception dates to September 1, 2022. Studies were included if they were conducted on military personnel and/or veterans and prevalence estimates of poor sleep quality could be generated from assessments with standardized tools. A random-effects model was used to calculate the pooled prevalence and its 95% confidence intervals (CIs). Fifty-nine studies (N = 28,100) were included for analysis with sample sizes ranging from 14 to 8481. Two studies were rated as "high quality" (3.39%), while 57 were rated as "moderate quality" (96.61%). The overall pooled prevalence of poor sleep quality in military personnel and veterans was 69.00% (95% CI: 62.33-75.30%); pooled rates were 57.79% (95% CI: 49.88-65.50%) and 82.88% (95% CI: 74.08-90.21%) for active duty personnel and veterans, respectively. Subgroup analyses indicated study region, study design, sampling method, Pittsburg Sleep Quality Index cut-off values, and service type moderated prevalence of poor sleep quality. Meta-regression analyses indicated sample size, mean age, depression and posttraumatic stress disorder (PTSD) were associated with prevalence differences between studies. Poor sleep quality was more common in both active duty military personnel and veterans who were older and those who reported PTSD or depression. Regular monitoring of sleep quality and sleep hygiene should be promoted in this population. More relevant studies in middle- and low-income countries should also be conducted.
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Affiliation(s)
- Wei Bai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
| | - Zhen Gui
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
| | - Meng-Yi Chen
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Mei Ieng Lam
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China; Kiang Wu Nursing College of Macau, Macau SAR, China
| | - Tong Leong Si
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Wan-Ying Zheng
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Yu-Fei Liu
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Todd Jackson
- Department of Psychology, University of Macau, Macao SAR, China
| | - Xiao-Hong Li
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China; The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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10
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Miele R. Tales from a Hospital Entrance Screener: An Autoethnography and Exploration of COVID-19, Risk, and Responsibility. JOURNAL OF CONTEMPORARY ETHNOGRAPHY 2023; 52:493-513. [PMID: 38603266 PMCID: PMC9574532 DOI: 10.1177/08912416221131512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
This autoethnography explores my experiences as a hospital entrance screener during the first wave of the pandemic in a hospital in Ontario, Canada. In April 2020, I was redeployed from my research role to a hospital entrance screener. Focused on my lived experiences, the purpose of this research is to provide a glimpse into what it was like to work in a hospital early in the pandemic, to understand these experiences in relation to sociocultural meanings, and to try to make sense of my experiences with COVID-19. Through reflections, I offer a critical account of my experiences working as a screener and analyze personal reflections about my thoughts, feelings, and experiences from a post-structural lens. My analysis reveals several themes: responsibilization, risk, emotional labor, policing and securitization, and the hero discourse. My experiences as a screener demonstrate the complexities of the COVID-19 society and experience.
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Affiliation(s)
- Rachelle Miele
- Faculty of Social Work, Wilfrid Laurier University, Brantford, ON, Canada
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11
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Sialakis C, Sialaki PA, Frantzana A, Iliadis C, Ouzounakis P, Kourkouta L. Prevalence of anxiety and depression of health care workers during COVID-19 - a systematic review and meta-analysis. Med Pharm Rep 2023; 96:246-253. [PMID: 37577023 PMCID: PMC10419692 DOI: 10.15386/mpr-2579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/25/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction During the COVID-19 pandemic, the workload of healthcare workers managing the disease, increased significantly. The objective of this review is to determine the anxiety and depression prevalence among healthcare workers during the pandemic period. Methods We searched systematically the literature in five electronic databases such as PubMed, CINAHL, ScienceDirect, MEDLINE, and Cochrane COVID-19 study register. The last online research was performed in May 2022. We included only cross-sectional studies and performed a meta-analysis of pooled prevalence. Publication bias was assessed with a funnel plot and Egger's and Begg's tests. A random effect was applied and heterogenicity I2 was calculated. Quality assessment of included studies was performed using the Joanna Briggs Institute tool. Results In this review, we included 14 cross-sectional studies comprising 7780 healthcare workers. Participants were from the whole spectrum of healthcare workers. The pooled prevalence of depression was 33.8% (95% CI: 24.6 - 43.6), heterogenicity I2: 98.69%. The pooled prevalence of anxiety was 41.3% (95% CI: 30.2 - 52.9), heterogenicity I2: 99.01%. Conclusion One-third of healthcare workers suffered from depression, and more than one-third suffered from anxiety during the COVID-19 pandemic. Increased measures of surveillance of mental health should have been taken, as well as the support of healthcare workers running a high risk of psychological distress during the COVID-19 pandemic.
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Affiliation(s)
- Christos Sialakis
- General Hospital “Agios Dimitrios-G. Gennimatas”, Thessaloninki, Greece
| | | | - Aikaterini Frantzana
- School of Sciences, Department of Health Sciences, School of Medicine, European University Cyprus, Nicosia, Cyprus
- George Papanikolaou General Hospital of Thessaloniki, Greece
| | | | | | - Labrini Kourkouta
- Nursing Department, International University of Greece, Thessaloniki, Greece
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12
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Nahidi M, Ghalandarzadeh M, Sinichi F, Sahebzadeh N, Eslami S, Reihani H, Emadzadeh M, Fayyazi Bordbar MR. Investigating the psychological effects of home quarantine during the early peaks of the COVID-19 pandemic: a survey from Iran. Int Clin Psychopharmacol 2023; 38:136-145. [PMID: 36730691 DOI: 10.1097/yic.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We assessed psychological symptoms among individuals who were quarantined during early coronavirus disease 2019 (COVID-19) peaks. This cross-sectional study was performed during April-October 2020 in Iran. We surveyed 100 individuals with COVID-19 patients in their families and 100 others with health conditions associated with a higher risk of developing critical forms of COVID-19 infection, who have completed at least 14 days of home quarantine. Validated Persian versions of the 21-item Depression, Anxiety, and Stress and 22-item Impact of Event Scale-Revised were used to measure the symptoms of depression, anxiety, stress and distress. The rates of stress, anxiety, depression and quarantine-related distress were 46.5, 48.5, 57.0 and 80.5%, respectively; however, they were not significantly different between the contact and no-contact groups. Female sex and being unemployed were significantly associated with quarantine-related distress, P = 0.007 and P = 0.018, respectively. Independent risk factors for anxiety were a history of medical comorbidity ( P = 0.025) and contact with COVID-19 patients ( P = 0.007). Findings show high prevalence rates of psychological symptoms among quarantined individuals, regardless of whether they had contact with COVID-19 patients or not. Female sex and unemployment were risk factors for quarantine-related distress.
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Affiliation(s)
- Mahsa Nahidi
- Psychiatry and Behavioral Sciences Research Centers
| | | | | | | | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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13
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Zhao YJ, Zhang C, Guo T, Sha S, Su Z, Cheung T, Jackson T, An FR, Xiang YT. Associations between post-traumatic stress symptoms and quality of life among psychiatric healthcare personnel in China during the COVID-19 pandemic: A network approach. Front Psychiatry 2023; 14:975443. [PMID: 36873200 PMCID: PMC9975756 DOI: 10.3389/fpsyt.2023.975443] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/10/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Post-traumatic stress symptoms (PTSS) are commonly reported by psychiatric healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic and negatively affect quality of life (QOL). However, associations between PTSS and QOL at symptom level are not clear. This study examined the network structure of PTSS and its connection with QOL in psychiatric healthcare personnel during the COVID-19 pandemic. METHODS This cross-sectional study was carried out between March 15 and March 20, 2020 based on convenience sampling. Self-report measures including the 17-item Post-Traumatic Stress Disorder Checklist - Civilian version (PCL-C) and World Health Organization Quality of Life Questionnaire - Brief Version (WHOQOL-BREF) were used to measure PTSS and global QOL, respectively. Network analysis was used to investigate the central symptoms of PTSS and pattern of connections between PTSS and QOL. An undirected network was constructed using an extended Bayesian Information Criterion (EBIC) model, while a directed network was established based on the Triangulated Maximally Filtered Graph (TMFG) method. RESULTS Altogether, 10,516 psychiatric healthcare personnel completed the assessment. "Avoidance of thoughts" (PTSS-6), "Avoidance of reminders" (PTSS-7), and "emotionally numb" (PTSS-11) were the most central symptoms in the PTSS community, all of which were in the Avoidance and Numbing domain. Key bridge symptoms connecting PTSS and QOL were "Sleep disturbances" (PTSS-13), "Irritability" (PTSS-14) and "Difficulty concentrating" (PTSS-15), all of which were within the Hyperarousal domain. CONCLUSION In this sample, the most prominent PTSS symptoms reflected avoidance while symptoms of hyper-arousal had the strongest links with QOL. As such, these symptom clusters are potentially useful targets for interventions to improve PTSS and QOL among healthcare personnel at work under pandemic conditions.
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Affiliation(s)
- Yan-Jie Zhao
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Cheng Zhang
- Yong Ding Lu Outpatient Department, Jingnan Medical Area, Chinese PLA General Hospital, Beijing, China
| | - Tong Guo
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Sha Sha
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Todd Jackson
- Department of Psychology, University of Macau, Taipa, Macao SAR, China
| | - Feng-Rong An
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Taipa, Macao SAR, China
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14
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Zhao YJ, Zhang SF, Li W, Zhang L, Guo T, Cheung T, Jackson T, Yang BX, Xiang YT. Associations between depressive symptoms and quality of life among residents of Wuhan, China during the later stage of the COVID-19 pandemic: A network analysis. J Affect Disord 2022; 318:456-464. [PMID: 36058363 PMCID: PMC9436879 DOI: 10.1016/j.jad.2022.08.104] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/23/2022] [Accepted: 08/26/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Various populations have experienced significant increases in depression and decreased quality of life (QOL) during the coronavirus disease 2019 (COVID-19) pandemic. This network analysis study was designed to elucidate interconnections between particular depressive symptoms and different aspects of QOL and identify the most clinically important symptoms in this network among adults in Wuhan China, the initial epicenter of the COVID-19 pandemic. METHODS This cross-sectional, convenience-sampling study (N = 2459) was conducted between May 25 to June 18, 2020, after the lockdown policy had been lifted in Wuhan. Depressive symptoms and QOL were measured with the Patient Health Questionnaire-9 (PHQ-9) and first two items of the World Health Organization Quality of Life Questionnaire - brief version (WHOQOL-BREF), respectively. A network structure was constructed from the extended Bayesian Information Criterion (EBIC) model. Network centrality strength and bridge strength were evaluated along with the stability of the derived network model. RESULTS Loss of energy (DEP-4) and Guilt feelings (DEP-6) were the two central symptoms with the highest strength as well as the two most prominent bridge symptoms connecting the clusters of depression and quality of life (QOL) in tandem with the two nodes from the QOL cluster. Network structure and bridge strengths remained stable after randomly dropping 75 % of the sample. CONCLUSION Interventions targeting "Loss of energy" and "Guilt feelings" should be evaluated as strategies for reducing depressive symptoms and promoting improved QOL in COVID-19-affected populations.
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Affiliation(s)
- Yan-Jie Zhao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
| | - Shu-Fang Zhang
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Hubei province, China; Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei province, China
| | - Wen Li
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, China; Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Tong Guo
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Todd Jackson
- Department of Psychology, University of Macau, Macao SAR, China
| | - Bing Xiang Yang
- School of Nursing, Wuhan University, Wuhan, Hubei province, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
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Zegarra-López AC, Luna-Victoria G, Romero-Montenegro D, Florentino-Santisteban B, Prieto-Molinari DE, Montoya-Cuadrao M. Prevalence and Predictors of Somatization in Peruvian Undergraduate Students during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15576. [PMID: 36497651 PMCID: PMC9739199 DOI: 10.3390/ijerph192315576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic had a strong impact on mental health. Multiple studies report the alarming prevalence of depression, anxiety, and stress-related conditions due to the lockdown measures. Nevertheless, somatization has been an overlooked topic in current literature despite its strong relationship with most mental health conditions. The aim of this study was to describe the prevalence of somatic symptoms and their associated factors in a sample of 3218 undergraduate students from Lima, Peru. A cross-sectional design was carried out. The prevalence of somatic symptoms was measured with the PHQ-15. As predictors of somatic symptom severity, we included psychopathological (depression, anxiety, and stress), psychological (perceived social support, resilience, satisfaction with life, and academic self-efficacy), and sociodemographic (e.g., age, sex, employment status, relationship status, daily hours of sleep) variables. A generalized linear model from a binomial family and a logit link function were applied based on a Factor Score Regression approach, with half of the sample presenting moderate-to-severe somatic symptoms. Anxiety was the strongest predictor of somatic symptom severity, followed by academic self-efficacy. Significant differences were found regarding sex, relationship status, daily hours of sleep and COVID-19 risk-related variables. In conclusion, interventions on reducing anxiety and promoting academic self-efficacy may have a stronger impact on somatic symptom severity and should focus on more vulnerable specific demographic groups such as females.
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Affiliation(s)
- Angel Christopher Zegarra-López
- Faculty of Psychology, Universidad de Lima, Lima 15023, Peru
- Grupo de Investigación en Psicología, Bienestar y Sociedad, Instituto de Investigación Científica, Universidad de Lima, Lima 15023, Peru
| | | | | | | | - Diego Eduardo Prieto-Molinari
- Faculty of Psychology, Universidad de Lima, Lima 15023, Peru
- Grupo de Investigación en Psicología, Bienestar y Sociedad, Instituto de Investigación Científica, Universidad de Lima, Lima 15023, Peru
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Chen P, Zhang L, Feng Y, Liu YF, Si TL, Su Z, Cheung T, Ungvari GS, Ng CH, Xiang YT. Brain-gut axis and psychiatric disorders: A perspective from bibliometric and visual analysis. Front Immunol 2022; 13:1047007. [PMID: 36466907 PMCID: PMC9709456 DOI: 10.3389/fimmu.2022.1047007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 10/24/2022] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The Brain-Gut Axis, a bidirectional signaling pathway that connects the intestinal and central nervous systems, plays an important role in the development of psychiatric disorders. However, the overall research trends in this field are unclear. This study explored the patterns of research on the brain-gut axis and psychiatric disorders from a bibliometric perspective. METHODS Relevant data were retrieved from the Web of Science Core Collection, with search terms on psychiatric disorders and the brain-gut axis. R (version 4.2.0), VOSviewer (version 1.6.17), CiteSpace software, and the online bibliometric platform were used in the data analysis. RESULTS A total of 2,298 articles published between 1993 and 2022 were identified, showing an increasing trend over time. China (1,859; 20.70%) was the country that contributed the most publications. The journal Nutrients (95; 4.13%) published the most publications. Cryan JF (153; H-index=73) and University College Cork (559; 22.54%) were the most influential author and the most productive institution, respectively. The high-frequency keywords were clustered into six themes, including neurodegenerative diseases, stress-related diseases, immune, brain behavior, depression, and probiotic-related topics; of which, depression (880; 2019), anxiety (207; 2018) and autism (191; 2019) were the most studied psychiatric disorders in the past 5 years. "Depressive symptom" (2019-2020) and "probiotic treatment" (2019-2020) were the main areas addressed in recent years. CONCLUSION Research on the brain-gut axis and psychiatric disorders has attracted increasing attention in the past decade, with most publications originating from high-income level countries. This study provides a useful perspective on understanding the research trends, key hot topics, and research gaps in this expanding field.
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Affiliation(s)
- Pan Chen
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macau SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macau SAR, China
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuan Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yu-Fei Liu
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macau SAR, China
| | - Tong Leong Si
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macau SAR, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX, United States
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Gabor S. Ungvari
- University of Notre Dame Australia, Fremantle, WA, Australia
- Division of Psychiatry, School of Medicine, University of Western Australia / Graylands Hospital, Perth, WA, Australia
| | - Chee H. Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VIC, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macau SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macau SAR, China
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Mejri I, Youssfi I, Znegui T, Mechergui N, El Kefi H, Hammami R, Chenik S, Ben Mansour A, Ben Saad S, Moatemri Z. Mental health status of healthcare workers at a third line Tunisian hospital during COVID-19 pandemic. LA TUNISIE MEDICALE 2022; 100:670-675. [PMID: 36571751 PMCID: PMC9833317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION During the COVID-19(coronavirus-19 disease) pandemic, health care workers (HCWs) faced the risk of infection and distressing work to meet health requirements. The aim of the present stud ywas to evaluate perceptions of HCWs of their security at work in COVID-19 units and their coping strategies, at the military hospital of Tunis, during the second wave of COVID-19. METHODS A cross-sectional study was conducted via an auto-questionnaire on February 2021.HCWs of the military hospital of Tunis were included. Participants were asked about their perceived security at work in COVID-19 units and their coping behaviors. Mental disorders were assessed, via qualitative questionnaires. RESULTS A total of 110 HCWs' responses were collected. Fifty-eight participants (52.7%) were females. The mean age was 33.7 years (SD 9.3). They were doctors at 45.5% and nurses at 39.1%. HCWs declared having worked in COVID-19 units in 81.8% of cases. The participants reported their fears about being infected in 58.2% and infecting family members in 85.5% of cases. Protective factors included information about the disease (80%), availability of personal protective equipment (PPE) (80.9%), support from colleagues(72.7%)or superiors at work (50.9%), and ability to communicate with others (63.6%). Depression, anxiety, and insomnia were found in respectively 25.5%, 30%, and 41.8% of HCWs. In multivariate analysis, suffering from a traumatic distress was significantly associated with anxiety and depression (p (p<0.01 and, p<0.05 respectively). In addition, insomnia severity was linked to age (p=0.05) and having colleagues infected with COVID-19 (p<0.05). CONCLUSION In the present study, HCWs of the military hospital of Tunis stated having high levels of insomnia, anxiety, and depression since the early outbreak of the COVID-19 pandemic. These mental disorders may have a negative impact on the quality of life of HCWs and should be enhanced by psychological support and preventive measures.
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Affiliation(s)
- Islam Mejri
- 1. Pneumology Department, Military Hospital of Tunis, Tunis, Tunisia / Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Imen Youssfi
- 2. Occupational Health Department, Charles Nicolle Hospital of Tunis, Tunis, Tunisia, / Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Tasnim Znegui
- 1. Pneumology Department, Military Hospital of Tunis, Tunis, Tunisia / Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Nejla Mechergui
- 2. Occupational Health Department, Charles Nicolle Hospital of Tunis, Tunis, Tunisia, / Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hamdi El Kefi
- 3. Psychiatry Department, Military Hospital of Tunis, Tunis, Tunisia / Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Rim Hammami
- 4. Emergency Department, Military Hospital of Tunis, Tunis, Tunisia / Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Sarra Chenik
- 5. Cardiology Department, Military Hospital of Tunis, Tunis, Tunisia / Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ameni Ben Mansour
- 6. Pneumology C Department, AbderrahmenMami Hospital of Ariana, Tunisia / Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Soumaya Ben Saad
- 6. Pneumology C Department, AbderrahmenMami Hospital of Ariana, Tunisia / Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Zied Moatemri
- 1. Pneumology Department, Military Hospital of Tunis, Tunis, Tunisia / Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Jin Y, Sha S, Tian T, Wang Q, Liang S, Wang Z, Liu Y, Cheung T, Su Z, Ng CH, Xiang YT. Network analysis of comorbid depression and anxiety and their associations with quality of life among clinicians in public hospitals during the late stage of the COVID-19 pandemic in China. J Affect Disord 2022; 314:193-200. [PMID: 35780965 PMCID: PMC9242942 DOI: 10.1016/j.jad.2022.06.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/25/2022] [Accepted: 06/20/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mental health problems are common among clinicians working in public hospitals even in the late stage of the COVID-19 pandemic. Network analysis is a novel approach to explore interactions between mental health problems at the symptom level. This study examined the network structure of comorbid depression and anxiety and their associations with quality of life (QOL) among hospital clinicians in China during the late stage of the COVID-19 pandemic. METHODS A total of 4931 participants were recruited from October 13 to 22, 2020. The nine-item Patient Health Questionnaire (PHQ-9), seven-item Generalized Anxiety Disorder Scale (GAD-7), and the World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF) were used to measure depressive and anxiety symptoms, and QOL, respectively. Central and bridge symptoms were identified with centrality and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure. RESULTS The prevalence of depression (defined as PHQ-9 total score ≥ 5) was 35.1 % [95 % confidence interval (CI) = 33.73-36.41 %)], the prevalence of anxiety (GAD-7 total score ≥ 5) was 32.5 % (95 % CI = 31.20-33.84 %), while the prevalence of comorbid depression and anxiety was 26.9 % (95 % CI = 25.7-28.2 %). "Impaired motor skills", "Trouble relaxing" and "Uncontrollable worry" were the central symptoms in the whole depression-anxiety network. "Irritability", "Feeling afraid" and "Sad mood" were the most key bridge symptoms linking depression and anxiety. Three symptoms ("Fatigue", "Trouble relaxing" and "Nervousness") were the most strongly and negatively associated with QOL. Neither gender nor the experiences of caring for COVID-19 patients was associated with network global strength, distribution of edge weights or individual edge weights. LIMITATIONS The causality between variables could not be established. Depressive and anxiety symptoms were assessed by self-report measures, which may result in recall bias and limitations in capturing clinical phenomena. CONCLUSIONS Both the central (i.e., "Impaired motor skills", "Trouble relaxing" and "Uncontrollable worry") and bridge symptoms (i.e., "Irritability", "Feeling afraid" and "Sad mood") identified in this network analysis should be targeted in specific treatment and preventive measures for comorbid depressive and anxiety symptoms among clinicians in the late stage of the pandemic. Furthermore, "Fatigue", "Trouble relaxing" and "Nervousness" are key symptoms to address to improve clinicians' QOL.
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Affiliation(s)
- Yu Jin
- College of Education for the Future, Beijing Normal University, China
| | - Sha Sha
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China.
| | - Tengfei Tian
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Qian Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Sixiang Liang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Zhe Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Yinqi Liu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Chee H. Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia,Corresponding author
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China; Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China.
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19
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AlKandari S, Salman A, Al-Ghadban F, Ahmad R. A Cross-Sectional Study to Examine the Psychological Impact of the COVID-19 Pandemic on Healthcare Workers in Kuwait. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10464. [PMID: 36078180 PMCID: PMC9518443 DOI: 10.3390/ijerph191710464] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
In this study, we aimed to evaluate the psychological impact of the COVID-19 pandemic on healthcare workers to determine the prevalence of symptoms of depression, anxiety, and well-being, and to identify the factors associated with adverse psychological effects. This study was conducted 5 months into the COVID-19 pandemic. We used an online questionnaire to collect data from 378 healthcare workers. To examine the psychological impact, three standardized questionnaires were utilized. This includes the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), and the WHO Well-Being Scale (WHO-5) to measure depression, anxiety, and quality of life, respectively. More than half of the participants (52.9%) exhibited moderate or high levels of depression, and 40.5% reported moderate or high levels of anxiety. Unmarried HCWs reported more severe levels of depression; moderately severe depression (24.0% vs. 16.1%) and severe depression (12.4% vs. 6.8%). Unmarried HCWs also reported more severity of anxiety as well as lower overall wellbeing. Understanding how personal factors such as marital status can influence the degree of psychological distress can allow us to make better investments in supporting the mental health needs of HCWs in Kuwait. Governments and organizations must establish protective measures, such as continually assessing the mental health status of HCWs throughout the pandemic and providing support services for HCWs in need to minimize adverse consequences and ensure optimal health system operation.
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Affiliation(s)
- Sarah AlKandari
- Immunology and Microbiology Department, Dasman Diabetes Institute, Dasman 15462, Kuwait
| | | | - Fatima Al-Ghadban
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA
- Department of Public Health Practice, Faculty of Public Health, Kuwait University, Safat 13110, Kuwait
| | - Rasheed Ahmad
- Immunology and Microbiology Department, Dasman Diabetes Institute, Dasman 15462, Kuwait
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20
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Zhang L, Yan M, Takashima K, Guo W, Yamada Y. The effect of the COVID-19 pandemic on health care workers' anxiety levels: a meta-analysis. PeerJ 2022; 10:e13225. [PMID: 35433133 PMCID: PMC9009329 DOI: 10.7717/peerj.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/15/2022] [Indexed: 01/12/2023] Open
Abstract
Background The COVID-19 pandemic has been declared a public health emergency of international concern, causing excessive anxiety among health care workers. Additionally, publication bias and low-quality publications have become widespread, which can result in the dissemination of unreliable information. A meta-analysis was performed for this study with the following two aims: (1) to examine the prevalence of anxiety among health care workers and determine whether it has increased owing to the COVID-19 pandemic and (2) to investigate whether there has been an increase in publication bias. Methods All relevant studies published between 2015 and 2020 were searched in electronic databases (namely Web of Science, PubMed, Embase, PsycInfo, PsyArXiv, and medRxiv). The heterogeneity of the studies was assessed using the I 2 statistic. The effect size (prevalence rate of anxiety) and 95% CI for each study were also calculated. We used moderator analysis to test for the effect of the COVID-19 pandemic on health care workers' anxiety levels and to detect publication bias in COVID-19 studies. We assessed publication bias using funnel plots and Egger's regression. Results A total of 122 studies with 118,025 participants met the inclusion criteria. Eighty-eight articles (75,066 participants) were related to COVID-19, 13 articles (9,222 participants) were unrelated to COVID-19 (i.e., articles related to other outbreaks, which were excluded), and 21 preprints (33,737 participants) were related to COVID-19. The pooled meta-analysis prevalence was 33.6% (95% CI [30.5-36.8]; 95% PI [6.5-76.3]). Moderator analysis revealed no significant differences between articles related to COVID-19 and those unrelated to COVID-19 (p = 0.824). Moreover, no significant differences were found between articles and preprints related to COVID-19 (p = 0.843). Significant heterogeneity was observed in each subgroup. An Egger's test revealed publication bias in both articles and preprints related to COVID-19 (p < 0.001). Conclusions Determining whether the anxiety state of health care workers is altered by the COVID-19 pandemic is currently difficult. However, there is evidence that their anxiety levels may always be high, which suggests that more attention should be paid to their mental health. Furthermore, we found a substantial publication bias; however, the quality of the studies was relatively stable and reliable.
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Affiliation(s)
- Lunbo Zhang
- Graduate School of Human-Environment Studies, Kyushu University, Japan
| | - Ming Yan
- Graduate School of Human-Environment Studies, Kyushu University, Japan
| | - Kaito Takashima
- Graduate School of Human-Environment Studies, Kyushu University, Japan
| | - Wenru Guo
- Graduate School of Human-Environment Studies, Kyushu University, Japan
| | - Yuki Yamada
- Faculty of Arts and Science, Kyushu University, Japan
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21
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Yang Y, Zhang SF, Yang BX, Li W, Sha S, Jia FJ, Cheung T, Zhang DX, Ng CH, Xiang YT. Mapping Network Connectivity Among Symptoms of Depression and Pain in Wuhan Residents During the Late-Stage of the COVID-19 Pandemic. Front Psychiatry 2022; 13:814790. [PMID: 35370830 PMCID: PMC8968182 DOI: 10.3389/fpsyt.2022.814790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Symptoms of depression and pain often overlap, and they negatively influence the prognosis and treatment outcome of both conditions. However, the comorbidity of depression and pain has not been examined using network analysis, especially in the context of a pandemic. Thus, we mapped out the network connectivity among the symptoms of depression and pain in Wuhan residents in China during the late stage of the COVID-19 pandemic. Methods This cross-sectional study was conducted from May 25, 2020 to June 18, 2020 in Wuhan, China. Participants' depressive and pain symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ9) and a pain numeric rating scale (NRS), respectively. Network analyses were performed. Results In total, 2,598 participants completed all assessments. PHQ4 (fatigue) in the depression community showed the highest strength value, followed by PHQ6 (worthlessness) and PHQ2 (depressed or sad mood). PHQ4 (fatigue) was also the most key bridge symptom liking depression and pain, followed by PHQ3 (sleep difficulties). There were no significant differences in network global strength (females: 4.36 vs. males: 4.29; S = 0.075, P = 0.427), network structure-distribution of edge weights (M = 0.12, P = 0.541), and individual edge weights between male and female participants. Conclusion Depressive and pain symptoms showed strong cross-association with each other. "Fatigue" was the strongest central and bridge symptom in the network model, while "sleep difficulties" was the second strongest bridge symptom. Targeting treatment of both fatigue and sleep problems may help improve depressive and pain symptoms in those affected.
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Affiliation(s)
- Yuan Yang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shu-Fang Zhang
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
| | | | - Wen Li
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Sha Sha
- Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Fu-Jun Jia
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - De-Xing Zhang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chee H. Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VA, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, Institute of Translational Medicine, University of Macau, Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macau, Macao SAR, China
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22
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Sudom KA, Lee JEC. Well-being of Canadian Armed Forces members during the COVID-19 pandemic: the influence of positive health behaviours. Health Promot Chronic Dis Prev Can 2022; 42:113-121. [PMID: 35262313 PMCID: PMC9022951 DOI: 10.24095/hpcdp.42.3.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has been linked to increased depression, anxiety and other adverse mental health outcomes. Understanding the behaviours that positively influence health is important for the development of strategies to maintain andimprove well-being during the pandemic. METHODS This study focussed on Canadian Armed Forces Regular Force members (N = 13 668) who participated in the COVID-19 Defence Team Survey, administered between April and May 2020. The use of positive health behaviours and the extent to which such behaviours were associated with anxiety, depression and self-reported change in health and stress levels compared to before the pandemic were examined. RESULTS Depression and anxiety were experienced by 14% and 15% of the sample, respectively, while 36% reported that their mental health had gotten worse since the pandemic started, and close to half reported worse physical health and stress levels. The most common behaviours respondents reported engaging in to maintain or improve their health were exercising outdoors, healthy eating and connecting with loved ones. Although most behaviours were associated with better health outcomes, meditation and connecting with loved ones showed associations with worse health. CONCLUSION Engaging in behaviours such as exercise and healthy eating was generally associated with better health outcomes. Unexpected relationships of meditation and connecting with loved ones are discussed in terms of their use in stressful times among those with mental health issues, past research on coping strategies and impacts of the pandemic and physical distancing on social connections. The findings may have implications for strategies to promote healthy behaviours during the remainder of the pandemic and similar crises in the future.
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Affiliation(s)
- Kerry A Sudom
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, Ontario, Canada
| | - Jennifer E C Lee
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, Ontario, Canada
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23
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Pan X, Xiao Y, Ren D, Xu ZM, Zhang Q, Yang LY, Liu F, Hao YS, Zhao F, Bai YH. Prevalence of mental health problems and associated risk factors among military healthcare workers in specialized COVID-19 hospitals in Wuhan, China: A cross-sectional survey. Asia Pac Psychiatry 2022; 14:e12427. [PMID: 33089622 PMCID: PMC7645907 DOI: 10.1111/appy.12427] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION China has been severely affected by coronavirus disease 2019 (COVID-19) since December 2019. Military healthcare workers in China have experienced many pressures when combating COVID-19. This study aimed to investigate the current psychological status and associated risk factors among military healthcare workers. METHODS We collected data from 194 military healthcare workers from three inpatient wards in two specialized COVID-19 hospitals using a web-based cross-sectional survey. The survey covered demographic information, the patient health questionnaire-9, the Generalized Anxiety Disorder-7, and the patient health questionnaire-15. Hierarchical regression analysis was used to explore potential risk factors for mental health problems. RESULTS The overall prevalence rates of depressive, generalized anxiety, and somatic symptoms were 37.6%, 32.5%, and 50%, respectively. Rates of severe depression, generalized anxiety, and somatic symptoms were 5.2%, 3.6%, and 15.5%, respectively. In 22.7% of cases, comorbidities existed between depression, generalized anxiety, and somatization. A junior-grade professional title was associated with depression, older age was associated with generalized anxiety and somatization, and short sleep duration and poor sleep quality were associated with all three symptoms. DISCUSSION The prevalence of depression, generalized anxiety, and somatic symptoms among military healthcare workers in specialized COVID-19 hospitals is high during the current COVID-19 outbreak. A junior-grade professional title, older age, short sleep duration, and poor sleep quality significantly affect military healthcare workers' mental health. Continuous surveillance and monitoring of the psychological consequences of the COVID-19 outbreak should be routine to promote mental health among military healthcare workers.
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Affiliation(s)
- Xiao Pan
- Department of Medical Psychology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ying Xiao
- Hongkou District of Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ding Ren
- Department of Medical Psychology, PLA Navy No.905 Hospital, Second Military Medical University, Shanghai, China
| | - Zheng-Mei Xu
- Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Qian Zhang
- Department of Hyperbaric, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Li-Ying Yang
- Department of Radiotherapy, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Fen Liu
- Department of Critical Medicine, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yu-Shi Hao
- Department of Medical Psychology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Feng Zhao
- Hongkou District of Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yong-Hai Bai
- Department of Medical Psychology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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24
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Bai W, Cai H, Liu S, Chen X, Sha S, Cheung T, Lin JJ, Cui X, Ng CH, Xiang YT. Anxiety and depressive symptoms in college students during the late stage of the COVID-19 outbreak: a network approach. Transl Psychiatry 2021; 11:638. [PMID: 34921138 PMCID: PMC8678580 DOI: 10.1038/s41398-021-01738-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/23/2021] [Accepted: 10/28/2021] [Indexed: 12/12/2022] Open
Abstract
Mental health problems are common in college students even in the late stage of the coronavirus disease 2019 (COVID-19) outbreak. Network analysis is a novel approach to explore interactions of mental disorders at the symptom level. The aim of this study was to elucidate characteristics of depressive and anxiety symptoms network in college students in the late stage of the COVID-19 outbreak. A total of 3062 college students were included. The seven-item Generalized Anxiety Disorder Scale (GAD-7) and nine-item Patient Health Questionnaire (PHQ-9) were used to measure anxiety and depressive symptoms, respectively. Central symptoms and bridge symptoms were identified based on centrality and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure. The strongest direct relation was between anxiety symptoms "Nervousness" and "Uncontrollable worry". "Fatigue" has the highest node strength in the anxiety and depression network, followed by "Excessive worry", "Trouble relaxing", and "Uncontrollable worry". "Motor" showed the highest bridge strength, followed by "Feeling afraid" and "Restlessness". The whole network was robust in both stability and accuracy tests. Central symptoms "Fatigue", "Excessive worry", "Trouble relaxing" and "Uncontrollable worry", and critical bridge symptoms "Motor", "Feeling afraid" and "Restlessness" were highlighted in this study. Targeting interventions to these symptoms may be important to effectively alleviate the overall level of anxiety and depressive symptoms in college students.
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Affiliation(s)
- Wei Bai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao, SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, SAR, China
| | - Hong Cai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao, SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, SAR, China
| | - Shou Liu
- Department of Public Health, Medical College, Qinghai University, Xining, Qinghai Province, China
| | - Xu Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Sha Sha
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Jessie Jingxia Lin
- Department of Rehabilitation Sciences, & Mental Health Research Centre, Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Xiling Cui
- Department of Business Administration, Hong Kong Shue Yan University, Hong Kong, China
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao, SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, SAR, China
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25
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Liu R, Li Y, An Y, Zhang L, An FR, Luo J, Wang A, Zhao YJ, Yuan A, Cheung T, Ungvari GS, Qin MZ, Xiang YT. Workplace violence against frontline clinicians in emergency departments during the COVID-19 pandemic. PeerJ 2021; 9:e12459. [PMID: 34900420 PMCID: PMC8621782 DOI: 10.7717/peerj.12459] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/18/2021] [Indexed: 12/24/2022] Open
Abstract
Background Frontline clinicians working in emergency departments (ED) were at disportionate risk of workplace violence (WPV). We investigated the prevalence of WPV and its relationship with quality of life (QOL) in this group of health professionals in China during the COVID-19 pandemic. Methods A cross-sectional, online study was conducted. The nine-item Workplace Violence Scale measured WPV. Results A total of 1,103 ED clinicians participated in this study. The overall prevalence of WPV against ED clinicians was 29.2% (95% CI [26.5%-31.9%]). Having family/friends/colleagues infected with COVID-19 (Odds Ratio (OR) = 1.82, P = 0.01), current smoking (OR = 2.98, P < 0.01) and severity of anxiety symptoms (OR = 1.08, P < 0.01) were independently and positively associated with WPV, while working in emergency intensive care units (OR = 0.45, P < 0.01) was negatively associated with WPV. After controlling for covariates, clinicians experiencing WPV had a lower global QOL compared to those without (F(1, 1103) = 10.9,P < 0.01). Conclusions Prevalence of workplace violence against ED clinicians was common in China during the COVID-19 pandemic. Due to the negative impact of WPV on QOL and quality of care, timely preventive measures should be undertaken for ED clinicians.
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Affiliation(s)
- Rui Liu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Yue Li
- Department of Nursing, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying An
- Department of Emergency Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Feng-Rong An
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jia Luo
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Aiping Wang
- Department of Emergency Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yan-Jie Zhao
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Anzhe Yuan
- Eastside High School, Gainesville, FL, USA
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hongkong SAR, China
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia.,University of Notre Dame Australia, Fremantle, Australia
| | - Ming-Zhao Qin
- Department of Geriatric Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
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26
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Chen X, Liu P, Lei GF, Tong L, Wang H, Zhang XQ. Sleep Quality and the Depression-Anxiety-Stress State of Frontline Nurses Who Perform Nucleic Acid Sample Collection During COVID-19: A Cross-Sectional Study. Psychol Res Behav Manag 2021; 14:1889-1900. [PMID: 34858069 PMCID: PMC8631986 DOI: 10.2147/prbm.s338495] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/16/2021] [Indexed: 12/23/2022] Open
Abstract
Objective To explore the sleep quality and depression-anxiety-stress state of frontline nurses in high-risk areas who conduct nucleic acid sampling testing for COVID-19 to provide a basis for formulating intervention programs in crisis management. Methods From August 22 to 30, 2021, a convenient sampling method was used in Zhangjiajie City, Hunan Province, China. A total of 248 frontline nurses who performed nucleic acid sample collection were selected. The following tests were used: the general information questionnaire, Pittsburgh Sleep Quality Questionnaire (PSQI), and Depression–Anxiety Stress Scale (DASS-21). Results A total of 236 nurses completed the survey; 88.14% (n = 208) were women, the average age was 33.02±6.81, the PSQI score was 15 (13–17), and 231 (97.88%) nurses had sleep disorders during the period in Zhangjiajie, 219 nurses (81.36%) had anxiety, 135 nurses (45.76%) had depression, and 112 nurses (42.59%) felt stressed. Spearman correlation analysis was used to associate the PSQI with the DASS-21. The results showed that the use of hypnotic drugs was negatively correlated with DASS-21 (P<0.05), while the rest were positively correlated. The results of the multivariate analysis of sleep disorders showed that depression, anxiety, and stress were related to sleep quality (P<0.05), and there was no statistical difference in the other variables. Conclusion During the COVID-19 pandemic, the sleep quality and depression-anxiety-stress state of the frontline nurses performing nucleic acid testing were adversely affected. Sleep disturbance is a serious problem among nurses testing for the delta strain during the pandemic. Anxiety, stress, and depression are associated with sleep disorders. It is necessary to take corresponding measures and conduct crisis management interventions to improve sleep quality and mental health adjustment during public health emergencies.
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Affiliation(s)
- Xiang Chen
- Department of Nursing, The First People's Hospital of Changde City, Changde, 415000, Hunan Province, People's Republic of China
| | - Ping Liu
- Department of Nursing, The First People's Hospital of Changde City, Changde, 415000, Hunan Province, People's Republic of China
| | - Guang-Feng Lei
- Department of Nursing, The First People's Hospital of Changde City, Changde, 415000, Hunan Province, People's Republic of China
| | - Li Tong
- Department of Nursing, The First People's Hospital of Changde City, Changde, 415000, Hunan Province, People's Republic of China
| | - Hui Wang
- Department of Nursing, The First People's Hospital of Changde City, Changde, 415000, Hunan Province, People's Republic of China
| | - Xue-Qing Zhang
- Department of Nursing, The First People's Hospital of Changde City, Changde, 415000, Hunan Province, People's Republic of China
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Bai W, Zhao Y, An F, Zhang Q, Sha S, Cheung T, Cheng CPW, Ng CH, Xiang YT. Network Analysis of Insomnia in Chinese Mental Health Professionals During the COVID-19 Pandemic: A Cross-Sectional Study. Nat Sci Sleep 2021; 13:1921-1930. [PMID: 34737660 PMCID: PMC8560171 DOI: 10.2147/nss.s326880] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/16/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic is associated with increased risk of insomnia symptoms (insomnia hereafter) in health-care professionals. Network analysis is a novel approach in linking mechanisms at the symptom level. The aim of this study was to characterize the insomnia network structure in mental health professionals during the COVID-19 pandemic. PATIENTS AND METHODS A total of 10,516 mental health professionals were recruited from psychiatric hospitals or psychiatric units of general hospitals nationwide between March 15 and March 20, 2020. Insomnia was assessed with the insomnia severity index (ISI). Centrality index (ie, strength) was used to identify symptoms central to the network. The stability of network was examined using a case-dropping bootstrap procedure. The network structures between different genders were also compared. RESULTS The overall network model showed that the item ISI7 (interference with daytime functioning) was the most central symptom in mental health professionals with the highest strength. The network was robust in stability and accuracy tests. The item ISI4 (sleep dissatisfaction) was connected to the two main clusters of insomnia symptoms (ie, the cluster of nocturnal and daytime symptoms). No significant gender network difference was found. CONCLUSION Interference with daytime functioning was the most central symptom, suggesting that it may be an important treatment outcome measure for insomnia. Appropriate treatments, such as stimulus control techniques, cognitive behavioral therapy and relaxation training, could be developed. Moreover, addressing sleep satisfaction in treatment could simultaneously ameliorate daytime and nocturnal symptoms.
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Affiliation(s)
- Wei Bai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, People’s Republic of China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, People’s Republic of China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, People’s Republic of China
| | - Yanjie Zhao
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, People’s Republic of China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, People’s Republic of China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, People’s Republic of China
| | - Fengrong An
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, People’s Republic of China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, People’s Republic of China
| | - Sha Sha
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, People’s Republic of China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, People’s Republic of China
| | - Calvin Pak-Wing Cheng
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent’s Hospital, University of Melbourne, Richmond, VIC, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, People’s Republic of China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, People’s Republic of China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, People’s Republic of China
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Th’ng F, Rao KA, Ge L, Mao D, Neo HN, Molina JAD, Seow E. A One-Year Longitudinal Study: Changes in Depression and Anxiety in Frontline Emergency Department Healthcare Workers in the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111228. [PMID: 34769750 PMCID: PMC8583330 DOI: 10.3390/ijerph182111228] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 02/04/2023]
Abstract
Frontline healthcare workers (HCWs) fighting COVID-19 have been associated with depression and anxiety, but there is limited data to illustrate these changes over time. We aim to quantify the changes in depression and anxiety amongst Emergency Department (ED) HCWs over one year and examine the factors associated with these changes. In this longitudinal single-centre study in Singapore, all ED HCWs were prospectively recruited face-to-face. Paper-based surveys were administered in June 2020 and June 2021. Depression and anxiety were measured using DASS-21. The results of 241 HCWs who had completed both surveys were matched. There was significant improvement in anxiety amongst all HCWs (Mean: 2020: 2.85 (±3.19) vs. 2021: 2.54 (±3.11); Median: 2020: 2 (0–4) vs. 2021: 2 (0–4), p = 0.045). HCWs living with elderly and with concerns about infection risk had higher odds of anxiety; those living with young children had lower odds of anxiety. There was significant worsening depression amongst doctors (Mean: 2020: 2.71 (±4.18) vs. 2021: 3.60 (±4.50); Median: 2020: 1 (0–3) vs. 2021: 3 (0–5), p = 0.018). HCWs ≥ 41 years, living with elderly and with greater concerns about workload had higher odds of depression. HCWs who perceived better workplace support and better social connectedness had lower odds of depression. In summary, our study showed significant improvement in anxiety amongst ED HCWs and significant worsening depression amongst ED doctors over one year. Age, living with elderly, and concerns about workload and infection risk were associated with higher odds of depression and anxiety.
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Affiliation(s)
- Francesca Th’ng
- Acute & Emergency Care Department, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore; (K.A.R.); (D.M.); (H.N.N.); (E.S.)
- Correspondence: ; Tel.: +65-98821657
| | - Kailing Adriel Rao
- Acute & Emergency Care Department, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore; (K.A.R.); (D.M.); (H.N.N.); (E.S.)
| | - Lixia Ge
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link, Singapore 138543, Singapore; (L.G.); (J.A.D.M.)
| | - Desmond Mao
- Acute & Emergency Care Department, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore; (K.A.R.); (D.M.); (H.N.N.); (E.S.)
| | - Hwee Nah Neo
- Acute & Emergency Care Department, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore; (K.A.R.); (D.M.); (H.N.N.); (E.S.)
| | - Joseph Antonio De Molina
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link, Singapore 138543, Singapore; (L.G.); (J.A.D.M.)
| | - Eillyne Seow
- Acute & Emergency Care Department, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore; (K.A.R.); (D.M.); (H.N.N.); (E.S.)
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Ching SM, Ng KY, Lee KW, Yee A, Lim PY, Ranita H, Devaraj NK, Ooi PB, Cheong AT. Psychological distress among healthcare providers during COVID-19 in Asia: Systematic review and meta-analysis. PLoS One 2021; 16:e0257983. [PMID: 34648526 PMCID: PMC8516240 DOI: 10.1371/journal.pone.0257983] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/14/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION COVID-19 pandemic is having a devastating effect on the mental health and wellbeing of healthcare providers (HCPs) globally. This review is aimed at determining the prevalence of depression, anxiety, stress, fear, burnout and resilience and its associated factors among HCPs in Asia during the COVID-19 pandemic. MATERIAL AND METHODS We performed literature search using 4 databases from Medline, Cinahl, PubMed and Scopus from inception up to March 15, 2021 and selected relevant cross-sectional studies. Publication bias was assessed using funnel plot. Random effects model was used to estimate the pooled prevalence while risk factors were reported in odds ratio (OR) with 95% CI. RESULTS We included 148 studies with 159,194 HCPs and the pooled prevalence for depression was 37.5% (95%CI: 33.8-41.3), anxiety 39.7(95%CI: 34.3-45.1), stress 36.4% (95%CI: 23.2-49.7), fear 71.3% (95%CI: 54.6-88.0), burnout 68.3% (95%CI: 54.0-82.5), and low resilience was 16.1% (95%CI: 12.8-19.4), respectively. The heterogeneity was high (I2>99.4%). Meta-analysis reported that both females (OR = 1.48; 95% CI = 1.30-1.68) and nurses (OR = 1.21; 95%CI = 1.02-1.45) were at increased risk of having depression and anxiety [(Female: OR = 1.66; 95% CI = 1.49-1.85), (Nurse: OR = 1.36; 95%CI = 1.16-1.58)]. Females were at increased risk of getting stress (OR = 1.59; 95%CI = 1.28-1.97). CONCLUSION In conclusion, one third of HCPs suffered from depression, anxiety and stress and more than two third of HCPs suffered from fear and burnout during the COVID-19 pandemic in Asia.
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Affiliation(s)
- Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia
- Centre for Research, Bharath Institute of Higher Education and Research, Selaiyur, Chennai, Tamil Nadu, India
| | - Kar Yean Ng
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor, Malaysia
| | - Kai Wei Lee
- Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Malaysia
- Centre for Research on Communicable Diseases, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Anne Yee
- Department of Psychological Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Hisham Ranita
- Universiti Malaya Library, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Navin Kumar Devaraj
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Pei Boon Ooi
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia
| | - Ai Theng Cheong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor, Malaysia
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Zhao N, Li W, Zhang SF, Yang BX, Sha S, Cheung T, Jackson T, Zang YF, Xiang YT. Network Analysis of Depressive Symptoms Among Residents of Wuhan in the Later Stage of the COVID-19 Pandemic. Front Psychiatry 2021; 12:735973. [PMID: 34658968 PMCID: PMC8514718 DOI: 10.3389/fpsyt.2021.735973] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/24/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Depression has been a common mental health problem during the COVID-19 epidemic. From a network perspective, depression can be conceptualized as the result of mutual interactions among individual symptoms, an approach that may elucidate the structure and mechanisms underlying this disorder. This study aimed to examine the structure of depression among residents in Wuhan, the epicenter of the COVID-19 outbreak in China, in the later stage of the COVID-19 pandemic. Methods: A total of 2,515 participants were recruited from the community via snowball sampling. The Patient Health Questionnaire was used to assess self-reported depressive symptoms with the QuestionnaireStar program. The network structure and relevant centrality indices of depression were examined in this sample. Results: Network analysis revealed Fatigue, Sad mood, Guilt and Motor disturbances as the most central symptoms, while Suicide and Sleep problems had the lowest centrality. No significant differences were found between women and men regarding network structure (maximum difference = 0.11, p = 0.44) and global strength (global strength difference = 0.04; female vs. male: 3.78 vs. 3.83, p = 0.51), a finding that suggests there are no gender differences in the structure or centrality of depressive symptoms. Limitations: Due to the cross-sectional study design, causal relationships between these depressive symptoms or dynamic changes in networks over time could not be established. Conclusions: Fatigue, Sad mood, Guilt, and Motor disturbances should be prioritized as targets in interventions and prevention efforts to reduce depression among residents in Wuhan, in the later stage of the COVID-19 pandemic.
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Affiliation(s)
- Na Zhao
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, and Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, SAR China
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University, Hangzhou, China
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China
| | - Wen Li
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Shu-Fang Zhang
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
| | | | - Sha Sha
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong, SAR China
| | - Todd Jackson
- Department of Psychology, University of Macau, Macao, SAR China
| | - Yu-Feng Zang
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University, Hangzhou, China
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, and Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, SAR China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao, SAR China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, SAR China
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31
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Substance and Internet use during the COVID-19 pandemic in China. Transl Psychiatry 2021; 11:491. [PMID: 34556627 PMCID: PMC8459580 DOI: 10.1038/s41398-021-01614-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/29/2021] [Accepted: 09/10/2021] [Indexed: 12/21/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) has adversely influenced human physical and mental health, including emotional disorders and addictions. This study examined substance and Internet use behavior and their associations with anxiety and depression during the COVID-19 pandemic. An online self-report questionnaire was administered to 2196 Chinese adults between February 17 and 29, 2020. The questionnaire contained the seven-item Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ-9), questions on demographic information, and items about substance and Internet use characteristics. Our results revealed that males consumed less alcohol (p < 0.001) and areca-nut (p = 0.012) during the pandemic than before the pandemic. Age, gender, education status, and occupation significantly differed among increased substance users, regular substance users, and nonsubstance users. Time spent on the Internet was significantly longer during the pandemic (p < 0.001) and 72% of participants reported increased dependence on the Internet. Compared to regular Internet users, increased users were more likely to be younger and female. Multiple logistic regression analysis revealed that age <33 years (OR = 2.034, p < 0.001), increased substance use (OR = 3.439, p < 0.001), and increased Internet use (OR = 1.914, p < 0.001) were significantly associated with depression. Moreover, anxiety was significantly related to female gender (OR = 2.065, p < 0.001), "unmarried" status (OR = 1.480, p = 0.017), nonstudents (OR = 1.946-3.030, p = 0.001), and increased substance use (OR = 4.291, p < 0.001). Although there was a significant decrease in social substance use during the pandemic, more attention should be paid to increased Internet use. Increased Internet use was significantly associated with both anxiety and depression, and increased substance use was related to depression. Professional support should be provided to vulnerable individuals to prevent addiction.
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32
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Saragih ID, Tonapa SI, Saragih IS, Advani S, Batubara SO, Suarilah I, Lin CJ. Global prevalence of mental health problems among healthcare workers during the Covid-19 pandemic: A systematic review and meta-analysis. Int J Nurs Stud 2021; 121:104002. [PMID: 34271460 PMCID: PMC9701545 DOI: 10.1016/j.ijnurstu.2021.104002] [Citation(s) in RCA: 185] [Impact Index Per Article: 61.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Healthcare workers are at high risk of developing mental health issues during the coronavirus disease 2019 (COVID-19) pandemic. However, there is a need for a full picture of mental health problems with comprehensive analysis among healthcare workers during the COVID-19 pandemic. OBJECTIVE This review aimed to systematically identify the mental health problems among healthcare workers in various countries during the COVID-19 pandemic. DESIGN Systematic review and meta-analysis. METHODS A systematic literature search was performed of the following databases: PubMed, Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, MEDLINE Complete, and SocINDEX. The last date of our search was November 2, 2020. We included all cohort, case-control and cross-sectional studies and used the Joanna Briggs Institute tool to assess their quality. A meta-analysis was performed to synthesize the pooled prevalence of mental health problems using a random-effects model. Heterogeneity was measured using the I2 statistic and Egger's test was used to assess publication bias. RESULTS A total of 38 studies were identified that reported the mental health problems of healthcare workers during the COVID-19 pandemic. The distribution of healthcare workers analyzed in this review included 27.9% doctors, 43.7% nurses, and 7.0% allied health workers. The pooled prevalence of mental health problems for post-traumatic stress disorder, anxiety, depression, and distress was 49% (95% confidence interval [CI]: 22-75%), 40% (95% CI: 29-52%), 37% (95% CI: 29-45%), and 37% (95% CI: 25-50%), respectively. CONCLUSION This review yielded evidence that estimated the global prevalence of mental health problems among healthcare workers during the COVID-19 pandemic. Post-traumatic stress disorder was the most common mental health disorder reported by healthcare workers during the COVID-19 pandemic, followed by anxiety, depression, and distress. Additional studies remain necessary to assess the appropriate management strategies for treating and preventing mental health disorders among healthcare workers during the pandemic.
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Affiliation(s)
| | - Santo Imanuel Tonapa
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan,School of Nursing, Sam Ratulangi University, Manado, Indonesia
| | | | - Shailesh Advani
- Terasaki Institute of Biomedical Innovation, Los Angeles, CA, United States
| | | | - Ira Suarilah
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Ju Lin
- College of Nursing, Kaohsiung Medical University, No.100, Shin-Chuan 1st Road, San-min Dist., Kaohsiung 80708, Taiwan,Corresponding author
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33
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Norhayati MN, Che Yusof R, Azman MY. Prevalence of Psychological Impacts on Healthcare Providers during COVID-19 Pandemic in Asia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9157. [PMID: 34501747 PMCID: PMC8431592 DOI: 10.3390/ijerph18179157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 12/11/2022]
Abstract
COVID-19 has impacted people psychologically globally, including healthcare providers. Anxiety, depression, and stress are the most common impacts that have affected these people. Thus, this study was aimed to ascertain the estimated prevalence of psychological impacts among healthcare providers in the Asian region. A systematic search was performed in the MEDLINE, CINAHL, and Scopus databases for original research articles published between 2020 and April 2021. Only studies published in English were included. The quality of data was assessed using the Joanna Briggs Institute Meta-Analysis, and the analysis was performed using generic inverse variance with a random-effects model by Review Manager software. A total of 80 studies across 18 countries in Asia region were pooled to assess the data prevalence on anxiety (34.81% (95% CI: 30.80%, 38.83%)), depression (34.61% (95% CI: 30.87%, 38.36%)), stress (31.72% (95% CI: 21.25%, 42.18%)), insomnia (37.89% (95% CI: 25.43%, 50.35%)), and post-traumatic stress disorder (15.29% (95% CI: 11.43%, 19.15%)). Subgroup analyses were conducted across regions, type of healthcare providers, sex, and occupation. This review has identified a high prevalence of anxiety, depression, stress, and insomnia but a low prevalence of post-traumatic stress disorder among healthcare providers in Asia regions. Effective intervention support programs are urgently needed to improve psychological health of healthcare providers and maintaining the health system.
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Affiliation(s)
- Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Ruhana Che Yusof
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Mohd Yacob Azman
- Federal Government Administrative Centre, Medical Practice Division, Ministry of Health, Level 7, Block E1, Parcel E, Putrajaya 62590, Malaysia
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Siewe Fodjo JN, Ngarka L, Njamnshi WY, Nfor LN, Mengnjo MK, Mendo EL, Angwafor SA, Atchou Basseguin JG, Nkouonlack C, Njit EN, Ahidjo N, Chokote ES, Dema F, Fonsah JY, Tatah GY, Palmer N, Seke Etet PF, Palmer D, Nsagha DS, Etya’ale DE, Perrig S, Sztajzel R, Annoni JM, Zoung-Kanyi Bissek AC, Leke RGF, Abena Ondoa Obama MT, Nkengasong JN, Colebunders R, Njamnshi AK. Fear and depression during the COVID-19 outbreak in Cameroon: a nation-wide observational study. BMC Psychiatry 2021; 21:356. [PMID: 34266400 PMCID: PMC8280628 DOI: 10.1186/s12888-021-03323-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has been associated with significant psychological and social distress worldwide. We investigated fear and depression among adults in Cameroon during different phases of the COVID-19 outbreak. METHODS An online survey was conducted in Cameroon from June-December 2020 using a structured questionnaire. Socio-demographic data and information regarding COVID-19 history were obtained. Fear and depressive symptoms were assessed using the Fear of COVID-19 score (FCV-19S) and the Patient Health Questionnaire (PHQ-9), respectively. Responses were clustered in weeks to better appreciate their evolution over time. RESULTS Overall, 7381 responses from all ten regions of Cameroon were analysed (median age: 30 years, 73.3% male). The prevalence of depression (PHQ-9 score ≥ 10) was 8.4%, and that of high fear of COVID-19 (FCV-19S scores ≥19) was 57.4%. These rates were similar across genders, age-groups, and region of residence. While mean weekly PHQ-9 scores remained fairly stable throughout the study period (range: 2.53-3.21; p = 0.101), mean FCV-19S scores were highest during the early weeks but decreased significantly thereafter (from 20.31 to 18.34; p < 0.001). Multivariate analyses revealed that having a postgraduate degree, a history of quarantine, flu-like symptoms during the past 14 days, and higher FCV-19S scores were associated with more severe depressive symptoms, while obtaining COVID-19 information from various sources reduced the odds for depression. CONCLUSION Depression amidst the COVID-19 crisis is less prevalent in Cameroon than in other countries. Prompt and widespread dissemination of adequate COVID-19 information may reduce the risks for depression by dispelling fear and anxiety among Cameroonians.
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Affiliation(s)
- Joseph Nelson Siewe Fodjo
- grid.5284.b0000 0001 0790 3681Global Health Institute, University of Antwerp, Antwerp, Belgium ,Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Leonard Ngarka
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Wepnyu Y. Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon ,Brain Research Africa Initiative (BRAIN), Geneva, Switzerland
| | | | | | | | | | | | | | - Edith N. Njit
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Nene Ahidjo
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | | | - Fidèle Dema
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | | | | | - Nancy Palmer
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | | | - Dennis Palmer
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | | | | | - Stephen Perrig
- Brain Research Africa Initiative (BRAIN), Geneva, Switzerland
| | - Roman Sztajzel
- Brain Research Africa Initiative (BRAIN), Geneva, Switzerland
| | | | | | | | | | - John N. Nkengasong
- grid.503447.10000 0001 2189 9463CDC Africa, African Union, Addis Ababa, Ethiopia
| | - Robert Colebunders
- grid.5284.b0000 0001 0790 3681Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Alfred K. Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon ,Brain Research Africa Initiative (BRAIN), Geneva, Switzerland
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35
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Xiong LJ, Zhong BL, Cao XJ, Xiong HG, Huang M, Ding J, Li WT, Tong J, Shen HY, Xia JH, Hu Y. Possible posttraumatic stress disorder in Chinese frontline healthcare workers who survived COVID-19 6 months after the COVID-19 outbreak: prevalence, correlates, and symptoms. Transl Psychiatry 2021; 11:374. [PMID: 34226510 PMCID: PMC8256400 DOI: 10.1038/s41398-021-01503-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/03/2021] [Accepted: 06/16/2021] [Indexed: 12/19/2022] Open
Abstract
Suffering from COVID-19 and witnessing the suffering and deaths of patients with COVID-19 may place frontline healthcare workers (HCWs) at particularly high risk for posttraumatic stress disorder (PTSD); however, few data are available on the clinical characteristics of PTSD among frontline HCWs who survived COVID-19 ("surviving HCWs" hereafter). The present study examined the prevalence, correlates, and clinical symptoms of possible PTSD in surviving HCWs 6 months after the COVID-19 outbreak in China. A total of 291 surviving HCWs and 42 age- and gender-matched COVID-19-free frontline HCWs (control group) were recruited and administered the Chinese Essen Trauma Inventory, which was used to assess the presence of possible PTSD according to DSM-IV-TR criteria. Survivors' clinical data and characteristics of exposure to COVID-19 were collected via self-report questionnaires. Surviving HCWs had significantly higher rates of possible PTSD than controls (19.9% vs. 4.8%, P = 0.017). Correlates of PTSD in survivors were ICU admission (OR = 8.73, P = 0.003), >10 respiratory symptoms during the most symptomatic period of COVID-19 (OR = 3.08, P = 0.006), the residual symptom of dizziness (OR = 2.43, P = 0.013), the residual symptom of difficult breathing (OR = 2.23, P = 0.027), life in danger due to COVID-19 (OR = 16.59, P = 0.006), and exposure to other traumatic events (OR = 2.94, P = 0.035). Less commonly seen PTSD symptoms in survivors were having nightmares about the event (34.5%), suddenly feeling like they were living through the event suddenly (25.9%), being unable to remember an important part of the event (32.8%), and overalertness (31.0%). Nearly one-fifth of the surviving HCWs had possible PTSD 6 months after the COVID-19 outbreak. Mental health services for this vulnerable population should include periodic screening for PTSD, expanded social support, and, when necessary, psychotherapy and psychopharmacological treatment.
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Affiliation(s)
- Li-Juan Xiong
- grid.33199.310000 0004 0368 7223Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 Hubei China
| | - Bao-Liang Zhong
- grid.33199.310000 0004 0368 7223Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430012 Hubei province China
| | - Xiong-Jing Cao
- grid.33199.310000 0004 0368 7223Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 Hubei China
| | - Huang-Guo Xiong
- grid.33199.310000 0004 0368 7223Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 Hubei China
| | - Ming Huang
- grid.410648.f0000 0001 1816 6218State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617 China
| | - Jing Ding
- grid.503241.10000 0004 1760 9015Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, 430074 Hubei province China
| | - Wen-Tian Li
- grid.33199.310000 0004 0368 7223Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430012 Hubei province China
| | - Jun Tong
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430012, Hubei province, China. .,Institute of Analytical Psychology, City University of Macau, Macau, China.
| | - He-Yong Shen
- Institute of Analytical Psychology, City University of Macau, Macau, China.
| | - Jia-Hong Xia
- Department of Cardiovascular Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
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36
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Mahmud S, Hossain S, Muyeed A, Islam MM, Mohsin M. The global prevalence of depression, anxiety, stress, and, insomnia and its changes among health professionals during COVID-19 pandemic: A rapid systematic review and meta-analysis. Heliyon 2021; 7:e07393. [PMID: 34278018 PMCID: PMC8261554 DOI: 10.1016/j.heliyon.2021.e07393] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/04/2021] [Accepted: 06/21/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the health professionals who are at the frontline of this crisis have been facing extreme psychological disorders. This research aims to provide an overall scenario of the prevalence of depression, anxiety, stress, as well as insomnia and to inspect the changes in these prevalence over time by analyzing the existing evidence during this COVID-19 pandemic. METHODS A systematic search was performed on March 30, 2021, in PubMed, MEDLINE, Google Scholar databases, and Web of Science. To assess the heterogeneity, Q-test,I 2 statistics, and Meta regression and to search for the publication bias, Eggers's test and funnel plot were used. The random-effect model and subgroup analysis were performed due to the significant heterogeneity. RESULTS Among eighty-three eligible studies in the final synthesis, 69 studies (n = 144649) assessed the depression prevalence of 37.12% (95% CI: 31.80-42.43), 75 studies (n = 147435) reported the anxiety prevalence of 41.42% (95% CI: 36.17-46.54), 41 studies (n = 82783) assessed the stress prevalence of 44.86% (95% CI: 36.98-52.74), 21 studies (n = 33370) enunciated the insomnia prevalence of 43.76% (95% CI: 35.83-51.68). The severity of the mental health problems among health professionals increased over the time during January 2020 to September 2020. LIMITATIONS A significant level of heterogeneity was found among psychological measurement tools and across studies. CONCLUSIONS Therefore, it is an emergency to develop psychological interventions that can protect the mental health of vulnerable groups like health professionals.
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Affiliation(s)
- Sultan Mahmud
- Institute of Statistical Research and Training, University of Dhaka, Bangladesh
| | - Sorif Hossain
- Institute of Statistical Research and Training, University of Dhaka, Bangladesh
| | - Abdul Muyeed
- Department of Statistics, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh-2224, Bangladesh
| | - Md Mynul Islam
- Institute of Statistical Research and Training, University of Dhaka, Bangladesh
| | - Md. Mohsin
- Institute of Statistical Research and Training, University of Dhaka, Bangladesh
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37
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Yuan Y, Zhao YJ, Zhang QE, Zhang L, Cheung T, Jackson T, Jiang GQ, Xiang YT. COVID-19-related stigma and its sociodemographic correlates: a comparative study. Global Health 2021; 17:54. [PMID: 33962651 PMCID: PMC8103123 DOI: 10.1186/s12992-021-00705-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is closely associated with physical and mental health problems; however, little is known about the severity of stigma caused by COVID-19 among its survivors. Thus, the aim of this study was to compare differences in stigma experiences of COVID-19 survivors versus healthy controls after the COVID-19 outbreak peak in China. METHODS This cross-sectional study comprised 154 COVID-19 survivors and 194 healthy controls recruited through consecutive and convenience sampling methods, respectively. COVID-19 related stigma was measured by the Social Impact Scale (SIS). Stigma differences between the two groups were compared with analysis of covariance (ANCOVA) and a generalized linear model (GLM) was used to identify independent correlates of COVID-19-related stigma in this study. RESULTS Compared with healthy controls, COVID-19 survivors reported more overall stigma (F(1,347) = 60.82, p < 0.001), and stigma in domains of social rejection (F(1,347) = 56.54, p < 0.001), financial insecurity (F(1,347) = 19.96, p < 0.001), internalized shame (F(1,347) = 71.40, p < 0.001) and social isolation (F(1,347) = 34.73, p < 0.001). Status as a COVID-19 survivor, having family members infected with COVID-19, being married, economic loss during the COVID-19 pandemic, and depressive symptoms were positively associated with higher overall stigma levels (all p values < 0.05). CONCLUSION COVID-19-related stigma is commonly experienced among COVID-19 survivors even though the outbreak has been well-contained in China. Routine assessment of stigma experiences should be conducted on COVID-19 survivors and appropriate psychological assistance, public education, and anti-stigma campaigns and policies should be enforced to reduce stigma within this vulnerable subpopulation.
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Affiliation(s)
- Yuan Yuan
- Chongqing Mental Health Center, Chongqing, China
| | - Yan-Jie Zhao
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Qing-E Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Todd Jackson
- Department of Psychology, University of Macau, Taipa, Macau SAR, China
| | | | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China.
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China.
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38
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Tian ZR, Xie X, Li XY, Li Y, Zhang Q, Zhao YJ, Cheung T, Ungvari GS, An FR, Xiang YT. Prevalence of depression and its impact on quality of life in frontline otorhinolaryngology nurses during the COVID-19 pandemic in China. PeerJ 2021; 9:e11037. [PMID: 33976957 PMCID: PMC8063879 DOI: 10.7717/peerj.11037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/09/2021] [Indexed: 12/15/2022] Open
Abstract
Objective Exposure to the coronavirus disease 2019 (COVID-19) was associated with high risk of mental health problems among frontline nurses. This study examined the prevalence of depressive symptoms (depression hereafter) and its impact on quality of life (QOL) in otorhinolaryngology (ENT) nurses during the COVID-19 pandemic in China. Methods An online study was conducted between March 15 and March 20, 2020. Depression and QOL were assessed using standardized instruments. Results A total of 1,757 participants were recruited. The prevalence of depression was 33.75% (95% CI: 31.59%-35.97%). Results emerging from multiple logistic regression analysis showed that direct care of COVID-19 patients (OR: 1.441, 95% CI: 1.031–2.013, P = 0.032), and current smoking (OR: 2.880, 95% CI: 1.018–8.979, P = 0.048) were significantly associated with depression. After controlling for covariates, ENT nurses with depression had a lower overall QOL compared to those without depression (F(1, 1757)= 536.80, P < 0.001). Conclusions Depression was common among ENT nurses during the COVID-19 pandemic in China. Considering the negative impact of depression on QOL and care quality, regular screening for depression should be conducted in ENT nurses and treatment should be provided.
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Affiliation(s)
- Zi-Rong Tian
- Department of Nursing, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaomeng Xie
- Department of Public Health and Medicinal Administration & Centre for Cognitive and Brain Sciences, University of Macau, Macau SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macau SAR, China
| | - Xiu-Ya Li
- Department of Otorhinolaryngology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yue Li
- Department of Nursing, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Yan-Jie Zhao
- Department of Public Health and Medicinal Administration & Centre for Cognitive and Brain Sciences, University of Macau, Macau SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macau SAR, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia.,Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | - Feng-Rong An
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Yu-Tao Xiang
- Department of Public Health and Medicinal Administration & Centre for Cognitive and Brain Sciences, University of Macau, Macau SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macau SAR, China
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39
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Yıldırım M, Özaslan A. Worry, Severity, Controllability, and Preventive Behaviours of COVID-19 and Their Associations with Mental Health of Turkish Healthcare Workers Working at a Pandemic Hospital. Int J Ment Health Addict 2021; 20:2306-2320. [PMID: 33686345 PMCID: PMC7928196 DOI: 10.1007/s11469-021-00515-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 12/19/2022] Open
Abstract
Previous research suggests that psychological and behavioural factors such as worry, severity, controllability, and preventive behaviours are associated with mental health and well-being. Less is known about simultaneous effects of those factors in predicting mental health and well-being. This study aimed to present the prevalence of mental health problems and identify the predictors of mental health and subjective well-being of healthcare workers during the COVID-19 pandemic. Participants included 245 healthcare workers (Mage = 33.16 ± 7.33; 50.61% females) from a pandemic hospital in Turkey. Healthcare workers reported mild/severe depression, anxiety, and stress. Females tended to be more vulnerable to developing psychiatric symptoms. Worry, severity, and controllability significantly predicted depression, anxiety, stress, and subjective well-being while preventive behaviours only predicted subjective well-being. These findings suggest the importance of assessing healthcare workers’ experiences of mental health and subjective well-being and their associated factors to assist mental health providers tailor assessments and treatment during a pandemic.
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Affiliation(s)
- Murat Yıldırım
- Department of Psychology, Faculty of Science and Letters, Ağrı İbrahim Çeçen University, Erzurum Yolu 4 Km 04100, Merkez, Ağrı, Turkey.,Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Ahmet Özaslan
- Department of Child and Adolescent Psychiatry, Gazi University, Ankara, Turkey
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40
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Busch IM, Moretti F, Mazzi M, Wu AW, Rimondini M. What We Have Learned from Two Decades of Epidemics and Pandemics: A Systematic Review and Meta-Analysis of the Psychological Burden of Frontline Healthcare Workers. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:178-190. [PMID: 33524983 PMCID: PMC8018214 DOI: 10.1159/000513733] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/12/2020] [Indexed: 12/13/2022]
Abstract
In light of the current coronavirus disease 2019 (COVID-19) pandemic and potential future infectious disease outbreaks, a comprehensive understanding of the negative effects of epidemics and pandemics on healthcare workers' mental health could inform appropriate support interventions. Thus, we aimed to synthesize and quantify the psychological and psychosomatic symptoms among frontline medical staff. We searched four databases up to March 19, 2020 and additional literature, with daily search alerts set up until October 26, 2020. Studies reporting psychological and/or psychosomatic symptoms of healthcare workers caring for patients with severe acute respiratory syndrome, H1N1, Ebola, Middle East respiratory syndrome, or COVID-19 were eligible for inclusion. Two reviewers independently conducted the search, study selection, quality appraisal, data extraction, and synthesis and involved a third reviewer in case of disagreement. We used random effects modeling to estimate the overall prevalence rates of psychological/psychosomatic symptoms and the I2 statistic. We included 86 studies, reporting data from 75,991 participants. Frontline staff showed a wide range of symptoms, including concern about transmitting the virus to the family (60.39%, 95% CI 42.53-76.96), perceived stress (56.77%, 95% CI 34.21-77.95), concerns about own health (45.97%, 95% CI 31.08-61.23), sleeping difficulties (39.88%, 95% CI 27.70-52.72), burnout (31.81%, 95% CI 13.32-53.89), symptoms of depression (25.72%, 95% CI 18.34-33.86), symptoms of anxiety (25.36%, 95% CI 17.90-33.64), symptoms of posttraumatic stress disorder (24.51%, 95% CI 18.16-31.46), mental health issues (23.11%, 95% CI 15.98-31.10), and symptoms of somatization (14.68%, 95% CI 10.67-19.18). We found consistent evidence for the pervasive and profound impact of large-scale outbreaks on the mental health of frontline healthcare workers. As the CO-VID-19 crisis continues to unfold, guaranteeing easy access to support structures for the entire healthcare workforce is vitally important.
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Affiliation(s)
- Isolde M. Busch
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Moretti
- Direzione Medica di Presidio Ospedale di Legnago, AULSS 9 Scaligera, Legnago, Italy
| | - Mariangela Mazzi
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Albert W. Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michela Rimondini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy,
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41
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Al Maqbali M, Al Sinani M, Al-Lenjawi B. Prevalence of stress, depression, anxiety and sleep disturbance among nurses during the COVID-19 pandemic: A systematic review and meta-analysis. J Psychosom Res 2021; 141:110343. [PMID: 33360329 PMCID: PMC7831768 DOI: 10.1016/j.jpsychores.2020.110343] [Citation(s) in RCA: 227] [Impact Index Per Article: 75.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The new coronavirus disease's (COVID-19) high risk of infection can increase the workload of healthcare workers, especially nurses, as they are most of the healthcare workforce. These problems can lead to psychological problems. Therefore, the aim of this systematic review and meta-analysis to ascertain the present impact of the COVID-19 outbreak on the prevalence of stress, anxiety, depression and sleep disturbance among nurses. METHODS A systematic review and meta-analysis were conducted. The following databases were searched: PubMed, CHINAL, MEDLINE, EMBASE, PsycINFO, MedRxiv and Google Scholar, from January 2020 up to 26th October 2020. Prevalence rates were pooled with meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I2) statistics. RESULTS A total of 93 studies (n = 93,112), published between January 2020 and September 2020, met the inclusion criteria. The overall prevalence of stress was assessed in 40 studies which accounted for 43% (95% CI 37-49). The pooled prevalence of anxiety was 37% (95% CI 32-41) in 73 studies. Depression was assessed in 62 studies, with a pooled prevalence of 35% (95% CI 31-39). Finally, 18 studies assessed sleep disturbance and the pooled prevalence was 43% (95% CI 36-50). CONCLUSION This meta-analysis found that approximately one third of nurses working during the COVID-19 epidemic were suffering from psychological symptoms. This highlights the importance of providing comprehensive support strategies to reduce the psychological impact of the COVID-19 outbreak among nurses under pandemic conditions. Further longitudinal study is needed to distinguish of psychological symptoms during and after the infectious disease outbreaks.
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Affiliation(s)
| | - Mohammed Al Sinani
- Reproductive and Developmental Biology Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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42
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Zhang HH, Zhao YJ, Wang C, Zhang Q, Yu HY, Cheung T, Hall BJ, An FR, Xiang YT. Depression and its relationship with quality of life in frontline psychiatric clinicians during the COVID-19 pandemic in China: a national survey. Int J Biol Sci 2021; 17:683-688. [PMID: 33767580 PMCID: PMC7975709 DOI: 10.7150/ijbs.56037] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/07/2021] [Indexed: 01/08/2023] Open
Abstract
This was a national survey that determined the prevalence of depressive symptoms (depression thereafter) and its relationship with quality of life (QOL) in frontline clinicians working in psychiatric hospitals in China during the COVID-19 pandemic. Depression and QOL were assessed using the Patient Health Questionnaire nine items (PHQ-9) and the World Health Organization Quality of Life Questionnaire-brief version (WHOQOL-BREF), respectively. Multivariable logistic regression analyses and analysis of covariance were used. A total of 10,516 frontline clinicians participated in this study, of which, 28.52% (n=2,999) met screening criteria for depression. Compared to those without depression, clinicians with depression had a lower quality of life (F (1, 10515) =2874.66, P<0.001). Higher educational level (OR=1.225, P=0.014), if the number of COVID-19 patients in the hospital catchment area surpassed 500 (OR=1.146, P=0.032), having family/friends/colleagues who were infected (OR=1.695, P<0.001), being a current smoker (OR=1.533, P<0.001), and longer working hours (OR=1.020, P=0.022) were independently associated with higher risk of depression. Living with family members (OR=0.786, P<0.001), and being junior clinicians (OR=0.851, P=0.011) were independently associated with lower odds of depression. The results showed that depression was common in frontline psychiatric clinicians during the COVID-19 pandemic. Timely assessment and effective interventions of depression for frontline clinicians in psychiatric hospitals were warranted.
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Affiliation(s)
- Hong-He Zhang
- Department of Psychiatry, Xiamen Xianyue Hospital, Xiamen, China
| | - Yan-Jie Zhao
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China.,Centre for Cognitive and Brain Sciences, & Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Chun Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Hai-Yang Yu
- Department of General Surgery, Beijing Liangxiang Hospital, Capital Medical University, Beijing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Brian J Hall
- Global and Community Mental Health Research Group, New York University (Shanghai), Shanghai PR China.,School of Global Public Health, New York University, NY, USA
| | - Feng-Rong An
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China.,Centre for Cognitive and Brain Sciences, & Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
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