Responding to mental health needs after terror attacks

Bereaved parents' and siblings' healthcare needs, healthcare utilization, and satisfaction with healthcare services eight years after the 2011 Utøya terror attack

Understanding the healthcare needs of bereaved individuals following terrorism is crucial for organizing healthcare services. This cross-sectional study examined the terror-related healthcare needs, healthcare utilization, and satisfaction with professional healthcare among 122 traumatically bereaved parents and siblings eight years after the 2011 Utøya terrorist attack in Norway. Results showed that over 50% of the participants currently needed help coping with their grief or with mental and somatic symptoms, and only 34% were actively utilizing healthcare related to the terror attack. Furthermore, 68% reported not getting sufficient help, suggesting a treatment gap. One-third rated the professional help and treatment as unsatisfactory, with 28% reporting that they had not received competent help. More somatic and posttraumatic stress symptoms were associated with higher healthcare needs, whilst higher levels of insomnia symptoms were associated with lower healthcare satisfaction. This emphasizes the need to recognize, professionally intervene, and provide competent support for traumatically bereaved individuals.

Lessons of the Boom: A Playbook for Crisis Centers to Prevent, Survive, and Respond to Active Assailants, Targeted Violence, and Mass Violence

Modern crisis centers need to be prepared for mass shootings, active assailant incidents, and related forms of targeted violence. While crisis engagement has traditionally been seen as a "right of boom" or post-incident responder, crisis leaders need to prepare their teams to identify people at risk for violence, use tools like Behavioral Threat Assessment and Management to reduce risk in those persons, and prepare their teams for potential incidents in their community. Evidence suggests that acute stressors are a common proximal risk factor for severe violence implying a potential synergy for using crisis services as a tool for prevention of violence.

Exploring Psychological Consequences of COVID-19 Pandemic on Nurses Caring Patients with COVID-19: A Qualitative Study

Introduction

COVID-19 is a new disease infecting a large number of people, and undoubtedly have psychological impacts on healthcare workers. Among healthcare staff, nurses are the most involved ones in fighting against COVID-19. Therefore, this study aimed to explore nurses' experiences of psychological consequences during caring patients with COVID-19.

Methods

The present qualitative study was conducted using the conventional content analysis approach (Graneheim and Lundman) Iran. Participants in this study included 15 nurses working with patients with COVID-19, selected by purposive sampling. Data were collected using in-depth interviews. The rigor of data was assessed using the criteria proposed by Guba and Lincoln.

Results

Nurses reported the four following psychological consequences of COVID-19 pandemic on caring patients with COVID-19: post-traumatic stress disorder, depression, physical exhaustion, and aggressive behaviors.

Conclusion

The data showed that nurses experienced a variety of psychological consequences during caring patients with COVID-19. Therefore, it is necessary to monitor nurses' psychological problems and implement interventions to improve their mental health.

Impact of long working hours on depressive symptoms among COVID-19 frontline medical staff: The mediation of job burnout and the moderation of family and organizational support

Background

During the COVID-19 pandemic, the frontline medical staff faced more workload and heavier physical and mental stress, which increased their job burnout and negative emotions. However, little is known about the potential factors mediating and moderating these relations. This study investigates the association between long working hours and depressive symptoms among frontline medical staff in China, and explores the potential mediating effect of job burnout, and moderating effect of family and organizational support on these associations.

Methods

Data of 992 frontline medical staff who participated in the prevention and control of COVID-19 was obtained from the online survey conducted in November to December 2021 in China. Depressive symptoms were evaluated using the Patient Health Questionaire-9 (PHQ-9). Moderated mediating model was employed to understand the relationship between long working hours (X), depressive symptoms (Y) mediated through job burnout (M), moderated by family support (W1) and organizational support (W2), while controlling all possible covariates.

Results

56.96% of participants worked more than 8 h per day. 49.8% of them had depressive symptoms (PHQ-9 ≥ 5) and 65.8% experienced job-related burnout. Long working hours was positively associated with depressive symptoms score (β = 0.26, 95% CI:0.13 ~ 0.40). Mediation analyses revealed that job burnout significantly mediated this relationship (indirect effect = 0.17, 95% CI: 0.08 ~ 0.26). Moderated mediation further indicated that both two interactions of social support (family support W1, organizational support W2) and job burnout were negatively related to depressive symptoms among frontline medical staff, indicating that higher social support being less job burnout with lower depressive symptoms.

Conclusion

Longer working hours and higher job burnout may contribute to worse mental health among frontline medical staff. Social support could buffer the detrimental effects by reducing their job burnout.

Contribution

The main contribution of this study was to estimate the negative effect of long working hours on depressive symptoms among frontline medical staff and explore the potential mediating role of job burnout and moderating role of social support on these associations.

Impacts of the COVID-19 Pandemic on Anxiety and Depressive Symptoms in Pregnant Women and Related Perinatal Outcomes

To evaluate the impacts of the COVID-19 pandemic on anxiety and depression symptoms in pregnant women and their relationship with pregnancy outcomes, 1087 pregnant women completed online questionnaires. Anxiety symptoms were measured using the Self-Rating Anxiety Scale (SAS). Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS), and the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Univariate analysis and logistic regression analysis were used to determine the association between depression and anxiety symptoms, participants’ characteristics, and pregnancy outcomes. Of the 986 pregnant women who were included in this study, the rates of anxiety symptoms and depressive tendencies were 13.4% and 18.3%, respectively. Sleep disorder ((Adjusted odds ratio, AOR = 4.166; 95% confidence interval, CI: 2.797−6.205), time spent paying attention to the epidemic per day (≥1 h/d AOR = 1.568; 95% CI: 1.052−2.338), and the time spent with their spouses (Increase AOR = 0.629; 95% CI: 0.409−0.967) were associated with the risk of anxiety. Sleep disorder (AOR = 3.839; 95% CI: 2.718−5.432) and educational level (bachelor’s degree or above AOR = 1.833; 95% CI: 1.004−3.345) were associated with the risk of depression. Psychological status was not correlated with the pregnancy outcomes (p > 0.05). Anxiety and depression symptoms were common among pregnant women during the COVID-19 pandemic. Special attention should be paid to manage their risk factors.

Mental health in Italy after two years of COVID-19 from the perspective of 1281 Italian physicians: looking back to plan forward

BACKGROUND

The COVID-19 pandemic has generated an unprecedented global crisis that is profoundly affecting mental health and mental health care. The aim of this study was to survey a relatively large group of Italian physicians about their perceived impact of COVID-19 on the mental health of the Italian population and about their suggestions on the best strategies to address the current and future challenges.

METHODS

One thousand two hundred eighty-one (1,281) physicians were surveyed between November 2021 and February 2022.

RESULTS

Eighty-one percent of respondents reported an increase in the number of people with mental illness presenting to their practice during the COVID-19 pandemic. Thirty-four percent reported a 26-50% increase in the number of people with mental illness in their community; approximately 33% reported a 1-25% increase; and 26.9% reported a 51-75% increase. The most commonly reported mental issues that increased because of COVID-19 were agitation, mood and anxiety disorders. Regarding the suggested strategies to address future challenges related to the COVID-19 pandemic, 34.6% of respondents recommended providing psychoeducation to the general population for early detection of mental illness and developing strategies to reduce the impact of COVID-19-related stress. In addition, 12.6% of respondents suggested improving telehealth services, while 12.3% suggested the need for increased funding for community-based care. When asked about physicians' opinion on the possibility of an increased prevalence of mental illness in the next 12 months, more than 30% of them predicted an increase in stress-related illnesses, while 25.2% were more concerned about a worsening of the ongoing clinical conditions of patients with previous psychiatric disorders. However, 21% of respondents believed that people's ability to cope with the pandemic would increase in the next 12 months.

CONCLUSIONS

This study confirmed a strong and negative impact on the mental health of the past 2 years of COVID-19 pandemic in the Italian population. Providing psychoeducation to the general population and improving the availability of telemedicine services could reduce the impact of future challenges related to the pandemic.

Survivors' experiences of informal social support in coping and recovering after the 2017 Manchester Arena bombing

BACKGROUND

Much of the psychosocial care people receive after major incidents and disasters is informal and is provided by families, friends, peer groups and wider social networks. Terrorist attacks have increased in recent years. Therefore, there is a need to better understand and facilitate the informal social support given to survivors.

AIMS

We addressed three questions. First, what is the nature of any informal support-seeking and provision for people who experienced the 2017 Manchester Arena terrorist attack? Second, who provided support, and what makes it helpful? Third, to what extent do support groups based on shared experience of the attack operate as springboards to recovery?

METHOD

Semi-structured interviews were carried out with a purposive sample of 18 physically non-injured survivors of the Manchester Arena bombing, registered at the NHS Manchester Resilience Hub. Interview transcripts were thematically analysed.

RESULTS

Participants often felt constrained from sharing their feelings with friends and families, who were perceived as unable to understand their experiences. They described a variety of forms of helpful informal social support, including social validation, which was a feature of support provided by others based on shared experience. For many participants, accessing groups based on shared experience was an important factor in their coping and recovery, and was a springboard to personal growth.

CONCLUSIONS

We recommend that people who respond to survivors' psychosocial and mental healthcare needs after emergencies and major incidents should facilitate interventions for survivors and their social networks that maximise the benefits of shared experience and social validation.

Three Mental Health Symptoms of Frontline Medical Staff Associated With Occupational Stressors During the COVID-19 Peak Outbreak in China: The Mediation of Perceived Stress and the Moderation of Social Support

The outbreak of COVID-19 epidemic has increased work demands for medical staff and has a certain impact on their mental health. The present study aimed to examine the role of perceived stress and social support in explaining the association between the occupational stressors and three mental health symptoms (i.e., anxiety, depression, and insomnia) of frontline medical staff. Five hundred twenty five frontline medical staff were investigated online after the outbreak of the COVID-19 (16 February, 2020-2 March, 2020) in China. The results found that the prevalence of anxiety, depression, and insomnia among frontline medical staff were 39.8, 29.9, and 37.9%, respectively. Occupational stressors were associated with anxiety, depression, and insomnia symptoms. Perceived stress significantly mediated this link. Social support moderated the second half of the indirect effect of occupational stressors on anxiety and depression symptoms. Under the epidemic situation of COVID-19, for frontline medical staff, high perceived stress and low social support may increase vulnerability for mental health symptoms triggered by occupational stressors. Thus, improving the social support and promoting the cognitive reappraisal of perceived stress may help to maintain mental health among medical staff.

Psychosocial care responses to terrorist attacks: a country case study of Norway, France and Belgium

Background

The international terrorism threat urges societies to invest in the planning and organization of psychosocial care. With the aim to contribute to cross-national learning, this study describes the content, target populations and providers of psychosocial care to civilians after terrorist attacks in Norway, France and Belgium.

Methods

We identified and reviewed pre- and post-attack policy documents, guidelines, reports and other relevant grey literature addressing the psychosocial care response to terrorist attacks in Oslo/Utøya, Norway on 22 July 2011; in Paris, France on 13 November 2015; and in Brussels, Belgium on 22 March 2016.

Results

In Norway, there was a primary care based approach with multidisciplinary crisis teams in the local municipalities. In response to the terrorist attacks, there were proactive follow-up programs within primary care and occupational health services with screenings of target groups throughout a year. In France, there was a national network of specialized emergency psychosocial units primarily consisting of psychiatrists, psychologists and psychiatric nurses organized by the regional health agencies. They provided psychological support the first month including guidance for long-term healthcare, but there were no systematic screening programs after the acute phase. In Belgium, there were psychosocial intervention networks in the local municipalities, yet the acute psychosocial care was coordinated at a federal level. A reception centre was organized to provide acute psychosocial care, but there were no reported public long-term psychosocial care initiatives in response to the attacks.

Conclusions

Psychosocial care responses, especially long-term follow-up activities, differed substantially between countries. Models for registration of affected individuals, monitoring of their health and continuous evaluation of countries’ psychosocial care provision incorporated in international guidelines may strengthen public health responses to mass-casualty incidents.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07691-2.

Prevalence of Burnout, Depression, Anxiety, Stress, and Hopelessness Among Healthcare Workers in COVID-19 Pandemic in Turkey

BACKGROUND

This study's aim was to reveal the burnout, depression, anxiety, stress, and hopelessness levels of HCWs in the pandemic period.

METHODS

The cross-sectional study was carried out with 1015 HCWs, between September 1 and October 1, 2021, in Turkey. Maslach Burnout Inventory, Beck Hopelessness Scale, and Depression Anxiety Stress Scale-21 (DASS-21) were used.

RESULTS

Of the HCWs, 56.7% had moderate/high emotional exhaustion (EE), 35.8% had moderate/high depersonalization (D), 58.0% had low personal accomplishment (PA), 34.9% had high depression, 31.9% had high anxiety, 15.4% had high stress, and 33.3% had moderate/severe hopelessness. Risk factors for EE were working in a public hospital, increased workload intensity, decreased income, and difficulty in procuring personal protective equipment (PPE). Risk factors for D were having a male gender, being under the age of 40, being a physician, working in a public hospital, and difficulty in procuring PPE. Risk factors for depression were being under the age of 40, having contact with COVID-19 patients, and decreased income. Risk factors for anxiety were having a female gender, being under the age of 40, working in a public hospital, having a chronic disease, having contact with COVID-19 patients, and having individuals at high risk for COVID-19 at home. Risk factors for hopelessness were having a female gender, being a physician, and increased income.

CONCLUSION

The negative effects of the pandemic, which has been going on for over a year and a half, on the mental health of HCWs were high.

Anticipating PTSD in severe COVID survivors: the case for screen-and-treat

Based on research from previous pandemics, studies of critical care survivors, and emerging COVID-19 data, we estimate that up to 30% of survivors of severe COVID will develop PTSD. PTSD is frequently undetected across primary and secondary care settings and the psychological needs of survivors may be overshadowed by a focus on physical recovery. Delayed PTSD diagnosis is associated with poor outcomes. There is a clear case for survivors of severe COVID to be systematically screened for PTSD, and those that develop PTSD should receive timely access to evidence-based treatment for PTSD and other mental health problems by multidisciplinary teams.

Nurses' experiences during the COVID-19 pandemic in Iran: a qualitative study

BACKGROUND

Nurses are at the forefront of patient care during infectious disease pandemics and they play a key role in treating and preventing the upward trend of the disease. Hence, it is crucial to consider their experiences in designing action plans to combat coronavirus disease 2019 (COVID-19). Since there is not enough data in this regard, the current study aimed to investigate the nurses' experiences in caring for patients with COVID-19 in Iran.

METHODS

In this descriptive qualitative study, a total of 20 nurses were selected by purposive sampling. Semi-structured interviews were conducted and analyzed using qualitative content analysis to collect data.

RESULTS

Data analysis revealed four main themes, including 'duality in the form of care,' 'confusion and ambiguity in care planning', 'workload', and 'social isolation in spite of positive image.'

CONCLUSION

Our findings indicated that the nurses experienced a range of paradoxes during the COVID-19 pandemic; these paradoxes included distraction from providing care due to focus on marginal factors in spite of empathy and cooperation in nurses, the presence of volunteer support staff despite the lack of equipment, lack of scientific information and the unreliability of online information, overload in the hospital due to insufficient facilities and equipment, and the physical avoidance of people in the community in spite of social support for nurses in the media. The results of this study can lead to a clear understanding for managers and healthcare policymakers in the country and aid them in taking optimal measures to support nurses and improve the quality of nursing care against COVID-19.

Association between perceived stress and depression among medical students during the outbreak of COVID-19: The mediating role of insomnia

BACKGROUND

The purpose of this study was to explore the association between perceived stress and depression among medical students and the mediating role of insomnia in this relationship during the COVID-19 pandemic in China.

METHODS

A cross-sectional survey was conducted from March to April 2020 in medical university. Levels of perceived stress, insomnia and depression were measured using Perceived Stress Scale (PSS), Insomnia Severity Index (ISI) and Patient Health Questionnaire 9 (PHQ-9). The descriptive analyses of the demographic characteristics and correlation analyses of the three variables were calculated. The significance of the mediation effect was obtained using a bootstrap approach with SPSS PROCESS macro.

RESULTS

The mean age of medical students was 21.46 years (SD=2.50). Of these medical students, 10,185 (34.3%) were male and 19,478 (65.7%) were female. Perceived stress was significantly associated with depression (β=0.513, P < 0.001). Insomnia mediated the association between perceived stress and depression (β=0.513, P < 0.001). The results of the non-parametric bootstrapping method confirmed the significance of the indirect effect of perceived stress through insomnia (95% bootstrap CI =0.137, 0.149). The indirect effect of insomnia accounted for 44.13% of the total variance in depression.

CONCLUSIONS

These findings contribute to a better understanding of the interactive mechanisms underlying perceived stress and depression, and elucidating the mediating effects of insomnia on the association. This research provides a useful theoretical and methodological approach for prevention of depression in medical students. Findings from this study indicated that it may be effective to reduce depression among medical students by improving sleep quality and easing perceived stress.

A qualitative evaluation of Southwark Council's public health response to mitigating the mental health impact of the 2017 London bridge and borough market terror attack

BACKGROUND

Over recent years there have been several major terror attacks in cities across Europe. These attacks result in deaths, physical injuries, and pose long-term threats to mental health and wellbeing of large populations. Although psychologists have completed important work on mental health responses to disaster exposure including terrorist attacks, the mental health impacts of such attacks have been comparatively less examined in academic literature than the acute health response to physical injuries. This paper reflects on Southwark Council's pioneering public mental health response to the June 2017 terror attack at London Bridge and Borough Market. It aims to explore perceptions of the mental health impact of the incident by those living and working in the borough.

METHODS

A rapid qualitative evaluation informed by the logic underpinning Southwark Council's response was conducted. Seven formative interviews were undertaken with individuals involved in the response planning and/or delivery, enabling the evaluation team to establish the response's theoretical basis. Subsequently, nineteen semi-structured interviews with consenting Council employees, residents, business owners, and workers from the Borough were conducted to understand perceived mental health impacts of the attack and the success of the Council response. Thematic analysis of transcribed interviews was undertaken to evaluate the extent to which the response was implemented successfully.

RESULTS

Participants reported feeling the attack had a wide-reaching negative impact on the mental health of residents, those working in the borough and visitors who witnessed the attack. Delivering the response was a challenge and response visibility within the community was limited. Participants suggested a comprehensive systematic approach to health needs assessment informed by knowledge and relationships of key Council workers and community stakeholders is imperative when responding to terrorist incidents. Improved communication and working relationships between statutory organisations and community stakeholders would ensure community groups are better supported. Prioritising mental health needs of terror attack responders to mitigate persisting negative impacts was highlighted.

CONCLUSIONS

This article highlights a potential public health approach and need for developing robust practical guidance in the aftermath of terror attacks. This approach has already influenced the response to the Christchurch mosque shooting in 2019.

Work-Related Stress and Anxiety Among Frontline Nurses During the COVID-19 Pandemic: A Cross-Sectional Study

The coronavirus disease 2019 (COVID-19) pandemic has strained the health system worldwide. Nurses caring for patients with COVID-19 reported experiencing significant work-related stress and anxiety. The current online descriptive cross-sectional correlational study aimed to investigate work-related stress and anxiety among nurses caring for patients with COVID-19. Data were collected from 240 nurses using the Stress Overload Scale and Self-Rated Anxiety Scale. Average stress and anxiety scores were 34.96 (SD = 5.85) and 52.8 (SD = 5.48), respectively. Statistically significant differences were found in mean stress overload and anxiety scores based on gender, professional title, average working hours per week, working area, and presence of fear of being infected with COVID-19. These findings suggest the need to promote well-being in nurses and assist nurses and other health care workers experiencing mental and psychological health problems in the context of the COVID-19 pandemic. [Journal of Psychosocial Nursing and Mental Health Services, 59(8), 31-42.].

History of contact with the SARS-COV-2 virus and the sense of coherence in the development of psychological distress in the occupational health professionals in Spain

The COVID-19 pandemic has affected the psychological well-being of healthcare professionals, among them, on medical and nursing occupational specialists. This study describes the psychological distress that this group has suffered, analyzing the effect that the sense of coherence related with the history of contact with infected people has generated in their mental health. Cross-sectional descriptive study using online questionnaires. Data were collected on a sample of 499 subjects, representing 42.0% and 38.8% of the associations of specialists in Occupational Medicine and Nursing, respectively. A univariate data analysis, independence test, and the CHAID multivariate method were carried out. The percentage of workers with high psychological distress was higher among women than among men; this was also higher in public sector workers than in the private sector. No differences have been observed regarding psychological distress and educational level, coexistence, having children, working away from home, having a pet, or between being a physician or nurse. The most efficient measure to prevent psychological distress was acting regarding the comprehensibility dimension of the sense of coherence. Sex, contact with any infected person, age, living as a couple, working in public or private centers, the availability of diagnostic tests, and the correlation with the manageability dimension were modulating factors. Sense of coherence is an effective measure to prevent psychological distress due to contact with people affected by COVID-19 in Occupational Health professionals.

Meaningful activities during COVID-19 lockdown and association with mental health in Belgian adults

BACKGROUND

The spread of COVID-19 has affected people's daily lives, and the lockdown may have led to a disruption of daily activities and a decrease of people's mental health.

AIM

To identify correlates of adults' mental health during the COVID-19 lockdown in Belgium and to assess the role of meaningful activities in particular.

METHODS

A cross-sectional web survey for assessing mental health (General Health Questionnaire), resilience (Connor-Davidson Resilience Scale), meaning in activities (Engagement in Meaningful Activities Survey), and demographics was conducted during the first Belgian lockdown between April 24 and May 4, 2020. The lockdown consisted of closing schools, non-essential shops, and recreational settings, employees worked from home or were technically unemployed, and it was forbidden to undertake social activities. Every adult who had access to the internet and lived in Belgium could participate in the survey; respondents were recruited online through social media and e-mails. Hierarchical linear regression was used to identify key correlates.

RESULTS

Participants (N = 1781) reported low mental health (M = 14.85/36). In total, 42.4% of the variance in mental health could be explained by variables such as gender, having children, living space, marital status, health condition, and resilience (β = -.33). Loss of meaningful activities was strongly related to mental health (β = -.36) and explained 9% incremental variance (R2 change = .092, p < .001) above control variables.

CONCLUSIONS

The extent of performing meaningful activities during the COVID-19 lockdown in Belgium was positively related to adults' mental health. Insights from this study can be taken into account during future lockdown measures in case of pandemics.

Exploring nurses' experiences of psychological distress during care of patients with COVID-19: a qualitative study

BACKGROUND

COVID-19 infection is a new disease that infects a large number of people, killing a ratio of whom every day in the world. Healthcare staff, especially nurses, experience a great deal of psychological distress during care of COVID-19 patients. Detecting factors that disturb nurses' mental health during care of these patients can help to reduce their psychological distress. Therefore, this study aimed to explore nurses' experiences of psychological distress during care of patients with COVID-19.

METHODS

The present qualitative research was performed using the conventional content analysis method in Iran from March to May 2020. Participants in this study included the nurses caring for patients with COVID-19, and they were selected based on the purposeful sampling method. The data was collected through 20 phone call interviews and analyzed based on the method proposed by Lundman and Graneheim.

RESULTS

Qualitative data analysis revealed 11 categories including death anxiety, anxiety due to the nature of the disease, anxiety caused by corpse burial, fear of infecting the family, distress about time wasting, emotional distress of delivering bad news, fear of being contaminated, the emergence of obsessive thoughts, the bad feeling of wearing personal protective equipment, conflict between fear and conscience, and the public ignorance of preventive measures.

CONCLUSION

The data showed that the nurses experienced a variety of psychological distress during care of patients with COVID-19. Through proper planning by authorities, it is possible to manage the risk factors of mental health distress in nurses and improve their mental health status.

The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public - A systematic review and meta-analysis

The coronavirus disease 2019 (COVID-19) pandemic has caused enormous psychological impact worldwide. We conducted a systematic review and meta-analysis on the psychological and mental impact of COVID-19 among healthcare workers, the general population, and patients with higher COVID-19 risk published between 1 Nov 2019 to 25 May 2020. We conducted literature research using Embase, PubMed, Google scholar and WHO COVID-19 databases. Among the initial search of 9207 studies, 62 studies with 162,639 participants from 17 countries were included in the review. The pooled prevalence of anxiety and depression was 33% (95% confidence interval: 28%-38%) and 28% (23%-32%), respectively. The prevalence of anxiety and depression was the highest among patients with pre-existing conditions and COVID-19 infection (56% [39%-73%] and 55% [48%-62%]), and it was similar between healthcare workers and the general public. Studies from China, Italy, Turkey, Spain and Iran reported higher-than-pooled prevalence among healthcare workers and the general public. Common risk factors included being women, being nurses, having lower socioeconomic status, having high risks of contracting COVID-19, and social isolation. Protective factors included having sufficient medical resources, up-to-date and accurate information, and taking precautionary measures. In conclusion, psychological interventions targeting high-risk populations with heavy psychological distress are in urgent need.

Emotional and Cognitive Responses and Behavioral Coping of Chinese Medical Workers and General Population during the Pandemic of COVID-19

BACKGROUND

The outbreak of Corona Virus Disease 2019 (COVID-19) might affect the psychological health of population, especially medical workers. We aimed to investigate the impact of the COVID-19 pandemic on emotional and cognitive responses and behavioral coping among Chinese residents.

METHODS

An online investigation was run from 5 February to 25 February 2020, which recruited a total of 616 Chinese residents. Self-designed questionnaires were used to collect demographic information, epidemic knowledge and prevention of COVID-19 and characteristics of medical workers. The emotional and cognitive responses were assessed via the Symptom Check List-30 (SCL-30) and Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Behavioral coping was assessed via Simplified Coping Style Questionnaire (SCSQ).

RESULTS

In total, 131 (21.3%) medical workers and 485 (78.7%) members of the general public completed the structured online survey. The structural equation models showed that emotional response interacted with cognitive response, and both emotional response and cognitive response affected the behavioral coping. Multivariate regression showed that positive coping enhanced emotional and cognitive responses, while negative coping reduced emotional and cognitive responses. The emotional response (depression, anxiety and photic anxiety) scores of the participants were higher than the norm (all p < 0.001); in particular, the panic scores of members of the general public were higher than those of medical workers (p < 0.05), as well as the cognitive response (paranoia and compulsion). Both positive and negative coping scores of the participants were lower than the norm (p < 0.001), and the general public had higher negative coping than medical workers (p < 0.05).

CONCLUSION

During the preliminary stage of COVID-19, our study confirmed the significance of emotional and cognitive responses, which were associated with behavioral coping and significantly influenced the medical workers and the general public's cognition and level of public health emergency preparedness. These results emphasize the importance of psychological health at times of widespread crisis.

Child and adolescent mental health amidst emergencies and disasters

The mental health of children and young people can be disproportionally affected and easily overlooked in the context of emergencies and disasters. Child and adolescent mental health services can contribute greatly to emergency preparedness, resilience and response and, ultimately, mitigate harmful effects on the most vulnerable members of society.

Different Trajectories of Prolonged Grief in Bereaved Family Members After Terror

Introduction: The loss of a loved one in a terror incident is associated with elevated risk for mental health disorders such as prolonged grief disorder (PGD) and posttraumatic stress disorder (PTSD), but the long- term adaptation after such losses are not well understood. This study aims to explore the trajectories of PGD among parents and siblings (n = 129) after the 2011 terror attack on Utøya Island, Norway. Methods: The 19-item Inventory of Complicated grief (ICG) was used to measure PGD at 18, 28, and 40 months post-loss. Latent class growth analysis (LCGA) was used to identify trajectories of grief and a multinomial regression analysis was conducted to examine predictors of class membership. Results: The analysis identified three grief trajectories; moderate/decreasing class (23%), high/slow decreasing class (64%), and a high/chronic class (13%). Predictors of high/slow recovery or chronic grief was female gender, previous depressive symptoms, and intrusion and avoidance symptoms. Conclusion: The findings highlights the difficult grief process and slow recovery that characterizes the majority of close family members bereaved by a terror-incident. Community mental health programs should strive for both early outreach and long-term follow-up after such incidents.