Multi-level predictors of psychological problems among methadone maintenance treatment patients in difference types of settings in Vietnam

Quantifying the benefits of healthy lifestyle behaviors and emotional expressivity in lowering the risk of COVID-19 infection: a national survey of Chinese population

BACKGROUND

COVID-19 is still prevalent in most countries around the world at the low level. Residents' lifestyle behaviors and emotions are critical to prevent COVID-19 and keep healthy, but there is lacking of confirmative evidence on how residents' lifestyle behaviors and emotional expressivity affected COVID-19 infection.

METHODS

Baseline study was conducted in August 2022 and follow-up study was conducted in February 2023. Baseline survey collected information on residents' basic information, as well as their lifestyle behaviors and emotions. Follow-up study was carried out to gather data on COVID-19 infection condition. Binary logistic regression was utilized to identify factors that may influence COVID-19 infection. Attributable risk (AR) was computed to determine the proportion of unhealthy lifestyle behaviors and emotional factors that could be attributed to COVID-19 infection. Sensitivity analysis was performed to test the robustness of the results.

RESULTS

A total of 5776 participants (46.57% males) were included in this study, yielding an overall COVID-19 infection rate of 54.8% (95%CI: 53.5 - 56.0%). The findings revealed that higher stress levels [aOR = 1.027 (95%CI; 1.005-1.050)] and lower frequency in wearing masks, washing hands, and keeping distance [aOR = 1.615 (95%CI; 1.087-2.401)], were positively associated with an increased likelihood of COVID-19 infection (all P < 0.05). If these associations were causal, 8.1% of COVID-19 infection would have been prevented if all participants had normal stress levels [Attributable Risk Percentage: 8.1% (95%CI: 5.9-10.3%)]. A significant interaction effect between stress and the frequency in wearing masks, washing hands, and keeping distance on COVID-19 infection was observed (β = 0.006, P < 0.001), which also was independent factor of COVID-19 infection.

CONCLUSIONS

The overall COVID-19 infection rate among residents is at a medium level. Residents' increasing stress and decreasing frequency in wearing masks and washing hands and keeping distance contribute to increasing risk of infection, residents should increase the frequency of mask-wearing, practice hand hygiene, keep safe distance from others, ensure stable emotional state, minimize psychological stress, providing evidence support for future responses to emerging infectious diseases.

The risk assessment of relapse among newly enrolled participants in methadone maintenance treatment: A group-LASSO based Bayesian network study

Background

Relapse is a great barrier to improving the effectiveness of methadone maintenance treatment (MMT). Participants with different treatment durations could vary in their compliance with MMT, which may lead to different levels of relapse risk. This study aims to identify the risk factors for relapse and assess the relapse risk of MMT participants of different treatment durations.

Method

This retrospective study used data collected from seven MMT clinics in Guangdong Province, China, from January 2010 to April 2017. Newly enrolled participants who received 6 (n = 903) and 12 (n = 710) months of consecutive treatment with complete data were included. We selected significant risk factors for relapse through the group lasso regression and then incorporated them into Bayesian networks to reveal relationships between factors and predict the relapse risk.

Results

The results showed that participants who received 6-month treatment had a lower relapse rate (32.0%) than those of 12-month treatment (39.0%, P < 0.05). Factors including personal living status and daily methadone dose were only influential to those who received the 6-month treatment. However, age, age at the initial drug use, HIV infection status, sexual behaviors, and continuous treatment days were common factors of both durations. The highest relapse risk for those after the 6-month treatment was inferred as 66.7% while that of the 12-month treatment was 83.3%. Farmers and those who have high accessibility to MMT services may require additional attention.

Conclusion

It is necessary to implement targeted interventions and education based on the treatment durations of participants to decrease the relapse rate. Meanwhile, those about HIV/sexually transmitted infection prevention and anti-narcotics should be held in the whole process.

Psychological challenges and related factors of ordinary residents after "7.20" heavy rainstorm disaster in Zhengzhou: a cross-sectional survey and study

BACKGROUND

In 2021, a once-in-a-century heavy rainstorm suddenly attacked Zhengzhou, an important inland city in northern China. However, there have been no studies on the psychological health of disaster-stricken residents. This study is the first to comprehensively report on the mental health status and related factors of local ordinary residents after the heavy rainstorm.

OBJECTIVE

The purpose of this study is to investigate the mental health status and related influencing factors of local ordinary residents after the flood disaster, and to provide reference for government departments to formulate disaster psychological intervention countermeasures based on evidence-driven strategies.

METHODS

The snowball sampling technique was used in this study, and measurement tools of Rainstorm Exposure Questionnaire, Subjective Perception of Rainstorm, Post-Traumatic Stress Disorder Checklist-Civilian version (PCL-C), Depression, Anxiety and Stress Scale-21 (DAS-21) and Chinese version of Social Support Rating Scale (SSRS) were used to evaluate the rainstorm exposure, subjective perception of the rainstorm, psychological symptoms and social support of the disaster-stricken residents within a week after the rainstorm. Logistic regression analysis was used to examine the psychological status and related factors of local residents after the rainstorm disaster.

RESULTS

A total of 469 valid samples were obtained in this study. All the subjects were in the disaster area and experienced the rainstorm personally, with normal intelligence. The statistical results showed that 25.37% people had experienced at least three rainstorm-related stresses, nearly 20.26% people had post-traumatic stress disorder (PTSD) symptoms, and 39.3%, 53.92% and 65.83% people had depression, anxiety and stress symptoms, respectively. Multivariable logistic regression analyses indicated that female (all p < 0.05), the divorced, agricultural workers/farmers (all p < 0.05), students (all p < 0.05), people experiencing at least three rainstorm-related stresses (p < 0.05 or p < 0.01), people with lower satisfaction at the social flood fighting measures (p < 0.05 or p < 0.01) and people with low social support (p < 0.05 or p < 0.01) were all independent risk factors for poor psychological health, and college education or above (p < 0.05 or p < 0.01), the lower degree of worrying about themselves (all p < 0.01), family members (all p < 0.01) and family property (all p < 0.01) were all related to higher psychological health among flood survivors after the disaster.

CONCLUSIONS

Rainstorm could cause local residents to have various degrees of psychological symptoms. This study identified factors associated with the psychological health of disaster-stricken residents, which could be used to develop psychological interventions in improving psychological health of local residents.

Investigating the effect of zinc supplementation on probability of relapse and mental health in patients with opioid use disorder undergoing methadone maintenance treatment

BACKGROUND

Considering different factors, such as high withdrawal rates in methadone maintenance treatment (MMT) programs alongside mental health (MH) problems appearing in patients with opioid use disorder and the lack of prior research on the effect of zinc supplementation in this respect, the present study aimed to investigate the effect of zinc supplementation on the probability of relapse (PoR) and MH problems in patients with opioid use disorder undergoing MMT.

METHODS

For this purpose, a randomized controlled trial with a clinical basis was fulfilled on a total of 68 patients with opioid use disorder receiving MMT, allocated to two groups, viz. intervention, and control (each one consisting of 34 individuals). Then, the participants in the intervention group were given zinc supplements combined with methadone for three months, and the controls only took methadone, according to the treatment plan. The data were collected using the Relapse Prediction Scale (RPS) and the Depression, Anxiety, and Stress Scale 21 (DASS-21) before, one month after, and at the end of the intervention program.

FINDINGS

Compared to the control group, the likelihood of drug use (p = 0.01), drug craving (p = 0.002), and the RPS total score (p = 0.002) in the intervention group was significantly lower. Moreover, the results revealed a significant decreasing trend in depression (p = 0.01), anxiety (p < 0.001), stress (p = 0.001), and the DASS-21 total score (p = 0.001) in the intervention. Compared to the control group, the DASS-21 total score (p < 0.001) in the intervention group was significantly lower.

CONCLUSION

Accordingly, it was concluded that zinc supplementation could reduce the PoR and improve MH problems in patients with opioid use disorder experiencing MMT. However, further research is recommended to fill the gaps.

TRIAL REGISTRATION

The research protocol has also been listed on the Iranian Registry of Clinical Trials (IRCT) with code no. IRCT2020050904736N1.

Stigma experienced by people living with HIV who are on methadone maintenance treatment and have symptoms of common mental disorders in Hanoi, Vietnam: a qualitative study

BACKGROUND

Stigma around human immunodeficiency virus (HIV), injection drug use (IDU), and mental health disorders can be co-occurring and have different impacts on the well-being of people living with HIV (PWH) who use drugs and have mental health disorders. This stigma can come from society, health professionals, and internalized stigma. A person who has more than one health condition can experience overlapping health-related stigma and levels of stigma which can prevent them from receiving necessary support and healthcare, serving to intensify their experience with stigma. This study investigates HIV, drug use, and mental health stigmas in three dimensions (social, internalized, and professional) around PWH on methadone maintenance treatment (MMT) who have common mental disorders (CMDs) including depression, anxiety, and stress-related disorders in Hanoi, Vietnam.Please check and confirm whether corresponding author's email id is correctly identified.The cooresponding author's email is correct METHODS: We conducted semi-structured, in-depth interviews (IDIs) (n = 21) and two focus group discussions (FGDs) (n = 10) with PWH receiving MMT who have CMD symptoms, their family members, clinic health care providers, and clinic directors. We applied thematic analysis using NVIVO software version 12.0, with themes based on IDI and FGD guides and emergent themes from interview transcripts.

RESULTS

The study found evidence of different stigmas towards HIV, IDU, and CMDs from the community, family, health care providers, and participants themselves. Community and family members were physically and emotionally distant from patients due to societal stigma around illicit drug use and fears of acquiring HIV. Participants often conflated stigmas around drug use and HIV, referring to these stigmas interchangeably. The internalized stigma around having HIV and injecting drugs made PWH on MMT hesitant to seek support for CMDs. These stigmas compounded to negatively impact participants' health.

CONCLUSIONS

Strategies to reduce stigma affecting PWH on MMT should concurrently address stigmas around HIV, drug addiction, and mental health. Future studies could explore approaches to address internalized stigma to improve self-esteem, mental health, and capacities to cope with stigma for PWH on MMT.

TRIAL REGISTRATION

NCT04790201, available at clinicaltrials.gov.

Interactive Compensation Effects of Physical Activity and Sleep on Mental Health: A Longitudinal Panel Study among Chinese College Students during the COVID-19 Pandemic

Physical activity (PA) and sleep are both important to mental health. However, their joint effects on mental distress have not been well explored. The aim of this study was to investigate the joint effects of PA and sleep on mental health, as well as the dose-response relationships between PA and mental health under different sleep health statuses. A longitudinal panel study was adopted to evaluate the relationship between PA, sleep, and mental health among 66 healthy Chinese college students with four online questionnaire surveys. A mixed-effect model with individual-level random effect was used to analyze the interactive regulation effect of PA and sleep on mental health, and a generalized additive model with splines was further fitted to analyze dose-response relationships between variables. When sleep was at a healthy level, no significant difference in mental health was observed between different levels of PA (p > 0.05). However, poor sleepers with moderate and high PA levels indicated significantly fewer negative emotions than those with low PA levels (p = 0.001, p = 0.004). Likewise, poor sleepers who engaged in more moderate intensity PA could significantly reduce negative emotions (β = -0.470, p = 0.011) in a near-linear trend. In summary, both sleep and PA benefit mental health, and they probably regulate mental health through an interactive compensation mode. For good and poor sleepers, PA plays a different role in maintaining and improving mental health. Increasing moderate intensity PA up to moderate-and-high levels is recommended for those who simultaneously suffer from sleep and psychological health problems.

The Pandemic COVID-19 and Its Impact on Indian Agricultural Sectors

The outbreak of COVID-19 has created a major panic among the agricultural sectors as well as the farmers in India owing to its’ transmissions, severity, and a lack of proper treatment methodology. From the cross-sectional study with the help of designed questionnaire relating to the “demographic-information”, ”knowledge, attitudes and practices” of Indian farmers and “DASS-21 variables”, the data from 143 farmers’ were collected and analyzed. Further, by using the "Interpretive Structural Modeling (ISM)" approach, an ISM model was developed followed by MICMAC analysis for possible mitigation measures during this pandemic outbreak. The findings provided the interrelationships among the possible mitigation measures for the farmers as well as for the benefits in Indian agricultures, which can be suitably used in appropriate psychological-interventions preparation for improving the mental-health among the farmers during this pandemic period.

Adaptation of a Problem-solving Program (Friendship Bench) to Treat Common Mental Disorders Among People Living With HIV and AIDS and on Methadone Maintenance Treatment in Vietnam: Formative Study

BACKGROUND

The prevalence of common mental disorders (CMDs) among people living with HIV and people who inject drugs is high worldwide and in Vietnam. However, few evidence-informed CMD programs for people living with HIV who inject drugs have been adapted for use in Vietnam. We adapted the Friendship Bench (FB), a problem-solving therapy (PST)-based program that was successfully implemented among patients with CMDs in primary health settings in Zimbabwe and Malawi for use among people living with HIV on methadone maintenance treatment (MMT) with CMDs in Hanoi, Vietnam.

OBJECTIVE

This study aimed to describe the adaptation process with a detailed presentation of 4 phases from the third (adaptation) to the sixth (integration) of the Assessment-Decision-Adaptation-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT) framework.

METHODS

The adaptation phase followed a qualitative study design to explore symptoms of CMDs, facilitators, and barriers to conducting FB for people living with HIV on MMT in Vietnam, and patient, provider, and caretaker concerns about FB. In the production phase, we revised the original program manual and developed illustrated PST cases. In the topical expert and integration phases, 2 investigators (BNG and BWP) and 3 subject matter experts (RV, DC, and GML) reviewed the manual, with reviewer comments incorporated in the final, revised manual to be used in the training. The draft program will be used in the training and testing phases.

RESULTS

The study was methodologically aligned with the ADAPT-ITT goals as we chose a proven, effective program for adaptation. Insights from the adaptation phase addressed the who, where, when, and how of FB program implementation in the MMT clinics. The ADAPT-ITT framework guided the appropriate adaptation of the program manual while maintaining the core components of the PST of the original program throughout counseling techniques in all program sessions. The deliverable of this study was an adapted FB manual to be used for training and piloting to make a final program manual.

CONCLUSIONS

This study successfully illustrated the process of operationalizing the ADAPT-ITT framework to adapt a mental health program in Vietnam. This study selected and culturally adapted an evidence-informed PST program to improve CMDs among people living with HIV on MMT in Vietnam. This adapted program has the potential to effectively address CMDs among people living with HIV on MMT in Vietnam.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04790201; https://clinicaltrials.gov/ct2/show/NCT04790201.

Effects of Two Alcohol Reduction Interventions on Depression and Anxiety Symptoms of ART Clients in Vietnam

Little is known about the potential mental health impacts of cognitive behavioral therapy and motivational interviewing interventions that focus on alcohol reduction among people with HIV (PWH). Our study aimed to assess the impact of two evidence-based alcohol reduction interventions on depression and anxiety symptoms of antiretroviral therapy (ART) clients with hazardous alcohol use. We conducted a secondary data analysis of data from a three-arm randomized controlled trial among ART clients in Thai Nguyen, Vietnam that evaluated the impacts of two alcohol reduction interventions in Vietnam. ART clients 18 years old or more with hazardous alcohol use (based on the Alcohol Use Disorders Identification Test-Consumption) were enrolled and randomized into one of three arms: Combined intervention, Brief intervention, and Standard of care (SOC). Symptoms of depression, measured with the Patient Health Questionnaire-9, and anxiety, measured with the Generalized Anxiety Disorder-7 scale, were assessed at baseline and 3, 6, and 12 months post-intervention. Generalized estimating equations were used to evaluate the effects of the interventions on depression and anxiety symptoms. The prevalence of depression and anxiety symptoms at baseline was 25.1% and 16.1%, respectively. Decreases in depression and anxiety symptoms were observed in all three arms from baseline to 12-month follow-up. There were no significant differences in depression and anxiety symptoms among participants receiving either intervention, relative to the SOC. Interventions with a dual focus on alcohol and mental health are needed to achieve more pronounced and sustainable improvements in depression and anxiety symptoms for PWH with hazardous alcohol use.

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

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

Comparing the Effects of Melatonin and Zolpidem on Mental Health and Sexual Function in Men With Opioid Addiction: Evidence From a Randomized Clinical Trial

BACKGROUND

Mental health problems and impaired sexual function are widely reported among those suffering from drug abuse, particularly among those under methadone maintenance therapy (MMT).

AIMS

The current study aimed to, firstly, investigate the effect of melatonin and zolpidem on mental health and sexual function of those with drug abuse under MMT, and, secondly, to compare the effects of melatonin and zolpidem on the studied outcomes.

METHODS

The current randomized, single-blind, placebo-controlled clinical trial was conducted on 98 participants who were randomly assigned into three groups of melatonin (n = 34), zolpidem (n = 32), and placebo (n = 32). All participants received the intervention once a day for 30 days, without changes in nutrition. Mental health and sexual function were measured before and 30 days after the intervention.

RESULTS

The mean age of participants in the groups of melatonin, zolpidem, and placebo was 35.8 ± 9.6 years (22-58 years of old), 35.9 ± 9.3 years (21-58), and 37.2 ± 7.8 years (26-53), respectively. Sexual function mean score was significantly increased from 38 to 41 in the melatonin group, while it deceased in zolpidem (from 39.1 to 38) and placebo (39.25-38.59) groups. Also, mental health mean scores improved statistically significantly in the melatonin group (from 60.65 to 43.56; p = 0.002), and descriptively in the zolpidem group (57.88-51.18; p = 0.129). Concerning both outcomes, the observed improvement was considerably higher in the melatonin group. The highest improvement was observed in dimensions of overall satisfaction and depression in the melatonin group (1.18 and -8.4, respectively).

CONCLUSION

Melatonin could significantly improve both mental health and some domains of sexual function of those with drug abuse under MMT, while zolpidem did not show a significant effect.

TRIAL REGISTRATION NUMBER

https://www.irct.ir/trial/53047, identifier: IRCT20201214049718N1.

The Effects of Probiotic Supplementation on Opioid-Related Disorder in Patients under Methadone Maintenance Treatment Programs

INTRODUCTION

Patients under methadone maintenance treatment programs (MMTPs) are susceptible to numerous complications (e.g., mental and metabolic disorders). This study evaluated the effects of probiotics on clinical symptoms, biomarkers of oxidative stress, inflammation, insulin resistance, and serum lipid content in patients receiving MMTPs.

MATERIALS AND METHODS

A randomized, double-blind, placebo-controlled trial was conducted among 70 patients receiving MMTPs to receive either 1.8 × 10⁹ CFU/day probiotics (n = 35) or placebo (n = 35) for 12 weeks. Clinical symptoms and metabolic profiles were measured before and after the intervention in patients receiving MMTPs.

RESULTS

Compared with the placebo group, probiotic supplementation resulted in a significant improvement in the severity of depression (P < 0.05). In addition, probiotic administration significantly decreased fasting plasma glucose (FPG), total cholesterol, and low-density lipoprotein cholesterol (LDL cholesterol) (P < 0.05). Furthermore, probiotics resulted in a significant reduction in high-sensitivity C-reactive protein (hs-CRP) and a significant elevation in total antioxidant capacity (TAC) and total glutathione (GSH) levels (P < 0.05).

CONCLUSION

Treatment with probiotics for 12 weeks to patients receiving MMTPs had beneficial effects on symptoms of depression, as well as several metabolic profiles. Clinical Trial Registration: this study was registered in the Iranian website (https://www.irct.ir) for clinical trials registration (https://fa.irct.ir/trial/46363/IRCT20170420033551N9). The registration date is March 22, 2020.

Investigating Effects of COVID-19 Pandemic on the Mental Health of Nursing Students During Remote Learning: An Experience from Dong A University, Vietnam

Introduction

There was a radically changed in nursing education during the nationwide lockdown due to the COVID-19 outbreaks. The transition to remote learning stressed nursing students in many countries, particularly in Vietnam. However, there is still lacking a novel study to describe the mental characteristics of nursing students in detail.

Objectives

To assess the mental health of nursing students, including stress, anxiety, and depression, and to identify the related factors to their mental health during the online study period because of the COVID-19 pandemic.

Methods

A cross-sectional survey was conducted on 540 nursing students at Dong A university using a socio-demographic questionnaire, the Depression, Anxiety, and Stress Scale - 21 Items (DASS-21). Data were analyzed by descriptive statistics and tests, including Mann-Whitney, Kruskal-Wallis, and Spearman's correlation to identify the related factors.

Results

In total 540 participants, nursing students reported stress (N  =  120, 22.2%), anxiety (n  =  195, 36.1%), and depression symptoms (n  =  135, 23.1%). There was a significant relationship between age, work status, married status, number of children, stress, anxiety, and depression (P < 0.01). In addition, our study showed a negative correlation between frequency of physical activity, perceived health and stress (r  =  -0.117; p < 0.01, r  =  -0.127, p < 0.01), anxiety (r  =  -0.133; p < 0.01, r  =  -0.112, p < 0.01), depression (r  =  -0.134; p < 0.01, r  =  -0.135, p < 0.01). A significant relationship was observed between e-learning space and Internet status with mental health (p < 0.05). Especially, there was no association between average online learning time, academic workload, stress, anxiety, and depression (p > 0.05). However, the authors found a positive association between perceived level of stress related to evaluative activities and stress, anxiety, depression (r  =  0.120, p < 0.01; r  =  0.089, p < 0.05; r  =  0.088, p < 0.05).

Conclusion

Nursing students suffered stress, anxiety, and depression during online learning due to the COVID-19 pandemic in the presence of some related factors. Therefore, this study may increase more attention of universities, families, and governments to reduce the stress of nursing students during distance education.

Prevalence and determinant factors of mental health problems among healthcare professionals during COVID-19 pandemic in southern Ethiopia: multicentre cross-sectional study

OBJECTIVE

To assess the prevalence of depression, anxiety and stress and its determinant factors during COVID-19 pandemic among healthcare professionals in southern Ethiopia.

DESIGN

Multi-centre cross-sectional study.

SETTING AND STUDY PERIOD

Randomly selected public hospitals in Sidama, southern Ethiopia between 25 September 2020 and 25 October 2020.

PARTICIPANTS

387 healthcare professionals were randomly selected.

OUTCOME MEASURES

Prevalence and determinant factors of depression, anxiety and stress was assessed.

RESULT

Depression, anxiety and stress prevalence were shown to be 50.1% (95% confidence interval (CI) 45.0% to 55.0%), 55.0% (95% CI 51.1% to 59.9%) and 38.5% (95% CI 33.6% to 43.2%), respectively. Being female (adjusted odd ratio (AOR) 3.71, 95% CI 2.31 to 5.97), married (AOR 2.28, 95% CI 1.34 to 3.86), living alone (AOR 1.87, 95% CI 1.09 to 3.20), nurses (AOR 2.94, 95% CI 1.44 to 5.99) and working in inpatients (AOR 0.53, 95% CI 0.29 to 0.93) were significantly associated with depressive symptoms. Moreover, older age groups (AOR 3.15, 95% CI 1.04 to 6.56), females (AOR 3.25, 95% CI 2.01 to 5.25), married (AOR 1.69, 95% CI 1.01 to 2.87) and nurses (AOR 3.32, 95% CI 1.63 to 6.78) were significantly associated with symptoms of anxiety. Stress symptoms were significantly high among females (AOR 2.47, 95% CI 1.53 to 3.97), married (AOR 2.77, 95% CI 1.60 to 4.78), living alone (AOR 2.01, 95% CI 1.15 to 3.52), nurses (AOR 2.34, 95% CI 1.11 to 4.92) and working in units other than emergency (inpatient (AOR 0.32, 95% CI 0.18 to 0.57) and other units (AOR 0.48, 95% CI 0.25 to 0.95)).

CONCLUSION

The current study found that healthcare professionals have high levels of depression, anxiety and stress symptoms. Sex, age, marital status, type of profession, living status and working environment were significant factors for mental health problems in healthcare professionals during the pandemic. Healthcare professionals require mental health support at which monitoring and control can be performed during and after the pandemic.

Validation of screening tools for common mental health disorders in the methadone maintenance population in Hanoi, Vietnam

BACKGROUND

Common mental health disorders (CMDs), including depression, anxiety and post-traumatic stress disorder (PTSD) may worsen both HIV and drug use outcomes, yet feasible tools to accurately identify CMDs have received limited study in this population. We aimed to validate the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder screen (GAD-7) and Primary Care PTSD screen for DSM-5 (PC-PTSD-5) in a methadone maintenance therapy (MMT) patient population in Hanoi, Vietnam.

METHODS

We conducted a cross-sectional survey. The PHQ-9, GAD-7, and PC-PTSD-5 were administered to MMT patients. A blinded interviewer administered the Mini-International Neuropsychiatric Interview (MINI) as the reference gold standard. Total scores of each tool were compared with the MINI diagnoses using a receiver operating characteristic curves, and we identified the optimal respective cut-off scores using the Youden's Index.

RESULTS

We enrolled 400 MMT patients. Approximately 99.3% were male (n = 397) and 21.8% (n = 87) were HIV positive. The prevalence of major depressive disorder, generalized anxiety disorder and PTSD, respectively, was 10.5, 4 and 2%. Optimal cut-off scores for the PHQ-9, GAD-7 and PC-PTSD were ≥ 5, ≥3, and ≥ 4 with a sensitivity/specificity of 95.2%/91.9, 93.8%/87.5, and 62.5%/95.2%.

CONCLUSIONS

The prevalence of CMDs in the MMT population was lower than expected. A lower cut-off score may be considered when screening for CMDs in this population. Further research should investigate the validity of somatic symptom-based screening tools among other drug-using or MMT populations.

Mental health and social support of caregivers of children and adolescents with ASD and other developmental disorders during COVID-19 pandemic

Background

Previous studies showed that caregivers of children with autism spectrum disorder (ASD) and other developmental disorders had higher levels of parenting stress, anxiety and depression. In the present study, the author examined the caregivers' mental health and investigated the mediating role of social support between symptoms severity and parenting stress during COVID-19.

Methods

During 20 March to 8 April 2020, 1932 caregivers of children and adolescents with ASD and other developmental disorders from China were enrolled to fill in a sociodemographic questionnaire, Depression, Anxiety and Stress Scale and Social Support Rating Scale. The author also collected children's disability severity symptoms and behavioral problems.

Results

The results showed that 46.01% of the caregivers reported symptoms of depression, 44.67% showed anxiety and 44.62% showed stress during COVID-19 pandemic. Fathers were found to get more subjective support than mothers (P < 0.05). Caregivers who had the highest educational attainment had the most social support (P = 0.01). People who had the more household income showed the significantly lower levels of depression and anxiety (P < 0.05). The caregivers' employment status during COVID-19 was found significantly related with their depression, anxiety, stress and social support (P < 0.05).

Limitations

This study has some limitations, such as it did not conduct the longitudinal analysis of variables before COVID-19.

Conclusions

The findings showed that many caregivers experienced mental health problems during COVID-19. The author suggested to promote caregivers' engagement in functional social support and the behavioral interventions for their children to reduce the impact of stress, anxiety and depression.

Successful transfer of stable patients on opioid agonist therapies from specialty addiction treatment to primary care settings in Ukraine: A pilot study

INTRODUCTION

In Ukraine, HIV is concentrated among people who inject drugs (PWID), and opioid agonist therapies (OAT) are the most effective approach to preventing HIV transmission. OAT coverage is well below internationally recommended levels, with OAT provided primarily in specialty addiction treatment clinics. Integrating OAT into primary care settings represents a promising practice for increasing OAT coverage.

METHODS

The study collected data prospectively from the first 50 stable patients transferred from the largest OAT site to 10 primary care clinics in Kiev; patients had negative urine drug tests for the previous six months. Participants completed the BASIS-24-the 24-item Behaviour and Symptom Identification Scale-to assess symptoms of psychiatric and social function across 6 domains: (1) depression and functioning, (2) relationships, (3) self-harm, (4) emotional lability, (5) psychosis, and (6) substance use before transfer and 6 months after transfer from May through November 2019.

RESULTS

Participants were on average 36 years old, mostly male (84.0%) and had some employment (64.0%). After six months, some employment increased to 88.0% and BASIS-24 scores significantly improved on four domains: depression (1.09 vs 0.73, p = 0.0005), relationships (2.15 vs 1.7, p < 0.0001), emotional liability (1.30 vs 1.00, p = 0.0209) and substance use (1.23 vs 1.07, p = 0073).

CONCLUSIONS

Stable OAT patients can be successfully transferred from specialty to primary care clinics without deterioration in mental health symptoms or functioning. Patients transferred to primary care showed significant improvement in their emotional well-being, their substance use, and their employment status.

The impact of the COVID-19 pandemic on physical and mental health in the two largest economies in the world: a comparison between the United States and China

The broad impact of the COVID-19 on self-reported daily behaviors and health in Chinese and US samples remains unknown. This study aimed to compare physical and mental health between people from the United States (U.S.) and China, and to correlate mental health parameters with variables relating to physical symptoms, knowledge about COVID-19, and precautionary health behaviors. To minimize risk of exposure, respondents were electronically invited by existing study respondents or by data sourcing software and surveys were completed via online survey platforms. Information was collected on demographics, physical symptoms, contact history, knowledge about COVID-19, psychologic parameters (i.e. IES-R; DASS-21), and health behaviors. The study included a total of 1445 respondents (584 U.S.; 861 China). Overall, Americans reported more physical symptoms, contact history, and perceived likelihood of contracting COVID-19. Americans reported more stress and depressive symptoms, while Chinese reported higher acute-traumatic stress symptoms. Differences were identified regarding face mask use and desires for COVID-19 related health information, with differential mental health implications. Physical symptoms that were possibly COVID-19 related were associated with adverse mental health. Overall, American and Chinese participants reported different mental and physical health parameters, health behaviors, precautionary measures, and knowledge of COVID-19; different risk and protective factors were also identified.

The Impact of the COVID-19 Pandemic on Physical and Mental Health in China and Spain: Cross-sectional Study

BACKGROUND

Differences in physical and mental health impact across continents during the COVID-19 pandemic are unknown.

OBJECTIVE

This study compared the levels of impact of COVID-19 on mental health among people from Spain and China and correlated mental health parameters with variables relating to symptoms similar to COVID-19, COVID-19 knowledge, and precautionary measures.

METHODS

We collected information on demographic data, physical symptoms, contact history with persons with a confirmed COVID-19 diagnosis, COVID-19 knowledge, and precautionary measures. Participants completed the Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety and Stress Scale-21 Items (DASS-21). To analyze the differences in the mental health parameters, the mean scores between Chinese and Spanish respondents were compared using the independent samples t test. The differences in categorical variables between the two samples were analyzed by the chi-square test. Linear regression was used to calculate the univariate associations between the independent variables and mental health parameters for both groups separately, with adjustments made for age, gender, and education.

RESULTS

A total of 1528 participants (Spain: n=687; China: n=841) were recruited. The mean age of the Chinese respondents was 24.73 years (SD 7.60; range 18-65 years), and the mean age of the Spanish respondents was 43.06 years (SD 11.95; range 18-76 years). Spanish participants reported significantly more symptoms similar to COVID-19 infection (eg, fever, sore throat, and breathing difficulties), contact history with COVID-19, higher perceived risk of contracting COVID-19, frequent use of medical services, and less confidence in medical services compared with their Chinese counterparts (P<.001). Spanish participants reported significantly higher DASS-21 stress and depression scores, while Chinese participants reported significantly higher IES-R scores (P<.001). Chinese participants encountered more discrimination from other countries (P<.001). Significantly more Chinese participants reported using face masks than Spanish ones (P<.001). More exposure to health information was associated with adverse mental health in Spain (depression: P=.02; anxiety: P=.02; stress: P=.001).

CONCLUSIONS

Our study found that Spanish respondents reported higher levels of stress and depression as well as more symptoms and use of medical services. In preparation for the next pandemic, Spain needs to establish a prompt policy to implement rapid response and enhance medical services to safeguard physical and mental health.

Mental Health Adverse Effects of COVID-19 Pandemic on Health Care Workers in North West Ethiopia: A Multicenter Cross-Sectional Study

BACKGROUND

The coronavirus has affected nearly every aspect of our lives. Most importantly the health-care workers (HCWs) are under insurmountable psychological pressures which lead them to various mental health problems, such as anxiety, stress, and depression.

OBJECTIVE

This study aimed to assess mental health adverse effects of COVID-19 pandemic on health-care workers in North West Ethiopia 2020.

MATERIALS AND METHODS

Institutional-based cross-sectional study was conducted. A simple random sampling technique was applied and 419 participants completed the questionnaire. Mental health adverse effects were measured using the depression, anxiety and stress scale (DASS-21). Data were entered into Epi data version 4.4.2 then exported to SPSS version 24 for analysis. Descriptive, bivariate, and multivariate binary logistic regressions with odds ratios and 95% confidence interval were employed. The level of significance of association was determined at a p-value < 0.05.

RESULTS

Prevalence of depression, anxiety, and stress in this study was 58.2%, 64.7%, and 63.7%, respectively Those who had a medical illness, and mental illness, contact with confirmed COVID-19 pts, and poor social support showed a statistically significant association with depression. Female sex, participants who had families with chronic illness, had contact with confirmed COVID-19 case and poor social support had statistically significant association with anxiety, whereas participants who had families with chronic illness had contact with confirmed COVID-19 cases, and those participants who had poor social support were predictors of stress during COVID-19 pandemic.

CONCLUSION

The magnitudes of mental health problems were higher and the concerned body should emphasize the continuous assessment of the mental health of health-care workers during this pandemic.

Examining common mental health disorders in people living with HIV on methadone maintenance therapy in Hanoi, Vietnam

BACKGROUND

Injection drug use drives HIV transmission in Southeast Asia, where around a quarter of users are living with HIV. Vietnam developed Methadone Maintenance Therapy (MMT) programs to reduce unsafe drug abuse. Common mental health disorders (CMD), including depression, anxiety and post-traumatic stress disorder (PTSD), can worsen MMT outcomes and are highly prevalent among people living with HIV (PLH). We aimed to characterize HIV and CMD among MMT patients and assess the impact of HIV and CMD on MMT engagement outcomes in Hanoi, Vietnam.

METHODS

This cross-sectional study was conducted at an urban MMT clinic in Hanoi. Participants were screened for CMD with the relevant sections of the Mini International Neuropsychiatric Interview (MINI). Tabular comparisons and regression models were used to understand the association of HIV and CMD with substance use and methadone compliance.

RESULTS

Of the 400 MMT participants, 22% were living with HIV, 11% a CMD, 27% reported injection drug use, and 27% reported methadone noncompliance. Around 17% of those with HIV also had a CMD. Reporting non injection and injection drug use were each higher among those with CMD regardless of HIV status. In addition, reporting any drug use was much higher among those with both HIV and CMD than among those with neither (73% vs 31%, p value 0.001). While methadone noncompliance was lower among PLH than among those without HIV (16.3% vs 30.1%, p value 0.010), noncompliance was higher among those with CMD than among those without (40.5% vs 25.6%, p value 0.045). Among those without HIV, noncompliance was higher among those with CMD than among those without, but among those with HIV, the opposite relationship was observed.

CONCLUSION

There is complex overlap between substance use and methadone noncompliance among MMT patients living with HIV, CMD or both. In this population, we found a high prevalence of CMD and substance use among PLH, and a high prevalence of substance use and methadone noncompliance among those with CMD. Prioritizing provision of mental health care services to MMT patients living with HIV can help improve engagement with substance use disorder treatment and reduce the risk of HIV transmission.

A chain mediation model on COVID-19 symptoms and mental health outcomes in Americans, Asians and Europeans

The novel Coronavirus-2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) in March 2020, impacting the lifestyles, economy, physical and mental health of individuals globally. This study aimed to test the model triggered by physical symptoms resembling COVID-19 infection, in which the need for health information and perceived impact of the pandemic mediated the path sequentially, leading to adverse mental health outcomes. A cross-sectional research design with chain mediation model involving 4612 participants from participating 8 countries selected via a respondent-driven sampling strategy was used. Participants completed online questionnaires on physical symptoms, the need for health information, the Impact of Event Scale-Revised (IES-R) questionnaire and Depression, Anxiety and Stress Scale (DASS-21). The results showed that Poland and the Philippines were the two countries with the highest levels of anxiety, depression and stress; conversely, Vietnam had the lowest mean scores in these areas. Chain mediation model showed the need for health information, and the perceived impact of the pandemic were sequential mediators between physical symptoms resembling COVID-19 infection (predictor) and consequent mental health status (outcome). Excessive and contradictory health information might increase the perceived impact of the pandemic. Rapid COVID-19 testing should be implemented to minimize the psychological burden associated with physical symptoms, whilst public mental health interventions could target adverse mental outcomes associated with the pandemic.

Mental Health of the General Population during the 2019 Coronavirus Disease (COVID-19) Pandemic: A Tale of Two Developing Countries

Background: This study aimed to compare the severity of psychological impact, anxiety and depression between people from two developing countries, Iran and China, and to correlate mental health parameters with variables relating to the COVID-19 pandemic. Although China and Iran are developing countries based on the World Bank’s criteria, these two countries are different in access to resources and health care systems. We hypothesized that Iranians would show higher levels of depression, anxiety and stress as compared to Chinese. Methods: This study collected information related to the COVID-19 pandemic including physical health, precautionary measures and knowledge about the pandemic. We also used validated questionnaires such as the Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety and Stress Scale (DASS-21) to assess the mental health status. Results: There were a total of 1411 respondents (550 from Iran; 861 from China). The mean IES-R scores of respondents from both countries were above the cut-off for post-traumatic stress disorder (PTSD) symptoms. Iranians had significantly higher levels of anxiety and depression (p < 0.01). Significantly more Iranians believed COVID-19 was transmitted via contact, practised hand hygiene, were unsatisfied with health information and expressed less confidence in their doctors, but were less likely to wear a facemask (p < 0.001). Significantly more Iranians received health information related to COVID-19 via television while Chinese preferred the Internet (p < 0.001). Conclusions: This cross-country study found that Iranians had significantly higher levels of anxiety and depression as compared to Chinese. The difference in reported measures between respondents from Iran and China were due to differences in access to healthcare services and governments’ responses to the pandemic.

The impact of COVID-19 pandemic on physical and mental health of Asians: A study of seven middle-income countries in Asia

The coronavirus disease (COVID-19) pandemic has impacted the economy, livelihood, and physical and mental well-being of people worldwide. This study aimed to compare the mental health status during the pandemic in the general population of seven middle income countries (MICs) in Asia (China, Iran, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). All the countries used the Impact of Event Scale–Revised (IES-R) and Depression, Anxiety and Stress Scale (DASS-21) to measure mental health. There were 4479 Asians completed the questionnaire with demographic characteristics, physical symptoms and health service utilization, contact history, knowledge and concern, precautionary measure, and rated their mental health with the IES-R and DASS-21. Descriptive statistics, One-Way analysis of variance (ANOVA), and linear regression were used to identify protective and risk factors associated with mental health parameters. There were significant differences in IES-R and DASS-21 scores between 7 MICs (p<0.05). Thailand had all the highest scores of IES-R, DASS-21 stress, anxiety, and depression scores whereas Vietnam had all the lowest scores. The risk factors for adverse mental health during the COVID-19 pandemic include age <30 years, high education background, single and separated status, discrimination by other countries and contact with people with COVID-19 (p<0.05). The protective factors for mental health include male gender, staying with children or more than 6 people in the same household, employment, confidence in doctors, high perceived likelihood of survival, and spending less time on health information (p<0.05). This comparative study among 7 MICs enhanced the understanding of metal health in the general population during the COVID-19 pandemic.

Effects of treatment status and life quality on anxiety in MMT patients

Background

Anxiety, an important factor that affects the therapeutic effect and preservation rate of methadone maintenance treatment, has a high prevalence among MMT patients. This study aims to investigate the effects of treatment status and life quality on anxiety in MMT patients.

Methods

One hundred and Seventy-seven methadone maintenance treatment users in Guangzhou, China were evaluated. The socio-demographic, duration and MMT-related characteristics were documented. Anxiety level and quality of life were evaluated by Beck Anxiety inventory (BAI) and the Quality of Life-Drug Addiction (QOL-DA) respectively. The correlation between different factors and BAI score was also analyzed.

Results

The BAI total score and the QOL-DA score were 7.1±8.2, 163.5±21.4 respectively. 30.5% of the subjects showed mild to severe anxiety. Treatment interruption and QOL-DA score had strong correlations with the score of BAI, with correlation coefficients of 0.17 and − 0.08 respectively.

Conclusions

Anxiety symptoms were commonly presented in MMT patients. Treatment interruption and quality of life are two major factors affecting anxiety of MMT patients.

Psychological Impacts of COVID-19 During the First Nationwide Lockdown in Vietnam: Web-Based, Cross-Sectional Survey Study

Background

The first nationwide lockdown due to the COVID-19 pandemic was implemented in Vietnam from April 1 to 15, 2020. Nevertheless, there has been limited information on the impact of COVID-19 on the psychological health of the public.

Objective

This study aimed to estimate the prevalence of psychological issues and identify the factors associated with the psychological impact of COVID-19 during the first nationwide lockdown among the general population in Vietnam.

Methods

We employed a cross-sectional study design with convenience sampling. A self-administered, online survey was used to collect data and assess psychological distress, depression, anxiety, and stress of participants from April 10 to 15, 2020. The Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety, and Stress Scale-21 (DASS-21) were utilized to assess psychological distress, depression, anxiety, and stress of participants during social distancing due to COVID-19. Associations across factors were explored using regression analysis.

Results

A total of 1385 respondents completed the survey. Of this, 35.9% (n=497) experienced psychological distress, as well as depression (n=325, 23.5%), anxiety (n=195, 14.1%), and stress (n=309, 22.3%). Respondents who evaluated their physical health as average had a higher IES-R score (beta coefficient [B]=9.16, 95% CI 6.43 to 11.89), as well as higher depression (B=5.85, 95% CI 4.49 to 7.21), anxiety (B=3.64, 95% CI 2.64 to 4.63), and stress (B=5.19, 95% CI 3.83 to 6.56) scores for DASS-21 than those who rated their health as good or very good. Those who self-reported their health as bad or very bad experienced more severe depression (B=9.57, 95% CI 4.54 to 14.59), anxiety (B=7.24, 95% CI 3.55 to 10.9), and stress (B=10.60, 95% CI 5.56 to 15.65). Unemployment was more likely to be associated with depression (B=3.34, 95% CI 1.68 to 5.01) and stress (B=2.34, 95% CI 0.84 to 3.85). Regarding worries about COVID-19, more than half (n=755, 54.5%) expressed concern for their children aged <18 years, which increased their IES-R score (B=7.81, 95% CI 4.98 to 10.64) and DASS-21 stress score (B=1.75, 95% CI 0.27 to 3.24). The majority of respondents (n=1335, 96.4%) were confident about their doctor’s expertise in terms of COVID-19 diagnosis and treatment, which was positively associated with less distress caused by the outbreak (B=–7.84, 95% CI –14.58 to –1.11).

Conclusions

The findings highlight the effect of COVID-19 on mental health during the nationwide lockdown among the general population in Vietnam. The study provides useful evidence for policy decision makers to develop and implement interventions to mitigate these impacts.

A one-year hospital-based prospective COVID-19 open-cohort in the Eastern Mediterranean region: The Khorshid COVID Cohort (KCC) study

The COVID-19 is rapidly scattering worldwide, and the number of cases in the Eastern Mediterranean Region is rising. Thus, there is a need for immediate targeted actions. We designed a longitudinal study in a hot outbreak zone to analyze the serial findings between infected patients for detecting temporal changes from February 2020. In a hospital-based open-cohort study, patients are followed from admission until one year from their discharge (the 1st, 4th, 12th weeks, and the first year). The patient recruitment phase finished at the end of August 2020, and the follow-up continues by the end of August 2021. The measurements included demographic, socio-economics, symptoms, health service diagnosis and treatment, contact history, and psychological variables. The signs improvement, death, length of stay in hospital were considered primary, and impaired pulmonary function and psychotic disorders were considered main secondary outcomes. Moreover, clinical symptoms and respiratory functions are being determined in such follow-ups. Among the first 600 COVID-19 cases, 490 patients with complete information (39% female; the average age of 57±15 years) were analyzed. Seven percent of these patients died. The three main leading causes of admission were: fever (77%), dry cough (73%), and fatigue (69%). The most prevalent comorbidities between COVID-19 patients were hypertension (35%), diabetes (28%), and ischemic heart disease (14%). The percentage of primary composite endpoints (PCEP), defined as death, the use of mechanical ventilation, or admission to an intensive care unit was 18%. The Cox Proportional-Hazards Model for PCEP indicated the following significant risk factors: Oxygen saturation < 80% (HR = 6.3; [CI 95%: 2.5,15.5]), lymphopenia (HR = 3.5; [CI 95%: 2.2,5.5]), Oxygen saturation 80%-90% (HR = 2.5; [CI 95%: 1.1,5.8]), and thrombocytopenia (HR = 1.6; [CI 95%: 1.1,2.5]). This long-term prospective Cohort may support healthcare professionals in the management of resources following this pandemic.

Self-perceived general and ear-nose-throat symptoms related to the COVID-19 outbreak: a survey study during quarantine in Italy

OBJECTIVE

To survey perceived general and ear-nose-throat (ENT) symptoms of COVID-19 in relation to psychological impact, mental health, perception of information and demographic characteristics in quarantined subjects during a lockdown period in Italy.

METHODS

Participants were 1380 respondents who completed an online survey. A logistic regression model was used to evaluate the association between the independent variables and perceived symptoms.

RESULTS

Participants reported different prevalences of perceived ENT and general symptoms. Coryza, cough, sore throat and tinnitus were the most common symptoms, and there was a low prevalence of anxiety, depression and stress compared with the psychological impact of the symptom. Comparison of the two symptom groups demonstrated a common need for updates, their relationship with the media and correct information about the route of transmission.

CONCLUSIONS

The health information provided during a disease outbreak must be grounded in evidence. This would help to prevent adverse psychological reactions and somatization symptoms that can engulf healthcare systems, especially in clinical areas like ENT, which frequently treat airway problems.

Financial threat, hardship and distress predict depression, anxiety and stress among the unemployed youths: A Bangladeshi multi-city study

INTRODUCTION

Unemployment has a contributory role in the development of mental health problems and in Bangladesh there is increasing unemployment, particularly among youth. Consequently, the present study investigated depression, anxiety, and stress among recent graduates in a multi-city study across the country.

METHODS

A cross-sectional study was conducted among 988 Bangladeshi graduate jobseekers in six major cities of the country between August to November 2019. The measures included socio-demographics and life-style factors, study and job-related information, Economic Hardship Questionnaire, Financial Threat Scale, Financial Well-Being Scale, and Depression Anxiety Stress Scale-21.

RESULTS

Depression, anxiety and stress rates among the present sample were 81.1% (n = 801), 61.5% (n = 608) and 64.8% (n = 640) respectively. Factors related to gender, age, socioeconomic conditions, educational background, lack of extra-curricular activities, and high screen activity were significant risk factors of depression, anxiety, and stress. Structural equation modeling indicated that (while controlling for age, daily time spent on sleep study, and social media use), financial threat was moderately positively related to depression, anxiety, and stress. Financial hardship was weakly positively associated with depression, anxiety, and stress, whereas financial wellbeing was weakly negatively associated with depression, anxiety, and stress.

LIMITATIONS

Due to the nature of the present study (i.e., cross-sectional study) and sampling method (i.e., convenience sampling), determining causality between the variables is not possible.

CONCLUSIONS

The present results emphasized the important detrimental role of financial troubles on young people's mental health by showing that financial problems among unemployed youth predict elevated psychiatric distress in both men and women.

Mental health status of relapsing-remitting multiple sclerosis Italian patients returning to work soon after the easing of lockdown during COVID-19 pandemic: A monocentric experience

BACKGROUND

The prolonged lockdown related to COVID-19 pandemic determined disruption of lifestyle and social isolation.

METHODS

To assess the mental health status of Relapsing-Remitting Multiple Sclerosis (RRMS) patients regularly followed at the MS center of Catania (Italy) and returning to work after the easing of lockdown during COVID-19 pandemic. Then, to identify any variables associated to psychological distress. RRMS patients returning to work during the COVID-19 pandemic were invited to answer a telephonic interview consisting of the administration of the Short-Screening-Scale for DSM IV (SSS-DSM-IV), the Depression, Anxiety, Stress Scale- 21 (DASS-21) and the Insomnia Severity Index (ISI). Other information was extracted from electronic medical records.

RESULTS

Valid and complete interviews were obtained from 432 patients (response rate 64.3%). Out of them, 277 (64.1%) were female, mean age 40.4 (SD 12.4) years. One-hundred thirty-seven (31.7%) RRMS patients received a score ≥4 at the SSS-DSM-IV, indicating clinically significant PTSD-like symptoms. About DASS-21, moderate-to-severe anxiety was reported by 210 RRMS patients (48.6%), moderate-to-severe depression, and moderate-to-severe stress were respectively reported by 95 (22%) and 220 (50.9%) RRMS patients. Insomnia was reported by 128 patients (29.6%). Factors associated with major severity of symptoms were: marital status, previous diagnosis of mood disorders, switching/starting Disease-Modifying Therapies in the last 12 months, and a higher level of disability measured with Expanded Disability Status Scale (for all, p<.05).

CONCLUSIONS

Our findings highlight the need to provide psychological support to MS patients facing the delicate phase of returning to work and to normal activities.

A quantitative and qualitative study on the neuropsychiatric sequelae of acutely ill COVID-19 inpatients in isolation facilities

This study examined the neuropsychiatric sequelae of acutely ill patients with coronavirus disease 2019 (COVID-19) infection who received treatment in hospital isolation wards during the COVID-19 pandemic. Ten COVID-19 patients who received treatment in various hospitals in Chongqing, China; 10 age- and gender-matched psychiatric patients; and 10 healthy control participants residing in the same city were recruited. All participants completed a survey that collected information on demographic data, physical symptoms in the past 14 days and psychological parameters. Face-to-face interviews with COVID-19 patients were also performed using semi-structured questions. Among the COVID-19 patients, 40% had abnormal findings on the chest computed topography scan, 20% had dysosmia, 10% had dysgeusia, and 80% had repeated positivity on COVID-19 reverse-transcription polymerase chain reaction testing. COVID-19 and psychiatric patients were significantly more worried about their health than healthy controls (p = 0.019). A greater proportion of COVID-19 patients experienced impulsivity (p = 0.016) and insomnia (p = 0.039) than psychiatric patients and healthy controls. COVID-19 patients reported a higher psychological impact of the outbreak than psychiatric patients and healthy controls, with half of them having clinically significant symptoms of posttraumatic stress disorder. COVID-19 and psychiatric patients had higher levels of depression, anxiety and stress than healthy controls. Three themes emerged from the interviews with COVID-19 patients: (i) The emotions experienced by patients after COVID-19 infection (i.e., shock, fear, despair, hope, and boredom); (ii) the external factors that affected patients' mood (i.e., discrimination, medical expenses, care by healthcare workers); and (iii) coping and self-help behavior (i.e., distraction, problem-solving and online support). The future direction in COVID-19 management involves the development of a holistic inpatient service to promote immune and psychological resilience.

Social support modifies the association between hazardous drinking and depression symptoms among ART clients in Vietnam

INTRODUCTION

Hazardous drinking is widespread among people with HIV (PWH). PWH are also vulnerable to depression due to HIV-related social stigma, and social support can play an important role in improving mental health for this population. No studies have explored whether social support modifies the association of hazardous drinking and depressive symptoms among PWH.

METHODS

We used baseline data from a randomized controlled trial of two evidence-based alcohol reduction interventions among antiretroviral therapy clients in Vietnam. Hazardous alcohol use was defined as having a score ≥8 for men and ≥ 7 for women on the Alcohol Use Disorders Identification Test. The presence of depression symptoms was defined as a score ≥ 5 on the Patient Health Questionnaire-9. Social support was measured with a 5-question modified version of the Medical Outcomes Study Social Support Instrument. Crude (CPRs) and adjusted prevalence ratios (aPRs) of the association were presented.

RESULTS

Hazardous drinking was significantly associated with increased likelihood of having depressive symptoms (aPR = 1.26;95%CI 1.04-1.52). Hazardous drinking and depression symptoms were not associated among those with high social support (aPR = 1.01;95%CI 0.76-1.35), but were associated among those with medium (aPR = 1.24;95%CI 0.92-1.69) and low social support (aPR = 1.71;95%CI 1.25-2.34).

CONCLUSIONS

Social support significantly modified the association between hazardous drinking and depression symptoms among ART clients in Vietnam. Interventions to decrease hazardous alcohol use are broadly indicated for PWH in Vietnam and other low-resource settings, but special attention or modifications may be needed to support mental health among those with lower levels of social support.

The magnitude of COVID-19 related stress, anxiety and depression associated with intense mass media coverage in Saudi Arabia

The Coronavirus Disease 2019 (COVID-19) has resulted in catastrophic consequences in many aspects of life; including negative psychological effects. We aimed to assess the mental health status of a group of Saudi population during this pandemic. Also, we aimed to assess the effect of the intensive media coverage of the pandemic news on mental health status. A questionnaire was distributed online to test depression, anxiety, and stress (using the DASS-21 scale) and their relationship to certain variables. A total of 215 respondents were included. Higher mental health prevalence rates were reported in non-Saudi participants compared to Saudi ones (i.e., 50.74% vs. 30.40%; 34.23% vs. 13.51% and 59.70% vs. 27.70%; for depression, anxiety and stress, respectively). About 55.8% of the participants felt the extensive coverage in the media of COVID-19 news, which caused higher mental sufferings. Higher mental health prevalence rates were reported in females compared to males participants (i.e., 56.97% vs. 23.25%; 30.23% vs. 13.17% and 54.65% vs. 26.35%; for depression, anxiety and stress, respectively). Reasonable following of the COVID-19 news; and less exposure to the pandemic information could help in reducing the mental health issues related to the ongoing pandemic. Special care and attention should be paid to females and younger people who seem to be particularly affected during the era of COVID-19.

The Magnitude of Psychological Problem and Associated Factor in Response to COVID-19 Pandemic Among Communities Living in Addis Ababa, Ethiopia, March 2020: A Cross-Sectional Study Design

PURPOSE

COVID-19 pandemic is a World Health Organization day-to-day work and has a significant crisis on the physical and mental health of humans. However, little is known about the mental health crisis of the pandemic in Sub-Saharan countries. Therefore, this study aimed to determine the magnitude of psychological problems and associated factors among communities living in Addis Ababa, Ethiopia.

METHODS

A community-based cross-sectional study design was conducted from March 10 to 30, 2020. Data were collected from 420 respondents selected using a consecutive sampling technique. An online self-administered and Depression, Anxiety, and Stress Scale (DASS-21) survey during the initial phase of the pandemic was conducted to assess the presence of psychological problems for the last two weeks in response to the infection.

RESULTS

The magnitude of the psychological problem from moderate to severe levels was 66.4%. The predictor variables of the outcome were female gender, above the secondary level of education, monthly income below 3000 ETB, and more than three family size at 95% CI, P<0.05.

CONCLUSION

At the time of the initial COVID-19 pandemic in Ethiopia, nearly two-thirds of the respondents reported moderate to severe levels of psychological problems. Therefore, working on those identified factors would be vital to promote the mental resilience of a community towards the pandemic.

Is returning to work during the COVID-19 pandemic stressful? A study on immediate mental health status and psychoneuroimmunity prevention measures of Chinese workforce

This study aimed to quantify the immediate psychological effects and psychoneuroimmunity prevention measures of a workforce returning to work during the COVID-19 epidemic. Workforce returning to work was invited to complete an online questionnaire regarding their attitude toward the COVID-19 epidemic and return-to-work along with psychological parameters including the Impact of Event Scale-Revised, Depression, Anxiety, Stress Scale- 21 (DASS-21) and Insomnia Severity Index (ISI). Psychoneuroimmunity prevention measures include precautions at personal and organization levels. From 673 valid questionnaires, we found that 10.8% of respondents met the diagnosis of post-traumatic stress disorder (PTSD) after returning to work. The respondents reported a low prevalence of anxiety (3.8%), depression (3.7%), stress (1.5%) and insomnia (2.3%). There were no significant differences in the severity of psychiatric symptoms between workers/technicians and executives/managers. >95% reported psychoneuroimmunity prevention measures including good ventilation in the workplace and wore a face mask as protective. Factors that were associated with the severity of psychiatric symptoms in the workforce were marital status, presence of physical symptom, poor physical health and viewing return to work as a health hazard (p < 0.05). In contrast, personal psychoneuroimmunity prevention measures including hand hygiene and wearing face masks as well as organizational measures including significant improvement of workplace hygiene and concerns from the company were associated with less severe psychiatric symptoms (p < 0.05). Contrary to expectations, returning to work had not caused a high level of psychiatric symptoms in the workforce. The low prevalence of psychiatric symptoms could be due to confidence instilled by psychoneuroimmunity prevention measures before the resumption of work. Our findings would provide information for other countries during the COVID-19 pandemic.

Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry

This study aimed to assess and compare the immediate stress and psychological impact experienced by people with and without psychiatric illnesses during the peak of 2019 coronavirus disease (COVID-19) epidemic with strict lockdown measures. Seventy-six psychiatric patients and 109 healthy control subjects were recruited from Chongqing, China and completed a survey on demographic data, physical symptoms during the past 14 days and a range of psychiatric symptoms using the Impact of Event Scale-Revised (IES-R), Depression, Anxiety and Stress Scale (DASS-21) and Insomnia Severity Index (ISI). IES-R measures PTSD symptoms in survivorship after an event. DASS-21 is based on tripartite model of psychopathology that comprise a general distress construct with distinct characteristics. The mean IES-R, DASS-21 anxiety, depression and stress subscale and ISI scores were higher in psychiatric patients than healthy controls (p < 0.001). Serious worries about their physical health, anger and impulsivity and intense suicidal ideation were significantly higher in psychiatric patients than healthy controls (p < 0.05). More than one-third of psychiatric patients might fulfil the diagnostic criteria post-traumatic stress disorder (PTSD). More than one-quarter of psychiatric patients suffered from moderately severe to severe insomnia. Respondents who reported no change, poor or worse physical health status and had a psychiatric illness were significantly more likely to have higher mean IES-R, DASS depression, anxiety and stress subscale scores and ISI scores (p < 0.05). This study confirms the severity of negative psychological impact on psychiatric patients during the COVID-19 epidemic with strict lockdown measures. Understanding the psychological impact on psychiatric patients during the COVID-19 pandemic has the potential to provide insight into how to develop a new immunopsychiatry service. Further research is required to compare pro-inflammatory cytokines between psychiatric patients and healthy controls during the pandemic.

Psychological Impact and Associated Factors During the Initial Stage of the Coronavirus (COVID-19) Pandemic Among the General Population in Spain

The outbreak of COVID-19 in Spain started at the end of February. By 9th April 2020 Spain was the second country in confirmed cases and in deaths. On March 14, 2020, the Spanish Government declared the state of alarm to limit viral transmission. During such state, citizens must stay confined at home with few justified exceptions. This whole situation drastically changed the life of the population, which can cause a wide range of psychosocial impacts. This study explored the psychological impact of the COVID-19 pandemic in the general adult population (N = 3055) during the first stages of the outbreak in Spain, as well as their anxiety, stress and depression levels. We also examined the extent to which the following variables were associated to participants' mental health: (1) demographics; (2) degree of concern about the pandemic; (3) environmental conditions during the home confinement, (4) changes in daily life as a consequence of the pandemic; (5) contact with the COVID-19 disease; (6) actual and perceived severity of the crisis; (7) information about the COVID-19, (8) perceived health status and (9) leisure activities conducted within the last 24 h. Our results show that Spanish consider the current COVID-19 health crisis as fairly severe, and the majority felt that the COVID-19 crisis had greatly impacted on their daily life, including changes in their daily routines and cancelation of important activities. About 36% of the participants reported moderate to severe psychological impact, 25% showed mild to severe levels of anxiety, 41% reported depressive symptoms, and 41% felt stressed. Women, young, and those who that lost their job during the health crisis showed the strongest negative psychological symptoms. What worried Spaniards the most was the likelihood of suffering an economic crisis derived from the pandemic. We found factors associated with better mental health, such as being satisfied with the information received about the health crisis, conducting leisure activities, and the perception of being in good health. These findings can be used to design psychological interventions to help coping with COVID-19 pandemic, both in Spain and other countries.

Mental Health Problems during the COVID-19 Pandemics and the Mitigation Effects of Exercise: A Longitudinal Study of College Students in China

(1) Background: The novel coronavirus disease 2019 (COVID-19) is a global public health emergency that has caused worldwide concern. Vast resources have been allocated to control the pandemic and treat patients. However, little attention has been paid to the adverse impact on mental health or effective mitigation strategies to improve mental health. (2) Purpose: The aim of this study was to assess the adverse impact of the COVID-19 outbreak on Chinese college students’ mental health, understand the underlying mechanisms, and explore feasible mitigation strategies. (3) Methods: During the peak time of the COVID-19 outbreak in China, we conducted longitudinal surveys of sixty-six college students. Structured questionnaires collected information on demographics, physical activity, negative emotions, sleep quality, and aggressiveness level. A mixed-effect model was used to evaluate associations between variables, and the mediating effect of sleep quality was further explored. A generalized additive model was used to determine the dose-response relationships between the COVID-19 death count, physical activity, and negative emotions. (4) Results: The COVID-19 death count showed a direct negative impact on general sleep quality (β = 1.37, 95% confidence interval [95% CI]: 0.55, 2.19) and reduced aggressiveness (β = −6.57, 95% CI: −12.78, −0.36). In contrast, the COVID-19 death count imposed not a direct but an indirect impact on general negative emotions (indirect effect (IE) = 0.81, p = 0.012), stress (IE = 0.40, p < 0.001), and anxiety (IE = 0.27, p = 0.004) with sleep quality as a mediator. Moreover, physical activity directly alleviated general negative emotions (β = −0.12, 95% CI: −0.22, −0.01), and the maximal mitigation effect occurred when weekly physical activity was about 2500 METs. (5) Conclusions: (a) The severity of the COVID-19 outbreak has an indirect effect on negative emotions by affecting sleep quality. (b) A possible mitigation strategy for improving mental health includes taking suitable amounts of daily physical activity and sleeping well. (c) The COVID-19 outbreak has reduced people’s aggressiveness, probably by making people realize the fragility and preciousness of life.

Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.

Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.

Impact of the COVID-19 Pandemic on Physical and Mental Health in Lower and Upper Middle-Income Asian Countries: A Comparison Between the Philippines and China

Objective: The differences between the physical and mental health of people living in a lower-middle-income country (LMIC) and upper-middle-income country (UMIC) during the COVID-19 pandemic was unknown. This study aimed to compare the levels of psychological impact and mental health between people from the Philippines (LMIC) and China (UMIC) and correlate mental health parameters with variables relating to physical symptoms and knowledge about COVID-19. Methods: The survey collected information on demographic data, physical symptoms, contact history, and knowledge about COVID-19. The psychological impact was assessed using the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety, and Stress Scale (DASS-21). Findings: The study population included 849 participants from 71 cities in the Philippines and 861 participants from 159 cities in China. Filipino (LMIC) respondents reported significantly higher levels of depression, anxiety, and stress than Chinese (UMIC) during the COVID-19 (p < 0.01) while only Chinese respondents' IES-R scores were above the cut-off for PTSD symptoms. Filipino respondents were more likely to report physical symptoms resembling COVID-19 infection (p < 0.05), recent use of but with lower confidence on medical services (p < 0.01), recent direct and indirect contact with COVID (p < 0.01), concerns about family members contracting COVID-19 (p < 0.001), dissatisfaction with health information (p < 0.001). In contrast, Chinese respondents requested more health information about COVID-19. For the Philippines, student status, low confidence in doctors, dissatisfaction with health information, long daily duration spent on health information, worries about family members contracting COVID-19, ostracization, and unnecessary worries about COVID-19 were associated with adverse mental health. Physical symptoms and poor self-rated health were associated with adverse mental health in both countries (p < 0.05). Conclusion: The findings of this study suggest the need for widely available COVID-19 testing in MIC to alleviate the adverse mental health in people who present with symptoms. A health education and literacy campaign is required in the Philippines to enhance the satisfaction of health information.

The Association Between Physical and Mental Health and Face Mask Use During the COVID-19 Pandemic: A Comparison of Two Countries With Different Views and Practices

BACKGROUND

The physical and mental health of citizens living in a country that encouraged face masks (China) and discouraged face masks (Poland) during the initial stage of the COVID-19 pandemic remained unknown. We conducted a cross-country study to compare the psychological impact of the COVID-19 pandemic on Poles and Chinese. This study aimed to compare the levels of psychological impact of pandemic and levels of anxiety and depression between China and Poland.

METHODS

The survey collected information on demographic data, physical symptoms, contact history, and precautionary measures. The psychological impact was assessed using the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). The chi-squared test was used to analyze the differences in categorical variables between the two populations. Linear regression was used to calculate the bivariate associations between independents variables (e.g., physical symptoms and precautionary measures) and dependent variables (e.g., mental health outcomes).

RESULTS

This study included a total of 2,266 respondents from both countries (1,056 Poles and 1,210 Chinese). There were significantly less Polish respondents who wore face masks (Poles: 35.0%; Chinese: 96.8% p < 0.001). Significantly more Polish respondents reported physical symptoms resembling COVID-19 infection (p < 0.001), recent medical consultation (p < 0.01), recent COVID-19 testing (p < 0.001), and hospitalization (p < 0.01). Furthermore, Polish respondents had significantly higher levels of anxiety, depression and stress (p < 0.001) than Chinese. The mean IES-R scores of Poland and China were above the cut-off for post-traumatic stress disorder (PTSD) symptoms. Besides precautionary measures, unemployment, retirement, physical symptoms resembling COVID-19 infection, recent medical consultation or COVID-19 testing, and long daily duration of home confinement were risk factors for PTSD symptoms, anxiety, depression, or stress for Polish respondents.

CONCLUSION

Use of face masks at the community level may safeguard better physical and mental health during the COVID-19 pandemic. There is a need of health education with scientific information from Polish health authority on the proper use of face masks and reduce social stigma. This study was limited by the respondent sampling method that had compromised the representativeness of samples.

Occupational Stress Among Health Worker in a National Dermatology Hospital in Vietnam, 2018

A cross-sectional study was conducted among 171 doctors and nurses in a National Dermatology hospital using the Karasek's Job Content Questionnaire which has been validated in Vietnamese (JCQ-V), to assess the prevalence of occupational stress and to explore the association with some associated factors among them. The result showed that doctors and nurses with occupational stress accounted for 6.4%. This proportion was higher among nurse compared to doctor (8.0% vs. 2.2%); among those with diploma literacy compared to bachelor and above (10.6% and 2.3%). This rate was also higher in health workers under 30 years old (12.9%), health workers under 5 years at work (12.1%), working night shift from 3-4 nights (33.3%), temporary employment (12.8%), heavy workload occasionally (12.5%), and working hard occasionally (17.2%) compared to those in the comparison groups with p value <0,05. This prevalence concentrated in some departments such as surgery (11.9%), internal medicine (6.7%), dermatology, and others (1.5%). The study has not found the significant association between the prevalence of occupational stress and heavy workload and skill level. Therefore, it is essential for hospital should conduct screening all doctors, nurses, and medical staffs to identify subjects having occupational stress and give appropriate intervention.