Avoidance behaviors and negative psychological responses in the general population in the initial stage of the H1N1 pandemic in Hong Kong

Don't say it's over: The perceived epidemic stage and COVID preventive behaviour

Little is known about the perceptions of the COVID-19 pandemic's dynamic and its effect on self-protective behaviour. Using survey data from 1343 university students we explored how the perceived temporal distance to the COVID pandemic peak associates with risk perception and the adherence of preventive behaviours. Results show that individuals differ in their perception of the pandemic stage despite being in the same environment. The belief that the COVID peak is in the past was associated with less perceived risk and decreased self-protection. A high COVID-19 media involvement and trust in the authorities were associated with higher perceived risk and preventive behaviour implementation. Overall, the perception that the pandemic wave is in its final stages could be an independent predictor of more risky behaviour. Thus, the communication of the pandemic dynamic should be provided by policy makers with caution to avoid the possibility of discounting the risk.

Risk Perception and Maternal Prenatal Depressive Symptoms in the Early Stage of COVID-19 Pandemic in China: Role of Negative Emotions and Family Sense of Coherence

BACKGROUND

Prenatal depression is associated with adverse health outcomes for both mothers and their children. The worldwide COVID-19 pandemic has presented new risks and challenges for expectant mothers. The aims of the study were to investigate the underlying mechanism between COVID-19 risk perception of Chinese pregnant women and their prenatal depressive symptoms and potential protective factors such as family sense of coherence (FSOC).

METHOD

A total of 181 Chinese pregnant women (Mage = 31.40 years, SD = 3.67, ranged from 23 to 43) participated in an online survey from April 22 to May 16, 2020. Risk perception and negative emotions (fear and anxiety) related with COVID-19, FSOC, and prenatal depressive symptoms were assessed.

RESULTS

The experience of maternal COVID-19 related negative emotion fully mediated the positive relationship between COVID-19 risk perception and prenatal depressive symptoms of pregnant women (β = 0.12, 95% CI [0.06, 0.19]). When confronting COVID-19 related fear and anxiety, expectant mothers from higher coherent families experienced a significantly lower level of prenatal depressive symptoms.

CONCLUSIONS

Contextual negative emotional experience was demonstrated to explain how risk perception impacts depressive symptoms during severe public health crisis for pregnant women. FSOC may be a psychological resource protecting pregnant women from experiencing adverse psychological outcomes during COVID-19 pandemic.

Predictors of fear of COVID-19 in a low-income country: health literacy is important

Introduction

Excessive fear of a threatening condition or situation can result in individuals engaging in unhealthy behaviors, especially during the COVID-19 pandemic. Identifying the influential factors of fear can be effective in designing and implementing health-center interventions to control and reduce the COVID-19 pandemic.

Methods

This study was a cross-sectional design implemented in Iran in 2022. Participants were adults 18-65 years of age recruited randomly from primary Health Care Services Centers (HCSCs) by medical records (n = 380, 64.7% female, mean (SD) age 32.14 ± 10.98 years) in urban and rural areas of the county. The data collection included a demographic form, Fear of COVID-19 questionnaire, Perceived Barriers of COVID-19 preventive behaviors, Self-efficacy, and Health Literacy for Iranian Adults (HELIA) questionnaire.

Results

It was determined that the fear of COVID-19 showed statistically significant differences according to gender (p-value = 0.013), education level (p-value = 0.001), and job status (p-value = 0.001). According to the hierarchical linear regression, educational level (p-value = 0.001; β = 0.665), job (β = 0.126; p-value = 0.018), self-efficacy (p-value = 0.015; β = 0.103), and Health Literacy (HL) (p-value = 0.001; β = 0.446) were significant predictors of fear of COVID-19. Also, among variables, educational level (p-value = 0.001; β = 0.665) and HL (p-value = 0.001; β = 0.446) were the most important predictors for fear of COVID-19.

Discussion

This research shows that HL has a potential and determinative role in controlling fear of COVID-19. The findings can help healthy policymakers and healthcare providers design HL-based programs in similar epidemics and pandemic situations.

A Complex Interplay: Navigating the Crossroads of Tobacco Use, Cardiovascular Disease, and the COVID-19 Pandemic: A WHF Policy Brief

The Coronavirus Disease 2019, commonly referred to as COVID-19, is responsible for one of the deadliest pandemics in human history. The direct, indirect and lasting repercussions of the COVID-19 pandemic on individuals and public health, as well as health systems can still be observed, even today. In the midst of the initial chaos, the role of tobacco as a prognostic factor for unfavourable COVID-19 outcomes was largely neglected. As of 2023, numerous studies have confirmed that use of tobacco, a leading risk factor for cardiovascular and other diseases, is strongly associated with increased risks of severe COVID-19 complications (e.g., hospitalisation, ICU admission, need for mechanical ventilation, long COVID, etc.) and deaths from COVID-19. In addition, evidence suggests that COVID-19 directly affects multiple organs beyond the respiratory system, disproportionately impacting individuals with comorbidities. Notably, people living with cardiovascular disease are more prone to experiencing worse outcomes, as COVID-19 often inherently manifests as thrombotic cardiovascular complications. As such, the triad of tobacco, COVID-19 and cardiovascular disease constitutes a dangerous cocktail. The lockdowns and social distancing measures imposed by governments have also had adverse effects on our lifestyles (e.g., shifts in diets, physical activity, tobacco consumption patterns, etc.) and mental well-being, all of which affect cardiovascular health. In particular, vulnerable populations are especially susceptible to tobacco use, cardiovascular disease and the psychological fallout from the pandemic. Therefore, national pandemic responses need to consider health equity as well as the social determinants of health. The pandemic has also had catastrophic impacts on many health systems, bringing some to the brink of collapse. As a result, many health services, such as services for cardiovascular disease or tobacco cessation, were severely disrupted due to fears of transmission and redirection of resources for COVID-19 care. Unfortunately, the return to pre-pandemic levels of cardiovascular disease care activity has stagnated. Nevertheless, digital solutions, such as telemedicine and apps, have flourished, and may help reduce the gaps. Advancing tobacco control was especially challenging due to interference from the tobacco industry. The industry exploited lingering uncertainties to propagate misleading information on tobacco and COVID-19 in order to promote its products. Regrettably, the links between tobacco use and risk of SARS-CoV-2 infection remain inconclusive. However, a robust body of evidence has, since then, demonstrated that tobacco use is associated with more severe COVID-19 illness and complications. Additionally, the tobacco industry also repeatedly attempted to forge partnerships with governments under the guise of corporate social responsibility. The implementation of the WHO Framework Convention on Tobacco Control could address many of the aforementioned challenges and alleviate the burden of tobacco, COVID-19, and cardiovascular disease. In particular, the implementation of Article 5.3 could protect public health policies from the vested interests of the industry. The world can learn from the COVID-19 pandemic to better prepare for future health emergencies of international concern. In light of the impact of tobacco on the COVID-19 pandemic, it is imperative that tobacco control remains a central component in pandemic preparedness and response plans.

Improvements in mental health associated with increased electronic communication and deterioration in physical health in adults aged 50+ during the COVID-19 pandemic

Background

Previous studies have documented changes in physical health, mental health and social parameters during COVID-19. At the same time, there are no comprehensive analyses of these parameters designed as longitudinal studies on large-scale older populations before and during the pandemic.

Objective

This longitudinal study aims to provide a quantitative analysis of the COVID-19 impact on the physical, mental, and social parameters in adults aged 50 and older before, in the early stages, and during the COVID-19 pandemic.

Methods

The data for this study were collected from three waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), a supranational longitudinal database: pre-COVID (October 2019-March 2020), early-COVID (June-September 2020), and during-COVID (June-August 2021). The sample included 31,526 individuals, compared across the three-time points through nonparametric group comparison tests.

Results

Physical health was subjectively rated as poorer in the during-COVID wave compared to the pre-COVID wave. Additionally, the number of illnesses or health conditions reported in the during-COVID wave was significantly higher than in the pre-COVID wave, with the biggest increases registered for cardiovascular diseases. The results also show that employment and overall social contact decreased while loneliness increased over time. Unexpectedly, mental health issues, such as sadness or depression and trouble sleeping, decreased significantly in the COVID waves compared to the pre-COVID wave. The analysis of two additional pre-COVID waves (2015, 2017) revealed that poorer pre-COVID mental health reflected in high values of sadness or depression and trouble sleeping was not an isolated peak but represented a typical baseline. The positive influence on the individuals' mental health during COVID-19 was found to be electronic communication, which showed higher values than face-to-face communication and lowered the odds of sadness or depression.

Conclusion

Future policies should thus consider the positive impact of electronic contacts on mental health to promote overall health in adults aged 50 and older.

Psychological Responses of Chinese Medical Students to the COVID-19 Pandemic: Empirical Research Qualitative

Aim

This study aims to explore the psychological reactions of medical students during the pandemic.

Design

A qualitative study.

Methods

A purposive sampling technique was employed, and a qualitative approach was adopted. Semi-structured questionnaires were utilized, and online interviews were conducted. Forty medical students were selected as participants for the interviews. The interview data were analyzed using Colaizzi's seven-step analysis method.

Results

The study identified five themes related to the psychological reactions of medical students during the pandemic. Firstly, COVID-19's influence on medical careers was characterized by increased interest and determination in pursuing medical professions, heightened admiration for frontline workers, reinforced commitment to a medical career due to the pandemic, and recognition of the significance of medical education. Secondly, challenges and concerns in medical career pursuit were identified, including negative sentiments towards medical careers during COVID-19 and hesitations and concerns about entering the medical field amidst the pandemic. Thirdly, the impact on mental well-being encompassed diverse anxieties expressed by participants regarding control, transmission, treatment, and intentional spreading of the virus. Participants experienced an emotional progression from calmness to fear and anxiety, with heightened anxiety when relatives or acquaintances contracted COVID-19. Academic delays also contributed to anxiety among medical students. Fourthly, changes in behaviors and mindset were observed, including altered behaviors and mindset in response to the pandemic, as well as increased attention to personal hygiene and disease prevention measures. Lastly, expectations of medical students from government, public, and parents were explored.

Conclusion

Understanding the psychological reactions of medical students during public health emergencies is crucial for their well-being and professional development. The findings have implications for medical education and the development of strategies to enhance the psychological well-being of medical students during similar crises.

Changes of college students' psychological stress during the COVID-19 pandemic in China: A two-wave repeated survey

COVID-19 has posed unprecedented challenges to the mental health of college students worldwide. We examined the trends in students' stress levels during and after China's first wave of COVID-19 outbreaks by analyzing their demographics, behavior, mental health status, career confidence, and Chinese Perceived Stress Scale (CPSS) scores. Our findings indicate an increase in students' stress levels since the COVID-19 onset, with more students experiencing higher stress levels after the first outbreak than during it (OR = 2.03, 95% CI 1.79, 2.30). Several factors were identified as being associated with higher CPSS scores, including higher class levels, residence in rural or town areas, low family income, and lack of familiarity with COVID-19, among others. Our study highlighted the urgency of developing and implementing effective strategies to cope with students' stress during and after a global pandemic.

Rumination and Gender in the Relation Between Perceived Threat and State Anxiety During COVID-19

OBJECTIVES

Perception of and subsequent responses to counter threats by disease, such as COVID-19, are essential for engagement in self-protective behaviors. But, associated increases in anxiety that accompany the threat of disease may negatively impact well-being. Therefore, identifying variables that may modulate the association between perceived threat from COVID-19 and anxiety is important. We conducted a study to examine the moderating roles of two subtypes of rumination (brooding and reflection) in the association between perceived threat from COVID-19 and state anxiety. Additionally, as both COVID-19 outcomes and the tendency to ruminate differ across genders, we explored gender as a second moderator.

METHODS

Participants (N = 300; Men = 144) were recruited online in April 2020 and completed measures of state anxiety, brooding and reflective rumination, and perceived threat from COVID-19.

RESULTS

Moderation regression analyses revealed that perceived threat and brooding were independently associated with increased state anxiety. Reflective rumination and gender, however, significantly moderated the relation between perceived threat and state anxiety. For men, reflective rumination strengthened the association between threat and anxiety. For women, reflective rumination weakened this association; women with the highest scores in reflective rumination also reported high state anxiety at low, medium, and high perceived threat levels.

CONCLUSIONS

These findings illuminate gender differences in the relations between perceived threat, rumination, and experienced state anxiety during the pandemic.

Mental health during the COVID-19 pandemic and first lockdown in Lebanon: Risk factors and daily life difficulties in a multiple-crises setting

INTRODUCTION

Research from around the world shows important differences in the impact of the COVID-19 pandemic and lockdowns on mental health. This study examined the extent of mental health challenges (depressive and anxiety symptoms and daily life difficulties) and their associations with pandemic- and response-related factors during the first lockdown in Lebanon, which happened amid a severe economic crisis and socio-political turmoil.

METHODS

Data come from a cross-sectional internet-based survey (May-June 2020). Association of depressive (Patient Health Questionnaire (PHQ-9)) and anxiety symptoms (Generalized Anxiety Disorder (GAD-7)) with outbreak-related worries and knowledge, information sources, and confidence and satisfaction in response measures were estimated using logistic regression adjusted for sociodemographic and socioeconomic indicators.

RESULTS

Among 510 participants (mean age 36.1±11.3; 69.4% women), 32.3% had elevated depressive and 27.3% had elevated anxiety symptoms; younger age, unemployment, loss of employment, and lower income were related to more mental health symptoms. Most prevalent daily life challenges were feelings of uncertainty (74.5%) and financial (52.2%) and emotional (42.2%) difficulties; these and all other daily life difficulties (work-related, caregiving, and online learning) were significantly higher among participants with higher depressive and anxiety symptoms. Higher outbreak-related worries were associated with higher depressive (OR = 1.36, 95% CI = 1.20,1.53) and anxiety symptoms (OR = 1.47, 95% CI = 1.30,1.67). Higher pandemic-related knowledge, reliance on and trust in local health agencies and professionals' information, and satisfaction and confidence regarding governmental and health institutions' response were all related to lower mental health symptoms.

CONCLUSION

Results show that mental health burden in Lebanon during the first lockdown (when the COVID-19 outbreak was still minimal) is among the highest reported worldwide and highlight elevated emotional and financial tolls and widespread impact on daily life. In this high-burden and multiple-challenges context, results suggest an important role for the healthcare body, knowledge, and trust in the institutions managing the response.

Do nutritional habits and supplement use affect health-related quality of life during social isolation period in the community of North Cyprus?

The aim of study was to comprehensively investigate the effect of nutritional habits and supplement use on health-related quality of life during social isolation period. This study was a cross-sectional study. A total of 418 participants (73.4% were women and 26.6% were men) participated in this study. Participants' demographic information, nutritional habits, and quality of life were questioned, and anthropometric measurements were obtained. A significant difference was found in the main meal skipping status of individuals by age group. The consumption of milk, yoghurt, ayran, legumes, cereal products other than bread, vegetables, fruits, oilseeds, and snack foods was similar in both periods. Furthermore, frequencies of multivitamins, multiminerals, vitamin B12, vitamin C, vitamin D, iron, calcium, omega-3, and probiotics were similar during and before the pandemic. A significant difference was found in scores obtained on the Quality of Life Scale (QOLS) by age group. There was a significant difference in the quality of life scores by body mass index (BMI) groups. It was concluded that quality of life decreased due to the increase in body weight during pandemic period. The social isolation period did not make a clear difference in the nutritional habits of individuals and the use of nutritional supplements. When the main meal skipping situations were evaluated within the scope of nutritional habits, those who did not skip their main meal received the highest score on the QOLS.

Locus of control and pre-pandemic depressive symptoms relate to psychological adjustment of college students to the COVID-19 pandemic

OBJECTIVE

The current study examines the relationships between change in depressive symptoms and locus of control orientations among college students during the COVID-19 pandemic. Participants: A sample of 341 undergraduate students were recruited from a large Midwestern United States university.Methods: Participants completed an online cross-sectional survey with self-report measures of current depressive symptoms, retrospective pre-pandemic depressive symptoms, and locus of control.Results: Depressive symptoms changed significantly during the COVID-19 pandemic (t(340) = 7.49, p < 0.01). Pre-pandemic depressive symptoms predicted symptom change with the greatest changes among students who had fewer pre-pandemic symptoms (b = -0.58, p < 0.01) and higher external locus of control orientation (b = 0.24, p < 0.01).Conclusions: An increased presence of mental health resources is needed on college campuses and external locus of control should be targeted through clinical intervention as a risk factor for adverse depressive responses to stressors among college students.

Perceived value threats are related to fear of health impairments

Health impairments are problems in the body and mental functioning, which can be a result of a disease or side effects of treatment. Fear of health impairments plays an important role in decision-making and behavior. People might fear health impairments because of their beliefs about their dangerousness, but also because these impairments threaten important values. However, while the role of cognitive appraisal in the fear of health impairments is investigated, the role of motivation is less clear. To fill this gap, this study analyzed the role of values as motivational constructs in the fear of cognitive, motor, and sensory impairments, as well as impairments of reproductive functions and disfiguring impairments. Participants evaluated these health impairments as frightening or not. They also evaluated how these health impairments may threaten values and reported their value priorities. Health impairments are believed to threaten personally focused values (openness to change and self-enhancement) more than socially focused values (conservation and self-transcendence). Threats to personally focused values are related to higher fear of health impairments.

Stroke metrics during the first year of the COVID-19 pandemic, a tale of two comprehensive stroke centers

Although a decrease in stroke admissions during the SARS-CoV-2 pandemic has been observed, detailed analyses of the evolution of stroke metrics during the pandemic are lacking. We analyzed changes in stroke presentation, in-hospital systems-of-care, and treatment time metrics at two representative Comprehensive Stroke Centers (CSCs) during the first year of Coronavirus disease 2019 pandemic. From January 2018 to May 2021, data from stroke presentations to two CSCs were obtained. The study duration was split into: period 0 (prepandemic), period 1 (Wave 1), period 2 (Lull), and period 3 (Wave 2). Acute stroke therapies rates and workflow times were compared among pandemic and prepandemic periods. Analyses were adjusted for age, sex, comorbidities, and pre-morbid care needs. There was a significant decrease in monthly hospital presentations of stroke during Wave 1. Both centers reported declines in reperfusion therapies during Wave 1, slowly catching up but never to pre pandemic numbers, and dropping again in Wave 2. Both CSCs experienced in-hospital workflow delays during Waves 1 and 2, and even during the Lull period. Our results highlight the need for proactive strategies to reduce barriers to workflow and hospital avoidance for stroke patients during crisis periods.

A systematic review of fear, stigma, and mental health outcomes of pandemics

BACKGROUND

The COVID-19 pandemic has negatively affected the mental health of people globally. Despite substantial research on the short-term psychological impact of COVID-19, its long-term consequences on mental health remain relatively unexplored.

AIMS

We aimed to examine mental health literature on prior outbreaks to provide recommendations for developing effective strategies to mitigate the short- and long-term psychological impact of the current pandemic.

METHODS

We conducted a narrative review of 41 studies to analyze the adverse impact of the following epidemics and pandemics on the mental health of individuals, groups, and communities: Middle East Respiratory Syndrome, Severe Acute Respiratory Syndrome, Influenza A/H1N1, and Ebola Virus Disease.

RESULTS

We noted that these past epidemics and pandemics escalated stress, distress, anxiety, fear, and stigma that persisted in countries and communities. We also identified the role of misinformation in propagating discrimination and prejudice towards certain groups.

CONCLUSIONS

We discuss how the mental health outcomes of previous pandemics differed from the COVID-19 outbreak. We believe that strategies that reduce misinformation, educational initiatives, and mental health programs when introduced at the individual and community level have the potential to effectively diminish the negative psychological impact of COVID-19.

PRISMA

This study followed the PRISMA guidance and was not registered in PROSPERO. This is a narrative review that used qualitative thematic analysis. Publishing a protocol on a protocol repository for such reviews is not the standard of practice.

The COVID-19 pandemic and mental health in Kazakhstan

The COVID-19 pandemic had significant impacts on mental health. We examined factors associated with symptoms of depression and anxiety during the COVID-19 pandemic in Kazakhstan. We surveyed 991 adults in Kazakhstan in July 2021 using multistage stratified sampling. Depression and anxiety were measured with the Patient Health Questionnaire-4. We conducted logistic regression to assess associations between depression and anxiety and sociobehavioral factors. Overall, 12.01% reported depressive symptoms and 8.38% anxiety. Higher likelihood of depression was associated with being female (AOR: 1.64; 95% CI [1.05, 2.55]), having experience with COVID-19 in the social environment (AOR: 1.85; 95% CI [1.1-3.14]), experiencing food insecurity (AOR: 1.80; 95% CI [1.11-2.89]), increased family conflict (AOR: 2.43; 95% CI [1.32-4.48]) and impaired healthcare access (AOR: 2.41; 95% CI [1.32-4.41]). Higher likelihood of anxiety was associated with being female (AOR: 3.43; 95% CI [1.91-6.15]), increased family conflict (AOR: 2.22; 95% CI [1.11-4.44]) and impaired healthcare access (AOR: 2.63; 95% CI [1.36-5.12]). Multiple factors were associated with mental health in Kazakhstan during the COVID-19 pandemic. Further research is needed to determine the extent to which these factors and their associated mental health outcomes may persist.

Use of interviewer-administered telephone surveys during infectious disease outbreaks, epidemics and pandemics: a scoping review

INTRODUCTION

During the COVID-19 crisis, researchers had to collect data remotely. Telephone surveys and interviews can quickly gather data from a distance without heavy expense. Although interviewer-administered telephone surveys (IATS) can accommodate the needs of international public health research, the literature on their use during infectious disease outbreaks is scarce. This scoping review aimed to map the characteristics of IATS during infectious disease outbreaks.

METHODS

IATS conducted principally during infectious disease outbreaks and answered by informants at least 18 years old were searched from PubMed and EBSCO. There was a manual addition of relevant documents identified during an initial search. Overall trends were reported using different groupings, including WHO regions, and study details were compared before and during the COVID-19 pandemic.

RESULTS

70 IATS published between 2003 and 2022 were identified. 57.1% were conducted during the COVID-19 pandemic. Among 30 IATS conducted before the COVID-19 pandemic in the world, only 3.3% were carried out in low-income and middle-income countries (LMICs). This percentage of studies in LMICs out of all the IATS rose to 32.5% during the pandemic. The share of qualitative studies grew from 6.7% before the COVID-19 outbreak to 32.5% during the outbreak. IATS performed during the COVID-19 pandemic focused on more diverse, specific population groups, such as patients and healthcare professionals. Mobile phones are increasingly used for IATS over time.

CONCLUSION

IATS are used globally with high frequency in the Western Pacific Region and high-income countries. Technical and financial challenges continue to exist, and assessments of inclusiveness and representativeness should be carefully conducted. A lack of details related to methods was observed, and this scoping review urges researchers using this data collection method in the future to specify how they executed IATS for better use and more efficient deployment.

Response to COVID-19 recommended preventive behavioral messages among Guraghe zone communities, South Ethiopia: using constructs of the Extended Parallel Process Model (EPPM)

INTRODUCTION

The World Health Organization declared COVID-19 is a pandemic disease. Countries should take standard measures and responses to battle the effects of the viruses. However, little is known in Ethiopia regarding the recommended preventive behavioral messages responses. Therefore, the study aimed to assess the response to COVID-19 recommended preventive behavioral messages.

METHODS

Community-based cross-sectional study design was carried out from 1 to 20, July 2020. We recruited 634 respondents by using a systematic sampling method. Data were analyzed using Statistical Package Software for Social Sciences version 23. Association between variables were explored using a bivariable and multi variable logistic regression model. The strength of the association is presented using odds ratio and regression coefficient with 95% confidence interval. A p-value of less than 0.05 was declared statistically significant.

RESULTS

Three hundred thirty-six (53.1%) of respondents had good response to recommended preventive behavioral messages. The general precise rate of the knowledge questionnaire was 92.21%. The study showed that merchant was 1.86 (p ≈ 0.01) times more likely respond to COVID-19 recommended preventive behavioral messages than government-employed. Respondents who scored one unit increase for self-efficacy and response-efficacy, the odds of responding to COVID-19 recommended preventive behavioral messages were increased by 1.22 (p < 0.001), and 1.05 times (p = 0.002) respectively. Respondents who scored one unit increase to cues to action, the odds of responding to COVID-19 recommended preventive behavioral messages were 43% (p < 0.001) less likely.

CONCLUSION

Even though respondents were highly knowledgeable about COVID-19, there is a lower level of applying response to recommended preventive behavioral messages. Merchant, self-efficacy, response efficacy, and cues to action were significantly associated with response to recommended preventive behavioral messages. Like merchants, government employer should be applying preventive behavioral messages and also, participants' self and response efficacy should be strengthened to improve the response. In addition, we should be changed or modified the way how-to deliver relevant information, promoting awareness, and also using appropriate reminder systems to preventive behavioral messages.

The impact of the COVID-19 pandemic on individuals with Fontan circulation: Focus on gaps in care

Background

Gaps in subspecialty cardiology care could potentially delay identification and care for multi-organ complications common in patients with Fontan circulation. This study analyzed the frequency of gaps in care for individuals with Fontan circulation during the COVID-19 pandemic and associated demographic and clinical factors.

Methods

This retrospective study evaluated individuals with Fontan circulation followed at our center since 2010. A gap in care was defined as an absence of any formal cardiology provider-patient contact (clinic visit or telehealth) for >15 months.

Results

Over a third of 308 patients with Fontan circulation experienced at least one gap in care between 2010 and 2022, and 77 experienced a gap in care during the COVID-19 pandemic. Of this latter group, 27 (35%) had never experienced a prior gap in cardiology care until the pandemic. Those who experienced gaps in care during the pandemic were on average older (18.0 [IQR 9.6-25.6] vs. 14.2 [7.2-21.2] years, p = 0.01), more likely to be of Black/African American race (23.4% vs 7.4%, p = 0.001), and less likely to have a diagnosis of protein-losing enteropathy or plastic bronchitis (0% vs. 8.6%, p = 0.005). Those without a gap in care during the pandemic were more likely to have utilized telehealth visits (13% vs 3%, p = 0.02).

Conclusion

Gaps in care are common and appear to have been exacerbated by the COVID-19 pandemic in those with a Fontan circulation. Such gaps are particularly common among African American and adult patients, and may potentially be mitigated by expanding telehealth access.

Cyberchondria and COVID-19 anxiety and internet addiction among nursing students

This study was conducted to determine the relationship between cyberchondria and COVID-19 anxiety and internet addiction in nursing students. This cross-sectional study was conducted with 843 students studying in the nursing department of Adnan Menderes University. The mean age of the students was 20.8 ± 1.72 years and 61.2% were female. The Cyberchondria Severity Scale-Short Form, Coronavirus Anxiety Scale, and the Young Internet Addiction Test-Short Form were used to collect data. The study found a positive association between internet addiction, cyberchondria severity, and anxiety about COVID-19. It was found that the anxiety of COVID-19 had a mediating role in the association between internet addiction and cyberchondria severity. It was found that the use of the internet as a source of information on health problems and trusting the health information found had a significant effect on high cyberchondria levels (p < 0.05). Taken together, the findings of previous studies and this study on the role of the association between internet addiction and cyberchondria exacerbating anxiety due to the pandemic provide further evidence for healthcare professionals that greater focus is needed on the problems of the new era related to people-internet interaction. To reduce the negative effects of the current health crisis and future health crises, interventions for nursing students to control their internet use and cyberchondria behaviors should be prioritized.

Impact of death anxiety on mental health during COVID-19: The mediating role of the meaning in life

The aim of this article is to explore whether COVID-19 aroused an awareness of death, inflamed death anxiety, and affected mental health and to assess the degree that meaning in life played in the relationship between death anxiety and general mental health. A total of 197 participants were recruited using convenience sampling and were divided into an experimental group ( n = 100) and a control group ( n = 97). All participants completed the Death Anxiety Scale (DA), the Meaning in Life Questionnaire (MLQ), and the General Health Questionnaire (GHQ-12). Death anxiety had a significant positive predictive effect on general mental health and meaning in life. When death anxiety and meaning in life were included in the regression equation, death anxiety still had a significant positive predictive effect on general mental health, and meaning in life had a significant positive predictive effect on general mental health. These results indicated that meaning in life played a partially mediating role in the influence of death anxiety on general mental health. In the COVID-19 context, death information was found to arouse awareness of death and death anxiety, which adversely affected mental health, and it was also confirmed that meaning in life played a partially mediating role between death anxiety and general mental health, which suggested that mental health problems could be alleviated in the future by helping people find meaning and value in their lives and cope more positively with death.

The association between fear of Covid-19 and smartphone addiction among individuals: the mediating and moderating role of cyberchondria severity

The coronavirus disease-2019 (COVID-19) has quickly spread all over the world and has contributed to psychological consequences including fear of the virus. Depending upon the severity of their problems, individuals often search the internet via their mobile devices to understand whether the symptoms they perceive are symptoms of the disease. This condition has been termed 'cyberchondria'. In this context, the aim of this study is examine the mediating and moderating role of cyberchondria severity in the association between smartphone addiction and the fear of COVID-19. The sample comprised 520 participants (335 females [64.4%], 185 males [35.6%] aged 17 to 65 years [Mean = 28.61 years, SD = 10.60]). A survey included the Cyberchondria Severity Scale Short-Form, The Smartphone Addiction Scale-Short Version, and The Fear of COVID-19 Scale. Structural equation modeling and SPSS Process Macro moderator variable analysis were used to test the research model. The study found a positive association between smartphone addiction, fear of COVID-19, and cyberchondria severity. Cyberchondria severity had both moderating and mediating role in the association between smartphone addiction and the fear of COVID-19. In conclusion, it has been determined that during the COVID-19 pandemic, cyberchondria severity has negative effects on individuals' fear of COVID-19.

Prevalence of negative mental health status during COVID-19 pandemic among general population of seven Arab countries: A cross-sectional study of 28843 participants

BACKGROUND

Previous studies documented a narrow scope of knowledge about the negative mental health status during the lockdown following the COVID-19 pandemic, especially in Arab countries.

AIM

We aimed to assess the association between negative mental health status and the COVID-19 pandemic and determine the different factors affecting mental health among the general population of seven Arab countries.

METHODS

This study is a multinational cross-sectional questionnaire-based survey conducted online from June 11, 2020 to June 25, 2020. The depression, anxiety, and stress Scale 21 Items (DASS-21) and the Event scale-Revised Arabic version (IES-R-13) scales were used. Multiple linear regressions were performed to study the association between the scales' total scores with COVID-19 and demographic characteristics.

RESULTS

A total of 28,843 participants from seven Arab countries were included. During the COVID-19 pandemic, the prevalence of mental health disorders has significantly increased. A total of 19006 participants (66%) were affected by variable degrees of depression, 13,688 (47%) had anxiety, and 14,374 (50%) had stress ranging from mild to severe. Higher levels were associated with other factors, such as lower age, female gender, chronic disease, unemployed, fear of getting infected, and a history of psychiatric disorders.

CONCLUSION

Our study findings show an increased incidence of mental disorders during the pandemic. This is expected to play a crucial role in guiding a psychological support strategy provided by healthcare systems to the general public during pandemics.

Effect of COVID-19 infection related experiences on social behaviors when a state of emergency is declared: a cohort study

BACKGROUND

Restricting the movement of the public to gathering places and limiting close physical contact are effective measures against COVID-19 infection. In Japan, states of emergency have been declared in specific prefectures to reduce public movement and control COVID-19 transmission. We investigated how COVID-19 infection related experiences including people with a history of infection, people with a history of close contact, and people whose acquaintances have been infected, affected self-restraint from social behaviors during the second state of emergency in Japan.

METHODS

A prospective cohort study was conducted among workers aged 20-65 years using data from an internet survey. The baseline survey was conducted on December 22-25, 2020, and a follow-up survey was on February 18-19, 2021. There were 19,051 participants who completed both surveys and were included in the final analysis. We identified eight social behaviors: (1) eating out (4 people or fewer); (2) eating out (5 people or more); (3) gathering with friends and colleagues; (4) day trip; (5) overnight trip (excluding visiting home); (6) visiting home; (7) shopping for daily necessities; and (8) shopping for other than daily necessities. We set self-restraint regarding each social behavior after the second state of emergency was declared in January 2021 as the dependent variable, and COVID-19 infection related experiences as independent variables. Odds ratios were estimated using multilevel logistic regression analyses nested in the prefecture of residence.

RESULTS

Significant differences by COVID-19 infection related experiences were identified: compared to people without COVID-19 related experiences, people with a history of COVID-19 were less likely self-restraint from most social behaviors. People whose acquaintance had been diagnosed with COVID-19 were significantly more likely to refrain from most social behaviors. There was no significant difference in any social behaviors for people with a history of close contact only.

CONCLUSION

To maximize the effect of a state of emergency, health authorities should disseminate information for each person in the target population, taking into account potential differences related to the infection related experiences.

Access to Healthcare for Children and Adolescents with a Chronic Health Condition during the COVID-19 Pandemic: First Results from the KICK-COVID Study in Germany

This study examines the access to healthcare for children and adolescents with three common chronic diseases (type-1 diabetes (T1D), obesity, or juvenile idiopathic arthritis (JIA)) within the 4th (Delta), 5th (Omicron), and beginning of the 6th (Omicron) wave (June 2021 until July 2022) of the COVID-19 pandemic in Germany in a cross-sectional study using three national patient registries. A paper-and-pencil questionnaire was given to parents of pediatric patients (<21 years) during the routine check-ups. The questionnaire contains self-constructed items assessing the frequency of healthcare appointments and cancellations, remote healthcare, and satisfaction with healthcare. In total, 905 parents participated in the T1D-sample, 175 in the obesity-sample, and 786 in the JIA-sample. In general, satisfaction with healthcare (scale: 0−10; 10 reflecting the highest satisfaction) was quite high (median values: T1D 10, JIA 10, obesity 8.5). The proportion of children and adolescents with canceled appointments was relatively small (T1D 14.1%, JIA 11.1%, obesity 20%), with a median of 1 missed appointment, respectively. Only a few parents (T1D 8.6%; obesity 13.1%; JIA 5%) reported obstacles regarding health services during the pandemic. To conclude, it seems that access to healthcare was largely preserved for children and adolescents with chronic health conditions during the COVID-19 pandemic in Germany.

COVID-19 and Unmet Medical Needs for People With Chronic Diseases: A Cross-Sectional Study

Gaps between medical needs and health services accessibility are defined as unmet medical needs (UMN). Previous studies assessing UMNs during the coronavirus disease 2019 (COVID-19) pandemic did not account for factors such as the type of medical insurance or chronic disease. Therefore, this study investigated various factors, including medical insurance and chronic diseases, affecting self-reported UMN during the pandemic in Daejeon Metropolitan City, South Korea. This cross-sectional study was conducted using Daejeon Metropolitan City Health Surveys data from 2020. The weighted prevalence of UMN was estimated among participants (n = 1494) aged ≥18 years, while chi-squared and logistic models were used to assess the association between UMN and participant characteristics. The prevalence of UMN was 6.4% (n = 97). Female sex and low education levels were significantly associated with reporting UMN. Medical aid beneficiaries were less likely to report UMN than adults with National Health Programs coverage. Participants with chronic diseases, such as hypertension and arthritis, and those with depression, were more likely to report UMN than adults without these conditions. The findings highlight the need for targeted efforts to decrease UMN in the COVID-19 pandemic, especially for women and individuals with low education levels. The results also indicate that high-risk disease groups should be targeted with additional enabling services to support the management of chronic conditions.

Travel intention during the COVID-19 epidemic: The influence of institutional and interpersonal trust

The global pandemic, COVID-19, has dealt a heavy blow to the tourism industry. Therefore, exploring the mechanisms influencing travel intention in the post-epidemic era can help provide management insights for the recovery of the travel market. Relying on the logic of social cognition theory, we conducted an empirical analysis from the perspective of trust and found that institutional trust and interpersonal trust can positively predict travel intention in the context of the epidemic, while travelers’ health risk perception and safety self-efficacy mediate the relationship between trust and travel intention. Moreover, we verified the moderating role of tourists’ psychological resilience. Further, the study confirms that China’s active prevention policy not only reduces the physical health harm caused by the epidemic, but also effectively increases individuals’ institutional trust in a proactive government. Through China’s active anti-epidemic policy, individuals were able to counteract the negative impact of the COVID 19 epidemic on their travel intention. Further, theoretical and practical implications are discussed.

Insomnia Mediate the Influence of Reassurance-Seeking Behavior and Viral Anxiety on Preoccupation With COVID-19 Among the General Population

Background and Objective We explored in this study whether insomnia, viral anxiety, reassurance- seeking behavior, and preoccupation with coronavirus disease (COVID-19) are related among the general population. As well, we explored the possibility that insomnia may mediate the association between COVID-19 viral anxiety and preoccupation.Methods During November 9–15, 2021, 400 participants voluntarily completed this survey, and participants’ age, sex, living location, and marital status were collected. Responses to questions about COVID-19 were also gathered, and their symptoms were rated using the Obsession with COVID-19 Scale (OCS), Coronavirus Reassurance-Seeking Behaviors Scale (CRBS), Fear of COVID-19 scale (FCV-19S), and Insomnia Severity Index (ISI).Results Preoccupation with COVID-19 was predicted by young age (β = -0.08, p = 0.012), CRBS (β = 0.52, p < 0.001), FCV-19S (β = 0.30, p < 0.001), and ISI (β = 0.07, p = 0.029) (adjusted R2 = 0.62, F = 163.6, p < 0.001). Mediation analysis showed that insomnia partially mediates the influence of reassurance seeking behavior and viral anxiety on preoccupation with COVID-19.Conclusions Sleep disturbances can contribute to a vicious cycle of hypochondriacal preoccupation with COVID-19. In order to reduce an individual’s viral anxiety, insomnia symptoms must be addressed.

Physical Activity and Mental Health Declined during the Time of the COVID-19 Pandemic: A Narrative Literature Review

(1) Introduction: Mental health (MH) and physical activity (PA) share a bi-directional relationship, but most studies report MH as the outcome. With diminishing pandemic-related MH, this review examines the impact of diminished MH on PA. (2) Methods: This narrative literature review included 19 empirical studies published since the COVID-19 pandemic. Electronic databases such as MEDLINE, PsycINFO, and CINAHL were searched for English language articles in peer-reviewed journals using equivalent index terms: "anxiety", "depression", "stress", "mental health", "exercise", "activity", "COVID-19", "coronavirus", and "2019 pandemic". The search reviewed 187 articles with double-rater reliability using Covidence. A total of 19 articles met the inclusion criteria. (3) Results: MH themes that impacted PA were depression and/or anxiety (n = 17), one of which identified inadequate coping and excessive pandemic stress (n = 2). In addition, women are more likely to suffer diminished MH and reduced PA throughout the pandemic. (4) Conclusion: Current research suggests that individuals with pre-pandemic MH episodes are correlated with more effective coping skills and fewer adverse effects from COVID-19 than expected. As we emerge from this pandemic, equipping all individuals, especially women, with positive coping strategies may accelerate a seamless return to PA.

Patient-reported factors associated with avoidance of in-person care during the COVID-19 pandemic: Results from a national survey

Background

There has been a substantial decline in in-person care in inpatient and outpatient settings during the ongoing COVID-19 pandemic. Avoidance of needed in-person care may contribute to an avoidable decline in patient health and an increase in mortality. While several systems and behavioral theories have been put forward to explain the decline, there is a lack of studies informed by patients’ own experiences. The current study applied a socio-ecological model encompassing patient, environmental, and institutional-related variables to examine patient-reported factors associated with avoidance of in-person care.

Methods

Between October and December 2020, a total of 3840 persons responded to a nationwide online questionnaire that was administered using ResearchMatch and Facebook. Self-reported avoidance of in-person care among those who needed it was the main outcome. Multivariable logistic regression analysis was used to identify factors associated with avoidance of needed care.

Findings

Out of a total of 3372 respondents who reported that they needed in-person care during the early phase of the pandemic, 257 (7.6%) avoided it. Patient-related variables associated with avoiding needed care included younger age (odds ratio (OR), 1.46, 95% CI 1.11 to 1.94, p<0.01; <45 y/o vs 45+), inability to afford care (OR = 1.65, 95% CI 1.17 to 2.34, p<0.01), and greater COVID-related stress (OR = 1.36, CI 1.01 to 1.83, p<0.05). More frequent discussions about COVID with family and friends was the only significant environment-related avoidance of care variable (OR = 1.39, 95% CI 1.01–1.91, p < .05). Institution-related care avoidance variables included a negative patient healthcare experience rating (OR 1.83, 95% CI 1.38 to 2.42, p<0.001), poor awareness of the institution’s safety protocol (OR = 1.79, 95% CI 1.28 to 2.51, p<0.01), and low ratings of the institution’s effectiveness in communicating their safety protocol (OR = 3.45, 95% CI 1.94 to 6.12, p<0.001). The final model predicted 11.9% of the variance in care avoidance.

Conclusions

These results suggest that care avoidance of in-person care during the initial phase of the pandemic was influenced by a patient’s demographics as well as environmental and healthcare institutional factors. Patients’ previous experiences and their awareness of healthcare systems’ safety protocols are important factors in care avoidance.

Remember the past, plan for the future: How interactions between risk perception and behavior during the COVID-19 pandemic can inform future Canadian public health policy

The ongoing COVID-19 pandemic necessitated the implementation of numerous temporary public health policies, including social distancing, masking, and movement limitations. These types of measures require most citizens to follow them to be effective at a population level. This study examined population adherence to emergency public health measures using early data collected in the Spring of 2020, when all Canadian jurisdictions were under relatively strict measures. In total, 1,369 participants completed an online questionnaire package to assess adherence, perceptions of government response, and perceptions of COVID-19 risk. Results indicated that most Canadians were pleased with the government's handling of the early phases of the pandemic and immediately engaged new public health mandates. Willingness to change behaviors was unrelated to satisfaction with the government response. Similarly, behavioral adherence was also unrelated to satisfaction with government, or personal risk perceptions; however, adherence to public health guidelines was related to elevated psychological distress. As the pandemic continues, public health officials must balance the mental health of the population with the physical health concerns posed by COVID-19 when applying public health mandates.

Intimate Relationships during COVID-19 across the Genders: An Examination of the Interactions of Digital Dating, Sexual Behavior, and Mental Health

The COVID-19 pandemic has resulted in economic hardship, psychological stress, anxiety, and depression in a significant proportion of the global population. However, the bidirectional effects of social isolation and pre-existing or developed psychological stress could inform sexual behaviors and affect digital dating outcomes. Additionally, it is unknown whether intimate behaviors and relationships have been equally affected across the genders during the COVID-19 pandemic. The purpose of this study is to contrast the course of intimate relationships pre-and post-COVID-19, with a focus on diverse genders, digital dating, mental health, and behavior. A review of the dating landscape during COVID-19 is developed in this study, encompassing themes including diverse genders, sexual orientation, demographic characteristics, sexual behavior, the state of psychological wellbeing, and interactions with digital dating apps. The authors reviewed the trends and challenges of digital romance. Dating before and during the pandemic is explored, discussing how COVID-19 experiences may inform future romantic partnerships. Mobile dating applications saw a surge in downloads and usage across popular platforms, including Tinder (3 billion swipes in March 2020) and Ok Cupid (700% increase in dates), with the top 20 dating apps gaining 1.5 million daily users. Cross-sectionally, being younger, single, and having higher levels of stress was a predictor of higher dating-app usage during the COVID-19 lockdowns. Risky sexual behavior and having multiple sexual partners were reduced during social distancing as there was an increased worry of contracting the virus. Heightened incidents of domestic/intimate partner abuse have caught the headlines in several countries. COVID-19 during lockdown has also posed barriers to accessing support and help from sexual and mental health services.

Inpatient hyperglycaemia, and impact on morbidity, mortality and re-hospitalisation rates

INTRODUCTION

Hyperglycaemia is related to poorer outcomes among hospital inpatients. We investigated the impact of hyperglycaemia at admission on length of hospital stay, readmission rate and mortality rate.

METHOD

We retrospectively analysed the records of 1,132 patients admitted to hospital in January 2019, April 2019, August 2019 and April 2020.

RESULTS

Hyperglycaemia was present in 14.1% of patients. New-onset hyperglycaemia on admission (in 3.9% of patients) was related to a higher mortality rate than in patients known to have diabetes admitted with hyperglycaemia (43.3% vs 17.9%; p=0.006). Mortality at 90 days and 1 year increased with higher admission glucose levels (p=0.03 and p=0.005, respectively), severe hyperglycaemia (>20 mmol/L) having a 1-year mortality of 34.3%. After accounting for confounding variables, admission glucose and length of stay remained significant predictors of 1-year mortality (p=0.034 and p=0.003, respectively).

CONCLUSION

Hyperglycaemia is an important prognostic marker and may indicate a more severe illness. These patients should be highlighted for a greater level of care.

Mental Health Among College Students During the COVID-19 Pandemic at a Hispanic-Serving Institution

This study examines the prevalence and severity of stress, anxiety, depression, and substance use among college students during the COVID-19 pandemic at a Hispanic-serving institution. The aim of the study is to increase knowledge about student mental health during a public health emergency in order to help develop strategies that promote student success. Using the Perceived Stress Scale-4 (PSS-4) and the Patient Health Questionnaire for Depression and Anxiety-4 (PHQ-4), we found high levels of stress, depression, and anxiety in the sample. Based on these findings, we propose a greater investment of time and resources to promote mental health and positive coping strategies among college students through culturally competent mental health and supportive programs.

Learning in Adverse Circumstances: Impaired by Learning With Anxiety, Maladaptive Cognitions, and Emotions, but Supported by Self-Concept and Motivation

The COVID-19 summer semester 2020 posed many challenges and uncertainties, quite unexpectedly and suddenly. In a sample of 314 psychology students, it was investigated how they experienced learning and preparing for an end-of-semester exam, which emotions and strain they experienced, how academic performance was affected, and how personal antecedents of learning as important facets of a learner’s identity could support or prevent overcoming adverse circumstances of learning. The participants of the study filled in a questionnaire about their achievement emotions and strain they experienced during learning and exam preparation as well as academic self-concept, motivation, gender, proneness to anxiety. Points achieved in the exam were also recorded. The interaction between the variables was investigated by a structural equation model. It showed that the investigated variables can be distinguished into two groups, variables that contribute mainly negatively to performance and variables with a positive contribution. Strain experienced during the COVID-19 pandemic and unpleasant emotions “belong together” in the sense that they inhibit academic performance directly or indirectly. Proneness to anxiety in academic situations was related with higher levels of mental, emotional, and physical disturbances due to the COVID-19 situation. In contrast, motivation and a high academic self-concept acted as support for learning and performance. Both contribute to pleasant achievement emotions in the learning situation; moreover, motivation had a direct relationship to academic performance. The results from the present study do not only provide insight into important students’ personal dispositions and their role for learning in adverse circumstances but also give advice how to strengthen students for successful learning.

The effect of cyberchondria on anxiety, depression and quality of life during COVID-19: the mediational role of obsessive-compulsive symptoms and Internet addiction

Since the global pandemic of the coronavirus disease 2019 (COVID-19), online health information-seeking behaviors have notably increased. Cyberchondria can be a vulnerability factor for the worsening of anxiety-depressive symptoms and quality of life. The current study aims to understand the predictive effect of cyberchondria on health anxiety, anxiety, depression and quality of life considering the mediating effect of obsessive-compulsive symptoms and Internet addiction and the moderating effect of COVID anxiety. 572 Italian participants (66% female; Mean age = 34; SD = 15) took part in a cross-sectional online survey involving CSS-12, MOCQ-R, IAT, SHAI, HADS, WHOQoL-BREF and CAS. Mediation and moderation analyses were conducted. Obsessive-compulsive symptoms and Internet addiction were found to partially mediate the cyberchondria-health anxiety and the cyberchondria-anxiety links and to totally mediate the cyberchondria-depression and the cyberchondria-quality of life links. COVID anxiety was found to moderate the relationship between cyberchondria and anxiety. The findings suggest that compulsivity may have a key role in the explanation of the underlying mechanisms of cyberchondria. Healthcare practitioners should provide additional support for individuals with cyberchondria. As such, cyberchondria is a contributing factor to the exacerbation of anxiety-depressive disorders and may impact on the quality of life.

Public perceptions during the first wave of the COVID-19 pandemic in Canada: a demographic analysis of self-reported beliefs, behaviors, and information acquisition

Introduction

We explored associations between sociodemographic factors and public beliefs, behaviors, and information acquisition related to the coronavirus disease 2019 (COVID-19) to identify how the experiences of subpopulations in Canada may vary.

Methods

We administered a national online survey through Ipsos Incorporated to adults residing in Canada. Sampling was stratified by population age, sex, and regional distributions. We used descriptive statistics to summarize responses and test for differences based on gender, age, educational attainment, and household income using chi-squared tests, followed by weighted logistic regression.

Results

We collected 1996 eligible questionnaires between April 26th and May 1st, 2020. Respondents mean age was 50 years, 51% were women, 56% had a post-secondary degree, and 72% had a household income <$100,000. Our analysis found differences within the four demographic groups, with age effects most acutely evidenced. Respondents 65 years and older were more likely to perceive the pandemic as very serious, less likely to report declines in overall health, and more likely to intend to get vaccinated, compared to 18–29 year olds. Women overall were more likely to report negative outcomes than men, including stress due to the pandemic, and worsening social, mental/emotional, and spiritual health. Respondents 45 and older were more likely to seek and trust information from traditional Canadian news sources, while 18-29 year olds were more likely to seek and trust information on social media; overall, women and respondents with a post-secondary degree were more likely to access and trust online information from public health sites.

Conclusion

This study found important demographic differences in how adults living in Canada perceived the COVID-19 pandemic, the impacts on their health, and their preferences for information acquisition. Our results highlight the need to consider demographic characteristics in tailoring the format and information medium to improve large scale acceptance and uptake of mitigation and containment measures.

The impact of the COVID-19 pandemic on the mental health of the adult population in Bangladesh: a nationwide cross-sectional study

The recent COVID-19 pandemic has imposed threats on both physical and mental health since its outbreak. This study aimed to explore the impact of the COVID-19 pandemic on mental health among a representative sample of home-quarantined Bangladeshi adults. A cross-sectional design was used with an online survey completed by a convenience sample recruited via social media. A total of 1,427 respondents were recruited, and their mental health was assessed by the DASS-21 measure. The prevalence of anxiety symptoms and depressive symptoms was 33.7% and 57.9%, respectively, and 59.7% reported mild to extremely severe levels of stress. Perceptions that the pandemic disrupted life events, affected mental health, jobs, the economy and education, predictions of a worsening situation, and uncertainty of the health care system capacities were significantly associated with poor mental health outcomes. Multivariate logistic regressions showed that sociodemographic factors and perceptions of COVID-19 significantly predict mental health outcomes. These findings warrant the consideration of easily accessible low-intensity mental health interventions during and beyond this pandemic.

Mental well-being, health, and locus of control in Danish adults before and during COVID-19

AIM

The aim of this study was to investigate the possible impact of the Covid-19 pandemic on general health, mental well-being, and experiences of control compared to pre-pandemic populations. Our hypotheses were that we would observe a significantly lower level of psychological well-being and general health in the 2020 sample compared to the pre-pandemic samples, and that we would observe younger age groups to be the most affected.

METHOD

Two representative Danish populations (2016, n = 1656) and (2017, n = 3366) were compared to a representative Danish population (2020, n = 1538) sampled during the first lockdown in May 2020. Two-tailed tests of proportions were used to investigate possible differences between samples in proportions reporting poorer mental well-being measured by 5-item World Health Organization Well-Being Index, general health, and internal locus of control.

RESULTS

Younger men (aged 18-24) and younger women (aged 18-44) as well as elderly women (aged 65-74) reported lower mental well-being during the early phase of the pandemic compared to the population from 2016. Both women and men in 2020 reported significantly lower levels of internal locus of control compared to the 2017 sample. This was especially true for younger men and women. There were no statistically significant differences in general health between populations.

DISCUSSION

This study partly supports the hypothesis that the Covid-19 pandemic affected mental well-being negatively among younger persons. However, longitudinal studies are needed to investigate possible long-term effects of the pandemic on mental health and well-being. Further, qualitative studies are needed to investigate the in-depth consequences of Covid-19.

Healthcare providers' perceptions of virtual-care with children's mental health in a pandemic: A hospital and community perspective

AIM

The purpose of the present study was to explore the experiences of a diverse group of mental health clinicians both in hospital and in the community, who were required to rapidly adopt virtual-care practices in the delivery of mental health services to children, adolescents, and their families.

METHODS

Mental health clinicians (N = 117) completed the Clinician Virtual-Care Experience Survey assessing the following domains: ease of technology use, client/patient-provider interaction quality, and clinician wellbeing.

RESULTS

Although over 70% of clinicians had not used virtual-care to deliver mental health services prior to the Coronavirus Disease 2019 pandemic, more than 80% felt it was easy to operate the virtual platforms. Clinicians were divided in their perceptions of the effectiveness of virtual-care, with only 42% reporting that they felt they were as effective in delivering healthcare services virtually as compared to in-person. Virtual-care was described as being more effective for specific populations, while challenges were described in building rapport and when delivering difficult or unexpected feedback.

CONCLUSIONS

Clinicians felt there were some benefits of adopting virtual-care practices, while challenges were also identified. Understanding of the impact of virtual-care on service providers is essential in order to strengthen mental healthcare for children, adolescents, and their families even beyond the pandemic.

Self-reported anxiety level and related factors in senior high school students in China during the outbreak of coronavirus disease 2019

BACKGROUND

The outbreak of COVID-19 has been a big challenge for senior high school students in China who are facing tremendous pressure of the highly competitive College Entrance Examination.

METHODS

To evaluate the psychological impact of the event in the population, we conducted an anonymous online survey among senior high school students in China between 26 Feb and 4 March, 2020. Information collected included demographic characteristics, attitude toward medical study, infection of COVID-19 in acquaintances, anxiety symptoms evaluated using the GAD-7, and health literacy level measured using the IDSHL.

RESULTS

Of 21,085 participants, 3,575 (17.0%), 943 (4.5%) and 448 (2.1%) reported with mild, moderate, and severe anxiety. Female, higher academic year, worse self-evaluated academic performance, negative attitude toward medical study, living in Hubei province and having acquaintance infected with COVID-19 were significantly associated with anxiety level, while higher education level of mother and higher IDSHL score were associated with a lower risk. The score of IDSHL, particularly of the domain "infectious disease prevention", was associated with the GAD-7 score in a linear pattern (β=-0.0371, p<0.01).

LIMITATIONS

Limitations included the cross-sectional study design unable to infer the casual relationship, anonymous survey, selection bias and self-reported anxiety disorder levels.

CONCLUSIONS

The results suggested that COVID-19 outbreak may increase anxiety level in senior high school students in China. The anxiety related factors observed in this study may help to identify vulnerable individuals and develop interventions.

A Cognitive Behavior Therapy Chatbot (Otis) for Health Anxiety Management: A Mixed-Methods Pilot Study (Preprint)

Background

An increase in health anxiety was observed during the COVID-19 pandemic. However, due to physical distancing restrictions and a strained mental health system, people were unable to access support to manage health anxiety. Chatbots are emerging as an interactive means to deliver psychological interventions in a scalable manner and provide an opportunity for novel therapy delivery to large groups of people including those who might struggle to access traditional therapies.

Objective

The aim of this mixed methods pilot study was to investigate the feasibility, acceptability, engagement, and effectiveness of a cognitive behavioral therapy (CBT)–based chatbot (Otis) as an early health anxiety management intervention for adults in New Zealand during the COVID-19 pandemic.

Methods

Users were asked to complete a 14-day program run by Otis, a primarily decision tree–based chatbot on Facebook Messenger. Health anxiety, general anxiety, intolerance of uncertainty, personal well-being, and quality of life were measured pre-intervention, postintervention, and at a 12-week follow-up. Paired samples t tests and 1-way ANOVAs were conducted to investigate the associated changes in the outcomes over time. Semistructured interviews and written responses in the self-report questionnaires and Facebook Messenger were thematically analyzed.

Results

The trial was completed by 29 participants who provided outcome measures at both postintervention and follow-up. Although an average decrease in health anxiety did not reach significance at postintervention (P=.55) or follow-up (P=.08), qualitative analysis demonstrated that participants perceived benefiting from the intervention. Significant improvement in general anxiety, personal well-being, and quality of life was associated with the use of Otis at postintervention and follow-up. Anthropomorphism, Otis’ appearance, and delivery of content facilitated the use of Otis. Technical difficulties and high performance and effort expectancy were, in contrast, barriers to acceptance and engagement of Otis.

Conclusions

Otis may be a feasible, acceptable, and engaging means of delivering CBT to improve anxiety management, quality of life, and personal well-being but might not significantly reduce health anxiety.

Lessons Learned about the Need for Early Screening for Depression during the First Months of the COVID-19 Pandemic in the United States

A nationwide survey assessed the prevalence and pandemic-related risk factors of major depressive disorder (MDD) at the initial onset of the COVID-19 pandemic. Findings showed a significant increase in the prevalence of MDD (22.7%) compared to the pre-pandemic 12-month estimate (10.4%). Specific pandemic-related concerns, along with significant increases in stress, loneliness, fatigue, and substance use behaviors are noted for those with the provisional diagnosis of MDD. Early screening and detection for potential MDD cases can reduce the severity and duration of maladaptive symptoms, decreasing the risk for future depression episodes and the potential loss of quality of life and productivity.

Potential joint effects of perceptions related to COVID-19 and future social development on depressive symptoms: a Chinese population-based study

BACKGROUND

The COVID-19 pandemic has caused significant negative socio-political, economic, and psychological consequences.

AIMS

To investigate the impact of individual-level (illness representations of COVID-19) and structurally derived (anticipated social-political development in the economy, security, and social harmony in the next year) factors, and their potential moderation effects on depressive symptoms.

METHODS

An anonymous population-based telephone survey was conducted among the general public of Hong Kong, China during 3-10 April 2020 (n = 300, response rate 56%). Depressive symptoms were assessed by the validated Chinese version of the Patient Health Questionnaire-9.

RESULTS

Of the participants, 8.7% showed probable moderate-to-severe depression. Hierarchical linear regression models showed that illness representations of personal/treatment control and emotional responses and anticipated deterioration in social harmony were independently and significantly associated with depressive symptoms. Anticipated deterioration in security significantly moderated the associations between perceived consequence/treatment control of COVID-19 and depressive symptoms, such that the associations were stronger among people who anticipated a strong deterioration in security.

CONCLUSIONS

The findings suggested that perceptions of COVID-19 and future social-political development jointly and interactively contributed to depressive symptoms during the COVID-19 pandemic. Mental health professionals and promotions should take the multiple-level mental health determinants into account.

The impact of lockdown and other stressors during the COVID-19 pandemic on depression and anxiety in a Lebanese opportunistic sample: an online cross-sectional survey

Lockdown measures were taken since February 2020 in Lebanon, a country already going through a socio-economic crisis, to fight the new coronavirus pandemic. The aim of this study is to evaluate the psychological impact of the lockdown in Lebanon. A cross-sectional, online survey was conducted during the lockdown period in order to punctually assess depression, anxiety symptoms as well as eating and substance use disorders using self-rating scales (the DASS-21, SCOFF and CAGE-AID respectively), while identifying factors that might affect those outcomes. Overall, 1133 participants completed the questionnaire. The DASS-21 score was positively correlated with the impact of lockdown on participants' lifestyle and lockdown duration. A highest effect on DASS-21 score was related to the intensity of other stressful life events that have happened during the last 3 months. Linear regression analysis also showed that age, monthly income, professional status, the SCOFF and CAGE-AID scores, the intensity of the lockdown's impact on lifestyle and having been through other stressful life events unrelated to the lockdown per se, were risk factors affecting significantly the DASS-21 score. Lockdown, as well as other stressful life event that have happened during the last 3 months, were therefore associated with higher depression, anxiety, and stress symptoms. These findings may guide future policy making strategies in order to prevent mental health problems in case of a pandemic concomitant with other critical stressors.

Reduction of admissions for urgent and elective pacemaker implant during the COVID-19 outbreak in Northern Italy

AIMS

The coronavirus disease-19 (COVID-19) outbreak has been recently associated with lower hospitalization rates for acute coronary syndromes. Aim of the study was to investigate whether a similar behaviour is observed in admissions for urgent pacemaker implant.

METHODS

This retrospective study included 1315 patients from 18 hospitals in Northern Italy with a high number of COVID-19 cases. Hospitalization rates for urgent pacemaker implant were compared between the following periods: 20 February to 20 April 2020 (case period); from 1 January to 19 February 2020 (intra-year control period); from 20 February to 20 April 2019 (inter-year control period).

RESULTS

The incidence rate of urgent implants was 5.0/day in the case period, 6.0/day in the intra-year control period and 5.8/day in the inter-year control period. Incidence rate in the case period was significantly lower than both the intra-year [incidence rate ratio (IRR): 0.81, 95% CI 0.67-0.99, P = 0.040] and inter-year control periods (IRR: 0.79, 95% CI 0.66-0.95, P = 0.012); this reduction was highest after the national lockdown (IRR 0.68, 95% CI 0.52-0.91, P = 0.009). The prevalence of residents in rural areas undergoing urgent pacemaker implant was lower in the case period (36%) than in both the intra-year (47%, P = 0.03) and inter-year control periods (51%, P = 0.002). Elective pacemaker implants also decreased in the case period, with the incidence rate here being 3.5/day vs. 6.4/day in the intra-year (-45%) and 6.9/day in the inter-year period (-49%).

CONCLUSION

Despite severe clinical patterns, the COVID-19 outbreak has negatively affected the population presentation to Emergency Departments for bradyarrhythmias requiring urgent pacemaker implant in Northern Italy. This mainly occurred after the national lockdown and concerned patients living in rural areas.

An international study on psychological coping during COVID-19: Towards a meaning-centered coping style

BACKGROUND/OBJECTIVE

This study examined the role of different psychological coping mechanisms in mental and physical health during the initial phases of the COVID-19 crisis with an emphasis on meaning-centered coping.

METHOD

A total of 11,227 people from 30 countries across all continents participated in the study and completed measures of psychological distress (depression, stress, and anxiety), loneliness, well-being, and physical health, together with measures of problem-focused and emotion-focused coping, and a measure called the Meaning-centered Coping Scale (MCCS) that was developed in the present study. Validation analyses of the MCCS were performed in all countries, and data were assessed by multilevel modeling (MLM).

RESULTS

The MCCS showed a robust one-factor structure in 30 countries with good test-retest, concurrent and divergent validity results. MLM analyses showed mixed results regarding emotion and problem-focused coping strategies. However, the MCCS was the strongest positive predictor of physical and mental health among all coping strategies, independently of demographic characteristics and country-level variables.

CONCLUSIONS

The findings suggest that the MCCS is a valid measure to assess meaning-centered coping. The results also call for policies promoting effective coping to mitigate collective suffering during the pandemic.

Gender perspective of psychological discomfort during COVID-19 confinement among Spanish adult population: a cross-sectional study

OBJECTIVE

COVID-19 disease has affected more than a hundred countries worldwide and has exposed the population to an increase in mental health problems. The objective of this study was to assess the emotional impact of the pandemic from a gender perspective, as well as to study the modulating variables of that impact.

DESIGN

A descriptive and cross-sectional study through the General Health Questionnaire scale and the Sense of Coherence (SOC) scale is developed.

SETTING

General population of Spain was the target of this study PARTICIPANTS: The sample consisted of 3801 adult subjects living in Spain, without diagnosis for Sars-Cov-2 virus infection during confinement.

INTERVENTION

Data collection was carried out using an online questionnaire, from 26 March 2020 to 26 April 2020.

PRIMARY AND SECONDARY OUTCOMES MEASURES

A sample profile description was obtained, regarding to the study variables. Later, a regression model was implemented in order to test the relationship between these variables, and to achieve a predictive model of psychological discomfort controlling the gender variable.

RESULTS

The results showed that women, as compared with men, had increased psychological discomfort during confinement (t=-12.877; p<0.001; d=0.470). In contrast, significantly higher scores were observed on the SOC scale (t=6.336; p<0.001; d=0.231) in men, as compared with those obtained by women.

CONCLUSIONS

Women have higher levels of psychological discomfort, increased concern about getting infected with COVID-19 and infecting others, as well as a lower level of SOC and perceived health. In addition, low levels of SOC predict greater concern about contagion and increased psychological discomfort.

COVID-19 Pandemic, Personality and Geriatric Population: Proposed Pragmatism

The elderly population is a sensitive and delicate cohort of society who is being compelled to bear the significant smoulders of disruptive social behavior of humankind amidst the COVID-19 pandemic. Our aim for this review was (1) to find out the root of disruption of societal integrity and self-centeredness by analyzing the spokes of HEXACO; (2) to delineate their possible relationships with the formation of Neuroticism and eventually Psychopathy, which have endangered human civilization the most in this pandemic; and (3) to search for the potential ways to get rid of these dark times. The constellation of different negative human behaviors probably originate from the negative deflection of components of the HEXACO model of personality towards the genesis of the dark triad. COVID-19 pandemic and upsurge of the dark triad in the form of Neuroticism, Narcissism and Machiavellianism potentially portend major mental health threats. Cultivation and practice of positive emotions and triumph of honesty, humility and humanity are imperative to save the mankind from the savagery of this pandemic.

Trends in presentations to a private emergency department during the first and second waves of the COVID-19 pandemic in Australia

Objective The COVID-19 pandemic in Australia coincided with an early trend of reduced visits to the emergency department (ED), but to determine which patients presented less requires closer evaluation. Identifying which patient groups are presenting less frequently will provide a better understanding of health care utilisation behaviours during a pandemic and inform healthcare providers of the potential challenges in managing these groups. Methods This single-centre retrospective study examined trends in presentations in 2020 to a private, mixed paediatric and adult ED in an inner city suburb within the state of Victoria that treats both COVID-19 and non-COVID-19 patients. The 2019 dataset was used as a reference baseline for comparison. All analyses were performed using baseline characteristics and triage data. Results The total number of visits to the ED dropped from 24 775 in 2019 to 22 754 in 2020, representing an overall reduction of 8%. Significant reductions in daily presentations and admissions from the ED were observed in the months immediately following the peak of the two COVID-19 waves in the state of Victoria. Visits by those in the 0- to 17-year age group, triage categories 4 and 5 and musculoskeletal presentations were also reduced for most of 2020. Gastrointestinal/abdominal and urological/renal presentations were reduced immediately after the first COVID-19 wave, whereas infectious diseases visits were reduced during and after the second COVID-19 wave. Conclusions These findings add to the growing body of evidence regarding emergency care underutilisation during the COVID-19 pandemic. Reduced private ED presentations were observed overall and in paediatric patients, lower acuity triage categories, musculoskeletal, abdominal/gastrointestinal and urological/renal presentations during the first wave, whereas infectious disease cases were reduced during the second wave. What is known about the topic? During the first and second waves of COVID-19 in Victoria, ED visits were reduced in the public sector across all diagnostic categories and all triage categories. The effect of the COVID-19 pandemic on private ED attendance is less well known. What does this paper add? Total visits to the private ED during the first and second waves of COVID-19 were reduced across all major diagnostic categories except cardiac presentations. During this same period, visits for triage categories 4 and 5 were significantly reduced. What are the implications for practitioners? ED underutilisation during the initial two waves of the COVID-19 pandemic is apparent in both the private and public sector. Patients should be encouraged not to delay seeking urgent medical care during the pandemic.

Trauma exposure and the PTSD symptoms of college teachers during the peak of the COVID-19 outbreak

This study aimed to explore influencing factors for the psychological impact of coronavirus disease 2019 (COVID-19) on Wuhan college teachers, posttraumatic stress symptoms in particular, so as to inform evidence-based strategy development to ameliorate such adverse impacts. An online survey was conducted from 26 to 29 April 2020, and 1650 teachers (47.54% male; M = 40.28 years, SD = 8.3 years) enrolled in Wuhan universities and colleges participated. The results showed that the overall incidence of posttraumatic stress disorder (PTSD) among college teachers was as high as 24.55%, but the average level of PTSD score was low (M = 1.06, SD = 0.72). Logistic regression analysis showed that for those with confirmed COVID-19, the ratio was much higher, up to 2.814 (95% confidence interval [CI]: [1.542, 5.136], p < 0.001); that is, compared with those without symptoms, the ratio of PTSD increased by 181%. For those who had family members or relatives who died of COVID-19, the ratio was 5.592 (95% CI: [2.271, 13.766], p < 0.001), 459% higher than those who had no one who died. But the living places during the pandemic had no significant effect on PTSD. The findings suggest that mental health services reducing PTSD should be provided. Teachers who confirmed COVID-19 or lost loved ones to COVID-19 should be given particular care.