Posttraumatic stress disorder and depression of survivors 12 months after the outbreak of Middle East respiratory syndrome in South Korea

Elucidating the role of PPARG inhibition in enhancing MERS virus immune response: A network pharmacology and computational drug discovery

BACKGROUND

Middle East Respiratory Syndrome (MERS) has become a severe zoonotic disease, posing significant public health concerns due to the lack of specific medications. This urgently demands the development of novel therapeutic molecules. Understanding MERS's genetic underpinnings and potential therapeutic targets is crucial for developing effective treatments.

METHODS

Two gene expression datasets (GSE81909 and GSE100504) were analyzed to identify differentially expressed genes (DEGs) using GEO2R. Furthermore, gene ontology (GO), pathway enrichment analysis, and protein-protein interaction (PPI) network were performed to understand the gene's functions. A possible drug target was identified, and an FDA-approved drug library was screened against the selected target using molecular docking and validated the findings through molecular dynamics simulation, principal component analysis, free energy landscape, and MM/GBSA calculations.

RESULTS

The study on GSE81909 and GSE100504 datasets with icMERS and MOCK samples at 24 and 48 h revealed an upregulation in 73 and 267 DEGs, respectively. In the network pharmacology, STAT1, MX1, DDX58, EIF2AK2, ISG15, IFIT1, IFIH1, OAS1, IRF9, and OASL were identified as the top 10 hub genes. STAT1 was identified as the most connected hub gene among these top 10 hub genes, which plays a crucial role in the immune response to the MERS virus. Further study on STAT1 showed that PPARG helps reduce STAT1, which could modulate the immune response. Therefore, by inhibiting PPARG, the immunological response can be successfully enhanced. The known inhibitor of PPARG, 570 (Farglitazar), was used as a control. Further, screening using Tanimoto and K-mean clustering was performed, from which three compounds were identified: 2267, 3478, and 40326. Compound 3478 showed characteristics similar to the control, indicating robust binding to PPARG. 3478 showed the highest negative binding free energy with -41.20 kcal/mol, indicating strong binding with PPARG.

CONCLUSIONS

These findings suggest that 3478 promises to be a potential inhibitor of PPARG, and further experimental investigations can explore its potential as a MERS inhibitor.

Effect of COVID-19 response work experience on turnover intention among employees of dedicated COVID-19 hospitals in Seoul

BACKGROUND

According to previous studies, stress and job burnout among medical personnel increased during the COVID-19 pandemic. This study analyzed the effect of the experience of COVID-19 response work on the intention of municipal hospital staffs to leave their workplaces during the pandemic.

METHODS

The 3556 employees who had worked for more than 1 year at one of the eight Seoul Municipal Hospitals that either provided inpatient treatment for quarantined COVID-19 patients or operated as screening clinics were taken as the study population. In total, 1227 employees completed a web or mobile survey between October 21 and November 18, 2020. A chi-squared test was performed to confirm the difference in the distribution of turnover intention depending on whether the employees performed COVID-19 response tasks. Multiple logistic regression analyses were performed to determine the factors that affected the intention to leave.

RESULTS

Of the 1227 respondents, 761 (62.0%) were frontline workers who were the first line of response to COVID-19. Experience with COVID-19 response tasks (OR = 1.59, p = 0.003) was significantly associated with the intention to leave. Additionally, the probability of turnover intention was significantly higher among workers aged 20-29 years (OR = 2.11, p = 0.038) and 40-49 years (OR = 1.57, p = 0.048), unmarried individuals (OR = 1.66, p = 0.005), doctors (OR = 2.41, p = 0.010), nurses (OR = 1.59, p = 0.036), and technical staff members (OR = 2.22, p = 0.009). High turnover intention was found among those who experienced high levels of burnout (OR = 2.03, p < 0.001) and those working in non-directly managed municipal hospitals (OR = 1.87, p = 0.018).

CONCLUSION

Employees directly involved in COVID-19 response work displayed higher turnover intention. Various personal, job, and organizational factors significantly influenced employees' intentions to leave their positions in dedicated COVID-19 hospitals. These findings suggest the necessity of introducing management programs to aid workers who have experienced sudden changes in their duties and loss of autonomy while performing COVID-19 response tasks.

Common mental health problems and associated factors among recovered COVID-19 patients in rural area: A community-based survey in Bangladesh

PURPOSE

Since the coronavirus (COVID-19) was announced as being a global pandemic on 11 March, governments from all parts of the world declared a quarantine period, during which people were prohibited from leaving their homes (except for essential activities) to contain the spread of the virus. Since then, the population has faced different levels of restrictions (i.e., mobility, social activities) that limited participation in normal daily routines. Consequently, these restrictions may have adversely changed physical activity, diet, sleep patterns, and screen time or work routine. So, the pandemic has had profound influence on the mental health of the entire societies. As the mental health status of Bangladeshi patients living in rural area that have recovered from COVID-19 has not been previously studied, this gap is addressed through the present investigation focusing on one rural Bangladeshi community.

METHODS

A convenience sampling method was employed to recruit participants for this cross-sectional study. Data was gathered by conducting face-to-face interviews with 243 recovered COVID-19 patients (as confirmed by a positive Reverse Transcription PCR test) attending a local primary health care facility center and instructed to consider how they felt in the preceding week.

RESULTS

By administering a validated Bengali version of the Depression, Anxiety, and Stress Scale (DASS-21) to measure participants' mental health status, we noted that 24% of the sample exhibited depressive symptoms. In addition, 30.9% and 21.8% of the participants experienced stress symptoms and reported anxiety, respectively. Sociodemographic factors such as female sex, lower educational level, living away from family, smaller living accommodations, and lower economic status significantly predicted mental health outcomes in multivariate logistic regressions.

CONCLUSION

These results may help health care providers formulate proper mental health interventions and preventive measures to minimize the mental health problems among patients that have recovered from COVID-19.

Improving mental health infrastructure across the Middle East

This study explores the difficulties and possible remedies, for enhancing health services and decreasing stigma in the Middle East. The paper underscores the significance of education integrating Western methods, involving leaders educating young people and utilizing social media. It also draws attention to social challenges in the region while offering strategies to train health professionals to be culturally sensitive. The goal is to improve healthcare standards, in the Middle East by tackling barriers and fostering empathy and respect.

Impact of long COVID-19 on posttraumatic stress disorder as modified by health literacy: an observational study in Vietnam

BACKGROUND

The prevalence of posttraumatic stress disorder (PTSD) has increased, particularly among individuals who have recovered from coronavirus disease 2019 (COVID-19) infection. Health literacy is considered a "social vaccine" that helps people respond effectively to the pandemic. We aimed to investigate the association between long COVID-19 and PTSD, and to examine the modifying role of health literacy in this association.

METHODS

A cross-sectional study was conducted at 18 hospitals and health centers in Vietnam from December 2021 to October 2022. We recruited 4,463 individuals who had recovered from COVID-19 infection for at least 4 weeks. Participants provided information about their sociodemographics, clinical parameters, health-related behaviors, health literacy (using the 12-item short-form health literacy scale), long COVID-19 symptoms and PTSD (Impact Event Scale-Revised score of 33 or higher). Logistic regression models were used to examine associations and interactions.

RESULTS

Out of the study sample, 55.9% had long COVID-19 symptoms, and 49.6% had PTSD. Individuals with long COVID-19 symptoms had a higher likelihood of PTSD (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.63-2.12; p<0.001). Higher health literacy was associated with a lower likelihood of PTSD (OR, 0.98; 95% CI, 0.97-0.99; p=0.001). Compared to those without long COVID-19 symptoms and the lowest health literacy score, those with long COVID-19 symptoms and a 1-point health literacy increment had a 3% lower likelihood of PTSD (OR, 0.97; 95% CI, 0.96-0.99; p=0.001).

CONCLUSION

Health literacy was found to be a protective factor against PTSD and modified the negative impact of long COVID-19 symptoms on PTSD.

Symptoms and management of long COVID: A scoping review

AIM

This scoping review aims to describe published work on the symptoms and management of long COVID conditions.

BACKGROUND

Symptoms and management of COVID-19 have focused on the acute stage. However, long-term consequences have also been observed.

METHODS

A scoping review was performed based on the framework suggested by Arksey and O'Malley. We conducted a literature search to retrieve articles published from May 2020 to March 2021 in CINHAL, Cochrane library, Embase, PubMed and Web of science, including backward and forward citation tracking from the included articles. Among the 1880 articles retrieved, 34 articles met our criteria for review: 21 were related to symptom presentation and 13 to the management of long COVID.

RESULTS

Long COVID symptoms were described in 21 articles. Following COVID-19 treatment, hospitalised patients most frequently reported dyspnoea, followed by anosmia/ageusia, fatigue and cough, while non-hospitalised patients commonly reported cough, followed by fever and myalgia/arthralgia. Thirteen studies described management for long COVID: Focused on a multidisciplinary approach in seven articles, pulmonary rehabilitation in three articles, fatigue management in two articles and psychological therapy in one study.

CONCLUSION

People experience varied COVID-19 symptoms after treatment. However, guidelines on evidence-based, multidisciplinary management for long COVID conditions are limited in the literature. The COVID-19 pandemic may extend due to virus mutations; therefore, it is crucial to develop and disseminate evidence-based, multidisciplinary management guidelines.

RELEVANCE TO CLINICAL PRACTICE

A rehabilitation care plan and community healthcare plans are necessary for COVID-19 patients before discharge. Remote programmes could facilitate the monitoring and screening of people with long COVID.

Depressive symptoms among people under COVID-19 quarantine or self-isolation in Korea: a propensity score matching analysis

Introduction

This study aims to determine the effect of COVID-19-related hospital isolation or self-isolation on depression using the propensity score matching method.

Methods

Data on 217,734 participants were divided into groups based on whether or not they underwent quarantine for their COVID-19 diagnosis. COVID-19-related anxiety, depressive symptoms, subjective health status, and perceived stress were evaluated.

Results

Based on the calculated propensity score, we matched the quarantined group and non-quarantined group using 1:2 matching with nearest neighbor matching and a caliper width of 0.1. Within the quarantined group, 16.4% of participants experienced significant depressive symptoms, which was significantly higher than that of the non-quarantined group. However, there was no significant difference between the two groups in COVID-19-related anxiety, self-rated health status, and perceived stress. In our multiple logistic regression analysis with related variables corrected, the quarantined group was 1.298 times more likely to have depressive symptoms than the non-quarantined group (95% CI = 1.030-1.634).

Conclusion

Our study confirmed that COVID-19 quarantine is associated with depressive symptoms. These results indicate that healthcare policymakers and healthcare professionals must consider the negative mental and physical effects of quarantine when determining quarantine measures during an infectious disease disaster such as the COVID-19 pandemic.

Do Social Support and Loneliness Influence Emerging Adults' Mental Health during the First Year of the COVID-19 Pandemic?

Youths' mental health is at a crisis level, with mental health problems doubling in the US since the pandemic began. To compound the mental health crisis, there is a global loneliness epidemic, with emerging adults worldwide experiencing some of the highest rates. One study with two phases examined the influence of social support and loneliness on mental health in US emerging adults during the pandemic, including changes in these relationships over one year. Emerging adults (N = 449) completed online questionnaires via Prolific in May 2020 (Phase 1) and again from January to May 2021 (N = 253; Phase 2). More perceived support was related to reduced loneliness, with family support having the most significant influence. Loneliness mediated the link between perceived support and adverse health outcomes. Higher loneliness predicted more perceived stress and sleep difficulties concurrently and over time. There was a bidirectional relationship between loneliness and depression, such that higher levels of either variable at Time 1 predicted increases in the other over time. Results highlight the detrimental impact of loneliness on emerging adults' mental health.

Social stigma during COVID-19: A systematic review

Objectives

Stigmatization was reported throughout the COVID pandemic for COVID-19 patients and close contacts. The aim of this systematic review was to comprehensively examine the prevalence and impact of stigmatization during COVID-19 pandemic.

Methods

English articles were searched using online databases that included PubMed, Scopus, Embase, and Web of Science up to 24 August 2022. A two-step screening and selection process was followed utilizing an inclusion and exclusion criteria and then data was extracted from eligible articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed, and the risk of bias was assessed using the Newcastle-Ottawa Scale.

Results

Seventy-six studies were eligible for inclusion. Twenty-two studies reported the prevalence of social stigma due to COVID-19 infection with social isolation being the most commonly reported stigma. There were 20 studies that reported the majority of participants experienced stigma due to COVID-19 infection, which was as high as 100% of participants in two studies. Participants in 16 studies reported blaming from others as the second most common type of stigma, with various other types reported such as psychological pressure, verbal violence, avoidance, and labeling. The most common effect of the stigma was anxiety followed by depression, and then reduction of socialization.

Conclusion

Findings from the present review have identified that COVID-19-related stigma studies have generally focused on its prevalence, type, and outcome. Greater awareness of this topic may assist with improving public education during pandemics such as COVID-19 as well as access to support services for individuals impacted by stigmatization.

"I Am Not the Same as I Was Before": A Qualitative Analysis of COVID-19 Survivors

BACKGROUND

Little is known about the illness experience of patients' long-term emotional and physical recovery from severe COVID-19 infection. This study aimed to expand upon the recovery process of COVID-19 survivors up to 6 months after hospital discharge.

METHODS

Qualitative analysis of free-response answers from a cohort study of 152 patients ≥ 18 years hospitalized with laboratory-confirmed SARS-CoV-2 surveyed at 1-month post hospital discharge and 6-months post hospital discharge. Responses were analyzed with a grounded theory approach to identify overarching themes.

RESULTS

Participants described persistent complications, both physical and mental, that have affected their recovery from COVID-19. Five overarching themes of post-acute patient experiences were generated: (1) an increased awareness of a mind and body connection, (2) feelings of premature aging, (3) an overall decline in quality of life, (4) a continued fear of infection, and (5) methods of coping.

CONCLUSIONS

Patients described lasting changes to their mental health and overall quality of life in connection to physical complications after severe COVID-19 infection. Patients' reports of their experience call for a greater awareness of the psychological aspects of COVID-19 recovery to provide both physical and psychological rehabilitation services. Additional resources such as education around re-infection and financial resources are needed.

Two-year follow-up of post-traumatic stress disorder symptoms in healthcare workers after the COVID-19 pandemic in China

OBJECTIVES

This study aimed to conduct a 2-year follow-up of mental disorders in healthcare workers (HCWs) in a region of China outside the epidemic's core zone who happened to be directly or possibly exposed to persons with COVID-19.

MATERIAL AND METHODS

A cognitive analysis scale was utilized in the evaluation the mental or emotional state of HCWs at Xuzhou Medical University's affiliated hospital in the city of Xuzhou, China (a non-core epidemic area) 2 years after the first assessment during the COVID-19 pandemic. A total of 165 HCWs were selected as the study subjects. In accordance to the exposure risk of COVID-19 patients, the subjects were separated into 2 categories: a group with a high risk HCW (HHCW) (HCWs working in COVID-19-positive wards; N = 91) and a group with a minimal risk HCW (LHCW) (HCWs who worked in wards without COVID-19 patients at the same hospital; N = 75). The clinical as well as demographic information of every HCWs were collected.

RESULTS

The demographic data revealed significant differences in terms of occupation, remuneration, and selfless concerns amidst both categories (p < 0.05). There lacked a statistically notable difference in the occurrence of PTSD between the 2 groups. Data was analyzed for factors associated with PTSD, and the results showed that psychological resilience, job risk, and stress in the workplace were risk factors for PTSD. Additionally, the results of the logistic regression analysis showed that psychological resilience was a significant shared risk factor for PTSD in HCWs after the COVID-19 pandemic.

CONCLUSIONS

The 2-year follow-up showed no statistical difference in the incidence of PTSD between the HHCW group and the LHCW group. Workplace stress, occupational hazards, and psychological resilience were the major contributing risk factors for PTSD in HCWs. Int J Occup Med Environ Health. 2023;36(3):324-32.

How Can We Deal with Psychosocial Issues in an Emerging Infectious Disease Outbreak? Lessons from a Qualitative Study for the MERS Outbreak in Korea

BACKGROUND

The 2015 Middle East respiratory syndrome (MERS) coronavirus outbreak in Korea led to profound emotional and social burdens, especially in patients and health care professionals.

MATERIALS AND METHODS

Focus group interviews were conducted with 2 patients, 1 family member and 6 health care professionals about psychological distress related to MERS in 2017 and analyzed the interview data using the consensual qualitative research method.

RESULTS

Four domains and 17 core ideas were identified within three interview groups, including psychological distress during the outbreak, problems regarding the response to the outbreak, positive experiences, and future directions for enhancing intervention to improve mental health and prevent psychosocial problems during the outbreak. Psychological consequences were affected by the characteristics of the emerging infectious disease and the structure and process of institutional or governmental response to the MERS outbreak. Mental health services and psychosocial support reduced the negative impact on psychological distress.

CONCLUSION

The MERS outbreak in 2015 gave rise to emotional and social injuries to patients and health care professionals, some of which can be long-lasting constraints in their lives. Preparedness in a society's response to a pandemic considering mental health in related parties can minimize negative psychological consequences and enhance resilience at the individual and society levels.

Trends in Depressive Symptoms and Suicidality of South Korean Adolescents: Comparison of Expected and Observed Prevalence During the COVID-19 Pandemic

PURPOSE

Depressive symptoms and suicidality of adolescents during the COVID-19 pandemic are emerging public health issues. However, there is a lack of representative studies on adolescents' mental health that considers the preceding secular trends.

METHODS

This descriptive study used nationally representative cross-sectional data of Korean adolescents from the Korea Youth Risk Behavior Survey from 2005 to 2020 (N = 1,035,382). We utilized joinpoint regression analysis to explore the temporal prevalence trends of depressive symptoms, suicidal ideation, and suicide attempts. Based on the annual percentage change until 2019, the expected and actual prevalence in 2020 (N = 54,948) was compared to describe departures of prevalence from the trend line. These trends between sex, school level, ethnic status, and socioeconomic status were also compared.

RESULTS

Considering the recent increase in secular trends until 2019, the actual observed values in 2020 were lower than expected by 13% in depressive symptoms, 20% in suicidal ideation, and 40% in suicide attempts. The gap between sexes, school levels, ethnic status, and socioeconomic groups was similar or narrowed in 2020 compared to previous trends.

DISCUSSION

We observed a lower prevalence of depressive symptoms and suicidality among Korean adolescents than expected about 9 months from the beginning of the COVID-19 pandemic despite the recent increase in secular trends.

Tryptophan catabolites, inflammation, and insulin resistance as determinants of chronic fatigue syndrome and affective symptoms in long COVID

Critical COVID-19 disease is accompanied by depletion of plasma tryptophan (TRY) and increases in indoleamine-dioxygenase (IDO)-stimulated production of neuroactive tryptophan catabolites (TRYCATs), including kynurenine (KYN). The TRYCAT pathway has not been studied extensively in association with the physiosomatic and affective symptoms of Long COVID. In the present study, we measured serum TRY, TRYCATs, insulin resistance (using the Homeostatic Model Assessment Index 2-insulin resistance, HOMA2-IR), C-reactive protein (CRP), physiosomatic, depression, and anxiety symptoms in 90 Long COVID patients, 3-10 months after remission of acute infection. We were able to construct an endophenotypic class of severe Long COVID (22% of the patients) with very low TRY and oxygen saturation (SpO2, during acute infection), increased kynurenine, KYN/TRY ratio, CRP, and very high ratings on all symptom domains. One factor could be extracted from physiosomatic symptoms (including chronic fatigue-fibromyalgia), depression, and anxiety symptoms, indicating that all domains are manifestations of the common physio-affective phenome. Three Long COVID biomarkers (CRP, KYN/TRY, and IR) explained around 40% of the variance in the physio-affective phenome. The latter and the KYN/TRY ratio were significantly predicted by peak body temperature (PBT) and lowered SpO2 during acute infection. One validated latent vector could be extracted from the three symptom domains and a composite based on CRP, KYN/TRY, and IR (Long COVID), and PBT and SpO2 (acute COVID-19). In conclusion, the physio-affective phenome of Long COVID is a manifestation of inflammatory responses during acute and Long COVID, and lowered plasma tryptophan and increased kynurenine may contribute to these effects.

A cross-sectional study of the mental health burden among COVID-19 survivors

Introduction

Coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on mental health, including stress, anxiety, and depression. This study aimed to assess the incidence and severity of mental health issues among individuals diagnosed with COVID-19 infection.

Methods

A semi-structured proforma for socio-demographic and clinical parameters was used to collect cross-sectional hospital-based data of subjects who tested positive for COVID-19 infection. The Modified Fatigue Impact Scale (MFIS), Hospital Anxiety and Depression Scale (HADS), and Perceived Stress Scale (PSS) were used to assess the presence of physical, psychological, and cognitive symptoms. The presence of anxiety, depression, and stress was based on the cut-off scores for HADS-A (≥8), HADS-D (≥8), and PSS (≥14), respectively.

Results

A total of 101 patients comprising 39 (38.6%) males were recruited. Compared to nuclear families, we observed that patients living in joint families had significantly greater severity scores for fatigue [MFIS (p = 0.04)], anxiety [HADS-A (p = 0.004)], depression [HADS-D (p = 0.004)], and stress [PSS (p = 0.02)]. Based on the cut-off scores, we found that 44 (43.6%) patient had anxiety, 41 (40.6%) had depressive, and 72 (71.3%) had moderate to high stress symptoms, respectively. We also observed significantly greater fatigue and anxiety scores, that is, MFIS (p = 0.008) and HADS-A (p = 0.03) in those who received oxygen therapy compared to those who did not. The subjects who received corticosteroids were older (p = 0.01) and had significantly higher stress scores [PSS (p < 0.001)]. The study showed that patients who were assessed more than 3 months post-COVID-19 infection had higher fatigue and depression scores; however, the difference did not reach statistical significance (MFIS P = 0.058; HADS P = 0.059).

Conclusion

Our study confirms that COVID-19 infection can cause various adverse mental health issues. Mitigating the hazardous effects of COVID-19 pandemic on mental health should be a top priority for public health to prevent long-term complications.

Causing trouble and being transmissible: COVID-19 survivors’ experiences of stigma and discrimination in South Korea

Background

The stigma associated with coronavirus disease (COVID-19) is relatively neglected in policies for handling the disease. Stigmatization occurs only within specific social contexts in local societies.

Objective

This study aims to examine COVID-19 survivors’ experiences of social stigma and discrimination in South Korea in the first 2 years of the pandemic.

Methods

Semi-structured interviews were conducted.

Results

Of 52 participants, 45 reported that they had to cope with stigma and discrimination in their intimate social relationships, workplaces, and children’s schools, ranging from subtle actions to job loss. Sexual minorities who were involved in mass disease transmission in the early part of the pandemic experienced a higher level of stigmatization. The stigmatization dealt with in this study was related to two themes: survivors’ sense of causing trouble and possibility of transmission.

Conclusion

By intertwining this stigma with the experiences of public health measures through the voices of survivors, this study reveals the local context of East Asia in terms of culture-specific aspects of COVID-19-related stigma.

PTSS in COVID-19 survivors peritraumatic stress symptoms among COVID-19 survivors in Iraq

The COVID-19 pandemic became a source of psychological distress worldwide. People infected with the disease faced the possibility of losing their lives, and due to the high number of people with the disease, hospitals were overburdened. Therefore, the situation had characteristics of a traumatic event; this is especially true in Iraq since the healthcare system is on the brink of failure, and the hospitals are a place of low-quality service. Consequently, the current study aims to explore peritraumatic stress symptoms among survivors of COVID-19 in Iraq. Moreover, group differences based on several variables and the associated factors with peritraumatic stress are also investigated. The post-traumatic stress disorder checklist for DSM-5 was used as a measurement tool. A total of 370 survivors of COVID-19 from the different governorates of Iraq participated in this study; 148 females and 22 males. 51, 70, 165, and 84 participants were aged 18-25, 26-30, 31-40, and above 40, respectively. The results revealed that 31.1% of the participants had probable PTSD since they scored above the cut-off of the score of 23. Significant differences between males and females were not found. Regarding associated factors, education level was a significant predictor (i.e., no education, primary school, secondary school, diploma, bachelor's degree, and postgraduate degree). Compared to primary school education and no education, postgraduate education was significantly associated with probable PTSD. Furthermore, the longer duration of being infected with COVID-19 was associated with higher odds of having probable PTSD. This was one of the first studies in Iraq to explore peritraumatic stress symptoms following COVID-19 infection using standardized instruments and investigate the associated factors. The results have various implications for developing the healthcare system of Iraq and the need to have social workers and psychologists trained in psychological first aid available in the hospital to manage the patients' distress.

Psychosocial crisis intervention for coronavirus disease 2019 patients and healthcare workers

OBJECTIVES

Shelter hospital was an alternative way to provide large-scale medical isolation and treatment for people with mild coronavirus disease 2019 (COVID-19). Due to various reasons, patients admitted to the large shelter hospital was reported high level of psychological distress, so did the healthcare workers. This study aims to introduce a comprehensive and multifaceted psychosocial crisis intervention model.

METHODS

The psychosocial crisis intervention model was provided to 200 patients and 240 healthcare workers in Wuhan Wuchang shelter hospital. Patient volunteers and organized peer support, client-centered culturally sensitive supportive care, timely delivery of scientific information about COVID-19 and its complications, mental health knowledge acquisition of non-psychiatric healthcare workers, group activities, counseling and education, virtualization of psychological intervention, consultation and liaison were exhibited respectively in the model. Pre-service survey was done in 38 patients and 49 healthcare workers using the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Patient Health Questionnaire 2-item (PHQ-2) scale, and the Primary Care PTSD screen for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (PC-PTSD-5). Forty-eight healthcare workers gave feedback after the intervention.

RESULTS

The psychosocial crisis intervention model was successfully implemented by 10 mental health professionals and was well-accepted by both patients and healthcare workers in the shelter hospital. In pre-service survey, 15.8% of 38 patients were with anxiety, 55.3% were with stress, and 15.8% were with depression; 16.3% of 49 healthcare workers were with anxiety, 26.5% were with stress, and 22.4% were with depression. In post-service survey, 62.5% of 48 healthcare workers thought it was very practical, 37.5% thought more practical; 37.5% of them thought it was very helpful to relief anxiety and insomnia, and 27.1% thought much helpful; 37.5% of them thought it was very helpful to recognize patients with anxiety and insomnia, and 29.2% thought much helpful; 35.4% of them thought it was very helpful to deal with patients' anxiety and insomnia, and 37.5% thought much helpful.

CONCLUSIONS

Psychological crisis intervention is feasible, acceptable, and associated with positive outcomes. Future tastings of this model in larger population and different settings are warranted.

Post-traumatic stress among COVID-19 survivors: A descriptive study of hospitalized first-wave survivors

Introduction

The coronavirus Severe Acute Respiratory Syndrome Coronavirus Type 1 induces a severe respiratory disease, coronavirus disease 2019 (COVID-19). After Severe Acute Respiratory Syndrome Coronavirus Type 1 and Middle East Respiratory Syndrome infection, increased post-traumatic stress disorder (PTSD) rates were described.

Methods

This single-centred, prospective study aimed to evaluate the rates of PTSD in patients who were hospitalized for COVID-19. Inclusion criteria were COVID-19 patients hospitalized in the intensive care unit (ICU) or in a standard unit with at least 2 L/min oxygen. Six months post-hospitalization, subjects were assessed for PTSD using a validated screening tool, the Post-Traumatic Stress Checklist-5 (PCL-5).

Results

A total of 40 patients were included. No demographic differences between the ICU and non-ICU groups were found. The mean PCL-5 score for the population was 8.85±10. The mean PCL-5 score was 6.7±8 in the ICU group and 10.5±11 in the non-ICU group (P=0.27). We screened one patient with a positive PCL-5 score and one with a possible PCL-5 cluster score. Nine patients had a PCL-5 score of up to 15. Seven patients reported no symptoms. Seven patients accepted a psychological follow-up: one for PTSD, three for possible PTSD and three for other psychological problems.

Discussion

The PCL-5 tool can be used by lung physicians during consultations to identify patients for whom follow-up mental health assessment and treatment for PTSD are warranted.

Conclusion

Lung physicians should be aware of the risk of PTSD in patients hospitalized for COVID-19 and ensure appropriate screening and follow-up care.

COVID-19-related mental health difficulties among marginalised populations: A literature review

The COVID-19 pandemic has had negative consequences on the mental health of the population, which has been documented. Marginalised groups that are at risk of poor mental health overall have been particularly impacted. The purpose of this review is to describe the mental health impact of the COVID-19 pandemic on marginalised group (i.e. persons who are socio-economically disadvantaged, migrants and members of ethno-racial minorities, experience homelessness) and identified interventions which could be well-suited to prevent and address mental health difficulties. We conducted a literature review of systematic reviews on mental health difficulties since the beginning of the COVID-19 epidemic and appropriate interventions among marginalised groups published from January 1, 2020 to May 2, 2022, using Google Scholar and PubMed (MEDLINE). Among 792 studies on mental health difficulties among members of marginalised groups identified by keywords, 17 studies met our eligibility criteria. Twelve systematic reviews examining mental health difficulties in one or several marginalised groups during the COVID-19 pandemic and five systematic reviews on interventions that can mitigate the mental health impact of the COVID-19 pandemic were retained in our literature review. The mental health of marginalised groups was severely affected during the COVID-19 pandemic. Most frequently reported mental health difficulties included symptoms of anxiety and depression. Additionally, there are interventions that appear effective and well-suited for marginalised populations, which should be disseminated on a large scale to mitigate the psychiatric burden in these groups and at the population level.

Mental health status and psychosocial issues during Nationwide COVID-19 quarantine in Iran in 2020: A cross-sectional study in Mazandaran Province

The coronavirus disease 2019 (COVID-19) pandemic is spreading rapidly, and its psychosocial impact remains a big challenge. In this respect, quarantine has been recommended, as a significant practice, to prevent the given condition. Therefore, the present study was to determine the prevalence rates of depression, anxiety, and stress and to reflect on the impact of COVID-19, as a traumatic stressor event, on individuals. This web-based survey was fulfilled via an online questionnaire, completed by respondents selected through the cluster sampling technique, from March 24 to April 10, 2020, living in Mazandaran Province, Northern Iran. Accordingly, the data regarding demographic characteristics, physical health status, quarantine compliance, contact with COVID-19, and additional information were collected. The psychosocial impact of the pandemic was then assessed by the Impact of Event Scale-Revised (IES-R), and the respondents' mental health status was evaluated using the Depression, Anxiety, and Stress Scale-21 (DASS-21). Data analysis was further performed by linear regression. The study findings, from 1075 respondents, revealed that 22.5% of the cases had moderate-to-severe depression, 38.5% of the individuals were suffering from moderate-to-severe anxiety, and 47.2% of the participants were experiencing moderate-to-severe stress. In 14.5% of the respondents, the psychosocial impact of COVID-19 also varied from the possibility of post-traumatic stress disorder (PTSD) to immunosuppression (p < 0.01). With the high prevalence rates of depression, anxiety, and stress, mental health professionals are suggested to develop psychosocial interventions and support plans for the general population to reduce the impact of the COVID-19 pandemic on public mental health status.

COVID-19 perceived stigma among survivors: A cross-sectional study of prevalence and predictors

Background and objectives

Perceived stigma related to infectious diseases is of public health importance and can adversely impact patients' physical and mental health. This study aims to identify the level of perceived stigma among COVID-19 survivors in Qatar and investigate its predictors.

Methods

An analytical cross-sectional design was employed. Four hundred and four participants who had a positive COVID-19 PCR test were randomly selected from medical records. The selected participants were interviewed to collect sociodemographic and health-related information. Perceived stigma was assessed using the COVID-19 perceived stigma scale-22 (CPSS-22) that was developed by the researchers. A descriptive analysis followed by a bivariate analysis investigated possible associations between the perceived stigma levels and independent variables. A multivariable analysis was performed using logistic regression to identify any significant associations with perceived stigma. The validity and reliability of the developed tool were also tested.

Results

The prevalence of COVID-19 perceived stigma was twenty-six percent (n = 107, 26.4%) at 95% CI [22.4-30.4]. Factors associated with higher COVID-19 perceived stigma were male gender, being a manual worker, non-Arabic ethnicity, low educational level, living alone, and being isolated outside the home. However, only occupation, ethnicity, and low educational level predicted COVID-19 perceived stigma in multivariable analysis. The CPSS-22 showed excellent reliability (Cronbach's alpha 0.92).

Conclusion

Perceived stigma was relatively common among participants. Designing programs and interventions targeting male manual workers and those of low-educational levels may assist policymakers in mitigating the stigma related to COVID-19.

The lived experience of hospitalized and non-hospitalized health care providers of COVID-19 pandemic: a qualitative study

This paper explores the lived experience and any mental health issues of COVID-19 survivors throughout the disease crisis using a qualitative method. The semi-structured interviewing method was conducted with COVID-19 patients who were admitted and non-admitted to hospitals in Kurdistan, Iraq. The patients had positive and negative perceptions of the COVID-19 pandemic and disease, including beliefs and thoughts about COVID-19, conspiracy thinking, and concerns toward the family and their children. The patients were affected by the disease in different ways including physical consequences of COVID-19 infection, social isolation, life changes, and mental wellbeing. But they had some coping strategies to overcome the disease, such as seeking help, preventive measures, and coping techniques. The patients had some concerns about health settings and therapeutic procedures, including lack of sufficient care, receptiveness, hospital environment, and infection guidelines. This study showed that the COVID-19 disease had devastating effects on patients either physically or psychologically.

Psychological and Cognitive Effects of Long COVID: A Narrative Review Focusing on the Assessment and Rehabilitative Approach

Long COVID is a clinical syndrome characterized by profound fatigue, neurocognitive difficulties, muscle pain, weakness, and depression, lasting beyond the 3–12 weeks following infection with SARS-CoV-2. Among the symptoms, neurocognitive and psychiatric sequelae, including attention and memory alterations, as well as anxiety and depression symptoms, have become major targets of current healthcare providers given the significant public health impact. In this context, assessment tools play a crucial role in the early screening of cognitive alterations due to Long COVID. Among others, the general cognitive assessment tools, such as the Montreal Cognitive assessment, and more specific ones, including the State Trait Inventory of Cognitive Fatigue and the Digit Span, may be of help in investigating the main neurocognitive alterations. Moreover, appropriate neurorehabilitative programs using specific methods and techniques (conventional and/or advanced) through a multidisciplinary team are required to treat COVID-19-related cognitive and behavioral abnormalities. In this narrative review, we sought to describe the main neurocognitive and psychiatric symptoms as well as to provide some clinical advice for the assessment and treatment of Long COVID.

Environmental health, COVID-19, and the syndemic: internal medicine facing the challenge

Internists are experts in complexity, and the COVID-19 pandemic is disclosing complex and unexpected interactions between communicable and non-communicable diseases, environmental factors, and socio-economic disparities. The medicine of complexity cannot be limited to facing comorbidities and to the clinical management of multifaceted diseases. Evidence indicates how climate change, pollution, demographic unbalance, and inequalities can affect the spreading and outcomes of COVID-19 in vulnerable communities. These elements cannot be neglected, and a wide view of public health aspects by a "one-health" approach is strongly and urgently recommended. According to World Health Organization, 35% of infectious diseases involving the lower respiratory tract depend on environmental factors, and infections from SARS-Cov-2 is not an exception. Furthermore, environmental pollution generates a large burden of non-communicable diseases and disabilities, increasing the individual vulnerability to COVID-19 and the chance for the resilience of large communities worldwide. In this field, the awareness of internists must increase, as privileged healthcare providers. They need to gain a comprehensive knowledge of elements characterizing COVID-19 as part of a syndemic. This is the case when pandemic events hit vulnerable populations suffering from the increasing burden of chronic diseases, disabilities, and social and economic inequalities. Mastering the interplay of such events requires a change in overall strategy, to adequately manage not only the SARS-CoV-2 infection but also the growing burden of non-communicable diseases by a "one health" approach. In this context, experts in internal medicine have the knowledge and skills to drive this change.

Meta-analysis of prevalence: the psychological sequelae among COVID-19 survivors

OBJECTIVE

This meta-analysis aims to estimate the pooled prevalence of mental disorders among COVID-19 survivors.

METHODS

The databases Pubmed, Google Scholar, ScienceDirect, and medRxiv have been searched up to 1 August 2021 using COVID-19, survivors, mental disorders, and their related MeSH terms. The included studies were either cross-sectional, cohort, or case-control in design. Those studies included COVID-19 survivors after 14 or more days from their COVID-19 recovery and used validated questionnaires to assess their mental health outcomes. The random-effects model was used to pool the data from the incorporated studies. The heterogeneity was assessed using Cochran's Q heterogeneity test and I² statistic.

RESULTS

Twenty-seven studies were included in the data synthesis with a total sample size of 9605 COVID-19 survivors. The prevalence rates for Post-Traumatic Stress Disorder (PTSD), anxiety, psychological distress, depression, and sleeping disorders were 20% (95% CI = 16-24%), 22% (95% CI = 18-27%), 36% (95% CI = 22-51%), 21% (95% CI = 16-28%), and 35% (95% CI = 29-41%), respectively.

CONCLUSIONS

Although we found high heterogeneity across the included studies, our meta-analysis provides evidence that there are psychological sequelae in COVID-19 survivors that require medical assiduity as well as further research on the matter.KEY POINTSIncreased prevalence of psychological sequelae among COVID-19 survivors.The prevalence of PTSD was 20% (95% CI = 16-24%) and of anxiety was 22% (95% CI = 18-27%) among COVID-19 survivors.The prevalence of psychological distress was 36% (95% CI = 22-51%), of depression was 21% (95% CI = 16-28%), and of sleep disorders was 35% (95% CI = 29-41%) among COVID-19 survivors.Future researches are recommended to search for effective and safe methods to mitigate the psychological sequelae in COVID-19 patients.

Psychotherapy and Follow-Up in Health Care Workers After the COVID-19 Epidemic: A Single Center's Experience

Objective

The present study aims to analysis the mental health of high-risk health care workers (HHCWs) and low-risk HCWs (LHCWs) who were respectively exposed to COVID-19 wards and non-COVID-19 wards by following up on mental disorders in HCWs in China for 6 months.

Methods

A multi-psychological assessment questionnaire was used to follow up on the psychological status of HCWs in the Affiliated Hospital of Xuzhou Medical University in Xuzhou City (a non-core epidemic area) at 6 months after the first evaluation conducted during the COVID-19 epidemic. Based on the risk of exposure to COVID-19 patients, the HCWs were divided into two groups: high-risk HCWs, who worked in COVID-19 wards, and low-risk HCWs, who worked in non-COVID-19 wards.

Results

A total of 198 HCWs participated in the study, and 168 questionnaires were selected for evaluation. Among them, 93 (55.4%) were in the HHCW group and 75 (44.5%) were in the LHCW group. Significant differences were observed in salary, profession, and altruistic behavior between the two groups (P < 0.05). There were no significant differences in the anxiety, depression, insomnia, or posttraumatic stress disorder (PTSD) scores between the two groups. Logistic regression revealed that work stress was a major joint risk factor for mental disorders in HCWs. Among all the HCWs, a total of 58 voluntarily participated in psychotherapy; the analysis showed a significant decrease in anxiety, depression, PTSD, work stress, and work risk after attending psychotherapy. There were also significant differences in positive and negative coping styles before and after psychotherapy.

Conclusion

In the present follow-up, work stress was the major contributing factor to mental disorders in HCWs. Psychotherapy is helpful in terms of stress management and should be provided to first-line COVID-19 HCWs.

The Relationship between Mental Disorders and the COVID-19 Pandemic—Course, Risk Factors, and Potential Consequences

In this review the authors discuss that COVID-19 has already had a direct impact on the physical health of many people and that it appears to have put at risk the mental health of large populations. In this review, we also discuss the relationship between mental disorders and the SARS-CoV-2 infection. We convey the disorders’ risk factors and the more serious mental disorder consequences of COVID-19. People with mental health disorders could be more susceptible to the emotional responses brought on by the COVID-19 epidemic. The COVID-19 pandemic may adversely influence the mental health of patients with already diagnosed mental disorders. For the aim of dealing better with the psychological problems of people afflicted by the COVID-19 pandemic, new psychological procedures are required.

[Anxiety, depression and stress-related disorders in post Covid-19: A Tunisian study]

OBJECTIVES

- Our study aimed to assess anxiety, depression, and post-traumatic stress disorder in post coronavirus disease 2019 (Covid-19) and identify associated factors.

PATIENTS AND METHODS

- Our study is a descriptive and analytical cross-sectional study carried out during the period from March 1 to May 15th 2021 on patients who were hospitalized and discharged from the Covid-19 unit in the pneumology department at the Hedi Chaker hospital in Sfax (Tunisia). Patients who met all of the following criteria were included: aged 18 and over; having a diagnosis of Covid-19 by polymerase chain reaction (PCR) and/or by CT scan; monitored at the Covid-19 unit and who their clinical conditions did not require intensive care; survivors after 3 months of leaving the service; and having given their informed and informal consent to participate in the study.

RESULTS

- Our study included 154 patients. The prevalence of anxiety, depression and post-traumatic stress disorder was 24.7%, 11% and 13.6% respectively. We found an association between depression and female gender (p= 0.025), gastrointestinal involvement (p= 0.002) and stigma (p= 0.002). We found an association between anxiety and grade level (p= 0.034), and between anxiety and asthenia (p= 0.032).

CONCLUSIONS

- Anxiety, depression, and post-traumatic stress disorder were independent of the majority of disease characteristics including the severity of Covid-19.

Persistent Symptoms After Acute COVID-19 Infection in Omicron Era

BACKGROUND

We aim to compare the clinical characteristics and subjectively reported symptoms of the acute coronavirus disease (COVID) phase and those of the post-acute COVID phase to examine varying factors that affect the number of persistent symptoms and their categories.

METHODS

We categorized 1,122 patients who visited the post coronavirus disease 2019 (COVID-19) clinic into two groups: "acute group" (< 4 weeks following diagnosis of COVID-19) and "post-acute group" (> 4 weeks following diagnosis of COVID-19). We statistically compared clinical characteristics between the two groups and determined which factors are associated with the number of persistent symptoms and their categories.

RESULTS

The persistent symptoms of post COVID-19 conditions were classified into three categories as follows: Category A (the prevalence of symptoms is higher in the acute-visit group than in the post-acute-visit group), Category B (the prevalence of symptoms is not different between the two groups) and Category C (the prevalence of symptoms is higher in the post-acute-visit group than in the acute-visit group). Category A mainly included respiratory symptoms. Category B had generalized weakness, weight loss, cardiologic symptoms, hypogeusia, hyposmia, anxiety, and various gastrointestinal symptoms. Category C included fatigue, decreased attention, depression, blurred vision, hair loss, and sexual dysfunction. Anxiety, depression, fatigue and age were also associated with the number of symptoms and their categories, and anxiety is the most correlated factor (P < 0.001) among them.

CONCLUSION

The persistent symptoms of post COVID-19 condition involve multi-organ and continue for four weeks or greater. Therefore, long-term observation and multidisciplinary interventions are essential for patients with post COVID-19 conditions.

Factors Associated With Depression and Anxiety in Korean Adolescents During the COVID-19 Pandemic

OBJECTIVE

This study was performed to identify factors associated with depression and anxiety among Korean adolescents during the coronavirus disease (COVID-19) pandemic.

METHODS

We conducted a cross-sectional study of 1,898 Korean adolescents (55.2% male, 44.8% female) ranging in age from 12 to 17 years (mean±standard deviaion age, 15.4±2.6 years). Depression and anxiety were defined as a Patient Health Questionnaire-9 score ≥10 and Generalized Anxiety Disorder-7 score ≥10, respectively. Other questionnaires included sociodemographic data, psychosocial stresses, and experiences in association with COVID-19. Psychiatric scales included Gratitude Questionnaire-6, Perceived Stress Scale-10, and UCLA Loneliness Scale-3.

RESULTS

The prevalence rates of depressive and anxiety symptoms among participants were 13.8% and 21.0%, respectively. Multivariable logistic regression analysis revealed that female sex, fear of COVID-19 infection, low gratitude were risk factors for depression. Fear of COVID-19 infection, increased TV watching time, and academic-related stress were risk factors for anxiety.

CONCLUSION

Depression and anxiety were prevalent during the pandemic in Korean adolescents, and were associated with fear of COVID-19 infection. Providing appropriate information on COVID-19, helping adolescents manage academic-related stress and maintain daily life patterns, and implementing interventions to foster gratitude are important for preventing depression and anxiety in Korean adolescents.

Psychological experience of COVID-19 patients: A systematic review and qualitative meta-synthesis

BACKGROUND

Coronavirus disease 2019 (COVID-19) has not only placed an unprecedented strain on healthcare systems worldwide, but has also caused irreparable physical and psychological damage to those infected. It is essential to understand the disease process and psychological experience of patients with COVID-19, to provide them with efficacious psychological guidance and interventions. This qualitative systematic review sought to explore the experience of COVID-19 patients.

METHODS

The meta-analysis methodology developed by the Joanna Briggs Institute guided this systematic review and qualitative meta-analysis. Seven databases were searched, with no language restrictions. This study was registered with PROSPERO under accession number CRD42021279266.

RESULTS

A total of 3107 potentially eligible articles were identified through database and reference list searches, among which 23 studies (from 10 countries) were ultimately included in our analysis. Five interrelated themes emerged: the complex psychological course of COVID-19 patients; the impact of the disease on the body; the expectation of support and guidance from multiple sources; coping strategies; and post-traumatic growth.

CONCLUSIONS

Psychological distress among patients with COVID-19 was found to be widespread. Healthcare providers should pay attention to the psychological changes in patients, ensure continuity of care and provide professional support from hospital to home, and build patients' confidence so that they can return to their families and society. Long-term follow-up studies may provide deeper insight into the psychological needs of survivors.

Suicide attempts presenting to the emergency department before and during the COVID-19 pandemic: a comparative study

Objective

To compare and analyze the differences in the sociodemographic and clinical characteristics of suicide attempters who visited an emergency department (ED) before and during the coronavirus disease (COVID-19) pandemic.

Methods

This single center, retrospective study was conducted by reviewing the medical records of patients in the “self-injury/suicide” category of the National Emergency Department Information System who visited an ED between January 2019 and December 2020. We obtained information on baseline characteristics, suicide attempt, and disposition. Data were analyzed using the chi-squared test.

Results

A total of 456 patients were included. The number of patients visiting the ED for suicide attempts increased by 18.2% (from 209 to 247 cases) during the COVID-19 pandemic, and the ratio of suicide attempters to the total number of ED visits increased by 48.8% (from 0.43% to 0.64%, P<0.001). There were significant differences in methods of suicide attempt, endotracheal intubation, ED disposition, and the presence of mental illness. Drug overdose (42.1% vs. 53.4%) and gas inhalation (5.7% vs. 8.5%) increased, and hanging decreased (6.0% vs. 2.0%) during the pandemic. Endotracheal intubation (13.9% vs. 5.7%) and intensive care unit admission (29.7% vs. 14.6%) decreased. More patients with the history of mental illness visited during the pandemic (54.0% vs. 70.1%).

Conclusion

Since the COVID-19 pandemic began, suicide attempts have increased in this single ED although the lethality of those attempts is low.

Factors Related to Anxiety and Depression Among Adolescents During COVID-19: A Web-Based Cross-Sectional Survey

BACKGROUND

The coronavirus disease 2019 (COVID-19) outbreak and subsequent disease-containment measures (such as school closures) significantly affected the lives of adolescents. We evaluated the mental-health status and factors associated with anxiety and depression among South Korean adolescents.

METHODS

A nationwide online survey was conducted to evaluate the mental-health status of South Korean adolescents during the COVID-19 pandemic. In total, 570 adolescents aged 13-18 years were surveyed between May 27 and June 11, 2021. The participants completed the Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ-9) to determine anxiety and depression symptoms, respectively. Stepwise logistic regression models were constructed to determine factors related to anxiety and depression.

RESULTS

Among the study participants, 11.2% and 14.2% had anxiety and depression, respectively. The results suggested that several factors, such as the experience of COVID-19 infection and quarantine of oneself, a family member or an acquaintance, physical and mental health problems, and fear of one's local community being discriminated against as a COVID-19 area were related to anxiety and depression.

CONCLUSION

The present study identified COVID-19-related factors associated with anxiety and depression among adolescents, and provides insights regarding potential interventions to improve the mental health of adolescents. To promote the mental health of adolescents during the COVID-19 pandemic, special attention should be paid to individuals with physical or mental-health problems, and efforts should be made to reduce the negative social and emotional impacts of infection-control measures.

Associations of health-related quality of life with depression and stigma in MERS-CoV survivors during the recovery period

ABSTRACT

We explored factors related to health-related quality of life (HRQOL), including psychiatric symptoms and stigma related to Middle East respiratory syndrome coronavirus (MERS-CoV) infection, among MERS-CoV survivors during the recovery period.Sixty-three MERS-COV survivors were recruited from five hospitals for a cohort study, one year after their infection in 2015. The subjects' demographic information and medical conditions associated with MERS-CoV were recorded. HRQOL was evaluated using the Short Form-8 Health Survey (SF-8). Depression, post-traumatic stress symptoms, chronic fatigue, and perceived stigma were assessed using several questionnairesThe mean physical component summary (PCS) and mean mental component summary (MCS) of the SF-8 score were below 50 T (43.47 ± 9.60, 45.74 ± 10.18). Depression, chronic fatigue, posttraumatic stress symptoms and stigma were negatively correlated with the SF-8 PCS and MCS. Multivariate logistic regression analysis showed that the PCS was associated with stigma (OR 8.66, 95% CI 1.96-38.23), whereas MCS was associated with depression (OR 26.62, 95% CI 3.56-198.85).The estimated HRQOL of MERS-CoV survivors during recovery was poor and appeared to be associated with depression and MERS-related stigma.

COVID-19, Long COVID Syndrome, and Mental Health Sequelae in a Mexican Population

The COVID-19 pandemic is currently a worldwide threat and concern, not only because of COVID-19 itself but its sequelae. The aim of this study was to evaluate whether a relation between COVID-19, Long COVID, and the prevalence of mental health disorders exist. A total of 203 people from Tabasco were included in this study, answering a survey integrated by three dominions: General and epidemiological data, the DASS-21 test (to determine the presence of signs or symptoms suggestive of depression, anxiety, and/or stress) and an exploratory questionnaire about Long COVID syndrome. A descriptive and inferential statistical analysis was made via Microsoft Excel and Graphpad Prism software, evaluating differences through the Mann−Whitney U test and considering p < 0.05 as statistically significant. Of the 203 people surveyed, 96 (47.29%) had had COVID-19 and 107 (52.71%) had not; from the ones that had COVID-19, 29 (30.21%) presented mental health disorders and 88 (91.66%) presented at least one symptom or sign of Long COVID syndrome; meanwhile, 31 (32.29%) presented 10 or more symptoms or signs. From the comparison between the population with previous mental health disorders and COVID-19 and those without background disorders or COVID-19, the results were the following: 27.58% vs. 16.82% presented severe depression, 48.27% vs. 17.75% presented severe anxiety, and 27.58% vs. 20.56% presented severe stress. A high prevalence of mental health effects was observed in patients without COVID-19 and increased in the population with Long COVID syndrome and previous mental health disorders.

South Korean validation of the COVID-related-PTSD scale in a non-clinical sample exposed to the COVID-19 pandemic

The threat of COVID-19 outbreak in South Korea and around the globe challenged not only physical health but also mental health, increasing the chances of disorders such as posttraumatic stress disorder (PTSD). Such pandemic situation can be referred to a traumatic event for citizens. The present study aims to examine the psychometric properties of the PTSD Checklist (PCL-5), which is named the K-COVID-related-PTSD. The scale measures PTSD symptomology in the context of the COVID-19 pandemic in South Korea. A total of 1434 South Korean citizens were included in this study. The data were statistically analyzed using SPSS 21.0 and Mplus 8.0. The results of confirmatory factor analysis demonstrated a superior fit for the seven-factor hybrid model (x² = 1425.445 (df = 149), CFI = 0.950, TLI = 0.937, SRMR = 0.033, RMSEA = 0.077) consisting of re-experiencing, negative affect, anxious arousal, dysphoric arousal, avoidance, anhedonia, and externalizing behaviors. Furthermore, the K-COVID-related-PTSD showed a satisfactory level of internal consistency (α = 0.793 to α = 0.939) with good convergent and discriminant validity. Finally, concurrent validity was confirmed by the significant correlations with all the negative mental health outcomes, such as PTSD symptoms, somatization, depression, anxiety, anger, negative affect, job burnout, and suicidal ideation. Overall, the current results demonstrate the K-COVID-related-PTSD is a valid scale and therefore has important implications for future pandemic-related studies.

Mental health impact of the Middle East respiratory syndrome, SARS, and COVID-19: A comparative systematic review and meta-analysis

BACKGROUND

Over the last few decades, 3 pathogenic pandemics have impacted the global population; severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV) and SARS-CoV-2. The global disease burden has attributed to millions of deaths and morbidities, with the majority being attributed to SARS-CoV-2. As such, the evaluation of the mental health (MH) impact across healthcare professionals (HCPs), patients and the general public would be an important facet to evaluate to better understand short, medium and long-term exposures.

AIM

To identify and report: (1) MH conditions commonly observed across all 3 pandemics; (2) Impact of MH outcomes across HCPs, patients and the general public associated with all 3 pandemics; and (3) The prevalence of the MH impact and clinical epidemiological significance.

METHODS

A systematic methodology was developed and published on PROSPERO (CRD42021228697). The databases PubMed, EMBASE, ScienceDirect and the Cochrane Central Register of Controlled Trials were used as part of the data extraction process, and publications from January 1, 1990 to August 1, 2021 were searched. MeSH terms and keywords used included Mood disorders, PTSD, Anxiety, Depression, Psychological stress, Psychosis, Bipolar, Mental Health, Unipolar, Self-harm, BAME, Psychiatry disorders and Psychological distress. The terms were expanded with a ‘snowballing’ method. Cox-regression and the Monte-Carlo simulation method was used in addition to I² and Egger’s tests to determine heterogeneity and publication bias.

RESULTS

In comparison to MERS and SARS-CoV, it is evident SAR-CoV-2 has an ongoing MH impact, with emphasis on depression, anxiety and post-traumatic stress disorder.

CONCLUSION

It was evident MH studies during MERS and SARS-CoV was limited in comparison to SARS-CoV-2, with much emphasis on reporting symptoms of depression, anxiety, stress and sleep disturbances. The lack of comprehensive studies conducted during previous pandemics have introduced limitations to the “know-how” for clinicians and researchers to better support patients and deliver care with limited healthcare resources.

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The impact of COVID-19 quarantine measures on the mental health of families

SUMMARY

COVID-19 is shaping all aspects of life throughout the world. The unexpected number of people who have been infected with and died from coronavirus disease (COVID-19) is evidence that the pandemic has affected families and societies. The strong shock wave that has resulted in the international response has focused more on medical rather than psychosocial interventions. Little has been written or studied about the impact of COVID-19 on families. This article explores the impact of the COVID-19 quarantine on the mental health of families. We conducted 20 in-depth interviews with Jordanian families through snowball sampling.

FINDINGS

The results show that 20 interviewees described varied and new experiences. Many of the families we interviewed displayed symptoms of mental health problems, including disrupted sleep patterns, changes in eating habits, excessive digital media use, anxiety, depression, excessive smoking, stomach aches, bedwetting among children, and persistent headaches. The study also demonstrated the psychological stress partners felt during the lockdown due to their worries about job security. They also communicated their hope that renewed family commitments might bring more stability to their relationships. During the lockdown, family members spent more time together, and it became harder to conceal any issues from each other.

APPLICATIONS

The findings of this research demonstrate a critical need for social workers, and it is hoped that future legislation will include a role for social workers in various fields of crisis. Moreover, social workers should encourage families to ask for intervention to overcome the long-term effects that may result from COVID-19.

Factors associated with the mental health of back-to-Wuhan university students based on quantile regression model during the COVID-19 period

BACKGROUND

The COVID-19 pandemic had brought the increased levels of depression and anxiety on people. Our study investigated the levels of mental health and influencing factors among back-to-Wuhan university students.

METHODS

A cross-sectional questionnaire survey was conducted from 31 August 2020, to 14 September 2020 by convenience sampling on the back-to-Wuhan university students, which included the Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), the Insomnia Severity Index-7 (ISI-7), the revised Impact of Event Scale (IES-R) scales, and the basic demographic characteristics. Moreover, quantile regression analysis was used to identify the key factors related to the mental health variables of the back-to-Wuhan university students during the COVID-19 period.

RESULTS

The results from 1017 participants suggested that the prevalence rates of the anxiety, depression, insomnia, and distress were 44%, 47.5%, 37.7%, 57.7%, respectively. Quantile regression showed that mental health scores were negatively associated to age, years from graduation, being discriminated against owing to the experience in Wuhan, and the attitude on the future of COVID-19, while was positively related to the education level (P < 0.05). Especially, the education level was highly related with anxiety (25th = 1.64, 50th = 2.54).

CONCLUSION

The finding showed that the respondents who were near graduation, discriminated owing to the experience in Wuhan, and worried about the future trend of COVID-19 had a higher risk of negative psychologic status, especially in the bottom and median quantile, and might require more psycho-social interventions or support.

New endemic and pandemic pathologies with interhuman airborne transmission through ear, nose and throat anatomical sites

The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has once again stigmatised the importance of airborne pathogens and their clinical, social and public health impact. Respiratory viruses are transmitted between individuals when the pathogen is released from the upper airways or from the lower respiratory tract of an infected individual. Airborne transmission is defined as the inhalation of the infectious aerosol, named droplet nuclei which size is smaller than 5 mm and that can be inhaled at a distance up to 2 metres. This route of transmission is relevant for viral respiratory pathogens, including severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome (MERS)-CoV, influenza virus, human rhinovirus, respiratory syncytial virus (RSV) and other respiratory virus families that differ in viral and genomic structures, susceptibility of a population to the infection, severity, transmissibility, ways of transmission and seasonal recurrence. Human respiratory viruses generally infect cells of the upper respiratory tract, eliciting respiratory signs and symptoms, sometimes without the possibility to differentiate them clinically. As seen by the current Coronavirus Disease 2019 (COVID-19) pandemic, human respiratory viruses can substantially contribute to increased morbidity and mortality, economic losses and, eventually, social disruption. In this article, we describe the structural, clinical and transmission aspects of the main respiratory viruses responsible for endemic, epidemic and pandemic infections.

Mental Health and Quality of Life for Disaster Service Workers in a Province under COVID-19

Objective: Healthcare workers and disaster service workers have been reported to be vulnerable to mental health problems during outbreaks of infectious diseases such as the COVID-19 pandemic. This study aimed to investigate the psychosocial characteristics of disaster service workers in charge of COVID-19-related work and also identify the factors affecting their quality of life. Methods: From June 2020 to June 2021, a survey was conducted of 526 disaster service workers in charge of COVID-19-related work. This included those working in public health care centers (PHC), 119 rescue and emergency medical services (119 REMS), public servants of city hall (PS), and police officers. The Korean version of the Fear of COVID-19 Scale, Patient Health Questionnaire-15, Hospital Anxiety and Depression Scale, Insomnia Severity Index, Connor−Davidson Resilience Scale, and World Health Organization quality of life assessment instrument brief form were used. A one-way ANOVA was conducted, and a stepwise regression analysis was carried out to determine the factors affecting quality of life. Results: Regarding quality of life, 119 REMS (180.64 ± 26.20) scored significantly higher than PHC (165.76 ± 23.73) and PS (163.90 ± 23.60), while police officers (176.87 ± 23.17) scored significantly higher than PS (163.90 ± 23.60) (F = 12.373, p < 0.001). Resilience (β = 0.897, p < 0.01) was the most significant explanatory variable, and together with insomnia (β = 0.154, p < 0.01), depression (β = −0.152, p < 0.01), and COVID-19 anxiety (β = −0.057, p < 0.01) accounted for 91.8% of the explanatory variance with regard to quality of life. Discussion: Quality of life was found to be negatively correlated with insomnia, depression, and COVID-19 anxiety while being positively correlated with resilience. Therefore, active interventions are needed to improve the resilience of disaster service workers.

Acute COVID-19 severity and mental health morbidity trajectories in patient populations of six nations: an observational study

Background

Methods

Findings

Interpretation

Funding

Long-term effects of COVID-19 on mental health: A systematic review

BACKGROUND

Acute effects of COVID-19 can be life-threatening. Alterations in mental health during the active infection have been documented, but the long-term consequences are less clear.

METHOD

A systematic review was undertaken to investigate the effect of COVID-19 infection on long-term mental health outcomes. Three databases [PubMed, Medline (Ovid) and Cochrane library] were searched between 1st October 2019 and 29th August 2021 with additional hand searching to identify all published studies reporting symptoms of generalised anxiety, depression, post-traumatic stress disorder (PTSD), or sleep disturbance in participants at least one month after COVID-19 infection. The prevalence and mean symptom score of each were assessed.

RESULTS

Eight hundred and eighty five studies were found, of which 33 were included in the review involving a total of 6743 participants. The studies' risk of bias were typically fair quality. The median study age of participants was 57.8 years (IQR 49.3-60.7), with 63.0% male (IQR 57.0%-73.0%). Participants typically experienced no or mild symptoms of long-term anxiety (GAD-7, STAI-S, HADS) and depression (PHQ-9, BDI, PHQ-2, HADS). Prevalence varied depending on the measurement tool. Sleep disturbances (primarily insomnia) were most commonly reported as mild. PTSD prevalence was similar to anxiety and depression.

CONCLUSION

The overall effect of the pandemic has been linked with worsening psychiatric symptoms. However, the long-term effect from direct COVID-19 infection has been associated with no or mild symptoms. Studies exhibited the long-term prevalence of anxiety, depression, PTSD, and sleep disturbances to be comparable to general population levels.

Self-Injurious Behavior Rate in the Short-Term Period of the COVID-19 Pandemic in Korea

BACKGROUND

The objective of this study was to investigate the trend of self-injurious behavior (SIB) among persons who were directly impacted by coronavirus disease 2019 (COVID-19), especially those with pre-existing mental disorders.

METHODS

Using the National Health Insurance Service-COVID-19 database cohort, the monthly SIB rate was calculated by COVID-19 subgroups (i.e., positive for COVID-19 test, negative for COVID-19 test, and non-COVID-19 test [control]). In addition, moderated regression analysis was utilized to examine the statistical difference of SIB (suicide attempt and non-suicidal self-injury using ICD-10 code) trend between COVID-19 subgroups and with and without pre-existing mental disorder.

RESULTS

A total of 328,373 persons were included in the cohort study. Of these, 212,678 had been tested for COVID-19, and 7,713 of them were confirmed positive. During the pandemic peak, the "negative for COVID-19" group showed a large increase (P = 0.003) in SIB rates compared to the control group, the "positive for COVID-19" group showed a decreasing trend, but not significant (P = 0.314). Among those who were tested for COVID-19, those with pre-existing mental disorders showed an increasing trend of SIB compared to those without pre-existing mental disorders, however statistically insignificant (P = 0.137).

CONCLUSION

Our results suggest that people who are tested for COVID-19 are at a high risk of SIB during the peak COVID-19 pandemic. Therefore, screening for suicide risk and psychological interventions is needed for these high-risk groups.

The Moderating Effect of Resilience on Mental Health Deterioration among COVID-19 Survivors in a Mexican Sample

Resilience has been reported to be a protective psychological variable of mental health; however, little is known about its role in COVID-19 survivors. Thus, in this study, we aimed to evaluate the levels of depression, anxiety, stress, traumatic impact, and resilience associated with COVID-19, as well as to investigate the role of resilience as a moderating variable. A sample of 253 participants responded to an online survey; all were previously diagnosed with COVID-19 by a nasopharyngeal swab RT-PCR test, were older than 18 years, and signed an informed consent form. Significant negative correlations were found between resilience and the mental health variables. Higher resilience was significantly related to a lower impact of the event, stress, anxiety, and depression when the number of symptoms was low. Only when the duration of COVID-19 was short and resilience levels were medium or high was psychological distress reduced. Moreover, resilience moderated the effects of COVID-19 on mental health, even if a relapse occurred. The results emphasize the need for interdisciplinary interventions aimed at providing COVID-19 patients with psychological and social resources to cope with the disease, as well as with probable relapses.

Global prevalence and associated risk factors of posttraumatic stress disorder during COVID-19 pandemic: A meta-analysis

BACKGROUND

The COVID-19 pandemic has negatively impacted the psychological well-being of individuals and society. Previous studies conducted on coronavirus outbreaks including Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome pandemic found that posttraumatic stress disorder (PTSD), depression, and anxiety were the most common mental health problems and long-term consequences of these outbreaks. Currently, comprehensive and integrated information on the global prevalence of PTSD due to the COVID-19 pandemic is lacking.

OBJECTIVE

In the present meta-analysis, we examined the global prevalence and associated risk factors of PTSD in patients/survivors of COVID-19, health professionals, and the population at large.

DESIGN

Meta-analysis.

DATA SOURCE

Cochrane, CINAHL, Embase, MEDLINE, PubMed, Scopus, Web of Science, and manual search up to June 2021.

METHODS

We included studies evaluating the prevalence of PTSD during the COVID-19 pandemic in either patients/survivors, health professionals, and the population at large. The data were analyzed using logit transformation with the random-effects model. Risk of bias assessment was conducted using Hoy and colleagues.

RESULTS

A total of 63 studies (n = 124,952) from 24 different countries were involved. The overall pooled estimate of PTSD prevalence was 17.52% (95% CI 13.89 to 21.86), with no evidence of publication bias (t=-0.22, p-value=0.83). This study found a high prevalence of PTSD among patients with COVID-19 (15.45%; 95% CI 10.59 to 21.99), health professionals (17.23%; 95% CI 11.78 to 24.50), and the population at large (17.34%; 95% CI 12.21 to 24.03). Subgroup analyses showed that those working in COVID-19 units (30.98%; 95% CI, 16.85 to 49.86), nurses (28.22%; 95% CI, 15.83 to 45.10), those living in European countries (25.05%; 95% CI 19.14 to 32.06), and studies that used Clinician-Administered PTSD Scale for DSM-5 (30.18%, 95% CI 25.78 to 34.98) demonstrated to have the highest PTSD prevalence compared to other subgroups. Meta-regression analyses revealed that the elderly (above age 65) had lower PTSD prevalence (-1.75, 95% CI -3.16 to -0.34) than the adult population.

CONCLUSION AND IMPLICATIONS

Substantial PTSD prevalence was found in patients with COVID-19, health professionals, and the population at large. Moderator analysis revealed that age, unit of work, health profession, continent, and assessment tools as significant moderators. Mental health services are needed for everyone, especially adults under the age of 65, those who work in COVID-19 units, nurses, and people in the European continent.

REGISTRATION

The study protocol was registered with the International database of prospective registered systematic reviews (PROSPERO): CRD42020218762. Tweetable abstract: The pooled PTSD prevalence during COVID-19 pandemic for patients with COVID-19, health professionals, and the population at large was 17.52%.

Impact of the COVID-19 Pandemic on the Incidence and Characteristics of Patients with Psychiatric Illnesses Visiting Emergency Departments in Korea

The global coronavirus disease 2019 (COVID-19) pandemic has had wide-ranging effects on the mental health of the public. This study aimed to investigate the impact of the COVID-19 pandemic on the characteristics of psychiatric patients who visited emergency departments (ED) during this time. A cross-sectional study was conducted including patients visiting 402 nationwide EDs from 27 January 2020 to 29 June 2020 (22 weeks; during-COVID) and the corresponding period in 2019 (28 January 2019 to 30 June 2019, 22 weeks; before-COVID) to control for seasonal influences. Among the 6,210,613 patients who visited the ED, 88,520 (2.5%) patients who visited before the pandemic and 73,281 (2.7%) patients who visited during the pandemic had some kind of psychiatric illness. The incidence rates of psychiatric self-harm increased from 0.54 before the pandemic to 0.56 during the pandemic per 1,000,000 person-days (p = 0.04). Age- and sex-standardized rates of psychiatric illnesses per 100,000 ED visits increased during the pandemic (rate differences (95% CIs); 45.7 (20.1–71.4) for all psychiatric disorders and 42.2 (36.2–48.3) for psychiatric self-harm). The incidence of psychiatric self-harm and the proportion of psychiatric patients visiting EDs increased during the COVID-19 pandemic.