Migrant workers in China need emergency psychological interventions during the COVID-19 outbreak

Pandemic Fatigue and Preferences for COVID-19 Public Health and Social Measures in China: Nationwide Discrete Choice Experiment

BACKGROUND

Information on the public's preferences for current public health and social measures (PHSMs) and people's mental health under PHSMs is insufficient.

OBJECTIVE

This study aimed to quantify the public's preferences for varied PHSMs and measure the level of pandemic fatigue in the COVID-19 normalization stage in China.

METHODS

A nationwide cross-sectional study with a discrete choice experiment and psychometric scales was conducted to assess public preferences for and attitudes toward PHSMs, using the quota sampling method. The COVID-19 Pandemic Fatigue Scale (CPFS) was used to screen fatigue levels among respondents. The multinomial logit model, latent class model, and Mann-Whitney test were used for statistical analysis. We also conducted subgroup analysis based on sex, age, monthly income, mental health status, and pandemic fatigue status.

RESULTS

A total of 689 respondents across China completed the survey. The discrete choice experiment revealed that respondents attached the greatest importance to the risk of COVID-19 infection within 3 months (45.53%), followed by loss of income within 3 months (30.69%). Vulnerable populations (low-income populations and elderly people) were more sensitive to the risk of infection, while younger respondents were more sensitive to income loss and preferred nonsuspension of social places and transportation. Migrants and those with pandemic fatigue had less acceptance of the mandatory booster vaccination and suspension of transportation. Additionally, a higher pandemic fatigue level was observed in female respondents, younger respondents, migrants, and relatively lower-income respondents (CPFS correlation with age: r=-0.274, P<.001; correlation with monthly income: r=-0.25, P<.001). Mandatory booster COVID-19 vaccination was also not preferred by respondents with a higher level of pandemic fatigue, while universal COVID-19 booster vaccination was preferred by respondents with a lower level of pandemic fatigue.

CONCLUSIONS

Pandemic fatigue is widely prevalent in respondents across China, and respondents desired the resumption of normal social life while being confronted with the fear of COVID-19 infection in the normalization stage of COVID-19 in China. During future pandemics, the mental burden and adherence of residents should be considered for the proper implementation of PHSMs.

Effectiveness of a scalable, remotely delivered stepped-care intervention to reduce symptoms of psychological distress among Polish migrant workers in the Netherlands: study protocol for the RESPOND randomised controlled trial

BACKGROUND

The COVID-19 pandemic has negatively affected the mental health of international migrant workers (IMWs). IMWs experience multiple barriers to accessing mental health care. Two scalable interventions developed by the World Health Organization (WHO) were adapted to address some of these barriers: Doing What Matters in times of stress (DWM), a guided self-help web application, and Problem Management Plus (PM +), a brief facilitator-led program to enhance coping skills. This study examines whether DWM and PM + remotely delivered as a stepped-care programme (DWM/PM +) is effective and cost-effective in reducing psychological distress, among Polish migrant workers with psychological distress living in the Netherlands.

METHODS

The stepped-care DWM/PM + intervention will be tested in a two-arm, parallel-group, randomized controlled trial (RCT) among adult Polish migrant workers with self-reported psychological distress (Kessler Psychological Distress Scale; K10 > 15.9). Participants (n = 212) will be randomized into either the intervention group that receives DWM/PM + with psychological first aid (PFA) and care-as-usual (enhanced care-as-usual or eCAU), or into the control group that receives PFA and eCAU-only (1:1 allocation ratio). Baseline, 1-week post-DWM (week 7), 1-week post-PM + (week 13), and follow-up (week 21) self-reported assessments will be conducted. The primary outcome is psychological distress, assessed with the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). Secondary outcomes are self-reported symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), resilience, quality of life, and cost-effectiveness. In a process evaluation, stakeholders' views on barriers and facilitators to the implementation of DWM/PM + will be evaluated.

DISCUSSION

To our knowledge, this is one of the first RCTs that combines two scalable, psychosocial WHO interventions into a stepped-care programme for migrant populations. If proven to be effective, this may bridge the mental health treatment gap IMWs experience.

TRIAL REGISTRATION

Dutch trial register NL9630, 20/07/2021, https://www.onderzoekmetmensen.nl/en/trial/27052.

Does seasonality affect snoring? A study based on international data from the past decade

BACKGROUND

Though snoring is often regarded as a harmless condition that coincides with sound sleep, it is a sleep disorder that can be a potential indicator of more severe conditions such as sleep apnea syndrome. In the present study, we investigated the association between seasonal variations and snoring.

METHOD

Search index for snoring (SIS) data were obtained from Google Trends and Baidu Index. SIS data were collected for the USA, India, Germany, Russia, Japan, Australia, China, and Brazil from 2011 to 2020, with the periodicity of the relationship between seasonal time series data and snoring evaluated using a time series decomposition model.

RESULT

The highest average SIS growth rates from 2011 to 2020 were observed for Brazil, Japan, and Germany, with average SIS values of 94%, 68%, and 49%, respectively. The SIS of the USA, Russia, Japan, Brazil, Australia, Germany, and India increased by 22.3%, 12.4%, 11.9%, 35.4%, 12.3%, 28.0%, and 55.8%, respectively, in comparison with their SIS values in 2019, whereas for China, it decreased by 13.7%. Relative to countries in the southern hemisphere, those in the northern hemisphere showed comparable SIS trends, increasing from September to February and decreasing from March to August.

CONCLUSION

The SIS data showed cyclical changes over the study period. The search index for snoring increased during the cold season or the heating season, suggesting that snoring is associated with seasonal changes.

Is psychologically vulnerable rural-to-urban migrants' mental health further at stake under China's tightened COVID-19 measures: how should the government respond?

There is a well-documented scholarly discourse on how the COVID-19 outbreak adversely affects the mental health of Chinese nationals. However, there is little evidence revealing how the public health crisis negatively influenced the mental health of rural-to-urban migrants in China. The relevant literature argues that rural-to-urban migrant workers and their dependents have been experiencing discrimination, exclusion, and stigmatization in the urban labor market and social space, thereby jeopardizing their mental health to a large extent. However, whether the COVID-19 outbreak and its associated consequences further compounded rural-to-urban migrant workers' mental health has rarely been discussed. Since 2010, the Chinese government has emphasized the importance of promoting positive mental health. Without identifying how COVID-19 specifically imposed mental health challenges on rural-to-urban migrant cohorts, Chinese policymakers cannot effectively and efficiently address the dilemmas faced by such vulnerable groups. The significant rural-to-urban migrant population (i.e. 291 million), alongside their disposition to encounter social and psychological challenges, prompts the urgency to develop this narrative essay to examine whether their mental health burdens worsened during the pandemic. The author also discusses remedies for the worsened mental issues faced by migrant cohorts, and recommends policies that local Chinese governments should adopt to mitigate the mental health burdens encountered by rural-to-urban migrants.

Migration, Embeddedness, and Vulnerability During the COVID-19 Pandemic

The COVID-19 pandemic and concomitant policy measures have disproportionally affected the lives of migrants worldwide. Focusing on inequalities between social groups, studies have tended to neglect the role of local embeddedness as a factor influencing the extent to which individuals are affected by COVID-19. In this paper, we study the vulnerabilities of people with different migration experiences in an urban setting in the early stages of the pandemic, focusing on three key livelihood assets: economic, social, and human capital (health). Our analyses are based on online survey data (n = 1381) collected among international migrants, second-generation residents (those with at least one parent born abroad), and non-migrants residing in Amsterdam in July 2020. We find that international migrants, and particularly those who arrived in the city more recently, reported larger shocks to their economic and social capital than other city residents. This finding illustrates the vulnerabilities of "newcomers" to the city and their limited resilience to shocks. Second-generation residents were particularly vulnerable in terms of health, but this relationship was strongly mediated by education and neighborhood effects. In all three groups, those with poor relative wealth and those who were self-employed were more vulnerable to economic shocks. Our findings illustrate how the COVID-19 pandemic has exacerbated inequalities in vulnerabilities across migrant and non-migrant groups, and how those who were locally embedded, including migrants and non-migrants, were less likely to be negatively affected by the pandemic.

Health-care access and utilization among HIV-infected men who have sex with men in two Chinese municipalities with or without lockdown amidst early COVID-19 pandemic

City lockdown is critical to successfully contain the COVID-19 pandemic. The impact of lockdown and COVID-19 pandemic on healthcare among vulnerable population has yet to be explicated. A cross-sectional survey was conducted among HIV-infected men who have sex with men (MSM) in Wuhan with city lockdown and Shanghai without lockdown, and healthcare interruptions were evaluated and compared. A logistic regression analysis was employed to examine associates of HIV-related healthcare interruptions and compromised mental health. Compared to participants in Shanghai (N = 440), HIV-infected MSM in Wuhan (N = 503) had significantly higher proportion of untimely availability of antiretroviral drugs (ARVs) (20.6% vs. 8.4%), obtaining ARVs from outside institutions (29.1% vs. 8.1%), postponed non-AIDS treatment (6.4% vs. 2.8%) and untimely follow-up appointments (33.4% vs. 14.5%). HIV-related healthcare interruptions were positively associated with lockdown (OR = 4.89, 95% CI: 3.49-6.85) and non-local residence (OR = 1.91, 95% CI: 1.37-2.64). Compromised mental health, including insomnia and generalized anxiety disorders, was associated with non-local residence (OR  = 1.35, 95% CI: 1.01-1.81) and healthcare interruptions (OR = 1.34, 95% CI: 1.01-1.79). HIV-infected MSM are vulnerable to healthcare interruptions and mental health problems during the COVID-19 pandemic, underscoring the need for tailored intervention strategies to minimize deleterious health consequences.

Social Support for Acculturative Stress, Job Stress, and Perceived Discrimination Among Migrant Workers Moderates COVID-19 Pandemic Depression

Objectives: This study aimed to investigate the practical moderating effect of social support on the relationship between acculturative stress, job stress, and perceived discrimination, and depression among migrant workers during the coronavirus disease-19 pandemic as a vulnerable group susceptible to mental health problems. Methods: Data for this cross-sectional descriptive study were collected using an online survey from 214 Vietnamese and Cambodian migrant workers, who are among the largest migrant groups residing in South Korea. Participants were asked to report on acculturative stress, job stress, perceived discrimination, depression, and social support through questionnaires in their native languages. Results: The findings showed that acculturative stress affected depression, and this effect was moderated by social support. The impact of acculturative stress on depression was significant in the group with low mean scores of social support. However, the effect of the interaction of social support on the relationship of job stress and perceived discrimination to depression was not statistically significant. Conclusion: Our findings suggest the need for differentiated strategies to improve the mental health of migrant workers based on the level of social support.

Implementation Evaluation of a Cluster Randomized Controlled Trial to Promote the Use of Respiratory Protective Equipment Among Migrant Workers Exposed to Organic Solvents in Small and Medium-Sized Enterprises

Background

While the effectiveness of several occupational healthcare interventions has been demonstrated, successful implementation of such programs among internal migrant workers (IMWs) in small and medium-sized enterprises (SMEs) has been limited. This study aimed to evaluate the implementation of a three-arm cluster randomized controlled trial promoting respiratory protective equipment (RPE) use among IMWs exposed to organic solvents in SMEs and to assess the association between participants' compliance and effectiveness of intervention.

Methods

A total of 60 SMEs were randomly allocated to a low- or high-intensive intervention group, or a control group that did not receive any intervention. The low-intensive intervention group was subjected to both traditional and mHealth occupational health education. The high-intensive intervention group was subjected to the low-intensive group activities and peer education. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide implementation evaluation of this 6-months intervention. Generalized linear mixed models (GLMMs) were used to evaluate the effects of participants' compliance with the intervention on the primary outcomes, regarding the appropriate use of RPE.

Results

Of 4,527 potentially eligible participants, 1,211 individuals were enrolled, with a reach rate of 26.8%. Sixty of the 66 SMEs approached (90.9%) SMEs adopted the intervention. Fidelity to traditional education (100.0%) and mHealth intervention (97.5%) was higher than fidelity to peer education (20.0%). Peer leaders cited inconvenient time and unfamiliarity with peers as two major barriers to delivering peer education. Compared with the control group, IMWs who complied with the interventions in both groups were more likely to wear RPE appropriately [low-intensive group: adjusted odds ratio (aOR) = 2.58, 95% confidence interval (CI): 1.56–4.28; high-intensive group: aOR = 7.52, 95% CI: 3.72–15.23]. Most participants (95.8%) were satisfied with the program and 93.1% stated that they would maintain the use of RPE in the future.

Conclusions

A multi-component occupational health intervention to promote the use of RPE among IMWs in SMEs was feasible and acceptable. Peer education had great potential to enhance the occupational health behavior of IMWs, and thus strategies to improve participants' adherence to this component warrant further investigation.

Clinical Trial Registration

http://www.chictr.org.cn, identifier: ChiCTR-IOR-15006929.

Effects of Transcranial Pulse Stimulation (TPS) on Young Adults With Symptom of Depression: A Pilot Randomised Controlled Trial Protocol

Background

Since the emergence of the COVID-19 pandemic, there have been lots of published work examining the association between COVID-19 and mental health, particularly, anxiety and depression in the general populations and disease subpopulations globally. Depression is a debilitating disorder affecting individuals' level of bio-psychological-social functioning across different age groups. Since almost all studies were cross-sectional studies, there seems to be a lack of robust, large-scale, and technological-based interventional studies to restore the general public's optimal psychosocial wellbeing amidst the COVID-19 pandemic. Transcranial pulse stimulation (TPS) is a relatively new non-intrusive brain stimulation (NIBS) technology, and only a paucity of studies was conducted related to the TPS treatment on older adults with mild neurocognitive disorders. However, there is by far no study conducted on young adults with major depressive disorder nationwide. This gives us the impetus to execute the first nationwide study evaluating the efficacy of TPS on the treatment of depression among young adults in Hong Kong.

Methods

This study proposes a two-armed single-blinded randomised controlled trial including TPS as an intervention group and a waitlist control group. Both groups will be measured at baseline (T1), immediately after the intervention (T2), and at the 3- month follow-up (T3).

Recruitment

A total of 30 community-dwelling subjects who are aged 18 and above and diagnosed with major depressive disorder (MDD) will be recruited in this study. All subjects will be computer randomised into either the intervention group or the waitlist control group, balanced by gender and age on a 1:1 ratio.

Intervention

All subjects in each group will have to undertake functional MRI (fMRI) before and after six 30-min TPS sessions, which will be completed in 2 weeks' time.

Outcomes

Baseline measurements and post-TPS evaluation of the psychological outcomes (i.e., depression, cognition, anhedonia, and instrumental activities of daily living) will also be conducted on all participants. A 3-month follow-up period will be usedto assess the long-term sustainability of the TPS intervention. For statistical analysis, ANOVA with repeated measures will be used to analyse data. Missing data were managed by multiple mutations. The level of significance will be set to p < 0.05.

Significance of the Study

Results of this study will be used to inform health policy to determine whether TPS could be considered as a top treatment option for MDD.

Clinical Trial Registration

ClinicalTrials.gov, identifier: NCT05006365.

Factors associated with symptoms of poor mental health among women factory workers in China's supply chain

OBJECTIVE

Foreign direct investment (FDI) to China has motivated increased labor migration to export processing zones (EPZs). Work environments with high occupational stress, such as production line jobs typical in EPZs, have been associated with adverse mental health symptoms.

METHODS

A cross-sectional survey that examined occupational stress and symptoms of poor mental health was implemented among Chinese women factory workers in three electronic factories in the Tianjin Economic-Technological Development Area. Symptoms of mental health measured in the survey were hopelessness, depression, not feeling useful or needed, and trouble concentrating. Crude and adjusted prevalence odds ratios and their 95% confidence intervals were calculated with logistic regression.

RESULTS

Responses were collected from 696 women factory workers. Participants were aged 18-56 years (mean 28 ± 5.8), 66% of whom were married and 25% of whom were migrants. Nearly 50% of participants reported at least one symptom of poor mental health. After adjusting for covariates associated with each outcome in the bivariate analysis, high job strain was associated with hopelessness (OR 2.68, 95% CI 1.58, 4.56), not feeling useful (OR 2.05, 95% CI 1.22, 3.43), and feeling depressed (OR 1.78, 95% CI 1.16, 2.72).

CONCLUSION

This study expands on the international body of research on the well-being of women working in the global supply chain and provides evidence on the associations between occupational stressors, migration, and social support on symptoms of poor mental health among women workers. Future research to better understand and improve psychological health and to prevent suicide among workers in China's factories is critical to improve the health of China's labor force.

National and foreign experience in providing emergency psychological assistance to the population

The article presents the foreign and national experience of providing emergency psychological assistance. The analysis of modern publications made it possible to determine the specifics of psychotraumatic situations, as well as the psychological states of victims requiring emergency psychological intervention, to formulate the principles of providing this assistance. The practice of organizing the work of specialists of emergency psychological and social services with victims, survivors of domestic violence, victims of terrorist attack and other emergencies, medical workers and volunteers providing various assistance in the conditions of the COVID-19 pandemic in Russia and abroad is highlighted. The article considers the system of organization of psychological assistance by specialists of psychological service in the Russian Federation. The problem of assessment of the effectiveness of psychological assistance is actualized by the example of the methodology of monitoring and assessment of actions in the area of mental health and psychosocial support in emergency situations.

The optimal vaccination strategy to control COVID-19: a modeling study in Wuhan City, China

Background

Reaching optimal vaccination rates is an essential public health strategy to control the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to simulate the optimal vaccination strategy to control the disease by developing an age-specific model based on the current transmission patterns of COVID-19 in Wuhan City, China.

Methods

We collected two indicators of COVID-19, including illness onset data and age of confirmed case in Wuhan City, from December 2, 2019, to March 16, 2020. The reported cases were divided into four age groups: group 1, ≤ 14 years old; group 2, 15 to 44 years old; group 3, 44 to 64 years old; and group 4, ≥ 65 years old. An age-specific susceptible-exposed-symptomatic-asymptomatic-recovered/removed model was developed to estimate the transmissibility and simulate the optimal vaccination strategy. The effective reproduction number (R_eff) was used to estimate the transmission interaction in different age groups.

Results

A total of 47 722 new cases were reported in Wuhan City from December 2, 2019, to March 16, 2020. Before the travel ban of Wuhan City, the highest transmissibility was observed among age group 2 (R_eff = 4.28), followed by group 2 to 3 (R_eff = 2.61), and group 2 to 4 (R_eff = 1.69). China should vaccinate at least 85% of the total population to interrupt transmission. The priority for controlling transmission should be to vaccinate 5% to 8% of individuals in age group 2 per day (ultimately vaccinated 90% of age group 2), followed by 10% of age group 3 per day (ultimately vaccinated 90% age group 3). However, the optimal vaccination strategy for reducing the disease severity identified individuals ≥ 65 years old as a priority group, followed by those 45–64 years old.

Conclusions

Approximately 85% of the total population (nearly 1.2 billion people) should be vaccinated to build an immune barrier in China to safely consider removing border restrictions. Based on these results, we concluded that 90% of adults aged 15–64 years should first be vaccinated to prevent transmission in China.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-021-00922-4.

Impact Measurement of COVID-19 Lockdown on China's Electricity-Carbon Nexus

Lockdown measures to prevent the spread of coronavirus disease 2019 (COVID-19) resulted in the plummeting of China's overall electric-power demand and production. To date, power generation remains one of the largest carbon dioxide (CO2) emitting sectors of China on account of its high carbon intensity. Within this context, our study seeks to measure the impacts of COVID-19 lockdown on the electricity-power related carbon footprints on both generation and consumption sides. Built on statistical data of electricity generation and consumption released by the National Bureau of Statistics of China (NBSC), we calculate he nationwide electricity related CO2 emission changes in regional, economic-sectoral and technological dimensions during January-April 2020, when the strictest lock-down measures were taken in China and compare the results with the same months of the year prior. Our results show that both east and central China power grids witnessed drastic reduction (15.0% and 13.8%) in electricity-generation caused CO2 emissions; and the biggest falls of provincial-scale electricity-generation CO2 emission took place in Hubei (27.3%). Among China's electricity production mix, coal remains the biggest CO2 emitter and contributed 95.7% of the overall nationwide reduction. The most significant decline of the nationwide consumptive-electricity carbon footprint was by 10.1% in February, with the secondary economic sector the biggest contributor.

Effects of Wise Intervention on Perceived Discrimination Among College Students Returning Home From Wuhan During the COVID-19 Outbreak

At the beginning of the coronavirus disease 2019 (COVID-19) outbreak, college students returning home from Wuhan, Hubei Province, experienced various degrees of discrimination. This study first investigates perceived discrimination among college students returning home from Wuhan. Then, an experimental method is used to investigate the effectiveness of an intervention designed to reduce the perceived discrimination among those who returned to towns outside of Hubei Province. A total of 63 college students participated in the experiment. In the experimental group (N = 31), a wise intervention based on reading and writing was adopted to intervene in perceived discrimination among the participants. The results showed that the perceived discrimination among students returning from Wuhan to towns outside of Hubei Province was significantly higher than that among students returning to towns within Hubei Province. The wise intervention reduced the perceived discrimination in the experimental group but not in the control group. Further analysis found that perceived social support fully mediated the relationship between the intervention and perceived discrimination. These results provide insights on how the content of intervention (perceived social support) and the form of intervention (wise intervention) can prevent the occurrence of psychological problems in epidemic situations.

College students' stress and health in the COVID-19 pandemic: The role of academic workload, separation from school, and fears of contagion

The COVID-19 pandemic has unhinged the lives of people across the globe. In particular, more than 30 million Chinese college students are home-schooling, yet there is little understanding of how academic workload, separation from school, and fears of contagion lead to a decrease in their health. This study examined the relationships between Chinese college students' three critical stressors and two types of health in the COVID-19 pandemic context. We used a three-wave lagged design with a one-week interval. All the constructs were assessed by self-report in anonymous surveys during the COVID-19 pandemic. College students were asked to report their demographic information, academic workload, separation from school, fears of contagion, perceived stress, and health. The results of this study showed that academic workload, separation from school, and fears of contagion had negative effects on college students' health via perceived stress. In the COVID-19 crisis, multiple prevention and control measures focusing on college students may lead them to have different degrees of stress and health problems. Our results enrich the literature on stress and health and offer novel practical implications for all circles of the society to ensure students' health under the context of the COVID-19 epidemic.