The relationship between resilience, anxiety and depression among patients with mild symptoms of COVID-19 in China: A cross-sectional study

A network analysis of daily stressors, subjective well-being, psychological distress and psychological capital during the COVID-19 pandemic

BACKGROUND

There is already considerable evidence suggesting the potential existence of a comprehensive system that reflects how individuals utilize psychological capital (PsyCap) to preserve mental health amid daily stressors during the COVID-19 pandemic. To explore the underlying mechanism of this system, the current study is the first to use network analysis showing the dimension-level correlation patterns of daily stressors, subjective well-being (SWB), psychological distress and PsyCap during the pandemic.

METHOD

We recruited 1556 participants in China and assessed daily stressors, SWB, psychological distress, and PsyCap through self-report questionnaires. A dimension-level network analysis was conducted to identify key dimensions and their associations. Relative importance analysis examined the contribution of each PsyCap dimension to SWB and psychological distress.

RESULT

Depression, anxiety and stress demonstrated high strength, and life satisfaction exhibited the highest bridge strength in the network. The great majority dimensions of daily stressors had positive connections with stress and anxiety, while financial restrictions and dissatisfaction with education/occupation had negative connections with life satisfaction. Self-efficacy and optimism were positively connected with life satisfaction. Hope and resilience were negatively connected with stress, as well as hope and optimism were negatively connected with depression. Optimism and self-efficacy made the highest contribution to SWB, while resilience made the highest contribution to psychological distress among PsyCap dimensions.

CONCLUSION

The findings elucidate the intricate relationship between daily stressors, SWB, psychological distress and PsyCap during the pandemic. Targeted interventions focusing on the specific PsyCap dimensions may enhance mental health outcomes in the post-COVID-19 era.

Psychological Interventions and Those With Elements of Positive Psychology for Child and Youth Mental Health During the COVID-19 Pandemic: Literature Review, Lessons Learned, and Areas for Future Knowledge Dissemination

BACKGROUND

There was a marked decline in child and teenage mental health worldwide during the pandemic, with increasing prevalence of depression, anxiety, and suicide. Research indicates that positive psychological interventions may be beneficial for mental health.

OBJECTIVE

The aims of this review were to evaluate positive psychological interventions for child and youth mental health implemented during the COVID-19 pandemic and assess overall effectiveness for mental health and knowledge.

METHODS

We undertook a literature search of PubMed, MEDLINE, and Google Scholar for all eligible studies on digital and hybrid in-person psychological interventions for youth mental health during the COVID-19 pandemic. A particular emphasis was placed on positive psychological interventions or interventions that had components of positive psychology, including gratitude, acceptance, positive emotions, or resilience building.

RESULTS

A total of 41 interventions were included in this review. Most of the interventions were digital. Overall, most of the interventions assisted with one or more mental health or psychological indicators, such as depression, anxiety, posttraumatic stress disorder, stress, and resilience. However, findings were mixed when it came to targeting both depression and anxiety together. The interventions that promoted youth mental health most often had a range of diverse positive psychology components and were evidence based. Not all studies measured changes in mindfulness. Few studies examined knowledge acquired on mental health self-care, managing mental health problems, knowledge of positive psychological techniques, mindfulness knowledge, or mental health self-efficacy.

CONCLUSIONS

Diverse multicomponent interventions appear to assist with youth mental health overall, although their effects on both depression and anxiety are less clear. There is also a need for more research on knowledge gains to determine whether the interventions improved knowledge on mental health-supportive behaviors, which may be sustained beyond the intervention. Finally, more studies need to evaluate whether the interventions assisted with increasing self-efficacy for practicing positive psychological techniques as well as changes in mindfulness levels. Future studies should not only assess effectiveness for mental health outcomes but also assess knowledge translation, with valid measures of knowledge and self-efficacy for mental health-supportive behaviors and positive psychological skills acquired (eg, the ability to practice mindfulness).

Factors Influencing the Self-Management Stages of Older Patients With Chronic Pain: A Cross-Sectional Study

PURPOSE

To investigate the current status and related influencing factors of self-management stages in older patients with chronic pain.

DESIGN

A cross-sectional study.

METHODS

A total of 326 older patients with chronic pain were selected as the study subjects in five city districts from December 2022 to June 2023. We used a general information survey form, a numerical rating scale, a pain stages of change questionnaire, a health literacy assessment instrument for patients with chronic pain, and a psychological inflexibility in pain scale to collect relevant information from participants. Univariate analysis and multiple ordinal logistic regression analysis were conducted to identify the relevant influencing factors of the self-management stages.

RESULTS

The self-management stages of older patients with chronic pain were as follows: precontemplation stage (n = 52; 16.0%), contemplation stage (n = 103; 31.6%), action stage (n = 62; 19.0%), and maintenance stage (n = 109; 33.4%). Regression results showed that average monthly household income, smoking history, pain duration, health literacy, and psychological inflexibility were the influencing factors for the self-management stages of older patients with chronic pain.

CONCLUSIONS

In this study, the self-management stages of older patients with chronic pain still needed to be improved. Suitable personalized pain self-management strategies should be developed based on identified factors affecting patients to improve their self-management stages.

CLINICAL IMPLICATIONS

Nursing professionals can use research survey findings to identify patients at low levels of self-management stage and develop personalized intervention strategies based on various influencing factors. For example, nurses can provide practical smoking cessation guidance to assist older chronic pain patients in improving their lifestyle. Nurses can also seek support from family members to collectively offer better medical care and nursing services for the patient if financially feasible. Secondly, as our study has demonstrated, patients' health literacy and psychological flexibility were poor. Nurses can utilize available clinical resources to offer educational materials, such as portable handbooks and online videos, covering pain-related knowledge, managing pain medication, and coping strategies like massage and exercise. Combining this approach with mental health education, such as relaxation therapy, can help patients better understand their pain and actively participate in their self-management. In addition, nursing staff should pay more attention to the self-management stages of older chronic pain patients, and the assessment of self-management stages can be included in clinical pain management for patients. Regular assessment will help track more patients needing attention and make timely adjustments to their pain management plans.

The chain mediating effects of resilience and perceived social support in the relationship between perceived stress and depression in patients with COVID-19

Introduction

Perceived stress and depression were indirect effects of the COVID-19 pandemic, especially in square-cabin hospitals. It was paramount to understand their mediating effects, which might detonate factors that led to mental illness.

Materials and methods

We conducted a cross-sectional study to investigate perceived stress and depressive symptoms among patients with COVID-19 in Shanghai square-cabin hospitals from April 18 to May 19, 2022. The questionnaire included the Perceived Stress Scale 10, Patient Health Questionnaire 9, Perceived Social Support Scale, and the Connor-Davidson Resilience Scale 10.

Results

This study investigated the chain-mediating roles of perceived social support and resilience in the relationship between perceived stress and depression. Perceived stress positively predicted depression (r = 0.613, p < 0.01), negatively correlated with perceived social support (r = -0.318, p < 0.01) and resilience (r = -0.398, p < 0.01). In the chain mediating model, perceived stress had significant direct predictive effects on depression, and significant indirect predictive effects on depression through perceived social support and/or resilience.

Conclusion

It showed that higher perceived social support and resilience were associated with lower perceived stress among COVID-19 patients, which might lead to symptoms of mild depression, and highlights the importance of resilience and perceived social support in reducing depressive symptoms.

Financial toxicity, family resilience and negative emotions among young and middle-aged breast cancer patients: A multicentre cross-sectional study

PURPOSE

To determine financial toxicity in young and middle-aged women with breast cancer and examine the associations between family resilience and negative emotions.

METHODS

A multicentre cross-sectional study was conducted, 538 women with breast cancer were recruited from four hospitals. FT, family resilience, and negative emotions were collected using the Comprehensive Score for FT, the Chinese version of the Family Resilience Assessment in Breast Cancer Patients, Patient Health Questionnaire-9 item, and Generalized Anxiety Disorder-7. This study adhered to the STROBE guidelines.

RESULTS

The valid response rate was 96.8 % (N = 521). Overall, the score for FT was 19.63 ± 10.13. FT was significantly correlated with family resilience (r = 0.30, p < 0.010) and depression (r = -0.11, p < 0.050). The hierarchical multiple linear regression analysis showed that career status, monthly income, religion, and family resilience were the main factors influencing FT in patients with breast cancer (R2 = 0.37; F = 6.83; p < 0.001).

CONCLUSIONS

FT was more prevalent among women from low-income career. Women with poor family resilience, no religious also suffer greater financial toxicity. It is necessary to pay more attention of the financial toxicity of female' low-income career, no religious belief and poor family resilience. Developing effective interventions based on family resilience might be helpful in promoting their well-being.

COVID-19 infection, resilience, and depressive symptoms: the protective role of family functioning for aging Chinese adults in Hong Kong

OBJECTIVES

Older adults are at an elevated risk of experiencing long COVID, with post-COVID-19 depressive symptoms being prevalent. However, the protective factors against this remain understudied. This study examined (a) the role of resilience in the association between COVID-19 infection and depressive symptoms in aging adults; (b) the moderating role of family functioning in the relationships between COVID-19 and resilience and between resilience and depressive symptoms; and (c) potential gender differences in the moderation.

METHOD

Data were drawn from the first wave of the Panel Study of Active Ageing and Society, a representative survey of Hong Kong adults aged 50 or above. Mediation and moderated mediation analyses were conducted.

RESULTS

Approximately 35% of the participants had tested positive for COVID-19. Resilience significantly mediated the association between COVID-19 infection and post-COVID-19 depressive symptoms (p < 0.001). Family functioning was a significant moderator: the COVID-19-resilience association was stronger, and the resilience-depressive symptoms association was weaker among participants with higher family functioning. The moderating role of family functioning was more salient in women than in men.

CONCLUSION

Resilience can protect aging adults from post-COVID-19 depressive symptoms. Interventions for enhancing family functioning may promote the formation of resilience, especially among older women.

How Mental Health and Suicidality Changed during the COVID-19 Pandemic: A Longitudinal Study in the General and Psychiatric Population Illustrating Risk and Protective Factors

The COVID-19 pandemic has led to an increase in psychological distress in the general population, but contrasting results have been shown regarding its impact on psychological symptoms in clinical and non-clinical samples. Consequently, the aim of the present study was to compare in a longitudinal design (September-November 2020 and February-April 2021) the mental health outcomes of a clinical and a control sample and to determine the implications of various risk and protective factors in this regard. A total of 234 participants from the general population and 80 psychiatric patients took part in the present online study using the following measurements: the Brief Symptom Checklist (BSCL); Three-Item Loneliness Scale (TILS); Resilience Scale-13 (RS-13); and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-Non-Illness (FACIT-Sp Non-Illness). The results show an overall decrease in active suicidal ideation as well as "peace", a subscale of spiritual well-being, as well as increases in passive suicidal activation in the clinical sample, which did not change in the control sample. Psychological symptoms did not significantly change in either group. Significant group effects show an increase in resilience in the clinical sample. Resilience and peace turned out to be protective factors for negative mental health outcomes. However, loneliness, which interestingly increased only in the control sample, was shown to be an overall potential risk factor. Our results highlight the complex implications of the COVID-19 pandemic on the mental health outcomes of different groups in the population, demonstrating the necessity of further research, specifically regarding the risk of active and passive suicidal activation. Highlighted protective factors are discussed in regards to spirituality (i.e., peace), which is not strictly related to religion but rather personal spirituality related to the meaning of situations of one's life, as well as in terms of mental health interventions.

Personality dimensions, resilience, and depression during COVID-19 pandemic: A one-year longitudinal study

BACKGROUND

The onset of the COVID-19 pandemic has brought to light a significant surge in depression across diverse populations. While a considerable body of research has linked this upswing to lockdowns and restrictive measures, it is crucial to recognize that lockdowns alone cannot fully elucidate the observed increase in mental health disorders, given the vast array of individual psychological responses.

OBJECTIVE

This study aims to test e whether personality dimensions (Extroversion, Neuroticism, and Psychoticism) and resilience play a role in shielding individuals from developing depression during the COVID-19 pandemic, as observed in a sample of Brazilian adults.

METHODS

This research employed a one-year longitudinal naturalistic study involving the general population. It utilized a web-based questionnaire administered in three waves during the COVID-19 pandemic: April 2020, September 2020, and May 2021. The research protocol contains the Patient Health Questionnaire-9 - PHQ-9, the Connor-Davidson Resilience Scale - CD-RISC, and the Eysenck Personality Questionnaire Revised-Abbreviated - EPQR-A.

RESULTS

Our study encompassed 455 participants, of which 35.6 % met the criteria for depression in the first wave, and this figure decreased to 18.5 % in the second and third waves (p = 0.001). Resilience levels in the non-depressed group (consistently exhibited higher means across all three waves when compared to the depressed group (first wave: x¯= 27.98; second wave: x¯= 37.26; third wave: x¯= 36.67; p = 0.001). Furthermore, resilience exhibited an overall protective effect against depression in all waves (PR = 0.93, p = 0.000). Neuroticism and Psychoticism emerged as predictors of depression across all waves (PR = 1.346; p = 0.0001 and PR = 1.157; p = 0.030), while the Extroversion dimension showed no significant effect.

CONCLUSION

The decline in depression rates during the first year of the COVID-19 pandemic was influenced by levels of resilience, which acted as a protective factor against the development of depressive symptoms. Notably, Neuroticism and Psychoticism predicted the risk of developing depressive symptoms. Implications for practical intervention in future crisis scenarios suggest the need for public health policy programs featuring personalized interventions that prioritize enhancing resilience.

Domestic Violence, Mental Health, and Resilience Among Older Adults in the U.S. During COVID-19

OBJECTIVES

The current study based on the Stress Process Model investigated the impact of experiences of domestic violence on mental health as well as resilience against negative mental health outcomes among older adults in U.S. during COVID-19.

METHOD

Participants included 522 older adults (ages 51-80 and older) living in US at the time of the survey. Path analysis using Mplus was employed. Results:The experience of domestic violence among older adults during the pandemic was positively associated with loneliness and anxiety directly and indirectly. However, resilience acted as a protective factor between the experiences of domestic violence and anxiety. Conclusion: The experience of domestic violence may increase loneliness and anxiety among older adults during challenging times; however, resilience may weaken these negative psychological outcomes both directly and indirectly. Findings and implications are discussed.

Resilience and Overcoming Experiences of Coronavirus Disease 2019 Patients Hospitalized in a Single-Room Isolation Ward: A Mixed-Methods Study

PURPOSE

The coronavirus disease 2019 (COVID-19) pandemic has caused patients to suffer from various physical and psychological symptoms and social challenges, but the impact was harder for those COVID-19 patients receiving treatment in single-room isolation wards in South Korea. This study aimed to investigate resilience, anxiety, depression, and sleep quality of those patients and the relationships between those variables, and explore the patients' experience of resilience during the COVID-19 treatment in single-room isolation wards.

METHODS

This study employed a mixed-methods approach, collecting quantitative data through surveys and qualitative data through semistructured interviews conducted between May and October 2022. Quantitative surveys encompassing disease-specific and demographic information, visual analog scales to assess anxiety, depression, and sleep quality, and the Connor-Davidson resilience scale were administered to patients (N = 153). Qualitative thematic analyses were conducted following interviews with a subset of patients (N = 13) belonging to the high-resilience group.

RESULTS

Resilience exhibited a negative correlation with anxiety and depression, while showing a positive correlation with sleep quality. Factors affecting resilience include having a spouse, educational attainment, and depression. The qualitative thematic analysis results were categorized into: (1) facing the reality of being isolated in a room; (2) struggling to accept and adapt to isolation; and (3) seeking connections in isolation.

CONCLUSIONS

This research sheds light on the challenges faced by individuals in isolation and underscores the crucial role of resilience in overcoming such challenges. The resilience observed in these patients is grounded in both interpersonal and profound spiritual connections. These findings underscore the necessity for nurses to develop customized strategies to alleviate the impacts of social isolation.

Resilience and Social Support Improve Mental Health and Quality of Life in Patients with Post-COVID-19 Syndrome

Physical and mental health problems among post-COVID-19 patients are common, even a year after infection. As there is no prior study available, we investigated the impacts of resilience and social support on anxiety, depression, and quality of life among patients with post-COVID-19 syndrome. We conducted a cross-sectional study with a convenience sample. The measures included the demographic and clinical characteristics of patients, the Brief Resilience Scale, the Multidimensional Scale of Perceived Social Support, the Patient Health Questionnaire-4 (PHQ-4), and the EuroQol-5D-3L. The mean age of patients was 44.8 years. The total PHQ-4 score suggested that 32.8% of patients with post-COVID-19 syndrome experienced severe psychological distress, 32.8% experienced moderate distress, 23% experienced mild distress, and 11.5% had no distress. Moreover, 60.7% of patients had anxiety scores of ≥3 and 69.7% had depression scores of ≥3, indicating possible major anxiety or depression disorder. The mean EQ-5D-3L index value was 0.36, and the mean EQ-5D-3L VAS was 54.1. Multivariable analysis identified that resilience and social support reduced anxiety and depression among patients. Also, we found a significant positive relationship between resilience and social support, and quality of life. Our findings suggest that resilience and social support can be protective by reducing anxiety and depression and improving quality of life among patients with post-COVID-19 syndrome. Policymakers should develop and implement healthcare management programs to provide psychological support to these patients.

Connecting psychosocial and personality characteristics with mental health outcomes. An Italian co-twin control study

Exposure to stressful life events is common, and it is linked to increased psychological issues. As most likely people respond to stressors depending on environmental and genetic factors, we assessed in a twin study the association of some personal characteristics such as resilience and self-perception with anxiety, depression and stress in the late Covid pandemic period, to verify the underlying genetic and shared familial components. With this design, the strength of the associations was compared between individual-level and intrapair-level analyses. From June 2020 to December 2021, the Italian Twin Registry conducted a three-wave longitudinal study among adult twins using validated questionnaires, and 1,763 adult twins participated in the study (mean age 46 years, 67 % females, 70 % monozygotic). A regression-based within-pair differences model was applied to control for genetic and shared environmental confounding. Results showed that anxiety was linked negatively with resilience, social support and perceived health, and positively with risk perception and hypochondria. Depression was associated negatively with resilience, social support and perceived health, and positively with financial concern and hypochondria. Stress was associated negatively with resilience and perceived health, and positively with financial concern, risk perception and hypochondria. These results suggest potential etiological effects of the above-mentioned risk factors. While our findings need to be confirmed by longitudinal studies, they propose potential etiological models for mental disorders, indicating that addressing in the clinical practice factors such as self-perception, personality traits (resilience), environmental resources (social support), and comorbid disorders (hypochondria) could have therapeutic benefits while treating certain common mental disorders.

Depression, anxiety, stress and other mental health conditions of personnel undergoing hospital isolation during the COVID-19 pandemic and influencing factors

Objective

To understand the depression, anxiety, stress and other mental health conditions of personnel undergoing hospital isolation during the COVID-19 pandemic and the influencing factors.

Methods

This was retrospective study. A total of 120 personnel undergoing Baoding No.1 Hospital isolation who completed the questionnaires were included from June 10, 2021 to February 07, 2022. The Patient Health Questionnaire-9(PHQ-9), the Generalized Anxiety Scale (GAD7) and psychological stress measurement table (PSTR) were used for psychological problem screening for personnel undergoing hospital isolation.

Results

The incidence of depression was the lowest, while that of stress was the highest. The difference in the incidence of depression, anxiety and stress among personnel undergoing hospital isolation with different gender, age, income statuses, marital statuses and attitude towards isolation was statistically significant (p< 0.05), while the difference in the incidence of these problems among personnel with different degree of education was not statistically significant(p> 0.05). Multivariate Logistic regression analysis showed that age, gender, marital status, economic status and attitude towards isolation are factors associated with stress. Economic status and attitude towards isolation are factors associated with depression. A high economic level is a protective factor against depression, while a negative attitude is a risk factor for depression.

Conclusion

During the COVID-19 pandemic, anxiety, depression and stress increased to different extents in personnel undergoing hospital isolation, especially in females with poor economic conditions and poor attitudes towards isolation. Therefore, necessary psychological counseling and social support should be provided to these people.

Parental marital status and anxiety symptoms in adolescents: the mediating effect of childhood maltreatment

Although previous studies have established the association between parental marital status and mental health problems in adolescents, however, the adverse effects of incomplete family settings and childhood maltreatment on adolescent anxiety symptoms have not been fully investigated. Moreover, whether childhood maltreatment can mediate the relationship between parental marital status and anxiety symptoms remains unclear. A population-based cross-sectional study was performed among 35,573 adolescents in elementary schools across 17 provinces in China. And childhood maltreatment, resilience, and anxiety symptoms were assessed among adolescents, respectively. The parental marital status was self-reported as having two married biological parents, divorced parents, stepparents, and single-parent. We found that the rates of anxiety symptoms among adolescents were 35.1% in intact families, 48.8% in divorced families, 49% in stepparent families, and 48% in single-parent families. Divorced parents (aOR = 1.191, 95% CI [1.060-1.337]) was an independent risk factor for adolescents' anxiety symptom while having stepparents and single-parent were not. In addition, emotional abuse (aOR = 1.300, 95% CI [1.285-1.316]), sexual abuse (aOR = 1.088, 95% CI [1.063-1.114]), and physical neglect (aOR = 1.019, 95% CI [1.007-1.031]) were all independent risk factors for anxiety symptoms in adolescents, while physical abuse and emotional neglect were not. The negative impacts of divorced and remarried parents on adolescent anxiety symptoms were mediated by childhood maltreatment partially (64.9% and 72.2%), while childhood maltreatment completely mediated the adverse impacts of single-parent on adolescent anxiety symptoms. Childhood maltreatment intervention strategies could be necessary for anxiety symptoms of adolescents in divorced/stepparent/single-parent families.

Association between individual resilience and depression or anxiety among general adult population during COVID-19: a systematic review

BACKGROUND

The coronavirus disease (COVID-19) pandemic exacerbated depression and anxiety worldwide. Resilience is important to maintain mental health during uncertain times, but limited study has systematically reviewed its association with depression or anxiety with an emphasis on the general population.

METHODS

We searched PubMed and Embase for quantitative or mixed-methods studies on the general adult population published between 1 January 2020 and 31 April 2022 (PROSPERO ID: CRD 42022340935). National Institute of the Health quality assessment tools was used to assess the risk of bias. We qualitatively synthesized findings by outcome and study design.

RESULTS

A total of 2945 studies were screened and 35 studies were included in the narrative analysis (5 on depression, 9 on anxiety, and 21 on both). Overall, 21 studies identified statistically significant inverse associations between resilience and depression, while 24 studies found statistically significant inverse associations between resilience and anxiety. Eight studies reported no statistically significant relationships between resilience with depression or anxiety.

CONCLUSIONS

Resilience was found to be inversely associated with depression and anxiety during the COVID-19 pandemic. The findings highlight the importance of resilience-enhancing intervention in migrating the global mental health burden from outbreaks of infectious diseases.

COVID-19 anxiety and related factors amid adjusted epidemic prevention policies: a cross-sectional study on patients with late-life depression in China

OBJECTIVES

To explore the prevalence and associated factors of COVID-19 anxiety in patients with late-life depression (LLD) during the adjustment of epidemic prevention policies in China.

DESIGN

Cross-sectional study.

SETTING

The data analysed in this study were collected from seven regions in China between November 2022 and January 2023.

PARTICIPANTS

A total of 1205 patients with LLD (aged 60-78 years) participated in the survey. They completed a social demographic assessment and the Chinese version of the five-point Coronavirus Anxiety Scale (CAS).

PRIMARY OUTCOME MEASURES

The primary outcome was the anxiety level of the participants. Patients were categorised into two groups based on their anxiety levels, one with anxiety and one without, according to CAS scores.

RESULTS

The prevalence of COVID-19 anxiety in depressed older adults was 47.3%. Regression analysis revealed that the average COVID-19 anxiety score was significantly higher among females (AOR: 2.177, 95% CI 1.201 to 3.947), widowed individuals (AOR: 3.015, 95% CI 1.379 to 6.591), patients residing at a distance from healthcare facilities (AOR: 3.765, 95% CI 1.906 to 7.438), and those who frequently experienced worry (AOR: 1.984, 95% CI 1.111 to 3.543). Conversely, the anxiety score was significantly lower among divorced individuals (AOR: 0.491, 95% CI 0.245 to 0.988), those aged 70 years and above (AOR: 0.117, 95% CI 0.064 to 0.213), patients without difficulty obtaining medication (AOR: 0.027, 95% CI 0.007 to 0.097), those living with family members (AOR: 0.080, 95% CI 0.022 to 0.282) or in nursing homes compared with those living alone (AOR: 0.019, 95% CI 0.004 to 0.087).

CONCLUSION

Women with LLD who are widowed, live far from healthcare facilities, and are prone to excessive worry are more likely to experience anxiety. It is advisable to implement appropriate preventive measures and provide psychosocial support programmes for this vulnerable group during the COVID-19 pandemic.

The psychological impact of the COVID-19 pandemic and the role of resilience: cross cultural differences between Brazil, Italy, and the United States

OBJECTIVE

Restrictive measures consequent to the COVID-19 pandemic have had a significant psychological impact on everyday life in the general population, even though differences between countries remain poorly investigated. The present study sought to examine the different psychological impacts and resilience of the pandemic among three of the most heavily hit countries: Brazil, Italy, and the United States.

METHODS

This cross-sectional study separately involved three national community populations, namely the Brazilian, the Italian, and the American population. Participants aged 18 years or older were recruited through a shared online survey. Participants self-completed the Connor-Davidson Resilience Scale (CD-RISC-10) and the Center for Epidemiological Studies-Depression Scale (CES-D); post-traumatic stress was additionally assessed using the Impact of Event Scale-Revised (IES-R). Three separate Analyses of Covariance (ANCOVA) were performed in order to investigate differences in the levels of resilience, post-traumatic stress, and depression among the three populations.

RESULTS

The study included in total 734 participants (mean age = 27.60 ± 11.69 years; 77% of females). Results of ANCOVA comparisons showed significant differences between the three groups in the variable measuring resilience, post-traumatic stress symptoms, and depression. As for resilience, results of post-hoc tests showed significant differences between the groups from Brazil and Italy and between the groups from Brazil and USA. As for the post-traumatic stress symptoms, results showed significant differences between the USA and Brazil groups and between the USA and Italy groups. As for the depression symptoms, results showed significant differences between the USA and Brazil groups.

CONCLUSIONS

Overall, these findings may help to increase understanding of the psychological impact of COVID-19 in Brazil, Italy, and the USA. Interventions to prevent mental disorders among general populations should take into account these findings.

Effects of the COVID-19 pandemic on mental health and sleep quality in the Chinese general populations during sporadic and outbreak periods

The different coronavirus disease 2019 (COVID-19) outbreak patterns may have different impact on the mental health, but there is no such report at present. This study was aimed to investigate general populations mental health and sleep quality during the sporadic and outbreak of COVID-19 in Tianjin of China. Two cross-sectional studies included 1090 participants during the COVID-19 sporadic period from 28th January to 28th February 2022 and 2036 participants during the COVID-19 outbreak period from 1st January to 1st February 2023. We used the propensity score matching method to match the 2 samples (sporadic and outbreak group) with a ratio of 1:1. Finally, 1087 participants were included in each group. The demographics, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, Connor-Davidson Resilience Scale, and Pittsburgh Sleep Quality Index were collected from all participants. There was a significant difference between the sporadic and outbreak groups for COVID-19-infected status, anxiety levels, sleep quality, and phycological resilience (all P < .05). Logistic regression analysis showed that female (P < .05) and depression status (P < .05) were the risk factors for the incidence rate of anxiety and poor sleep quality in sporadic group, and outbreak group, while phycological resilience were robust related to the sleep quality (P < .01). Poor sleep quality (P < .01) was related to the incidence of anxiety in sporadic group but not the outbreak group; anxiety levels (P < .01) were related to sleep quality in sporadic group but not the outbreak group. During the COVID-19 pandemic, general populations experienced high anxiety and poor sleep quality incidence rates, especially in the outbreak period. Different risk models for anxiety and sleep quality were found in the different outbreak patterns.

Chain mediation model of consultation empathy, resilience and resignation coping on depression: a cross-sectional study among patients with COVID-19 in China

OBJECTIVES

This study aimed to explore the mediating role of resilience and resignation coping in the relationship between consultation empathy and depression in patients with COVID-19.

DESIGN

Cross-sectional study.

SETTING

Participants were recruited from a tertiary hospital in Guangzhou, Guangdong province.

PARTICIPANTS

A total of 215 patients were recruited for this study.

OUTCOME MEASURES

A total of 215 patients completed the Consultation and Relational Empathy Measure, Connor-Davidson Resilience Scale, Medical Coping Modes Questionnaire and Hospital Anxiety and Depression Scale. PROCESS 4.1 model 6 was used to analyse the moderated mediating effects.

RESULTS

Consultation empathy had a positive correlation with resilience (r=0.34, p<0.001), and a negative correlation with resignation (r=-0.288, p<0.001) and depression (r=-0.379, p<0.001). Resilience had a negative correlation with resignation (r=-0.463, p<0.001) and depression (r=-0.605, p<0.001). Resignation had a positive correlation (r=0.547, p<0.001) with depression. In the moderated mediating model, consultation empathy had significant indirect predictive effects on depression through resilience (95% CI -0.093 to -0.030) or resignation (95% CI -0.043 to -0.005). Consultation empathy had significant indirect predictive effects on depression through both resilience and resignation (95% CI -0.030 to -0.008).

CONCLUSIONS

Consultation empathy not only predicted depression directly, but also indirectly predicted depression through the chain mediating effects of resilience and resignation coping.

Associations between resilience and symptoms of depression and anxiety among adolescents: Examining the moderating effects of family environment

Depressive and anxiety symptoms in adolescents have experienced increase their risk of peripheral mental health and social problems. For adolescents, the role of family environmental factors should be taken into consideration. This study aimed to explore the association between resilience and depressive and anxiety symptoms in adolescents and to extend the findings by examining the moderating effects of family environment. A total of 35,573 adolescents in middle schools were recruited in China. Childhood abuse, resilience, and symptoms of depression and anxiety were evaluated in adolescents. We found a significant association between resilience and symptoms of depression and anxiety [OR = 0.976 (0.975-0.978), P < 0.001; OR = 0.980 (0.978-0.981), P < 0.001]. The adjusted ORs (95 % CIs) for mental health across the categories of resilience were as follows: 1 (reference) for low resilience, 0.660 (0.620-0.703) for medium resilience, 0.309 (0.286-0.333) for high resilience. The relationship between resilience and depressive symptoms was stronger for girls, non-only children, and those without child abuse experience compared to boys, only child, and those with child abuse experience (all p < 0.05). Our findings of a nationally representative sample in China suggest that gender, only child, parent-child relationship and child abuse moderated the relationship between resilience and symptoms of depression and anxiety.

Psychological resilience matters in the relationship between the decline in economic status and adults' depression half a year after the outbreak of the COVID-19 pandemic

Background/objective

The outbreak of COVID-19 in China since 2019 has had a significant impact on the mental health of people in Hubei Province during the three-year pandemic period. Therefore, studying the prevalence of depression among the population of Hubei Province since the pandemic is of great significance.

Methods

Based on opportunity and stress theory, we collected provincial-level data from Hubei (N = 3,285) to examine the impact of declining economic status on depressive symptoms and to investigate the moderating effect of psychological resilience during the period of economic adjustment.

Results

We used propensity score matching to estimate the treatment effect of economic status decline on depression severity and confirmed the moderating effect of psychological resilience. We found that the more that an individual's economic status declines, the more severe that his or her depressive symptoms become. Specifically, each unit decrease in economic status is associated with an increase of approximately 0.117 units in depression level. In addition, our results indicated that psychological resilience significantly moderated the relationship between economic decline and depression (-0.184*).

Conclusions and implications

Our study confirms the role of economic status in depressive symptoms. Compared with traditional research on the relationship between economic status and mental illness, this paper expands the research regarding the two in the context of a major public health emergency. Furthermore, we suggest ways to improve people's mental health following the pandemic.

Effects of Locomotion Regulatory Mode on COVID-19 Anxiety: The Mediating Role of Resilience

The COVID-19 pandemic has exerted a significant impact on mental health globally. The uncertainty, fear, and stress associated with this crisis have contributed to a heightened prevalence of anxiety, depression, and various other mental health disorders. In this scenario, the present study aimed at investigating the relationship between locomotion regulatory mode, resilience, and COVID-19 anxiety. It is worth noting that previous extensive research has established a significant correlation between high levels of locomotion and diverse positive psychological conditions, such as optimism, reduced hopelessness, and a positive effect. A total of 243 participants completed measures of locomotion regulatory mode, resilience, and COVID-19 anxiety. In line with our hypotheses, individuals' locomotion regulatory mode was negatively, although non-significatively, associated with COVID-19 anxiety. Furthermore, resilience was found to mediate the relationship between the locomotion regulatory mode and COVID-19 anxiety, indicating that individuals displaying high locomotion may be better equipped to cope with the stress and uncertainty of the COVID-19 pandemic due to their greater levels of resilience. Taken together, these findings highlight the importance of considering both locomotion and resilience in managing anxiety related to COVID-19, and suggest that interventions aimed at enhancing resilience may be particularly beneficial for individuals with a low locomotion regulatory mode.

The Relationship Between Social Media Use and Negative Emotions Among Chinese Medical College Students: The Mediating Role of Fear of Missing Out and the Moderating Role of Resilience

Objective

This study aimed to examine the mediating role of fear of missing out (FoMO) and the moderating role of resilience in the association between social media use and negative emotions among medical college students in China during the COVID-19 pandemic.

Participants and Methods

A cross-sectional study design was conducted, medical college students from Qiqihar Medical University, China participated in the study. A total of 470 medical college students were recruited voluntarily to complete questionnaires on social media use, FoMO, resilience, and negative emotions.

Results

Social media use was positively associated with FoMO and negative emotions among medical students (p < 0.01). The total effect of social media use on negative emotions was significant (β = 1.101, SE = 0.079, p < 0.001). Social media use had no significant direct effect on negative emotions (β = 0.168, SE = 0.096, p > 0.05), but it had an indirect effect on negative emotions via mediation of FoMO (β = 0.933, SE = 0.106, 95% CI: 0.731 to 1.149). Moreover, resilience had a significant moderating effect on the relationship between FoMO and negative emotions (β = -0.021, SE = 0.005, 95% CI: -0.032 to -0.012). FoMO had a significant positive predictive effect on negative emotions at both levels of resilience (low resilience individuals: β = 1.079, SE = 0.076, p < 0.001; high resilience individuals: β = 0.212, SE = 0.094, p < 0.05).

Conclusion

Social media use and FoMO may be risk factors for increased negative emotions, and resilience should be considered in prevention and intervention strategies designed to mitigate negative emotions among medical college students.

Assessing Resilience and Its Correlates among Residents of Fort McMurray during the COVID-19 Pandemic

BACKGROUND

The coronavirus disease of 2019 (COVID-19) pandemic has led to a global health crisis that has affected the psychological well-being of individuals across the world. The persistence of the pandemic and measures to curtail it have tested people's ability to cope successfully and bounce back from the pandemic, otherwise referred to as resilience. The present study examined resilience levels among residents of Fort McMurray and identified the demographic, clinical and social factors associated with resilience.

METHODS

The study used a cross-sectional survey design and collected data from 186 participants using online questionnaires. The survey included questions assessing sociodemographic information, mental health history and COVID-19-related variables. The main study outcome was resilience measured using the six-item Brief Resilience Scale (BRS). The data from the survey were analyzed using chi-squared tests and binary logistic regression analyses in the Statistical Package for Social Sciences (SPSS), version 25.

RESULTS

The results showed that seven independent variables (age, history of depression, history of anxiety, willingness to receive mental health counselling, support from the government of Alberta and support from employer) were statistically significant within the context of the logistic regression model. A history of an anxiety disorder was demonstrated to best predict low resilience. Participants who had a history of anxiety disorder were five times more likely to show low resilience compared to those without such a history. Participants with a history of depression showed a three-fold likelihood of having low resilience in comparison to those who did not have a history of depression. Individuals who expressed a desire to receive mental health counselling had a four-times likelihood of having low resilience than those who did not express a desire to receive mental health counselling. The results also showed that younger participants were more prone to low resilience compared to older participants. Receiving support from the government and one's employer is a protective factor.

CONCLUSIONS

This study highlights the importance of examining resilience and its associated factors during a pandemic such as COVID-19. The results demonstrated that a history of anxiety disorder, depression and being younger were important predictors of low resilience. Responders who reported the desire to receive mental health counselling also reported expressing low resilience. These findings could be used to design and implement interventions aimed at improving the resilience of individuals affected by the COVID-19 pandemic.

COVID-19 challenges, responses, and resilience among rural Black women: a study protocol

Despite the aggregated burdens and challenges experienced by rural Black women during the COVID-19 pandemic, many likely also demonstrated strength and resilience to overcome challenges. A mixed methodology and a community-based participatory approach will be used to collect multilevel data on challenges, responses, resilience, and lessons during the pandemic from Black women, community health workers, and community leaders in rural areas in South Carolina (SC). Specifically, the unique circumstances and lived experiences of rural Black women during the COVID-19 pandemic will be documented to understand their needs regarding effective management of social, physical, and mental health challenges through focus group discussions and in-depth interviews with Black women, community health workers, and local community leaders recruited from rural SC communities. Barriers, facilitators, and potential impacts of multilevel resilience development will be identified through a survey administered among rural Black women recruited from 11 rural counties (with one as site for a pilot testing of the questionnaire). A report for public health practice will be developed, including recommended strategies to optimize health systems' emergency preparedness and responses through triangulation of qualitative and quantitative data from multiple sources. Findings in the proposed study will provide valuable references in terms of addressing social determinants of health factor challenges during the pandemic, fostering resilience, and informing evidence-based decision-making for policymakers. The study will contribute to the development of public health emergency preparedness plans, which can promote the resilience of women, their families, and local communities as well as optimize effective preparedness and response of health systems for rural Black women and their families during infectious disease outbreaks and other public health emergencies.

The Situation and Influencing Factors of Depression and Anxiety in Patients of Hemodialysis during the COVID-19 Pandemic in China

OBJECTIVE

To investigate the incidence of depression and anxiety among maintenance hemodialysis (MHD) patients during the regular prevention and control stage of COVID-19 in China as well as the influencing factors.

METHODS

A cross-sectional study including 180 patients under the treatment of hemodialysis was conducted in the hemodialysis center of the 8th Affiliated Hospital of Sun Yat-Sen University. The questionnaire regarding the subject's general information, Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) was completed by the patients, and the laboratory test results were recorded.

RESULTS

The incidences of anxiety and depression were 35.6% and 38.9%, respectively, and the average scores of SAS and SDS were (48.03 ± 5.02) and (48.12 ± 5.42), respectively, in the subjects. The results showed that age, monthly income, vascular access of dialysis, feeling of pain and itching (within a week), worried about being infected by COVID-19, whether having health insurance and the levels of hemoglobin, parathyroid hormone, and phosphorus were the impact factors of both anxiety and depression in the MHD patients (p < 0.05 for all).

CONCLUSION

The proportion of depression and anxiety is relatively high in the MHD patients during the regular prevention and control stage of COVID-19.

Academic stress, COVID-19 anxiety, and quality of life among nursing students: The mediating role of resilience

AIM

This study investigated the mediating role of resilience in the relationship between academic stress, COVID-19 anxiety, and quality of life (QoL) among Filipino nursing students during the COVID-19 pandemic.

BACKGROUND

The COVID-19 pandemic has impacted the QoL of nursing students who are experiencing mental health issues. The mediating role of resilience in mitigating the effects of academic stress and COVID-19 anxiety on nursing students' QoL remains understudied.

METHODS

This study employed a correlational cross-sectional design, with a convenience sample of 611 Filipino nursing students. Data were collected using the scales Connor and Davidson Resilience, Brunnsviken Brief Quality of Life, COVID-19 Anxiety, and Perception of Academic Stress and analyzed using Pearson's r, bivariate analysis, and multistage regression analyses.

RESULTS

Academic stress and COVID-19 anxiety negatively correlated with QoL and resilience. Resilience was positively associated with QoL and reduced the effect of academic stress on QoL, indicating that resilience is a crucial mediating variable between academic stress and QoL. Finally, resilience had a significant mediating influence on QoL, as evidenced by a reduction in the effect of COVID-19 anxiety on QoL among nursing students.

CONCLUSIONS

Filipino nursing students' QoL was affected by academic stress and COVID-19-related anxiety. However, resilience mediated this impact, preserving QoL.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nursing colleges and affiliated hospitals must collaborate to monitor academic stress and pandemic-related anxiety. Nursing students should be provided with programs such as seminars and team-building activities to enhance their resilience.

Resilience during the COVID-19 pandemic among people living with HIV: A cross-sectional study

BACKGROUND

This study aims to investigate the factors shaping resilience during the COVID-19 pandemic among people living with HIV (PLWH).

METHODS

A total of 341 participants were included in this cross-sectional study. The online survey included scales of resilience, depression & anxiety, loneliness, social support, COVID-19 fear, stress, and sociodemographic information.

RESULTS

Logistic regression test results showed loneliness (OR = 2.548, 95% CI = 1.251, 5.189), social support (OR = 2.217, 95% CI = 1.148, 4.279), income (OR = 2.581, 95% CI = 1.217, 5.472), sexual orientation (OR = 2.707, 95% CI = 1.004, 7.300), age (OR = 1.044, 95% CI = 1.006, 1.083) and COVID-19 fear (OR = 0.891, 95% CI = 0.840, 0.944) were statistically significant factors associated with resilience among PLWH.

CONCLUSION

In conclusion, reducing COVID-19 fear by providing the correct information about the COVID-19 pandemic, fortifying the level of social support satisfaction, as well as minimising the level of loneliness have the potential to improve psychological resilience among PLWH.

The role of resilience in the relationship between role stress and psychological well-being during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

Stress resistance resources, such as social support and resilience, have been found to be important in promoting psychological well-being during the COVID-19 pandemic. However, most prior research studies have conceptualized stress resistance resource variables as having a mediating or moderating role. Cooper (2018) proposed a model of the relationship between stress and health which posits that coping resources are always present and not only invoked in the face of adversity. Thus, we hypothesize that coping resources are causally antecedent to stressors and influence well-being indirectly via the stressor. We focused specifically on school teachers due to them being at the frontlines of service provision during the pandemic. Teaching was already identified as a highly stressful profession prior to COVID-19 and disease containment measures placed additional strain on teachers who had to adapt to emergency remote teaching.

AIM

The current study tests this hypothesis by examining the indirect effects of resilience on indices of psychological health via role stress.

METHODS

Participants (N = 355) were teachers who completed the Connor-Davidson Resilience Scale-10, the Role Stress Scale, the Satisfaction with Life Scale, the State-Trait Anxiety Inventory-Trait Scale, and the Center for Epidemiological Studies Depression Scale. An electronic version of the questionnaires was distributed to teachers via Facebook and to officials from the Department of Education, who assisted with distribution of the electronic link to the survey. Participants were mostly women (76.6%) and mean number of years in the teaching profession was 15.7.

RESULTS

Structural equation modelling results demonstrated significant direct effects of resilience on life satisfaction, anxiety, and depression, which indicates that resilience is beneficial for psychological health even in the absence of stress. Resilience also had a significant indirect effect on indices of psychological well-being via role ambiguity but not role conflict.

CONCLUSION

These findings have theoretical implications for the understanding of the role of resilience in promoting psychological health among educators. Practical implications include an empirical contribution to education policy and information that can inform interventions aimed to promote resilience among educators.

Stress and depressive symptoms in university students in Hong Kong under the pandemic: Moderating effect of positive psychological attributes

Introduction

There are very few studies examining the psychological well-being of university students in Hong Kong under the COVID-19 pandemic. Besides COVID-19-related stress, the "social event" in 2019-2020 has caused significant stress in young people. As such, we attempted to answer several research questions in this paper. First, what are the relationships between stresses (COVID-19 and "social event" related stresses) and psychological well-being indexed by depressive symptoms? Based on the stress and coping perspective, we predicted that there would be positive relationships between both types of stress and depression. Second, what are the relationships between different positive psychological factors (including life satisfaction, resilience and emotional management, flourishing, and beliefs about adversity) and depression? Based on different theoretical models of positive psychology, we hypothesized that negative relationships would exist between positive psychological factors and depressive symptoms. Third, do positive psychological attributes moderate the associations between stresses (COVID-19 and "social event" related stresses) and depressive symptoms? Based on the positive psychology literature, we hypothesized that positive psychological attributes would buffer the negative impact of stresses on depression.

Methods

We recruited university students roughly one year after the first wave of the pandemic (N = 1,648) in early 2021. We used 25 items to measure COVID-19-related stress and "social event" related stress. For psychological well-being indexed by depressive symptoms, we used the "Centre for Epidemiologic Studies Depression Scale Revised (CESD-R)". For positive psychological attributes, we employed established measures of life satisfaction, resilience and emotional management, flourishing, and beliefs about adversity.

Results

Regarding the relationship between stress and depression, we found positive relationships between both types of stress and depressive symptoms. As predicted, negative relationships existed between all positive psychological attributes and depressive symptoms. Besides, the positive psychological attributes significantly moderated the effects of stresses on depression, suggesting that these factors can reduce the negative impacts of stresses on depression. The present findings provide support for those models, highlighting the importance of positive psychological attributes as protective factors for university students' depression.

Discussion

The findings of this study underscore the important role of positive psychological attributes in the stress-depression relationship in university students under the pandemic. The findings also generalize the positive youth development theory in the Chinese context. In terms of practice, university administrators and service providers should consider cultivating positive psychological attributes in university students with the purpose of promoting their psychological well-being.

Resilience, Perceived Stress from Adapted Medical Education Related to Depression among Medical Students during the COVID-19 Pandemic

The COVID-19 pandemic disrupted several routine teaching methods in clinical settings which causing psychological distress among medical students. This study aims to explore the association of perceived stress related to the adapted medical education, resilience, and depression among medical students at a medical school in northern Thailand during the COVID-19 outbreak. A total of 437 medical students were recruited in January 2022. Data were obtained using self-administered online questionnaires, including demographic data, perceived challenges in learning online classes, the Resilience Inventory (RI-9), and the Patient Health Questionnaire 9 (PHQ-9). Binary logistic regression analysis was employed to explore factors associated with depression (PHQ-9 ≥ 9). A total of 27% of the participants were identified as having depression. Logistic regression revealed that the presence of previous psychiatric conditions (ß = 2.80, p < 0.05), stress from lack of in-person contact with peers (ß = 1.48, p < 0.05), stress from lack of in-person communication with teachers (ß = 1.49, p < 0.05), and level of resilience (ß = 0.88, p < 0.001) were independently associated factors for depression among medical students. Level of resilience was negatively correlated with depressive symptoms (r = −0.436, p < 0.001). The rate of depression among medical students was higher during the pandemic. Resilience was associated with depression. Strengthening resilience might have an important implication for depression among medical students.

The psychometric properties and gender invariance of the Italian version of the Perceived Vulnerability to Disease Questionnaire (I-PVDQ) during the COVID-19 pandemic

BACKGROUND

The Perceived Vulnerability to Disease Questionnaire (PVDQ) measures beliefs associated with personal susceptibility to infectious diseases and behaviors or perceptions in the presence of potential risk of pathogen transmission. Given the onset of the Severe Acute Respiratory Syndrome Coronavirus 2 global pandemic, otherwise known as the COVID-19 pandemic, the construct being measured may function differently based on affective, behavioral, and cognitive changes along with the need to change norms and lifestyles in a global context. The present study aims to test the psychometric properties and the gender invariance of the Italian adaptation of the PVDQ to confirm that the scale can be used with Italian-speaking people, and that it functions effectively during a pandemic.

METHODS

A total of 509 participants filled out an online questionnaire including the Italian version of the I-PVDQ (I-PVDQ) and several measures of psychological constructs. Reliability and factor analyses (single and multigroup) were conducted. Bayesian correlation tests and Bayesian independent sample t-tests were used to assess the validity of I-PVDQ.

RESULTS

Exploratory factor analysis supported the two-factor structure of the I-PVDQ, and factor loadings loaded appropriately onto perceived infectability (PI) and germ aversion (GA). In terms of invariance, the scale showed configural, metric, scalar, and strict invariance across genders. Decisive evidence in favor of correlation with the measure of COVID-19 related fears for both PI and GA was found. There was strong evidence for observed correlations with COVID-19 related constructs such as intolerance to uncertainty, psychological inflexibility, resilience, stress, and anxiety. Women showed higher GA than men, while there were no gender differences in PI.

CONCLUSIONS

Taken together, these results suggest that the I-PVDQ confirms the psychometric properties of the original version and that can be used to detect PVD when it is affected by environmental circumstances since its functioning is preserved during a pandemic.

Prevalence of Depression and Related Factors among Patients with Chronic Disease during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

The management of chronic diseases in the midst of the COVID-19 pandemic is especially challenging, and reducing potential psychological harm is essential. This review aims to determine the prevalence of depression during the COVID-19 pandemic in patients with chronic disease, and to characterize the impacts of related factors. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The meta-analysis was performed using StatsDirect software. The review identified 33 articles with a total of 50,905 patients with chronic diseases. Four meta-analyses were performed to estimate the prevalence of depression. In diabetic patients, the prevalence ranged from 17% (95% CI = 7-31) (PHQ-9) to 33% (95% CI = 16-51) (PHQ-8); in obese patients, the prevalence was 48% (95% CI = 26-71); and in hypertensive patients, the prevalence was 18% (95% CI = 13-24). The factors significantly associated with depression were female sex, being single, deterioration in the clinical parameters of diabetes, a decrease in self-care behavior, reduced physical activity and sleep time and fear of contagion. The COVID-19 pandemic has significantly increased levels of depression among persons with chronic disease. Pandemics and other emergency events have a major impact on mental health, so early psychological interventions and health management policies are needed to reinforce chronic patients' physical and mental health.

The role of resilience in diabetes stigma among young and middle-aged patients with type 2 diabetes

AIM

To explore the prevalence and related factors influencing diabetes stigma among Chinese young and middle-aged patients with type 2 diabetes.

DESIGN

A cross-sectional, quantitative study was conducted through questionnaires.

METHODS

A total of 453 young and middle-aged patients with type 2 diabetes were recruited. Questionnaire survey was conducted with convenience sampling from September 2019 to December 2020. This included demographic questionnaire, Type 2 Diabetes Stigma Assessment Scale (DSAS-2) and Connor-Davidson Resilience Scale (CD-RISC). The STROBE checklist was applied as the reporting guideline for this study.

RESULTS

The scores of diabetes stigma and resilience of patients were 48.18 ± 14.52 and 66.02 ± 7.18, respectively. Diabetes stigma was negatively correlated with resilience, the correlation coefficient was -0.581. The results showed that the complications, diabetes year, monthly income and insulin treatment are important factors affecting stigma. In addition, it is resilience that was a protective factor of diabetes stigma, explaining 27.2% of the variance in diabetes stigma.

The role of resilience in depression and anxiety symptoms: A three-wave cross-lagged study

Cultivation of resilience is believed to ameliorate mental health problems. The impact of mental health problems on resilience is however rarely discussed. This study investigated the reciprocal relationship of resilience with depression and anxiety symptoms using a three-wave cross-lagged design. Resilience level, depression, and anxiety symptoms were assessed at baseline, the third and the sixth month in 125 university students without psychiatric disorders (62 females). No significant changes in resilience levels were observed across the 6 months. Depressive symptoms, but not anxiety symptoms significantly increased at the third and sixth months compared with baseline. The three-wave cross-lagged models revealed an unstable reciprocal relationship of resilience with depression and a stable reciprocal relationship between resilience and anxiety symptoms over time. The reciprocal relationship between resilience and mental health problems indicates the importance of cultivating resilience for the prevention of mental illness as well as the importance of managing mental health symptoms at non-clinical levels for monitoring resilience. The unstable reciprocal relationship between resilience and depression symptoms across time suggests the existence of potential moderators that impact the relationship between resilience and depression. Our findings further support the notion that resilience is conceptualized as a dynamic process.

The COVID-19 fear, anxiety, and resilience among emergency nurses

Background

Besides physical complications, COVID-19 is associated with psychological issues such as fear and anxiety. High resilience in nurses enables them to adopt positive coping mechanisms and successfully operate in the stressful environment of COVID-19 wards. The present study aimed to evaluate the correlation between COVID-19 fear and anxiety with resilience in the emergency nurses of the hospital affiliated with Kurdistan University of Medical Sciences (west of Iran) in 2021.

Materials and methods

This cross-sectional study was conducted on 295 emergency nurses of selected hospitals in Kurdistan province, Iran, in 2021. Data were collected using a demographic questionnaire, Fear of COVID-19 Scale (FCV-19S), Corona Disease Anxiety Scale (CDAS), and Connor-Davidson Resilience Scale (CD-RISC). Data analysis was performed in R software version 3.6.3.

Results

The mean scores of resilience, COVID-19 fear, and COVID-19 anxiety were 55.07 ± 19.82 (ranging from 0 to 100), 20 ± 7.37 (ranging from 7 to 35) and 36.48 ± 13.21 (ranging from 18 to 54) respectively. There was a negative and significant correlation between resilience with COVID-19 fear (r = -0.449, p = 0.001), COVID-19 anxiety (r = 0.458, p = 0.001). A significant correlation was observed between COVID-19 fear and anxiety, which indicated that if the other demographic variables remained unchanged, a one-unit increase in COVID-19 fear and anxiety decreased the mean resilience score by -0.66 (P = 0.008) and -0.34 (P = 0.015), respectively.

Conclusion

COVID-19 fear and anxiety were significantly correlated. Therefore, providing training courses for promoting resilience could reduce the fear and anxiety of nurses during the COVID-19 pandemic.

Psychosocial factors associated with mental health and quality of life during the COVID-19 pandemic among low-income urban dwellers in Peninsular Malaysia

Background and aims

Mental well-being among low-income urban populations is arguably challenged more than any other population amid the COVID-19 pandemic. This study investigates factors associated with depression and anxiety symptoms and quality of life among Malaysia’s multi-ethnic urban lower-income communities.

Methods

This is a community-based house-to-house survey conducted from September to November 2020 at the Petaling district in Selangor, Malaysia. Five hundred and four households were identified using random sampling, and heads of eligible households were recruited. Inclusion criteria were age ≥18 years with a monthly household income ≤RM6960 (estimated $1600) without acute psychiatric illness. The PHQ-9, GAD-7 and EQ-5D were used for depression, anxiety, and quality of life, respectively. Multivariable logistic regression was performed for the final analysis.

Results

A total of 432 (85.7%) respondents with a mean age of 43.1 years completed the survey. Mild to severe depression was detected in 29.6%, mild to severe anxiety in 14.7%, and problematic quality of life in 27.8% of respondents. Factors associated with mild to severe depression were younger age, chronic health conditions, past stressful events, lack of communication gadgets and lack of assets or commercial property. While respiratory diseases, marital status, workplace issues, financial constraints, absence of investments, substance use and lack of rental income were associated with mild to severe anxiety. Attributing poverty to structural issues, help-seeking from professionals, and self-stigma were barriers, while resiliency facilitated good psychological health. Problematic quality of life was associated with depression, older age, unemployment, cash shortage, hypertension, diabetes, stressful life events and low health literacy.

Conclusions

A high proportion of the sampled urban poor population reported mild to severe anxiety and depression symptoms. The psychosocial determinants should inform policymakers and shape future work within this underserved population.

Psychological impact of COVID-19: Assessing the COVID-19-related anxiety, individual’s resilience and conspiracy beliefs on attitudes to COVID-19 vaccination

It has been 2 years since the first outbreak of the COVID-19 virus, and continuous efforts and measures have been exerted and implemented to halt its spread, such as the introduction of vaccination programs. However, as with the consumption of other products and services, some people hold different beliefs, consequently affecting their attitudes toward COVID-19 vaccination. Thus, vaccine unwillingness and hesitancy remain an enormous concern for many countries. This paper explores the effects of anxiety, individual resilience, and conspiracy beliefs on attitudes toward COVID-19 vaccines among the population of Malaysia—with a focus on Muslim individuals. We used survey data from 438 respondents (205 male, 233 female) to assess the research model. To conduct the multi-group analysis, we used partial least square structural equation modeling in SmartPLS 3. The results suggest that anxiety is positively associated with COVID-19 vaccination attitudes, whereas conspiracy beliefs have an inverse effect on vaccination attitudes, while an individual’s resilience is also positively associated with vaccination attitudes. Furthermore, it is found that the relationship between conspiracy beliefs and vaccination attitudes is weakened for an individual with a higher level of resilience. The findings also reveal the differences and similarities between males and females. To the best of our knowledge, this study is the first to simultaneously explore and demonstrate the effects of COVID-19-related anxiety, conspiracy beliefs and resilience with people’s attitudes toward COVID-19 vaccines and to examine the homogeneity of both males and females—especially among Malaysia’s Muslim population—thereby offering a valuable contribution to the literature.

Stress, and coping strategy of university students during COVID-19 in Korea: The mediating role of ego-resiliency

We aimed to identify the level of stress, ego-resiliency (ER), and coping strategies of university students during the onset of coronavirus disease 2019 (COVID-19) and examine the mediating role of ER in the relationship between stress and coping strategies (e.g., problem-solving, social support seeking, and avoidance). We analyzed responses from 160 university students and found that problem-solving was the most common coping strategy (26.02 ± 4.65), followed by social support-seeking (25.08 ± 5.23), and avoidance (19.21 ± 3.78). ER was negatively associated with stress and showed a mediating effect on the relationship between stress and social support, and stress and problem-solving coping strategies. These findings indicate that ER helps decrease stress caused by the pandemic among university students and should be considered a significant factor for developing adaptive stress coping strategies.

[Post-COVID syndrome-Focus fatigue]

Die Weltgesundheitsorganisation (WHO) definiert Post-COVID-19(„coronavirus disease 2019“) als Zustand, der bei Personen mit einer anamnestisch wahrscheinlichen oder bestätigten SARS-CoV-2(„severe acute respiratory syndrome coronavirus type 2“)-Infektion 3 Monate nach Beginn der COVID-19-Symptome und mindestens 2 Monate andauernd vorhanden ist und durch eine alternative Diagnose nicht erklärbar ist. Kernsymptome des Post-COVID-Syndroms umfassen Atemnot, Fatigue und kognitive Dysfunktion, welche das alltägliche Funktionsniveau beeinflussen. Neuropsychiatrische Spätfolgen sind bei COVID-19-Patienten mit Inzidenzraten von über 30 % häufig. Neben den genannten Kernsymptomen zeigen Schlafstörungen, Depression und Angsterkrankungen erhöhte Inzidenzen. Nach gegenwärtiger Meinung werden assoziierte neuropsychiatrische Symptome sowohl unter dem Begriff Post-COVID-Syndrom subsumiert, aber auch als Komorbiditäten interpretiert, welche die Manifestation eines Post-COVID-Syndroms begünstigen können. So zeigt das Kernsymptom Fatigue Symptomüberlappung und Komorbidität mit psychischen Erkrankungen. Bildgebungsstudien deuten auf ein organisches Korrelat der Fatigue bei Post-COVID-Patienten hin, darüber hinaus wurden psychosoziale Aspekte und psychiatrische Komorbiditäten wie Depression und Angsterkrankungen als modulierende und damit potenziell behandelbare Faktoren identifiziert. Die Therapie der Fatigue umfasst neben dem pharmakologischen Management mit u. a. Stimulanzien und Antidepressiva auch nichtpharmakologische Strategien, hier vor allem die kognitive Verhaltenstherapie sowie körper- und bewegungsfokussierte Interventionen. Die Evidenz hierfür erwächst aus Metaanalysen bei tumorassoziierter oder postviraler Fatigue.

COVID-19 Pandemic Mental Health Challenges: Patients and Providers

Interviews with 15 Tennessee Advanced Practice Registered Nurses early in the COVID-19 pandemic revealed a major theme of mental health challenges unrelated to the primary study purpose. Without direct prompts, 13 out of 15 interviewees mentioned mental health issues among patients and 14 of the 15 interviewees discussed provider mental health problems. A secondary analysis of interview transcripts revealed three themes associated with mental health challenges: general barriers to mental health care, patient-specific concerns, and provider issues. Responding to the new and worsening mental health and substance use disorders revealed by informants and cited in the literature is an urgent priority.

Post-viral mental health sequelae in infected persons associated with COVID-19 and previous epidemics and pandemics: Systematic review and meta-analysis of prevalence estimates

AIMS

Post-viral mental health problems (MHP) in COVID-19 patients and survivors were anticipated already during early stages of this pandemic. We aimed to synthesize the prevalence of the anxiety, depression, post-traumatic and general distress domain associated with virus epidemics since 2002.

METHODS

In this systematic review and meta-analysis, we searched PubMed, PsycINFO, and Embase from 2002 to April 14, 2021 for peer-reviewed studies reporting prevalence of MHP in adults with laboratory-confirmed or suspected SARS-CoV-1, H1N1, MERS-CoV, H7N9, Ebolavirus, or SARS-CoV-2 infection. We included studies that assessed post-viral MHP with validated and frequently used scales. A three-level random-effects meta-analysis for dependent effect sizes was conducted to account for multiple outcome reporting. We pooled MHP across all domains and separately by severity (above mild or moderate-to-severe) and by acute (one month), ongoing (one to three months), and post-illness stages (longer than three months). A meta-regression was conducted to test for moderating effects, particularly for exploring estimate differences between SARS-Cov-2 and previous pandemics and epidemics. PROSPERO registration: CRD42020194535.

RESULTS

We identified 59 studies including between 14 and 1002 participants and providing 187 prevalence estimates. MHP, in general, decreased from acute to post-illness from 46.3% to 38.8% and for mild and moderate-to-severe from 22.3% to 18.8%, respectively. We found no evidence of moderating effects except for non-random sampling and H1N1 showing higher prevalence. There was a non-significant trend towards lower MHP for SARS-CoV-2 compared to previous epidemics.

CONCLUSIONS

MHP prevalence estimates decreased over time but were still on a substantial level at post-illness. Post-viral mental health problems caused by SARS-CoV-2 could have been expected much earlier, given the previous post-viral sequelae.

Psychological Health and Sleep Quality of Medical Graduates During the Second Wave of COVID-19 Pandemic in Post-epidemic Era

Recently, a COVID-19 virus variant spread rapidly in Guangzhou, China, causing public panic. This study aimed to understand the psychological and sleep-related consequences of the secondary outbreak of the pandemic on medical students. In this cross-sectional survey-based study, participants anonymously completed structured questionnaires online from June 8–22, 2021. We collected participants' demographic and general information. Anxiety, depression, and sleep quality were measured using the Zung Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI), respectively. Protective factors were assessed using the Coping Style Questionnaire (CSQ). Uni- and multivariate logistic regression analyses were performed examining factors associated with mental health and sleep quality problems. During the second wave of the pandemic in local outbreak areas in Guangzhou, China, more than one-third of medical students' mental health and sleep quality were affected. The prevalence of anxiety, depression, and poor sleep quality were 27.54%, 27.58%, and 18.19%, respectively. Students belonging to the Class of 2019, aged over 29 years, those with siblings, and those whose hometowns were in other provinces were more prone to the three health problems. Factors associated with an increased risk of mental health problems were vaccination status (adjusted odds ratio 1.603–1.839) and diet status (adjusted odds ratio 1.62–1.929). Positive coping styles served as protective factors (p < 0.05). We discovered that completed vaccination status, good diet, and positive coping styles were related to good mental health and sleep quality.

Caring for Psychological Distress of Patients With COVID-19: A Mixed-Method Cross-Sectional Study

Introduction

The 2019-2020 pandemic COVID-19 has become a global health crisis. While many recent studies on COVID-19 pandemic have focused on disease epidemiology and psychological status of patients, few have explored the multi-facet influential factors or combined perspectives from both the patients and healthcare workers. The purposes of this study were to: analyze the influencing factors of psychological distress of COVID-19 patients; and describe the experience of healthcare workers relieving psychological distress.

Materials and Methods

This study uses a mixed-method cross-sectional design, including a quantitative study and a qualitative study, targeting two populations: COVID-19 patient and health workers, respectively. In the quantitative part, we recruited a convenience sample of patients with COVID-19 from five hospitals in Wuhan, Hubei Province from 10 to 15 April, 2020. Besides, we collected data by using participants' socio-demographic information sheet, the Connor-Davidson Resilience Scale-10, the Herth Hope Index, the Distress Thermometer, the Revised Chinese Version of Mishel Uncertainty in Illness Scale, and the Chinese Version of Wake Forest Physician Trust Scale. In the qualitative part, the participants were healthcare workers involved in medical aid missions in Hubei Province, China. Meanwhile, we used sampling with convenient and purposive, data collection with a semi-structured online video interview, and text transcription with Colaizzi's phenomenological method.

Results

The results reveal that 25.7% of patients reported higher level of psychological distress (n = 31, scoring ≥4). After controlling the sociodemographic variables, only severity of COVID-19 (β = 0.282, P = 0.025) and uncertainty in illness (β = 0.345, P = 0.007) shown significant effect on psychological distress in the regression model (F = 10.862, R 2 = 0.222, P < 0.001). The experience of healthcare workers emerged five themes: Particularly needed psychological care, Manifestation of negative emotion, Manifestation of proactive adaptation, Strategies relieving psychological distress, and gains of healthcare workers after delivering effective psychological care.

Conclusion

The 25.7% of patients with COVID-19 still suffered from psychological distress, which should receive timely attention from healthcare workers. And the severity of the disease and disease uncertainty have a significant impact on distress. It is critical to train the healthcare workers on detecting the different manifestation of psychological distress, offering timely disease related information, and applying communication strategies.

Relationship Between Adverse Childhood Experiences and Resilience in College Students in China

A great body of literature has documented that adverse childhood experiences (ACEs) are related to individuals' psychological functioning and mental health. However, the majority of ACE studies focus on psychological dysfunction and less is known about how ACEs are associated with other positive psychological outcomes, including resilience. The current study assessed the relationship between ACEs and resilience, using a sample of college students in China. We hypothesized that college students who had ACEs would have lower levels of resilience. Data came from 1,871 college students from twelve colleges in China through an anonymous online survey between late September and early October 2020. Linear regression analyses were conducted. Aligned with our hypotheses, ACEs had a negative association with individuals' resilience. Despite several limitations, this study found a negative association between ACEs and college students' resilience. Preventive services and interventions are in need to protect individuals from ACEs.

Prevalence of depressive and anxiety symptoms among Chinese older adults during the COVID-19 pandemic: A systematic review and meta-analysis

Background: Estimating the prevalence of depressive and anxiety symptoms among older adults with different health conditions can inform mental health services for this population during the corona virus disease-2019 (COVID-19) pandemic. Method: A search of 12 scientific databases identified 17 studies with 11,237 Chinese older adults who were infected by COVID-19, were generally healthy, or had chronic illnesses. Meta-analysis was used to estimate the overall prevalence of depressive and anxiety symptoms in these three groups. Assessment criteria, region, and time phase of the pandemic were tested as sources of heterogeneity. Results: With an average risk of bias score of 6.71 (range = 6-8), the majority of included studies employed appropriate statistical methods, used validated measurement tools, and had adequate response rates; however, they might have deficiencies in sample frame, sampling method, and sample size. Within the COVID-19, general, and chronic illness groups, the prevalence of depressive symptoms was 27%, 26%, and 61%, respectively, and the prevalence of anxiety symptoms was 14%, 23%, and 85%, respectively. Among generally healthy older adults, anxiety was more prevalent during the Phase 2 (March-April 2020) of the pandemic compared with other time phases. Conclusions: The results have implications for addressing the mental health problems of Chinese older adults, especially those with chronic illnesses, during the COVID-19 pandemic.

Associations between COVID-19 related stigma and sleep quality among COVID-19 survivors six months after hospital discharge

BACKGROUND

Many COVID-19 survivors reported stigmatization after recovery. This study investigated the association between stigma (discrimination experiences, self-stigma and perceived affiliate stigma) and sleep quality among COVID-19 survivors six months after hospital discharge.

METHODS

Participants were recovered adult COVID-19 survivors discharged between February 1 and April 30, 2020. Medical staff of five participating hospitals approached all discharged COVID-19 period during this period. A total of 199 participants completed the telephone interview during July to September, 2020. Structural equation modeling was performed to test the hypothesize that resilience and social support would mediate the associations between stigma and sleep quality.

RESULTS

The results showed that 10.1% of the participants reported terrible/poor sleep quality, 26.1% reported worse sleep quality in the past week when comparing their current status versus the time before COVID-19. After adjusting for significant background characteristics, participants who had higher number of discrimination experience, perceived stronger self-stigma and stronger perceived affiliate stigma reported poorer sleep quality. Resilience and social support were positively and significantly associated with sleep quality. The indirect effect of self-stigma on sleep quality through social support and resilience was significant and negative. Perceived affiliate stigma also had a significant and negative indirect effect on sleep quality through social support and resilience.

CONCLUSIONS

Various types of stigma after recovery were associated with poor sleep quality among COVID-19 survivors, while social support and resilience were protective factors. Resilience and social support mediated the associations between self-stigma/perceived affiliate stigma and sleep quality.

Anxiety Levels among Polish and Turkish Dentists during the COVID-19 Pandemic

Working conditions, work-related stressors and high risk of infection, as well as the fear of contagion and spreading the disease to family members, may have influenced dentists' mental health during the COVID-19 pandemic. The aim of this study was to evaluate the anxiety levels among Polish and Turkish dentists during the COVID-19 pandemic and to investigate any relevant predictors. The study was an anonymous online questionnaire-based cross-sectional study that was conducted among dentists from two countries: Poland and Turkey. In total 400 dentists (200 from each country) participated in the study. The survey consisted of two parts: part 1 comprised demographic data, including age, gender, country of origin, COVID-19 infection history, place of work and lockdown history; part 2 was based on the State-Trait Anxiety Inventory (STAI). The mean trait and state anxiety levels of the Polish dentists was statistically significantly lower than that of the Turkish dentists (p = 0.000; p < 0.05). However, Polish dentists had higher state anxiety levels than trait levels, while both types of anxiety among Turkish dentists were almost at the same level. The number of dentists who suffered from COVID-19 was found to be statistically significantly higher in Poland (54%) than in Turkey (16%) (p = 0.000; p < 0.05). The percentage of dentists reporting anxiety was 51% in Poland and 95.5% in Turkey. Polish dentists reported a lower mean anxiety level during the COVID-19 pandemic than the dentists in Turkey but their anxiety levels were more affected by the COVID-19 pandemic as they had a higher difference between their state and trait anxiety levels. The higher coronavirus infection rate and lack of governmental lockdowns of dental practices during the pandemic in Poland compared with those in Turkey may explain the difference in the state and trait anxiety levels.

The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: A critical review across waves

The global public health crisis caused by COVID-19 has lasted longer than many of us would have hoped and expected. With its high uncertainty and limited control, the COVID-19 pandemic has undoubtedly asked a lot from all of us. One important central question is: how resilient have we proved in face of the unprecedented and prolonged coronavirus pandemic? There is a vast and rapidly growing literature that has examined the impact of the pandemic on mental health both on the shorter (2020) and longer (2021) term. This not only concerns pandemic-related effects on resilience in the general population, but also how the pandemic has challenged stress resilience and mental health outcomes across more specific vulnerable population groups: patients with a psychiatric disorder, COVID-19 diagnosed patients, health care workers, children and adolescents, pregnant women, and elderly people. It is challenging to keep up to date with, and interpret, this rapidly increasing scientific literature. In this review, we provide a critical overview on how the COVID-19 pandemic has impacted mental health and how human stress resilience has been shaped by the pandemic on the shorter and longer term. The vast literature is dominated by a wealth of data which are, however, not always of the highest quality and heavily depend on online and self-report surveys. Nevertheless, it appears that we have proven surprisingly resilient over time, with fast recovery from COVID-19 measures. Still, vulnerable groups such as adolescents and health care personnel that have been severely impacted by the COVID-19 pandemic do exist. Large interindividual differences exist, and for future pandemics there is a clear need to comprehensively and integratively assess resilience from the start to provide personalized help and interventions tailored to the specific needs for vulnerable groups.