COVID-19 pandemic related long-term chronic stress on the prevalence of depression and anxiety in the general population

Longitudinal associations of depression, anxiety, and stress among healthcare workers assisting patients with end-stage cancer during the COVID-19 pandemic: the moderator role of emotional exhaustion

BACKGROUND

This study aimed to analyze the moderating role of emotional exhaustion in the relationships between longitudinal associations of depression, anxiety, and stress among healthcare workers assisting end-of-life cancer patients during the COVID-19 pandemic.

METHODS

A longitudinal study involving a final sample of 122 healthcare workers (61.5% females, mean age = 39.09 ± 11.04 years) was conducted. These participants completed the Maslach Burnout Inventory (MBI) and the Depression Anxiety Stress Scales-21 (DASS-21).

RESULTS

Results of correlation analysis showed that emotional exhaustion was correlated with both T1 and T2 measures of depression, anxiety, and stress. Results of the moderation analysis indicated that emotional exhaustion moderated the relationships between consecutive measures of depression and anxiety. Each of the moderation models explained about half of the variance for depression and anxiety. When considering stress, results did not show a moderating role for emotional exhaustion.

CONCLUSIONS

Overall, the results of this study highlight that emotional exhaustion moderated depression and anxiety over time. Psychological interventions to promote psychological mental health among healthcare workers assisting patients with end-stage cancer should carefully consider these findings.

Mental health, COVID-19 burden and quality of life of kidney transplant recipients two years after the COVID-19 pandemic

Introduction

Few studies have evaluated the psychological distress of COVID-19 in kidney transplantation and the psychological impact that the COVID-19 pandemic has had on kidney transplant recipients is not yet well understood. The present study aimed to investigate the change in symptom burden and health-related quality of life in the two years after initial assessment, by outlining the change over time of symptoms at 12 and 24 months of follow-up.

Methods

This is a follow-up study. We performed a study published in 2021 (phase 1 of COVID-19); of the 89 kidney transplant recipients evaluated in this study, 60 completed the 12 months follow-up (March 2021 June 2021, phase 2 of COVID-19) and 57 completed the 24 months follow-up (March 2022 June 2022, post COVID-19). The same tools as in previous study were administered: the ad hoc questionnaire on emotional state and psychophysical well-being during COVID-19, the Middlesex Hospital Questionnaire (MHQ) to provide a simple and rapid quantification of the psychological and somatic symptoms and the Short Form Health Survey 36 (SF-36) was used to assess health-related quality of life.

Results

Compared to the first and second phase of COVID-19, the mean score of quality of life variables were higher in the post COVID-19 phase; thus the recipients physical health, mental health and their perception of their general health improved. Regarding the psychopathology variables the levels of Anxiety, Depression and Phobia in the Post COVID-19 phase decreased, while the Somatization score was higher. Lastly, burden of COVID-19 scores in the third phase, significantly decreased.

Discussion

Our study highlights a significant association between mental health and the burden of COVID-19 pandemic in kidney transplant recipients. This study showed, a significant worsening, over time, of some specific symptoms, such as somatization and phobias. However, the results showed that depressive symptoms improved during the study period. Long-term monitoring of kidney transplant recipients therefore remains fundamental. These results confirmed the need to provide integrated multidisciplinary services to adequately address the long-term effects of the COVID-19 pandemic on the mental health of the most vulnerable subjects.

Coronavirus Disease 2019 Pandemic-Related Long-Term Chronic Impacts on Psychological Health of Perinatal Women in China

OBJECTIVES

 The coronavirus disease 2019 (COVID-19) pandemic has caused far-reaching changes in all areas of society. However, limited data have focused on the long-term impacts on perinatal psychological health. This study aims to evaluate long-term impacts of COVID-19 pandemic crisis on psychological health among perinatal women and investigate associated factors.

STUDY DESIGN

 A multicenter, cross-sectional study, the psychological subproject of China Birth Cohort Study (CBCS), was conducted in 2021. Demographic and obstetric characteristics, pregnancy outcomes, psychological status, and COVID-19-pandemic-related factors were obtained. The symptoms of depression, anxiety, and insomnia of participants were assessed by Patient Health Questionnaire, Edinburgh Postpartum Depression Scale, Generalized Anxiety Disorder Scale, and Insomnia Severity Index, respectively. Multivariate logistic regression was used to identify associated factors of adverse psychological symptoms.

RESULTS

 Totally, 1,246 perinatal women were enrolled, with the overall prevalence of depression, anxiety, and insomnia symptoms being 63.16, 41.89, and 44.38%, respectively. Perinatal women who needed psychological counseling and were very worried about the COVID-19 pandemic were 1.8 to 7.2 times more likely to report symptoms of depression, anxiety, and insomnia. Unemployment, flu-like symptoms, younger maternal age, and previous diseases before pregnancy were risk factors for depression, anxiety, or insomnia.

CONCLUSION

 Our study revealed that the prevalence of perinatal depression, anxiety, and insomnia symptoms was at a high level even 1 year after the pandemic outbreak, implying pandemic-associated long-term psychological impacts on perinatal women existed. Government should not only pay attention to the acute effects of psychological health but also to long-term psychological impacts on perinatal women after major social events.

KEY POINTS

· The prevalence of perinatal psychological symptoms was at a high level after the COVID-19 outbreak.. · Perinatal women who were very worried about COVID-19 were more often to have psychological symptoms.. · Perinatal women with demands of mental counseling were more likely to report psychological symptoms..

The change of psychosocial stress factors in families with infants and toddlers during the COVID-19 pandemic. A longitudinal perspective on the CoronabaBY study from Germany

Background

Over nearly three years, the COVID-19 pandemic has had a lasting impact on people's lives and mental health worldwide with its far-reaching restrictions and concerns about infections and other personal consequences. Families were particularly affected and showed increased stress and psychological problems. Long-term effects cannot be ruled out. So far, data on young families are sparse. The present longitudinal analysis (n = 932) of the CoronabaBY study investigated the development of parenting stress, parental affective symptoms, and child's mental health in young families with children aged 0-3 years in Germany as well as potential influencing factors.

Methods

The observational study includes two measurement points over the course of the pandemic (baseline and follow-up). Data was collected by app using standardized questionnaires.

Results

N = 932 participants, mainly mothers (94.7%) born in Germany (93.1%) with higher education (61.3% with at least high school diploma) and a comfortable financial situation participated in the longitudinal study. Children were on average 14.7 months old at baseline (SD: 12, range: 1-39 months). While the proportion of parents who perceived the pandemic as stressful decreased significantly from baseline (60%) to follow-up (52.3%), the proportion with parenting stress increased significantly (from 40.1% to 45.4%). Both parental and child mental health problems remained constant over time, with infants crying/feeding/sleeping problems ranging above pre-pandemic comparative data. Most predictive for high parenting stress at follow-up was high parenting stress at baseline. This was also true for parental affective symptoms (depression/anxiety) and child mental health problems.

Conclusions

Despite faded pandemic restrictions, parents remained burdened. Support services do not appear to have been sufficient to help families out of their stressful situation. Our results indicate a need for action regarding low-threshold services that effectively reach affected families.

Trial registration

The study was pre-registered in OSF (https://osf.io/search/?q=tksh5&page=1).

Examining the Effect of SARS-CoV-2 Pandemic-Induced Stress and Anxiety on Humoral Immunity in Health Care Workers

OBJECTIVE

The effect of stress on vaccine-induced humoral immunity and therapeutic interventions to mitigate pandemic-related stress remain underexplored.

METHOD

Participants in a longitudinal cohort study ( n = 189) completed a validated measure, GAD-7, and 10-instrument stress measure to assess stress and anxiety after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Serum was collected to obtain SARS-CoV-2 antibody titer levels.

RESULTS

Participants experienced increased stress due to the SARS-CoV-2 pandemic with a positive correlation between GAD-7 scores and peak antibody titers overall; however, there was a negative association with scores commensurate with severe anxiety. Health care workers and younger participants were more significantly affected by anxiety.

CONCLUSIONS

Mild anxiety levels may have immune-enhancing effects, whereas severe anxiety may cause antibody generation reduction. Mental health-focused interventions are imperative for younger adults and health care workers. Young adults may be more resilient to increased stress levels.

Wearable and Implantable Cortisol-Sensing Electronics for Stress Monitoring

Cortisol is a steroid hormone that is released from the body in response to stress. Although a moderate level of cortisol secretion can help the body maintain homeostasis, excessive secretion can cause various diseases, such as depression and anxiety. Conventional methods for cortisol measurement undergo procedures that limit continuous monitoring, typically collecting samples of bodily fluids, followed by separate analysis in a laboratory setting that takes several hours. Thus, recent studies demonstrate wearable, miniaturized sensors integrated with electronic modules that enable wireless real-time analysis. Here, the primary focus is on wearable and implantable electronic devices that continuously measure cortisol concentration. Diverse types of cortisol-sensing techniques, such as antibody-, DNA-aptamer-, and molecularly imprinted polymer-based sensors, as well as wearable and implantable devices that aim to continuously monitor cortisol in a minimally invasive fashion are discussed. In addition to the cortisol monitors that directly measure stress levels, other schemes that indirectly measure stress, such as electrophysiological signals and sweat are also summarized. Finally, the challenges and future directions in stress monitoring and management electronics are reviewed.

Cross-sectional analysis reveals COVID-19 pandemic community lockdown was linked to dysregulated cortisol and salivary alpha amylase in children

The COVID-19 pandemic altered everyday life starting in March 2020. These alterations extended to the lives of children as their normal routines were disrupted by community lockdowns, online learning, limited in-person social contact, increased screen time, and reduced physical activity. Considerable research has investigated the physical health impact of COVID-19 infection, but far fewer studies have investigated the physiological impact of stressful pandemic-related changes to daily life, especially in children. The purpose of this study was to leverage an ongoing clinical trial to investigate physiological consequences associated with chronic stress of pandemic community lockdown on children. As a part of the clinical trial, children provided saliva samples. Saliva samples were analyzed for cortisol and salivary alpha amylase (sAA) content. This secondary cross-sectional analysis included 94 preadolescent children located within the Greater Boston, Massachusetts community. Children participated in the study either before, during, or following the pandemic community lockdown to form three groups for comparison. In response to chronic stress caused by the pandemic community lockdown, participants demonstrated dysregulation of fast-acting catecholamine response of the locus-coeruleus-norepinephrine system and slower-acting glucocorticoid response, resulting in an asymmetrical relationship of hypocortisolism (M = 0.78 ± 0.19 μg/mL, p < 0.001) paired with higher sAA (M = 12.73 ± 4.06 U/mL, p = 0.01). Results suggest that the abrupt COVID-19 disruption to daily life, including the stressful experience of community lockdown, had physiological effects on typically developing children. Further research is required to investigate mental health outcomes of children following the chronic stress of the pandemic community lockdown.

Insights into frontline healthcare workers' mental health amidst COVID-19 - Sources of workplace worries and coping strategies

Introduction

This study was aimed to measure the prevalence of depression, anxiety, and stress as well as to evaluate the associations of these mental disorders with sociodemographic factors, workplace worries, and coping strategies among frontline HCWs in Kuala Lumpur, Malaysia during the COVID-19 pandemic.

Methods

A cross-sectional study was conducted in a tertiary teaching hospital in Kuala Lumpur, Malaysia. Sociodemographic data questionnaire, Depression, Anxiety, and Stress Scale 21, sources of workplace worries questionnaire, and Brief-COPE inventory were randomly distributed to frontline HCWs who worked at the medical, emergency, and anaesthesiology departments. Data were analyzed using Chi-square tests and multivariable linear regression analysis.

Results

A total of 137 frontline HCWs responded to the questionnaires. The prevalence of depression, anxiety, and stress was 69.3%, 77.4%, and 57.7%, respectively. None of the sociodemographic characteristics was associated with depression, anxiety, and stress. Depression was associated to all sources of workplace worries, except "fear of getting infected" (p = 0.089), while anxiety and stress were associated with all sources of workplace worries. Humour (β = 0.821), self-blame (β = 0.686), denial (β = 0.676), substance use (β = 0.835), and behavioural disengagement (β = 0.583) were positively correlated to depression. However, active coping (β = -0.648) and acceptance (β = -0.602) were negatively correlated to depression. On the other hand, active coping (β = 0.913), planning (β = 0.879), acceptance (β = 0.831), religion (β = 0.704), and self-distraction (β = 0.929) were positively correlated to stress. Only substance use (β = -0.417) was negatively correlated to stress. All coping strategies did not correlate to anxiety.

Conclusion

The high prevalence of depression, anxiety and stress is attributed by the various sources of workplace worries and the inappropriate coping strategies among the frontline HCWs. Measures that minimise workplace worries and inappropriate coping strategies must be implemented promptly.

COVID and depression among stratified population groups: a narrative review

The Covid-19 pandemic has impacted and infiltrated every aspect of our lives. Successive lockdowns, social distancing measures, and reduction in economic activity have developed a new way of living and, in many cases, tend to lead to depression. The initial strict lockdown for about 3 months and eventually for a few more months has imposed greater challenges on children and adolescents in terms of psychological problems and psychiatric disorders. Regardless of their viral infection status, many people have been affected by the psychosocial changes associated with the Covid-19 pandemic. In the present review, we have attempted to evaluate the impact of COVID on the mental health of people from different age groups and occupations. The present review has highlighted the need for taking effective measures by the stakeholder to cope with depression among human population groups worldwide.

Sleep disturbance and anxiety symptoms among asymptomatic COVID-19 carriers in Shanghai, China: the mediating role of entrapment and defeat

BACKGROUND

The COVID-19 pandemic increases the risk of psychological problems, especially for the infected population. Sleep disturbance and feelings of defeat and entrapment are well-documented risk factors of anxiety symptoms. Exploring the psychological mechanism of the development of anxiety symptoms is essential for effective prevention. This study aimed to examine the mediating effects of entrapment and defeat in the association between sleep disturbance and anxiety symptoms among asymptomatic COVID-19 carriers in Shanghai, China.

METHODS

A cross-sectional study was conducted from March to April, 2022. Participants were 1,283 asymptomatic COVID-19 carriers enrolled from the Ruijin Jiahe Fangcang Shelter Hospital, Shanghai (59.6% male; mean age = 39.6 years). Questionnaire measures of sleep disturbance, entrapment, defeat, anxiety symptoms, and background characteristics were obtained. A mediation model was constructed to test the mediating effects of entrapment and defeat in the association between sleep disturbance and anxiety symptoms.

RESULTS

The prevalence rates of sleep disturbance and anxiety symptoms were 34.3% and 18.8%. Sleep disturbance was positively associated with anxiety symptoms (OR [95%CI] = 5.013 [3.721-6.753]). The relationship between sleep disturbance and anxiety symptoms (total effect: Std. Estimate = 0.509) was partially mediated by entrapment (indirect effect: Std. Estimate = 0.129) and defeat (indirect effect: Std. Estimate = 0.126). The mediating effect of entrapment and defeat accounted for 50.3% of the association between sleep disturbance and anxiety symptoms.

CONCLUSION

Sleep disturbance and anxiety symptoms were prevalent among asymptomatic COVID-19 carriers. Entrapment and defeat mediate the association between sleep disturbance and anxiety symptoms. More attention is needed to monitoring sleep conditions and feelings of defeat and entrapment to reduce the risk of anxiety.

Anxiety, insomnia and family support in nurses, two years after the onset of the pandemic crisis

Introduction

The Covid-19 pandemic continues to cause serious physical and mental problems for health professionals, particularly nurses.

Aim

To estimate the prevalence of anxiety and insomnia and to evaluate their possible association with family support received by nurses two years after the onset of the pandemic.

Materials and methods

In total, the study participants were 404 nurses (335 females and 69 males) with a mean age of 42.88 (SD = 10.9) years and a mean of 17.96 (SD = 12) years working as nurses. Nurses from five tertiary hospitals in Athens constituted the study population who completed the questionnaires State-Trait Anxiety Inventory (STAI), Athens Insomnia Scale (AIS) and Family Support Scale (FSS), in the months of November and December 2021. Regarding demographic and occupational characteristics, gender, age and years of experience as nurses were recorded.

Results

60.1% of the nurses showed abnormal scores in state anxiety, with 46.8% in trait anxiety, and 61.4% showed insomnia. Women showed higher scores on the two subscales of anxiety and the insomnia scale compared to men (p < 0.01 and p < 0.05 respectively), while they showed a lower score on the FSS without statistical significance (p > 0.05). Positive correlations (p < 0.01) were found between the State Anxiety Inventory, Trait Anxiety Inventory and AIS, while all of them showed a high negative correlation with FSS (p < 0.01). Age showed a negative correlation with Trait Anxiety Inventory (p < 0.05). As shown by the mediation analysis, the relationship between state anxiety and insomnia was mediated by trait anxiety, whereas state anxiety appeared to be dependent on family support.

Conclusions

Nurses continue to experience high levels of anxiety and insomnia and feel less supported by their families than in the first year of the pandemic. Insomnia appears to be dependent on state anxiety, with a significant indirect effect of trait anxiety, while family support seems to affect state anxiety.

Worse psychological traits associated with higher probability of emotional problems during the Omicron pandemic in Tianjin, China

Background and Objectives

Individuals with specific psychological weaknesses are prone to mental problems during the coronavirus pandemic. This self-rating study assessed the combined effects of infection-related stress, resilience, worry, and loneliness on the likelihood of depression and anxiety among infected and non-infected individuals during the Tianjin Pandemic in 2022.

Methods

Individuals infected with Omicron (n = 249) and health residents (n = 415) were recruited from two hospitals and communities in Tianjin. Each respondent completed the following on-site assessment: Self-developed Scale of Demographics, Zung Self-Rating Depression Scale (SDS), Zung Self-Rating Anxiety Scale (SAS), the Connor-Davidson Resilience Scale (CD-RISC), De Jong Gierveld Scale (DJGLS), and the Penn State Worry Questionnaire (PSWQ). The respondents were categorized into depression or non-depression group by SDS scores, and anxiety or non-anxiety group by SAS scores.

Results

The overall scores of CD-RISC, DJGJLS, and PSWQ were significantly different both between the depression group and non-depression groups and between the anxiety group and non-anxiety groups. The greater likelihood of depression was associated with lower overall scores of CD-RISC and higher scores of PSWQ; the greater likelihood of anxiety was associated with higher scores of PSWQ. The likelihood of depression was also positively associated with having infection-related stress and three demographics.

Conclusions

This on-site study demonstrates the importance of specific traits in a small-scale pandemic: the worse resilience and the greater worry propensity related to the higher probability of depression, and the greater propensity of worry related to the higher probability of anxiety. Moreover, those experiencing infection-related stress, being male, living alone, and being unemployed are more likely to have depressive problems.

Stuck in a Rut of Thought-That Is Just a Barrier: Dysfunctional Metacognitive Beliefs, Limitation on Individual Freedom and Well-Being of Adolescents during COVID-19 Lockdown

BACKGROUND

The aim of the cross-sectional study was to conduct an exploratory analysis of identifying factors related to mood, metacognitive beliefs, and limitation on individual freedom associated with lockdown restrictions during COVID-19, and to determine whether they may be relevant to the deteriorating well-being of adolescents.

METHODS

A total of 387 adolescents (M = 15.37; SD = 1.62): 85 with depression (DG) and 302 without any psychiatric diagnosis group (WPDG) were examined using the health survey and the CDI-2 questionnaire to assess the symptoms and severity of depression and MCQ-A to measure the intensity of dysfunctional metacognitive beliefs.

RESULTS

The feeling of restriction of freedom had an influence on worsened well-being in the whole group of responders OR = 4.15; p < 0.001 but was more in the DG than the WPDG (OR = 20.00; p < 0.001 vs. OR = 4.77; p < 0.001). Positive metacognitive beliefs were related to well-being (DG), but no effect was observed in the WPDG (OR = 0.88; p < 0.05 vs. OR = 1.05; p = 0.136). The lower age of the WPDG negatively impacted well-being (OR = 1.20; p < 0.05).

CONCLUSIONS

Dysfunctional metacognitive beliefs and the feeling of restriction of freedom are important in the deterioration of adolescents' well-being, but these factors have a stronger impact on well-being in the DG.

Recurrent COVID-19 Waves and Lockdown: Impact on Daily Life and Mental Health of People in Nepal

Background. Lockdown is recognized as an effective measure in limiting the spread of coronavirus (COVID-19) throughout the world. However, recurrent COVID-19 infection and the extension of lockdown have threatened the livelihoods of people, mainly socioeconomic and mental health dimensions. Objective. The present study is aimed at identifying the impact of COVID-19 lockdown on the daily life and mental health of the general population of Nepal. Furthermore, the study identified the predictors of the mental health status of the people during COVID-19 lockdown. Methods. The study was conducted among 354 Nepalese people specifically the breadwinner of the family. Respondents completed the questionnaires related to the sociodemographic characteristics, COVID-19, and its impact on various aspects of life, including mental health via Depression, Anxiety, and Stress Scale-21 items (DASS-21). Data was collected through the web-based method, Google Forms questionnaire. Respondents were contacted through email and social networks (Facebook, Messenger, WhatsApp, and Viber) following a snowball approach. Data was analyzed using descriptive and inferential statistics. Logistic regression analysis was done to identify significant demographic, COVID-related, and socioeconomic factors associated with mental health outcomes. Results. Based on DASS-21 scores, the prevalence of depression, anxiety, and stress was 46.6% (mild: 22.3%, moderate: 16.7%, severe: 6.5%, and extremely severe: 1.1), 42.1% (mild: 10.2%, moderate: 18.6%, severe: 11.6%, and extremely severe: 1.7%), and 39% (mild: 16.7%, moderate: 12.7%, and severe: 9.6%), respectively. Various factors associated with COVID-19, its lockdown measures, and sociodemographic characteristics of the people were identified as the significant predictors of depression, anxiety, and stress among the general population of Nepal. Conclusion. The impact of COVID-19 lockdown on individuals’ work, income, education, living standard, lifestyle, and consequently mental health is significant. The study findings warrant the importance of understanding the impact of the COVID-19 pandemic on individuals’ all aspects of life and timely monitoring and appropriate intervention on risk groups to reduce the severity and chronicity of mental health problems.

Psychometric properties of the traditional Chinese version of the COVID Stress Scales in Hong Kong

Introduction

The COVID Stress Scales (CSS) assess six domains of COVID-19-related stress, including (a) COVID danger, (b) COVID socioeconomic consequences, (c) COVID xenophobia, (d) COVID contamination, (e) COVID traumatic stress symptoms, and (f) COVID compulsive checking. Although the CSS have been validated in various cultural contexts, their psychometric properties in Hong Kong have not been examined. This study endeavors to validate the traditional Chinese version of the 36-item CSS (CSS-36) and the 18-item CSS (CSS-18) in Hong Kong.

Method

Participants were 521 Hong Kong undergraduate students (61% female) aged from 18 to 26 years (M = 20.65, SD = 1.56). An online questionnaire was used for data collection.

Results

The results of confirmatory factor analyses supported a six-factor structure for both the CSS-36 and the CSS-18. Multiple-group confirmatory factor analyses established the gender invariance of the six-factor model for both the CSS-36 and the CSS-18. The CSS-36 and the CSS-18 exhibited good internal consistency reliability and concurrent validity with fear of COVID-19 and negative emotional states.

Discussion

The findings offer evidence for the psychometric properties of the traditional Chinese version of the CSS-36 and the CSS-18 in the Hong Kong context.

Evolution of burnout and psychological distress in healthcare workers during the COVID-19 pandemic: a 1-year observational study

BACKGROUND

Long-term psychological impacts of the COVID-19 pandemic on healthcare workers remain unknown. We aimed to determine the one-year progression of burnout and mental health since pandemic onset, and verify if protective factors against psychological distress at the beginning of the COVID-19 pandemic (Cyr et al. in Front Psychiatry; 2021) remained associated when assessed several months later.

METHODS

We used validated questionnaires (Maslach Burnout Inventory, Hospital Anxiety and Depression and posttraumatic stress disorder [PTSD] Checklist for DSM-5 scales) to assess burnout and psychological distress in 410 healthcare workers from Quebec, Canada, at three and 12 months after pandemic onset. We then performed multivariable regression analyses to identify protective factors of burnout and mental health at 12 months. As the equivalent regression analyses at three months post-pandemic onset had already been conducted in the previous paper, we could compare the protective factors at both time points.

RESULTS

Prevalence of burnout and anxiety were similar at three and 12 months (52% vs. 51%, p = 0.66; 23% vs. 23%, p = 0.91), while PTSD (23% vs. 11%, p < 0.0001) and depression (11% vs. 6%, p = 0.001) decreased significantly over time. Higher resilience was associated with a lower probability of all outcomes at both time points. Perceived organizational support remained significantly associated with a reduced risk of burnout at 12 months. Social support emerged as a protective factor against burnout at 12 months and persisted over time for studied PTSD, anxiety, and depression.

CONCLUSIONS

Healthcare workers' occupational and mental health stabilized or improved between three and 12 months after the pandemic onset. The predominant protective factors against burnout remained resilience and perceived organizational support. For PTSD, anxiety and depression, resilience and social support were important factors over time.

The study strategies of small liberal arts college students before and after COVID-19

Research has clearly demonstrated that some study strategies (for example, self-testing and spaced studying) are effective, yet students often report studying ineffectively. Our focus with the current study is to update and extend the current literature on how college students study. We surveyed 484 introductory psychology students at a small liberal arts college-a different type of school from prior studies. Our survey built on an existing study strategies questionnaire used to assess a variety of student study behaviors and beliefs. Additionally, we asked new questions about multitasking and study scheduling. Overall, we found that the current sample reported studying in similar ways to what past research suggested; students used both effective and ineffective strategies, some of which correlated with grade point average (GPA). However, some differences emerged. For example, our students were more likely to report learning how to study from a teacher. Additionally, a majority of students believed that multitasking was ineffective, yet most reported multitasking while studying. Finally, an important, but exploratory, analysis demonstrated that study strategies were similar before and after COVID-19 forced classroom changes. We highlight the need for future research on study strategies to recruit participants from more diverse institutions.

High prevalence and risk factors of dropout intention among Chinese medical postgraduates

BACKGROUND

A high attrition rate in medical students has exacerbated the physician shortage in China. However, few studies have explored the risk factors of dropout intention in medical postgraduates. This study compared the prevalence of dropout intention and mental distress between medical and non-medical postgraduates in China and investigated risk factors for dropout intention. This study also explored the impact of medical postgraduates' perception of the Chinese healthcare environment on their mental status and dropout intention.

METHODS

This cross-sectional study was conducted using online questionnaires from October 2020 to April 2021. Convenience sampling was used to recruit postgraduates in different majors. Outcomes included dropout intention and potential risk factors, including mental distress, quality of life, and fatigue. Medical postgraduates were additionally assessed for healthcare environment satisfaction, burnout, career choice regret, and experiences of workplace violence. A logistic regression model was constructed to evaluate the association between dissatisfaction, mental distress, and turnover intention.

RESULTS

A total of 740 medical and 670 non-medical postgraduates participated in the survey. The rates of depression symptoms (33.8% vs. 39.0%, p < 0.001), anxiety symptoms (22.2% vs. 32.4%, p < 0.001), and somatic symptoms (34.7% vs. 42.4%, p = 0.004) were lower in medical postgraduates, while more medical postgraduates (58.4% vs. 48.4%, p < 0.001) reported dropout intention. Dissatisfaction with the healthcare environment (odds ratio [OR]: 1.65; 95% confidence interval [CI]: 1.17-2.34, p = 0.005), career choice regret (OR: 6.23; 95% CI: 4.42-8.78, p < 0.001), and high perceived stress (OR: 2.74; 95%CI: 1.90-3.94, p < 0.001) remained independently associated with turnover intention.

CONCLUSIONS

Mental distress is common among postgraduates, calling for timely interventions. Medical postgraduates reported higher turnover intention. Healthcare environment perception also affected the mental health and dropout intentions of medical students. A decent future income, reduced workload, shorter duration medical training, and better doctor-patient relationships are urgently needed.

Living alone is associated with a higher prevalence of psychiatric morbidity in a population-based cross-sectional study

Background

Living alone has been linked to poor mental health, however large-scale epidemiological studies on the association between living alone and psychiatric morbidity including depression and anxiety are lacking. The aim of this study was to investigate this issue in a large Taiwanese cohort.

Methods

In this cross-sectional study, we enrolled 121,601 volunteers from 29 community recruitment stations in Taiwan and divided them into two groups based on whether or not they lived alone. Psychiatric morbidity was defined as a Generalized Anxiety Disorder 2-item score ≥ 3, Patient Health Questionnaire 2-item score ≥ 3, or self-reported depression. Logistic regression was used to explore the associations between living alone and psychiatric morbidity.

Results

The participants who lived alone had a higher prevalence of psychiatric morbidity [odds ratio (OR) = 1.608, 95% confidence interval (CI) = 1.473 to 1.755] after adjusting for potential confounders. In a subgroup analysis, married subjects who lived alone and divorce/separation (OR = 2.013, 95% CI = 1.763 to 2.299) or widowing (OR = 1.750, 95% CI = 1.373 to 2.229) were more likely to have psychiatric morbidity than those who were married and not living alone.

Conclusions

Our findings suggest that living alone is a risk factor for psychiatric morbidity, especially for married subjects who live alone in concordance with divorce, separation, or the death of a spouse.

Factors associated with depressive symptomatology during the COVID-19 pandemic in Mexico: A 2021 national survey

BACKGROUND

Previous studies have identified a set of variables associated with depression during the COVID-19 pandemic. However, the existing antecedents in Mexico, in addition to being limited to the beginning of the health emergency, made use of small and unrepresentative samples. Therefore, the aim of the present study was to identify the prevalence and factors associated with clinically significant depressive symptomatology (CSDS) in a representative Mexican sample of 2021.

METHODS

A secondary cross-sectional analysis of the Encuesta Nacional de Bienestar Autorreportado (ENBIARE) was conducted. For the present study, the effective sample was 30,901. Univariate and bivariate anaylses were followed by a multiple Poisson regression, which served to obtain adjusted prevalence ratios of each variable under study.

RESULTS

The prevalence of CSDS in the year 2021 was 15.3 %. In the multivariable analysis, the factors associated with CSDS were the number of recent stressful events, having a major functional limitation, not having social support from family or friends, being female, having suffered recent discrimination, alcohol or other drug use (by oneself or someone at home), not being married or cohabiting, living in a rural area, having had a diagnosis of COVID-19, having lost a job, living with a chronic patient, not doing physical exercise, and having a low educational level.

LIMITATIONS

The main limitations were the cross-sectional nature of the data, the use of self-report measures, as well as the fact that this was a secondary analysis that did not allow consideration of additional variables.

CONCLUSIONS

A set of personal and contextual variables were identified that can help focus prevention and intervention efforts on the phenomenon of depression.

Sense of Control and Depression during Public Health Restrictions and the COVID-19 Pandemic

Depression rates have increased significantly since the onset of the COVID-19 pandemic, with a number of factors implicated in this increase, including stress, fear, social isolation and the psychological impact of public health restrictions. The main purpose of the current cross-sectional survey study was to examine the relationship between the experience of public health restrictions, the sense of control and depression, both during and after restrictions were lifted. A survey methodology was chosen, with data collected in the Republic of Ireland at two time points (January 2022 and May 2022). Time 1 participants (n = 314) were invited to repeat the measures 5 months later, with 172 agreeing to be recontacted, and 47 participants completing all measures at two time points. Findings showed that both the sense of control, in relation to perceived constraints, w = 0.43, and the experience of restrictions, w = 0.14, predicted depression at Time 1. Participants were less likely to be depressed at Time 2 and had a stronger sense of control. The Time 1 sense of control through perceived constraints predicted depression at Time 2, w = 0.45. Overall, these data show that public health restrictions and the sense of control are linked and that the sense of control has a powerful and long-lasting effect on depression status in restricted conditions, even once these have been lifted.

The emotional-behavioral state of Israeli adolescent and young adult females with anorexia nervosa during the COVID19 pandemic

BACKGROUND

During the COVID-19 pandemic in Israel, the number of patients with eating disorders (EDs) seeking treatment increased significantly. The present study sought to evaluate whether, during the pandemic (2020-21), patients with anorexia nervosa (AN) would show more ED-related, comorbid, and COVID-19-related symptoms in comparison to a naturalistic control group, and whether differences would be found between adult and adolescent patients with AN. We also examined attitudes to telemedicine use during the pandemic in patients receiving long-distance interventions.

METHODS

Using online self-report questionnaires, we assessed general and COVID-19-specific symptoms with a secure digital platform (REDCap^®) in 36 female adolescents with AN, 35 female adults with AN, and 25 female controls.

RESULTS

Compared with controls, patients with AN showed more symptoms of EDs, anxiety, depression, and post-traumatic stress disorder (PTSD), elevated suicidal ideation, more COVID-related emotional-behavioral disturbances, and lower resilience. Adult patients with AN fared worse than adolescent patients on most of these measures. Adult patients using telemedicine during the COVID-19 pandemic showed fewer positive attitudes toward this treatment than adolescents (telemedicine was offered to all, but used by 18/35 adolescents and 21/36 adults with AN). Last, elevated COVID-19-related symptomatology was correlated with more symptoms of ED, anxiety, depression and PTSD, and with lower resilience.

CONCLUSIONS

Our findings suggest that the emotional-behavioral state of Israeli females with AN, particularly adults, was worse during the COVID-19 pandemic in comparison to controls. Many patients did not use telemedicine for their treatment. Adult patients using telemedicine were less satisfied with it than adolescent patients.

Emotion-focused coping mediates the relationship between COVID-related distress and compulsive buying

Background and aims

COVID-19 posits psychological challenges worldwide and has given rise to nonadaptive behavior, especially in the presence of maladaptive coping. In the current study, we assessed whether the relationship between COVID-related distress and compulsive buying is mediated by task-focused and emotion-focused coping. We also examined whether these associations were invariant over time as the pandemic unfolded.

Methods

Self-report surveys were administered online in the United States in the first six months of the pandemic (March–October 2020) in sampling batches of 25 participants every three days, resulting in a total sample of N = 1,418 (40% female, mean age = 36.6). We carried out structural equation modeling to assess whether the relationship between distress related to COVID-19 and compulsive buying is mediated by task-focused and emotion-focused coping. Time was used as a grouping variable based on events related to the pandemic in the U.S. to calculate model invariance across three time periods.

Results

The results indicated significant mediation between distress, emotion-focused coping, and compulsive buying, but not between task-focused coping and compulsive buying. The mediation model showed excellent fit to the data (χ² = 1119.377, df = 420, RMSEA = 0.059 [0.055–0.064], SRMR = 0.049, CFI = 0.951, TLI = 0.947). Models were not invariant across the three examined time periods.

Conclusions

Our results indicate that compulsive buying is more likely to occur in relation to emotion-focused coping as a response to COVID-related distress than in relation to task-focused coping, especially during periods of increasing distress. However, model paths varied during the course of the pandemic.

Intravenous Thrombolysis for Acute Ischemic Stroke during the COVID-19 Pandemic-Polish Single-Center Retrospective Cohort Study

COVID-19 has affected the entire world and has had a great impact on healthcare, influencing the treatment of patients with acute ischemic stroke (AIS). The aim of this study was to determine the impact of the COVID-19 pandemic on the care of patients with AIS. We performed a retrospective analysis of 1599 patients diagnosed with AIS and hospitalized in the authors' institution from January 2018 to December 2021. The final sample consisted of 265 patients treated with thrombolysis without a diagnosis of COVID-19. The initiation of thrombolytic treatment during the pandemic was delayed (2:42 ± 0:51 vs. 2:25 ± 0:53; p = 0.0006). The delay was mainly related to the pre-hospital phase (1:41 ± 0:48 vs. 1:26 ± 0:49; p = 0.0014), and the door-to-needle time was not affected. There were no differences in stroke severity and patients' outcomes. Patients with AIS were less likely to have previously been diagnosed with atrial fibrillation (16.9% vs. 26.7%; p = 0.0383), ischemic heart disease (25.3% vs. 46.5%; p = 0.0003) and hyperlipidemia (31.2% vs. 46.5%; p = 0.0264). Patients treated during the pandemic had higher glycemia (149.45 ± 54. vs. 143.25 ± 60.71 mg/dL; p= 0.0012), while no significant differences in their lipid profiles were found. Conclusions: The COVID-19 pandemic affected the treatment of AIS patients locally at our stroke center. It caused treatment delay and hindered the recognition of risk factors prior to the occurrence of AIS.

Prevalence and associated factors of depressive symptoms among the young adults during the post-epidemic period - Evidence from the first wave of COVID-19 in Hubei Province, China

Introduction

China emerged from the first wave of COVID-19 in a short period of time and returned to normal economic and living order nationwide, making China's entry into the post-COVID-19 epidemic period since April 2020. However, the COVID-19 epidemic had a great impact on young adults' psychological status and may continue into the post-epidemic period. The enormous economic, employment and entrepreneurship pressures of this period may exacerbate this negative impact. This study investigated the depression status of the young adults and put forward the suggestions on how to strengthen the psychological crisis intervention and social security to cultivate the resilience of the young adults after major public health emergencies.

Methods

This study conducted a questionnaire survey to identify the prevalence of depressive symptoms and explore the associated factors of depressive symptoms among 1069 young adults in X City, Hubei province in September 2020. And the multistage stratified random sampling method was used for sampling. Depressive symptoms were measured using the 10-item version of the Center for Epidemiological Studies Depression Scale (CES-D-10). Descriptive statistics and logistic regression analysis were adopted for statistical analysis.

Results

1069 respondents (67.68% male; mean age = 28.87 ± 4.18 years; age range = 18–35 years) were included in final analyses. About 25.9% of the respondents reported depressive symptoms (CES-D-10 score = 7.28 ± 3.85). Age, marital status, employment status, monthly disposable income, the cognition, experience and social relationship of the COVID-19 epidemic, and regional discrimination were significantly associated with depressive symptoms. Being male (P = 0.025), age of 25–29 years (P = 0.011), having a household size with 4–5 (P = 0.01) and more than 8 (P = 0.012) family members, a little pessimism about the prospect of COVID-19 epidemic prevention and control (P = 0.044), often (P = 0.018) or always (P = 0.009) participation in anti-epidemic volunteer work were likely to lead to depressive symptoms.

Conclusions

In the post-COVID-19 epidemic period, the psychological status of young people is generally stable, but some of them are depressed. Life, work and mental stress affect the generation of depressive symptoms among the young adults.

The Prevalence of and Factors Associated With Anxiety and Depression Among Working-Age Adults in Mainland China at the Early Remission Stage of the Coronavirus 2019 Pandemic

Background

The Coronavirus 2019 (COVID-19) outbreak has led to a considerable proportion of adverse psychological symptoms in different subpopulations. This study aimed to investigate the status of anxiety and depression and their associated factors in the adult, working-age population in Mainland China at the early remission stage of the COVID-19 pandemic.

Methods

An online study was conducted among 1,863 participants in 29 provinces in Mainland China from March 23 to 31, 2020. Their mental health was evaluated by the generalized anxiety disorder scale (GAD-7) and the patient health questionnaire (PHQ-9). Descriptive analysis, Chi-square, and multiple logistic regressions were applied.

Results

About 44.5% of the participants had anxiety, 49.2% had depression, and 37.9% showed a combination of depression and anxiety. Around 83.7% of the participants claimed that the pandemic had a negative impact on their medical needs, which was the primary predictor of mental health, the degree of impact being positively related to the prevalence of anxiety and depression. More chronic diseases, moderate to bad self-rated health, severe perceived infection risk, and younger age group were the common risk factors for anxiety and depression. Having no children, unemployment, and a college-level educational background were associated with higher anxiety prevalence, whereas unmarried participants were correlated with higher depression prevalence.

Conclusion

The working-age population showed a relatively high risk of anxiety and depression in Mainland China at the early remission stage of the pandemic. To improve medical services capacity for routine and delayed medical service needs should be a part of policy-makers’ priority agenda during this period of crisis.

Orthostatic Intolerance in Adults Reporting Long COVID Symptoms Was Not Associated With Postural Orthostatic Tachycardia Syndrome

In this observational cross-sectional study, we investigated predictors of orthostatic intolerance (OI) in adults reporting long COVID symptoms. Participants underwent a 3-min active stand (AS) with Finapres^® NOVA, followed by a 10-min unmedicated 70° head-up tilt test. Eighty-five participants were included (mean age 46 years, range 25–78; 74% women), of which 56 (66%) reported OI during AS (OI_AS). OI_AS seemed associated with female sex, more fatigue and depressive symptoms, and greater inability to perform activities of daily living (ADL), as well as a higher heart rate (HR) at the lowest systolic blood pressure (SBP) point before the first minute post-stand (mean HR_nadir: 88 vs. 75 bpm, P = 0.004). In a regression model also including age, sex, fatigue, depression, ADL inability, and peak HR after the nadir SBP, HR_nadir was the only OI_AS predictor (OR = 1.09, 95% CI: 1.01–1.18, P = 0.027). Twenty-two (26%) participants had initial (iOH) and 5 (6%) classical (cOH_AS) orthostatic hypotension, but neither correlated with OI_AS. Seventy-one participants proceeded to tilt, of which 28 (39%) had OI during tilt (OI_tilt). Of the 53 who had a 10-min tilt, 7 (13%) had an HR increase >30 bpm without cOH_tilt (2 to HR > 120 bpm), but six did not report OI_tilt. In conclusion, OI_AS was associated with a higher initial HR on AS, which after 1 min equalised with the non-OI_AS group. Despite these initial orthostatic HR differences, POTS was infrequent (2%). ClinicalTrials.gov Identifier: NCT05027724 (retrospectively registered on August 30, 2021).

Immune response to the third COVID-19 vaccine dose is related to lymphocyte count in multiple sclerosis patients treated with fingolimod

Background

The majority of multiple sclerosis [MS] patients treated with fingolimod fail to develop a protective level of IgG humoral and adaptive cellular immune responses following full BNT162b2 SARS-CoV-2 vaccination.

Objective

To compare the efficacy of the third COVID-19 vaccine dose in vaccine non-responders fingolimod-treated MS patients.

Study design

This is a prospective 3-month, single-center, randomized clinical trial.

Methods

Twenty relapsing MS patients who had been on fingolimod therapy ≥ 12 months and failed to develop humoral IgG immune response to 2-dose Pfizer BNT162b2 COVID-19 vaccination were randomized into two groups: fingolimod-continuation group and fingolimod-discontinuation group. Humoral and memory cellular immune responses were assessed within 1 and 3 months following the third Pfizer BNT162b2 vaccine dose and compared between the groups.

Results

A higher rate of patients in the fingolimod-discontinuation group [n = 8/10] compared to fingolimod-continuation group [n = 2/10] developed positive SARS-COV-2 IgG. Median IgG titer 1 month following the third dose was 202.3 BAU/ml vs. 26.4 BAU/ml, respectively, p = 0.022. The development of IgG humoral response correlated with absolute lymphocyte count. Specific SARS-COV-2 memory B cell and T cell immune responses were not detected in both groups, either at 1 month or 3 months following the third COVID-19 vaccine dose.

Conclusions

Short period of fingolimod treatment discontinuation was associated with the development of humoral protection but not with adaptive cellular immunity.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00415-022-11030-0.

RESEARCH ARTICLEPrevalence and associated factors of depression, anxiety and stress among coronavirus disease 2019 (COVID-19) patients in Heart, Afghanistan

Objectives

Coronavirus disease 2019 (COVID-19) pandemic has been associated with a great level of psychological distresses in people around the world. This study aims to assess the prevalence of depression, anxiety and stress among COVID-19 patients and identify the associated factors, in Herat Province of Afghanistan.

Methods

This cross-sectional study was conducted on 459 hospitalized patients between May and September 2021. Data was collected with a structured questionnaire on depression, anxiety and stress scale, which was the validated Dari-version. Chi-square test was adopted to analyze the associations of the prevalence of the mental disorders and the factors.

Results

The mean age of participants was 38.05; 51.9% (238/459) were male and 84.1% (386/459) were married. Median scores for depression, anxiety and stress were 5.0, 8.0, and 10.0, respectively. Gender, general health condition, nutritional status, COVID-19 clinical manifestation and concurrent comorbidities (except diabetes and hypertension) were significantly associated with mental disorders; while association between marital status and these psychological disorders was not significant. Moreover, a significant difference was observed in the level of anxiety between healthcare workers and other respondents.

Conclusion

This is the first study to report the high prevalence of depression, anxiety and stress among COVID-19 patients in Herat, which indicates the negative effect of mental health for COVID-19 patients globally and highlights the need for urgent and appropriate interventions to improve mental health of people during the pandemic.

COVID-19-related anxiety and knowledge toward its preventive measures among patients with chronic medical illness on follow-up in public hospitals of Bale, East Bale, and West Arsi zones, Ethiopia

Background

Coronavirus disease 2019, also known as 2019-nCoV cluster of acute respiratory illness with unknown causes, which occurred in Wuhan, Hubei Province, in China, was first reported to World Health Organization country office as of December 30, 2019. People with medical illness are at a higher risk for coronavirus disease, and the pandemic influences mental health and causes psychological problems, particularly in those with chronic medical illness. Hence, this study aimed to assess coronavirus disease 2019-related anxiety and the knowledge on its preventive measures among patients with medical illness on follow-up in public hospitals of Bale, East Bale, and Arsi zones.

Objective

To assess coronavirus disease 2019-related anxiety and knowledge toward coronavirus disease 2019 preventive measures among patients with chronic medical illness on follow-up in public hospitals of Bale, East Bale, and West Arsi zones.

Methods

A hospital-based cross-sectional study was conducted in selected hospitals of Bale and West Arsi zones, Southeast Ethiopia. A total of 633 study participants were included in this study, and data were collected through an interviewer-administered questionnaire. A descriptive summary was computed. Bivariable and multivariable logistic regression analyses were carried out to identify the associated factors.

Results

Overall, the prevalence of anxiety among chronic patients in this study was 6.3% (95% confidence interval: 4.6%-8.5%) and 420 (66.35%) had good knowledge on the preventive measures of coronavirus disease 2019. Factors significantly associated with anxiety among chronic patients were being educated (95% confidence interval: adjusted odds ratio = 0.26 (0.09-0.74)), being male (95% confidence interval: 2.69 (1.11-6.53)), and use of mask (95% confidence interval: 0.11 (0.05-0.26)).

Conclusion

The prevalence of coronavirus disease 2019-related anxiety among chronic patients was high and being males, uneducated, and not using face mask was significantly associated with coronavirus disease 2019-related anxiety.

Neurological manifestations of long-COVID syndrome: a narrative review

Accumulating evidence points toward a very high prevalence of prolonged neurological symptoms among coronavirus disease 2019 (COVID-19) survivors. To date, there are no solidified criteria for 'long-COVID' diagnosis. Nevertheless, 'long-COVID' is conceptualized as a multi-organ disorder with a wide spectrum of clinical manifestations that may be indicative of underlying pulmonary, cardiovascular, endocrine, hematologic, renal, gastrointestinal, dermatologic, immunological, psychiatric, or neurological disease. Involvement of the central or peripheral nervous system is noted in more than one-third of patients with antecedent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while an approximately threefold higher incidence of neurological symptoms is recorded in observational studies including patient-reported data. The most frequent neurological manifestations of 'long-COVID' encompass fatigue; 'brain fog'; headache; cognitive impairment; sleep, mood, smell, or taste disorders; myalgias; sensorimotor deficits; and dysautonomia. Although very limited evidence exists to date on the pathophysiological mechanisms implicated in the manifestation of 'long-COVID', neuroinflammatory and oxidative stress processes are thought to prevail in propagating neurological 'long-COVID' sequelae. In this narrative review, we sought to present a comprehensive overview of our current understanding of clinical features, risk factors, and pathophysiological processes of neurological 'long-COVID' sequelae. Moreover, we propose diagnostic and therapeutic algorithms that may aid in the prompt recognition and management of underlying causes of neurological symptoms that persist beyond the resolution of acute COVID-19. Furthermore, as causal treatments for 'long-COVID' are currently unavailable, we propose therapeutic approaches for symptom-oriented management of neurological 'long-COVID' symptoms. In addition, we emphasize that collaborative research initiatives are urgently needed to expedite the development of preventive and therapeutic strategies for neurological 'long-COVID' sequelae.

How Do People Cope During the COVID-19 Pandemic and Stay Well? A Salutogenic Longitudinal Study in Israel

Employing the salutogenic approach, this longitudinal study explored the effects of coping with the COVID-19 pandemic in Israel, as it evolved from an acute to a chronic stress situation, during the first year. We examined the role of individual [sense of coherence (SOC)], social (perceived social support), and national [sense of national coherence (SONC)] coping resources, as well as situational and demographic factors, in predicting mental health and anxiety. Data was collected in five phases between March 2020 and February 2021 via a repeated panel sample and included 198 Jewish Israelis (52% males) age 18-64 (M = 43.5). The results confirmed the expected pattern of moving from acute to chronic stressful situation: levels of general anxiety were higher in the first phase of the pandemic outbreak as compared to the other phases. Levels of social and national coping resources significantly decreased over time. However, as expected, the salutogenic resource of the individual sense of coherence remained stable and was also found as the main predictor of both anxiety and mental health in the 5 phases of the study. Beyond the explanatory factor of SOC, mental health was better explained by the social and national coping resources, while anxiety was explained by situational factors (level of financial risk and gender). The discussion delineates the longitudinal effects of individual, social, and national coping resources on mental health and anxiety during the dynamic process of the long period of 1 year of the pandemic, evolving from acute to chronic phases of the complicated health, economic, social, and political crisis.

Analysis of Anxiety and Depression Status in Patients Undergoing Radiotherapy During the COVID-19 Epidemic

Background: The 2019 coronavirus (COVID-19) had caused a global pandemic and disrupted millions of lives. Cancer patients are a special group at greater risk of contracting viruses. This study aimed to evaluate the anxiety and depression status of cancer patients undergoing radiotherapy during the COVID-19 epidemic. Methods: 396 cancer patients who underwent radiotherapy were enrolled in this study. The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate patient anxiety and depression, respectively. 373 cancer patients completed the questionnaires. Results: During the COVID-19 outbreak, the incidence of anxiety and depression in cancer patients were 34.9 and 33.8%, respectively. Approximately 31.4% of tumor radiotherapy patients had anxiety and depression. Based on univariate analysis, age, work status, education level, and clinical stage were related to anxiety and depression in cancer patients. Based on multiple regression analysis, age and clinical stage were related to anxiety, but only age was related to depression. Conclusions: Due to the COVID-19 pandemic, cancer patients experienced increased psychological problems. Our results have contributed to a better understanding of these psychological problems in cancer patients and provide a basis for psychological counseling and intervention.